Patient Assessment & Nursing Skills: Skin, Hair and Nails

Patient Assessment

Nursing Skills: Skin, Hair, and Nails

Introduction to Skin, Hair, and Nails

  • Largest organ of the body
  • Weighs approximately 9 lbs.
  • Can suggest the status of a client’s:
    • Nutrition
    • Airway clearance
    • Thermoregulation
    • Tissue perfusion

Major Functions of the Skin

  • Perception: Recognizes touch, pressure, and temperature.
  • Protection: Safeguards against environmental damage and loss of water (H2O) and electrolytes.
  • Temperature Regulation: Helps maintain body temperature.
  • Wound Repair: Facilitates the repair of surface wounds.
  • Vitamin D Synthesis: Synthesizes Vitamin D when exposed to sunlight.
  • Identification: Provides uniqueness to individuals through fingerprints.

Skin Structure Components

  • Epidermis: Composed of keratinocytes; the outermost layer containing the stratum corneum and stratum germinativum.
    • Stratum Corneum: Outermost layer, composed of dead keratinocytes (horny cell layer).
    • Stratum Germinativum: Basal layer where new skin cells are produced.
  • Dermis: Contains blood vessels, nerves, and connective tissue.
  • Subcutaneous tissue: Provides insulation and houses adipose tissue.

Skin Glands

  • Sebaceous glands: Produce oil to lubricate the skin.
  • Eccrine sweat glands: Aid in thermoregulation.
  • Apocrine sweat glands: Found in specific areas, such as the axillae and groin.

Hair

  • Types of Hair:
    • Vellus hair: Fine, short strands found over the entire body.
    • Terminal hair: Thicker hair found in regions like the eyebrows and scalp.
  • Major Functions of Hair:
    • Insulates against heat and cold.
    • Protects eyes from sweat.
    • Protects nasal passages from foreign particles.

Nails

  • Anatomy of the Nail:
    • Lateral nail fold
    • Lunula
    • Cuticle
    • Nail bed
    • Nail root and free edge of nail
    • Body of nail: Main visible part.
    • Bone of fingertip: Provides support.
  • Major Functions of Nails:
    • Protect the tips of fingers and toes.
    • Aid in picking up small objects.
    • Facilitate grasping.
    • Serve as an instrument for scratching.

Skin Conditions in Infants and Children

  • Vernix Caseosa: A waxy substance covering newborns, providing insulation and protection.
  • Jaundice: Yellowing of the skin due to bilirubin buildup.
  • Milia: Small white cysts commonly seen on the face of newborns.
  • Mongolian Spots: Congenital blue-gray pigmented areas often found on the lower back and buttocks.
  • Temperature Regulation: Infants have less developed thermoregulatory mechanisms.
  • Lanugo: Fine hair covering a fetus or newborn.

Skin Changes in Older Adults

  • Senile Lentigines: Age spots resulting from sun exposure.
  • Cherry Angiomas: Small, red, benign tumors made up of small blood vessels.
  • Cutaneous Tags: Small benign growths on the skin.
  • Cutaneous Horns: Projections from the skin that resemble horns.

Psychological and Cultural Considerations

  • Psychological Factors: Stress can affect skin health and conditions.
  • Cultural Considerations:
    • Variations in skin color and how it's perceived culturally.
    • Religious practices that may influence skin appearance (tattoos, body piercing).

Assessment of the Skin

  • Inspection:

    • Cleanliness, presence of body odor.
    • Inspection for freckles or nevi (moles).

  • Palpation:

    • Skin temperature, moisture, texture, thickness assessed.
    • Edema Assessment:
    • 1+ Edema: 2 mm
    • 2+ Edema: 4 mm
    • 3+ Edema: 6 mm
    • 4+ Edema: 8 mm

Common Skin Lesions

  • Herpes Simplex: Viral infection presenting with vesicular lesions.
  • Herpes Zoster: Shingles; reactivation of varicella zoster virus in dermatomal pattern.
  • Psoriasis: Chronic skin condition characterized by red, scaly patches.
  • Contact Dermatitis: Inflammatory reaction to contact with an irritant or allergen.
  • Eczema: Inflammatory skin disease resulting in itchy, red, and swollen skin.
  • Impetigo: Bacterial skin infection forming pustules and honey-colored crusts.

