Physical Assessment ( Due maxomum 3 hours)

Edero2103

PPT_Ch09.pptx

Home >Nursing homework help >Physical Assessment ( Due maxomum 3 hours)

Chapter 9 The Integumentary System

Anatomy and Physiology

Provides a barrier

Regulates body temperature

Synthesizes vitamin D

Sensory perception

Provides nonverbal communication

Provides identity

Allows wound repair

Allows excretion of metabolic wastes

The Skin #1

The Skin #2

Layers

Epidermis

Superficial, thin, no blood vessels

Dermis

Blood vessels, connective tissue, sebaceous glands, sweat glands, hair follicles

Subcutaneous or adipose

Connects to underlying structures

The Skin #3

Pigments

Melanin

Carotene

Oxyhemoglobin

Deoxyhemoglobin

The Skin #4

Abnormal colors

Jaundice (yellowish color)

Deposition of bilirubin

Easier to observe in sclera, nails, palms, soles

Cyanosis (bluish color)

Lack of oxygen (central)

Lack of blood flow (peripheral)

Appendages #1

Hair

Vellus: short, fine, inconspicuous, unpigmented

Terminal: coarser, thicker, conspicuous, usually pigmented

Appendages #2

Nail

Protect distal ends of fingers and toes

Nail plate

Lunula

Cuticle

Glands

Sebaceous glands

Produce sebum

Lubricates hair and skin

Reduces water loss through skin

Sweat glands

Eccrine: widely distributed, open directly on surface, help control body temperature

Apocrine: in axillary and genital areas, stimulated by emotional stress, responsible for adult body odor

The Health History #1

Purpose to identify the following:

Diseases of the skin

Systemic diseases that have skin manifestations

Physical abuse

Risk for pressure ulcer formation

Risk for skin cancer

Need for health promotion education regarding the skin

The Health History #2

Common or Concerning Symptoms	Common or Concerning Symptoms
Rash	Lesions
Nonhealing lesions	Bruising (ecchymosis)
Moles	Hair loss
Growths	Nail changes

The Health History #3

Past history

Skin diseases

Diabetes or peripheral vascular disease

Allergies or food sensitivities

Burns or sunburns

Corticosteroid medications

Medication use

Immunization record

The Health History #4

Family history

Same or similar symptoms

Skin diseases

Allergies

The Health History #5

Lifestyle and personal habits

Bathing and shampooing routines

Change of products

Wear false nails or wigs

Go to nail salon or gym

Sun exposure

Skin self-examination

Exposure to chemicals or radiation

Diet

Question #1

The skin is recognized for performing which function?

A. Temperature control

B. Synthesizes vitamin K

C. Excretion of excessive electrolytes

D. Motor perception

Answer #1

The skin is recognized for performing which function?

A. Temperature control

The functions of the skin include synthesis of vitamin D from sunlight, provide a barrier of protection, regulate body temperature, sensory perception, provide identity, allow wound repair, and allow excretion of metabolic waste.

Physical Examination of Skin #1

Use natural or artificial light that resembles it.

Ensure patient is properly draped.

Inspect and palpate.

Color

Look for increased pigmentation, loss of pigmentation, or redness of skin.

Assess for cyanosis or pallor.

Assess for jaundice.

Skin Color Changes #1

Skin Color Changes #2

Skin Color Changes #3

Skin Color Changes #4

Skin Color Changes #5

Physical Examination of Skin #2

Moisture

Excessive dryness, sweating, oiliness

Should be dry to touch without flaking or cracking

Carefully inspect skin folds

Physical Examination of Skin #3

Temperature

Use back of hand

Note generalized warmth or coolness

Note increased temperature with erythema

Physical Examination of Skin #4

Texture

Roughness or smoothness

Mobility and turgor

Lift fold of skin.

Ease with which it lifts—mobility

Speed with which it returns into place—turgor

Physical Examination of Skin #5

Physical Examination of Skin #6

Edema

Excess fluid in interstitial spaces

Localized: injury

Systemic: most often in the dependent portions of body

Skin puffy and feels tight

Pitting: interstitial fluid mobile

Nonpitting: local infection or trauma; brawny edema

Physical Examination of Skin #7

Question #2

During your physical examination of the patient, you gently pinch the back of the hand. The skin remains in a “tent” shape and slowly returns to its normal position. This is a sign of:

A. Infection

B. Overhydration

C. Dehydration

D. Properly hydrated

Answer #2

During your physical examination of the patient, you gently pinch the back of the hand. The skin remains in a “tent” shape and slowly returns to its normal position. This is a sign of:

C. Dehydration

“Tenting” is a sign of poor turgor and occurs when a patient is dehydrated, often occurring with excessive vomiting, diarrhea, or heat-related situations. The patient should be further assessed for the need of intravenous fluids.

