Physical Assessment of the
Integumentary System
• Integument means covering.
• The skin and its accessory organs, hair,
nails and glands comprise the
integumentary system of the body.
• The skin is composed of several different
tissue types and is considered an organ .
Functions of the Integument
• Protection
• Physical Barrier
• Perception
• Temperature Regulation
• Identification
• Communication
Functions of the Integument
continued
• Wound Repair
• Absorption
• Excretion
• Vitamin D Production
The Three Layers of the
Integument
• Epidermis - the outermost layer of the
skin, made of stratified squamous
epithelium .
• Dermis - the inner layer of the skin, made
of dense fibrous connective tissue .
• Subcutaneous tissue - thick, fat-containing
tissue. Below the skin; the tissues
between the dermis and the muscles.
Epidermal Appendages
• Hair is threads of keratin
• Sebaceous glands secrete the oil, sebum
• Sweat glands
– Eccrine glands secrete sweat
– Apocrine glands secrete thicker, milky
secretion as in anogenital, nipples, and illae
areas
• Nails are hardened keratin
Receptors in the skin
• The sensory receptors in the dermis are
for cutaneous sensations which include:
touch, pressure, heat, cold, and pain.
• The purpose of sensory receptors is to
provide the CNS with information about
the external environment and its effect on
the skin.
Interview
• Chief Complaint
–
–
–
–
Recent Changes
Pruritus (itching)
Dryness (xerosis)
Rashes (identify primary site, migration, pattern and
evolution
– Lesions
– Ecchymoses (bruising)
– Masses or lumps
• Symptom analysis
– Pages 225-229, Jarvis
Interview (cont.)
• Past Health History
– Example:
• Immunologic, Endocrine, Collagen, Vascular, Renal,
Hepatic
– Previous exposure to insects, infectious
disease
– Previous trauma & surgical intervention
– History of past allergic reactions
Interview (cont.)
• Medications
– Sensitivities
– Photosensitizing drugs
– Ask about self treatment with herbal remedies
• Allergies
– Medications & Foods
Interview (cont.)
• Family Health History
– Helps determine genetic predisposition to skin
disorders
• Psychosocial History
– Particularly important in long-term & chronic
processes.
– Determine & correct any misconceptions
about skin problems.
Interview (cont.)
• Diet
– Excessive dryness may indicate Vitamin A deficiency.
• Occupation & Travel
– What have they been exposed to.
• Habits
– Frequency of hygiene practices.
– Exercise & Sleep Patterns
• Affects circulation, nourishment, & repair of the skin.
– Is there prolonged exposure to sun, unusual cold, or
other skin damaging conditions.
Dermatologic Assessment
History
• Chief complaint
• Definition of problem (onset, location)
• Duration
• Accompanying manifestations
• Evolution of lesion or eruption
• Aggravating & relieving factors
Dermatologic Assessment
History
• Medical intervention
• Self-treatment
• Compliance & treatment factors
Preparation for the Physical
Examination
• Strong direct lighting, natural sunlight is
best
• Small centimeter ruler
• Penlight
• Gloves
• Wood’s light (ultraviolet light) may be
needed for special procedures
Inspection
• Color, Page 249 Jarvis
–
–
–
–
–
Pallor
Cyanosis
Erythema
Jaundice
Document presence of tattoos
• General pigmentation
• Areas of hypopigmentation or
•
hyperpigmentation
Abnormal color changes
Hair and scalp Inspection
• Inspect distribution & quality
• Texture
• Inspect the Scalp:
– Lesions
– Excoriations
– Lumps
– Bruises
– Lice
Nails
• Color, Shape & Contour
• Texture
• Integrity
• Thickness
• Capillary refill
Palpation
• Temperature
– Assess with dorsum of hand
– Warmth reflects circulation
– Compare sides
• Moisture
– Refers to the skin’s hydration level in terms of both
wetness & oiliness
– Diaphoresis, dehydration
• Texture
– Should feel smooth, soft, & resilient
Palpation continued
• Tenderness
• Thickness
– Callus
– Atrophic
• Edema
– Not a “normal finding”
– Common in some disorders
• Cardiovascular
• Renal failure
• Cirrhosis
Edema grading
– May be pitting
– 1+ Barely Visible
– 2+ Indentation < 5mm
– 3+ Indentation of 5 to 10mm
– 4+ Indentation of 10mm or >
Palpation continued
• Turgor
– Reflection of skin’s elasticity & hydration
– Turgor is decreased (less elasticity) as the
skin “tents” and stands by itself
• Hygiene, odor
• Vascularity or bruising
Lesion Types
• Types of Lesions
– Primary - those developing from previously
unaltered skin
– Secondary – those which develop over time
because of a factor such as scratching or
infection
If any Lesions present, note
the:
•
•
•
•
•
•
•
Color
Shape and configuration
Size
Elevation
Excudate
Location and distribution
Table 12-3 to 12-11, pages 250-265, Jarvis
Self-Care Behaviors
Teach skin self-examination, using the
ABCDE rule
A—asymmetry
B—border
C—color
D—diameter
E—elevation and enlargement
Developmental Considerations
• Infants
– Lanugo (fine downy hair) from 3 months
gestation to a few months after birth
– Thin, smooth, highly permeable and elastic
skin
– Increased sebum through the first few weeks
of life
– Temperature regulation inefficient
Developmental Considerations
• Aging Adults
–
–
–
–
–
–
–
Skin loses elasticity and underlying fat reserves
Vascularity diminishes
Decreased response of sweat glands
Lifetime of environmental trauma
Wound healing decreased
Melanocytes decreases melanin production
Loss of self-esteem