This week, you will explore how to assess the skin, hair, and nails, as well as how to evaluate abnormal skin findings.

Learning Objectives

Students will:

• Apply assessment skills to diagnose skin conditions
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the skin, hair, and nails
• Apply assessment skills to collect patient health histories

Required Readings – NURS 6512: Week 4: Assessment of the Skin, Hair, and Nails 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 8, “Skin, Hair, and Nails” (pp. 114-165)This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 28, “Rashes and Skin Lesions” (pp. 325-343)This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.

Note: Download and use the Adult Examination Checklist and the Physical Exam Summary when you conduct your video assessment of the skin, hair, and nails.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for skin, hair, and nails. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Adult Examination Checklist: Guide for Skin, Hair, and Nails was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Skin, hair, and nails physical exam summary. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Skin, Hair, and Nails Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Everyday Health, Inc. (2013). Resources for dermatology and visual conditions.

Retrieved from http://www.skinsight.com/info/for_professionals

This interactive website allows you to explore skin conditions according to age, gender, and area of the body.

Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278–282. Retrieved from http://www.nurseprescribing.com/

Retrieved from the Walden Library Databases.

Watkins, J. (2013a). Skin rashes, part 1: Skin structure and taking a dermatological history. Practice Nursing, 24(1), 30–33. doi:10.12968/pnur.2013.24.1.30

Retrieved from the Walden Library Databases.

Watkins, J. (2013b). Skin rashes, part 2: Distribution and different types of rashes. Practice Nursing, 24(3), 124–127. Retrieved from http://www.practicenursing.com/

Retrieved from the Walden Library Databases.

Watkins, J. (2013c). Skin rashes, part 3: localized rashes. Practice Nursing, 24(5), 235–241. doi:10.12968/pnur.2013.24.5.235

Retrieved from the Walden Library Databases.

Document: Skin Conditions (Word document)

This document contains five images of different skin conditions. You will use this information in this week’s Discussion

Note: Clicking on the URLs in the APA citations for the Resources from the textbook will not link directly to the desired online content. Use the online menu to navigate to the desired content.

Required Media

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s media, it is highly recommended that you access and view the online resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 8 that relate to the assessment of the skin, hair, and nails.

The following suturing tutorials provide instruction on the basic interrupted suture, as well as the vertical and horizontal mattress suturing techniques:

Tulane Center for Advanced Medical Simulation & Team Training. (2010, July 8). Suturing technique.

Retrieved from https://www.youtube.com/watch?v=c-LDmCVtL0o

Mikheil. (2014, April 22). Basic suturing: Simple, interrupted, vertical mattress, horizontal mattress.

Retrieved from https://www.youtube.com/watch?v=MFP90aQvEVM

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 6, “The Skin and Nails”In this chapter, the authors provide guidelines and procedures to aid in the diagnosis of skin and nail disorders. The chapter supplies descriptions and pictures of common skin and nail conditions.

Ethicon, Inc. (n.d.a). Absorbable synthetic suture material. Retrieved from https://web.archive.org/web/20170215015223/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/absorbable_suture_chart.pdf

Ethicon, Inc. (2006). Dermabond topical skin adhesive application technique. Retrieved from https://web.archive.org/web/20150921174121/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_application_poster.pdf

Ethicon, Inc. (2001). Ethicon needle sales types. Retrieved from https://web.archive.org/web/20150921171922/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/needle_template.pdf

Ethicon, Inc. (n.d.b). Ethicon sutures. Retrieved from https://web.archive.org/web/20150921202525/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/suture_chart_ethicon.pdf

Ethicon, Inc. (2002). How to care for your wound after it’s treated with Dermabond topical skin adhesive. Retrieved from https://web.archive.org/web/20150926002534/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/db_wound_care.pdf

Ethicon, Inc. (2005). Knot tying manual. Retrieved from https://web.archive.org/web/20160915214422/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/knot_tying_manual.pdf

Ethicon, Inc. (n.d.c). Wound closure manual. Retrieved from https://web.archive.org/web/20170829043048/http://academicdepartments.musc.edu/surgery/education/resident_info/supplement/suture_manuals/eth

Assignment 1: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To prepare:

• Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Assignment.
• Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
• Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
• Consider which of the conditions is most likely to be the correct diagnosis, and why.
• Download the SOAP Template found in this week’s Learning Resources.

