Exam Methods

• Inspection
  • To ensure that all areas are examined, consider this order for inspection.
    • While patient is seated
      • Assess the hair, noting the distribution, texture, and quantity.
      • Use your fingers or cotton-tipped applicator to separate the hair and examine the scalp from one side to the other.
      • Inspect the head and neck, including forehead, eyebrows, eyelids, eyelashes, conjunctivae, sclerae, nose, ears, cheeks, lips, oral cavity, chin, and beard.
      • Have the patient lean forward to assess the upper back.
      • Inspect the shoulders, arms, and hands, including the fingernails.
      • Inspect the anterior chest and abdomen, followed by the anterior thighs and legs.
      • Assess the feet and toes including the soles, interdigital areas, and toenails.
    • While patient is standing
      • Inspect the lower back, followed by the posterior thighs and legs.
      • Lastly, inspect the breasts, axillae, and genitalia including hair in the axillae and pubic area.
• Palpation
  • While inspecting the integumentary system, palpate the fingernails and toenails, and also any lesions to determine texture, firmness, and scaliness.

PEARLS

• Pallor indicates anemia. Cyanosis can indicate decreased oxygen in the blood or decreased blood flow in response to a cold environment. Jaundice, or yellowing of the skin, results from increased bilirubin.
• Longitudinal bands of pigment on the nails are normal in people with darker skin.
• Special considerations for darkly pigmented skin:
  • Erythema may appear dark brown, instead of pink or red
  • Eczema may appear as scaly lesions with grayish or dark brown hue
  • Wheals may appear lighter in color
  • Dry skin may appear whitish or ashy and/or a reduction in shininess of skin
• If performing a routine physical assessment, integrate aspects of the integumentary assessment into that examination. For example, when auscultating the lungs posteriorly, fully assess the back at that time.
• Teach the patient about regular skin self-examination and the ABCDE-EFG method for assessing moles.
• Document your findings using the correct terminology to describe skin lesions.