1. Lecture two Assessment of Skin, Hair and Nails

2. Integument structures
Skin
Nails
Hair
Scalp

3. Structure of the Integument
The skin is the largest organ of the body comprising 15 percent of total body weight.
Layers of the skin
A. Epidermis B. Dermis C. Subcutaneous tissue
Epidermal appendages
Hair
Nails
Glands: two types of skin glands:
1. Sweat Gland
Eccrine sweat glands: are widely distributed and open directly onto the skin surface
Apocrine sweat glands: open into hair follicle in axillary and genital areas
2. Sebaceous glands: Produce sebum(oily secretion)

5. Functions of skin and epidermal appendages
Barrier to water and electrolyte loss
Regulation of body heat
Sensory organ for touch, temperature, and Pain
Production of protective skin film by eccrine and sebaceous glands
Participation in production of vitamin
Wound repair

6. Assessing the Integument
1. Subjective data (ask patient about the followings)
Skin infection, rashes, lesions, itching.
Precipitating factors:
Changes in skin color, lesions
Amount of sun exposure
Scalp lesions, itching, and infections.
Changes in texture and amount of hair.
Changes in nails and cuticles nail breaking
Changes in mole size, shape or color

7. 2. History of current symptom
Are you having experience of skin problem, such as rashes, lesion
moles
Have you had any hair loss or change in the condition of your hair?
Have you had any change in the condition or appearance of your nails?
Have you ever had any allergic skin reaction to food, medication, plants?
Has anyone in your family had a recent illness, rash, or other skin problem? (Family history)

8. 3. Physical Assessment Equipment
Penlight Tongue depressor Centimeter rule Gloves
Magnifying glass Flashlight Wood’s lamp
Technique to examination of skin
1) Inspection )Palpation
Inspections of skin
Color Moisture Temperature Thickness
Turgor Vascular changes Edema Lesions
Skin odors are usually noted in the skin fold.

9. Inspection color of skin
Skin color varies from body part to body part and from person to person.
Assessment first involves area of skin not exposed to the sun e.g. palms of the hands.
Pallor easily perceived in the buccal “mouth” mucosa particularly in individuals with dark skin.
Cyanosis readily seen in area of least pigmentation e.g. lips, nail beds conjunctiva and palm.
Jaundice or Yellow seen in client’s sclera.
Erythema may indicate circulatory changes

10. Palpation of moisture of skin
Skin is normally smooth and dry.
Skin folds e.g. axillae are normally moist.
In presence of lesions or ooze fluid, nurse must wear gloves to prevent exposure to infections drainage
Moisture indicates:
Degree of client’s hydration

11. Palpation of Temperature
Temperature of skin depends on the amount of blood circulating through dermis.
Generalized warmth: (Fever, Hyperthyroidism)
Local warmth: (Inflammation)
Coolness: (Hypothyroidism, Frost bite, Hypothermia, Shock, Low cardiac output)
Palpation of skin with dorsum of the hand.
Assessment of skin is critical point in some conditions such as: after cast application, or after vascular surgery.

12. Palpation of Texture
Texture of skin normally smooth, soft and flexible
If any abnormalities in texture found you must ask the client is he exposed to any recent injury to the skin?
Nurse determines whether the client’s skin is smooth or rough, thin or thick, tight or supple (flexible).
Very Soft: (Thyrotoxicosis)
Tight: (Scleroderma = hard skin)
Rough: (Hypothyroidism)

13. Palpation of Turgor
Turgor: is the skin elasticity diminished by edema or dehydration.
Assessment of turgor done by pinching skin between the thumb and forefinger and released.
Normally skin return immediately to its position.
Failure of this process means dehydration.
Decrease in turgor predisposes the client to skin breakdown.

14. Inspection and Palpation of Edema
Edema : "Build up of fluid in tissues“
Inspected for location, color, and shape.
Palpates areas of edema to determine mobility, consistency, and tenderness
Inspection and Palpation of Lesions
Normally skin free of lesions except common freckles.
If lesion present, inspection must done for distribution, arrangement, morphology, color and size
Palpation for lesion’s mobility, contour (flat, raised or depressed) and consistency (soft or hard are indicated).
Cancerous lesions frequently undergo changes in color and size.

15. Hair and Scalp
Assessment done for distribution, thickness, texture, of the hair.
Some events which affect the distribution of hair over the body e.g. client with hormone disorders, woman with hirsutism
Amount of hair covering extremities may be reduced as a result of aging and arterial insufficiency especially in lower limbs.
Scaliness or dryness of the scalp is frequently caused by dandruff or psoriasis.

16. Nails Assessment Nails reflect an individual's general state of health
Nails are normally transparent, smooth, and convex, with a nail bed angle of about 160 degrees.
The surrounding cuticles are smooth, intact and without inflammation.
Nail bed is normally firm on palpation.
Nails normally grow at a constant rate
Capillary refill: 2-3 seconds

17. Abnormal condition of nail
Anonychia: complete absence of nails
Koilonychia : nails like spoon shape (iron deficiencies anemia)
Paronychia: inflammation of tissue surrounding the nail
Clubbing nail: angle is more than 180