Physical Assessment of the Integumentary System

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Physical Assessment of the Integumentary System
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• Integument means covering.
• The skin and its accessory organs, hair, nails
  and glands comprise the integumentary system of
  the body.
• The skin is composed of several different tissue
  types and is considered an organ .

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Functions of the Integument

• Protection
• Physical Barrier
• Perception
• Temperature Regulation
• Identification
• Communication

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Functions of the Integument continued

• Wound Repair
• Absorption
• Excretion
• Vitamin D Production

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The Three Layers of the Integument

• Epidermis - the outermost layer of the skin, made
  of stratified squamous epithelium .
• Dermis - the inner layer of the skin, made of
  dense fibrous connective tissue .
• Subcutaneous tissue - thick, fat-containing
  tissue. Below the skin the tissues between the
  dermis and the muscles.

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Epidermal Appendages

• Hair is threads of keratin
• Sebaceous glands secrete the oil, sebum
• Sweat glands
• Eccrine glands secrete sweat
• Apocrine glands secrete thicker, milky secretion
  as in anogenital, nipples, and illae areas
• Nails are hardened keratin

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Receptors in the skin

• The sensory receptors in the dermis are for
  cutaneous sensations which include touch,
  pressure, heat, cold, and pain.
• The purpose of sensory receptors is to provide
  the CNS with information about the external
  environment and its effect on the skin.

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Interview

• Chief Complaint
• Recent Changes
• Pruritus (itching)
• Dryness (xerosis)
• Rashes (identify primary site, migration,
  pattern and evolution
• Lesions
• Ecchymoses (bruising)
• Masses or lumps
• Symptom analysis
• Pages 225-229, Jarvis

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Interview (cont.)

• Past Health History
• Example
• Immunologic, Endocrine, Collagen, Vascular,
  Renal, Hepatic
• Previous exposure to insects, infectious disease
• Previous trauma surgical intervention
• History of past allergic reactions

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Interview (cont.)

• Medications
• Sensitivities
• Photosensitizing drugs
• Ask about self treatment with herbal remedies
• Allergies
• Medications Foods

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Interview (cont.)

• Family Health History
• Helps determine genetic predisposition to skin
  disorders
• Psychosocial History
• Particularly important in long-term chronic
  processes.
• Determine correct any misconceptions about skin
  problems.

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Interview (cont.)

• Diet
• Excessive dryness may indicate Vitamin A
  deficiency.
• Occupation Travel
• What have they been exposed to.
• Habits
• Frequency of hygiene practices.
• Exercise Sleep Patterns
• Affects circulation, nourishment, repair of the
  skin.
• Is there prolonged exposure to sun, unusual cold,
  or other skin damaging conditions.

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Dermatologic Assessment History

• Chief complaint
• Definition of problem (onset, location)
• Duration
• Accompanying manifestations
• Evolution of lesion or eruption
• Aggravating relieving factors

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Dermatologic Assessment History

• Medical intervention
• Self-treatment
• Compliance treatment factors

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Preparation for the Physical Examination

• Strong direct lighting, natural sunlight is best
• Small centimeter ruler
• Penlight
• Gloves
• Woods light (ultraviolet light) may be needed
  for special procedures

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Inspection

• Color, Page 249 Jarvis
• Pallor
• Cyanosis
• Erythema
• Jaundice
• Document presence of tattoos
• General pigmentation
• Areas of hypopigmentation or hyperpigmentation
• Abnormal color changes

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Hair and scalp Inspection

• Inspect distribution quality
• Texture
• Inspect the Scalp
• Lesions
• Excoriations
• Lumps
• Bruises
• Lice

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Nails

• Color, Shape Contour
• Texture
• Integrity
• Thickness
• Capillary refill

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Palpation

• Temperature
• Assess with dorsum of hand
• Warmth reflects circulation
• Compare sides
• Moisture
• Refers to the skins hydration level in terms of
  both wetness oiliness
• Diaphoresis, dehydration
• Texture
• Should feel smooth, soft, resilient

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Palpation continued

• Tenderness
• Thickness
• Callus
• Atrophic
• Edema
• Not a normal finding
• Common in some disorders
• Cardiovascular
• Renal failure
• Cirrhosis

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Edema grading

• May be pitting
• 1 Barely Visible
• 2 Indentation lt 5mm
• 3 Indentation of 5 to 10mm
• 4 Indentation of 10mm or gt

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Palpation continued

• Turgor
• Reflection of skins elasticity hydration
• Turgor is decreased (less elasticity) as the skin
  tents and stands by itself
• Hygiene, odor
• Vascularity or bruising

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Lesion Types

• Types of Lesions
• Primary - those developing from previously
  unaltered skin
• Secondary those which develop over time because
  of a factor such as scratching or infection

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If any Lesions present, note the

• Color
• Shape and configuration
• Size
• Elevation
• Excudate
• Location and distribution
• Table 12-3 to 12-11, pages 250-265, Jarvis

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Self-Care Behaviors

• Teach skin self-examination, using the ABCDE rule
• Aasymmetry
• Bborder
• Ccolor
• Ddiameter
• Eelevation and enlargement

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Developmental Considerations

• Infants
• Lanugo (fine downy hair) from 3 months gestation
  to a few months after birth
• Thin, smooth, highly permeable and elastic skin
• Increased sebum through the first few weeks of
  life
• Temperature regulation inefficient

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Developmental Considerations

• Aging Adults
• Skin loses elasticity and underlying fat reserves
• Vascularity diminishes
• Decreased response of sweat glands
• Lifetime of environmental trauma
• Wound healing decreased
• Melanocytes decreases melanin production
• Loss of self-esteem

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