Skin Matters: Variations in Assessment Based on Skin Color

  The importance of thorough skin assessment, including patient history and physical examination, cannot be overemphasized. The patient should be made as comfortable as possible for the physical examination; the clinician should provide a warm, comfortable, private environment that has adequate lighting; eliminate distractions and disruptions; have needed equipment readily available (including a transparent ruler, penlight or flashlight, magnifier, and gloves); and warm her/his hands and equipment before touching the patient. The examination should be performed in the following manner:

  • Have the patient sit or stand for total exposure of the skin if possible. The patient may lie down if necessary. If the patient is lying down, the clinician stands on the patient’s right side if he/she is right-handed to perform the examination
  • Drape the patient well, exposing only those areas being examined
  • Always wear gloves when coming into contact with body fluids or open lesions on the skin
  • Explain each step to the patient as the examination progresses
  • Carefully assess areas where potential or actual problems were identified during the history and note findings in the patient’s record, which should include an assessment tool (a sample of Coloplast’s assessment instrument has been provided).

  Because certain skin conditions may vary in presentation according to skin color, Table 1 is provided as a comparison guide for assessment. Part 1 of this article (published in the June 2006 issue of Ostomy Wound Management) provides an over-all approach to assessment of the integumentary system.

  Once the assessment has been completed, any remarkable findings require referral to dermatologist, patient physician, or supervisor (when performed by nursing assistants). A plan of care — ideally that incorporates a multidisciplinary approach to management and prevention — will need to be developed. Including bedside care providers in care planning, regardless of facility and setting type, will encourage and empower the staff on the importance of maintaining and/or restoring skin health.

The Skin Matters series is made possible through the support of the Skin Health Division of Coloplast Corp., Marietta, Ga. This article was not subject to the Ostomy Wound Management peer-review process.