ASSESSMENT OF INTEGUMENTARY SYSTEM.pptx

health assessment of integumentary system

1. ASSESSMENT OF INTEGUMENTARY SYSTEM

2. The Integumentary system refers to the SKIN HAIR SCALP NAILS

3. SKIN Use the senses of sight , smell and touch while performing inspection and palpation of the skin. Assessment of the skin reveals the patient’s health status related to Oxygenation , Circulation , Nutrition, local tissue damage and hydration. Adequate lighting is needed for assessment the skin properly.

4. COLOUR Bluish(Cyanosis) - Increased amount of deoxygenated hemoglobin associated with hypoxia e.g. Heart or Lung disease, cold environment(Nail beds, lips ,mouth, skin) Pallor(decrease in color)- Reduced amount of oxyhemoglobin e.g Anaemia(Face , conjunctiva , nail beds , palms) Loss of pigmentation - Vitiligo e.g Congenital or autoimmune condition(Patchy areas on skin over face, hands , arms)

5. Continued……… Yellow orange(Jaundice)- Increased deposit of bilirubin in tissues e.g Liver disease, Destruction of RBC(Sclera , mucous membrane ,skin) Red( Erythema ) -Increased visibility of oxyhemoglobin caused by dilation or increased blood flow(Face, pressure area) Tan brown -Increased amount of melanin e.g Suntan , pregnancy(Face , arms)

6. Moisture The hydration of skin and mucous mambranes help to reveal body fluid imbalances, changes in the environment of the skin and regulation of body temperature. Dry skin is caused by lack of humidity, exposure to sun, smoking, stress, excessive perspiration and dehydration.

7. Temperature Increased or decreased skin temperatrure indicates an increase and decrease blood flow. An increased skin temperature often accompanies localized erythema or redness of the skin, inflammation , infection. A reduction indicates pallor and decresed blood flow.

8. Texture Texture refers to the character of the surface of the skin and how the deeper layers feel. By palpating it can be felt that the patient’s skin is smooth or rough , thin or thick , tight or supple and indurated or soft. Localized skin changes result from trauma, surgical wound or lesions.

9. Turgor Turgor refers to the elasticity of the skin. Normally the skin loses its elasticity with age , but fluid balance can also affect skin turgor. Edema or dehydration diminishes turgor. To assess the skin turgor grasp a fold of skin on the back of the forearm with the fingertips and release. Normally the skin lifts easily and falls immediately back to its resting position.. When turgor is poor it stays pinched and shows tenting.

10. Vascularity Vascularity occurs in localized area and lead to the appearance of superficial blood vessels. Petechiae are non blanching pinpoint size , red or purple spots on the skin caused by small haemorrhages in the skin layer.

11. Edema Palpate edematous area to determine mobility , consistency and tenderness. Edematous skin appears stretched and shiny. Assess for pitting edema. 2 mm deep-1+ 4 mm deep-2+ 6mm deep-3+ 8 mm deep-4+