skin, hair, nails

Integumentary System

Includes skin, hair, and nails.

• helps protect microbes/germs, retain water (prevent dehydration), temperature control

Temperature Lesions

Skin abnormalities indicating temperature changes.

Hair Growth Pattern

The distribution and density of hair.

• alopecia, balding

Skin Color Assessment

Evaluation of pigment and discoloration.

• moles, jaundice

Nail Assessment

Examination of shape, thickness, and color.

Diaphoresis

Excessive sweating or dampness.

Cyanosis

Bluish discoloration from low oxygen.

• indicates reduced circulations or hypoxia

• found in fingers, toes, around mouth, limbs

Jaundice

Yellowing of skin due to liver issues.

• increased serum bilirubin

• end stage liver failure

Skin Self-Examination

Checking for new or changing skin growths.

Temporal Artery Assessment

Evaluation of the temporal artery for abnormalities.

Scalp Conditions

Assessment for lice or trauma on the scalp.

Hirsutism

Excessive hair growth in women.

Throat Assessment

Examination of tonsils, uvula, and swallowing.

• tonsils, uvula, swallow, redness, patches, sores

Enlarged Lymph Nodes

Swollen lymph nodes indicating infection or disease.

Thyroid Examination

Assessment for enlargement or nodules in the thyroid.

Tracheal Deviation

Displacement of the trachea from midline.

Physical Assessment of Neck

range of motion, symmetry, lumps/ bumps, trachea midline

Sinus Palpation

Assessment of sinus areas for tenderness.

Mouth Assessment

Examination of teeth, gums, and oral cavity.

Nose Symmetry

Evaluation of the nose for alignment and function.

Subjective Data

Patient-reported information prompting focused assessments.

physical assessment of skin, hair, nails

color, pigment, discoloration: nail shape, thickness, color

temperature: dry, moist, cracked

lesions or rashes: bruising (ecchymosis), redness (erythema)

hair growth pattern: diaphoresis (damp, sweaty), flushing (sudden redness)

macule

flat, discolored area of skin that is not raised.

papule - small, rasied bump on the skin that is less than 1 cm. can be solid or fluid-filled and may appear as a pimple, wart, or mole.

nodule - pore ruptures under the skin, resulting in a large, raised bump.

cyst - creates when a pore is clogged with excess oil, dead skin cells, or bacteria

open comedones (blackheads) - follicle remains open, allowing the contents to oxidize and appear black

closed comedones (whiteheads): follicle is blocked, trapping the contents and forming a small, white bump

pustule: small, raised skin lesion filled with pus.

vesicle small, fluid-filled blister - clear fluid

bulla, large-filled blister - clear fluid - larger than vesicle

wheals: raised, itchy bumps on the skin that can be red, pink, or white. can appear and disappear. can be triggered by allergies, insect bites, and infections

telangiectasia

dilated, small blood vessels that appear as red or purple lines on the skin or mucous membranes

• caused by hormonal changes, sun damage, genetics, autoimmune disorders, meds

plaque: raised, well-defined areas of thickened and scaly skin.

petechiae - tony pinpoint red or purple spots that appear on the skin due to bleeding under the capillaries. can be a sign of something serious

nail conditions

• nail pitting - small round depressions

• central nail canal (

• nail plate crumbling = psoriasis, nutritional deficiencies

• nail clubbing - disease affecting lungs or heart (lung cancer, heart disease)

skin self-examination

ABCDE

asymmetry

border

color

diameter

evolving

sinuses

secrete mucus to trap dirt, dust, and pollutants and humidify air

head assessment

• shape/size:

• symmetry: scalp

• lump/bumps/tenderness: jae

• hair growth:

face assessment

expressions, affect, voice

shape and symmetry:

lumps/bumps/trauma

hair growth, hirsuitism

glands of face

• only parotid and submandibular glands are accessible to examination

• temporal, parotid glands, submandibular glands, sublingual gland

preacuricular

posterior auricular

occipital

submental

submandibular

jugulodigastric

superficial cervical

deep cervical chain

posterior cervical

supraclavicular