The Integumentary System

1. The Integumentary System Dr. Zyad Saleh J U School of Nursing

2. History of Present Health Concern Concerning Symptoms • rashes, • lesions, • dryness, • oiliness, • drainage, • bruising, • swelling, • or changes in skin color

3. History of Present Health Concern birthmarks or moles • describe them. • changed color, size, or shape •  A change in the appearance or bleeding  indicate cancer. • Asymmetry, irregular borders, color variations, diameter greater than 0.5 cm, and elevation are  cancerous lesions.

4. History of Present Health Concern • change in your ability to feel pain, pressure, light touch, or temperature variations •  vascular or neurologic problems  put the client at risk for developing pressure ulcers.

5. History of Present Health Concern • experiencing any pain, itching, tingling, or numbness • Pruritus allergies, lice, insect bites • Abnormal sensations of tingling, or burning  paresthesia. • Numbness or dulling of the sensations of pain  peripheral neuropathy.

6. History of Present Health Concern • taking any medications  assess the time period of taking medication

7. History of Present Health Concern • trouble controlling body odor • Uncontrolled body odor or excessive or insufficient perspiration •  an abnormality of the sweat glands or an endocrine problem such as hypothyroidism or hyperthyroidism. •  Poor hygiene practices

8. History of Present Health Concern • hair loss or change in the condition of hair •  Patchy hair loss  infections, • Generalized hair loss  systemic illnesses • male pattern baldness  aging.

9. History of Present Health Concern • change in the condition or appearance of nails • Nail changes  systemic disorders such as malnutrition • Bacterial infections  green, black, or brown nail discoloration. • Yellow, thick, crumbling nails  fungal infections. • white color and separation of the nail plate from the nail bed  Yeast infections.

10. Personal Health History • recall having severe sunburns as a child  risk factor for skin cancer • previous problems with skin, hair, or nails, including any treatment or surgery and its effectiveness. • recent hospitalizations or surgeries • any allergic skin reactions • a fever, nausea, vomiting, gastrointestinal (GI), or respiratory problems • Are you pregnant?

11. Family History • recent illness, rash, or other skin problem or allergy • skin cancer • history of keloids

12. Lifestyle and Health Practices • sun or tanning-booth exposure  type of protection used • perform skin self-examination • regularly exposed to chemicals that may harm the skin • spend long periods of time sitting or lying in one position • exposure to extreme temperatures • body piercings • tattoos

13. Lifestyle and Health Practices • routine for skin, hair, and nail care  products use Decreased flexibility and mobility • foods consume in a typical day • fluid drink each day • a history of smoking and/or drinking alcohol • skin problems  limit normal activities • skin disorder prevents from enjoying relationships. • stress

14. Physical Examination • SKIN: INSPECTION • general skin coloration.: evenly colored skin tones without unusual or prominent discolorations. • Cyanosis  blue-tinged, especially in the perioral, nail bed, and conjunctival areas. • Pallor (loss of color)  arterial insufficiency, decreased blood supply, and anemia

15. Physical Examination • SKIN: INSPECTION • general skin coloration.: • Jaundice  yellow skin tones, from pale to pumpkin, particularly in the sclera, oral mucosa, palms, and soles.

17. Physical Examination • SKIN: INSPECTION • color variations..: • Common variations include suntanned areas, freckles, or white patches known as vitiligo • Abnormal findings • Erythema (skin redness and warmth) • rashes

18. Physical Examination • SKIN: INSPECTION • inspecting any odors emanating from the skin: • A strong odor of perspiration or foul odor disorder of sweat glands and Poor hygiene practices

19. Physical Examination • SKIN: INSPECTION • Check skin integrity.: Pay special attention to pressure point areas • Skin is intact, and there are no reddened areas. • Skin breakdown is initially noted as a reddened area on the skin that may progress to serious and painful pressure ulcers

20. Physical Examination

21. Physical Examination • SKIN: INSPECTION • Inspect for lesions. • Note color, shape, and size of lesion. • Note its location, distribution, and configuration. • Normal: Skin is smooth, without lesions. Stretch marks (striae), healed scars, freckles, moles, or birthmarks

22. Physical Examination • SKIN: INSPECTION • Inspect for lesions. • Distribution: • diffuse (scattered all over), • localized to one area, or in sun-exposed areas. • Configuration: • discrete (separate and distinct), • grouped (clustered), • confluent (merged), • linear (in a line), • annular and arciform (circular or arcing), • or zosteriform (linear along a nerve route)

23. Physical Examination • SKIN: PALPATION • Palpate skin to assess texture. • Skin is smooth and even. • 2. Palpate to assess thickness.. • normally thin • calluses (rough, thick sections of epidermis)  exposed to constant pressure.