To complete:

• Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style.  Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
• Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least 3 different references from current evidence based literature.

Assignment 2: Health History Assessment Video

IMPORTANT INSTRUCTIONS: Adjust your camera to show a full view of both you and your patient volunteer, show your government issued photo ID/passport for verification of who you are, scan the room that you are using for verification that notes are not being used or posted, then begin the video. You may NOT take notes during the examination. You must show an interview with a patient who presents with a specific complaint/problem. The video must show you interviewing a patient and the patient must answer the questions. Omitting these instructions or obtaining a score of less than 69.5% will result in a failure of the video assignment and the course.

By Day 7

Submit your video using the Kaltura Mashup tool accessible through the Assignment submission link provided. NURS 6512: Week 4: Assessment of the Skin, Hair, and Nails

ADDITIONAL INFORMATION 

Assessment of the Skin, Hair, and Nails

Introduction

The skin, hair, and nails are all part of the body’s surface layer. They’re also important to consider when assessing health. In this article, we’ll discuss what each of these areas do and how they can affect your daily life.

Skin

The skin is the largest organ in your body and it plays an important role in protecting you from harmful organisms, such as bacteria and viruses. The skin also provides a protective barrier between the internal organs and the outside environment. It’s a vital organ that involves many different systems:

• Epidermis – acts as an outer layer, protecting underlying tissues (dermis) from external damage caused by UV rays or other factors; helps regulate temperature regulation through sweating; forms outermost layer on all visible parts of body except palms & soles

• Dermis – contains connective tissue such as collagen fibers which support other structures like hair follicles & sweat glands; produces elastin fibers that make up elasticity of skin

Hair

Hair is a part of the integumentary system, which includes skin and nails. Your hair follicles are lined with a special type of tissue called “keratin.” Keratin is a protein found in fingernails and toenails as well as in all living things (including animals). It’s also what makes up your hair!

A person’s hair grows from an area called the “follicle” where new cells grow at about once per month for about one year until they reach full length then stop growing completely by shedding off their outer layer (the cuticle) when ready for use again next time around.”

Hair grows from a special type of skin cell called “keratinocytes.” These cells form the root of your hair and are surrounded by a layer of fat, called the “subcutaneous tissue,” and another layer called the “epidermis” (the outermost layer).

Nails

Nails are made of keratin, a protein that is also found in hair and skin. The average nail grows at a rate of 0.1 inches per month, which means that it takes approximately 3 months for your fingernails to grow 1 inch long (an extra half-inch).

Nail growth is governed by several factors including age and gender; however, there are other factors that can affect how fast or slowly your nails will grow as well. For example: if you have diabetes or another disease that affects blood sugar levels, then this could cause slower-than normal growth because of low energy levels and lack of protein intake needed for healthy skin cells to be produced by the body’s immune system

Other factors that can affect nail growth include vitamin deficiencies, thyroid problems, poor circulation and even genetics. If you have a family history of slow-growing nails, then there’s a good chance this will also be an issue for you.

Takeaway:

When you’re done with this section, you should have a better understanding of the skin and its functions. You also know how to check for signs of aging, including wrinkles and age spots. And if you’re interested in treating your skin with any products or services offered by professionals at a salon or spa, then reading these tips will help guide your decision making process.

Finally, it’s important to remember that while we all want perfect hair and nails (and bodies), nobody is perfect—so don’t worry too much about what others think!

Conclusion

The assessment of the skin, hair, and nails is a vital tool for your evaluation of the health of a client. It can be used to determine what health issues are in play and if they are causing symptoms that you may not have noticed otherwise. This assessment is often more difficult than other assessments because it requires an understanding of how these systems work together as well as how they function individually.