Chapter 8 – Integumentary System Assessment
Objective Assessment
Your subjective assessment should segue into your objective assessment. Typically, you will identify priority areas to examine based on your discussion with your client. For example, you may do a focused assessment of a rash, lesion, or itchy patch of skin. Depending on the healthcare context and purpose of your assessment, you may also do a general scan of the integumental system as a baseline comparison to gauge any abnormalities, or as an overview to assess any further abnormalities not identified in the subjective assessment.
Prepare before conducting your objective assessment. For example:
- Tell the client what the objective assessment will entail: how long it will take, how much touching will be involved and where, whether they will need to remove clothing, will they be in a comfortable position. (Tip: Think about things you would like to know going into an assessment).
- Prepare the environment: ensure the temperature is comfortable and the room is bright. Always ensure privacy by drawing the curtains and/or closing the door. If the room temperature is not modifiable, do your best to minimize exposing the client and keep them covered as much as possible. This keeps the client comfortable and preserves their dignity. Prepare your equipment in advance so you are not distracted with locating items while conducting your assessment. Objective assessments of the integumental system usually require pen light, gloves, pen, measuring tape, magnifying glass, and swabs and/or cotton pads. Draping may also be required depending on the region being exposed.
Objective assessment of the integumentary system includes inspection and palpation of the skin, nails, and hair.
Contextualizing Inclusivity
A person-centred approach and cultural humility is imperative when providing care considering that an objective assessment of the integumentary system may involve asking the client to expose different body parts and/or hair. For example, some Muslim women wear head coverings as a part of their Islamic faith, and head coverings can vary greatly: some women may choose to cover their hair and neck only, whereas others may choose to cover every part of their body except for their eyes. Some Muslim women also choose to limit their encounters with the opposite gender, including healthcare professionals. Do not assume a Muslim women’s level of comfort: some Muslim women may find it acceptable to reveal parts of their body in front of males if it serves a medical purpose. You should assess their needs at the beginning of a healthcare encounter. If a Muslim woman expresses discomfort with revealing parts of their body and/or hair, you might offer accommodations including a healthcare provider of the same gender, having a female colleague in the room, asking if the client would like a chaperone (friend or family member) to be present in the exam room, or allowing the patient to drape themselves so only a portion of their skin and/or hair is exposed. Ultimately, you should use an individualized approach: assess what each client is comfortable with and conduct the assessment accordingly.
