SINHGAD COLLEGE OF NURSING NARHE, PUNE.

CLINICAL TEACHING
ON
ASSESSMENT OF
INTEGUMENTARY SYSTEM
SUBMITTED TO, SUBMITTED BY,
Mrs. Swati Gorad Ms. Nilopher Hasham Shaikh
Clinical Instructor F.Y. [Link]. Nursing
SCON, Pune. SCON, Pune.

SUBMITTED ON: -
 GENERAL OBJECTIVE:-
At the end of this clinical teaching students will be able to gain in depth knowledge about assessment of integumentary system and will
be able to apply the same in their clinical practices.

SPECIFIC OBJECTIVES:-
Student will be able to_
a) define skin and integumentary assessment.
b) describe the scientific principles of integumentary assessment.
c) demonstrate procedure for assessment of integumentary system.

SR. SPECIFIC TIME CONTENT TEACHER/LEARNER AV EVALUATION

NO. OBJECTIVE DURATION ACTIVITY AIDS
 ASSESSMENT OF
INTEGUMENTARY SYSTEM

INTRODUCTION: -
1. Introduction of 2 min
Skin disorders are encountered frequently in
assessment of Teacher introduces the topic Students understood
nursing practice.
integumentary assessment of integumentary the introduction of
The skin is a reflection of a person’s overall
system. system. assessment of
health, and alterations commonly correspond
integumentary
to disease in other organ systems.
system.
Skin-related disorders account for up to 10%
of all ambulatory patient visits.
In certain systemic conditions, such as
hepatitis and some cancers, dermatologic
manifestations may be the first sign of the
disorder.
So its very essential to know the assessment
of integumentary system.
Students understood
Definition of White the definition of skin
DEFINITION OF SKIN: -
2. skin and 3 min Teacher defines the skin and board and integumentary
“Skin is the body's outer covering,
integumentary integumentary assessment. assessment.
which protects against heat and light, injury,
assessment.
and infection.”

DEFINITION OF INTEGUMENTARY
ASSESSMENT: -
“Integumentary is a
systematic examination of different areas of
skin.”
3. describe the 6 min SCIENTIFIC PRINCIPLES OF Teacher describe the Handout Student understood
scientific BLOOD COLLECTION scientific principles of the scientific
principles of [Link] AND PHYISIOLOGY: - integumentary assessment. principles of
integumentary Structure: integumentary
assessment. assessment.
The skin has a surface area of about 1.5 to 2
m2 in adults and it contains glands, hair and
nails.
There are two main layers:
• epidermis • dermis
Between the skin and underlying structures
there is a layer of subcutaneous fat.
The epidermis is the most superficial layer of
the skin and is composed of stratified
keratinised squamous epithelium which varies
in thickness in different parts of the body. It is
thickest on the palms of the hands and soles of
the feet. There are no blood vessels or nerve
endings in the epidermis.
The dermis is tough and elastic.
The structures in the dermis are: blood
vessels, lymph vessels, sensory (somatic)
nerve endings, sweat glands and their ducts,
hairs, arrector pili muscles and sebaceous
glands.
Function:
 Protection
 Regulation of body temperature
 Control of body temperature
 Formation of vitamin D
 Sensation
  Excretion
 Absorption
-The skin contains numerous nerves be careful
during selection of the site to avoid injury to
these areas.
-The knowledge of the anatomy and
physiology of the body is essential for the safe
integumentary assessment.

2. MICROBIOLOGY: -
-Wash hands thoroughly before and after the
procedure to avoid cross infection.
-Articles required for intravenous infection
should be sterile and it should be sterilized by
autoclaving.

3. PHARMACOLOGICAL: -
-Nurse must know about the antidote and
bioavailability of the injectable drug.
4. PSYCHOLOGY: -
-Explain the procedure thoroughly to the
patient to win the confidence and get the co-
operation.
-Proper positioning will help to relax the
patient while intravenous injection.
demonstrate Teacher demonstrates Students understood
25 min -Maintain privacy if require. the integumentary
procedure for procedure for assessment of
4. assessment of integumentary system. assessment.
INTEGUMENTARY ASSESSMENT: -
integumentary
Nursing action before procedure: -
system.
[Link] the patient.

[Link]: - It include
a) Preparation of self: -
-Perform hand hygiene.
-Put on gloves.

b) Preparation of articles: -
-Arrange all the articles in clean tray.

c) Preparation of patient: -
-Inform the patient and explain all procedure
to patient.
-Provide proper position to patient i.e, sitting
or lying position.
-Explain the patient that movement of the
extremity should be minimal.

c) Preparation of environment: -
-Provide calm environment.
-Maintain adequate lighting in room.
-Provide privacy.

Nursing action during assessment: -

[Link] General Appearance:

The general appearance of the skin is assessed
by observing color, temperature, moisture or
dryness, skin texture (rough or smooth),
lesions, vascularity, mobility, and the
condition of the hair and nails. Skin turgor,
possible edema, and elasticity are assessed by
palpation.

2. Skin color: varies from person to person

and ranges from ivory to deep brown to
almost pure black.
The skin of exposed portions of the body,
especially in sunny, warm climates, tends to
be more pigmented than the rest of the body.
The vasodilation that occurs with fever,
sunburn, and inflammation produces a pink or
reddish hue to the skin.
Pallor is an absence of or a decrease in normal
skin color and vascularity and is best observed
in the conjunctivae or around the mouth.
The bluish hue of cyanosis indicates cellular
hypoxia and is easily observed in the
extremities, nail beds, lips, and mucous
membranes.
Jaundice, a yellowing of the skin, is directly
related to elevations in serum bilirubin and is
often first observed in the sclera and mucous
membranes.

