physical assessment

1. Lindsey Rodriguez, DMD
March 11, 2020

2.  Careful examination of the skin gives the examiner insight into the overall health
of the child.
 The largest organ in the body
 Five distinct functions
 1. Controls fluids
 2. Regulates temperature
 3. Protects against invasion from microbial and foreign bodies
 4. Protects against damage from the UV rays of the sun
 5. An organ of communication

3.  Skin consists of 3 layers:
 Epidermis
 Dermis
 Subcutaneous layer

4.  Outermost layer of skin
 Consists of 4 to 5 layers
 Stratum corneum
 Forms the protective barrier of skin
 Stacked, overlapping nonnucleated
keratinized cells (corneocytes)
 Contains keratin, which makes the
skin waterproof
 Thinnest on the face, thickest on the
soles of the feet
 Stratum lucidum-found only on palms
and soles of feet
 Stratum granulosum-keratinocytes
begin to lose their nuclei
 Stratum spinosum-contain
keratinocytes and Langerhans cells
 Stratum basale-keratinocytes originate
here; Also contain melanocytes and
Merkel cells

5.  Richly vascular layer consisting largely
of fibroblasts & collagen
 The collagen matrix supports &
separates the epidermis from the
subcutaneous fat layer
 Contains a large network of sensory
nerve fibers
 Provides sensations of pain &
temperature
 Contains autonomic nerve fibers that
innervate blood vessels, arrector pili
muscles, sweat glands, sebaceous
glands, hair, and nails

6.  Composed of adipose tissue
 Connects the dermis to underlying
organs
 Provides insulation and shock
absorption
 Generates heat for the body
 Provides a reserve of calories for
use by the body

7.  Hair is formed by epidermal cells
that go deep into the dermal layer of
the skin
 Consists of a root, a shaft, and a follicle
 Follicle—supplies nourishment to the
hair to promote growth
 Melanocytes—supply color to the hair
 First hair that forms is lanugo hair
 Lanugo is shed & replaced by hair that
is increased in diameter & coarseness
vellus hairs (short, fine, soft,
nonpigmented)terminal hairs (coarse,
thick, longer, pigmented)

8.  Protect the fingertip
 Contribute to tactile sensation by
acting as a counterforce to the
pad of the fingertip
 Aid in peripheral
thermoregulation via glomus
bodies in the nail bed and matrix

9.  Stratum corneum (protective layer) does not develop until between 23-25 weeks of
gestation
 Extremely premature infants are born without this critical top layer of skin &
have no protective barrier & are not able to control water loss.
 Can tolerate only a small amount of touching

14.  Look for abnormal conditions
 For any abnormal skin lesions, pay attention to:
 Morphology
 Distribution & pattern of lesions
 Shape of the skin lesions
 Are lesions clustered together or scattered?
 What does the border or margin look like?
 Any associated findings such as central clearing?
 Pigmentation of lesion
 Classify the lesion as primary or secondary

15.  Macule
 Papule
 Nodule
 Tumor
 Wheal
 Vesicle
 Bulla
 Pustule

16.  Arise from primary lesions
 Scale
 Crust
 Erosion
 Ulcer
 Fissure
 Lichenification
 Striae
 Purpuric Lesions, Petechiae
 Ecchymosis

19. Evolution
Monitor over time for
changes in any of
these characteristics

21.  Duderstadt, Karen G. Pediatric Physical Examination: An Illustrated
Handbook. 3rd edition. Mosby Elsevier. 2019.
 Engel, Joyce. Mosby’s Pocket Guide Series: Pediatric Assessment.
5th edition. Mosby Elsevier. 2006.