Denise Coffey MSN, RN

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Structure and FunctionSubjective Data—Health History

QuestionsObjective Data—The Physical ExamAbnormal Findings

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Epidermal appendages1. Hair2. Sebaceous glands3. Sweat glands

Eccrine glands Apocrine glands

4. Nails

Skin—three layers1. Epidermis

Stratum germinativum or basal cell layer

Stratum corneum or horny cell layer

Derivation of skin color

2. Dermis Connective tissue or

collagen Elastic tissue

3. Subcutaneous layer

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Protection Prevents penetration Perception Temperature regulation Identification Communication Wound repair Absorption and excretion Production of vitamin D

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Previous history of skin disease (allergies, hives, psoriasis, or eczema)

Change in moleChange in pigmentation (size or

color)Excessive dryness or moisturePruritusExcessive bruising

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Preparation External variables that influence skin

color Equipment needed

Strong direct lighting Small centimeter ruler Penlight Gloves For special procedures▪ Magnifying glass▪ Materials for laboratory tests: glass slide

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Skin—Inspect and palpateColor

General pigmentation Widespread color change▪ Pallor▪ Erythema▪ Cyanosis▪ Jaundice

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Skin—Inspect and palpate (cont.)Temperature

Hypothermia Hyperthermia

Moisture Diaphoresis Dehydration

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Skin—Inspect and palpate (cont.)TextureThicknessEdemaMobility and turgorVascularity or bruising

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Skin—Inspect and palpate (cont.)Lesions

Color Elevation Pattern or shape Size Location and distribution on body Exudate

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Promoting health and self-careTeach skin self-examination, using

the ABCDE rule A—asymmetry B—border C—color D—diameter E—elevation and enlargement

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Hemangiomas Port-wine stain

(nevus flammeus)

Strawberry mark (immature hemangioma)

Cavernous hemangioma (mature)

Telangiectases Spider or star angioma

Venous lake

Purpuric lesions Petechiae

Purpura Lesions caused by

trauma or abuse Pattern injury

Hematoma

Ecchymosis (bruise)

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Diaper dermatitis Interigo (candidiasis) ImpetigoAtopic dermatitis (eczema)Measles (rubeola)German measles (rubella)Chickenpox (varicella)

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Primary contact dermatitis Allergic drug reaction Tinea corporis (ringworm of the body) Tinea pedis (ringworm of the foot) Psoriasis Tinea versicolor Labial herpes simplex (cold sores) Herpes zoster (shingles) Erythema migrans of Lyme disease

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Basal cell carcinomaSquamous cell carcinomaMalignant melanoma

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A. CyanosisB. FlushingC. RuborD. Jaundice