Health Assessment 06

Module 06 Content

1.

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Conduct an assessment on the following body system: 

· Skin

You may conduct the assessment on a fellow student, friend, or family member. Remember to secure their permission.

Collect both subjective and objective data using the process described in the textbook. Review the Evolve resources & video on Skin located in the Overview tab under Module 6

Write a summary of the assessment and the skills utilized. Do not disclose any patient identifiers.

1. What skills (assessment techniques) were utilized during the assessment?

1. What subjective data did you collect? (list your findings)

1. What objective data did you collect? (list your findings

 APA format isn’t required.

Submit your completed assignment by following the directions linked below. Please check the Course Calendar
 for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the ” x” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Jstudent_exampleproblem_101504

Rubric for assignment:

10 points

Novice

Competent

Proficient

Technique

Technique not identified. Findings incomplete.

Technique identified. Only answered one question in the summary.

Technique utilized clearly identified, detailed answers to questions included in the summary.

Summary of Assessment

Summary includes minimal details of the assessment.

Summary includes some details of the assessment performed.

Summary inclusive of in depth discussion of assessment performed.

10 points

1-6 points

7-9 points

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Entire Volume – Nose, Mouth, and Neck | Bates’ Visual Guide (batesvisualguide.com)

Chapter 14

Head, Face, and Neck, and Regional Lymphatics

Copyright © 2020 by Elsevier Inc. All rights reserved.

1
Copyright 2015

Structure and Function:
Head (1 of 2)
Skull is rigid box that protects brain.
Includes bones of cranium and face
Supported by cervical vertebra
Cranial bones
Frontal
Parietal
Occipital
Temporal
Sutures—adjacent cranial bones mesh at sutures
Coronal
Sagittal
Lambdoid
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Structure and Function:
Head (2 of 2)
14 facial bones also articulate at sutures.
Facial expressions formed by facial muscles, which are mediated by cranial nerve VII, the facial nerve
Two pairs of salivary glands accessible to examination on the face:
Parotid glands are in cheeks over mandible, anterior to and below ear; the largest of salivary glands, they are not normally palpable.
Submandibular glands beneath mandible at angle of jaw
Third pair, sublingual glands, lies in floor of mouth.
Temporal artery lies superior to temporalis muscle, and pulsation is palpable anterior to ear.
Copyright © 2020 by Elsevier Inc. All rights reserved.

Structure: Head
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4

Structure and Function: Neck
Neck delimited by
Base of skull and inferior border of mandible above, and by manubrium sterni, clavicle, first rib, and first thoracic vertebra below
Think of neck as conduit of many structures.
Vessels, muscles, nerves, lymphatics, and viscera of respiratory and digestive systems
Internal carotid branches off common carotid and runs inward and upward to supply brain.
External carotid supplies face, salivary glands, and superficial temporal area.
Copyright © 2020 by Elsevier Inc. All rights reserved.

5

Structure and Function:
Neck Muscles
Major neck muscles
Sternomastoid and trapezius are innervated by cranial nerve XI.
Sternomastoid enables
Head rotation and flexion and divides each side of neck into two triangles: anterior and posterior triangles
Two trapezius muscles move shoulders and extend and turn head.
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6

Structure and Function: Thyroid
Endocrine gland
Straddles trachea in middle of the neck
Synthesizes and secretes
Thyroxine (T4) and triiodothyronine (T3), which are hormones that stimulate rate of cellular metabolism
The gland has two lobes
Connected in middle by a thin isthmus and above that by the cricoid cartilage or upper tracheal ring
Thyroid cartilage
Small palpable notch in upper edge (“Adam’s apple” in males)
Cricoid cartilage or upper tracheal ring
Isthmus of the thyroid gland
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7

Structures of Neck
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8

Structure and Function:
Lymphatic System
Major part of immune system
Detects and eliminates foreign substances from body
Rich supply of lymph nodes
Greatest supply is in head and neck.
Lymphatic drainage
Helps to prevent potentially harmful substances from entering the circulation
You should be familiar with direction of drainage patterns of lymph nodes.
Copyright © 2020 by Elsevier Inc. All rights reserved.

