ha_pe_skin

8/12/2019 HA_PE_SKIN

1/19

UNIT III: PHYSICAL

EXAMINATION


2/19

ANATOMY AND PHYSIOLOGY

0 Pregnant Woman, Infants

and Children

0 Vernix Caseosa

0 Milia

0 Mongolian Spots

0 Lanugo

0 Chloasma/Melasma

0 Linea Nigra

0 Older Adult0 Skin Wrinkling

0 Important

Anatomical

Structures

0 Skin Layers

0 Epidermis

0 Dermis

0 Subcutaneous Fat

0 Appendages

0 Hair

0 Sweat Glands

0 Sebaceous Glands

0 Nails


3/19

Assessment Techniques and

Normal Findings0 INSPECTION and

PALPATION are thetechniques used for

physical examination ofthe skin, hair and nails

0 Inspection includeslooking at the skin, hairand nails to determinecolor, consistency, shapeand hygiene-relatedfactors

0 SKIN0 The skin should be clean,

free from odor andconsistent in color.

0 It should feel warm andmoist; smooth as well

0 Should be free fromlesions except for frecklesand birthmarks

0 Sensitive to touch andtemperature

0 Should be mobile andelastic


4/19

Assessment Techniques and

Normal Findings0 SCALP and HAIR

0 Should be clean

0 Color is determined byamount of melanin

0 Hair texture may be coarseor thin depending on itslocation

0 The scalp has even hairdistribution (male patternbaldness is considered

normal)0 Fine hair is distributed over

the body with coarser anddarker hair in the axillaeand pubic regions in adults

0 NAILS

0 Should have a pink

undertone

0 It lies flat or form a

convex curve on the nail

bed

0 Forms a diamond

shaped opening


5/19

Equipment Needed

0 Examination gown and drape

0 Examination light

0 Examination gloves (clean and non-sterile)0 Centimeter ruler

0 Penlight

0 Magnifying glass

0 Woods lamp


6/19

Physical Examination of the Skin:

Procedure0 INSPECTION of the SKIN

1. Position client

Sitting

No clothes exceptexamination gown

2. Instruct the client

3. Observe for thecleanliness and use thesense of smell todetermine body odor

4. Observe the clients

skin tone5. Inspect the skin for

even pigmentation

over the body

6. Inspect the skin forsuperficial arteries and

veins


7/19

Physical Examination of the Skin:

Procedure0 PALPATION of the SKIN


2. Determine the clients

skin temperature

3. Assess the amount of

moisture

4. Palpate the skin for

texture

5. Palpate the skin to

determine its thickness


elasticity

8. Inspect and palpatethe skin lesions


sensitivity


8/19

Physical Examination of the Scalp, Hair

and Nails: Procedure0 ASSESSMENT of the SCALP

and HAIR


2. Observe for cleanliness3. Observe clients hair

color

4. Assess the texture of thehair

5. Observe the amount anddistribution of hairthroughout the scalp

6. Inspect scalp for lesions

0 ASSESSMENT of the NAILS


2. Assess for hygiene

3. Inspect for an even, pinkundertone

4. Assess capillary refill

5. Inspect and palpate thenails for shape and contour

6. Palpate nails to determinetheir thickness andattachment in the nail bed

7. Inspect and palpate cuticles


9/19

Common Abnormal Findings


10/19

Skin

Assessment0 Color

0 Pallor

0 Absence of Color

0 Cyanosis

0 Reddish Blue Tone

0 Erythema

0 Jaundice

0 Carotenemia0 Uremia

0 Brown


11/19

Skin

Assessment0 Mobility and Turgor

0 Temperature

0 Texture

0 Roughness

0 Smoothness

0 Moisture

0 Dryness

0 Sweating

0 Oiliness


12/19

Skin

Assessment:Lesions

0 MACULE0 Flat, non-palpable change in skin color

0 Smaller than 1 centimeter withcircumscribed border

0 Examples: Freckles, Petechiae

0 PATCH0 Flat, non-palpable change in skin color

0 Larger than 1 centimeter with irregular

border0 Examples: Mongolian Spots, Vitiligo

0 PAPULE0 Elevated, solid palpable mass with

circumscribed border

0 Smaller than 0.5 cm

0 Examples: Elevated Moles, Warts

0 PLAQUE0 Group of papules that form lesions larger

than 0.5 cm

0 Examples: Psoriatic patches

PRIMARY LESIONS

Macule

Patch

Papule

Plaque

Nodule

Tumor

Wheal

Vesicle

Bulla

Pustule

Cyst

SECONDARY LESIONS

Erosion

Crust

Ulcer

Scale

Fissure


13/19

Primary Lesions


14/19

Primary Skin Lesions

0 NODULES

0 Elevated, solid, hard orsoft palpable mass

extending into the dermiswith circumscribedborders and are 0.5-2 cm

0 TUMORS

0 Elevated, solid, hard orsoft palpable massextending into the dermiswith irregular borders andlarger than 0.5-2 cm

0 WHEAL

0 Elevated, often reddish

area with irregular

border caused by

diffused fluid in tissues

rather than free fluid in

a cavity

0 Examples: Insect bites


15/19

Primary Skin Lesions

0 VESICLE

0 Elevated, fluid-filled, roundand oval-shaped palpablemass with thin, translucent

walls with circumscribedborders

0 Smaller than 0.5 cm

0 Examples: Early chickenpox

0 BULLA

0 Elevated, fluid-filled, round

and oval-shaped palpablemass with thin, translucentwalls with circumscribedborders

0 Larger than 0.5 cm

0 Examples: Large Burn

Blisters

0 PUSTULE0 Elevated, pus-filled vesicle

or bulla withcircumscribed border

0 Examples: Acne,Carbuncles

0 CYST0 Elevated, encapsulated,

fluid-filled or semi-solidmass originating in thesubcutaneous fat ordermis usually 1 cm in sizeor larger


16/19

Primary Lesions


17/19

S

ECONDARY

LESIONS

0 EROSION0 Wearing away of the superficial epidermis causing a moist, shallow

depression

0 Examples: Scratch marks, Ruptured vesicles

0 CRUST0 Dry blood, serum or pus left on the skin when vesicles or pustules burst

0 Examples: Impetigo and Scabs

0 ULCER0 Deep, irregularly shaped area of skin loss extending into the dermis or

subcutaneous tissue

0 Examples: Pressure Ulcers0 KELOID

0 Elevated, irregular, darkened area of excess scar tissue caused by excessivecollagen formation

0 SCAR0 Flat irregular area of connective tissue left after a lesion or wound has

healed0 SCALE

0 Shedding flakes of greasy, keratinized skin tissue

0 Examples: Dry Skin, Eczema, Dandruff

0 FISSURE0 Linear crack with sharp edges into the dermis


18/19


19/19

Quiz 2 Lecture and Laboratory

0 Return Demonstration

0 Procedural

0Coverage0 The Skin, and its Appendages

0 Physical Examination: Skin Assessment

ha_pe_skin

Documents