Chapter 11 Skin, Hair, and Nails Assessment

Skin Functions

• Protects from the environment
• Prevents penetration
• Temperature regulation from heat and cold
• Absorption and excretion
• Wound repair
• Perception (sensory surface): touch, pain, temperature, pressure
• Aids in production of vitamin D from UV light

Skin Layers

• Epidermis: outermost layer, first line of defense against pathogens, chemical irritants, and moisture loss
• Consists of keratinocytes, melanocytes, Langerhans cells, Merkel cells, and inflammatory cells
• Specialized cells: pain, light touch, vibration, temperature, and detection of foreign antigens
• Dermis: supports epidermis, contains blood vessels, nerves, sebaceous glands, lymphatic vessels, hair follicles, and sweat glands
• Subcutaneous layer: provides insulation, storage of caloric reserves, and cushioning against external forces, composed mainly of fat and loose connective tissue

Hair

• Appendage of skin
• Functions: protection, insulation, conduit of sensory stimulation to nervous system, and contributes to gender identification
• Produced by hair follicles located in dermis, composed of keratin
• Vellus and terminal hair
• Arrector pili muscles
• Sebaceous glands

Nails

• Epidermal appendages near distal portions of each finger and toe
• Composed of hardened keratin
• Nail bed
• Border: lateral and proximal folds of skin

Glands

• Sudoriferous glands: produce sweat to maintain normal body temperature
• Types: Eccrine glands (secrete weak saline solution) and Apocrine glands (secrete thicker, milky sweat)
• Sebaceous glands: open into hair follicles, secrete sebum, assists with moisture retention and friction protection

Skin Changes in Older Adults

• Gradually loses elastin, collagen, and subcutaneous fat, resulting in thinner skin
• Decreased resilience, sagging and wrinkling of skin
• Increased visibility and fragility of superficial vascular structure
• Prone to increased bruising, tears, and shearing injuries
• Turgor decreases
• Increased risk of skin breakdown
• Decreased melanin production; tissue replacement slows
• Sun damage more apparent

Cultural Variations and Health Disparities

• Cultural beliefs and practices: head covering, need for chaperone
• Difference in hair, skin, sebum secretion, growths, keloids, traction alopecia, congenital dermal melanocytosis
• Birthmarks; café au lait spots
• Tattoos, body piercings, and other skin adornments
• Cupping, coining, therapeutic burning
• Pityriasis rosea

Skin Assessment

• Subjective data collection: history and risk factors, past medical history, lifestyle and personal habits, medications/allergies, family history
• Objective cues: equipment, examination gown, tape measure, adequate light source, magnifying glass, preparation, and consideration for cultural concerns
• Inspection: skin over each body area and over pressure points, fingernails and toenails, wounds
• Palpation: skin
• Inspection: hair
• Inspect entire body thoroughly
• Skin cancer screen: comprehensive skin assessment, inspection, palpation, skin temperature, moisture and texture, turgor, vascularity, lesions, fingernails, toenails, hair

Skin Cancer

• Most common of cancer
• Causes: UV radiation, genetic predisposition
• Three types: basal cell carcinoma, squamous cell carcinoma, melanoma
• Cultural variations: Asians are less susceptible, African Americans, Asians, and Hispanics are susceptible to melanoma
• Asians and African Americans tend to present with more advanced disease at diagnosis
• Risk factors: sun exposure, nonsolar sources of ultraviolet radiation, medical therapies, male gender, chemical exposure, family history and genetic susceptibility, moles, long-term skin inflammation or injury, alcohol intake, smoking, pigmentation irregularities, fair skin that burns and freckles easily, light hair, age, inadequate niacin in diet, Bowen disease, depressed immune system, actinic keratosis, human papillomavirus, xeroderma pigmentosum

Pressure Ulcer Risk Factors and Stages

• Risk factors: perception, neurological disease, mobility, moisture, nutrition, friction or shear against surfaces, immobility, tissue tolerance decreased, poor nutrition, ischemia, anemia
• Stages: stage I, stage II, stage III, stage IV, unstageable
• Occur over bony prominence: sacrum, heel, elbow, ischium

Test your knowledge on skin, hair, and nails assessment with a focus on skin functions, epidermis layers, and their roles in protection and sensory perception.