9

Drainage Patterns of Lymph Nodes
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Structure and Function:
Lymph Nodes (1 of 2)
Preauricular
In front of ear
Posterior auricular (mastoid)
Superficial to mastoid process
Occipital
At base of skull
Submental
Midline, behind tip of mandible
Submandibular
Halfway between angle and tip of mandible
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Structure and Function:
Lymph Nodes (2 of 2)
Jugulodigastric
Under angle of mandible
Superficial cervical
Overlying sternomastoid muscle
Deep cervical
Deep under sternomastoid muscle
Posterior cervical
In posterior triangle along edge of trapezius muscle
Supraclavicular
Just above and behind clavicle, at sternomastoid muscle
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Locations of Lymph Nodes
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Developmental Competence:
Infants and Children (1 of 2)
Bones of neonatal skull are separated by sutures and fontanels, spaces where the sutures intersect.
These membrane-covered “soft spots” allow growth of brain during first year; gradually ossify.
Closure of fontanels
Triangle-shaped posterior fontanel closes by 1 to 2 months.
Diamond-shaped anterior fontanel closes between 9 months and 2 years.
During fetal period, head growth predominates.
Head size is greater than chest circumference at birth and reaches 90% of final size at 6 years old.
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Developmental Competence:
Infants and Children (2 of 2)
During infancy, trunk growth predominates
so that head size changes in proportion to body height.
Facial bones grow at varying rates.
In toddler, mandible and maxilla are small and nasal bridge is low.
Lymphoid tissue
Well developed at birth and grows to adult size when the child is 6 years old
In adolescence
facial hair also appears on boys at this time: first on upper lip, then on cheeks and lower lip, and last on the chin.
noticeable enlargement of the thyroid cartilage occurs, and with it, the voice deepens.
Copyright © 2020 by Elsevier Inc. All rights reserved.

Developmental Competence
Pregnant female
Thyroid gland enlarges slightly during pregnancy as a result of hyperplasia of tissue and increased vascularity.
Aging adult
Facial bones and orbits appear more prominent.
Facial skin sags resulting from decreased elasticity, decreased subcutaneous fat, and decreased moisture in skin.
Lower face may look smaller if teeth have been lost.
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Headache
Leading cause of acute pain and lost productivity
Classified by etiology and often misdiagnosed
Chronic migraine
More than 15 days per month
Gender difference
More common in females than males with peak in midlife seen equally
Ethnic difference
More prevalent among Caucasian and Hispanic population
Various etiological theories proposed
Culture and Genetics
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Headache
Head injury
Dizziness
Neck pain, limitation of motion
Lumps or swelling
History of head or neck surgery
Subjective Data: Health History
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Ask about
onset pattern characteristics.
location pattern.
pain characteristics.
course and duration.
precipitating factors.
associated factors.
alleviating factors.
what makes it worse.
presence of comorbidities.
medication history.
patient-centered care.

Health History Questions: Headaches
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Health History Questions:
Head Injury
Ask about
onset, setting, and description of injury.
changes in levels of consciousness.
loss of consciousness and/or fall
history of comorbidity.
location of injury.
pattern of symptoms.
presence of associated symptoms.
treatment plan
emergency, hospitalization, and/or medication.
Copyright © 2020 by Elsevier Inc. All rights reserved.

20

Dizziness
Provide a description of “feeling” in patient’s own words
Associated with change of position, nausea, and/or vomiting
Neck pain
Onset, location, associated symptoms, limitation of ROM, precipitating factors, stress
Focus on patient-centered care
Lumps or swelling
History of recent infection, radiation, smoking, alcohol, difficulty swallowing, thyroid issues
History of head or neck surgery
Type of surgery, reason for surgery, response to surgery
Other Health History Questions
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Additional Health History Questions
For infants and children
Maternal alcohol or drug use?
Type of delivery?
Vaginal or by cesarean section? Any difficulty? Use of forceps?
Growth pattern?
Was it on schedule?
For aging adults—patient-centered care
Dizziness and/or neck pain
How does it affect your daily activities?
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22

