What Are 3 Observations Find When You Are Doing Palpation Of The Nails

The integumentary system protects the body against pathogens, regulates body temperature, provides sensory input and synthesizes vitamin D.

Assessment of the integumentary system involves gathering data virtually the skin, pilus, and nails. In gathering information about the integumentary system, a good inspection and a detailed description from the patient is required.

This article contains 7 Helpful Tips for Performing a Nursing Health Assessment of the Integumentary System.

To brainstorm the study of assessment of the integumentary organisation, review your anatomy and physiology of the system.

The process for performing an assessment of the integumentary system involves interview questions, inspection, and palpation.

Cess of the skin is non a separate cess simply is done throughout the head-to-toe assessment.

For more than information read this commodity Tips for A Better Nursing Health Cess to help you proceed through an assessment including the skin as you movement from head-to-toe.

Tip #i – Gather Information about the Patient's History.

11 Tips For Performing A Nursing Health Assessment of the Urinary System

Ask the following questions.

Do you have a history of skin problems?
Have you ever had a pare infection or illness?
Accept you lot always had an allergic skin reaction?
Do you lot have a family unit history of allergic pare reactions?
Practice you have whatever birthmarks or tattoos?

Tip #ii – Gather Information on Chief Complaints or Symptoms.

A patient's history of specific complaints and symptoms associated with the skin, hair, and nails are important.

The questions should elicit responses about the onset, duration, and frequency of symptoms.

Below are some questions to ask patients to brainstorm to gather information on primary complaints and symptoms of the integumentary organization.

Ask the following questions about the skin.

Are you having issues with your skin?
Have you noticed any change in the color of your skin? (hyperpigmentation or hypopigmentation)
Is your skin drier than usual?
Do you have any sores or lesions on your body?
Do you accept sores or lesions that do not heal?
Does your pare itch? (pruritus)
Have you noticed any excessive bruising?
Do yous have any rashes on your body?
Assess for possible causes of rashes. (Clothing, jewelry, cosmetics, etc.)
Practice you have whatever lesions, bumps, bruises or spots on your pare?
Do you take any tender or painful areas on the skin?
Have in that location been any changes to the size shape or colour of a mole?
Do you have an area that drains or weeps?
Exercise you apply anything to treat any pare status?
What medications do you take? Some skin problems may exist due to medication.

Ask the following questions virtually the hair.

Take y'all noticed any changes in your hair?
When did you lot notice the alter?
How often do you wash your pilus?
Have yous noticed whatsoever hair loss?
What prescription medications do you accept?
What over the counter medications exercise y'all accept?
Which products or appliances do you use to style your hair?
Practice you use whatever chemicals on your pilus such as perms, bleach or colour?

Inquire the following questions about the nails.

Have y'all noticed any changes to your nails?
Are your nails dry out, brittle, split, chipping or peeling?
Do you lot have whatever pain to your nails?
What prescription medications do you lot take?
Which over the counter medications exercise you lot take?
Usually exercise you lot habiliment nail smooth?
Practise yous wear artificial nails?
Do yous spend a large amount of time with your hands in water?

Tip #3 – Gather Information nigh Pain

Ask the following questions well-nigh pain.

Do you have whatsoever pain or discomfort to your pare?
Where is the pain?
How often exercise you take this pain?
How long accept y'all had this pain?
Have you noticed anything specific that causes this pain?
Is there any treatment yous have tried to salve the pain?
Does this handling work?
On a calibration of 0-10, how severe is the hurting?

A lot of people shy away from existence touched by strangers, so touching the patient'southward hand every bit you explain what you are most to do may help the patient feel more comfy with the assessment in general.

Also, performing inspection and palpation at the same time is a more efficient mode of working through the integumentary organisation cess as you proceed from head-to-toe.

Tip #4 – Inspect the Skin for Colour.

First, audit the overall advent of the peel.
Audit the peel for color.
Look to see if the patient's skin tone is the aforementioned all over the trunk. You lot are looking for areas of hyperpigmentation and hypopigmentation.
If whatever lesions, moles or rashes are noted, identify the characteristics.

When assessing the skin of different indigenous groups, remember that the unlike skin tones may affect the results of the examination.

When assessing the color, you are looking at the pare tone. People have unlike genetic makeups that affect their skin tone and undertones. Skin color can range from pinkish to dark brown.