Assessment of Scalp and Hair

  • Factors to Inspect:
    • Cleanliness, hair color, texture, distribution.
  • Inspect for Lesions: Look for any abnormalities or signs of infection.

Abnormalities of the Hair

  • Seborrheic Dermatitis: Scaly patches, red skin, and stubborn dandruff.
  • Alopecia Areata: Sudden hair loss that starts with one or more circular bald patches.
  • Folliculitis: Inflammation of hair follicles often due to infection.
  • Furuncle/Abscess: Boils that occur when hair follicles become infected.

Assessment of the Nails

  • Coffee/Assessment:
    • Assess for hygiene and even pink undertone.
    • Check capillary refill (should be <2 seconds).
    • Inspect and palpate for shape and contour.

Nail Abnormalities

  • Healthy vs. Clubbing:
    • Comparison between normal and clubbed nails.
    • Clubbing results in a diamond-shaped opening at the tip.
  • Spoon Nails: Nails that curve upwards, indicating potential iron deficiency.
  • Paronychia: Infection of the skin around the nails, leading to redness and swelling.

Head, Neck, and Lymphatics

Introduction

  • Assessment of several systems at once, including:
    • Integumentary system
    • Gastrointestinal system
    • Respiratory system
    • Cardiovascular system
  • Anatomy:
    • Protective shell formed by the facial bones.
    • Important facial landmarks, including the temporal artery.
  • Primary Function: Protects the brain.

Inspection Techniques

  • Head and Scalp Inspection:
    • Evaluate size, shape, symmetry, and integrity.
  • Facial Inspection:
    • The top of the ear should be equal to the canthi of the eye.
    • Observe movement of the head, face, and eyes.

Palpation Techniques

  • Head and Scalp Palpation:
    • Assess for lumps, tenderness, and integrity.
  • Temporal Artery Palpation:
    • Evaluate for distension or tenderness.
  • Test Range of Motion (ROM) of the Temporomandibular Joint (TMJ).

Neck Anatomy

  • Cervical Vertebrae: Formed by seven cervical vertebrae, ligaments, and muscles.
  • Important bones include:
    • Frontal bone
    • Parietal bone
    • Temporal bone
    • Occipital bone

Palpation of the Neck

  • Carotid Arteries and Jugular Veins:
    • Sternomastoid Muscle: Important anatomical landmark for feeling pulsing of carotid arteries.
    • Internal and External Jugular Veins: Aspect of assessing venous return and potential obstruction.

Lymphatics Assessment

  • Lymph Nodes: Important to identify swelling or tenderness in:
    • Postauricular
    • Occipital
    • Superficial cervical chain
    • Supra-clavicular
    • Preauricular
    • Retro-pharyngeal
    • Submaxillary
    • Submental
    • Deep cervical chain

Inspection of Neck and Carotids

  • Inspect for skin color, integrity, shape, and symmetry.
  • Test the range of motion of the neck.
  • Observe the carotid arteries and jugular veins for pulsations.

Palpation of Neck Structures

  • Trachea: Assess position and mobility.
  • Thyroid Gland: Inspect and palpate for enlargement or nodules.

Developmental Considerations

  • Infants and Children:
    • Assessment of fontanelles and ossification patterns.
    • Identify abnormalities such as hydrocephalus or thyroid issues.

Abnormalities of the Skull, Face, and Neck

  • Hydrocephalus: Accumulation of cerebrospinal fluid (CSF) within the brain, leading to increased intracranial pressure.
  • Stroke: Sudden loss of brain function due to blood supply disruption, resulting in varying symptoms depending on the affected area.
  • Bell's Palsy: Sudden, temporary weakness or loss of movement in the facial muscles on one side of the face.