Inspection and Palpation of the
Skull
Size and shape
Normocephalic: round and symmetric
Assess shape: place fingers in person’s hair and palpate scalp
Cranial bones that have normal protrusions:
Forehead, lateral edge of parietal bones, occipital bone, and mastoid process behind each ear
Temporal area
Palpate temporal artery above zygomatic (cheek) bone between eye and top of ear
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Inspection of the Face
Facial structures
Always should be symmetric.
Note facial expression and appropriateness to behavior or reported mood.
Note any abnormal facial structures
Coarse facial features, exophthalmos, changes in skin color or pigmentation, or abnormal swellings
Note any involuntary movements (tics) in facial muscles; normally none occur.
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Head and neck symmetry
Head position is centered in midline, and accessory neck muscles should be symmetric.
Head should be held erect and still.
Range of motion
Note any limitations.
Test muscle strength.
Observe for enlargement of glands and/or pulsations.
Lymph nodes
Palpate nodes noting location, size, shape, delimitation, mobility, consistency, and tenderness.
Inspection and Palpation
of the Neck (1 of 2)
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Trachea
Should be midline
Palpate for any tracheal shift
Note any deviation from midline
Thyroid gland
Difficult to palpate; check for enlargement, consistency, symmetry, and presence of nodules
Position patient for best approach
Posterior approach
Anterior approach
Auscultate thyroid for bruit, if enlarged.
Inspection and Palpation
of the Neck (2 of 2)
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Examining Lymph Nodes
Using a gentle circular motion of finger pads, palpate lymph nodes.
Beginning with preauricular lymph nodes in front of ear, palpate the 10 groups of lymph nodes in routine order
Many nodes are closely packed, so you must be systematic and thorough in your examination.
Do not vary sequence or you may miss some small nodes.
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Thyroid Palpation:
Anterior Approach
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Thyroid Palpation:
Posterior Approach
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Physical Examination:
Infants and Children (1 of 2)
Skull
Measure infant’s head at each visit up to age 2 years and yearly up to age 6 years.
Note infant’s head posture and head control; infant can turn head side to side by 2 weeks.
Two common variations in newborn cause shape of skull to look markedly asymmetric due to birth trauma:
Caput succedaneum: edematous swelling that is self-limiting and extends across suture lines
Cephalohematoma: subperiosteal hemorrhage, well defined over one cranial bone over periosteum, reabsorbed during first few weeks of life
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Physical Examination:
Infants and Children (2 of 2)
Skull
Molding
Overriding of the cranial bones during birth process that resolves over a few days or a week
Positional molding (positional plagiocephaly)
Flattening of the head due to infant sleeping position
Fontanels
Observe anterior and posterior fontanel.
Head and neck control
Observe for appearance of tonic neck reflex which disappears between 3 and 4 months of age.
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Physical Examination:
Infants and Children: Face
Check facial features for symmetry, appearance, and swelling.
Note symmetry of wrinkling when infant cries or smiles (e.g., both sides of lips rise and both sides of forehead wrinkle).
Normally, no swelling is evident.
Parotid gland enlargement best seen when child looks up; swelling appears below angle of jaw
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Physical Examination:
Infants and Children: Neck
An infant’s neck looks short; it lengthens during the first 3 to 4 years.
Assess muscle development with gentle passive ROM.
Cradle infant’s head with your hands and turn it side to side and test forward flexion, extension, and rotation.
Note resistance to movement, especially flexion.
During infancy, cervical lymph nodes are not palpable normally, but child’s lymph nodes are palpable.
Palpable nodes less than 3 mm are normal.
Children have a higher incidence of infection, so you will expect a greater incidence of inflammatory adenopathy; no other mass should occur in neck.
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Infants and Children:
Special Procedures
Percussion
With an infant, you may directly percuss with your plexor finger against head surface.
This yields a resonant or “cracked pot” sound, which is normal before closure of fontanels.
Auscultation
Bruits are common in skull of children under 4 or 5 years of age or children with anemia.
Systolic or continuous; heard over temporal area
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Physical Examination:
Pregnant Female
During second trimester
chloasma may show on face.
A blotchy, hyperpigmented area over cheeks and forehead that fades after delivery
Thyroid gland may be palpable normally during pregnancy.
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Physical Examination:
Aging Adult
Temporal arteries
may look twisted and prominent.
In some aging adults, a mild rhythmic tremor of head may be normal.
senile tremors are benign and include head nodding and tongue protrusion.
If some teeth have been lost
lower face looks unusually small, with mouth sunken in.
Neck may show an increased concave curve
to compensate for kyphosis.
Maintain patient safety by indicating patient perform ROM and position changes slowly
minimize potential for dizziness.
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Diagnosed by patient history with no abnormal findings on exam or laboratory results
Types of headaches:
Tension, migraine, and cluster
Factors to review:
Definition, location, character, duration, quantity and severity, and timing
Aggravating symptoms or triggers, associated symptoms and relieving factors, effort to treat
Abnormal Findings: Primary Headaches
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Abnormal Findings:
Pediatrics (1 of 2)
Hydrocephalus
Obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head,
Down syndrome
Most common chromosomal abnormality with characteristic facial abnormalities
Upslanting eyes with inner epicanthal folds
Flat nasal bridge and small, broad nose
Protruding thick tongue and ear dysplasia
Broad neck with webbing and small hands with single palmar crease
Plagiocephaly
Positional or deformational due to sleeping position

