Skin

Assessment

  • Inspect; color, texture, moisture, integrity

  • Palpate; texture, moisture, temperature, turgor, mobility 

  • Tools; penlight, gloves, ruler

  • Get skin history of the patient; rashes, allergies, treatment

Functions

  • Protection from environment, perception, homeostasis, identification, wound repair, secretion, excretion , absorption


  • Nail plate is a pink color

  • Angle between nail fold and nail plate should be less than 180 degrees 


Color 

  • Whitish pink, light or dark brown, yellow or olive tones

  • High vessel supply - more red - cheeks and chest

  • Darker skin tones tones have a light tone on their palms and feet 

Hyperpigmentation

  • Freckles, chloasma, age spots, tan lines

  • High melanin

Hypopigmentation

  • Low melanin

  • Scars, stretch marks, vitiligo

Jaundice

  • Yellow tint due to bilirubin; breakdown of the red blood cells 

Erythema

  • Due to inflammation, flushed

  • Purple tint in darker tones 

Texture

  • Should be smooth and dry

  • Xerosis - excessive dryness

  • Seborrhea - oil

  • Expected; black and white heads, scarring, oily skin. wrinkles(slower cells replacement over time)

  • Striae - stretch marks

  • Keloid - overgrowth of scar tissue

UNexpected 

  • Velvety skin - thyroid disease

  • Dry or flaky skin - dehydration, trauma, thyroid

  • Diaphoresis - heavy sweating

Assessment

  • Color, flat or raised, size, location, drainage

  • Can change over time 



Types of Lesions

  • Vascular; bleeding under the skin; trauma, infection, disease

  • Primary; flat, raised solid/fluid filled

  • Secondary; changes to the surface, debris, alteration


  • Macule - flat rash

  • Patch - birthmark

  • Papule - raised

  • Plaque - psoriasis, eczema

  • Nodular - melanoma, hemangioma

  • Tumor - large and firm

  • Vesicle - fluid filled

  • Pustule - pus, acne, herpes

  • Cyst - large, liquid or solid fluid 

  • Ulcer - pressure injury

  • Excoriation - abrasions, scratching

  • Lichenification - thick, raised skin caused by itching or scratching

  • Maculopapular -macules and papules


Patterns

  • Linear, clustered, bulls eye, annular

Malignant

  • ANCDE Rule; asymmetry, border, color, diameter, evolving 

Pressure INjury

  • Impaired circulation

  • Usually over a bony area 

Staging

  • 1 - Intact skin, non blanchable erythema

  • 2 - partial skin loss, shiny or dry

  • 3 - Full thickness skin loss, damage to the subcutaneous tissue

  • 4 - exposed muscle, tendons, bone, necrotic tissue

Temperature

  • Clients skin should be the same temp as yours 

  • Circulation issue can cause client to be cold/blue tint

Fingernail Clubbing

  • Spongy, spoon shaped, curved down, get wider

  • Congenital/ at birth, HD, IBD, pulmonary disease

  • Koilonychia - spoon shape

  • Paronychia - inflamed


  • Tenting - remains in elevated position, dehydration, extreme weight loss

  • Edema - excess fluid in interstitial space, kidney or heart failure, infection or trauma 

  • Pitting - leaving an indent


Health Promotion

  • Bathing at 110-15 degrees, sun protection, no indoor tanning, dermatology checkups

Children

  • Lanugo - fine hair

  • Vernix caseosa - cheesy substance 

  •  Sebum - holding water in the skin producing milia 

  • Chloasma - discoloration in the face during pregnancy 


Senile purpura - discoloration due to capillary fragility 

Skin breakdown - cell replacement is slower and wound healing is delayed as someone ages