05 skin assessment
TRANSCRIPT
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Skin
Assessment
Joy N. Bautista, RN, MPH, DRDM, MAN
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Health History: SKIN
Allergies?
Family history of skin cancer or other
significant diseases?
Fever or joint pain, weight loss? Recent insect bite?
Medications or herbal preparations?
Changes in the skin observed in the past
few years?
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Health History: SKIN
(For pediatric patients, ask parents)
Any birthmarks?
Experience of any change in skin -
cyanosis or jaundice? Rashes, burns, or bruises? Where and
when, and what was the cause?
Exposure to any contagious skin
conditions such as scabies, lice, orimpetigo or communicable diseases?
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Health History: HAIR
When?
Hair loss or gain? Sudden or gradual?
A few spots or all over body?
Related life events when problem started? Any medications or herbal preparations?
Itching, pain, discharge, fever, or weight
loss?
History of serious illness?
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Health History: NAILS
When?
Types of changes? Nail shape, color, orbrittleness?
Sudden or gradual?
Other signs or symptoms, such asbleeding, pain, itching, or discharge?
Normal condition or your nails?
History of serious illness?
History of nail problems? Bite nails?
Nail tips attached?
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Physical Exam: TOOLS
a clear ruler with centimeter and
millimeter markings
a tongue blade
a penlight or flashlight a magnifying glass
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Physical Exam: SKIN COLOR
Cyanosis - dull, bluish-dark color
Edema - decreased color
Erythema - palpate the area for warmth.
Jaundice - yellowish color Pallor - ashen color
Petechiae - tiny, purplish red dots in areas
that are light colored (abdomen)
Rashes - skin gesture changes Mongolian spots irregularly shaped
bluish discoloration in buttocks
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Mongolian spots
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Jaundice
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Pallor
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Cyanosis
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Erythema
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Physical Exam: SKIN TEXTURE
& TURGOR
Texture
Smooth and intact
Rough, dry skin -hypothyroidism, psoriasis,and excessive
keratinization
Turgor
Good
Poor - dehydration andedema cause poor skin
turgor
Edema
Overhydration
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Physical Exam: SKIN
MOISTURE
Relatively dry, with a minimal amount of
perspiration.
Skin-fold areas fairly dry.
Overly dry skin appears red flaky. Overly moist skin - anxiety, obesity, or an
environment thats too warm.
Heavy sweating, or diaphoresis - fever,
strenuous activity; cardiac, pulmonary, andother diseases; and any activity or illness that
elevates metabolic rate.
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Physical Exam: SKIN
TEMPERATURE
Palpate the skin bilaterally for temperature
Warm skin suggests normal calculation
Localized warmth local areas that areinfected, inflamed, or burned
Generalized warmth - fever or systemicdiseases such as hyperthyroidism
Cool skin
Localized - vasoconstriction associated
with cold environment or impaired arterialcirculation to a limb
Generalized - shock or hypothyroidism
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Physical Exam: SKIN LESIONS
Red lesions - caused by vascular changes Telangiectases - permanently dilated, small blood vessels
that typically form a weblike pattern
Purpura - caused by red blood cells and blood pigments inthe skin; dont blanch under pressure
Petechiae - red or brown lesions generally caused by
capillary fragility; d/t endocarditis, thrombocytopenia Ecchymoses - bluish or purplish discolorations d/t blood
accumulation in the skin after injury to the vessel wall
Hematomas - masses of blood that accumulates in atissue, organ, or body space after a break in a bloodvessel
Normal variations Birthmarks - generally flat and range in color from tan to red
or brown
Freckles - small, flat red-brown to brown macules locatedprimarily on the face, arms, and back
Nevi - either flat or raised, pink, tan, or dark brown
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Physical Exam: SKIN LESIONS
Primary lesion new
Secondary lesion - changes in a primary
lesion
Fissures Scales
Crusts
Scars
Excoriations
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Physical Exam: SKIN LESIONS
Macule
Flat, circumscribed area of altered skincolor
Generally less than 3/8 (1 cm)
Example = freckle, flat nevus
Papule Raised, circumscribed, solid area
Generally less than 3/8
Examples: elevated nevus, wart
Vesicle
Circumscribed, elevated lesion Contains serous fluid
Less than 3/8
Example: early chickenpox.
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Macule
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Papule
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Vesicle
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Cafe-au-lait
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Spider nevi
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Telangiectasis
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Hematoma
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Physical Exam: SKIN LESIONS
Solid - macules, papules, nodules, wheals, andhives
Fluid-filled - vesicles, bullae, pustules, and cysts
Macule vs papule
Reduce direct lighting and shine a penlight orflashlight at a right angle to lesion
If the light casts a shadow, the lesion is apapule
Solid vs fluid-filled
Place the tip of a flashlight or penlight againstthe side of the lesion
Fluid-filled lesions transilluminate with a redglow
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Physical Exam: SKIN LESIONS
Characteristics, pattern, location, and
distribution
Changes in size- increase in the size or
elevation
Take note of moles the rapidly change size,
especially moles that are 6 mm or larger
Note drainage, document the type, color,
and amount
Note if the lesion has a foul odor, which can
indicate a superimposed infection.
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Physical Exam: SKIN LESIONS
Confluent Discrete Grouped Linear
Annular Arciform Polycyclic Reticular
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Physical Exam: HAIR
Inspect and palpate the hair over the patients
entire body, not just on his head.
Note the distribution, quantity, texture, and color.
Check for patterns of hair loss and growth.
Examine the scalp for erythema, scaling, andencrustation
Note areas of excessive hair growth
Note the texture of scalp hair
Shiny and smooth Dry or brittle
Extreme oiliness
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Physical Exam: NAILS
Assess color of the nails Pinkish - Light-skinned people
Brownish - Dark-skinned people
Yellow nails - Smokers because of nicotine stains
Assess nail beds to estimate patients peripheral circulation
Normal capillary refill time (CRT) < 2 secs Inspect the shape and contour of the nails
The surface of the nail bed should be either slightlycurved or flat
The edges of the nail should be smooth, rounded, andclean
The angle of the nail base is normally less than 180degrees
Palpate the nail bed to check the thickness of the nailand the strength of its attachment to the bed.