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02-28-2013, 11:50 AM
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assessment of skin
NURSING ASSESSMENT Health History Skin problems are a fairly common complaint for the patient entering the health system. Many factors can influence the integumentary system. A skin problem may be the only complaint the patient has, or it may be a manifestation of an underlying systemic condition or psychological stress. Most important, the skin visibly communicates the patient’s health. Therefore the questions that are posed to the patient are important in determining if the skin problem is a disease entity of its own or a sign of a more systemic disorder. Table 50–1 provides examples of general questions that can be asked of the patient to elicit information. If further assessment of a particular problem area is necessary, the WHAT’S UP? line of questioning may be used. For example, if the patient has a rash, you can respond with the following questions: Where is it? Is that the only area where you have a rash? How does it feel? Does it itch? Burn? Aggravating and alleviating factors. Does scratching aggravate it? Does anything else aggravate it, such as soaps and detergents? What relieves it? How have you treated it in the past? Timing. How long have you had this problem? Does it recur? Severity. How bad is the discomfort on a scale of 0 to 10, with 0 being comfortable and 10 being unable to touch the area? Useful other data. Do you have other symptoms besides the rash, such as itching, discharge, tingling, or loss of sensation? Patient’s perception. What do you think is causing your rash? Physical Assessment Assessment of the skin involves **t only the entire skin area, but also the hair, nails, scalp, and mucous membranes. The main techniques utilized in physical assessment of the skin are inspection and palpation. Ensure that the patient is disrobed but adequately draped in a well-lighted and warm environment. A handheld magnifying glass or penlight may be utilized to see small details and further illuminate the area. **rmally the skin is intact, with ** abrasions, and is smooth, dry, well hydrated, and warm. skin turgor is firm andelastic. The skin surface is flexible and soft. skin color ranges from light to ruddy pink or olive in white-skinned patients and light brown to deep brown in dark-skinned patients. You need to be aware of **rmal developmental changes when performing an assessment. The skin of the neonate is very thin and friable (easily broken). During adolescence, the skin becomes thicker, with active sebaceous, eccrine, and apocrine glands. Body hair also changes during adolescence as a result of hormonal influences. In older patients the skin loses some of its elasticity and moisture. There is decreased activity of sebaceous and sweat glands. The older patient’s skin is thinner, more fragile, and more wrinkled.Inspection Inspect each area of the skin, including nails, hair, scalp, and mucous membranes, for color, moisture, lesions, edema, intactness, vascular markings, turgor, and cleanliness. This examination should be done in an orderly sequence, such as hair, scalp, nails, buccal mucosa, and then the general skin surface from head to toe (Gerontological Issues Box 50–1). COLOR. skin color can be influenced by many factors, including the temperature of the patient, oxygenation, blood 
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