Physical Assessment of the Integumentary System. Integument means covering. Integument means covering. The skin and its accessory organs, hair, nails

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Physical Assessment of the Integumentary System Slide 2 Integument means covering. Integument means covering. The skin and its accessory organs, hair, nails and glands comprise the integumentary system of the body. 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. The skin is composed of several different tissue types and is considered an organ. Slide 3 Functions of the Integument Protection Protection Physical Barrier Physical Barrier Perception Perception Temperature Regulation Temperature Regulation Identification Identification Communication Communication Slide 4 Functions of the Integument continued Wound Repair Wound Repair Absorption Absorption Excretion Excretion Vitamin D Production Vitamin D Production Slide 5 The Three Layers of the Integument Epidermis - the outermost layer of the skin, made of stratified squamous epithelium. 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. 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. Subcutaneous tissue - thick, fat-containing tissue. Below the skin; the tissues between the dermis and the muscles. Slide 6 Epidermal Appendages Hair is threads of keratin Hair is threads of keratin Sebaceous glands secrete the oil, sebum Sebaceous glands secrete the oil, sebum Sweat glands Sweat glands Eccrine glands secrete sweat Apocrine glands secrete thicker, milky secretion as in anogenital, nipples, and illae areas Nails are hardened keratin Nails are hardened keratin Slide 7 Receptors in the skin The sensory receptors in the dermis are for cutaneous sensations which include: touch, pressure, heat, cold, and pain. 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. The purpose of sensory receptors is to provide the CNS with information about the external environment and its effect on the skin. Slide 8 Interview Chief Complaint Chief Complaint Recent Changes Pruritus (itching) Dryness (xerosis) Rashes (identify primary site, migration, pattern and evolution Lesions Ecchymoses (bruising) Masses or lumps Symptom analysis Symptom analysis Pages 225-229, Jarvis Slide 9 Interview (cont.) Past Health History Past Health History Example: Immunologic, Endocrine, Collagen, Vascular, Renal, Hepatic Immunologic, Endocrine, Collagen, Vascular, Renal, Hepatic Previous exposure to insects, infectious disease Previous trauma & surgical intervention History of past allergic reactions Slide 10 Interview (cont.) Medications Medications Sensitivities Photosensitizing drugs Ask about self treatment with herbal remedies Allergies Allergies Medications & Foods Slide 11 Interview (cont.) Family Health History Family Health History Helps determine genetic predisposition to skin disorders Psychosocial History Psychosocial History Particularly important in long-term & chronic processes. Determine & correct any misconceptions about skin problems. Slide 12 Interview (cont.) Diet Diet Excessive dryness may indicate Vitamin A deficiency. Occupation & Travel Occupation & Travel What have they been exposed to. Habits Habits Frequency of hygiene practices. Exercise & Sleep Patterns Affects circulation, nourishment, & repair of the skin. Affects circulation, nourishment, & repair of the skin. Is there prolonged exposure to sun, unusual cold, or other skin damaging conditions. Slide 13 Dermatologic Assessment History Chief complaint Chief complaint Definition of problem (onset, location) Definition of problem (onset, location) Duration Duration Accompanying manifestations Accompanying manifestations Evolution of lesion or eruption Evolution of lesion or eruption Aggravating & relieving factors Aggravating & relieving factors Slide 14 Dermatologic Assessment History Medical intervention Medical intervention Self-treatment Self-treatment Compliance & treatment factors Compliance & treatment factors Slide 15 Preparation for the Physical Examination Strong direct lighting, natural sunlight is best Strong direct lighting, natural sunlight is best Small centimeter ruler Small centimeter ruler Penlight Penlight Gloves Gloves Woods light (ultraviolet light) may be needed for special procedures Woods light (ultraviolet light) may be needed for special procedures Slide 16 Inspection Color, Page 249 Jarvis Color, Page 249 Jarvis Pallor Cyanosis Erythema Jaundice Document presence of tattoos General pigmentation General pigmentation Areas of hypopigmentation or hyperpigmentation Areas of hypopigmentation or hyperpigmentation Abnormal color changes Abnormal color changes Slide 17 Hair and scalp Inspection Inspect distribution & quality Inspect distribution & quality Texture Texture Inspect the Scalp: Inspect the Scalp: Lesions Excoriations Lumps Bruises Lice Slide 18 Nails Color, Shape & Contour Color, Shape & Contour Texture Texture Integrity Integrity Thickness Thickness Capillary refill Capillary refill Slide 19 Palpation Temperature Temperature Assess with dorsum of hand Warmth reflects circulation Compare sides Moisture Moisture Refers to the skins hydration level in terms of both wetness & oiliness Diaphoresis, dehydration Texture Texture Should feel smooth, soft, & resilient Slide 20 Palpation continued Tenderness Tenderness Thickness Thickness Callus Atrophic Edema Edema Not a normal finding Common in some disorders Cardiovascular Cardiovascular Renal failure Renal failure Cirrhosis Cirrhosis Slide 21 Edema grading May be pitting 1+ Barely Visible 2+ Indentation < 5mm 3+ Indentation of 5 to 10mm 4+ Indentation of 10mm or > Slide 22 Palpation continued Turgor Turgor Reflection of skins elasticity & hydration Turgor is decreased (less elasticity) as the skin tents and stands by itself Hygiene, odor Hygiene, odor Vascularity or bruising Vascularity or bruising Slide 23 Lesion Types Types of Lesions 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 Slide 24 If any Lesions present, note the: Color Color Shape and configuration Shape and configuration Size Size Elevation Elevation Excudate Excudate Location and distribution Location and distribution Table 12-3 to 12-11, pages 250-265, Jarvis Table 12-3 to 12-11, pages 250-265, Jarvis Slide 25 Self-Care Behaviors Teach skin self-examination, using the ABCDE rule AasymmetryBborderCcolorDdiameter Eelevation and enlargement Slide 26 Developmental Considerations Infants 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 Slide 27 Developmental Considerations Aging Adults 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 Slide 28