Health Assessment Skills Development
Unit Two
Assessing the Integumentary System
Introduction:
• The intugumentaryu system consists of:
– Skin.
– Sweat and oil glands.
– Hair.
– Nails.
• The largest organ of the body.
Introduction:
• 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.
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?
Gathering the data:
• 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:
• 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:
• Nails:
– Have you ever had problems with your nail?
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.
Physical Assessment:
• 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:
• 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:
• Scalp and Hair:
– Observe the amount and distribution of the hair
throughout the scalp.
– Inspect the scalp for lesions.
Physical Assessment:
• 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:
• 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:
• 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)