A SKIN ASSESSMENT captures the patient's general physical condition, based on careful inspection and palpation of the skin and documentation of your findings. Here are some components of a good skin assessment. Obtain a history of the patient's skin condition from the patient, caregiver, or previous medical records. Go over the detailed family history with the patient or
patient's family, and make sure all skin conditions are reviewed. Also obtain a history of the patient's bathing routine and skin care products. Document the soaps, shampoos, conditioners, lotions, oils, and other topical products that the patient uses routinely. Ask the patient: Document your findings in the medical record. This includes assessment of skin color, moisture, temperature,
texture, mobility and turgor, and skin lesions. Inspect and palpate the fingernails and toenails, noting their color and shape and whether any lesions are present. Skin lesions can be categorized as primary or secondary, although the distinction isn't always clear. Make sure you use the correct term to describe any lesions you find. The following are primary lesions: Secondary lesions can be caused by disease progression, overtreatment, excessive scratching, or infection of a primary lesion:
Look out for dry skinIn long-term-care facilities, the most common skin problems are xerosis and pruritus. Between 59% and 85% of patients over age 64 have dry skin. More than 70% of patients who are hospitalized and 90% of nursing home residents over age 65 have dry skin. Many factors contribute to dry skin, including a low-humidity environment, the patient's personal habits (smoking, alcohol intake, and poor nutrition), seasonal changes, chronic diseases, medications, and skin cleaners. Xerosis is the most frequent cause of pruritus. The patient's skin may be rough and scaly, with dryness occurring most often over the lower legs, hands, and forearms. Skin dryness isn't usually associated with a dermatologic condition or systemic disease. Scratching can cause excoriations, which can progress to secondary eczema or a skin infection. Once you've assessed and documented the condition of your patient's skin, you can formulate an appropriate care plan to maintain skin integrity. RESOURCESBickley LS, Szilagyi PG. Bates' Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. Norman RA, Kligman AM. Diagnosis of Aging Skin Diseases. London, England: Springer-Verlag; 2008. BackgroundThe assessment of skin for clinical signs and symptoms is important when identifying adverse events following immunisation (AEFI). Most dermatological assessment guidelines commonly refer to the presentation of symptoms in patients with light skin tones. The skin is one of the most complex organs in the body. It consists of 3 layers, with each layer performing different roles. The colour of a person’s skin is influenced by the amount of melanin (natural pigment) which is produced by the melanocytes located in the epidermis (outer layer of the skin), with darker toned skin having more melanin present than lighter toned skin. The amount of melanin will affect the appearance of AEFI on a patient’s skin and therefore AEFI, such as pallor, cyanosis, erythema and urticaria, may appear differently in varied skin tones. This can pose a challenge for immunisation providers to identify symptoms of AEFI in a timely manner. PallorPallor refers to the pale appearance of the skin, nail beds and mucous membranes. Pallor is not always a symptom of disease. Pallor may be difficult to detect in dark toned skin and may present as ashen or grey. In brown toned skin the skin will present more yellowish in colour. An alternative method for identifying pallor in darker skin tones can be assessing the palmer surface which can appear paler. Following immunisation, pallor can be noted in events such as vasovagal syncope (fainting) and hypotonic hypo-responsive episodes (HHE). CyanosisCyanosis is a symptom of decreased oxygen in the bloodstream. There are 2 types of cyanosis:
In those with light skin tones, cyanosis will present as a bluish/purple hue. In patients with naturally yellow toned skin, cyanosis may cause a grayish-greenish appearance. In those with darker skin tones, cyanosis may be trickier to assess and may be observed as grey or white. Following immunisation, cyanosis may occur in the setting of a HHE, apnoea, breath holding episode or high fever. ErythemaErythema describes a red appearance of skin caused by the dilation of superficial blood vessels and increased blood flow. It often occurs with skin trauma, inflammation, infection or rash. Erythema is clearly visible on light toned skin. It may appear red or cause a purplish discoloration on some darker toned skins however it is difficult to see on very dark skin. Assessing the affected site or area for other signs including warmth, swelling or induration can assist in clinical assessment and diagnosis of erythema. Following immunisation, erythema can be widespread or localised at the injection site. UrticariaUrticaria, or hives, occur when the mast cells that lie within the skin release histamine that irritates nerve endings and causes local blood vessels to dilate and leak fluid. They can appear anywhere on the body and can be transient in nature. The cause is often not known however, they may be associated with infections or allergy. On light toned skin, hives appear as itchy, raised red welts. They often have a white center or wheal which looks like a mosquito bite and are surrounded by an erythematous ring. In darker toned skin, hives appear as raised lumps however the colour changes to the skin may not be as obvious. Following immunisation, hives can occur anywhere on the body and may occur in the setting of an allergic reaction. ResourcesImages
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Authors: Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children’s Research Institute), Mel Addison (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator) Date: May 31, 2022 Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy. You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional. What signs of cyanosis does a nurse inspect for in a darkBut in dark-skinned patients, cyanosis may present as gray or whitish (not bluish) skin around the mouth, and the conjunctivae may appear gray or bluish.
Which is an effective way of assessing for inflammation of the skin in a darkInflammation can be assessed in a dark-skinned patient by touch. Their skin will be warm to the touch. Cyanosis is a bluish tone to the skin. This is due to a decrease in the oxygenation to the tissue.
What are the components of a nail examination?Step 1: Examine the nail folds for abnormalities in color and shape. Step 2 Examine the lunula for abnormalities in color and shape. Step 3: Examine the nail bed for abnormalities in color and shape. Step 4: Examine the hyponychium for abnormalities in color and shape.
When taking the health history the patient complains of pruritus what is a common cause of this symptom?Pruritus can be a symptom of an underlying condition. It has many possible causes; the most common being contacting an allergen, dry skin, pregnancy and your body's reaction to a medication. Pruritus can be chronic if your itching persists for six weeks or more.
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To determine if a dark-skinned patient is pale, the nurse should assess the color of the:
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