HEALTH ASSESSMENT OR EXAMINATION OF SKIN, HAIR AND NAILS WITH THE HELP OF METHODS OF HEALTH ASSESSMENT: INSPECTION, ASCULTATION, PALPATION AND PERCUSSION TECHNIQUES.

1. EXAMINATION OF
SKIN, HAIR AND
NAILS
By:
V. Prasanthy,
M.Sc Nursing,
Medical Surgical Nursing.

2. SKIN, HAIR AND NAILS
The integument consist of the skin, hair,
scalp and nails. First inspect all skin
surfaces, or assess the skin gradually
while examining other body systems.

3. SKIN
Skin colour:- Fair/ weightish, brown/ dark in
complexion.
Erythema, cyanosis, jaundice, pallor, vitiligo,
ecchymosis, diaphoresis- Present/absent.

4. Inspect skin lesion:
Note bruises, scratches, cuts, insect bites, and wounds.
Lesions: Primary or secondary.
Wounds: Size, shape, depth, location, and presence of
drainage or odor.
Scars.
Rashes: Type, elevation, coloring, presence of
drainage, and itching.
Observe for presence/ absence of edema: Specify the
location and grade if present.

5. Palpation:
Skin temperature: Warm/ cold.
Texture: Smooth/ Soft/ rough/dry
Turgor: Normal/ decreased.

6. HAIR AND SCALP:
 Distribution: Even/ uneven.
 Lubrication: Dry/ oily
 Colour: Black/gray/brown/white.
 Thickness: Smooth/ rough.
 Texture: Smooth/ rough.
 Observe for presence/ absence of abnormalities
like baldness, alopecia, pediculosis, and dandruff.

7. Face:
• Features: Symmetric/ asymmetric.
• Distribution of facial hair.
• Observe for presence or absence of periorbital
edema, tics, fasciculation and tremors if noted,
mention the location, amount, and time.

8. TICS PERIORBITAL EDEMA

9. Nails
The condition of the nails reflects general health, state
of nutrition, a persons occupation, and level of self
care. The most visible portion of the nails is the nail
plate, the transparent layer of epithelial cells covering
the nail bed.

10. Nails
Ask the patient if there have been any recent
changes in the nails.
Determine the patients care nail care practices, such
as acrylic nails.

11. Nails
Determine if there are any risk factors for nail
problems
( eg: Diabetes mellitus, Peripheral vascular disease, or
older age.)

12. ABNORMALITIES OF NAIL BED:
Approximately 160
degree angle between
nail plate and nail

13. ABNORMALITIES OF NAIL BED:

14. ABNORMALITIES OF NAIL BED:

15. HEAD AND NECK
An examination of the head and neck includes
assessment of the head, eyes, nose, mouth,
pharynx, and neck ( lymph nodes, carotid
arteries, thyroid gland, and trachea). During
assessment at peripheral arteries also assess
the carotid arteries. Assessment of the head
and neck uses inspection, palpation and
auscultation.

16. HEAD
Assessment of the head begins with a
general inspection. Observe the
general size of the head. Inspect the
skull for shape and symmetry. Note
any deformities.

17. Sensory system assessment
Vision:
Assess the vision with the use of snellen’s
chart or ask the client to read a book or
newspaper.

18. Hearing:
Assessed by whispering near the patient ear
and ask the client to identify the words.

19. Smell:
Ask the client to close the eyes and identify
the smell of a powder, soap, etc.

20. Taste:
keep salt/ sugar in the anterior tongue and ask the
client to verbalize the taste.

21. Touch:
Touch is identified by placing the hot and cold
water in the test tube on the patient skin. Ask the
client to close the eyes and verbalize the type of
sensation felt.

22. Eyes:
Inspect the eyes for symmetry, movement and
the condition of the pupils, iris and sclera.
Look for nodules or swelling.
The eyebrows should be symmetric, with the
evenly hair distribution.
The pupils and iris are assessed together.

