Integumentary System

Skin, Hair, Nails.

Review A & P

Layers of skinEpidermis

Dermis

Subcutaneous tissue

Glands of the skin

Hair

Nails

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.)

Anatomy of Nails

Image p 275

What are the major functions of the integumentary system?

1. *Prevents penetration: barrier

2. *Protection: physical, chemical and thermal

3. Regulation: temperature

4. Perception: sensory organ (pain, touch, pressure,

temperature)

Other functions

Identification

Communication

Wound repair

Absorption/excretion

Production of vitamin D

Functions of Hair

Provides ……..Warmth

Protection

Sensation

………to underlying structures

Functions of Nails

Provides ….Protection to distal surfaces

Can be used for self-protection

Subjective Data

Health history

(blue pages)

Integumentary System-Health History

any past skin problems and their management

skin colour changes

temperature changes

texture changes

sweating

any masses including warts or moles (nevi)

Integumentary System-Health History

changes in masses, warts, nevi – also, cosmetic concerns and physical discomfort

rashes or eruptions

changes in hair texture or oiliness, hair loss, dandruff, hair bleaching, dyeing

management of any problems with hair or scalp

medications

Integumentary System-Health History

complaints of tenderness, flakiness, itchiness, lumps, sores on scalp, bleeding

problems with nails including breaking, ingrown nails, paronyhia (hangnails), nail biting

Self-care behaviours

Describe how to assess the client’s integumentary system by inspection and palpation?

Inspection and Palpation

1.How will you prepare the environment?

2. How will you prepare the client?

3.How will you protect the client’s privacy?

*4. What equipment is needed?(Direct lighting, small ruler, penlight,

gloves)

Objective Data

What are the general characteristics of the skin that should always be noted?

Inspection and Palpation of the skin

Inspect Colour

General pigmentation: freckles, mole (nevus), birthmarks.

Widespread colour changes: pallor, erythema, cyanosis, jaundice.

Palpate Temperature

Should be warm & equal bilaterally

Hypothermia: immobilized extremity, cast, IV (normal)

Hyperthermia: fever, exercise, trauma, infection or sunburn.

Palpate Moisture

Normal perspiration

Diaphoresis

Dehydration in mucous membranes

Palpate Texture

Smooth and firm

Even texture

Palpate Thickness

Epidermis is thin over most of the body

Calluses over palms and soles

Palpate Edema

Not normally present

Scale from 1+ to 4+

Most evident on feet, ankles, and sacral areas

Note extent and location

Palpate Mobility and Turgor

Mobility is the skin’s ease of rising

Turgor is its ability to return to place promptly.

Pinch up on skin and let go (ant. Chest under clavicle)

Inspect Vascularity or Bruising

Cherry (senile) angiomas

Ecchymosis (bruising): consistent with traumas of life.

Tattoos: document location on chart.

Inspect Lesions

1. Colour2. Elevation3. Pattern or shape (p.250-251)4. Size in cm (avoid quarter or pea)5. Location and distribution on body-

e.g. generalized or localized6. Exudate, note colour and odor

(See OH for images on p 290 -293)

Danger Signs….ABCDE

Asymmetry of a pigmented lesion

Border irregularity

Colour variation

Diameter greater than 6 mm

Elevation and enlargement(any change)

How do you examine a lesion?

Palpate, wear gloves

Roll nodule between thumb and forefinger to assess depth

Does it blanche with pressure or when stretched?

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.252

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.253

Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.254

What are the criteria used in assessing the hair and scalp?

Inspection and Palpation of the hair and scalp

Inspect Colour

Pale blonde to total black

graying

Palpate Texture

Fine or thick

Straight, curly or kinky

shiny

Palpate Distribution

Fine hair coats the body

Coarse hair at the eyebrows, eyelashes and scalp

Puberty: hair to face (male), axillae and pubic region

Inspect Lesions

Clean and free from lesions

No nits or head lice

Seborrhea (dandruff) is normal

What criteria are used in assessing nails?

Inspection and Palpation of the nails

Inspect Shape and contour

Normally slightly curved or flat

Nail folds smooth and rounded

Nail edges are smooth, rounded and clean.

Normal nail angle- 160 degrees

Clubbing: occurs with long standing hypoxia - emphysema and chronic bronchitis

Inspect Consistency

Smooth and regular, not brittle or splitting

Thickness is uniform throughout nail

Nail firmly attached to nail bed

Inspect & Palpate Colour

Nail bed is pink

Brownish-black linear bands or streaks along the nail edge in dark-skinned individuals

White hairline linear markings usual as well.

Capillary refill: colour return is instant or within a few seconds. A sluggish return takes longer than 1 to 2 seconds.