Chapter Objectives:

  1. Obtain a health history of the integumentary system.
  2. Describe variations of normal findings of the integumentary system
  3. Describe common lesions of the skin, hair, and nails.
  4. Perform physical assessment of the integumentary system using correct techniques of assessment.
  5.  Document the integumentary system assessment

I. Overview of Assessment of the Hair, Skin and Nails

The assessment of the integumentary system which includes the skin, hair and nails is an important element of the nurse’s assessment of the patient’s health status. These body structures do have specific functions but they also reflect functions or dysfunctions of other body systems as well. This chapter presents important concepts that will prepare the nurse to assess the patient’s integumentary system.

II. Review of Anatomy and Physiology

Knowledge of anatomy and physiology of body systems is essential to the assessment process as the nurse compare normal expected findings and patient manifestations. Open the following resources to review foundational concepts:

Anatomy and Physiology of the Integumentary System

Nail-Anatomy.pdf

III. Medical Terminology: 

Open the link below and learn the definitions of the terms below:

Medical terminology: Integumentary System

Macule

Papule

Nodule

Cyst

Ecchymosis

Cyanosis

Excoriation

Fissure

Ulcer

Vesicle

Pustule

IV. Integumentary system  focused Assessment

This is usually not a specific step, but evaluating the skin, hair, and nails is an ongoing element of a full  body assessment . In certain instances, a comprehensive or focused skin assessment must be performed, such as assessing risk factors for pressure ulcers.

Skin, hair, and nails:

  • Obtain health history:
  • If the patient presents with complaints regarding skin, hair and nails, perform a symptom analysis (OLDCARTS)
  • Review related medical, surgical and family history
  • Review risk factors related to problems with skin, hair and nails
  • Inspect for lesions, bruising, and rashes.
  • Palpate¬†skin for temperature, moisture, and texture.
  • Inspect¬†for pressure areas.
  • Inspect skin for edema.
  • Inspect scalp for lesions and hair and scalp for presence of lice and/or nits.
  • Inspect¬†nails for consistency, colour, and capillary refill.
Check for and follow up on the presence of lesions, bruising, and rashes.Variations in skin temperature, texture, and perspiration or dehydration may indicate underlying conditions.Redness of the skin at pressure areas such as heels, elbows, buttocks, and hips indicates the need to reassess patient’s need for position changes.

Unilateral edema may indicate a local or peripheral cause, whereas bilateral-pitting edema usually indicates cardiac or kidney failure.

Check hair for the presence of lice and/or nits (eggs), which are oval in shape and adhere to the hair shaft.

V. Documentation

VI. Related Laboratory Tests and Diagnostic Procedures

 

VII. Learning Activities: This video provides NCLEX style questions to assess your knowledge of integumentary system assessment:

https://www.youtube.com/watch?v=LGf0YXKzxWI

VIII. Citations and Attributions

License

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Guide to Health Assessment for Nurses Copyright © by Raki Bertiz and Ching-Chuen Feng is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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