HEALTH ASSESSMENT

ASSESSING SKIN, HAIR, AND NAILS

PROF. EDNA ROBLES

INTEGUMENTARY SYSTEM FIVE (5) LAYERS OF EPIDERMIS:

 Outermost System
 This is made up of the skin the covers and protects all the body #5: STRATUM BASALE [“BASAL LAYER”]
parts, as well as its derivatives, like certain glands, as well as hair  The deepest layer, the one attached to the dermis, meaning
and nails. “Basal Layer”
 Single row of (cells) keratinocytes.
STRUCTURES AND FUNCTIONS:  These are rapidly dividing all the time, pushing new cells up into
the layers above, to help regenerate dead skin, and producing
lots of keratins as they do so.
PART 1: THE SKIN  This is necessary because millions of dead keratinocytes rub off
your skin every day, due to friction, and even more from your
 Is a remarkable organ, acting as the first line of defense from the hands and feet, so these constantly dividing cells; in the stratum
Basale ensure that a new epidermis forms every few weeks, so
elements that surround us
that we always have our skin intact.
 It keeps bacteria out, and water and heat in.
 This layer also contains melanocytes, which produce
melanin, and tactile cells, which acts as the sensory receptor
 Is the heaviest and biggest single organ of the body.
for touch.
 Its major function is to keep the body in homeostasis.
 The skin provides boundaries for body fluid; while protecting the
#4 STRATUM SPINOSUM [“PRICKLY LAYER”]
underlying tissues from microorganisms: harmful substances. And
radiation.  Meaning “pricky layer”.
 It also modulates body temperature and synthesizes vitamin d.  This section is several layers of cells thick and is full of cells
 (CONT.) It is influenced not only by pigments but also by the with a weblike system of intermediate filaments attached to
scattering of light as it is reflected back through the turbid desmosomes.
superficial layers of the skin or lessens walls.
 Our skin is made of two regions: a thin outer layer which is the PRICKLY  Sometimes called; because they look kind of
CELLS spiky.
epidermis, and a thicker layer, called the dermis.
DENDRITIC  which ingest foreign substances and active the
REGIONS OF SKIN: CELLS immune system

EPIDERMIS
#STRATUM GRANULOSUM [“GRANULAR LAYER”]
 This is 4 to 6 cell layers thick; keratinization begins here as
IMPORTANT INFO
cells continue to move their way upwards from the basal layer.
Is made of epithelial tissue, is avascular, so it gets nutrients by  This is when the cells get far enough from the dermal capillaries
diffusion through the tissue fluid from the dermis. below to receive sufficient nutrients, so the cells fill up with
keratin as they die, and they flatten while the organelles
 This is made of keratinized stratified squamous epithelium, made of disintegrate (flatten and harden).
four different cell types in five layers.  This makes the cell tougher and scalier, which allows for the
outer layers to better protect the body.
 The superficial layers; is thin and has no blood vessels on it.
 It is divided into two layers #2 STRATUM LUCIDUM [“CLEAR LAYER”]
o Horny layer  This is two of three cell layers thick, made of dead keratinocytes
 Dead keratinized cells; outer that have become flat and clear.
o Outer Layer  This is where they begin to aggregate into arrays called
 Inner; melanin and keratin are formed. tonofilaments
 For its nutrition, it depends on the underlying dermis.
CHAPTER 8: ASSESSING SKIN, HAIR, AND NAILS

 It contains connective tissue:

#1 STRATUM CORNEUM [“HORNY LAYER”]  Sebaceous gland
 This outermost section is twenty to thirty cell layers thick, and  Sweat gland
all of these cells are enucleated, meaning the nucleus has  Hair follicle
disintegrated.  The dermis merges below with subcutaneous tissue of adipose
 All the cells covering the outside of the body are actually dead, or fat.
but they are dead in a specialized way, with thick plasma
membranes surrounding lots of keratins.
 These dead cells protect all the living ones inside from all the SWEAT GLANDS
outside dangers.  Either eccrine or apocrine

ECCRINE  Widely distributed

 Open directly to the skin surface
DERMIS  Help control body temperature through sweat
production.
IMPORTANT INFO
is a tough layer of fibrous connective tissue, is vascularized, getting APROCRINE  Chiefly in axillary and genital areas.
 Usually open into hair follicles.
its nutrients from the bloodstream.
 Stimulated by emotional stress.

