integumentary system skin, hair, nails.. review a & p layers of skin epidermis dermis subcutaneous...

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  • Integumentary SystemSkin, Hair, Nails.

  • Review A & PLayers of skinEpidermisDermisSubcutaneous tissueGlands of the skinHair Nails

  • Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.)

  • Anatomy of NailsImage p 275

  • What are the major functions of the integumentary system?*Prevents penetration: barrier

    *Protection: physical, chemical and thermal

    Regulation: temperature

    Perception: sensory organ (pain, touch, pressure, temperature)

  • Other functionsIdentificationCommunicationWound repairAbsorption/excretionProduction of vitamin D

  • Functions of HairProvides ..WarmthProtectionSensation to underlying structures

  • Functions of NailsProvides .Protection to distal surfacesCan be used for self-protection

  • Subjective DataHealth history(blue pages)

  • Integumentary System-Health History

    any past skin problems and their managementskin colour changestemperature changestexture changessweatingany masses including warts or moles (nevi)

  • Integumentary System-Health History

    changes in masses, warts, nevi also, cosmetic concerns and physical discomfortrashes or eruptionschanges in hair texture or oiliness, hair loss, dandruff, hair bleaching, dyeingmanagement of any problems with hair or scalpmedications

  • Integumentary System-Health History

    complaints of tenderness, flakiness, itchiness, lumps, sores on scalp, bleedingproblems with nails including breaking, ingrown nails, paronyhia (hangnails), nail bitingSelf-care behaviours

  • Describe how to assess the clients integumentary system by inspection and palpation?Inspection and Palpation

  • 1.How will you prepare the environment?2. How will you prepare the client?

    3.How will you protect the clients privacy?

    *4. What equipment is needed?(Direct lighting, small ruler, penlight, gloves)

  • Objective Data

  • What are the general characteristics of the skin that should always be noted?Inspection and Palpation of the skin

  • Inspect Colour

    General pigmentation: freckles, mole (nevus), birthmarks.

    Widespread colour changes: pallor, erythema, cyanosis, jaundice.

  • Palpate Temperature

    Should be warm & equal bilaterally

    Hypothermia: immobilized extremity, cast, IV (normal)

    Hyperthermia: fever, exercise, trauma, infection or sunburn.

  • Palpate MoistureNormal perspiration


    Dehydration in mucous membranes

  • Palpate TextureSmooth and firm

    Even texture

  • Palpate ThicknessEpidermis is thin over most of the body

    Calluses over palms and soles

  • Palpate EdemaNot normally presentScale from 1+ to 4+Most evident on feet, ankles, and sacral areasNote extent and location

  • Palpate Mobility and TurgorMobility is the skins ease of rising

    Turgor is its ability to return to place promptly.

    Pinch up on skin and let go (ant. Chest under clavicle)

  • Inspect Vascularity or BruisingCherry (senile) angiomas

    Ecchymosis (bruising): consistent with traumas of life.

    Tattoos: document location on chart.

  • Inspect LesionsColourElevationPattern or shape (p.250-251)Size in cm (avoid quarter or pea)Location and distribution on body-e.g. generalized or localizedExudate, note colour and odor(See OH for images on p 290 -293)

  • Danger Signs.ABCDEAsymmetry of a pigmented lesion Border irregularityColour variationDiameter greater than 6 mmElevation and enlargement(any change)

  • How do you examine a lesion?Palpate, wear glovesRoll nodule between thumb and forefinger to assess depthDoes it blanche with pressure or when stretched?

  • Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.252

  • Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.253

  • Copyright 1996 by W.B. Saunders Company. All rights reserved. (From Jarvis C.:Physical Examination and Health Assessment, 2nd ed.), p.254

  • What are the criteria used in assessing the hair and scalp?Inspection and Palpation of the hair and scalp

  • Inspect Colour Pale blonde to total black


  • Palpate TextureFine or thick

    Straight, curly or kinky


  • Palpate Distribution Fine hair coats the body

    Coarse hair at the eyebrows, eyelashes and scalp

    Puberty: hair to face (male), axillae and pubic region

  • Inspect LesionsClean and free from lesionsNo nits or head liceSeborrhea (dandruff) is normal

  • What criteria are used in assessing nails?Inspection and Palpation of the nails

  • Inspect Shape and contourNormally slightly curved or flatNail folds smooth and roundedNail edges are smooth, rounded and clean.Normal nail angle- 160 degrees

    Clubbing: occurs with long standing hypoxia - emphysema and chronic bronchitis

  • Inspect ConsistencySmooth and regular, not brittle or splitting

    Thickness is uniform throughout nail

    Nail firmly attached to nail bed

  • Inspect & Palpate ColourNail bed is pinkBrownish-black linear bands or streaks along the nail edge in dark-skinned individualsWhite hairline linear markings usual as well.Capillary refill: colour return is instant or within a few seconds. A sluggish return takes longer than 1 to 2 seconds.