24. Physical Examination • SKIN: PALPATION • Palpate lesions for size, mobility, consistency, and tenderness. Observe for drainage or other characteristics. • Infected lesions may be tender to palpate. • Nonmobile, fixed lesions may be cancer.

25. Physical Examination • SKIN: PALPATION • Palpate to assess moisture. • Skin surfaces vary from moist to dry depending on the area assessed and environment • Increased moisture or diaphoresis • Decreased moisture occurs with dehydration • Clammy skin is typical in shock or hypotension.

26. Physical Examination • SKIN: PALPATION • Palpate to assess temperature.. • normally a warm temperature. • Cold skin may accompany shock or hypotension. • Cool skin may accompany arterial disease. • Very warm skin may indicate a febrile state.

27. Physical Examination • SKIN: PALPATION • Palpate to assess mobility and turgor. • Mobility refers to how easily the skin can be pinched. • Turgor refers to the skin’s elasticity and how quickly the skin returns to its original shape after being pinched. • Normally, the skin is mobile, with elasticity and returns to original shape quickly. • Decreased mobility is seen with edema. • Decreased turgor (taking longer than 30 seconds) is seen in dehydration.

28. Physical Examination • SKIN: PALPATION • Palpate to detect edema. • Normally, Skin rebounds and does not remain indented when pressure is released.. • Indentations on the skin

29. Edema Scale 1 + Mild pitting, slight Indentation / 2mm 2 + Moderate pitting, indentation subsides quickly / 4mm 3 + Deep Pitting, indent remains for a short period leg looks swollen / 6 mm 4 + Very Deep Pitting, indent lasts a long time. leg is very swollen /8 mm

30. Physical Examination • Scalp and Hair: INSPECTION AND PALPATION • Inspect the scalp and hair for general color and condition. • Nutritional deficiencies  patchy gray hair in some clients. • Severe malnutrition in African American children  a copperred hair color

31. Physical Examination • Scalp and Hair: INSPECTION AND PALPATION • inspect and palpate the hair and scalp for cleanliness, dryness or oiliness, parasites, and lesions • Normally, Scalp is clean and dry. • dandruff may be visible. • Hair is smooth and firm, somewhat elastic. • Excessive scaliness dermatitis. • Raised lesions  infections or tumor growth. • Dull, dry hair  hypothyroidism and malnutrition. • Pustules with hair loss in patches  fungal disease • folliculitis

32. Physical Examination • Scalp and Hair: INSPECTION AND PALPATION • Inspect amount and distribution of scalp, body, axillae, and pubic hair. • Normally, Fine vellus hair covers the entire body except for the soles, palms, lips, and nipples. • Normal male pattern balding is symmetric • Excessive generalized hair loss infection, nutritional deficiencies, hormonal disorders, thyroid or liver disease, drug • Patchy hair loss  infections of the scalp • Hirsutism (facial hair on females)  Cushing’s disease

33. Physical Examination • Nails: INSPECTION • Inspect nail grooming and cleanliness. • Inspect nail color and markings. • Normally, Pink tones should be seen. • Pale or cyanotic nails  hypoxia or anemia. • Splinter hemorrhages  trauma. • Yellow discoloration  fungal infections

34. Physical Examination • Nails: INSPECTION • Inspect shape of nails. • Normally, a 160-degree angle between the nail base and the skin. • Early clubbing (180-degree angle with spongy sensation) and late clubbing (greater than 180-degree angle)  hypoxia.

36. Physical Examination • Nails: PALPATION • Palpate nail to assess texture.. • Normally, Nails are hard and basically immobile. • Thickened nails (especially toenails)  decreased circulation,

37. Physical Examination • Nails: PALPATION • Palpate to assess texture and consistency, noting whether nail plate is attached to nail bed. • Normally, Nails are smooth and firm; nail plate should be firmly attached to nail bed. • Detachment of nail plate from nail bed  infections or trauma.

38. Physical Examination • Nails: PALPATION • Test capillary refill in nail beds • Normally, Pink tone returns immediately to blanched nail beds when pressure is released. • There is slow (greater than 2 seconds) capillary nail bed refill (return of pink tone) with respiratory or cardiovascular diseases that cause hypoxia..

39. Types of skin lesions (macules, papules, vesicles). Macule: Change in color Flat Less than 1 cm Ex: Freckles

40. Papules: Something you can feel – elevation Less than 1 cm Ex: mole Vesicles: Elevated Contain fluid about 1 cm

41. Scar: Fibrosis after healing of a wound Fissure: Linear crack Abrupt edges Dry or moist

42. Erosion: Shallow depression Superficial Moist No bleeding Ulcer: Deeper depression Irregular Bleed