Skin Assessment Quiz

Motivational Activity

• Divide into three groups (a, b, and c) based on seating.
• Given words: SKIN, HAIR, NAIL
• Form sentences using the letters of the words to describe them. For example, LOVE - living out valuable emotions.

Skin, Hair & Nail Assessment

• Unit 3: Assessment of Health Status (Systematic Approach)
• Presented by Mrs. Keren Jones-Fraser, PhD candidate, MSCN, BSCN, Cert Ed, RN
• Objectives of the three-hour session include:
  • Outlining client preparation for assessment.
  • Describing the normal assessment findings of skin, hair, and nails.
  • Explaining the process of assessing client skin, hair, and nails.

Preparation

• Ensure appropriate environment: privacy, lighting, and ventilation.
• Have necessary equipment on hand at the start of the assessment.
• Ensure client comfort.

Procedure

• Introduce self and verify client identity.
• Explain the procedure and its importance to the client.
• Perform hand hygiene and observe appropriate infection control procedures (e.g., donning gloves if needed).
• Ask client to remove clothing, jewelry, and put on an examination gown. Expose only the body part to be examined.
• Request removal of wigs, toupees, hairpieces, nail enamel, or artificial nails.
• Position client appropriately.

COLDSPA

• Gather subjective data by questioning the client:
  • Character (Describe the sign/symptom, how does it feel, look, smell?).
  • Onset (When did it begin?).
  • Location (Where is it? Local or generalized?).
  • Duration (How long does it last? Does it recur?).
  • Severity (How bad is it?).
  • Pattern (What makes it better? What makes it worse?).
  • Associated factors (What other symptoms occur with it?).

Sample Questions

• Describe any skin problems (rashes, lesions, dryness, oiliness, drainage, bruising, swelling, or increased pigmentation).
• What aggravates the problem?
• What relieves the problem?
• Has the colour, size, or shape of any birthmarks, tattoos, or moles changed?
• Are you experiencing any pain, itching, tingling, or numbness?
• Is there any change in your ability to feel pain, pressure, light touch, or temperature?
• Have you ever received treatment for any skin problems (including surgery)?
• Have you ever had allergic skin reactions to medications, plants, food, or other substances?
• Has anyone in your family recently had an illness, rash, or other skin problem or allergy? If yes, please describe.
• Do you spend long hours in the sun?
• Have you ever had any hair loss or change in the condition of your hair? If yes, please describe.
• Have you had any change in the condition or appearance of your nails? If yes, describe.
• Are you regularly exposed to chemicals (including paint, bleach, cleaning products, petroleum)?

Equipment Needed

• Examination light
• Penlight
• Mirror for client self-examination of skin
• Magnifying glass
• Centimeter ruler
• Gloves
• Wood's light
• Examination gown or drape

Skin Assessment - Inspection

• General color (Normal: even skin tone or Abnormal: pale skin without underlying pink, cyanosis, jaundice)
• Abnormal findings: pallor, cyanosis, jaundice, acanthosis nigricans.
• Color variations (Normal: suntanned areas or freckles, or Abnormal: vitiligo, striae, rashes, albinism, erythema)
• Skin integrity (Normal: intact skin with no reddened areas or Abnormal: skin breakdown or reddened areas.)
• Pressure ulcers (stages 1-4)
• Lesions (Normal: absence of lesions, smooth skin, Abnormal: any abnormal growth or appearance compared to surrounding skin.)
• Texture (Normal: smooth and even or Abnormal: rough, flaky)

Skin Assessment - Palpation

• Texture (Normal: smooth, even skin, or Abnormal: rough, flaky)
• Thickness
  • Normal: Thin skin and/or calluses in pressure areas
  • Abnormal: Very thin skin from arterial insufficiency or steroid therapy
• Moisture (Normal: varies with warmth of environment, or Abnormal: profuse sweating [diaphoresis], clammy skin, or decreased moisture [dehydration])
• Temperature (Normal: warm skin, Abnormal: cold skin, hypotension or shock)
• Mobility and Turgor (Normal: skin returns immediately to original shape, or Abnormal: slow return, poor turgor, edema)
• Edema (grading scale 0+, 1+, 2+, 3+, and 4+).

Hair Assessment - Inspection

• General color and condition
  • Normal: Natural hair color, varying from pale blond to black to gray or white.
  • Abnormal: Nutritional deficiencies causing color changes (e.g., patchy gray to copper-red hair)
• Amount and distribution (normal vs. abnormal: Vellus hair [pre-pubertal] covers whole body except soles, and palms; terminal hair in scalp, axillary, body, and public areas varies by gender)
• Excessive generalized hair loss (due to infection, illness, nutritional deficiencies, chemotherapy, radiation treatment)

Hair Assessment - Palpation

• Cleanliness, dryness, or oiliness, parasites, and lesions
  • Normal: Clean, dry scalp, sparse dandruff may be visible, smooth, firm hair with some elasticity.
  • Abnormal: excessive scaliness, raised lesions, dull, dry hair, poor hygiene

Nail Assessment - Inspection

• Cleanliness and grooming
  • Normal: nails are clean and trimmed.
  • Abnormal: dirty, broken, or jagged nails (result from poor hygiene or occupation/hobby)
• Colour and markings
  • Normal: pink tones, longitudinal ridging, and freckles/pigmented streaks (especially in dark-skinned clients).
  • Abnormal: pale/cyanotic nails (hypoxia/anemia), splinter hemorrhages (trauma), Beau's lines after acute illness, yellow discoloration (fungal infection/psoriasis)
• Shape
  • Normal: 160-degree angle between the nail base and the skin.
  • Abnormal: 180+ degrees (early or late clubbing), spoon nails (concave) possibly iron deficiency anemia or hypoxia

Nail Assessment - Palpation

• Texture & Consistency
  • Normal: smooth, firm, firmly attached.
  • Abnormal: paronychia (nail bed inflammation), detachment of nail from nail bed
• Capillary Refill
  • Normal: rapid pink tone return to blanched nail bed after pressure release
  • Abnormal: slow return (2+ seconds) of pink tone