integumentary system  skin and glands  hair  nails

Integumentary SystemSkin and Glands HairNails

HistoryIntegumentary SystemPrevious skin historyChanges in pigmentationMoles, any changesExcessive dryness or moistureItching (pruritus)Excessive bruisingRash or lesionsMedications Hair lossNail changes

Skin ColorGeneral pigmentation (skin tone)Vitiligo-absence of pigmentFrecklesSmall, flat macules, brownMoleProliferation of melanocytes, macular or papularTan to brownBirthmarksTan to brown in color

Widespread color changes

Pallor (white)Unnatural paleness d/t constriction of cutaneous vesselsAnemia, Shock Erythema (redness)Excess blood in superficial capillaries d/t vasodilatationFever or localized inflammation

Cyanosis (blue)Decreased perfusionShock, heart failure, bronchitis, congenital ht dxJaundice (yellow)Excess bilirubin in the bloodCirrhosis, sickle-cell anemia, transfusion reactions

Temperature and MoistureTemperatureUse back of handHypothermiaCoolnessSurgery, immobilized extremity, shockHyperthermiaIncreased metabolic rateHyperthyroidism, fever, heavy exercise, trauma, infection, sunburn

MoistureDiaphoresis- excessive perspirationDehydration-dry, parched and cracked lips

Texture and ThicknessTextureCharacter of the skins surface. It is not normally uniform throughout. Elbow vs. cheekHyperthyroidism-velvetHypothyroidism-rough,dry, and flakyThicknessThin over bodyThick over palms & soles

Mobility & TurgorMobility = rise of skinTurgor = return of skin, the elasticity of skin. It may be diminished by edema or dehydration. The skin normally loses elasticity with ageElderly chestInfants abdomenAdult/teen - arms

Vascularity or BruisingVascularity or BruisingPetechiaeTiny purple or redspots d/t minute hemorrhages in the dermisCherry angiomasSmall, smooth, raised red dots on trunk in adults over 30Bruising (ecchymosis)Tattoos

Hair2 TypesTerminal HairLong, coarse, thick. Found on scalp, axilla and pubic areas.Vellus HairSmall, soft, tiny hairs. Covering entire body except hands, soles of feet and penisColorTextureDistributionCondition of scalp

Common Hair AbnormalitiesHirsutismMale pattern growth in women, especially the faceAlopecia - BaldingExcessively oily hairAssociated with androgen hormone stimulation

Dry brittle hairAssociated with aging and excessive use of shampoo, etcDry coarse discolored hairSuspect poor nutritionDecreased hair on the extremitiesArterial insufficiency

NailsShape & contourNormally transparent, smooth, convex with white tipsStrength/ThicknessCan be a nutritional indicatorColor determined by vascularity of nailbed Linear pigmentationPigment bands normal in dark skinned individualsLeukonychia striataMarkings from trauma, picking at cuticlesCapillary refillClubbing

Note if bite their nailsIf nails are dirty, cleanWell trimmed or groomed