Performing a skin assessment.

A SKIN ASSESSMENT captures the patient' s general physical condition, based on careful inspection and pal-pation of the skin and documentation of your findings. Here are some components of a good skin assessment. Take a thorough history Obtain a history of the patient' s skin condition from the patient, caregiver, or previous medical records. Go over the detailed family history with the patient or patient' s family, and make sure all skin conditions are reviewed. Also obtain a history of the pa-tient' s bathing routine and skin care products. Document the soaps, shampoos, conditioners, lotions, oils, and other topical products that the patient uses routinely. Ask the patient: • about skin changes such as xerosis (skin dryness), pruritus, wounds, rashes, or changes in skin pigmentation or color • if skin appearance changes with the seasons • about any changes in nail thickness , splitting, discoloration, breaking , and separation from the nail bed. A change in the patient' s nails may be a sign of a systemic condition. • about allergies, including those to medications, topical skin and wound products, and food. Document your findings in the medical record. This includes assessment of skin color, moisture, temperature, texture , mobility and turgor, and skin lesions. Inspect and palpate the fingernails and toenails, noting their color and shape and whether any lesions are present. Skin lesions can be categorized as primary or secondary, although the distinction isn't always clear. Make sure you use the correct term to describe any lesions you find. The following are primary lesions: • macule, a flat, nonpalpable circumscribed area (up to 1 cm) of color change that' s brown, red, white, or tan • patch, a flat, nonpalpable lesion with changes in skin color, 1 cm or larger • papule, an elevated, palpable, firm, circumscribed lesion up to 1 cm • plaque, an elevated, flat-topped, firm, rough, superficial lesion 1 cm or larger, often formed by coalescence of papules • nodule, an elevated, firm, circum-scribed, palpable area larger than 0.5 cm; it' s typically deeper and firmer than a papule • cyst, a nodule filled with an ex-pressible liquid or semisolid material • vesicle, a palpable, elevated, circumscribed, superficial, fluid-filled blister up to 1 cm • bulla, a vesicle 1 cm or larger, filled with serous fluid • pustule, which is elevated and superficial , similar to a vesicle, but is filled with pus • wheal, …