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Abnormal Findings:
Pediatrics (2 of 2)
Craniosynostosis
Premature closing of one or more cranial sutures that leads to head malformation
Atopic (allergic) facies
A variety of presentations seen in children who have chronic allergies
Include exhausted face, allergic shiners, Morgan lines, central facial pallor and allergic gaping
Fetal alcohol spectrum disorders (FASD)
Narrow palpebral fissures, epicanthal folds, thin upper lip, and midfacial hypoplasia
Allergic salute and crease
Appearance of transverse line on the nose in response to chronically repeated use of hand to push the nose up and back

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Fetal Alcohol Spectrum Disorders
(FASD)
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Abnormal Findings: Swellings of Head and Neck
Congenital torticollis
Hematoma in one sternomastoid muscle, probably injured by intrauterine malposition, results in head tilt to one side and limited neck ROM to opposite side
Simple diffuse goiter (SDG)
Endemic goiter due to iodine deficiency that results in chronic enlargement of the thyroid gland
Thyroid—multinodular goiter (MNG)
Multiple nodules usually indicate inflammation or multinodular goiter rather than a neoplasm; however, suspect any rapidly enlarging or firm nodule
Pilar cyst (Wen)
Benign growth that presents as smooth, fluctuant swelling on scalp
Parotid gland enlargement
Rapid painful enlargement seen in response to mumps, blockage of duct, abscess, or tumor
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Thyroid Disorders: Graves Disease
Physical presentation neck and face
Goiter
Eyelid retraction
Exophthalmos
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Thyroid Disorders: Hypothyroidism
Physical presentation neck and face
Puffy edematous face
Periorbital edema
Coarse facial features
Coarse hair and eyebrows
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Acromegaly
Elongated head, massive face, overgrowth of nose, lower jaw, heavy eyebrow ridge, and coarse facial features
Cushing syndrome
Classic “moonlike” face, red cheeks, and hirsutism
Bell palsy
Paralysis on one side of the face as a result of LMN lesion
Stroke or brain attack
UMN lesion leading to paralysis of lower facial muscles
Parkinson syndrome
Classic “maskline” appearance, elevated eyebrows, staring gaze, oily skin and drooling due to dopamine deficiency
Cachectic appearance
Sunken eyes, hollow cheeks, and defeated expression that accompanies chronic wasting diseases
Abnormal Facial Appearances
Associated with Chronic Illnesses
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Summary Checklist: Head, Face, and Neck, including Regional Lymphatics Examination
Inspect and palpate the skin.
General size and contour.
Note any deformities.
Palpate temporal artery and temporomandibular join (TMJ) joint.
Inspect and palpate the face.
Observe facial expression.
Cranial nerve VII: symmetry of movement.
Observe for any abnormal movements.
Inspect and palpate the neck.
Active ROM, potential enlargement and position of trachea
Auscultate thyroid (if enlarged) for bruit.
Copyright © 2020 by Elsevier Inc. All rights reserved.

Chapter 13

Skin, Hair, and Nails

1
Copyright 2015

Structure: Skin
Think of skin as body’s largest organ system.
Covers 20 square feet of surface area in adults
Skin is the sentry that guards body.
Skin has two layers
Epidermis: outer highly differentiated layer
Basal cell layer forms new skin cells.
Outer horny cell layer of dead keratinized cells
Dermis: inner supportive layer
Connective tissue or collagen
Elastic tissue
Beneath these layers is a subcutaneous layer of adipose tissue.
Stores fat for energy, provides insulation for temperature control and aids in protection

Layers of Skin

Copyright 2015

Derived from three sources:
Melanin—brown pigment
Carotene—yellow-orange pigment
Red purple tones in the underlying vascular bed
All individuals have varying amounts (red, yellow, and brown).
With the relative proportion affecting prevailing color
Also modified by thickness of skin and presence of edema
Skin Color

