King Saud University College of Nursing Adult Nursing

King Saud University College of Nursing Adult Nursing (NUR 316) Skin, hair, and nail assessment

Integumentary System Skin and accessory structures Hair Nails

Skin Largest Organ of the Body Protection from environment Temperature regulation Synthesis of vitamin D Storage of fat and blood Excretion of waste Sensation Composed of the Epidermal and Dermal Layers

Figure 11. 1 Skin structure. Three-dimensional view of the skin, subcutaneous tissue, glands, and hairs.

The Major Functions of the Skin Perceiving touch, pressure, temperature, and pain via the nerve endings Protecting against mechanical, chemical, thermal, and solar damage Protecting against loss of water and electrolytes Regulating body temperature

The Major Functions of the Skin Repairing surface wounds through cellular replacement Synthesizing vitamin D Allowing identification through uniqueness of facial contours, skin and hair color, and fingerprints

Oil or Sebaceous Glands Produce Sebum That Is Usually Released in Hair Follicles

The Major Functions of the Cutaneous Glands Excreting uric acid, urea, ammonia, sodium, potassium, and other metabolic wastes Regulating temperature through evaporation of perspiration on the skin surface Protecting against bacterial growth on the skin surface

The Major Functions of the Cutaneous Glands Softening, lubricating, and waterproofing skin and hair Resisting water loss from the skin surface in low-humidity environments Protecting deeper skin regions from bacteria on the skin surface

Hair Thin Fiber Compound of Dead Keratinized Cells Vellus Terminal

Nails Thin Plates of Keratinized Epidermal Cells That Cover the Distal Ends of Fingers and Toes

Figure 11. 2 Structure of a nail.

Focused Interview General questions

Specific Questions Illness or infection Symptoms Pain Behaviors Infants and children Pregnant females Older adults Environment

Box 11. 2 Self. Examination of the Skin

Removal of: Clothing Jewelry Cosmetics Wigs Hairpieces

Abnormal Skin Findings Primary and secondary lesions Vascular lesions Purpuric lesions Infections Malignant lesions ABCDE Criteria

Figure 11. 22 ABCDE Criteria for Melanoma Assessment

Table 11. 2 Potential Secondary Sources for Client Data Related to the Skin, Hair, and Nails

Figure 11. 29 Spoon nail.

Figure 11. 30 Hemangioma.

Figure 11. 31 Port-wine stain (nevus flammeus).

Figure 11. 32 Spider (star) angioma.

Figure 11. 33 Venous lake.

Figure 11. 34 Petechiae.

Figure 11. 35 Purpura.

Figure 11. 36 Ecchymosis (bruise).

Figure 11. 37 Hematoma.

Figure 11. 38 Macule and patch.

Figure 11. 39 Papule and plaque.

Figure 11. 40 Nodule and tumor.

Figure 11. 41 Vesicle and bulla.

Figure 11. 42 Wheal.

Figure 11. 43 Pustule.

Figure 11. 44 Cyst.

Figure 11. 45 Atrophy.

Figure 11. 46 Erosion.

Figure 11. 47 Lichenification.

Figure 11. 48 Scales.

Figure 11. 49 Crust.

Figure 11. 50 Ulcer.

Figure 11. 51 Fissure.

Figure 11. 52 Scar.

Skin Lesions Tinea Measles Varicella Herpes Psoriasis Dermatitis Eczema Impetigo

Figure 11. 63 Tinea corporis.

Figure 11. 64 Measles (rubeola).

Figure 11. 65 German measles (rubella).

Figure 11. 66 Chickenpox (varicella).

Figure 11. 67 Herpes simplex.

Figure 11. 68 Herpes zoster (shingles).

Figure 11. 69 Psoriasis.

Figure 11. 70 Contact dermatitis.

Figure 11. 71 Eczema (atopic dermatitis).

Figure 11. 72 Impetigo.

Malignant Lesions Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Kaposi’s sarcoma

Figure 11. 73 Basal cell carcinoma.

Figure 11. 74 Squamous cell carcinoma.

Figure 11. 75 Malignant melanoma.

Figure 11. 76 Kaposi’s sarcoma.

Abnormal Hair Findings Seborrhea Tinea capitis Alopecia areata Infection Folliculitis Furuncles Hirsutism

Figure 11. 77 Seborrheic dermatitis (cradle cap).

Figure 11. 78 Tinea capitis (scalp ringworm).

Figure 11. 79 Alopecia areata.

Figure 11. 80 Folliculitis.

Figure 11. 81 Furuncle/abscess.

Figure 11. 82 Hirsutism.

Abnormal Nail Findings Spoon nails Paronychia Beau’s line Splinter hemorrhage Onycholysis

Figure 11. 83 Spoon nails (Koilonychia).

Figure 11. 84 Paronychia.

Figure 11. 85 Beau’s line.

Figure 11. 86 Splinter hemorrhages.

Figure 11. 88 Onycholysis.

Special Considerations Developmental, Psychosocial, Cultural, and Environmental

Developmental Considerations Pediatric Newborn skin is covered with vernix caseosa. Infants have skin that is thin, soft, and free of terminal hair. Milia and “Stork bites” are common, harmless markings in newborns Infants may be born with lanugo present Temperature regulation is inefficient in infants.

Figure 11. 3 Milia.

Figure 11. 4 Mongolian spots.

Developmental Considerations Pregnant Female Skin pigmentation increases. Development of melasma and the linea nigra are common

Figure 11. 6 Melasma.

Figure 11. 7 Linea nigra.

Developmental Considerations Geriatric Skin elasticity decreases with aging Sebum production decreases and causes dryness Perspiration decreases Decrease in melanin production resulting in graying hair Increased sensitivity to sunlight Nails tend to become thicker and more brittle

Figure 11. 8 Tenting. A. Step 1: Nurse grasps the skin. A

Figure 11. 8 (continued) Tenting. B. Step 2: Nurse releases grasp, tenting present. B

Psychosocial Considerations Stress-induced illnesses Visible skin disorders and self-esteem/body image

Cultural and Environmental Considerations Religion Birth anomalies Dietary deficiencies

Table 11. 1 Color Variations in Light and Dark Skin

Table 11. 1 Color Variations in Light and Dark Skin (continued)

Table 11. 1 Color Variations in Light and Dark Skin (continued)

Box 11. 1 Coining, Cupping, Pinching

Obese Clients Skinfold Incontinence Hygiene

Objectives for Skin Health Outlined in Healthy People 2020 Occupational skin disorders Education on skin cancer risks and prevention

Key Objectives for Occupational Skin Disorders Reduce occupational skin disorders in full-time workers

Key Objective for Skin Cancer Increase the number of persons using protective measures to reduce the rate of sunburns