 This is made of strong and flexible connective tissue and is full of

nerves and blood vessels.
 This is where hair follicles begin HYPOEDERMIS
 The dermis has two sections, the papillary layer, and the reticular  A subcutaneous layer below the dermis. It is made of predominately
layer. of adipose tissue, and it anchors the skin to the structures below.

PAPILARRY LAYER [1ST SECTION]

 Descending from the epidermis, which is very thin, made of areolar PART 1: THE SKIN (CONT.)
connective tissue with a network of collagen and elastic fibers.
MELANOCYTES
 This leave room for defensive cells to patrol the area of bacteria
 Contained by Stratum Basale, which produce melanin.
that may have made it through the skin.
 This is a pigment molecule, and this is one of the components of
1 DERMAL PAPILLAE the skin that determines its color and protects the skin from
 The word papillary, refers to the projections from the surface ultraviolet radiation.
of this layer, that stick out into the epidermis above.
 These contains lots of tactile as described previously.
NORMAL SKIN
2 DERMAL RIDGES COLOR: FOUR PIGMENTS
 Mounds where papillae sit on, in areas where there is a lot MELANIN  Brownish pigment
of friction like the hands.  Genetically determined
 which cause ridges in the epidermis as well, which are meant  Increased by sunlight
to enhance the gripping ability of the fingers, and they are
visible as the line on our fingertips that make our unique CARTONE  Golden yellow pigment.
fingerprints.  Can be found in subcutaneous tissue and heavily
keratinized areas such as palms, and sole.

RETICULAR LAYER [2ND SECTION] HEMOGLOBIN  Present in RCB

 Which is most of the dermis and it is made of dense fibrous  Carries most of the oxygen of the blood
connective tissue that is arranged irregularly.  Red when oxygenated
 A network of blood vessels sits below this, just before the hypodermis.
OXYHEMOGLOBIN
 Which is well supplied with blood.

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 Bright red pigment in arteries and proximal FRECKLES  Are flat macules of pigment that appear following
capillaries. sun exposure, especially in white skinned people.
DEOXYHEMOGLOBIN
 Darker and bluer pigment in distal capillaries VITILIGO  Pigmentation of the skin; due to the distraction of
and veins the melanocytes.
 Losing the oxygen (cyanosis)  An autoimmune disease, wherein the system is
attacking melanocytes that cause pamumuti to the
patient that have vitiligo.

STRIAE  Stretchmarks. Usually found in the lower abdomen,

thigh, buttocks, axilla, in obese patients.
SKIN VARIATION
PALE  Anemia: LINEA  Also called, “Pregnancy Line”.
 Due to decreased hemoglobin, hemotocrene, NIGRA  A dark line that develops across the belly.
and RBC.  During pregnancy, but prior to pregnancy it is
 You need to check the Conjunctiva of the already noticeable because of its light color.
patient.
 Decreased amount of Melanin; it will also make the BUTTERFLY  Also called, “Mollar Rash”
patient look pale because of the white skin of the RASH  It is characterized by arrhythmia to rash, flat or
patient. raised across the breached of the nose and cheeks.
 If the conjunctiva is pinkish; the patient is not  Present in patient who have Systemic Lupus
anemic. Erythematosus

JAUNDICED  It is the yellowing of skin tones, particularly on the MONGOLIAN  Frequently pigmentation in newborns.
sclera on the mucosa, palms and soles of the patient. SPOT  Can be present at birth or can be developed in the
 Present in patients that have liver diseases, there will first few weeks of life.
be impairment of the flow of the bile.  They are flat, blue; gray in color, sometimes green;
blue.
CYANOTIC  If the patient has a white skinned: blueish, while the  Most common size: sacral area, gluteal region, and
patient that has dark skinned: blue & brown. shoulders.
 Due to cyanotic diseases; wherein there is a mixture
of oxygenated and non-oxygenated blood circulating CUTAENEOUS  Are skin tags that are small growths of tissue on the
in the body. TAG skin surface.
 Due to respiratory diseases  They are benign and painless.
 They can be found anywhere in the body, but usually
CENTRAL CYANOSIS located on the neck, armpits, trunks, face, and body
 Best identified in the lips, oral mucosa, and forms.
tongue.  More common: on people who are obese and diabetic.
 The lip can also turn blue in the cold and melanin
in the lips may stimulate cyanosis in darker CUTANEOUS  Is a hard chronicle projection on the skin made up
skinned people. HORN of compact keratin.
 They may arise from benign cancerous, or cancerous
PERIPHERAL CYANOSIS skin lesions.
 Caused by anxiety and a cold examination room.
CHERRY  Bright Red or Purple spots in the skin.
ANGIOMAS  It is made up of blood vessels.
 They often appear in the torso, but they can develop
in any part of the body.
ACANTHOSIS  This a gravity darkening in the body folds increases,
NIGRICANS especially in the neck, groin, and axilla part.
SEBORRHEIC  Brown, Black, or Light tanning color.
 Obese. It typically presents in people who are obese
KERATOSIS  Lesions: waxy, scaly. It is less and non-contagious.
and diabetic patients with insulin resistance.

