NUR111 Skin, Nail, Hair Assessment

Skin, Nail, Hair Assessment

• The lecture is given by Research Assistant Eda Nur YILMAZ
• Contact her at [email protected]
• The department is HSF /Nursing (English)
• The lecture is NUR111-Health Assessment

Technique and Normal Findings

• The following techniques are important for normal findings:
  • Inspection
  • Palpation

Subjective Data Collection

• Involves questions to assess history and risks
• It is important to assess family history, including whether any first-degree family members (parent, sibling, child) have a history of melanoma, identifying who had the problem, and determining if any first-degree relatives have multiple dark, irregular moles.
• Important to assess past history, to determine the presence of pigmented skin lesions, their quantity, location, and any changes (itching, bleeding, nonhealing, color, size, borders)
• Severe sunburns, especially during youth, are important to note
• Medication allergies should be noted, along with allergies to latex, nuts, bees, or other items, and reactions to sunscreen should be identified.
• Lifestyle, occupational history, and personal behaviors are relevant
• Important to ask about occupation, hobbies, exposure to excessive sunlight or other sources of radiation, and methods of sun protection.
• Assess the risk for skin breakdown and inquire about diabetes mellitus, peripheral vascular disease, or any known sensory loss.

Objective Data Collection

• Requires equipment, including:
  • Examination gown
  • Tape measure
  • Adequate light source
  • Magnifying glass

Technique-Inspection

• Inspect all body areas, starting with the head and progressing to the feet.
• Part hair to visualize the scalp.
• Assess the soles of the feet and separate the toes.
• Note general skin color.
• Normal findings include consistent body pigmentation, and patients with dark skin may have hypopigmented palms and soles
• If lesions are observed, identify morphology, configuration, distribution pattern, size, and exact location
• Common benign lesions include freckles, birthmarks, skin tags, moles, and cherry angiomas

Lesion Configurations

• Annular lesions are ring-like and circular
• Arciform lesions are half-ring shaped
• Linear lesions are line-shaped
• Polymorphous lesions have several different shapes
• Serpiginous lesions are curving and snake-like
• Nummular/Discoid lesions are coin-shaped
• Umbilicated lesions have a central depression
• Punctuate lesions are small, marked with points or dots
• Filiform lesions are papilla-like or finger-like projections similar to tongue papillae

Lesion Distribution Pattern

• Asymmetric distribution occurs solely on one side of the body
• Diffuse distribution occurs widely across the affected area without any pattern
• Localized distribution occurs at a distinct area
• Symmetric distribution occurs equally on both sides of the body

Skin Lesions

• Primary skin lesions, present at the disease onset, developing as a direct result of disease process
• Secondary skin lesions result from changes over time caused by disease progression, manipulation (scratching, picking, rubbing), or treatment, or evolve from primary lesions as a consequence of patient activities

Skin Lesions - Primary

• Macule: Freckles
• Papule: Mura
• Patch
• Plaque : Leve
• Nodule : Ben
• Vesicle: Kabarcık
• Bulla: Bl

Skin Lesions - Secondary

• Ulcer : Yara (denn)
• Crust
• Atrophy : Skin loss
• Scar : Yara izi
• Erosion
• Fissure : çizme

Skin Tumors and Growths

• Lipoma

  • Characterized as single or multiple tumors of different sizes comprising fat cells
  • Commonly found on the back of the neck, torso, arms, and legs
  • Though benign, some varieties are painful

• Lentigo

  • Benign, acquired, circumscribed, pigmented macules found generally on sun-exposed skin

• Squamous Cell Carcinoma

  • This is the second most frequent skin cancer
  • It is related to actinic keratosis and sun exposure, with lesions typically papular, modular, or plaques

• Kaposi Sarcoma

  • Opportunistic skin infection resulting from impaired immune status (e.g., AIDS)
  • Lesions occur on the nose, penis, and extremities; with advanced HIV, distribution may be generalized

• Basal Cell Carcinoma

  • Modular or papular skin cancer that appears shiny with a rolled pearly border, typically having small spider veins on its surface
  • Grows slowly and rarely metastasizes

Technique - Inspecting Wounds or Incisions

• First identify any infections, using infection-control principles
• Note any inflammatory lesions, growths, tumors, or vascular lesions
• If wounds or incisions are observed, note the shape and measure the length, width, and depth with a ruler
• For deep or tunneled wounds, use a cotton applicator to measure depth
• Describe wounds related to trauma and assess blood supply
• Look for any bleeding or ecchymosis (bruising)

Skin Inspection

• Identify risk for skin breakdown, especially important in hospitalized or inactive patients
• Classify the wound as partial or full-thickness
• If a pressure ulcer is present, identify the stage, size (depth and diameter), margins, condition of surrounding tissues, and any drainage, odor, or necrotic tissue
• Describe the color and texture of the tissue
• Identify the amount, color, consistency, and odor of exudate (drainage), using appropriate landmarks
• Assess for non-pressure ulcers and note the characteristics of the wound

Nail Inspection

• Inspect each fingernail and toenail for color, thickness, and consistency
• Normal nails are smooth, translucent, and consistent in color and thickness
• Longitudinal ridging is common in aging patients
• Longitudinal pigmentation in dark-skinned patients is a normal variant
• Assess the nail angle by having the patient place the fingernails of both index fingers together
• A diamond-shaped opening indicates a nail angle of at least 160 degrees

Hair Inspection

• Inspect the hair, noting the color, consistency, distribution, areas of hair loss, and the condition of the hair shaft
• Normal hair if equally and symmetrically distributed across the scalp
• Note any decreased or absent hair, scalp lesions, or color changes
• Healthy scalp is of consistent color with the body

Abnormal Hair Findings

• Alopecia Areata presents an autoimmune disorder with noninflammatory loss of hair in a circumscribed distribution.

Technique - Palpation

• The dorsal surface of the hands can assess skin temperature
• The palmar surface of the fingers and hands can assess skin moisture and texture
• Normal skin temperature is consistently warm or cool and appropriate to the environment
• Healthy skin has consistent moisture throughout, with evenly smooth texture
• To assess skin turgor, gently grasp a fold of the patient’s skin between your fingers and pull up
• Then note that skin promptly recoils to its normal position
• Assess for vascularity by applying direct pressure to the skin surface with the pads of the fingers
• When released, color promptly returns to normal
• Palpate lesions for tenderness, mobility, and consistency
• Palpate each fingernail and toenail to ensure they are smooth, nontender, and firmly adherent to the nail bed, without tenderness or swelling in the lateral and proximal folds
• To assess hair, grasp 10 to 12 hairs and gently pull, noting if only a few hairs are released

Documentation of Normal Subjective and Objective Findings

• The patient denies pruritus, skin lesions, and excessive dryness of the skin or changes to existing moles
• Skin is evenly colored, smooth, soft, consistently warm, with intact turgor
• There are no suspicious lesions
• The nails are smooth and translucent, with lateral and proximal folds without swelling or erythema
• The hair texture is smooth, symmetrically distributed on the scalp, consistently colored, and hydrated without evidence of excessive breakage or loss
• The scalp has consistent pigmentation and no lesions are noted