Assessing Skin, Hair, and

Nails
Structure and Function of Skin
• The skin is the largest organ of the body.
• The skin is a physical barrier that
protects the underlying tissues and
structures from microorganisms, physical
trauma, ultraviolet radiation, and
dehydration.
• Vital role in temperature maintenance,
fluid and electrolyte balance, absorption,
excretion, sensation, immunity, and
vitamin D synthesis.
Skin, Hair, and Nails
• Skin: epidermis, dermis,
sebaceous glands, sweat glands,
subcutaneous layers
• Hair: vellus, terminal
• Nails: nail body, lunula
 Question #1
Is the following statement true or
false?

Sebum has some fungicidal and

bactericidal effects.
Answer to Question #1
True.
Sebum has some fungicidal and
bactericidal effects.
 Question #2
Is the following statement true or
false?
Asians and Native Americans have
strong body odor.
Answer to Question #2
False.
Asians and Native Americans have
mild to no body odor because of
decreased sweat production.
Caucasians and African Americans
tend to have a strong body odor.
 Skin Cancer
• Most common of cancers
• Three types: melanoma, basal cell
carcinoma, squamous cell
carcinoma
• Asians are less susceptible
Common types of Cancer
Risk Factors of Skin Cancer #1
• Sun exposure
• Nonsolar sources of ultraviolet radiation
• Medical therapies
• Family history and genetic susceptibility
• Moles
• Pigmentation irregularities
• Fair skin that burns and freckles easily; light
hair
• Age
• Actinic keratosis
Risk Factors of Skin Cancer #2
• Male gender
• Chemical exposure
• Human papillomavirus
• Xeroderma pigmentosum
• Long-term skin inflammation or injury
• Alcohol intake; smoking
• Inadequate niacin in diet
• Bowen disease (scaly or thickened patch)
(SCC)
• Depressed immune system
Risk Reduction in Skin Cancer #1
• Reduce skin exposure.
• Always use sunscreen when sun exposure is
anticipated.
• Wear long-sleeve shirts and wide-brimmed
hats.
• Avoid sunburns.
• Wear sunglasses that wrap around.
• Understand the link between sun exposure and
skin cancer and the accumulating effects of sun
exposure on developing cancers.
• Have annual skin cancer screenings.
Risk Reduction in Skin Cancer #2
• Ensure that diet is adequate in vitamin
B3 (niacin).
• Examine the skin for suspected lesions
using the ABCDE mnemonic to assess
suspicious lesions:
– Asymmetry
– Border
– Color
– Diameter
– Evolution (changes over time)
 Question #3
Which skin disorder may be caused
by exposure to the sun?
A. Acne
B. Cancer
C. Vitiligo
D. Warts
Answer to Question #3
B. Cancer.
Skin cancer may be caused by
exposure to the sun. Acne, vitiligo,
and warts are not caused by sun
exposure.
Cultural Variations in Skin Cancer
• Asians are less susceptible to skin
cancer
• African Americans, Asians, and
Hispanics are susceptible to
melanoma
• Asian Americans and African
Americans tend to present with
more advanced disease at
diagnosis
 Methicillin-Resistant
Staphylococcus aureus
Risk Factors for Methicillin-Resistant
Staphylococcus aureus #1
• Assess for hospital-acquired
MRSA risk factors:
– Having an invasive medical
device
– Residing in a long-term care
facility
– Presence of an MRSA-positive
person in the facility
Risk Factors for Methicillin-Resistant
Staphylococcus aureus #2
• Assess for community-acquired MRSA
risk factors:
– Participating in contact sports
– Sharing personal items such as towels or
razors
– Suppression of immune system function
(e.g., HIV, cancer, or chemotherapy)
– Residing in unsanitary or crowded living
conditions (e.g., dormitories or military
barracks)
 Risk Factors for Methicillin-
Resistant Staphylococcus aureus #3
– Working in the health care industry
– Receiving antibiotics within the past
3 to 6 months
– Young or advanced age
– Men having sex with men
– Hemodialysis
 Measures to Reduce Risk Factors for
Methicillin-Resistant Staphylococcus aureus
• Keep wounds covered.
• Do not share personal items.
• Avoid unsanitary or unsafe nail care practices.
• If treatment has been started, do not stop until
recovery is complete.
• Use universal precautions when touching others to
avoid contact with contaminated body fluids. Wash
your hands.
• Clean sports equipment between uses to avoid
spread of infection.
• Wash clothes, sheets, towels, razors, and other
personal items before and after use.
• Clean hands often.
Nursing History: Present
Health Concern #1
• Body odor problems
• Skin problems (rashes, lesions,
dryness, oiliness, drainage, bruising,
swelling, pigmentation)
• Changes in lesion appearance
• Feeling changes (pain, pressure, itch,
tingling)
• Hair loss or changes
• Nail changes
