PHYSICAL ASSESSMENT: THE

INTEGUMENT
THE INTEGUMENT
 Includes:
 Skin
 Hair
 Nails
THE SKIN, HAIR, AND NAILS
SKIN
 Assessment of the skin invloves inspection
and palpation.
 In some instances, the nurse may also use the
olfactory sense.
SKIN COLOR CHANGES
PALLOR
CYANOSIS
CYANOSIS
CYANOSIS
JAUNDICE
JAUNDICE
ERYTHEMA
BIRTHMARK
VITILIGO
ALBINISM
ALBINISM
EDEMA
EDEMA
SKIN LESIONS
SKIN LESIONS
 Can be primary or secondary
 Nurses are responsible for describing skin
lesions accurately in terms of location,
distribution, and configuration.
PRIMARY SKIN LESIONS
MACULES
 Flat, unelevated change in color
 1mm-1cm, circumscribed
 Ex: Freckles, measles, petechiae
PAPULE
 Circumscribed, solid elevation of skin
 <1cm
 Ex: Warts, pimple, acne
PLAQUE
 Larger than 1 cm
 Examples: Psoriasis, rubeola
NODULE/TUMOR
 Solid, hard mass that extends deeper into the
dermis
 0.5 to 2 cm (Nodule), have circumscribed
border
 Ex: squamous cell ca, fibroma
VESSICLE / BULLA
 A circumscribed, round or oval, thin
transluscent-filled mass with fluid or blood
 Size: 0.5cm
 Ex: Herpes simplex, early chickenpox, burn
blister
PUSTULE
WHEAL
 A slightly irregular, relatively transient,
superficial area of localized skin edema.
WHEAL
 A slightly irregular, relatively transient,
superficial area of localized skin edema.
CYST
 Mass arising from the dermis or
subcutaneous tissue.
SECONDARY SKIN LESIONS
ASSESSING THE SKIN
 In general, we assess the client’s skin for the
following:
 Color
 Lesions
 Moisture
 Temperature
 Texture
 Mobility and turgor
ASSESSING THE SKIN ACROSS THE
LIFESPAN
INFANTS
INFANTS
 Physiologic Vs. Pathologic Jaundice
INFANTS
 Milia
INFANTS
 Vernix Caseosa
INFANTS
 Lanugo
INFANTS
INFANTS
 Diaper Dermatitis
INFANTS
CHILDREN
CHILDREN
 Children have minor skin lesions on arms and
legs due to high-activity level
 Secondary skin lesion may occur frequently
CHILDREN
ELDERS
ELDERS
 Changes in white skin occur at an earlier age
than in black skin
 Common skin findings:
 Wrinkles
 Thin and dry skin
 Poor skin turgor
 Senile lentigines
ELDERS
ELDERS
ELDERS
ELDERS
ELDERS
ELDERS
ELDERS
THE NAILS AND HAIR
THE HAIR
 The hair, together with the nails, is
differentiated tissue but continuous extension
of the skin.
 Hair is generally distributed over the body
except in some areas
 The amount and texture varies with age, sex,
race, and body part
 Types:
 Vellus
 Terminal hair
NORMAL HAIR
ABNORMAL HAIR FINDINGS
ABNORMAL HAIR FINDINGS
HAIR ASSESSMENT PROCEDURES
 1. Introduce self
 2. Perform hand hygiene
 3. Provide privacy
 4. Inquire if the patient has any history of
using hair cosmetics and presence of any
disease
HAIR ASSESSMENT PROCEDURES
 5. Inspect the hair for the ff:
 Evenness
 Thickness/thinness
 Texture and oiliness
 Infections or infestations
 Amount of body hair
 Document findings
THE NAILS
THE NAILS
 Nails are inspected for:
 Nail plate shape
 Angle
 Texture
 Nail bed color
 Intactness of surrounding tissues
THE NORMAL NAIL
ABNORMAL NAIL FINDINGS
ABNORMAL NAIL FINDINGS
ABNORMAL NAIL FINDINGS
ABNORMAL NAIL FINDINGS
ABNORMAL NAIL FINDINGS
ABNORMAL NAIL FINDINGS
ABNORMAL NAIL FINDINGS
ABNORMAL NAIL FINDINGS
BLANCH TEST
BLANCH TEST (CAPILLARY
REFILL TEST)
BLANCH TEST: AN EARLY
INDICATOR OF SHOCK?
ASSESSMENT OF THE NAILS
 1. Introduce self
 2. Observe infection control procedures
 3. Provide for privacy
 4. Inquire for presence of certain diseases
ASSESSMENT OF THE NAILS
 5. Inspect nails for:
 Nail plate shape
 Texture
 Color
 Surrounding tissue
 6. Perform blanch test
 7. Document findings
 What are the Lifespan Considerations when
assessing the nails?
THANK YOU!