Overview
This lecture covers the basics of integumentary assessment, focusing on how to examine the skin, hair, and nails through observation and palpation, including recognizing normal and abnormal findings.
Components of Integumentary Assessment
- Assess the skin, hair, and nails by observation and palpation per textbook guidelines (p. 523-531).
- Main assessment traits: color, moisture, temperature, texture, turgor, vascularity, edema, and lesions.
Skin Assessment Details
- Skin color changes can indicate conditions: cyanosis (bluish, low oxygen), erythema (redness), jaundice (yellow, liver issues), and pallor (pale, low oxygen).
- Assessment can be challenging in darker skin; check mucosa, sclera, palms, and soles for changes.
- Assess moisture: normal skin is relatively dry with minimal perspiration; look for dryness or cracking.
- Assess temperature bilaterally using the back of the fingers; normal skin is warm.
- Cool, clammy skin may indicate hypothermia or poor circulation; warmth and redness may indicate infection.
- Texture should be smooth; note roughness or irregularities.
- Test turgor (elasticity) for hydration by pinching skin; tenting suggests dehydration.
Edema and Lesion Recognition
- Edema (swelling) can be unilateral or bilateral; assess for pitting by pressing for indentation.
- Grade pitting edema from 1+ (2 mm) to 4+ (8 mm).
- Assess lesions for color, location, size, shape, texture, distribution, and exudate.
- Recognize lesion types: macules, papules, plaques, nodules/tumors, pustules, and secondary lesions (atrophy, erosion, scales, crusts, keloids, fissures).
Hair and Nail Assessment
- Hair should be evenly distributed, silky/resilient, and not coarse or dry.
- Nails: nail beds should be pink (depending on ethnicity); cuticles intact, not cracked or bleeding.
- Check the angle between nail and nail bed (normal: 160°); clubbing (>180°) suggests chronic oxygen deficiency.
- Capillary refill should be <3 seconds when the nail bed is pressed and released.
Key Terms & Definitions
- Cyanosis — bluish skin discoloration due to low oxygen.
- Erythema — redness of the skin.
- Jaundice — yellow discoloration from liver issues.
- Pallor — pale skin due to decreased oxygenation.
- Turgor — skin’s elasticity, used to assess hydration.
- Edema — swelling caused by fluid accumulation.
- Pitting Edema — indentation remains when skin is pressed.
- Clubbing — increased angle of nail bed, indicating long-term oxygen deprivation.
Action Items / Next Steps
- Read textbook pages 523–531 covering skin, hair, and nail assessment.
- Review lesion types and grading of edema in textbook tables and figures.
- Bring any questions to the first lab session for practice and discussion.