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CHAPTER 8: ASSESSING SKIN, HAIR, AND NAILS

SCAR  Red or Purple: it is a low scar, and it is still RAISED

experiencing lining. PLAQUE >10mm
 White: Old Scar PAPULE <10mm
 Keloid or Hypertrophic Scar is a thick based scar as
a result of overgrowth tissue.

MOLE  Nevus, it is flat or raised; tan or brown, and usually

less than 6mm diameter and can develop anywhere CONSTITUENCY
in the body. LIQUID FILLED
BULLA >10mm
VESICLE <10mm
LESIONS: SKIN CANCER
BASAL CELL CARCINOMA  Beginning of the cancer, it begins in the
basal cells of the skin. PUS FILLED
 Fast to replicate cells. PUSTULE Pus inside the lesion.

SQUAMOUS CELL  Topmost layer of the epidermis

CARCINOMA SOLID
MELANOMA  Serious type of cancer. NODULE 0.5 to 2 cm
 It develops in the cells that produce TUMOR >1 to 2 cm
melanin; MELANOCYTES

ENCAPSULATED
“ABCDE” METHOD CYST
A ASYMMETRY  Are sack packets of membranous tissue
 Dividing the lesion with imaginary line that contains fluid, most benign and
not cancerous.
B BORDERS
 Irregular; not rounded BENIGN
 Kapag ang lesion ay gumagalaw.
C COLOR VARIATION:
 (Blue & Black mixed with White & Red) CANCEROUS
o Benign: One Color  Encapsulated at hindi gumagalaw.
o Suspicious for Skin Cancer: Multi Color

D DIAMETER:
 (Greater than 6mm)
 Normal Lesion: Less than wamport inch

E EVOLUTION:
SKIN BLEEDING; FLAT AND RAISED
 (Changes in the symptoms & Morphology)
PETECHIAE
 Non palpable; < 3mm
TYPES OF SKIN LESIONS
 Tiny, round, red or purple macules, that is secondary in blood
1. PRIMARY MORPHOLOGY
extravagation, and associated with bleeding tending emboli into the
 Present on the onset of the disease. skin.
 Initial lesions that are not altered by trauma or manipulation like
rubbing or scratching.
PURPURA
 This is not altered by the complication of infection
 Larger areas, may be palpable
 3 to 10mm
FLAT PATCH >10mm
MACULE <10mm ECCHYMOSIS

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 Non palpable; > 10 mm STAGING OF PRESSURE ULCER:

 Round, regular lesion, color varies and changes (black, yellow, green.) CONFIGURATION (SHAPE)
 Associated with chroma and bleeding tendencies. ANNULAR (ROUND)  Content here
 They are “NON BLANCHABLE”, meaning even when you put pressure LINEAR (LINE)  Content here
on it, it will ot turn white. NUMMULAR (COIN  Content here
SHAPED)
HEMATOMA CLUSTERED  Content here
 Localized collection of blood creating an elevated erythematosus. DISCRETE  Content here
 It is associated in Trauma CONFLUENT 

CHERRY ANGIOMA PART 2: THE HAIR (SKIN APPENDAGES)