 Nursing History #2
• Personal health history
• Family history
• Lifestyle and health practices
– Exposure to sun or chemicals
– Daily care of skin, hair, and nails
– Usual diet and exercise patterns
 Client Preparation
• Ask the client to remove all
clothing and jewelry.
• Have the client sit comfortably.
• Ensure privacy.
• Maintain comfortable room
temperature.
Equipment for Skin, Hair, and
Nail Assessment
• Gloves
• Examination light and penlight
• Mirror for client’s self-examination of skin
• Magnifying glass
• Centimeter ruler
• Wood light
• Examination gown or drape
• Assessment Tool 14-1, Braden Scale For
Predicting Pressure Sore Risk
• Assessment Tool 14-2, PUSH Tool to
Measure Pressure Ulcer Healing
Skin Assessment: Inspection
• Note any distinctive odor
• Generalized color variations
• Skin breakdown
• Primary, secondary, or vascular
lesions
Skin Assessment: Palpation
• Lesions
• Texture
• Temperature and moisture
• Thickness of skin
• Mobility and turgor
• Edema
Pressure Ulcer Risk Factors
• Perception
• Mobility
• Moisture
• Nutrition
• Friction or shear against surfaces
• Tissue tolerance decreased
Pressure Ulcer Risk Reduction #1
• Inspect the skin at least daily and more
often if at greater risk using risk
assessment tool (such as Braden Scale or
PUSH tool) and keep flow chart to
document.
• Bathe with mild soap or other agent; limit
friction; use warm, not hot, water; set bath
schedule that is individualized.
• For dry skin: use moisturizers; avoid low
humidity and cold air.
• Avoid vigorous massage.
Pressure Ulcer Risk Reduction #2
• Use careful positioning, turning, and
transferring techniques to avoid shear and
friction or prolonged pressure on any point.
• Refer nutritional supplementation needs to
primary care provider or dietitian, especially if
protein deficient.
• Refer incontinence condition to primary care
provider.
• Use incontinence skin cleansing methods as
needed: frequency and methods of cleaning,
avoiding dryness with protective barrier
products.
 Scalp and Hair
• Inspection and palpation
– General color and condition,
cleanliness, dryness or oiliness,
parasites, and lesions
– Amount and distribution of scalp,
body, axillae, and pubic hair
 Nail Assessment
• Nails
– Inspection: Nail grooming and
cleanliness, nail color and markings,
shape of nails
– Palpation: Assess texture and
consistency, capillary refill
 Nails Risk Factors
• Nails in moist environment, especially walking in
damp public locales or continuously wearing closed
shoes; excessive perspiration
• Nail injury, trauma, or irritation
• Repeated irritation (especially water, detergents)
• Immune system disorders such as diabetes mellitus
and AIDS or on immunosuppressive medications
• Skin conditions such as psoriasis or lichen
• Some trades or professions
• Contagion from one digit to another or one person to
another
• Possibly family predisposition
Nails Risk Reduction Tips
• Wear leather shoes except for sports.
• Avoid wearing closed shoes all the time.
• Wear socks that wick away moisture.
• Avoid going barefoot in damp public areas.
• Avoid too much perspiration or water (wear
gloves for hands).
• Avoid trauma to nails.
• Avoid unsanitary or unsafe nail care practices.
• If treatment is started, do not stop until recovery
is complete.
Physical Assessment
• Capillary refill assessment
procedure
• Hair color and texture
– Individuals of African American
descent often have very dry scalps
and dry, fragile hair.
Self-Assessment of Skin, Hair,
Nails
• Refer to Box 14-1, Self-
Assessment: How to Examine
Your Own Skin
Normal and Abnormal Findings
• Share outcomes of skin, hair, and
nails assessment with peers
Pressure Ulcer Stages
• Stage I
• Stage II
• Stage III
• Stage IV
• Unstagable
Pressure Ulcer Stages
Primary Skin Lesions
• Macule and patch
• Papule and plaque
• Nodule and tumor
• Vesicle and bulla
• Wheal
• Pustule
• Cyst
Primary Skin Lesions
Secondary Skin Lesions
• Erosion
• Ulcer
• Scar
• Fissure
Secondary Skin Lesions
Vascular Skin Lesions
• Petechia
• Ecchymosis
• Hematoma
• Cherry angioma
• Spider angioma
• Telangiectasis
Vascular Skin Lesions
Common Nail Disorders
• Longitudinal ridging
• Half-and-half nails
• Pitting
• Koilonychia
• Yellow nail syndrome
• Paronychia
Common Nail Disorders
Common Changes in Aging Skin,
Hair, and Nails
• Skin
– Pale
– Skin lesions
– Dry
– Loses turgor
• Hair: Thinner
• Nails: Thickened, yellow, brittle
 Skin condition

Cyanosis

Jaundice

Turgor
Validating and Documenting
Findings
• Health promotion diagnoses
• Risk diagnoses
• Actual diagnoses
• Collaborative problems
• Medical problems