1. Health Assessment Skills Development Unit Two Assessing the Integumentary System

2. Introduction: The intugumentaryu system consists of: – Skin. – Sweat and oil glands. – Hair. – Nails. The largest organ of the body.

3. It work with other body systems to regulate body temperature, synthesize vit. D, store blood and fat, excrete body waste, and help sense the world around us. The skin, hair, and nails can suggest the status of a client's nutrition, airway clearance, thermolregulation, and tissue perfusion and can reveal alteration in activity, sleep and rest, level of styress, and self-care ability. Introduction:

4. Gathering the data: Skin: – Have you ever had a skin problem? – Is there a history of allergies, rashes, or other skin problems in your family? – Does your skin itch?

5. Skin: – Have you noticed any rashes on your body? If yes: – Do they appear after wearing certain clothes or using certain skin products? – Do you have start a new medication? – Have you changed your diet recently? Gathering the data:

6. Hair: – Have you noticed an increased hair loss recently? (hair loss in women that follows a male pattern may be due to an imbalance of adernal hormones) – Are you taking any medication? Gathering the data:

7. Nails: – Have you ever had problems with your nail? Gathering the data:

8. Physical Assessment: Skin: – Confirm that skin is clean and free from body odor. (body odor is produced when bacterial waste products mix with perspiration on skin surface, during heavy activity, body odor increases because increased amounts of urea and ammonia are excreted in pertspiration. Increased urea and ammonia may occur in clients with kidney disorders) – Observe the client's skin tone. Color changes, cyanosis, pallor, erythema, or jaundice.

9. Skin: – Inspect the skin for even pigmentation over the body. (in most cases increased or decreased pigmentation is caused by differences in the distribution of melanin throughout the body, and are normal variation) – Determine the client's skin temperature. (use the dorsal surface of you hand, palpate the forehead or face first, then continue to hands and feet) – Assess the amount of moisture on skin surface. – Palpate skin for texture. (normal skin feels smooth, firm, and even) Physical Assessment:

10. Skin – Palpate the skin for elasticity (elasticity is a combination of turgor -the skin ability to return to its normal position and shape- and mobility –the skin's ability to be lifted) – Inspect the skin for superficial arteries and veins. – Inspect and palpate skin for lesions. – Palpate the skin for sensitivity. Physical Assessment:

11. Scalp and Hair: – Observe the amount and distribution of the hair throughout the scalp. – Inspect the scalp for lesions. Physical Assessment:

12. Nails: – Inspect the nails for an even, pink undertone. The nails appear: – pale and colorless in clients with pripheral arteriosclerosis and anemia. – Yellow in client with jaundice. – Dark red in client with polycythemia. – Assess capillary refill: Is the rate at which blood refills empty capillaries, normally, less than 2 seconds. Physical Assessment:

13. Nails: – Inspect and palpate the nails for shape and contour. Perform the Schamroth technique to assess clubbing: – Ask client to bring the dorsal aspect of corresponding finfers together, creating a mirror image. – Look at the distal phalanx and observe the diamond-shape opening created by the nails. When clubbing present, the diamond is not formed and the distance increases at the fingertip. The angle between the skin and the nail base is greater than 160 degree. Physical Assessment:

14. Nails: – (clupping of fingeenails occurs when there is hypoxia or impaired peripheral tissue perfusion over a long period of time. It may occur with cirrhosis, colitis, or thyroid disease) Physical Assessment: