Skin

• Skin, Nails, Hair Assessment

  NURS 1030: Introduction to Health Assessment
• Developed by Parivash Enghiad MN, RN
• Winter 2024
• Readings


  • Jarvis, C. (2019). Physical Examination & Health Assessment (3rd Canadian. ed.). Elsevier
  • Skin, Hair, Nails (Chapter 13)
  • Pgs. 219 – 248
• Epidermal appendages


  • Hair
  • Sebaceous glands
  • Sweat glands (Eccrine glands, Apocrine glands (vestigial))
  • Nails
• Layers of skin


  • Epidermis (Stratum germinativum (basal cell layer), Stratum corneum (horny cell layer))
  • Dermis (Connective tissue (collagen), Elastic tissue)
  • Subcutaneous layer (Adipose tissue)
• Functions of the Skin

  • Protection
  • Perception
  • Temperature regulation
  • Identification
  • Communication
  • Wound repair
  • Absorption and excretion
  • Production of Vitamin D
• Lunula


  Whitened, half-moon area at the proximal end of the nail
• Nail matrix


  Generates new cells that make the nail
• Cuticle


  Protective cover around the nail matrix
• Nail bed


  Skin that nail is on
• Functions of the Nails

  • Protects the tips of the fingers and toes
  • Scratching
  • Grasping small objects
• Bulb matrix


  Where new cells are produced
• Arrector pili


  Muscle that contracts and elevate the hair (goosebumps)
• Hair shaft


  Visible portion of the hair
• Root


  Found below the surface
• Functions of Hair


  • Protection
  • Regulation of body temperature
  • Sensory reception
  • Expression of emotion
• Types of Hair


  • Lanugo (fine, fetal hair)
  • Vellus hair (fine, faint hair covering most of the body)
  • Terminal Hair (darker, thicker hair)
• Subjective Data: Health History

  • Previous history of skin disease
  • Change in pigmentation
  • Change in mole (size or colour)
  • Excessive dryness or moisture
  • Pruritus
  • Excessive bruising
  • Rash or lesion
  • Medications
  • Hair loss
  • Change in nails
  • Environmental or occupational hazards
  • Self-care behaviours
• Assessment Risk Factors


  • Demographics
  • Past medical History
  • History of skin disease
  • Medications
  • Hair Loss
  • Occupation, lifestyle
  • Self-care behaviours
• Objective Data: Skin (1 of 2)

  • Colour (General pigmentation, Presence of freckles, moles, birthmarks, Widespread colour change, Pallor, Erythema, Cyanosis, Jaundice)
  • Temperature (hypothermia/hyperthermia)
  • Moisture (diaphoresis/dehydration)
• Objective Data: Skin (2 of 2)

  • Texture
  • Thickness
  • Edema
  • Mobility and turgor
  • Vascularity or bruising
  • Lesions (Colour, Elevation, Pattern or shape, Size, Location and distribution on body, Exudate)
• ABCDE rule


  • A: asymmetry
  • B: border irregularity
  • C: colour variation
  • D: diameter
  • E: elevation and enlargement
• Braden Scale Risk Assessment Tool

  Categories: Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction and Shear
• Mobility

  Skin's ability to stretch or "rise" easily
• Turgor


  Skin's ability to return quickly back to place when released
• Pressure Ulcers


  • Appear on the skin over a bony prominence when circulation is impaired
  • Risk factors: impaired mobility, thin fragile skin of aging, decreased sensory perception, impaired level of consciousness, moisture from urine or stool incontinence, excessive perspiration or wound drainage, shearing injury, poor nutrition, and infection
• Physical Examination: Hair


  • Colour, texture, distribution, lesions
• Physical Examination: Nails


  • Colour, shape, contour, consistency
• Profile sign


  Measures the angle between the proximal nail fold and the curved nail plate
• Objective Data: Inspect & Palpate

  • Hair (Colour, Texture, Distribution, Lesions)
  • Nails (Shape and contour, Profile Sign, Consistency, Colour, Capillary refill)
• Risk factors for skin cancer

  • Prolonged exposure to UV rays
  • History of skin cancer
  • Under 18 years
  • Fair skinned
  • Have freckles or moles
  • Have a family history
  • Using medications that increase sensitivity to UV rays
• Tanning beds: Are they safe? What is the issue, or is there one?
• Health Promotion: Nail Hygiene

  • Keep nails short and trim often
  • Clean underside of nails with soap and water (or a nail brush)
  • Use clean nail grooming tools before use
  • Avoid biting or chewing nails
  • Avoid cutting cuticles, as they provide protection against infection
  • Never rip or bite a hangnail
  • Clip with a clean, sanitized nail trimmer