Health Assessment
Test Two Study Guide:
Chapters 12,13,14,15,16, 18, 19, 20, 21
Chapter 12 and 13: Skin hair and Nails, and head face, and neck and lymph nodes :
Critical components and factors in conducting an assessment of the head, face, neck, skin, hair
and nails:
Objective and subjective data regarding the above:
o Subjective data questions:
Past history of skin disease, allergies, hives, psoriasis, or eczema?
Change in pigmentation or color, size, shape, tenderness?
Excessive dryness or moisture?
Pruritus or skin itching?
Excessive bruising?
Rash or lesions?
Medications: prescription and over the counter?
Hair loss?
Change in nails’ shape color, or brittleness?
Environmental or occupational hazards?
Self-care behaviors?
Concepts involved in tissue integrity:
o Immunity, infection, mobility
Oxygenation, perfusion, neuro, elimination, F/E and acid base, cellular
regulation, metabolism, nutrition, digestion, comfort
Immunity: immune system assessment- impaired tissue integrity triggers
immune responses; immune responses can also lead to impaired tissue integrity
Assess for rash and inflammation, be alert to topical and latex allergies
that could worsen symptoms, be alert for abscess formation, anticipate
aspirin, antipyretics, cold packs
Infection: chain of infection, standard precautions, infection assessment;
microorganisms grow on the skin and breaks in the skin serve as portals for
these microorganisms to enter the body
Assess for complication of infectious disease, exercise infection control
measures and use personal protective equipment. Anticipate blood
cultures, antibiotics, and isolation practices
Mobility: mobility assessment, independent interventions and therapies;
impaired mobility may lead to skin breakdown and the development of pressure
ulcers
Assess for skin breakdown at least once per shift, pay special attention
to bony prominences. Anticipate repositioning wound care, comfort
measures, hygiene care, and infection control measures. Educate client
about how to care for impaired skin
o Skin conditions that are noted to be specific to Black patients are as follows:
, Keloids
Pigmentary disorders
Pseudofolliculitis
Melasma
o Epidermis: outer highly differentiated layer
Basal cell layer forms new skin cells
Outer horny cell layer of dead keratinized cells
Hair, sebaceous glands, sweat glands (eccrine glands, apocrine glands)
o Dermis: inner supportive layer
Connective tissue or collagen
Elastic tissue
(underneath both these layers is a subcutaneous layer of adipose tissue)
o Skin function: skin is waterproof, protective, and adaptive
Protection from environment, prevents penetration, perception, temperature
regulation, identification, communication, wound repair, absorption and
excretion, production of vit d
o Cultural considerations:
Genetic attributes of dark skinned individuals afford protection against skin
cancer due to melanin.
Whites have greater skin cancer risk than black and Hispanic populations
UV rays increase cancer risk
o Palor: vasoconstriction is present
White or light skinned person: skin takes on white hue, which is color of collagen
fibers in subcutaneous connective tissue
Dark skinned person: skin loses underlying red tones, brown skinned person
appears yellow-brown, black skinned person appears ashen gray. Mucous
membranes, lips, and nailbeds are pale or gray
o Erythema, inflammation: cutaneous vasodilation
White/light skinned person: skin is red
Dark skinned: palpate for increased warmth of skin, edema tightness or
induration of skin. Streaking and redness are difficult to assess
o Cyanosis: hypoxia of tissue
White skinned: skin especially in earlobes as well as in lips oral mucosa, and nail
beds has blueish tinge
Dark skinned: lips, tongue, conjunctiva, pals, soles of feet are pale of ashen gray.
Apply light pressure to create pallor in cyanosis, tissue color returns slowly by
spreading from periphery to the center
o Ecchymosis: deoxygenated blood seeps from broken blood vessel into subcutaneous
tissue
Light skinned: skin changes from purple to blue to yellow to green to yellow
Dark skinned: oral mucous membranes or conjunctiva show color changes from
purple blue to yellow green to yellow. Obtain history of trauma and discomfort
note swelling and induration
o Petechiae: intradermal or submucosal bleeding
Test Two Study Guide:
Chapters 12,13,14,15,16, 18, 19, 20, 21
Chapter 12 and 13: Skin hair and Nails, and head face, and neck and lymph nodes :
Critical components and factors in conducting an assessment of the head, face, neck, skin, hair
and nails:
Objective and subjective data regarding the above:
o Subjective data questions:
Past history of skin disease, allergies, hives, psoriasis, or eczema?
