Integumentary System Assessment Quiz

The skin, nails, hairs, glands, and associated nerve endings make up the integumentary system.
Skin acts as a physical, biochemical, and immunological barrier between the outside world and the body.

Perceiving touch, pressure, temperature, and pain via nerve endings.
Protecting against mechanical, chemical, thermal, and solar damage.
Protecting against loss of water and electrolytes.
Repairing surface wounds through cellular replacement.
Synthesizing vitamin D.
Allowing identification through unique facial contours, skin and hair color, and fingerprints.
Regulating body temperature.

Excreting uric acid, urea, ammonia, sodium, potassium, and other metabolic wastes.
Regulating temperature via evaporation of perspiration on the skin surface.
Protecting against bacterial growth on the skin surface.
Softening, lubricating, and waterproofing skin and hair.
Resisting water loss in low-humidity environments.
Protecting deeper skin regions from bacteria on the skin surface.

Provides external protection, regulates temperature, and is a sensory organ for pain, temperature, and touch.
Assessment reveals patient's health status related to oxygenation, circulation, nutrition, local tissue damage, and hydration,
The examination begins with a generalized inspection using a good light source (preferably indirect natural daylight).
Assess for unusual skin odors, typically noticeable in skin folds and armpits. These unusual odors might be related to hygiene issues or excessive sweating.
Skin assessments are often conducted daily for patients. This is typically done when a patient is newly admitted, transferring between levels of care, or discharged.
Screening Intervals
- Patients 20-40 years old: every 3 years
- Patients over 40 years old: annually
- Patients over 50 or with dysplastic nevi/melanoma history: monthly self-examination and regular clinical screening.
Skin is the largest organ, comprising 15% of total body weight.
Teach the ABCDE screen for dysplastic nevi/melanomas: Asymmetry, irregular Borders, variation in Color, Diameter 6 mm, and Evolution or change in size, symptoms, or morphology.

Sheets of keratin continuously produced by the matrix at the proximal end of the nail plate.

When was the problem first noticed?
How has the problem changed?
Where did the issue begin?
Is the issue spreading? If so, from where?
What is the distribution of the problem?
Any discharge, bleeding, or scaling?
Is there pain, itching, or altered sensation?
Has the problem started resolving?
Are there triggers or relievers? (consider UV light, food, temperature, and other contacts)

Previous skin problems?
Do they have diabetes, connective tissue disease, inflammatory bowel disease, or asthma?
What products do they use on their skin (soaps, creams, cleansers, aloe, etc)?

Pallor: Result of inadequate blood circulation or reduced hemoglobin and tissue oxygenation. Appears as absence of underlying red in dark skin, yellowish-brown tinge in brown skin, and ashen gray in black skin.
Jaundice: Yellow tinge to skin (particularly in sclera).
Carotenemia: Yellow-orange tinge to skin, but the sclera are spared.
Hemochromatosis: Slate-gray skin coloration.

Vitiligo: Patches of hypopigmented (lighter) skin caused by destruction of melanocytes.
Albinism: Absence or reduced melanin in skin, hair, and eyes.
Addison's disease: Darkened scars and creases on palms and soles, mucosa darkening.
Edema: Presence of excess interstitial fluid causing swelling, shininess, and tautness in skin. Blanching might occur or if inflammation is present reddening will show. Generalized edema suggests impaired venous circulation and possibly cardiac dysfunction or venous abnormalities.

Primary Lesions: Appear by change in external or internal environment of the skin.
Secondary Lesions: Result from complications of primary lesions (trauma or infection).
Types of lesions noted include different types and shapes of flat or raised lesions, with or without fluid.

Shape, angle between fingernail and nail bed, texture, color, and intact tissues around nails are key components.
The normal angle between the nail and nail bed is 160 degrees

Clubbing: indicates chronic hypoxia (flat or rounded base, not concave).
Cyanosis: May be present in the nail bed, indicating poor perfusion and potential underlying vascular insufficiency.
Splinter hemorrhages: Tiny longitudinal streak hemorrhages under the nails.
Pitting: Tiny indentations in the surface of the nail (feature of psoriasis).
Onycholysis: Premature lifting of the nail.
Leukonychia: White discoloration of the nail (can be a sign of low albumin or chronic ill health).

Beau's lines: Transverse depressions in the nail associated with arrested nail growth, usually during an acute illness.
Paronychia - Infection of the skin adjacent to the nail (pain, swelling, redness, and tenderness).
Koilonychia: Spooning (concave indentation) of the nail (associated with severe iron deficiency).
Clubbing nails: Increase in curvature of the nails (leads to a loss of the diamond-shaped appearance).
Onychomycosis: fungal nail infection (thickening, opaqueness, crumbling, and yellowing).
Anonychia (absence of nails).