 Popular and Ground Rash.  Hair in the heads; hair all over the body, including eyelashes and
 May red or purple lesion nose hairs, and these all have specific protective functions.
 May be blanched in pressure.
 It is made up exactly: a hair is flexible strand made largely of
 It is normal skin related alteration; it is usually not clinically
significant. dead, keratinized cells. This is hard keratin, which is a bit different
 Can be seen in elderly. from the soft keratin found in cells of the epidermis, which makes
them more durable and not as flaky.
SPIER ANGIOMA  Hairs are produced by hair follicles.
 Red arterial lesion with a center body radiating blanches.
 Face, neck, trunk STRUCTURES OF THE HAIR: (PARTS)
 It is rare to be found below the waist
 Associated with Liver Disease, Pregnancy, and Vitamin D deficiency. 1. HAIR FOLLICLE

ROOT  A part deep inside the follicle where keratinization is

TYPES OF LESION happening
2. SECONDARY MORPHOLOGY
 Developed by trauma and manipulation. (laging kinakamot) SHAFT  The part closer to the surface of the skin and then
 Complication in the initial lesion. extending outside the body, where keratinization is
 Resulted in changes over time, by the disease progression. complete.

EROSION  Loss of superficial epidermis that does not extend in

the dermis.  The hair itself consists of three layers of cells.
FISSURE  Linear crack in the skin that might extend in the
dermis. MEDULLA  Is the innermost, containing large cells and soft
 Painful keratin.

ULCER  Skin loss extends past the dermis, necrotic tissue CORTEX  Are several layers of flattened cells.
loss. CUTICLE  which is a single layer of overlapping cells, the most
keratinized cells in the hair.
SCAR  Marks left after a wound healed.
 Replacement of the connective tissue in the injured
area.  In general, a hair follicle is a pocket that folds down from the
surface of the epidermis down into the dermis, about four millimeters
below the surface.
TYPES OF LESIONS  Each follicle has an arrector pili. This is a small bundle of muscle
3. VASCULAR SKIN LESIONS cells that can contract and pull the follicle in such a way that the
 Result of numerous or large blood vessels that form directly under surface of the skin dimples out, producing what we refer to as
the skin. goosebumps when cold or afraid.

2. HAIR BULB
 Formed by the deep end then expands slightly.

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 A bundle of nerve ending attach to the bulb and act as a receptor, HAIR LOSS  Content here
responding to any bending of the hair and alerting the brain in HIRSUTISM  Condition in women wherein excessive hair
case an insect is there, or something of the like. growth in the face, chest, back with a male
pattern due to the increase of androgen
3. HAIR PAPILLA
 A little bit of dermal tissue called a hair papilla protrudes into the bulb,
which supplies signals and nutrients to the hair so it can grow. PART 3: THE NAIL (SKIN APPENDAGES)
 The wall of each follicle has a few layers.  Nails found on our fingers and toes are also part of the
integumentary system.
LAYERS OF THE WALL OF HAIR FOLLICLE
 These are products of a modification of the epidermis.
PERIPHERAL CONNECTIVE TISSUE  Outermost; derived from
SHEATH the dermis.  Nails contains hard keratin, making them great tools of
scratching or picking up objects.
GLASSY MEMBRANE  Derived from the Basal
lamina. PARTS OF THE NAIL:
FREE EDGE  The very tip.
EPITHELIAL ROOT SHEATH  Innermost; derived from LANULA  Note the whitish moon.
the epidermis. NAIL BODY  Most of what we see.
 The last section has an PROXIMAL ROOT  Embedded in the skin.
external part and an NAIL PLATE  The firm, rectangular and usually curving;
internal part, which this as gets its pink color from the vascular “nail
it approaches the bulb. bed”.

NAIL BED  The part of the epidermis in the nails sits

4. HAIR MATRIX on; it grows out of the nail matrix.
 The cells that actively divide are found in the hair matrix, which
push existing cells upwards as they divide, causing the hair to grow. NAIL MATRIX  Which pushes the nail outwards across the
nail bed as these cells divide.

 Our body hair is pretty sparse, so this no longer serves much purpose, NAIL FOLDS  There are also skin folds overlapping the
but for much furrier mammals it is an important defense mechanism borders of the nail.
for trapping heat and intimidating enemies.  sitting on the lateral ad proximal borders,
and the latter extends onto the nail as the
HAIR TYPES: EPONYCHIUM.
VELLUS HAIR  Which is pale and fine.  Covers roughly 14 of the nail plate: “Nail
 Short, fine, inconspicuous, and relatively
Root”
unpigmented
HYPONYCHIUM  Edge of the finger; where the dirt tents to
TERMINAL HAIR  Which is darker and coarser, like hair of collect.
the eyebrows and scalp.
 Coarser, thicker, not conspicuous, and CUTICLE  Extends from the proximal nail fold and
usually pigmented functions as the seal protects the space
 Ex. scalp hair and eyebrows. between the fold and the plate from
external moisture.

