skin, hair, and nails

Skin, Hair, and Nail Assessments

Course Information

  • Course Title: NUR 152 Nursing Theory & Science I

Objectives

  • Discuss assessment considerations related to skin, hair, and nails

  • Document assessment findings pertinent to skin, hair, and nails

Health History Considerations

Skin Assessment

  • Allergies: Include inquiries about known allergies.

  • Hives: Document any presence of urticaria.

  • Psoriasis or Eczema: Note any history of skin conditions such as psoriasis or eczema.

  • Change in Mole: Identify changes in existing moles, such as size or coloration.

  • Cancer: Inquire about any known history of skin cancer.

  • Change in Pigmentation: Document any alterations in skin coloration.

  • Dryness/Pruritus: Ask about dryness or itching sensations.

  • Excessive Bruising: Note any instances of abnormal bruising.

  • Rash or Lesion: Document any presence of rashes or lesions on the skin.

  • Medications: Record any medications that may impact skin health.

  • Hair Loss: Ask about any instances of hair thinning or loss.

  • Change in Nails: Note any changes pertaining to the nails.

  • Environmental or Occupational Hazards: Inquire about possible exposure to harmful substances.

  • Self-Care Behaviors: Evaluate the patient's self-care practices related to skin health.

Hair and Nails Assessment
Hair and Scalp

  • Hygiene Practices: Inquire about hair hygiene practices to assess overall care.

  • Chemical Products: Document use of chemical treatments or products on hair.

Nails

  • Recent Trauma: Ask about any recent injuries to the nail bed.

  • Acrylic/Artificial Nails: Note if the patient uses artificial nails.

Physical Examination: Equipment Needed

  • Strong Direct Lighting: To adequately visualize areas being examined.

  • Small Centimeter Ruler: For measuring size of lesions or moles.

  • Penlight: To assess individuals and areas that need focused light.

  • Gloves: For maintaining hygiene during examination.

  • Wood’s Lamp: Used for special diagnostic procedures to assess skin conditions.

  • Magnifying Glass: Utilized to examine finer details during skin evaluations.

Physical Exam for Skin

Inspection

  • Color: Assess the overall skin color for abnormalities.

  • Lesions: Note any lesions present on the skin.

  • Vascularity or Bruising: Check for signs of vascular issues or bruising.

Palpation

  • Temperature: Assess the temperature of the skin.

  • Texture: Feel the texture of the skin, noting any abnormalities.

  • Thickness: Evaluate the thickness of the skin where applicable.

  • Turgor: Check skin turgor to assess hydration levels.

  • Moisture: Depending on the condition, assess moisture levels on the skin.

Lesion Characteristics

  • Color: Note the color of skin lesions.

  • Pattern or Shape: Document the pattern and the shape of the lesions.

  • Size: Measure lesions to quantify their size.

  • Location and Distribution: Assess where lesions are situated and their distribution across the body.

  • Exudate Presence: Check for any discharge from lesions.

  • Contour: Note the contour of the lesions.

Edema Assessment

  • Check for Edema:

    • Pitting Edema: Edema is rated using a scale to determine its severity.

Physical Exam for Hair and Scalp

Hair Inspection and Palpation

  • Color: Inspect the scalp hair and body hair for color consistency.

  • Texture: Palpate hair strands between the fingertips to assess condition.

  • Distribution: Evaluate hair distribution across the body, including the face and scalp.

Physical Exam for Nails

Nails Inspection and Palpation

  • Shape, Angle, Texture, and Color Assessment:

    • Normal finding: Nail base angle should be 160ext°160^{ ext{°}}.

    • Clubbing: If nail base angle is ext≥180ext°ext{≥ } 180^{ ext{°}}, this may indicate clubbing.

    • Nail surface should appear smooth with proper palpation.

    • Nail base should be firm and non-tender upon palpation;

    • Cuticles must be intact and color should align with patient’s race/ethnicity.

Promoting Health and Self Care

Skin Self-Examination

  • Teach patients the ABCDE rule:

    • A - Asymmetry

    • B - Border irregularity

    • C - Color variation

    • D - Diameter (greater than 6extmm6 ext{ mm} should be evaluated)

    • E - Elevation and enlargement

    • F - Feeling (itching, tenderness, or pain should be noted)

Abnormal Findings

Primary Skin Lesions

  • Macule: Flat, distinct, colored area of skin.

  • Papule: Small, raised, solid pimple or swelling.

  • Nodule: A larger, solid tumor that can be felt.

  • Wheal: Swollen, red, itchy area resembling hives.

  • Urticaria (Hives): Raised, itchy welts on the skin.

  • Vesicle: Small, fluid-filled blister.

Secondary Skin Lesions

  • Fissure: A deep crack or split in the skin.

  • Erosion: A loss of part of the skin, especially superficial layers.

  • Ulcer: A sore that results from a loss of skin surface.

  • Excoriation: Skin abrasions caused by scratching.

  • Keloid: A thick, raised scar area.

  • Pustule: A small bump on the skin filled with pus.

Focused Interview Questions for Older Adults

  • What changes have you noticed in your skin over the last few years?

  • Have you experienced any delay in wound healing?

  • Have there been any changes observed in your feet and toenails?

  • Do you experience frequent falls?

  • Do you have any history of diabetes or peripheral vascular disease?

Changes Observed in Older Adults

  • Thickened, yellow toenails: Often indicate aging or health issues.

  • Decreased Hair Growth to No Hair Growth: Notable absence on lower extremities.

  • Lower Extremities Cool to Touch: Possible circulatory issues.

  • Decreased Peripheral Pulses: Indicates a decrease in blood circulation.