Hair, Sebaceous Glands and Sweat Glands
Structures formed by tubular invagination of epidermis down into underlying dermis
Hair
Sebaceous glands
Sweat glands: important for fluid balance and thermoregulation
Eccrine glands
Apocrine glands

Hair
Threads of keratin—hair shaft and bulb matrix
Types of hair—vellus and terminal
Follicle—cyclical with active and resting phases
Sebaceous glands
Sebum—secreted lipid substance through hair follicles
Lubricate skin and form emulsion
Sweat glands
Eccrine produce sweat.
Apocrine produce milky secretion and open into hair follicles.
Nails
Hard plates of keratin on dorsal edges of fingers and toes
Hair, Sebaceous Glands, Sweat Glands and Nails

Structure of Nails

Skin Function
Skin is waterproof, protective, and adaptive
Protection from environment
Prevents penetration
Perception
Temperature regulation
Identification
Communication
Wound repair
Absorption and excretion
Production of vitamin D

Developmental Competence: Infants, Children, and Adolescents
Newborn infants
Lanugo: fine downy hair of newborn infant
Vernix caseosa: thick, cheesy substance
Sebum: holding water in the skin producing milia
Children
Epidermis thickens, darkens, and becomes lubricated.
Hair growth accelerates.
Adolescents
Secretions from apocrine sweat glands increase.
Subcutaneous fat deposits increase.
Secondary sex characteristics

Developmental Competence:
The Pregnant Woman
Increase in metabolism leads to increase secretion of sweat and sebaceous glands to dissipate heat.
Expected skin color changes due to increased hormone levels.
Fat deposits are laid down as maternal reserves for nursing baby.

Developmental Competence:
The Aging Adult
Elasticity
Loses elasticity; skinfolds and sags
Sweat and sebaceous glands
Decrease in number and function, leaving skin dry
Senile purpura
Discoloration due to increasing capillary fragility
Skin breakdown due to multiple factors
Cell replacement is slower and wound healing is delayed.
Hair matrix
Functioning melanocytes decrease, leading to gray fine hair

Culture and Genetics
Genetic attributes of dark-skinned individuals afford protection against skin cancer due to melanin.
Increased likelihood of skin cancer in whites than in black and Hispanic populations
Succession of genetic mutations leading to increased chromosome sensitivity to sun damage
Most important environmental risk factor for skin cancer is exposure to ultraviolet (UV) radiation both from sun and indoor tanning sources.
Increased risk for melanoma r/t increased number of sunburns during one’s lifetime.
Certain skin presentations are associated with different ethnic groups.

Subjective Data Health History Questions
Past history of skin disease, allergies, hives, psoriasis, or eczema?
Change in pigmentation?
Change in mole (size or color)?
Excessive dryness or moisture?
Pruritus?
Excessive bruising?
Rash or lesions?
Medications?
Hair loss?
Change in nails?
Environmental or occupational hazards?
Patient-centered care?

13

Additional History Questions for Infants and Children
Does child have any birthmarks?
Any change in skin color as a newborn?
Does child have any rash or sores?
Does child have diaper rash?
Does child have any burns or bruises?
Has child been exposed to contagious or communicable disease?
Does child have habits such as nail biting or twisting hair?
What steps are taken to protect child from sun exposure?

14

Additional Health History Questions
Adolescents
Skin problems such as pimples, blackheads?
Aging adults
What changes have you noticed in your skin in past few years?
Any delay in wound healing?
Any change in feet: toenails, bunions, wearing shoes?
Falling: bruises, trauma?
History of diabetes or peripheral vascular disease?

15

Objective Data
Preparation
Consciously attend to skin characteristics; the danger is one of omission.
Equipment needed
Strong direct lighting, gloves, penlight, and small centimeter ruler
For special procedures
Wood’s light
Magnifying glass
Materials for laboratory tests: potassium hydroxide (KOH) and glass slide

16

Physical Examination
Complete physical examination
Skin assessment integrated throughout examination
Scrutinize the outer skin surface first before you concentrate on underlying structures.
Separate intertriginous areas (areas with skinfolds) such as under large breasts, obese abdomen, and groin, and inspect them thoroughly
Always inspect feet, toenails, and between toes.
Regional physical examination
Individuals may seek health care for skin problems and assessment focused on skin alone.
Assess skin as one entity; getting overall impression helps reveal distribution patterns.

