Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 51: Patient Assessment: Integumentary System

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins History Assessment: OPQRST Onset: When did the symptoms start? Precipitating factor: Is it associated with dry skin? Foods? Allergies? Quality: Is it itchy? Burning? Stinging? Describe your symptoms in your own words. Radiation: Has it spread from a single area? Severity: How bothersome is it to you on a scale of 1 to 10? Timing: How long has it lasted? Medication review: What medications are you taking? Antibiotics? Steroids? Are you allergic to anything?

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In an African-American patient, a decrease in oxyhemoglobin to the skin would result in: A. Jaundice skin color B. Vitiligo C. Cyanosis D. Ashy skin color

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Ashy skin color Rationale: A decreased oxyhemoglobin level in a dark- skinned patient is seen as an ashy skin color. Jaundice would be seen as a greenish-yellow cast to the mucous membranes first. Vitiligo may be seen in dark-skinned patients, but it is the absence of pigment. Cyanosis would be seen in the mucous membranes.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Inspection: Color of the Skin

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question When admitting an elderly woman to the ICU, the nurse notes many small, bright-red lesions around her face and neck. The nurse is most likely observing: A. Spider nevus B. Cherry angiomas C. Nevus flammeus D. Telangiectasias

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Cherry angiomas Rationale: Cherry angiomas are small, bright-red lesions; they are normal. Spider nevi, small veins that terminate in a central point, are abnormal. Nevus flammeus is a birthmark. Telangiectasias are irregular fine red lines associated with superficial blood vessels.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Skin Lesions Described by color, shape, location, appearance, distribution, and size Vascular lesions (normal) –Nevus flammeus –Telangiectasias –Cherry angiomas –Immature hemangioma Abnormal lesions –Petechiae –Purpura –Ecchymoses –Spider angiomas –Urticaria

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment for Skin, Hair, and Nail Infections Rashes –Superficial to deep tissue invasion –Opportunistic infections –Observation for candidiasis Hair –Alopecia –Hirsutism Nails –Capillary refill –Cyanosis –Nail contour and shape: clubbing, spoon-shaped nails

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Palpation Texture Moisture Temperature Mobility/turgor Edema

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Edema Scale

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment for Pressure Ulcers High-risk patients –Incontinent of bowel/bladder –Decreased sensation –Decreased circulation –Dark-skinned patients Braden’s Assessment Scale Treatment –Turning regimen –Clean, dry skin –Decrease friction/shear –Pad appliances, wounds, etc.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Dark-skinned patients have the highest risk of skin cancer. A. True B. False

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. False Rationale: Fair-skinned patients with exposure to sun have the highest risk of developing skin cancer.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Skin Tumors Basal cell carcinoma Squamous cell carcinoma Malignant melanoma