Skin, Hair, and Nail

Assessment
 Skin
• Physical barrier that protects the
underlying structures from
microorganisms, physical trauma,
ultraviolet, radiation and dehydration.
• body's first line of defense
 Vital role of the Skin
• Temperature maintenance
• Fluid and electrolyte balance
• Absorption
• Excretion
• Sensation
• Immunity
• Vitamin D synthesis
• Identity of a person
 Three layers of skin

• Epidermis
• Dermis
• Subcutaneous tissue
 Epidermis
• Outer layer of the skin
• Composed of:
– Stratum corneum
– Stratum lucidum
– Stratum granulosum
– Stratum spinosum
– Stratum germinativum
 Stratum corneum
• the outermost layer of the epidermis,
composed of large, flat, polyhedral, plate-
like envelopes filled with keratin, which is
comprised of dead cells that have
migrated up from the stratum granulosum.
• contain keratin - a protein that helps keep
the skin hydrated by preventing water
evaporation.
 Stratum Lucidum
• a layer of the epidermis found only in
palmoplantar skin (the thicker skin of the
palms and soles), between the
stratum granulosum and stratum corneum
layers.
 Stratum granulosum
• A layer of granular cells interposed
between the stratum corneum and the
stratum germinativum in the thick skin of
the palms and soles.
 Stratum spinosum
• a layer of the epidermis found between the
stratum granulosum and stratum basale
• also referred to as the "spinous" or
"prickle-cell" layer
 Stratum Germinativum
• the deepest layer of the epidermis, a
continuous layer of cells often described
as one cell thick,
• considered the "stem cells" of the
epidermis
• Only layer that undergoes cell division and
contains melanin (brown pigment) and
keratin forming cells.
 Dermis
• Inner layer of the skin
• It is connected to the epidermis by means of
papilae(base of ridges that forms the pattern of
fingerprints with which we are familiar)
• Well-vascularized connective tissue layer
containing collagen and elastic fibers, nerve
endings,
• Origin of hair follicles, sebaceous glands and
sweat glands.
 Subcutaneous tissue
• layer of fat that lies between the dermis of the
skin and underlying fascia
• insulates the body, absorbs trauma, and is a
reserve energy source. Assist with heat
regulation. Pathways for supply of nutrients
and removal of waste product from the skin.
• Loose connective tse containing fat cells,
blood vessels, nerves and the remaining
portion of the sweat glands and hair follicles
 Fascia-responsible for maintaining structural
integrity; for providing support and protection;
and acts as a shock absorber
 Sebaceous gland
• It is develop from hair follicles
• They secrete oily substance called Sebum
–which lubricates hair and skin and
reduces water loss through the skin. also
has fungicidal and bactericidal effect.
• abundance on the face and scalp .
 Sweat Glands
• exocrine glands, found in the skin
• used for body temperature regulation
• Has two types
– Eccrine- located over the entire skin surface
and secrete an odorless, colorless fluid
– Apocrine-concentrated in the axillae,
perineum and areolae of the breast, usually
open through hair follicle.It secrete a milky
sweat. Dormant until puberty. Linked with
menstrual cycle.
Hair
• It consists of layers of keratinized cells
and is found over much of the body,
except for the lips, nipples, soles of the
feet, palms of the hands, labia minora and
penis.
• Develops within a sheath of epidermal cells
called hair follicle
• Growth occurs at the base of the follicle
• Hair shaft- it is visible above the skin
• Hair root-is surrounded by the hair follicle
• Erector pili muscles-Muscle in the dermis which
raises hair, improving heat retention in the body
by trapping a layer of air on the skin surface
• Hair color- it varies and determined by the
amount of pigment production. hair functions-
scalp as protective covering, nasal hair, ear hair,
eyelashes and eyebrows filter dust and airborne
debris.
 Two general types of hair
• Vellus
– Hair is short, pale and fine present over much
in the body.
• Terminal-
– Hair is longer, darker, and coarser
Nails
 nails
• Located on the distal phalanges of fingers
and toes
• Hard transparent plates of keratinized
epidermal cells
 Parts of the Nail
• Eponychium or cuticle- the fold of skin at the
proximal end of the nail.
• Paronychium- the fold of skin on the sides of the
nail.
• Hyponychium- the attachment between the skin of
the finger or toe and the distal end of the nail
• Nail plate -the hard and translucent portion,
composed of keratin.
• Nail bed -the adherent connective tissue that
underlies the nail.
• Lunula -the crescent-shaped whitish area of the nail
bed (when visible)
• proximal end of the nail, concealed under a fold of
skin
 Preparing the Client
• Ask the client to remove all clothing (expose only
the body part being examine) and jewelry and
put on an examination gown
• Ask the client to remove the nail enamel,
artificial nails, wigs, toupees, hairpieces as
appropriate.
• Make sure that the room has comfortable
temperature.
• Sunlight is best for inspecting the skin.
• Provide privacy
 Equipment
• Examination light
• Penlight
• Mirror for client’s self-examination of skin.
• Magnifying glass
• Centimeter ruler
• Gloves
• Wood’s light
• Examination gown or drape
 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.
Skin color
Sample images
Pressure ulcers
Stage I
Stage II
Stage III
Stage IV