Skin

Interviewing Clients
- Importance of obtaining subjective data prior to assessment.
- Clinical questions can be posed in person or via questionnaires.
- Follow-up questions are essential to gather relevant details.

Skin Color
- Should be even and consistent with genetic background.
- Skin color derived from melanin, pigments, and underlying blood vessels.
- Range from whitish pink, light brown, to dark brown; variations appear based on blood flow in areas like cheeks and chest.
- Darker Skin Tones typically show light pigmentation on palms and soles.

Generalized vs. Localized
- Sun exposure increases generalized pigmentation.
- Hyperpigmentation: melanin increases in one area (examples: birthmarks, sun damage, pregnancy changes such as freckles and melasma).
- Hypopigmentation: decreased melanin (examples: scars, stretch marks, vitiligo).

Cyanosis: bluish skin indicating oxygen deficiency; hard to detect in dark skin—check oral mucosa.
Ecchymosis (Bruising): bleeding under the skin; appears as blue/yellow marks as they heal, often less visible in darker skin.
- Different types: petechiae (small spots), erythema (redness from inflammation), jaundice (yellow from bilirubin excess), pallor (decreased skin color due to anemia or circulation problems).

Expected Findings: skin should be smooth, dry, oil levels vary.
Unexpected Findings: skin conditions such as acne and wrinkles.
- Acne: characterized by blackheads, whiteheads, and scarring, often exacerbated by stress and hormonal changes during puberty.
- Wrinkles: result from aging and decreased oil production; the skin becomes thinner and less elastic.
- Scars: types include atrophic scars (depressions) and keloids (overgrowth).

Skin should be smooth and intact; dryness may indicate thyroid disease or dehydration.
Diaphoresis: excessive sweating can be caused by fever, anxiety, or other conditions.
Skin Lesions: include vascular, primary, secondary, and potentially malignant.
- Vascular lesions: result from blood vessel leakage (e.g., petechiae, ecchymosis).

Primary Lesions: result from a triggering agent (e.g., macules, papules, plaques).
Secondary Lesions: evolved from primary lesions over time (e.g., crusts, scales, fissures).
Potentially Malignant Lesions: require examination for skin cancer; use the ABCDE criteria (Asymmetry, Border, Color, Diameter, Evolving).

UPDRULE Method: assess moles for danger signs, prompting biopsy if two or more criteria are met.
- Asymmetry, irregular border, color variation, diameter >6mm, and evolving characteristics.

Limited mobility, thinner skin due to aging, poor nutrition, moisture presence (incontinence), friction injuries.
Stages of Pressure Injuries:
- Stage I: reddish area that does not blanch, texture change.
- Stage II: partial loss of dermis, shiny/pink wound bed.
- Stage III: full thickness loss, subcutaneous fat visible.
- Stage IV: full thickness loss exposed bone/tendon.

Nails should be slightly curved/flat, smooth, and uniform in thickness. Expected variations include slower growth and brittleness in older adults.

Brown streaks could indicate melanoma, cyanosis shows lack of oxygen, and pallor may link to anemia.
Clubbing: signifies possible underlying health conditions (e.g. heart or respiratory diseases).

Discuss bathing and hygiene practices: remove bacteria/oil, promote circulation, appropriate temperatures for bathing.
Skin Protection: use broad spectrum sunscreen SPF 30 or greater 15 minutes before sun exposure; wear protective clothing.
Self-Assessment of Moles: educate about risk factors for skin cancer and encourage self-examination to monitor changes.

Significant sun exposure, family history of melanoma, many atypical moles, red/light hair color, former blistering sunburns, and immunosuppression.