1. Skin Assessment

2.  Skin is the largest organ in the body  Skin is composed of 1.Epidermis- outermost portion of a relatively uniform, thin but tough, composed of thickness stratum germinativum and stratum corneum ◦ a. color derived from three sources Brown- pigment melanin Yellow-orange tones of pigment carotene Red-purple tone in underlying vascular bed Skin Assessment

3. 2. Dermis- bulk of skin; the inner supportive layer consisting mostly of connective tissue or collagen is tough fibrous protein that enables skin to resist tearing and allows skin to stretch with movement. 3. Subcutaneous layer- adipose tissue made up of lobules of fat cells used for energy. It provides insulation for temperature control and aids in protection by its soft cushioning effect

4. Skin function Protection/Barrier Sensation Temperature regulation Identification Communication Wound Repair Absorption/Excretion Vitamin D

5. 1. Previous history of skin diseases 2. Skin Color- affected by genetic factors and physiological factors. -Variations of skin color Cyanosis- blue tinge Pallor- loss of rosy glow in skin, paleness Erythema- redness of the skin, increase in climate temperature, inflammation, infection Assess Skin of Adults

6. Plethora- redness of skin caused by increase red blood cell Ecchymosis- large diffuse areas usually black and blue, results of injuries Petechiae- small pinpoint hemorrhages can denote some type of blood disorder Jaundice- yellow staining of skin usually caused by bile pigments

7. 3. Changes in mole size, shape, tenderness, bleeding check for abnormal characteristics of pigmented lesions. Note any freckles and changes and any birthmarks (report any changes in size, itching, burning, bleeding of moles)

8. Abnormal characteristics of pigmented lesions:  ABCDE Asymmetry of pigmented lesion -one that is not regularly round or oval Border irregularity -notching, scalloping, ragged edges or poorly defined margins Color variation -areas of brown, tan, black, blue, red, white or combination Diameter greater than 6mm Elevation and enlargement

9. 4.Texture- palpate note any marks or scaring skin should be smooth and firm 5.Temperature- symmetrically feel each part of the body, compare upper area with lower areas check for hypothermia and hyperthermia Normal finding: warm Changes: cool, cold, hot

10. 6.Turgor-amount of elasticity in skin, grasp index finger pull it taut and quickly release- elastic skin immediately assumes in normal position, poor turgor suspended or tented; turgor shows hydration and nutrition 7.Moisture or dryness- check face, hands, axilla, skin folds; shows diaphoresis or dehydration 8.Are there any rashes or lesions; note color, elevation, pattern or shapes, size, location and distribution on body, any exudates

11. 9.Is there any itching (purities) 10.What medication are you taking 11.Note mobility 12.Note any edema- accumulation of fluid in the intercellular spaces; to check for edema, imprint your thumbs firmly against the ankle malleolus or the tibia. If pressure leaves a dent in the skin “pitting” present 1+= mild pitting, slight indentation, no perceptible swelling of the leg 2+= moderate pitting, indentation subsides rapid ly

12. 3 += Deep pitting, indentation remains for a short time; leg looks swollen 4+=Very Deep pitting, indentation lasts a long time, leg is very swollen. 13.thickening uniform over body except thick over palms and soles of feet

13. Edema

14. Pitting edema

15. Assessing for Edema Depress pretibial area & medial malleolus for 5 seconds Grade pitting edema 1+ to 4 +

16. 1.Hair- ◦inspect for color (comes from melanin) graying may begin at 3 rd decade; ◦Texture maybe fine or thick; straight, curly, or kinky; ◦Quality maybe shinny or dull; ◦Distribution- coarse or elastic 2. Scalp- inspect for ticks or lice 3. Nails- Shape and Contour- curved or flat, edges smooth, rounded, clean; - Consistency- smooth, regular, nor brittle or splitting, thickness, firm - Color- translucent, pink nails base - inspect nail beds for clubbing Accessory structure of skin of adults

17. Capillary return or refill: normal = less than 3 seconds – used to evaluate the ability of the circulatory system to restore blood to the capillary system (perfusion). – Capillary refill is evaluated at the nail bed in a finger. (a)Place your thumb on the patient’s fingernail and gently compress. (b)Pressure forces blood from the capillaries. (c)Release the pressure and observe the fingernail. (d) As the capillaries refill, the nail bed returns to its normal deep pink color. (e)Capillary refill should be both prompt and pink. (f)Color in the nail bed should be restored within 2 seconds, about the time it takes to say "capillary refill."

19. Check color Temperature Abnormalities Excessive dryness, moisture, itching, flaking General texture of skin Skin turgor Edema Cleanliness Odor Discoloration (ecchymosis, petechiae, purpura, erythema, altered pigmentation) Monitoring Skin Condition

20. Vocabulary – Alopecia – Hirsutism – Clubbing of nail – Onycholysis

21. Benefits and Disadvantages ☺ Quick Inexpensive Can be done ‘on-site’ Valid for all visible skin conditions Subjective, no quantitative data Requires experience/training May not indicate subclinical damage Surface conditions do not always correlate with conditions in the

22. Go to this website for a tutorial on skin assessment http://www.logicalimages.com:80/morpholog y/morphology3_content.html Practice