LATERAL NAIL FOLD  Cover the sides of the nail plate.

SCALP AND HAIR DISORDERS  Note that the angle between the proximal
SCALINESS  Content here nail fold and the nail plate is normally
PUSTULES WITH HAIR  Content here less than 180 degrees in conditions.
LOSS  CHRONIC HYPOXIA
PATCHY GRAY HAIR  Content here  Possible detection of clubbing of nails, in
PATCHY HAIR LOSS  Content here which case the nail plate may become

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CHAPTER 8: ASSESSING SKIN, HAIR, AND NAILS

more convex with the angle increasing to 1 Reduction in body water loss
greater than 180 degrees 2 Acts as a barrier that prevents microorganisms and other foreign
substances from entering the body.

PART 4: THE GLANDS (SKIN APPENDAGES) 3 Protects underlying structures against abrasion.
 Vast collection of glands that can be found. 4 Melanin absorbs ultraviolet light and protects underlying structures
from tis damaging effects.
SWEAT GLANDS OR SUDORIFEROUS GLANDS 5 Hair protection
 These are found almost everywhere on the surface of the skin,  The hair on the head acts as a heat insulator, eyebrows
totaling up to around three million. keep sweat out of the eyes, eyelashes protect the eyes
from foreign objects, and hair in the nose and ears
prevents the entry of dust and other materials.
2 TYPES OF SWEAT GLANDS:
1. ECCRINE OR MEROCRINE SWEAT GLANDS. 6 The nails protect the ends of the fingers and toes from damage and
 Most of them are of this type, and it consist of a coiled tube. can be used in defense.
 Secretion occurs in the dermis, and the resulting fluid, or sweat,
travels through the tube towards a tunnel shaped opening called a SENSORY RECEPTOR
“pore”.  Many sensory receptors are associated with the skin.
 Sweat is 99% water, but it contains some salts and metabolic wastes.
 Receptors in the epidermis and dermis can detect pain, heat, cold,
It is also secreted by apocrine sweat glands, which are far fewer,
found only in certain areas, and secrete fat and protein components and pressure.
along with the normal mixture, which is the cause of body odor.  Although hair does not have a nerve supply, sensory receptors
around the hair follicle can detect the movement of a hair.
TYPES OF APOCRINE GLANDS:
CERUMINOUS GLANDS  Produce earwax. VITAMIN D PRODUCTION
MAMMARY GLANDS  Produce breast mlik.  C UV light causes the skin to produce a precursor molecule of
vitamin D.
 The precursor molecule is carried by the blood to the liver where
2. SEBACEOUS GLANDS OR OIL GLANDS
it is enzymatically converted.
 These are branched alveolar glands that secrete sebum, which is
made of oily lipids.  The enzymatically converted molecule is carried by the blood to
 This will soften and lubricate hair and skin, slowing water loss and the kidneys where it is converted again to the active form of
killing certain bacteria. vitamin D.
 Vitamin D stimulates the small intestine to absorb calcium and
phosphate for many bodies functions.
NOTE: ADDITIONAL NOTES! <3
TEMPERATURE REGULATION
NAIL DISORDERS:
 Regulation of body temperature is important because the rate of
LONGITUDINAL  Content here
RIDGING chemical reactions within the body can be increased or decreased
HALF AND HALF  Content here by changes in body temperature.
NAILS  Even slight changes in temperature can make enzymes operate less
PITTING  Content here efficiently and disrupt the normal rates of chemical in the body
KOILONYCHIA  Content here  Exercise, fever, and an increase in environmental temperature tend
YELLOW NAIL  Content here to raise body temperature.
SYNDROME  In order to maintain homeostasis, the body must rid itself of excess
CLUBBING 
heat.
PARONYCHIA 
 Blood vessels in the dermis dilate and enable more blood to flow
ANAPHY OF INTEG (FROM 1ST SEMESTER) within the skin, thus causing heat to dissipate from the body.
 Sweat also assists in loss of heat through evaporating cooling.
INTEGUMENTARY SYSTEM PROTECTION (FUNCTION)

