King Saud University

College of Nursing

Health Assessment (NUR 224)

The Skin, Hair, and Nails

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Anatomy and PhysiologyMajor function of skin is to keep the body in

homeostasis

Provides boundaries for body fluid

Protects underlying tissues from microorganisms, harmful substances, and radiation

Modulates body temperature

Synthesizes vitamin D

Heaviest single organ in body

16% of body weight

Anatomy and Physiology (cont.)Three layers

EpidermisDermisSubcutaneous tissue

Hair, nails, and sebaceous and sweat glands are appendages of skin

Anatomy and Physiology (cont.)Hair

Vellus hair – short, fine, less pigmentation

Terminal hair – coarser, pigmented (scalp/eyebrows)

Nails - protect distal ends of fingers/toes

Sebaceous glands – present all surfaces except palms/soles; produce a fatty substance secreted onto skin surface through hair follicles

Sweat glands

Eccrine glands – widely distributed, open directly onto skin surface, help control body temperature

Apocrine glands – found in axilla and groin, stimulated by emotional stress

The Health HistoryCommon or concerning symptoms

Hair loss

Rash

Moles

Ask the patient

“Have you noticed any changes in your skin or your hair?”

“Have you noticed any moles that have changed size, shape, color, or sensation?”

“Have you noticed any new moles?”

Health Promotion and Counseling

Clinicians play an important role in educating patients

Early detection of suspicious moles

Protective measures for skin care

Hazards of excessive sun exposure

Skin cancers are most common cancers in some countries.

Most prevalent on hands, neck, and head

HARMM Risk Factors for Melanoma

History of previous melanoma

Age over 50

Regular dermatologist absent

Mole changing

Male gender

Additional Risk Factors for Melanoma

≥50 common moles

Red or light hair

Heavy sun exposure (especially severe childhood

sunburns)

Light eye or skin color (especially freckles/burns

easily)

Family history of melanoma

ABCDE: Screening Moles for Possible Melanoma

A for asymmetryB for irregular borders, especially ragged, notched,

or blurredC for variation or change in color, especially blue or

blackD for diameter ≥6 mm or different from other

moles, especially changing, itching, or bleedingE for elevation or enlargement

Techniques of ExaminationExamination of the skin, hair, and nails begins with the

general survey of the patient

Make sure the patient wears a gown

Drape appropriately to facilitate close inspection of hair,

anterior and posterior surfaces of body, palms and soles,

and webspaces

Inspect entire skin surface in good light

Preferably in natural light (or artificial light that

resembles natural)

o Artificial light often distorts colors

Techniques of Examination (cont.)

Inspect and palpate skinNote characteristics of:

ColorMoistureTemperatureTextureMobility and turgorLesions

Techniques of Examination (cont.)

Color

Patients often notice change in color before physician

Look for increased pigmentation, loss of pigmentation

Look for redness, pallor, cyanosis, and yellowing

o Red color of oxyhemoglobin best assessed at fingertips, lips, and mucous membranes

In dark-skinned people, palms and soles

o For central cyanosis, look in lips, oral mucosa, and tongue

o Jaundice - sclera

Techniques of Examination (cont.)

Moisture Dryness, sweating, and oiliness

Temperature Use back of fingertips Identify warmth or coolness of skin

Texture Roughness or smoothness.

Techniques of Examination (cont.)

Mobility and turgor Lift fold of skin

Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)

Techniques of Examination (cont.)

Lesions

Note characteristics

o Anatomic location and distribution

o Patterns and shapes

o Type of lesion (macules, papules, nevi,

vesicles)

o Color

Techniques of Examination (cont.)

Skin lesions in context

Whenever you see a skin lesion, look it up in a well-illustrated textbook of dermatology

To arrive at a dermatologic diagnosis, consider the type of lesions, location, and distribution, along with the patient’s history and physical

Examples of skin lesions

Techniques of Examination (cont.)

Hair

Inspect and palpate

Note quantity, distribution, and texture

Techniques of Examination (cont.)

Nails

Inspect and palpate fingernails/toenails

Note color and shape

Note lesions

o Longitudinal bands of pigment may be a normal finding in people with darker skin

Evaluating the Bedbound PatientPeople confined to bed are particularly

susceptible to skin damage and ulceration

Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin

Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels.

Evaluating the Bedbound PatientRoll patient onto one side to see sacrum and

buttocks

Recording the Physical Examination

Initially you may use sentences to describe findings; later you will use phrases

Examples: “Color good. Skin warm and moist. Nails without clubbing or

cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”

“Marked facial pallor, with circuoral cyanosis. Palms cold and moist. Cyanosis in nail beds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”

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