05 Skin Assessment

7/27/2019 05 Skin Assessment

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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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Primary lesion new

Secondary lesion - changes in a primary

lesion

Fissures Scales

Crusts

Scars

Excoriations


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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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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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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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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.

Documents

05 Skin Assessment