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 If body temperature begins to drop below normal, heat can be 2ND DEGREE BURN
conserved by the constriction of dermal blood vessels, which reduces  A Second-degree (partial thickness) burns damage both the
blood flow to the skin. epidermis and the dermis.
 Less heat is transferred from deeper structures to the skin, and  If dermal damage is minimal, symptoms include redness, pain,
heat loss is reduced. edema, and blisters.
 With smaller amounts of warm blood flowing through the skin,  Healing takes about 2 weeks, and no scarring results.
the skin temperature decreases.  If the burn goes deep into the dermis, the wound appears red,
tan, or white; can take several months to heal and might scar.
EXCRETION
 The integumentary system plays a minor role in excretion, the 3RD DEGREE BURN
removal of waste products from the body.  Third-degree (full thickness) burns damage the complete epidermis
 In addition to water and salts, sweat contains small amounts of and dermis.
waste products, such as urea, uric acid, and ammonia.  The region of third-degree burn is usually painless because sensory
 Even though the body can lose large amounts o sweat, the sweat receptors in the epidermis and dermis have been destroyed.
glands do not play a significant role in the excretion of waste  Third-degree burns appear white, tan, brown, black, or deep cheery
products. red.

DIAGNOSTIC AID BURN HEALING

 The integumentary system is useful in diagnosis because it is observed  In all second-degree burns, the epidermis, including the stratum
easily. basale where the stem cells are found is damaged.
 Rashes and lesions in the skin can be symptoms of problems  The epidermis regenerates from epithelial tissue in hair follicles and
elsewhere in the body. sweat glands, as well as from the edges of the wound.
 Deep partial thickness and full-thickness burns take a long time to
CYANOSIS  A bluish color to the skin caused by decreased blood heal, and they form scar tissue with disfiguring and debilitating
O2 content, is an indication of impaired circulatory wound contractures.
or respiratory function.
TREATMENT OF BURNS
JAUNDICE  A yellowish skin colors
 Can occur when the liver is damaged by a disease,  To prevent complications of deep partial thickness and full thickness
such as viral hepatitis. burns and to speed healing, skin grafts are often performed.
 When it is not possible or practical to move skin from on part of
the body to a burn site, physicians sometimes use artificial skin or
grafts from human cadavers.
BURNS
 A burn is injury to a tissue caused by heat, cold, friction, chemicals,
SPLIT SKIN GRAFT  The epidermis and parts of the dermis are
electricity, or radiation.
removed from another part of the body and
 Bruns are classified according to their depth.
placed over the burn.
PARTIAL THICKNESS BURNS  Are classified as first degree and
second degree.
SKIN CANCER
FULL THICKNESS  A third-degree burn.
 Most common cancer
1ST DEGREE BURN  Mainly caused by UV light exposure
 A first degree (superficial) burn involves only the epidermis and is
red and painful.  Fair-skinned people more prone
 Slight edema, or swelling may be present  Prevented by limiting sun exposure and using sunscreens
 They can be caused by sunburn or brief exposure to very hot or
very cold objects, and they heal without scarring in about a week.  UVA rays cause tan and is associated with malignant melanomas

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 UVB rays cause sunburns 6 Medication of the Patient

 Sunscreens should block UVA and UVB rays

HISTORY OF PRESENT HEALTH CONCERN
TYPES OF SKIN CANCER [HAIR & NAILS]
BASAL CELL CARCINOMA  Cells in stratum basale affected.
 Cancer removed by surgery. 1 Changes in condition of hair and hair loss.
 Halophyxia: nakakalbo ba ang patient.
SQUAMOUS CELL CARCINOMA  Cells above stratum basale  Patchy hair loss
affected.  Thinning of hair
 Can cause death.  Ex. Anemic Patient

