Skin, Hair, and Nails Anatomy

• Epidermis: Outer layer of skin.

  • Horny Layer (Stratum Corneum): Outermost layer, composed of dead skin cells.
  • Malpighian Layer (Stratum Granulosum): Responsible for the formation of new skin cells.
  • Cellular Layer (Basal Layer): Deepest layer of the epidermis, where new cell generation occurs.

• Dermis: Below epidermis, contains connective tissue, blood vessels, and nerves.

  • Dermal Papilla: Projections into the epidermis, providing nutrients.

• Subcutaneous Tissue: Layer of fat and connective tissue, providing insulation and cushioning.

• Hair: Follicles with sebaceous (oil) and sweat glands regulating skin moisture.

Course Objectives

• Students will be able to:
  • Assess skin, hair, and nails.
  • Apply knowledge of anatomy and physiology for assessments.
  • Identify general survey findings.
  • Create health history questions relevant to skin conditions.
  • Use appropriate techniques for physical assessment.
  • Describe characteristics of skin lesions.
  • Differentiate expected vs unexpected findings.
  • Document assessment findings accurately.

Health Concepts Related to Skin Assessment

• Homeostasis and Regulation:

  • Essential for skin integrity and overall health, involving:
  • Gas exchange
  • Fluid and electrolytes balance
  • Nutrition
  • Thermoregulation
  • Clotting

• Protection and Movement: Skin functions in sensory perception, tissue integrity, and inflammation response.

General Survey of Skin, Hair, and Nails

• Skin Colour Assessment:

  • Importance of assessing uniformity and potential conditions like color blindness.
  • Fitzpatrick Skin Type Classification: Tool for skin type assessment.

• Physical Assessment Techniques:

  • Inspection:
  • Inspect color, lesions, lesions' characteristics, and hygiene.
  • Use natural or halogen lighting for accuracy.
  • Palpation:
  • Check temperature, moisture, texture, thickness, and turgor using dorsal surface of hands.

Skin Lesions and Rashes Assessment

• Types of Lesions:

  • Macules, papules, pustules, plaques, nodules, vesicles, bullae, urticaria.
  • Each type has unique characteristics to be inspected and described.

• Lesion Attributes:

  • Size, shape, color, texture, exudate, tenderness, configuration, and location/distribution.

ABCDEs of Melanoma Diagnosis

• A: Asymmetry
• B: Borders are irregular
• C: Colour variation within the lesion
• D: Diameter usually >6 mm
• E: Evolving changes in size, shape, or color.

Physical Assessment of Hair and Scalp

• Inspect hair for:
  • Quality, distribution, pattern of loss, and color changes.
• Scalp should be palpated for tenderness and mobility.

Physical Assessment of Nails

• Inspection:
  • Color (normal pink to light brown), shape, and surface texture.
• Palpation:
  • Assess capillary refill time (<3 seconds indicates good circulation).

Nail Conditions to Recognize

• Clubbing: Angle >180°, indicative of hypoxia or peripheral disease.
• Beau's Lines: Indicate past trauma or systemic illness.
• Spoon Nails: Can indicate iron deficiency.

Red Flags in Skin Assessment

• Critical conditions include:
  • Pressure injuries, dehydration, cyanosis, melanoma, acute trauma/burns.

References

• Giddens, J.F. (2017). Concepts for Nursing Practice. St. Louis, MS: Elsevier.
• Stephen, T.C. & Skillen, D.L. (2021). Canadian Nursing Health Assessment: A Best Practice Approach. 2nd edition. Wolters Kluwer.