6512 Assignment Wk 4
Amblerchick8-3
RTF-downloadable Physical Exam Summary
Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Mosby items and derived items © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Seidel: Mosby’s Guide to Physical Examination, 7 th Edition
Chapter 8 : Skin, Hair, and Nails
RTF-downloadable Physical Exam Summary
This review discusses examination of the skin, hair, and nails.
Before the exam, gather the necessary equipment: a clear, flexible centimeter ruler; flashlight with transilluminator; handheld magnifying glass; and Wood’s lamp.
To examine the skin, perform the following.
Use inspection and palpation to examine the skin. Make sure you have adequate lighting, preferably with daylight.
When evaluating the skin (and mucous membranes) in each part of the body, note six characteristics.
First, describe its size (measured in centimeters in all dimensions), shape, color, texture, elevation or depression, and attachment at the base.
To examine the hair, perform the following.
- To assess the hair, palpate its texture. Scalp hair may be coarse or fine, and curly or straight. It should be shiny, smooth, and resilient.
- During palpation, also inspect the hair for three characteristics: color, distribution, and quantity.
- Hair color ranges from very light blond to black to gray.
- Hair distribution and quantity varies with genetics. Hair commonly appears on the scalp, lower face, neck, nares, ears, chest, axillae, back, shoulders, arms, legs, toes, pubic area, and around the nipples.
To examine the nails, perform the following.
- Use inspection and palpation to assess the nails. Ask yourself: Are the nails dirty, bitten to the quick, or unkempt? Or are they clean, smooth, and neat? The condition of the hair and nails provides clues to the patient’s self-care, emotions, and social integration.
- I nspect the nails for five characteristics: color, length, condition, configuration, symmetry, and cleanliness.
- Although nail shape and opacity can vary greatly, the nail bed color should be pink. Pigment deposits may appear in the nail beds of dark-skinned patients.
- The nail length and condition should be appropriate—not bitten down to the quick. The nail edges should be smooth and rounded, with no peeling or jagged, broken, or bitten nail edges or cuticles.
- In configuration, the nail plate should appear smooth and flat or slightly convex. It should have no ridges, grooves, depressions, or pits.
- The nails should appear bilaterally symmetrical.
- And the nails should be clean, smooth, and neat.
- Measure the nail-base angle by placing a ruler across the nail and dorsal surface of the finger and checking the angle formed by the proximal nail fold and nail plate.
- The nail-base angle should measure 160 degrees.
- If the nail-base angle is 180 degrees or more, clubbing is present, which suggests a cardiopulmonary or other disorder.
- Inspect and palpate the proximal and lateral nail folds for redness, swelling, pain, and exudate as well as warts, cysts, and tumors. Pain usually accompanies ingrown nails or infections.
- Palpate the nail plate for four characteristics: texture, firmness, thickness, and adherence to the nail bed.
- The texture of the nail plate should be hard and smooth.
- The nail base should be firm—not boggy.
- The nail thickness should be uniform. Thickened nails may result from tight-fitting shoes, chronic trauma, or a fungal infection. Nail thinning may accompany a nail disease.
- The nail should adhere to the nail bed when you gently squeeze the patient’s nail between your thumb and fingerpad.