Some undertones include ruby, orangish, yellow and olive. People with dark brown skin tend to have a lighter pigmentation to the lips, palms of the mitt and the fingernail.

A normal benign pigmented area may include a freckle, a mole, and a birthmark.

Normal Areas of Pigmentation.

Freckles are patches of melanin pigmentation that occur usually or when the skin is exposed to the lord's day in some patients. These patches depend on the patient's distribution of melanin. These patches are ordinarily pocket-size and flat.
Moles also are known as a nevus and are an excessive growth of melanocytes. They are usually pocket-sized, shine and symmetrical. Moles range in colour from tan to dark brown.
Birthmarks are apartment areas of discoloration that are usually brown or tan.

Likewise, a change in pigmentation can affect the unabridged trunk. These skin discolorations include pallor, erythema, cyanosis, and jaundice.

In patients with darker pare, these skin discolorations may be hard to determine. If yous suspect a trouble, assess the mucous membrane in the mouth and the sclera of the eye.

Peel Discolorations.

Pallor is when there is a loss of the pink tones of the peel due to the lack of claret catamenia to the surface of the skin or a decrease in blood cells. The skin takes on a whitish color. The skin of patients with a darker complexion becomes ashen or irksome. Pallor is usually a symptom of shock or anemia.
Erythema is a reddish color to the skin. This occurs when at that place is a rush of blood to the surface of the peel. Erythema is usually associated with a fever or some type of localized inflammation. Inflammation can be assessed in a night-skinned patient past touch. Their peel volition exist warm to the impact.
Cyanosis is a bluish tone to the peel. This is due to a subtract in the oxygenation to the tissue. Cyanosis normally indicates hypoxemia. Hypoxemia is a low concentration of oxygen in the blood. Cyanosis occurs in patients with shock and heart failure. Cyanosis tin can exist centrally acquired by problems with the center and lungs or peripherally due to exposure to cold temperatures. Also, assess the conjunctiva, nail beds, and mucous membrane for cyanosis.
Jaundice is a yellow tint to the skin, mucous membranes or the sclera of the eye. This is due to increased levels of serum bilirubin in the blood. Increased bilirubin in the claret is nigh commonly due to liver inflammation. It is also seen in some newborns.

Tip #5 – Inspect and Palpate the Skin for Temperature, Wet, Texture, Thickness, and Turgor

Appraise the temperature.

Explain to the patient that yous will exist assessing the peel as you go along through your assessment.
Use the dorsum of the hand (dorsal surface) to assess the patient's skin temperature. The patient's temperature should range from lightly warm to slightly cool.
Some patients' hands and feet may be normally cooler.
Begin with the brow and assess as y'all motility from caput-to-toe of your assessment.
Palpate down the trunk post-obit your sequence for your head-to-toe assessment.
Compare the skin on the correct and left sides as you move down to the feet.
The temperatures on both sides of the body should be equal.

Appraise for Moisture.

The skin should not be overly moist or overly dry.
Inspect the amount of wet in areas where perspiration is normally noted.
This includes the face, palms of the hands, and pare folds.
Profuse sweating is called diaphoresis. This can occur during a fever, exertion or when a patient is in hurting.

Assessing dryness.

Dry out peel volition accept a weathered look.
You volition notation sloughing of skin cells.
Patients with dry pare may have pruritus. Pruritus is itchy peel.

Assess for Texture.

Palpation is used to assess for texture.
Utilize the palm (palmar surface) of the paw and the fingers to palpate for texture.
The skin should be smooth and business firm.
Skin that is rough may bespeak a trouble with keratinization. This is when the epithelial cells lose their wet and go dry out.
Scar tissue volition be depressed and feel polish.

Appraise Skin Thickness.

Palpation is used to assess for peel thickness.
Use the palm (palmar surface) of the mitt and the fingers to palpate for thickness.
Skin is normally thin and firm over most of the body.
The pare on the palm of the easily, the sole of the feet, knees, and elbows is normally thicker.

Assess Skin Turgor.

The pare should be elastic and mobile.
Turgor is the ability of the skin to return back to normal position when stretched.
Assess turgor by gently grasping the patient's peel between your finger and thumb, then release it.
The skin should jump back into place.
When the skin springs back, the turgor is normal.
When the skin holds its position and slowly returns to normal, the turgor is decreased. Decreased peel turgor is caused by conditions such as aridity.
Skin that holds its position and slowly returns to normal position is known as tenting.
Turgor is increased in conditions such as scleroderma when the connective tissue of the skin is immobile.