Inspection and Palpation:
Skin (1 of 3)
Color
General pigmentation, freckles, moles, birthmarks
Widespread color change
Note color change over entire body skin, such as pallor (pale), erythema (red), cyanosis (blue), or jaundice (yellow).
Note if color change transient or due to pathology.
Temperature
Use backs of hands to palpate person.
Skin should be warm, and temperature equal bilaterally; warmth suggests normal circulatory status.
Hands and feet may be slightly cooler in a cool environment.
Hypothermia
Hyperthermia

Inspection and Palpation:
Skin (2 of 3)
Moisture
Diaphoresis
Dehydration
Texture
Normal skin feels smooth and firm with even surface.
Thickness
Observe for thickened areas (callus formation).
Edema
Assess for fluid accumulation in the interstitial space
Mobility and turgor
Assess skin elasticity
Vascularity or bruising
Assess for presence of tattoos and/or variations

Lesions: if any are present, note the following:
Color
Elevation
Pattern or shape
Size
Location and distribution on body
Any exudate: note color and odor
Use a Wood’s light (ultraviolet light filtered through special glass) to detect fluorescing lesions.
Inspection and Palpation:
Skin (3 of 3)

Inspection and Palpation: Hair
Color
Due to melanin production
Texture
Characteristics range from fine to thick to curly to straight and may be affected by use of hair care products.
Distribution
Tanner staging identifies gender patterns of hair distribution.
Lesions
Identification by looking at scalp and dividing hair into sections

Inspection and Palpation: Nails
Shape and contour
Profile sign: view index finger at its profile and note angle of nail base; it should be about 160 degrees
Consistency
Observe for smooth, regular, not brittle or splitting, uniform nail thickness.
Color
Translucent nail plate to pink nail bed below
Note ethnic variations
Capillary refill
Depress nail edge to blanch and then release, noting return of color; indicates status of peripheral circulation.

Profile Sign: Clubbing

ABCDEF Skin Assessment
Promoting health and self-care
Teach skin self-examination using ABCDEF rule to detect suspicious lesions
A: asymmetry
B: border irregularity
C: color variations
D: diameter greater than 6 mm
E: elevation or evolution
F: funny looking—“ugly duckling” —different from others

Skin color—general pigmentation
Mongolian spot
Café-au-lait spot
Skin color change
Harlequin color change
Erythema toxicum
Temporary cyanotic conditions
Acrocyanosis
Cutis marmorata
Physiologic jaundice
Carotenemia
Moisture, texture, thickness, mobility and turgor
Vascularity or bruising—nevus simplex
Hair and nails—lanugo and presence of cyanosis in newborn

Developmental Competence: Infant Skin Presentations

Adolescent
Acne
Open and closed comedones
Pregnancy
Striae
Linea nigra
Chloasma
Vascular spiders
Developmental Competence:
Life-Cycle Presentations (1 of 2)

Aging
Skin color and presentations
Senile lentigines
Keratoses
Moisture
Xerosis
Texture
Skin tags or acrochordons
Thickness
Thin parchment
Decreased mobility and turgor
Decreased hair growth, nail growth, and brittle nails
Developmental Competence:
Life-Cycle Presentations (2 of 2)

Be aware of normal variations for the following variables:
Pallor
Cyanosis
Erythema
Jaundice
Brown-tan
Detecting Color Changes in Light and Dark Skin

Shapes and Configurations of Lesions (1 of 2)
Annular or circular
Begins in center and spreads to periphery
Confluent
Lesions run together
Discrete
Distinct and separate
Grouped
Cluster of lesions
Gyrate
Twisted, coiled, or snakelike

Shapes and Configurations of Lesions (2 of 2)
Target or iris
Resembles iris of eyes, concentric rings
Linear
Scratch, streak, line, or stripe
Polycyclic
Annular lesions grow together.
Zosteriform
Linear arrangement following a unilateral nerve route

Annular or Circular
Begins in center and spreads to periphery

Confluent
Lesions run together

Discrete
Distinct and separate

Grouped
Cluster of lesions

Gyrate
Twisted, coiled, or snakelike

Target or Iris
Resembles iris of eyes, concentric rings

Linear
Scratch, streak, line or stripe

Polycyclic
Annular lesions grow together.

