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    Assessment of Skin

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    Azeem
    The document provides guidelines for assessing the skin through collecting a health history and conducting a physical examination, describing the components and layers of normal skin, outlining the process and equipment used for examination, and listing examination procedures and normal and abnormal physical findings.

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    Assessment of Skin

    Uploaded by

    Azeem
    32 views22 pages
    The document provides guidelines for assessing the skin through collecting a health history and conducting a physical examination, describing the components and layers of normal skin, outlining the process and equipment used for examination, and listing examination procedures and normal and abnormal physical findings.

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    Assessment of skin

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    The document provides guidelines for assessing the skin through collecting a health history and conducting a physical examination, describing the components and layers of normal skin, outlining the process and equipment used for examination, and listing examination procedures and normal and abnormal physical findings.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    32 views22 pages

    Assessment of Skin

    Uploaded by

    Azeem
    The document provides guidelines for assessing the skin through collecting a health history and conducting a physical examination, describing the components and layers of normal skin, outlining the process and equipment used for examination, and listing examination procedures and normal and abnormal physical findings.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    ASSESSMENT OF SKIN

    Prepared by
    Bushra Ikram
    (Lecturer) FUCN
    OBJECTIVES
    • Describe the component of health history that should be elicited
    during the assessment of Skin
    • Describe specific assessments to be made during the physical
    examination of the above systems.
    • Document findings.
    Review the Anatomy and Physiology of
    skin
    • The skin is primarily made up of three layers. 
    • Epidermis
    • Dermis
    • subcutaneous tissue (deepest layer) .
    • The epidermis, the outermost layer of skin,
    provides a waterproof barrier and contributes to skin tone
    COLLECTING OBJECTIVE DATA:
    PHYSICAL EXAMINATION
    • Preparing the Client
    • To prepare for the skin, hair, and nail examination, ask the client to
    remove all clothing and jewelry and put on an examination gown
    • Have the client sit comfortably on the examination table or bed for
    the beginning of the examination
    • To assess the skin on the buttocks and dorsal surfaces of the legs
    properly, the client may lie on her side or abdomen.
    • During the skin examination, ensure privacy by exposing only the
    body part being examined.
    COLLECTING OBJECTIVE DATA:
    PHYSICAL EXAMINATION
    • Sunlight is best for inspecting the skin. However, a bright light that can
    be focused on.
    • Explain what you are going to do, and answer any questions the client
    may have.
    • Wear gloves when palpating any lesions because you may be exposed
    to drainage
    • Respect the client’s modesty or desire for privacy, provide a long
    examination gown or robe.
    Equipment
    • Examination light
    • Penlight
    • Mirror for client’s self-examination of skin
    • Magnifying glass
    • Centimeter ruler
    • Gloves
    • Wood’s light
    • Examination gown or drape
    • Braden Scale for Predicting Pressure Sore Risk
    • Pressure Ulcer Scale for Healing (PUSH) tool to measure
    Physical Assessment
    • When preparing to examine the skin, hair, and nails,
    remember these key points:
    • Inspect skin color, temperature, moisture, texture.
    • Check skin integrity.
    • Be alert for skin lesions.
    • Evaluate hair condition; loss or unusual growth.
    • Note nail bed condition and capillary refill.
    PHYSICAL ASSESSMENT- Skin
    Assessment procedure Normal findings Abnormal findings
    Inspection Inspection reveals Pallor (loss of color) is seen in arterial insufficiency,
    Inspect general skin coloration evenly colored skin decreased blood supply, and anemia. Pallid tones vary
    Keep in mind that the amount tones without from pale to ashen without underlying pink.
    of unusual or Cyanosis may cause white skin to appear blue-tinged,
    pigment in the skin accounts for prominent especially in the perioral, nail bed, and conjunctival areas.
    the intensity of color as well as discolorations. Dark skin may appear blue, dull and lifeless in the same
    hue. Small amounts of areas.
    melanin are Central cyanosis results from a cardiopulmonary problem
    common in whiter whereas peripheral cyanosis may be a local problem
    skins, while large resulting from vasoconstriction.
    amounts of Jaundice in light- and dark-skinned people is characterized
    melanin are by yellow skin tones, from pale to pumpkin, particularly in
    common in darker the sclera, oral mucosa, palms, and soles.
    skins.. Acanthosis nigricans is roughening and darkening of skin
    in localized areas, especially the posterior neck
    PHYSICAL ASSESSMENT

    Assessment procedure Normal findings Abnormal findings


    While inspecting skin coloration, Client has slight or no odor of A strong odor of perspiration or
    note any odors emanating from perspiration, depending on foul odor may indicate disorder
    the skin. activity. of sweat glands. Poor hygiene
    practices may indicate a need
    for client teaching or assistance
    with activities of daily living.
    PHYSICAL ASSESSMENT
    Assessment procedure Normal findings Abnormal findings
    Inspect for color variations. Keep in mind that some clients have Abnormal findings include rashes, such as
    Inspect localized parts of the suntanned areas, freckles, or white the reddish (in light-skinned people) or
    body, noting any color patches known as vitiligo. The variations darkened (in dark-skinned people) butterfly
    variation. are due to different amounts of melanin rash across the bridge of the nose
    in certain areas. A generalized loss of and cheeks, characteristic of discoid lupus
    pigmentation is seen in albinism. Dark- erythematosus (DLE).
    skinned clients have lighter-colored Albinism is a generalized loss of
    palms, soles, nail beds, and lips. Freckle pigmentation.
    like or dark streaks of pigmentation are Erythema (skin redness and warmth) is seen
    also common in the sclera and nail beds in inflammation, allergic reactions, or
    of dark-skinned clients. trauma.
    PHYSICAL ASSESSMENT

    Assessment procedure Normal findings Abnormal findings


    Check skin integrity, especially Skin is intact, and there are no Skin breakdown is initially noted as a
    carefully in pressure point areas. reddened areas. reddened area on the skin that may
    Use the Braden Scale to predict progress to serious and painful pressure
    pressure sore risk. If any skin ulcers.
    breakdown is noted, use the Depending on the color of the client’s
    PUSH tool to document the skin, reddened areas may not be
    degree of skin breakdown. prominent, although the skin may feel
    warmer in the area of breakdown than
    elsewhere.

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