Tip #half dozen – Assess for Edema.

Edema is the accumulation of fluid in the intercellular spaces.
Check the areas that are normally dependent such every bit the feet and ankles.
The peel over areas of edema will look puffy and tight.
Edema may be localized or generalized.
To access edema, find an expanse you suspect edema is present.
Use your finger to lightly apply force per unit area for a minimum of five seconds.
If there is no edema present, the skin will be polish.
Pitting edema is when you finger leaves an indentation when the force per unit area is released.

When pitting edema is present, use the post-obit grading scale:

1+ Mild pitting, slight indentation, no perceptible swelling of the leg
2+ Moderate pitting, indentation subsides rapidly
3+ Deep pitting, the indentation remains for a brusk time, leg looks bloated
4+ Very deep pitting, indentation last a long time, the leg is very swollen.

Taken from Jarvis, C. (2008). Concrete Test and Wellness Assessment. 5th ed. St Louis Mi. Saunders.

Tip #half-dozen – Audit and Palpate the Nails.

Explain to the patient that you are going to check their nails.
Check to meet if the nails are well groomed and clean.
Patients with poorly groomed nails may suggest a self-care deficit problem.
Nails that appear bitten, are very short or have a jagged edge may indicate a nervous addiction.
The nail, the nail fold, and nail edges should be smooth.

Appraise the contour and shape of the blast.

Assess the surface of the nail looking at the contour of the nail.
The profile is the side view.
Some patients' nails may be flat and some may be slightly circular.
The bending of the blast should be 160 degrees or less.

Assess the nail for clubbing.

Clubbing is when the angle of the boom is greater than 160 degrees.
This occurs with hypoxia over a long catamenia of time.
To assess the boom for clubbing, have the patient bring two nails on opposite hands with the dorsal side of the hand (top of the easily) facing each other to create a mirror image.
Normal nails should create a diamond shape opening at the blast beds.
When a patient has clubbing, the fingers will not create a diamond shaped opening simply instead, create a Five-shape as the distance betwixt the fingertips is increased.

Tip #7 – Inspect and Palpate the Pilus.

7 Tips for Performing a Nursing Health Assessment of the Integumentary System

Explain to the patient that you are going to check their pilus and scalp.
Enquire the patient to remove accessories and wigs.
Office the hair in small sections and examine the scalp. Lesions or sores may exist nowadays on the scalp.
Check the hair for cleanliness.
Check the scalp for dandruff. Dandruff is dead flakes of epidermal cells. Some patients with psoriasis may have a large number of expressionless peel cells that have sloughed off.

Observe the hair color.

Hair color will vary among patients.
Almost graying is normal depending on the patient's age and genetics. Some patients may grayness as early as their teens.
However, sometimes graying tin be the result of a nutritional deficiency.

Assess the texture of the hair.

Take a few strands of pilus betwixt your thumb and finger and curl the hair.
Next, have a few strands of hair between the thumb and finger of i hand about the cease and utilize the opposite hand to slide your fingers down the length of the pilus.
The hair may have a texture that is thick or fine. The hair may also be straight, curly or wavy.
Patients that have a metabolic or nutritional problem may have hair that is coarse, dry, or breakable.

Assess the distribution of the hair.

Bank check to see if there is even distribution of the hair throughout the scalp.
The thickness or thinness of the pilus volition depend on the patient's age, gender, and overall health.
Inspect the scalp for lesions.

Determination

In conclusion, the tips to a higher place will help yous with a nursing wellness cess of the integumentary arrangement. Remember to integrate the skin cess into the total head-to-toe assessment. Use inspection and palpation every bit you motility through your assessment.

Reference

Bickley LS., Szilagyi PG., (2017). Bates Guide to Concrete Exam and History Taking. 12th ed. Philadelphia, PA. Wolters Kluwer/Lippincott Williams & Wilkins.

Jarvis C., (2017). Concrete Examination & Wellness Assessment. St Louis, MO. Elsevier Inc.

Mosby's Medical Dictionary (2017). 10th ed. St Louis, MO. Elsevier Inc.

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