Physical Examination (Integumentary)

• 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
• 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
  • 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
• 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

  
• Focused Interview

  • General questions
  • Specific Questions
  • Illness or infection
  • Symptoms
  • Pain
  • Behaviors
  • Infants and children
  • Pregnant females
  • Older adults
  • Environment
• Abnormal Skin Findings

  • Primary and secondary lesions
  • Vascular lesions
  • Purpuric lesions
  • Infections
  • Malignant lesions
  • ABCDE Criteria
• Common Shapes and Configurations of Lesions

  • Annular or circular
  • Confluent
  • Discrete
  • Grouped
  • Gyrate
  • Target or iris
  • Linear
  • Polycyclic
  • Zosteriform
• Primary skin lesions are original lesions arising from previously normal skin. Secondary lesions can originate from primary lesions.
• Primary Skin Lesions

  • Non palpable Change in Skin Color (Macule, Patch)
  • Palpable elevated solid masse (Papule, Plaque, Nodule, Tumors, Wheal, Cyst)
  • Palpable elevated serous fluid filled cavities (Vesicles, Bulla, Pustules)
• Secondary Skin Lesions

  • Erosions, Ulcers, Fissure, Scales, Crust, Scar, Lichenification, Atrophic Skin, Keloids
• Skin Lesions

  • Tinea
  • Measles
  • Varicella
  • Herpes
  • Psoriasis
  • Dermatitis
  • Eczema
  • Impetigo
• Lesions caused by trauma or abuse

  • Pattern injury
  • Hematoma
  • Ecchymosis
• Malignant Lesions

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Malignant melanoma
  • Kaposi's sarcoma
• Abnormal Hair Findings

  • Seborrhea
  • Tinea capitis
  • Alopecia areata
  • Infection
  • Folliculitis
  • Furuncles
  • Hirsutism
• Abnormal Nail Findings

  • Spoon nails
  • Paronychia
  • Beau's line
  • Splinter hemorrhage
  • Onycholysis

  
• Developmental Considerations

  • Pediatric
  • Pregnant Female
  • Geriatric
• Psychosocial Considerations

  • Stress-induced illnesses
  • Visible skin disorders and self-esteem/body image
• Cultural and Environmental Considerations

  • Religion
  • Birth anomalies
  • Dietary deficiencies
• Considerations for 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
• Edema


  The presence of excess interstitial fluid; an area that appears swollen, shiny and taut and tends to blanch the skin color or, if accompanied by inflammation, may redden the skin. It may also described as pitting or non-pitting edema.
• Pressure Ulcers


  Also known as pressure sores or bedsores, are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.
• Pressure Ulcer Nursing Responsibility

  • Use repositioning schedules (every 15 minutes when on chair or every 2 hours when on bed)
  • Use pressure mattress or chair cushion
  • Use lifting devices as directed to reduce shear (trapeze bar for patients, or lifts for family, if necessary)
  • Use positioning with pillows or wedges to avoid bony prominence contact with surfaces and to maintain body alignment
  • For those who are bedbound, avoid elevating the head of bed beyond 30 degrees except for brief periods
• A patient who is admitted for liver failure

  Would be likely to show jaundice
• The following should be removed before performing a physical examination:

  • Clothing
  • Jewelry
  • Cosmetics
  • Wigs
  • Hairpieces