"Clinical Assessment of Integumentary System" Notes for Nursing Students Subject: Medical Surgical Nursing Integumentary system.

1. ASSESSMENT
OF
INTEGUMENTAR
Y
SYSTEM

2. ANATOMY AND PHYSIOLOGY OVERVIEW

3. ASSESSMENT OF SKIN – SKIN LESIONS
Skin Lesions
Primary Secondary Special

4. PRIMARY SKIN LESIONS
Macules
Hypopigmented Hyperpigmented
Flat circumscribed nonpalpable lesion < 1cm

6. PATCH
 Large Macule >1 cm

7. PAPULE – ELEVATED SOLID LESION <1 CM

8. PUSTULES – DUE TO COLLECTION OF PURULENT MATERIAL,
COMMONLY INFECTIOUS BUT MAY BE STERILE

9. NODULES – ELEVATED SOLID LESIONS >1 CM

11. PLAQUE – ELEVATED LESION >1 CM IN DIAMETER, WITH FLAT
SURFACE, MAY BE FORMED BY COALESCENCE OF PAPULES

12. VESICLE – FLUID (CLEAR, SEROUS, HAEMORRHAGIC) FILLED
CIRCUMSCRIBED ELEVATED

13. BULLAE – LARGER >1 CM, CAN BE MULTILOCULAR (IF DUE TO
COALESCED VESICLES) OR UNILOCULAR

14. WHEAL OR WEAL – TRANSIENT ELEVATION DUE TO DERMAL OR
HYPODERMAL EDEMA, SUBSIDES WITHIN 24 HRS

15. PETECHIA – A PUNCTURE HAEMORRHAGIC SPOT (1-2 MM)

16. PURPURA – ERYTHEMATOUS MACULE DUE TO EXTRAVASATION OF
BLOOD INTO DERMIS (3-9 MM) NON BLANCHABLE

17. ECCHYMOSIS – 1 CM OR MORE

20. SECONDARY SKIN LESIONS –
CURST – DRIED SERUM EXUDATE OR TISSUE FLUID

21. ULCER – LOSS OF EPIDERMIS AND DERMIS

22. EXCORIATION – LINEAR EROSION OR ULCER PRODUCED BY
SCRATCHING

23. EROSION – LOSS OF EPIDERMIS

24. FISSURE – SLIT IN THE SKIN

25. SCAR – RESULT OF HEALING, NORMAL STRUCTURE REPLACED BY
FIBROUS TISSUE

26. ATROPHY – THINNING OF SKIN DUE TO DIMINUTION OF THE
EPIDERMIS, DERMIS OR SUBCUTANEOUS FAT

27. LICHENIFICATION – COMPRISES OF THICKENING,
HYPERPIGMENTATION, ACCENTUATED SKIN FOLD MARKINGS

28. MILIA – A TINY WHITE CYST CONTAINING LAMELLATED KERATIN

29. SCALE – FLAKE FROM STRATUM CORNEUM

30. SPECIAL SKIN LESIONS
COMEDO (COMEDONES) – A PLUG OF KERATIN AND SEBUM IN A DILATED
PILOSEBACEOUS ORIFICE

31. BURROW – A SMALL TUNNEL IN THE SKIN THAT HOUSES SCABIES
(ACARUS) MITE

32. POIKILODERMA – COMBINATION OF ATROPHY, RETICULATE
HYPERPIGMENTATION AND TELANGIECTASIA ( NON CANCEROUS –
REDDISH BROWN SPOTS)

33.  Telangiectasia - a condition characterized by
dilatation of the capillaries causing them to appear
as small red or purple clusters, often spidery in
appearance, on the skin or the surface of an organ

34. SCLEROSIS – INDURATION (INCREASED FIRMNESS ON PALPATION)
OF THE SUBCUTANEOUS TISSUES

36. HISTORY OF PRESENT ILLNESS
 Character, Onset, Location, Duration, Severity, Pattern, Associated factors
 Ask about
 Initial locations of the lesions
 Symptoms: Itching, pain, tenderness, burning, inflammation
 Date of onset and duration
 Severity: Mild, moderate, severe
 Relieving and worsening factors
 Medication: Got relief or not
 Over the counter drug used for treatment and response to the treatment
 History of similar problem in the past

37. IF PATIENT'S CHIEF COMPLAINT IS RELATED TO SKIN TUMOR OR
GROWTH MORE ATTENTION IS TO BE GIVEN ON FOLLOWING
QUESTIONS WHILE TAKING HISTORY
 What changes have you noticed in the particular appearance of the
lesions?
 Size of the lesions and if any change ?
 Is there history of bleeding in the lesions?
 Is there history of bleeding in the lesions?
 Is patient's occupation related to excessive sun exposure? ? Does
patient has history of using sunscreen?

38. ASSESSMENT OF SCALP AND HAIR
Anagen Phase
Catagen Phase
Telogen Phase

39. COMMON HAIR DISEASE
 Dandruff
 Hair lice
 Hirsutism – Facial hair growth in female due to increased testosterone
 Alopecia
 Baldness
 Tinea capitis – Ring worm infection
 Folliculitis – inflammation of the follicles due to infection of Staphylococcus aureus
 Piedra – Fungal infection of the scalp. It causes formation of nodules on the
hair shaft

40. ASSESSMENT OF NAILS

42. COMMON NAIL DISEASES
 Nail Discoloration
 Lifted nail Plate (Onycholysis) : White colour appearance Caused by certain types of deep cleaning,
formalin in nail polish, rough removal of artificial nails, Psoriasis, Tinea due to fungal infection.
 Thickened nails : due to fungal infection, injury, poor circulation, arthritis,
tight fitted shoes, Psoriasis
 Splitting nails : regular use of nail polish, mild trauma to nail bed
 Brittle nails : Advanced age, Infection S.aureus, nail biting,
Eczema around fingernails
 Paronychia : infection of side lying skin of the nails due to staphylococcus aureus
 Nail Tumour : nail melanoma

43. ABNORMALITIES OF NAILS
CLUBBING OF NAILS

44. KOILONYCHIAS (SPOON NAIL) IRON DEFICIENCY, MALNUTRITION,
INFECTION

45. PARANYCHIA

46. BEAU’S LINES (INDENTATION IN NAIL) ANEMIA, MALNUTRITION,
INFECTIOUS DISEASE

47. SCHAMROTH’S SIGN TEST

48. CAPILLARY REFILL TEST