Physical Examination of Skin #8

Lesions

Color

Size

Elevation

Number

Texture

Type of skin lesions

Shape and Pattern

Anatomic location and distribution

Skin Lesions #1

Skin Lesions #2

Skin Lesions #3

Skin Lesions #4

Skin Lesions: Patterns and Shapes #1

Skin Lesions: Patterns and Shapes #2

Skin Lesions: Patterns and Shapes #3

Primary Skin Lesions (Initial Presentation) #1

Primary Skin Lesions(Initial Presentation) #2

Primary Skin Lesions(Initial Presentation) #3

Primary Skin Lesions(Initial Presentation) #4

Primary Skin Lesions (Initial Presentation) #5

Primary Skin Lesions (Initial Presentation) #6

Primary Skin Lesions (Initial Presentation) #7

Primary Skin Lesions (Initial Presentation) #8

Secondary Skin Lesions Overtreatment, Excess Scratching, Infection #1

Secondary Skin Lesions Overtreatment, Excess Scratching, Infection #2

Secondary Skin Lesions Overtreatment, Excess Scratching, Infection #3

Secondary Skin Lesions Depressed #1

Secondary Skin Lesions Depressed #2

Acne Vulgaris Primary Lesions

Acne Vulgaris Secondary Lesions

Vascular Lesions

Purpuric Lesions

Skin Tumors #1

Skin Tumors #2

Benign Nevi

Question #3

Vesicles in a unilateral dermatomal pattern are typical of:

A. Herpes zoster

B. Herpes simplex

C. Tinea capitis

D. Acne vulgaris

Answer #3

Vesicles in a unilateral dermatomal pattern are typical of:

A. Herpes zoster

Herpes zoster (also known as shingles) forms vesicles that follow a dermatome of the body, usually trunk. These usually occur on only one side of the body (unilateral).

Evaluating Patient With Decreased Mobility

Susceptible to skin damage and ulceration

Pressure sores

Sustained compression

Shearing forces from bodily movements

Easier to prevent than heal

Assessment tool: Braden scale for predicting pressure sore risk (pages 184–185)

Pressure Ulcers #1

Pressure Ulcers #2

Pressure Ulcers #3

Hair

Note quantity, distribution, and texture.

Inspect for lesions, flaking, and parasites.

Inspect body, axillae, and pubic hair.

Changes

Loss of hair on legs: peripheral artery disease

Changes in pubic or axilla: hormonal problems

Inquire about laser hair removal treatments.

Hair Loss #1

Hair Loss #2

Hair Loss #3

Nails #1

Inspect and palpate fingernails and toenails.

Note color, shape, and any lesions.

Should be pink with white lunulae

Smooth and firm in texture

Rounded in shape

Nails #2

Findings in or Near the Nails #1

Findings in or Near the Nails #2

Findings in or Near the Nails #3

Findings in or Near the Nails #4

Record Your Findings

May use sentences

May use phrases

Carefully record your findings

Health Promotion and Counseling

Important topics

Skin cancer prevention

Risk factors for skin cancers

Avoidance of excessive sun exposure and artificial tanning lamps

Use of sun screen

Skin Cancer

Basal cell carcinoma

Basal level of epidermis

80% of skin cancers, rarely metastasize

Squamous cell carcinoma

Upper layer of epidermis

16% of skin cancers, can metastasize

Melanoma

Arise from melanocytes in epidermis

4% of skin cancers, most lethal

Skin Tumors #3

Skin Tumors #4

Malignant Melanoma

Some Risk Factors for Melanoma #1

Personal or family history of previous melanoma

Atypical or dysplastic moles

Male gender

50 or more common moles

Red or light hair

Some Risk Factors for Melanoma #2

Light eye or skin color

Actinic keratoses, solar lentigines

Ultraviolet radiation from heavy sun exposure, sunlamps or tanning booths

Severe blistering sunburns as child

Immunosuppression from HIV or chemotherapy

Preventing Skin Cancer

Avoiding ultraviolet radiation and tanning beds

Intermittent sun exposure more harmful

Best defense—avoidance

Regular use of sunscreen prevents skin cancer

Recommend use of Sun Protective Factor (SPF) 30 and broad spectrum protection

Water exposure should use water-resistant sunscreen

Skin Cancer Screening

Clinician Screening

Remain alert during routine assessments

Full body examinations recommended for patients over 50

Take advantage of “opportunistic screening”

Skin Self-Examination #1

Equipment

Full-length mirror

Hand-held mirror

Well-lit room

Privacy

Skin Self-Examination #2

Examine body front and back in mirror, then right and left sides with arms raised.

Skin Self-Examination #3

Bend elbows and look carefully at forearms, upper underarms, and palms.

Skin Self-Examination #4

Look at back of legs and feet, the spaces between toes and the sole of feet.

Skin Self-Examination #5

Examine back of neck and scalp with hand mirror. Part hair for closer look.

Skin Self-Examination #6

Check back and buttocks with hand mirror.

ABCDE-EFGs of Examining Moles for Possible Melanoma #1

A: Asymmetry of one side of mole compared to other

B: Irregular borders, especially ragged, notched, blurred

C: Variation or change in color, especially black or blue

D: Diameter ≥6 mm or different from others, especially if changing, itching, or bleeding

E: Evolving, a mole or skin lesion that looks different from the rest or is changing in size, shape, or color

ABCDE-EFGs of Examining Moles for Possible Melanoma #2

Suggested adding EFG to help detect aggressive nodular melanomas

E: Elevated

F: Firm to palpation

G: Growing progressively over several weeks

Question #4

To prevent skin cancer, a sunscreen with a “skin protection factor” (SPF) of _____ is recommended.

A. 10

B. 20

C. 30

D. 40

Answer #4

To prevent skin cancer, a sunscreen with a “skin protection factor” (SPF) of _____ is recommended.

C. 30

An SPF of at least 30 and broad spectrum protection is recommended.