M05_MURR8663_08_SE_CH05.QXD 5/27/08 10:20 AM Page 139

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TABLE 5-12 Clinical Assessment of Skin Color Characteristic White or Light-skinned Person Dark-skinned Person

Pallor Skin takes on white hue, which is color of Skin loses underlying red tones. Brown-skinned Vasoconstriction present collagen fibers in subcutaneous connec- person appears yellow-brown. Black-skinned tive tissue. person appears ashen gray. Mucous membranes, lips, and nailbeds are pale or gray. Erythema, Inflammation Skin is red. Palpate for increased warmth of skin, edema, Cutaneous vasodilation tightness, or induration of skin. Streaking and redness are difficult to assess. Cyanosis Skin, especially in earlobes, as well as in lips, Lips, tongue, conjunctiva, palms, soles of feet are Hypoxia of tissue oral mucosa, and nailbeds, has bluish pale or ashen gray. tinge. Apply light pressure to create pallor; in cyanosis, tissue color returns slowly by spreading from periphery to the center. Ecchymosis Skin changes from purple-blue to yellow- Oral mucous membrane or conjunctiva show Deoxygenated blood seeps green to yellow. color changes from purple-blue to yellow- from broken blood vessel green to yellow. into subcutaneous tissue Obtain history of trauma and discomfort. Note swelling and induration. Petechiae Round, pinpoint purplish red spots are Oral mucosa or conjunctiva show purplish red Intradermal or submucosal present on skin. spots if person has black skin. bleeding Jaundice Skin, mucosa membranes, and sclera of Sclera of eyes, oral mucosa membranes, palms Accumulated bilirubin in eyes are yellow. Light-colored stools and of hand, and soles of feet have yellow tissues dark urine often occur. discoloration.

sions for African Americans, including infants, should contain this 1. What do you think caused your problem? Is it related to your component (2, 37). religious beliefs? Pain assessment must consider cultural factors: Different popula- 2. Why do you think it started when it did? tion groups have about the same physical thresholds of pain, although 3. What do you think this illness does to you? What problems there is individual variation in each group. However, how different has it caused for you? populations express pain varies according to whether the individuals 4. What do you fear most about your illness? Its outcome? were taught to speak about or give evidence of their pain (physical 5. How severe is your illness? What helps you bear the symptoms and emotional). It is necessary to look for subtle cues of pain and illness? among Northern European, Asian, and American Indian popula- 6. What kind of treatment have you already tried? What else tions and not to overmedicate patients who tend to be more ex- would help? Should spiritual or folk healers be contacted? pressive, such as Latino or Jewish people. Family members may 7. What would you like for health care providers to do for you? also react differently when they see the patient in pain. Families of What results do you want or expect from treatment? Eastern European groups tend to be proactive and assertive on be- half of the patient. Patients also respond differently when family NURSING DIAGNOSES members are present. In some cultures, for example, Anglo Amer- The nursing diagnoses in the Box titled Nursing Diagnoses Re- ican, the patient is not expected to talk about the pain to the fam- lated to Transcultural Nursing may be applicable to working with ily (2, 24, 61, 125). people from various cultures (90). Leininger discusses the impor- Spiritual and Religious Assessment Learn about the significant re- tance of not focusing on Anglo-American Western cultural values ligious practices and their influences on everyday patterns of hygiene, in the North American Nursing Diagnosis Association (NANDA) types of foods eaten, sleeping, elimination, use of space, and various taxonomy (66). It is important to use wellness nursing diagnoses rituals that are a part of the person’s culture. Because the client and to help the person focus on health, progress, and strengths, and not the practitioner may have different perspectives of health and ill- focus only on problems. Wellness diagnoses could include (66, 90) ness, you may ask any of the following questions, which can enhance (a) gaining new information, (b) learning new skills, (c) acquiring understanding about the client’s viewpoint: new roles, and (d) achieving developmental tasks.