Physical assessment - Skin, hair, and nails: Nursing

Assessment of the skin, hair, and nails should be completed as part of a comprehensive client assessment or as a part of a focused exam when a client is experiencing issues that affect the integumentary system, such as hair loss or skin irritation. Let’s review the process of completing an assessment of the skin, hair, and nails.

Okay, the supplies you’ll need for your assessment include a flexible ruler, penlight, a magnifying lens or dermatoscope, and a good source of light.

Then, prepare for the exam by ensuring your client is in a comfortable position, that your hands and stethoscope are warm, and that the temperature in the room is comfortable. Provide privacy by closing the door and curtains, properly draping your client, and only exposing areas of their body as needed to perform your examination.

Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

There are no specific landmarks for skin and hair, but the nails do have landmarks such as the nail plate or body, lunula, cuticles, the lateral folds and the proximal nail fold. Locating the anatomical landmarks of the nails will help guide your assessment. The methods of skin, hair and nails assessment include inspection and palpation.

Alright, first, you should start with a general inspection of the skin, which should be intact and have a uniformity of color without areas of discoloration or the presence of lesions. Be sure to also check any area that is not commonly visible, such as the axillae, perineum, and between the toes.

During your inspection, note the thickness of the skin, which will vary depending on the body area. For example, calluses can appear on hands and feet due to frequent use, whereas the skin of the eyelids will be thin and delicate.

Also note your client’s skin color, which normally ranges from various shades of black, brown, and tan, to shades of white and pink. These variations in pigmentation are due to factors like genetics and sun exposure. You should always consider these natural variations in skin color and tone when assessing your client, especially when looking for localized skin changes.

For example, let's look at rashes. In clients with light skin, they appear pinkish-red, but in clients with dark skin, look for areas of hyperpigmentation or a purplish tone.