Good Skin Assessment Skills

When someone is a victim of a crime and presents in the emergency department, a thorough skin assessment is critical. The primary nurse plays a key role in helping law enforcement assess and collect evidence. The exam should be begin with the inspection of skin, then palpation. In some cases a woods lamp or alternate light source may be needed for inspection. Keeping in mind patients with darker skin color may present different. Lesion or wounds should be documented including the location, size, color, pattern, and characteristics. For bruises consider the location, appearance, and pattern and the type of mark made. One can determine the age of a bruise by its appearance. Bruises associated with abuse may be caused by objects that leave distinctive patterns. Bite marks are a common injury associated with abuse. The size of the bite mark is important to note to determine the age of the person who left the mark. The most common type of burn is immersion. This appears by a “glove” or “stocking” pattern. Another is a contact burn; they leave a “branded pattern” on the skin. Depending on the nurse’s role in the investigation she/he may also be take photo documentation of findings. A body diagram may also be of use in explaining location of injury. Nurses must be thorough and descriptive during a skin assessment. – “Health Assessment for Nursing Practice” third edition, Wilson Giddens

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