23. Eyes:
Visual acuity is treated by use of snellen
chart. Patient is allowed to sit at a distance of
20 feet, the findings are normal if the patient
is able to read from 20 feet. In case the patient
is unable to identify the letters, then the
findings may be recorded as myopia (near
sightedness) or hyperopia ( far sightedness)

24. Snellen chart

25. Ears
Inspect each pinna for placement, symmetry of the ear
and surrounding tissue for deformities, lumps or skin
lesions.
Palpate the auricle up and down, press the tragus and
press firmly just behind to assess pain, discharge or
inflammation.

26. Ears
Perform the otoscopic examination to observe the
tympanic membrane and external auditory canal. It is done
to note any discharge, inflammation or foreign body in the
external auditory canal.

27. DURING ASSESSMENT OF EARS USING OTOSCOPE
• Hold the otoscope upside down with thumb and fingers
so that the ulnar aspect of hand makes contact with the
patient.
• For adults, pull the ear upwards and backward to
straighten the canal.
• For children pull the ear down and back.
• Inspect the ear canal and middle ear structures using
speculum to note redness, drainage or deformity.
• Repeat for other ear.

28. Whisper test (or voice test)
Assess the hearing acuity. Ask the patient
to occlude one ear with the palm of the hand.
Then the examiner whispers softly unrelated
words from a distance of 1 or 2 feet from the
unoccluded ear and out of the patients sight.
The patient with normal hearing acuity can
correctly repeat what was whispered by the
examiner.

29. Whisper test (or voice test)

30. Weber test and Rinne test
Assess the bone conduction and air conduction of the
sound with a tuning fork.

31. Nose:
Inspect the external nose for shape, symmetry, colour and
swelling. The presence of discharge and lesions are abnormal
findings. If the patient complaints of nose bleeds, ask him
about the frequency, amount and colour of the nose bleed.

32. Nose:
Palpate the paranasal sinuses by using a
penlight or otoscope, to assess the presence
of tenderness.

33. Mouth and Pharynx
Lips: Inspect the colour, texture, hydration and
presence of lesions
Oral mucosa: Inspect the color and surface for
nodules, ulceration or presence of any discoloration

34. Gums and teeth : Inspect the colour of Gums
and look for atrophy, edema, ulceration or
hypertrophy. Inspect color of teeth and look for
any surface changes indicating plaque or early
dental decay.

35. Tongue : Inspect the tongue in normal resting and in a
protruded position for color, texture of dorsal, ventral
and lateral surface, Palpate the entire sublingual and
submandibular areas by bimanual palpation to detect
nodules, different in consistency of sublingual glands
and tissues.

36. Palate : Inspect the hard palate and uvula by
using penlight. Inspect the color of hard and
soft palate, ulceration, thickness.

37. Pharynx: Inspect the colour and presence any drainage in the
posterior wall of the pharynx. Normally it is pink, smooth and
with out any edema or inflammation.
While examining the pharynx ask client to widely open mouth
and say AH or with the help of spatula firmly press the tongue
from midpoint.
Abnormal findings:
Difficulty in swallowing.
Tonsillitis (red and enlarged tonsils)
Pharyngitis(redness of uvula)

38. Pharynx:

39. Neck:
Inspect the neck for symmetry, swelling, any masses or
scars.
Palpate the parotid or submandibular glands for swelling and
tenderness.
Range of motion (ROM)
.Turn the head to right and left.
.Try to touch each ear to the shoulder without elevating
shoulders and extend the head backward
 Abnormal findings: Pain at particular movements or
limited movement

40. Thyroid Glands
Inspection : Inspect the neck looking for the
thyroid gland. Observe for symmetry and any
visible enlargement of the gland.
Ask the patient to sip some water, the thyroid
gland will move upward with swallowing and then
fall to its resting position.

42. Palpation :
Note the size, symmetry and position of
the lobes, as well as note the presence of
any nodules.

43. Normal findings: Trachea is in midline, no
deviation from midline. Normally, the
thyroid gland is not palpated.

44. Abnormal findings: Enlargement of thyroid
gland is goiter (irregular growth of the thyroid
gland), tenderness or pain.

45. THANK YOU