-Erythema: is redness of the skin caused by

the congestion of capillaries.
In light-skinned people, it is easily observed at
any location where it appears.
-Rash In instances of pruritus (i.e, itching) the
patient should be asked to indicate which
areas of the body are involved.
Pointing a penlight laterally across the skin
may effectively highlight the rash.
The differences in skin texture are then
assessed by running the tips of the fingers
lightly over the skin.
The borders of the rash may be palpable.
The patient’s mouth and ears are included in
the examination.
The patient’s temperature is assessed, and
the lymph nodes are palpated.
Cyanosis is the bluish discoloration that
results from a lack of oxygen in the blood.
It appears with shock or with respiratory or
circulatory compromise. In people with light
skin, cyanosis manifests as a bluish hue to the
lips, fingertips, and nail beds. Other
indications of decreased tissue perfusion
include cold, clammy skin; a rapid, thready
pulse; and rapid, shallow respirations. The
conjunctivae of the eyelids are examined for
pallor and petechiae (ie, pinpoint red spots
that appear on the skin as a result of blood
leakage into the skin). In a person with dark
skin, the skin usually assumes a grayish cast.
To detect cyanosis, the areas around the
mouth and lips and over the cheekbones and
earlobes should be observed.

3. Assessing patients with dark skin: The

color gradations that occur in people with
dark skin are largely determined by genetic
transmission; they may be described as light,
medium, or dark. In people with dark skin,
melanin is produced at a faster rate and in
larger quantities than in people with light skin.
Healthy dark skin has a reddish base or
undertone. The buccal mucosa, tongue, lips,
and nails normally are pink. The degree of
pigmentation of the patient’s skin may affect
the appearance of a lesion. Lesions may be
black, purple, or gray instead of the tan or red
seen in patients with light skin. Dark pigment
responds with discoloration after injury or
inflammation, and patients with dark skin
more often experience post inflammatory
hyperpigmentation than those with lighter
skin. The hyperpigmentation eventually fades
but may require months to a year to do so. In
general, people with dark skin suffer the same
skin conditions as those with light skin. They
are less likely to have skin cancer but more
likely to have keloid or scar formation and
disorders resulting from occlusion or blockage
of hair follicles.

4. Assessing skin lesions: Skin lesions are the

most prominent characteristics of
dermatologic conditions. They vary in size,
shape, and cause and are classified according
to their appearance and origin. Skin lesions
can be described as primary or secondary.
Primary lesions are the initial lesions and are
characteristic of the disease itself. Secondary
lesions result from external causes, such as
scratching, trauma, infections, or changes
caused by wound healing. Depending on the
stage of development, skin lesions are further
categorized according to type and appearance.
A preliminary assessment of the eruption or
lesion should help to identify the type of
dermatosis and indicate whether the lesion is
primary or secondary.

5. Assessing Vascularity and Hydration

After the color of the skin has been evaluated
and lesions have been inspected, an
assessment of vascular changes in the skin is
performed. A description of vascular changes
includes location, distribution, color, size, and
the presence of pulsations. Common vascular
changes include petechiae, ecchymoses,
telangiectases (ie, red marks on the skin
caused by stretching of the superficial blood
vessels), angiomas, and venous stars. Skin
moisture, temperature, and texture are
assessed primarily by palpation. The elasticity
(ie, turgor) of the skin, which decreases in
normal aging, may be a factor in assessing the
hydration status of a patient.

6. Assessing the Nails and Hair: A brief

inspection of the nails includes observation of
configuration, color, and consistency. Many
alterations in the nail or nail bed reflect local
or systemic abnormalities in progress or
resulting from past events. Transverse
depressions known as Beau’s lines in the nails
may reflect retarded growth of the nail matrix
because of severe illness or, more commonly,
local trauma. Ridging, hypertrophy, and other
changes may also be visible with local trauma.
Paronychia, an inflammation of the skin
around the nail, is usually accompanied by
tenderness and erythema. The hair assessment
is carried out by inspecting and palpating.
Gloves are worn, and the examination room
should be well lighted. Separating the hair so
that the condition of the skin underneath can
be easily seen, the nurse assesses color,
texture, and distribution. Any abnormal
lesions, evidence of itching, inflammation,
scaling, or signs of infestation (ie, lice or
mites) are documented.

ASSIGNMENT: -

Q. Enlist advantages and complications of

integumentary assessment?

SUMMERY: -

In this CT, we have seen_

a) define skin and integumentary

assessment.
b) describe the scientific principles of
integumentary assessment.
c) demonstrate procedure for assessment
of integumentary system.
CONCLUSION: -
This topic helps student to improve
their practical skill as well as knowledge
regarding assessment of integumentary system
and helps to apply these skills in clinical
practice.

BIBLIOGRAPHY: -
[Link]. Nancy
Principles and practice of nursing
6th edition
Page no: - 210-211.

2. Annamma Jacob,
clinical nursing procedures the art of nursing
practice,
2nd edition,
Page no: - 350-353.

[Link] and Wilson (2003)

“Anatomy and Physiology”
9th edition
Published by Churchill living stone
Philadelphia
Page No: - 78-80.
REFERENCES: -

1. [Link]
assessment of integumentary system
2. [Link]
mahesh0926/iv- assessment of
integumentary system -133188009
3. [Link]
aparnaclakshmi/ assessment of
integumentary system