Chapter 23: Assessing the Integumentary
System
What You Will Learn
• How general observations, the resident interview, inspection,
and palpation are used to assess the integumentary system in the
elderly resident
Author:
Key Terms
Andrea Langston MSN, NP-C,
Family Nurse Practitioner,
Specialized Wound
Management, St. Charles, MO
Intertriginous — Two surfaces of skin that are in contact making it
prone to irritation (e.g., the armpits, under the breasts, between thighs,
and skin folds)
Dermatomal — Following a natural and defined peripheral nerve path
Performing a skin assessment is critical when assessing a resident.
Evaluating the individual’s general physical condition, inspection and
palpation of the skin, and documenting findings are the components of
the skin assessment.
Inspection
Adequate lighting is essential
when inspecting the skin to determine any color variations.
When assessing the skin, observe for rashes, lumps, sores, itching, dryness, color change, and changes in hair and nails.
Skin is usually observed as each part of the body is examined; however,
it is important to make a brief overall visual sweep of the entire body.
This gives a good idea of the distribution and extent of any lesions. It
also allows observation of skin symmetry and detection of differences
between body areas.
Examining the skin for lesions and any abnormalities is necessary to
distinguish the arrangement of certain linear, clustered, or dermatomal
findings. Non-pigmented striae (stretch marks) would be an example
of linear arrangement. Warts are an example of clustered lesions, and
shingles would be an example of a dermatomal arrangement.
Fair-skinned persons are more
susceptible to harm from the sun
and tend to freckle easy.
FENCE Student Manual
There are different skin types. The palms of the hands and soles of the
feet are lighter in color than the rest of the body in people with darker
skin tones. It is also harder to notice imperfections in the skin due to the
pigment in darker-skinned individuals. Pay careful attention on examination to differentiate injured skin from normal skin. This is where
palpation with inspection is key.
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Skin color can be masked by
make-up or tanning agents.
The range of normal skin color varies from dark brown to light tan with
pink or yellow overtones. Color should have overall uniformity, although
there may be sun-darkened areas and darker skin around the knees and
elbows. Calloused areas may appear yellow, and flushed areas may appear pinkish or red. Several variations of skin texture are common in the
elderly. There is smooth skin, rough skin, thin skin, wrinkled skin, and
tough skin. Elderly persons tend to have thin skin due to the thinning of
the epidermis and dermis as well as the decrease in subcutaneous tissue.
Rough skin may develop over the elbows, knees, soles of the feet, and
palms of the hand as a result of callousing. Tough skin can result from
scarring or repeat injury such as in diabetics that perform blood sugar
monitoring and receive insulin routinely. Wrinkled skin develops from the
lack of collagen and elastin as the body ages.
Palpation
In a healthy person, perspiration
and oiliness should be minimal on
examination.
During palpation, assess the skin for moisture, temperature, turgor, and
texture. Palpation will provide additional data for describing lesions, particularly in evaluating elevation or depression of skin abnormalities.
Increased perspiration may be associated with activity, warm environment, obesity, anxiety, or excitement and may be very noticeable on the
palms, scalp, forehead, and axillae. The intertriginous areas should show
minimal dampness. Close attention should be focused on the areas under
the breasts and skin folds, especially on the obese resident.
Roughness on exposed areas of
pressure (elbows, soles, palms)
may be caused by heavy woolen
clothing, cold weather or soap.
The skin should range from cool to warm. When assessing the temperature of the skin, use the dorsal (back) surface of the hand because it is
most sensitive to temperature change. This is a rough estimate of temperature; what needs to be distinguished is bilateral symmetry in skin
temperature.
Skin texture should feel smooth, soft, and even. Uniformity bilateral
should also be evident when assessing skin texture.
Skin turgor of the older adult is usually best checked by gently pinching
a small section of skin on the sternal area between the thumb and forefinger, then releasing the skin. The skin should feel resilient, move easily
when pinched and return back to place immediately after released. The
skin will not spring back to place after release in a dehydrated person or if
edema is present.
Close inspection and palpation of
the skin will ensure proper recognition of normal and abnormal skin
conditions.
When assessing the elderly resident’s skin, a thorough examination from
head to toe is essential, especially when the resident is immobile or obese.
Those with hemiplegia from a stroke should have an assessment that
focuses on the paralyzed side. Assessment of extremities for individuals with contractures is also a special consideration when evaluating the
elderly long-term care resident.
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Chapter 23 Review Questions
Define the following terms:
10. An intertrigious area would be:
1. Intertrigious —
a. Buttocks
2. Dermatomal —
c. Hand
Circle “True” or “False” as appropriate for the
following statements:
3. (True/False) — There is only one skin type.
4. (True/False) — The elderly have many different skin textures that include smooth, rough,
thin, wrinkled, and tough skin.
b. Foot
d. Skin folds
Complete the following:
11.Adequate ______________ is essential when
inspecting the skin to determine any color
variations.
5. (True/False) — Wrinkled skin develops from
the lack of collagen and elastin the body ages.
6. (True/False) — As you inspect the skin palpate for moisture, temperature, turgor, and
texture.
7. (True/False) — Warts are an example of dermatomal lesions.
Answer the following multiple-choice questions:
8. Non-pigmented striae are commonly called:
a. Age spots
b. Moles
c. Stretch marks
d. Warts
9. Fair-skinned persons are more susceptible to
harm from:
a. Night light
b. Moon light
c. Rain
d. Sun
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