The nurse is caring for a client with dark skin and needs to assess the skin for jaundice. Which of the following actions would be appropriate for the nurse in this situation?
1. Use a bright lamp and a magnifying glass.
2. Document "unable to assess" for skin changes.
3. Assess the skin the same way you would inspect a client with lighter skin.
4. Inspect the lips, oral mucosa, sclera, conjunctivae, and palms.
4
Rationale 1: A bright light may assist the nurse, but the nurse should inspect the client's lips, oral mucosa, sclera, conjunctivae, and palms when assessing for jaundice.
Rationale 2: It is not appropriate to document that the nurse is unable to assess the client for jaundice.
Rationale 3: The nurse will not find it as useful to assess the client with darker skin in the same way that the nurse would assess the client with lighter skin. The nurse should inspect areas of the body with less pigmentation such as the lips, oral mucosa, sclera, palms of the hand, and conjunctivae.
Rationale 4: Changes in skin color may be difficult to discover when assessing clients with dark skin. The nurse should inspect areas of the body with less pigmentation such as the lips, oral mucosa, sclera, palms of the hand, and conjunctivae.
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