Zosteriform
Linear arrangement following a unilateral nerve route

Macules
Solely a color change, flat and circumscribed, less than 1 cm
Papules
Felt and caused by superficial thickening of the epidermis
Patches
Macules that are larger than 1 cm
Plaques
Papules coalescing to form surface elevation wider than 1 cm
Nodules
Solid, elevated, hard or soft, greater than 1 cm that may extend deeper into dermis than papule
Wheals
Superficial, raised, transient and erythematous, irregular in shape due to edema
Primary Skin Lesions (1 of 2)

Tumors
Larger in diameter, firm or soft, deeper into dermis, may be benign or malignant,
Urticaria (hives)
Wheals coalesce to form extensive pruritic reaction.
Vesicles
Elevated cavity containing fluid up to 1 cm (blister)
Cysts
Encapsulated fluid filled cavity
Bullas
Larger than 1 cm diameter, usually single chamber, superficial in dermis and ruptures easily
Pustules
Pus in cavity that is circumscribed and elevated.
Primary Skin Lesions (2 of 2)

Macule and Patch

Papule and Plaque

Nodule and Tumor

Wheal and Urticaria/Hives

Vesicle and Bulla

Cyst

Pustule

Debris on skin surfaces
Crust—Thickened dried out exudate
Scale—Compact flakes of desiccated skin from shedding of dead excess keratin cells
Break in continuity of skin surface
Fissures—Linear crack with abrupt edges extending into dermis
Erosions—Scooped out but shallow depression
Ulcers—Deeper depression extending into dermis with irregular shape, may bleed, leaves scar
Secondary Skin Lesions (1 of 2)

Break in continuity of skin surface
Excoriations—Self-inflicted abrasion that is superficial
Scars—Permanent fibrotic change after healing
Atrophic scars—Resulting skin level is depressed with loss of tissue and thinning
Lichenifications—Prolonged intense scratching leads to thickened skin producing tightly packed set of papules
Keloids—Benign excess of scar tissue beyond original injury
Secondary Skin Lesions (2 of 2)

Crust

Scale

Fissure

Erosion

Ulcer

Excoriation

Scar

Atrophic Scar

Lichenification

Keloid

Stages
Stage I: Non-blanchable erythema
Stage II: Partial-thickness skin loss
Stage III: Full-thickness skin loss
Stage IV: Full-thickness skin/tissue loss
Deep tissue pressure injury (DTPI)
PI caused by medical device
Pressure Injuries (PI)
Pressure Ulcer, Decubitus Ulcer

Hemangiomas
Port-wine stain (nevus flammeus)
Strawberry mark (immature hemangioma)
Cavernous hemangioma (mature)
Telangiectases
Spider or star angioma
Venous lake
Vascular Lesions (1 of 2)

Purpuric lesions
Petechiae
Ecchymosis
Purpura
Lesions caused by trauma or abuse:
Pattern injury
Hematoma
Contusion (bruise)
Vascular Lesions (2 of 2)

Common Skin Lesions in Children
Diaper dermatitis
Intertrigo (candidiasis)
Impetigo
Atopic dermatitis (eczema)
Measles (rubeola)
German measles (rubella)
Chickenpox (varicella)

Primary contact dermatitis
Allergic drug reaction
Tinea corporis (ringworm of the body)
Tinea pedis (ringworm of the foot)—Athlete’s foot
Labial herpes simplex (cold sores)
Tinea versicolor
Herpes zoster (shingles)
Erythema migrans of lyme disease
Psoriasis

Common Skin Lesions

Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma
Malignant Skin Lesions

AIDS-related Kaposi sarcoma: patch stage
Toxic alopecia
Tinea capitis (scalp ringworm)
Traction alopecia
Seborrheic dermatitis (cradle cap)
Pediculosis capitis (head lice)
Folliculitis barbae (“razor bumps”)
Hirsutism
Furuncle and abscess
Abnormal Hair Conditions

Scabies
Paronychia
Beau line
Splinter hemorrhages
Onychomycosis
Late clubbing
Pitting
Habit-tic dystrophy
Abnormal Conditions of the Nails

Summary Checklist: Skin,
Hair, and Nails
Inspection of the skin, hair, and nails
Color and pigmentation
Texture and distribution
Shape, contour, and consistency
Palpation of the skin, hair, and nails
Temperature and texture
Edema, mobility, and turgor
Note presence of lesions
Shape, configuration, and distribution
Teach self-examination
Health promotion

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