MALIGNANT MELANOMA  Arises from melanocytes in a

2 Changes in the condition and appearance of nails.
mole
 Rare type
 Can cause death
PERSONAL HEALTH HISTORY
1 Sunburn; can cause skin cancer.
AGING AND THE INTEGUMENT
2 Previous problems on skin, hair, and nails.
 Blood flow decreases and skin becomes thinner due to decreased
amounts of collagen 3 Hospitalizations and Surgeries
May acquire hospital infection MRSA.
 Decreased activity of sebaceous and sweat glands make temperature 4 Allergic Reaction
regulation more difficult. 5 Viral or Bacterial Illness
That results on the lesions formations.
 Loss of elastic fibers cause skin to sag and wrinkle
6 Pregnant and Menstruation Cycle
7 Self-Injury
SUBJECTIVE DATA FAMILY HISTORY
1 Anyone in family with skin problem.
 Because sometime skin problem can be contagious, such
HISTORY OF PRESENT HEALTH CONCERN
[SKIN] as mizzles and chicken fox.

1 Ask for any current skin problems such as rasher, lesions, dryness, 2 Anyone in the family with skin cancer.
oiliness, and others.
3 Family history of keloid.
Characterize the present health concern with the use of “COLDSPA”,  Skin type is heredity.
use even in skin concerns.

2 Presence of Birthmarks or moles (ABCDE) LIFESTYLE AND HEALTH PRACTICES

1 Sunbathing Activity
3 Changes in Sensation  Excessive and unprotective sun exposure.
 Pain: Nawala ba
 Pressure: Touch or Vibration 2 Tanning booth exposure
 Lagi ba syang nag papatan.
4 Any itching, pain, numbness, tingling, sensation.
3 Use of Sunblock
5 Body odor and excessive sweating 4 Skin Self Examination
5 Exposure to Chemicals

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CHAPTER 8: ASSESSING SKIN, HAIR, AND NAILS

6 Long period of Sitting or Lying Position  Normal: Intact and no reddened areas.
 That may cause pressure on the bony prominences
 LESIONS
7 Extreme temperature exposure  Observe skin surfaces to detect abnormalities.
 Malamig at Mainit  Normal Findings: Skin is smooth, no lesions, no stretchmarks, scars,
moles, freckles.
8 Body Piercing
9 Tattoos PALPATION:
10 Daily Skin, Hair, Nail Care
11 Product Use 1. SKIN TEXTURE:
12 Nail cutting
 Use the palmer surface of the 3 middle fingers to palpate this. Light
13 Daily food and water intake
Palpation.
14 Smoking and Drinking
15 Others:  Normal: Skin is smooth and even.
 Socialization Problem
2. SKIN THICKNESS:
 Stress Level Problem
 Skin is normally thin but callouses which is the rough skin on the
epidermis.
 Normal: No Lesion Palpated.
OBJECTIVE DATA
3. SKIN MOISTURE:
 Palpate in an exposed area; skin surface varies to moist or dry depending
on the area where they assess
SKIN:
4. SKIN TEMPERATURE:
INSPECTION:
 Use the dorsal of the hands to palpate the skin.
SKIN  Normal: Skin is Warm.
 GENERAL SKIN COLORATION.
5. SKIN MOBILITY AND TURGOR
 The amount of pigment accounts for the intensity of the color, as
 Ask the client to lie down using two fingers pinch the area on the
well as hue.
clavicle.
 Normal Findings: Reveal evenly skin tones color, without unusual
 Normal: Skin is mobile and with elasticity to return to it original form
discoloration.
quickly.
 ODOR
6. EDEMA
 Note any odor that is assimilating from the skin.
 Palpate using the thumb to press down in the feet, ankle, or any on
 Normally, the client has light or no odor of perspiration depending
the tibial area.
on the patient’s activity.
 Normal: Skin rebounds and not remained indented when the pressure is
released.
 COLOR VARIATIONS
 Inspect localized part of the body, noting any color variation.
 Normal: includes suntan area, freckles which may be normal SCALP AND HAIR
depending on the skin type of the patient.
 Variations due to different amount of melanin in the certain areas INSPECTION AND PALPATION
of the body.
1 General Color and Condition
Normal: Natural Hair Color
 SKIN INTEGRITY
2 Amount and distribution of scalp, body, axilla, and pubic hair.
 Pay attention to the pressure point area.

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CHAPTER 8: ASSESSING SKIN, HAIR, AND NAILS

NAILS INSPECTION
1 Grooming and Cleanliness
2 Color and Markings
3 Shape

HEALTH PROMOTION & DISEASE PREVENTION

1 Screening
2 Risk Assessment
3 Client Education

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