The skin is composed of three layers: the epidermis, dermis, and hypodermis. The dermis contains connective tissue, nerves, blood vessels, and skin appendages. The skin acts as a protective barrier and regulates temperature and moisture. It produces vitamin D and allows for communication through touch and body language. During pregnancy and aging, the skin's color and texture can change. A full skin examination evaluates for lesions, rashes, dryness, discoloration, thickness, temperature, and capillary refill through visual inspection and physical palpation. Hair, nails, and scalp are also inspected for abnormalities that could indicate underlying health issues.

1. Skin hair and nail
STRUCTURE OF SKIN :
✓ Epidermis: thin layer
✓ Dermis: connective tissue nerves, sensory receptors, blood vessels, and lymphatics
lie in the dermis. In addition, appendages from the epidermis such as the hair
follicles, sebaceous glands, and sweat glands are embedded in the dermis.
✓ Hypodermis: the subcutaneous tissue stores fat for energy, provides insulation for
temperature control

2. Function of the skin
• Protection
• Prevents Penetration
• Perception
• Temperature regulation through sweat gland
• Identification
• Communication by emotions and body language
• Absorption and excretion
• Production of vitamin D

3. Developmental competence
• The Pregnant Woman : skin color changes due to increased hormone levels.
• The Aging Adult: it looks parchment thin, lax, dry, and wrinkled.

4. Subjective Data
• 1. Past history of skin disease (allergies, hives, psoriasis, eczema)
• 2. Change in pigmentation
• 3. Change in mole (size or color)
• 4. Excessive dryness or moisture
• 5. Pruritus
• 6. Excessive bruising
• 7. Rash or lesion
• 8. Medications
• 9. Hair loss
• 10. Change in nails
• 11. Environmental or occupational hazards
• 12. Patient-centered care

5. Equipment Needed
• Strong direct lighting
• Small centimeter ruler
• Penlight
• Gloves

6. Skin inspection
According to the genetic background
Normal finding :
Color of skin : dark , pink , white , brown
Body tan and the body should be even color
Abnormal finding:
Pale color indicate anemia
Cyanosis indicates cardiovascular and respiratory disease

7. inspection
• SKIN BREAKDOWN:
• discharge or any scar
• Primary pills for no reason like acne
• Secondary pill due to disease { size , color , discharge , location , single or
combined }

8. Skin Palpation
• Temperature : it should be warm and equal [ by dorsal side of hand]
• Moisture : normal skin is dry or oily
• Texture : normal skin is smooth not rough [ palpate by balms]
• Edema is abnormal finding : collection of fluid
To check for edema imprint your thumbs firmly for 3 seconds on the ankle [ its
severity depends on the time period of the mark that left on the ankle
• Mobility and turgor : pinch up a large fold of skin on the anterior chest under the
clavicle Mobility is the ease of skin to rise, and turgor is its ability to return to place
promptly when released. This reflects the elasticity of the skin
• thickness

9. Note any lesions
• color
• Shape and configuration
• Size
• Location and distribution on body

10. Inspection of hair
• Color : black or brown
• quantity and distribution : females at puberty under the arm and pubic
Male at puberty : under the arm , face and pubic
• Cleanness

11. Palpation of hair
• Thickness : thin hair means bad nutrition
• Texture
• Any scalp lesions

12. Nail inspection
• Color it should be pink in normal people
• Cleanness
• Thickness
Abnormal finding
Blue and bent nail indicate a respiratory disease
Lump on the nail indicate a liver disease and vitamin deficiency

13. Nail palpation
• Capillary Refill:
• With the index or middle fingertip at heart level, depress the nail edge at
least 5 seconds to blanch and then release, noting the return of color.
Normally color return is instant or at least within a few seconds in a cold
environment. This indicates the status of the peripheral circulation. A
healthy color return takes 1 or 2 seconds. Inspect the toenails. Separate the
toes and note the smooth skin in between.

14. Summarized and prepared by shahd awd allah
Good luck <3