Change in pigmentation or color, size, shape, tenderness?
Excessive dryness or moisture?
Pruritus or skin itching?
Excessive bruising?
Rash or lesions?
Medications: prescription and over the counter?
Hair loss?
Change in nails’ shape color, or brittleness?
Environmental or occupational hazards?
Self-care behaviors?
Concepts involved in tissue integrity:
o Immunity, infection, mobility
Oxygenation, perfusion, neuro, elimination, F/E and acid base, cellular
regulation, metabolism, nutrition, digestion, comfort
Immunity: immune system assessment- impaired tissue integrity triggers
immune responses; immune responses can also lead to impaired tissue integrity
Assess for rash and inflammation, be alert to topical and latex allergies
that could worsen symptoms, be alert for abscess formation, anticipate
aspirin, antipyretics, cold packs
Infection: chain of infection, standard precautions, infection assessment;
microorganisms grow on the skin and breaks in the skin serve as portals for
these microorganisms to enter the body
Assess for complication of infectious disease, exercise infection control
measures and use personal protective equipment. Anticipate blood
cultures, antibiotics, and isolation practices
Mobility: mobility assessment, independent interventions and therapies;
impaired mobility may lead to skin breakdown and the development of pressure
ulcers
Assess for skin breakdown at least once per shift, pay special attention
to bony prominences. Anticipate repositioning wound care, comfort
measures, hygiene care, and infection control measures. Educate client
about how to care for impaired skin
o Skin conditions that are noted to be specific to Black patients are as follows:
, Keloids
Pigmentary disorders
Pseudofolliculitis
Melasma
o Epidermis: outer highly differentiated layer
Basal cell layer forms new skin cells
Outer horny cell layer of dead keratinized cells
Hair, sebaceous glands, sweat glands (eccrine glands, apocrine glands)
o Dermis: inner supportive layer
Connective tissue or collagen
Elastic tissue
(underneath both these layers is a subcutaneous layer of adipose tissue)
o Skin function: skin is waterproof, protective, and adaptive
Protection from environment, prevents penetration, perception, temperature
regulation, identification, communication, wound repair, absorption and
excretion, production of vit d
o Cultural considerations:
Genetic attributes of dark skinned individuals afford protection against skin
cancer due to melanin.
Whites have greater skin cancer risk than black and Hispanic populations
UV rays increase cancer risk
o Palor: vasoconstriction is present
White or light skinned person: skin takes on white hue, which is color of collagen
fibers in subcutaneous connective tissue
Dark skinned person: skin loses underlying red tones, brown skinned person
appears yellow-brown, black skinned person appears ashen gray. Mucous
membranes, lips, and nailbeds are pale or gray
o Erythema, inflammation: cutaneous vasodilation
White/light skinned person: skin is red
Dark skinned: palpate for increased warmth of skin, edema tightness or
induration of skin. Streaking and redness are difficult to assess
o Cyanosis: hypoxia of tissue
White skinned: skin especially in earlobes as well as in lips oral mucosa, and nail
beds has blueish tinge
Dark skinned: lips, tongue, conjunctiva, pals, soles of feet are pale of ashen gray.
Apply light pressure to create pallor in cyanosis, tissue color returns slowly by
spreading from periphery to the center
o Ecchymosis: deoxygenated blood seeps from broken blood vessel into subcutaneous
tissue
Light skinned: skin changes from purple to blue to yellow to green to yellow
Dark skinned: oral mucous membranes or conjunctiva show color changes from
purple blue to yellow green to yellow. Obtain history of trauma and discomfort
note swelling and induration
o Petechiae: intradermal or submucosal bleeding
