King Saud University

College of Nursing

Adult Nursing (NUR 316)

Skin, hair, and nail assessment

Integumentary System

 Skin and accessory structures

 Hair
 Nails
Skin

 Largest Organ of the Body

 Protection from environment
 Temperature regulation
 Synthesis of vitamin D
 Storage of fat and blood
 Excretion of waste
 Sensation
 Composed of the Epidermal and Dermal
Layers
Figure 11.1 Skin structure. Three-dimensional view of the skin, subcutaneous tissue, glands, and hairs.
The Major Functions of the Skin

 Perceiving touch, pressure, temperature, and pain via the nerve

endings
 Protecting against mechanical, chemical, thermal, and solar
damage
 Protecting against loss of water and electrolytes
 Regulating body temperature
The Major Functions of the Skin

 Repairing surface wounds through cellular replacement

 Synthesizing vitamin D
 Allowing identification through uniqueness of facial contours,
skin and hair color, and fingerprints
Oil or Sebaceous Glands

 Produce Sebum That Is Usually Released in Hair Follicles

The Major Functions of the
Cutaneous Glands
 Excreting uric acid, urea, ammonia, sodium, potassium, and
other metabolic wastes
 Regulating temperature through evaporation of perspiration on
the skin surface
 Protecting against bacterial growth on the skin surface
The Major Functions of the
Cutaneous Glands
 Softening, lubricating, and waterproofing skin and hair
 Resisting water loss from the skin surface in low-humidity
environments
 Protecting deeper skin regions from bacteria on the skin
surface
Hair

 Thin Fiber Compound of Dead Keratinized Cells

 Vellus
 Terminal
Nails

 Thin Plates of Keratinized Epidermal Cells That Cover the

Distal Ends of Fingers and Toes
Figure 11.2 Structure of a nail.
Focused Interview

 General questions
Specific Questions

 Illness or infection
 Symptoms
 Pain
 Behaviors
 Infants and children
 Pregnant females
 Older adults
 Environment
Box 11.2 Self-
Examination of the Skin
Removal of:

 Clothing
 Jewelry
 Cosmetics
 Wigs
 Hairpieces
Abnormal Skin Findings

 Primary and secondary lesions

 Vascular lesions
 Purpuric lesions
 Infections
 Malignant lesions
 ABCDE Criteria
Figure 11.22 ABCDE Criteria for Melanoma Assessment
Table 11.2 Potential
Secondary Sources for
Client Data Related to the
Skin, Hair, and Nails
Figure 11.29 Spoon nail.
Figure 11.30 Hemangioma.
Figure 11.31 Port-wine stain (nevus flammeus).
Figure 11.32 Spider (star) angioma.
Figure 11.33 Venous lake.
Figure 11.34 Petechiae.
Figure 11.35 Purpura.
Figure 11.36 Ecchymosis (bruise).
Figure 11.37 Hematoma.
Figure 11.38 Macule and patch.
Figure 11.39 Papule and plaque.
Figure 11.40 Nodule and tumor.
Figure 11.41 Vesicle and bulla.
Figure 11.42 Wheal.
Figure 11.43 Pustule.
Figure 11.44 Cyst.
Figure 11.45 Atrophy.
Figure 11.46 Erosion.
Figure 11.47 Lichenification.
Figure 11.48 Scales.
Figure 11.49 Crust.
Figure 11.50 Ulcer.
Figure 11.51 Fissure.
Figure 11.52 Scar.
Skin Lesions

 Tinea
 Measles
 Varicella
 Herpes
 Psoriasis
 Dermatitis
 Eczema
 Impetigo
Figure 11.63 Tinea corporis.
Figure 11.64 Measles (rubeola).
Figure 11.65 German measles (rubella).
Figure 11.66 Chickenpox (varicella).
Figure 11.67 Herpes simplex.
Figure 11.68 Herpes zoster (shingles).
Figure 11.69 Psoriasis.
Figure 11.70 Contact dermatitis.
Figure 11.71 Eczema (atopic dermatitis).
Figure 11.72 Impetigo.
Malignant Lesions

 Basal cell carcinoma

 Squamous cell carcinoma
 Malignant melanoma
 Kaposi’s sarcoma
Figure 11.73 Basal cell carcinoma.
Figure 11.74 Squamous cell carcinoma.
Figure 11.75 Malignant melanoma.
Figure 11.76 Kaposi’s sarcoma.
Abnormal Hair Findings

 Seborrhea
 Tinea capitis
 Alopecia areata
 Infection
 Folliculitis
 Furuncles
 Hirsutism
Figure 11.77 Seborrheic dermatitis (cradle cap).
Figure 11.78 Tinea capitis (scalp ringworm).
Figure 11.79 Alopecia areata.
Figure 11.80 Folliculitis.
Figure 11.81 Furuncle/abscess.
Figure 11.82 Hirsutism.
Abnormal Nail Findings

 Spoon nails
 Paronychia
 Beau’s line
 Splinter hemorrhage
 Onycholysis
Figure 11.83 Spoon nails (Koilonychia).
Figure 11.84 Paronychia.
Figure 11.85 Beau’s line.
Figure 11.86 Splinter hemorrhages.
Figure 11.88 Onycholysis.
Special Considerations

 Developmental, Psychosocial, Cultural, and Environmental

Developmental Considerations

 Pediatric
 Newborn skin is covered with vernix caseosa.
 Infants have skin that is thin, soft, and free of terminal hair.
 Milia and “Stork bites” are common, harmless markings in
newborns
 Infants may be born with lanugo present
 Temperature regulation is inefficient in infants.
Figure 11.3 Milia.
Figure 11.4 Mongolian spots.
Developmental Considerations

 Pregnant Female
 Skin pigmentation increases.
 Development of melasma and the linea nigra are common
Figure 11.6 Melasma.
Figure 11.7 Linea nigra.
Developmental Considerations

 Geriatric
 Skin elasticity decreases with aging
 Sebum production decreases and causes dryness
 Perspiration decreases
 Decrease in melanin production resulting in graying hair
 Increased sensitivity to sunlight
 Nails tend to become thicker and more brittle
Figure 11.8 Tenting. A. Step 1: Nurse grasps the skin.

A
Figure 11.8 (continued) Tenting. B. Step 2: Nurse releases grasp, tenting present.

B
Psychosocial Considerations

 Stress-induced illnesses
 Visible skin disorders and self-esteem/body image
Cultural and Environmental
Considerations
 Religion
 Birth anomalies
 Dietary deficiencies
Table 11.1 Color
Variations in Light
and Dark Skin
Table 11.1 Color
Variations in Light and
Dark Skin (continued)
Table 11.1 Color
Variations in Light and
Dark Skin (continued)
Box 11.1
Coining,
Cupping,
Pinching
Obese Clients

 Skinfold
 Incontinence
 Hygiene
Objectives for Skin Health
Outlined in Healthy People 2020
 Occupational skin disorders
 Education on skin cancer risks and prevention
Key Objectives for Occupational
Skin Disorders
 Reduce occupational skin disorders in full-time workers
Key Objective for Skin Cancer

 Increase the number of persons using protective measures to

reduce the rate of sunburns