Weber

Health Assessment in Nursing

Chapter 13: Skin, Hair, and

Nails

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Structure and Function of Skin

The skin is a physical barrier that protects the

underlying tissues and structures from
microorganisms, physical trauma, ultraviolet
radiation, and dehydration.
Vital role in temperature maintenance, fluid and
electrolyte balance, absorption, excretion, sensation,
immunity, and vitamin D synthesis.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Skin, Hair and Nails

Skin- epidermis, dermis, subcutaneous

layers
Hair- vellus, terminal
Nails- hard, transparent plates of
keratinized epidermal cells

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Structure of Skin and Hair

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Skin Cancer

Most common of cancers

Three types: melanoma, basal cell
carcinoma, squamous cell carcinoma
Asians are less susceptible

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk Factors of Skin Cancer
Sun exposure
Nonsolar sources of ultraviolet radiation
Medical therapies
Family history and genetic susceptibility
Moles
Pigmentation irregularities
Fair skin that burns and freckles easily; light hair
Age

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk Factors of Skin Cancer (Contd)
Male gender
Chemical exposure
Human papillomavirus
Long-term skin inflammation or injury
Alcohol intake; smoking
Inadequate niacin in diet

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk Reduction in Skin Cancer
Reduce skin exposure
Always use sunscreen when sun exposure is anticipated
Wear long-sleeve shirts and wide-brimmed hats
Avoid sunburns
Understand the link between sun exposure and skin
cancer and the accumulating effects of sun exposure on
developing cancers
Have annual skin cancer screenings

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk Reduction in Skin Cancer
Ensure diet is adequate in vitamin B 3
Examine the skin for suspected lesions
Use the ABCDE mnemonic to assess suspicious lesions:
Asymmetry
Border
Color
Diameter
Elevation

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cultural Variations in Skin Cancer

Lowest rates: Asians

Highest rates: white Australians
Most susceptible are people with pale
white, freckled skin and red hair

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Current Symptoms
Skin problems
Changes in lesion appearance
Feeling changes (pain, pressure, itch, tingling)
Hair loss or changes
Nail changes
Body odor problems

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

History
Past History
Previous problems with skin, hair, nails
Allergic reactions
Family history of skin problems or skin cancer
Lifestyle and health practices
Exposure to sun or chemicals
Daily care of skin, hairs, nails
Usual diet and exercise patterns

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Client Preparation

Ask the client to remove all clothing

and jewelry
Have the client sit comfortably
Ensure privacy
Maintain comfortable room
temperature

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Equipment

Gloves
Examination light and penlight
Magnifying glass
Centimeter ruler
Woods light
Examination gown or drape

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Skin Assessment: Inspection

Note any distinctive odor

Generalized color variations
Skin breakdown
Primary, secondary, or vascular lesions

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Skin Assessment: Palpation

Lesions
Texture
Temperature and moisture
Thickness of skin
Mobility and turgor
Edema

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Skin Assessment: Inspection

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pressure Ulcer Risk Factors

Perception
Mobility
Moisture
Nutrition
Friction or shear against surfaces
Tissue tolerance decreased

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Scalp and Hair

Inspection and palpation

General color and condition,
cleanliness, dryness or oiliness,
parasites, and lesions
Amount and distribution of scalp,
body, axillae, and pubic hair

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nail Assessment

Nails
Inspection: Nail grooming and
cleanliness, nail color and markings,
shape of nails,
Palpation: Texture, assess texture
and consistency, capillary refill

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Differences in Hair Color

Black American descent often have

very dry scalps and dry, fragile hair

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Changes Aging

Skin
Pale
Skin lesions
Dry
Loses turgor
Hair: Thinner
Nails: Thickened, yellow, brittle

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins