NR 302 Week 3 Skin Assessment Write-Up Example

Skin Assessment Write-Up: A 61-Year-Old Volunteer Who Gardens Without Sun Protection

Student Name

College of Nursing, Chamberlain University

NR 302: Health Assessment I

Instructor Name

Month Day, Year

Skin Assessment Write-Up: A 61-Year-Old Volunteer Who Gardens Without Sun Protection

Conditions of the Examination

The volunteer, Mrs. P., is a 61-year-old retired teacher who gardens most mornings from April to October, usually without a hat or sunscreen by her own report. The examination was done in the nursing skills laboratory under overhead fluorescent light supplemented by a handheld penlight, with the room at a comfortable temperature, at 1030 on a weekday. She wore a gown and was draped, with each area uncovered in turn. A flexible plastic ruler marked in millimeters was kept on the table so that anything with edges was measured while the student was still looking at it. Findings are recorded as observed; almost nothing below is a conclusion. Where a technical term is available and the student can define it, it appears in parentheses after the plain description, following the vocabulary in the course text (Jarvis & Eckhardt, 2024).

Overall Color and Texture

Color, unexposed areas (abdomen, upper thighs, inner arms): pale pink-beige, even across each area.

Color, exposed areas (face, neck, forearms, backs of hands, lower legs): light tan-brown, darker than unexposed areas, with a sharp line at the edge of her short sleeves and at mid-thigh.

Texture: smooth over the trunk; the backs of the hands and forearms feel thin and slightly crinkled when pinched gently, like tissue paper (decreased thickness and elasticity, common in sun-exposed skin with age).

Moisture: dry to the touch on the lower legs, with fine white scaling over both shins; other areas neither dry nor damp.

Temperature (back of the student's hand): warm and equal on both sides of the body.

Turgor (skin over the collarbone lifted and released): returns to flat within about 2 seconds.

Lesions, Measured and Located

Backs of both hands and forearms: 14 flat, light-to-medium brown spots, each round or oval, the largest 9 millimeters across on the back of the left hand, the smallest about 2 millimeters; edges smooth; color even within each spot (macules; the text describes spots like these as solar lentigines, a term the student is recording as a possibility, not a diagnosis). Mrs. P. says they have been there for years and have slowly increased in number.

Upper back, between the shoulder blades: 3 raised, waxy-looking, light brown to dark brown spots that look stuck on the skin, 6, 8 and 11 millimeters across; surfaces rough and slightly crumbly to light touch (raised lesions, papules and small plaques; the student has seen these called seborrheic keratoses in the text). Mrs. P. has noticed them for about 5 years.

Trunk, front and back: 6 bright red, round, dome-shaped dots, 1 to 3 millimeters, that did not blanch completely under pressure from a glass slide (small vascular papules).

Left forearm, outer side, 7 centimeters above the wrist: 1 flat to slightly raised spot, 7 by 5 millimeters, irregular in outline with one notched edge, two shades of brown and a darker area at the upper edge. Mrs. P. says she is not sure how long it has been there and that her daughter pointed it out last month.

Face: on the left cheekbone, a 4-millimeter rough, sandpaper-like pink patch that she says comes and goes when she picks at it (rough, scaly macule).

Hair and Nails

Scalp and hair: hair evenly thick over the scalp, gray-brown; no bald patches; scalp without scaling or lesions, checked by parting the hair in four lines.

Body hair: fine and sparse on the arms and lower legs, equal on both sides.

Fingernails: pink beds; nail surfaces smooth; the angle where the nail meets the skin at about 160 degrees; the nail beds return to pink under 2 seconds after pressing (capillary refill).

Toenails: the nails of both big toes thickened and yellowish with crumbly edges; Mrs. P. says they have been that way for years.

What the Student Flagged for the Instructor

The student did not interpret any lesion but flagged one for the instructor because it met several features on the course's checklist for lesions that warrant evaluation: the spot on the left forearm is asymmetric, has an irregular border, has more than one color and is larger than 6 millimeters, and its history is unknown. These features match the ABCDE guide for recognizing lesions that may be melanoma, which lists asymmetry, border irregularity, color variation, diameter greater than 6 millimeters and evolution over time (Abbasi et al., 2004). The student understood that a checklist does not make a diagnosis and that many lesions with some of these features are harmless. With the instructor, the student told Mrs. P. that the spot should be looked at by her primary care provider or a dermatologist soon, and recommended she take a photograph of it with a ruler beside it so that any change could be seen. The rough patch on the cheek was also mentioned as something to show her provider.

Mrs. P. asked about sun protection, and the student shared the general advice in the course text: a wide-brimmed hat, clothing that covers the arms, and a broad-spectrum sunscreen when gardening, especially in late morning and early afternoon (Bickley et al., 2021).

What Was Hard

The hardest part was resisting adjectives. The student's first notes said the spots on her hands were age spots and the forearm lesion looked weird. Neither description would help anyone who had not seen the skin. Measuring each lesion with the ruler before writing anything forced a more useful record: size, shape, edge, color and whether it was flat or raised. The second difficulty was light; under the overhead light alone, the two shades in the forearm lesion were hard to see, and they became clear only with the penlight held at an angle.

The third difficulty was knowing when to stop describing and ask. For the forearm spot, the most useful fact turned out to be one the student could not see at all: whether it had changed. Mrs. P. could not answer, which is itself worth recording, because the fifth feature on the checklist, evolution, depends on history rather than on looking (Abbasi et al., 2004). Next time the student will ask about every lesion with edges in the same three questions: how long it has been there, whether it has changed in size, shape or color, and whether it itches or bleeds. Recording the answers, including I don't know, turns a single look into a baseline that someone can compare against later, which is the main reason to write a skin examination down at all. The ruler photograph Mrs. P. agreed to take will serve the same purpose at home.

References

Abbasi, N. R., Shaw, H. M., Rigel, D. S., Friedman, R. J., McCarthy, W. H., Osman, I., Kopf, A. W., & Polsky, D. (2004). Early diagnosis of cutaneous melanoma: Revisiting the ABCD criteria. JAMA, 292(22), 2771-2776. https://doi.org/10.1001/jama.292.22.2771

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.

Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.