Skin Hair and Nails Physical Examination

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[00:00:09]For a thorough skin examination, make sure there's adequate lighting. You'll need a small ruler or tape measure and a magnifying glass or dermascope to examine lesions more closely.

[00:00:20]The patient should wear a gown with an opening in the back and clothes removed except for underwear.

[00:00:25]There are two techniques for performing the full body skin examination.

[00:00:30]Examine the skin in the same order every time so you are less likely to skip part of the exam.

[00:00:36]At every step, explain to the patient what part of the body you will be examining and ask permission to expose the skin.

[00:00:43]In the standard technique, have the patient seated on the examining table.

[00:00:47]Start by examining the hair and scalp.

[00:00:50]Note the distribution, texture, and quantity of hair.

[00:00:53]Separate the hair to examine the scalp.

[00:00:56]Now inspect the head and neck including forehead, eyes, nose, ears, cheeks, lips, oral cavity, and chin.

[00:01:06]Examine the eyebrows, eyelashes, and beard.

[00:01:09]Ask the patient to lean forward and inspect the upper back.

[00:01:13]Inspect the shoulders, arms, and hands.

[00:01:16]Note the color and shape of the fingernails.

[00:01:19]Now inspect the chest and abdomen.

[00:01:22]Lower or raise the gown to expose these areas and cover them up when you're finished.

[00:01:27]Inspect the anterior thighs and legs moving down to the feet and toes including the toenails, between the toes, and the soles of the feet.

[00:01:36]Now ask the patient to stand so that you can inspect the lower back and posterior legs. If needed, ask the patient to uncover the buttocks.

[00:01:45]Exam of the breasts and genitalia may be saved for the last and are described in other sections.

[00:01:51]An alternative to the standard technique of the full body skin examination begins with the patient supine.

[00:01:57]Start with the scalp, face, and neck.

[00:02:00]Move to the shoulders, arms, and hands, then to the chest and abdomen, anterior thighs, lower legs, and feet.

[00:02:07]As noted previously, explain which areas you will be examining and ask permission when exposing the skin.

[00:02:14]Now ask the patient to turn over to the prone position.

[00:02:18]Examine the posterior scalp, neck, back, posterior thighs, legs, soles of the feet, and buttocks if needed.

[00:02:27]Throughout the exam, inspect and palpate the skin, noting its color, moisture, temperature, texture, mobility, and turgor, and any lesions.

[00:02:38]A patient may notice changes in the skin color before you do.

[00:02:42]Ask about and assess for increased pigmentation or loss of pigmentation, redness, pallor, cyanosis, or yellowing of the skin.

[00:02:51]Assess for moisture, noting characteristics such as dryness, sweating, and oiliness.

[00:02:58]When assessing for skin temperature, use the backs of your fingers. Carefully note the temperature of any red areas.

[00:03:05]Characteristics of texture include roughness and smoothness.

[00:03:09]To assess mobility, lift a fold of skin and note the ease with which it lifts up.

[00:03:15]To assess turgor, note the speed with which the skin returns into place.

[00:03:20]Observe and thoroughly describe any lesions of the skin, noting their important characteristics.