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Integumentary 104

Integumentary Nursing from Lewis

Epidermis thin superficial layer of skin (0.05 – 0.1 mm in thickness) protects
Dermis connective tissue below the epidermis (1-4 mm) Blood supply, blood pressure because the skin can vasodilate and decrease pressure
Subcutaneous tissue below the dermis, not part of the skin. Attaches skin to underlying tissue (such as bone and muscle) loose connective tissue and fat cells that provide insulation Meds given here for slow use because of the lack of blood supply
Skin appendages develop from the epidermal layer and receive nutrients, electrolytes and fluids from the dermis
Hair forms from keratin
Nails forms from keratin
Sebaceous glands secrete sebum which is emptied into the hair follicles. (prevents dryness of the skin)
apocrine sweat glands axillae, breast areola, umbilical and anogenital aread, ear canals and eyelids. Thick milky substance tat becomes odoriferous when altered by skin bacteria
eccerine sweat glands transparent watery solution, cools body
Functions of the Skin protect the underlying tissues of the body by serving as a surface barrier to environment, barrier against invasion by bacteria and viruses, Barrier against excessive water loss, Insulation, and protection from trauma, Sensory perception, Heat regulation
Functions of the skin continued Synthesis of Vitamin D, Administer meds, Express emotion
Primary Skin Lesions are physical changes in the skin considered to be caused directly by the disease process
Macule circumscribed flat area with a change in skin color less than 1 cm. eg Freckles, petechiae, measels
Papule elevated solid lesion. Eg mole, wart
Vesicle circumscribed superficial collection of serous fluid, less than 1 cm. eg. Chicken pox, shingles, second degree burn
Plaque circumscribed, elevated superficial SOLID lesion, greater than 1 cm. eg psoriasis
Wheal firm, edematous, irregularly shaped area. Eg. Insect bite
Pustule elevated, superficial lesion filled with purulent fluid. Eg. acne
Secondary Skin Lesions may evolve from primary lesions, or may be caused by external forces such as scratching, trauma, infection, or the healing process. The distinction between a primary and secondary lesion is not always clear
Fissure linear crack or break from the epidermis to dermis, dry or moist. Eg. Athlete’s foot, crack in mouth corners
Scale excess, dead epidermal cells produced by abnormal keratinization and shedding. Eg. Scarlet fever, flaking of skin after drug reaction
Scar abnormal formation of connective tissue that replaces normal skin. In dark skin, higher incidence of Keloid devoloping.
Ulcer loss of the epidermis and dermis, crater like, irregular shape
Atrophy depression in the skin resulting from thinning of the epidermis and dermis
Excoriation area in which the epidermis is missing exposing the dermis. Eg. Scabies, abrasion
Lesion Configuration Terms
Annular ring shaped
Gyrate spiral shaped
Iris lesions concentric rings (bulls eye) lyme disease is and example
Linear in a line
Nummular, discoid coinlike
Polymorphous occurring in several forms
Punctate marked by points or dots
Serpiginous snakelike
Lesion Distribution Terms
Asymmetric unilateral distribution, one side of body
Confluent merging together, overlapping
Diffuse wide distribution, all over
Discrete separate from other lesions
Generalized diffuse distribution
Grouped cluster of lesions
Localized limited area of involvement that are clearly defined
Satellite single lesion in close proximity to a large grouping
Solitary single lesion
Symmetric bilateral distribution
Zosteriform bandlike distribution along a dermatome area, like shingles
Common Assessment Abnormalities
Alopecia loss of hair
Angioma tumor consisting of blood or lymph vessels
Carotenemia yellow discoloration of skin, no yellowing of sclera
Comedo enlarged hair follicle plugged with sebum, bacteria and skin cells (blackhead, whitehead)
Cyanosis slightly bluish grey discoloration of the skin, in dark skin ashen or gray color (check in eye and nail beds)
Cyst sac containing fluid or semisolid material
Ecchymosis large bruiselike lesion caused by collection of extravascular blood in dermis and subq. In dark skin deeper purple to brownish black, difficult to see.
Erythema redness occurring in patches of variable size and shape. In dark skin Deeper brown or purple skin tone with increase in skin temp.
Hematoma extravasation of blood of sufficient size to cause visible swelling
Hirsutism male distribution of hair in women
Hypopigmentation congential or acquired loss of pigment resulting in white patchy areas
Intertrigo dermatitis of overlying surfaces of the skin
Jaundice yellow discoloration of skin. In dark skin yellowish green color most apparent in sclera of eyes, palms of hands, soles of feet.
Keloid hypertrophied scar beyond wound margins
Lichenification thickening of the skin with accentuated skin markings
Mole benign overgrowth of melanocytes
Petechiae pinpoint discrete deposit of blood less then 1-2 mm in the extravascular tissues. In dark skin difficult to see but may be evident in mouth or eyes
Telangiectasia visibly dilated superficial cutaneous small blood vessels (spider veins)
Tenting failure of skin to return immediately to normal position after gentle pinching
Varicosity increased prominence of superficial veins
Diagnostic Studies
Biopsy punch, excisional, incisional, shave
Microscopic tests culture of pustules
Wood’s lamp long wave uv light (black light) - tinea shows as green
Patch test/allergy test allergy testing
Malignant Skin Neoplasms
Diagnosis:ABCD Asymmetry, Border irregularity, Color change/ variation – tan, brown, black, Diameter of 6 mm or more
Risk Factors Fair skin, hx of chronic skin exposure, family hx of skin cancer, exposure to tar and systemic arsenicals. Living near the equator, outdoor living, tanning smoking
Nonmelanoma skin cancers
Actinic Keratosis (solar keratosis) premaligant form of squamous cell carcinoma. Affects nearly all older whites, most common. Irregularly shaped, flat, slightly reddened papule with indistinct border.
Basal Cell Carcinoma locally invasive malignancy arising from epidermal basal cells. Most common type of skin cancer (least deadly). B is best, rarely metastisizes
Squamous Cell Carcinoma malignant neoplasm of keratinizing epidermal cells. Less common than BCC. Aggressive, metastatic
Malignant Melanoma tumor arising in melanocytes which are the cells that produce melanin., metastisize to ANY organ. Most deadly skin cancer. Incidence increasing faster than others as well
Treatment of skin cancer Surgical removal
Moh’s Surgery Incision for suspected or known cancer. Pt under anesthesia, check right then to see if they got all the cancer. Removed in small slices, checked under microscope to see if there was still cancer, if so another slice. Repeat until the slide is clear.
Tx of Skin Cancer Metastisized also needs chemotherapy
Skin Infections and Infestations
Bacterial Skin Infections bacteria on skin cause infection. Staph A. and group B strep are most responsible for skin infections.
Impetigo kids, mouth, nose and pierced ears. Bacterial postules, itchy. Antibiotics and warm compresses
Folliculitis infected hair follicles, postules, painful, itchy cysts. antibiotics
Furuncles hair follicles infection, necrotic sacs requiring incision and drainage. Antibiotics
Cellulitis subq secondary infection. Hot, tender, red, fever, chills, malaise. Tx elevation, moist heat antibiotics
Viral Skin infections virus can cause lesions. Antivirals for treatment
Herpes Simplex Virus painful vesicles on the skin. (cold sore). Red, crusty, life long virus
Herpes Zoster Shingles (varicella) common in immunocompromised. Happens along dermatomes
Veruca Vulgaris wart (HPV) TX freezing
Plantar warts foot warts TX freezing
Fungal skin infections treat with antifungals
Candidiasis yeast infection, any warm moist area
Tinea Corporis ringworm, anywhere on body
Tinea Cruris jock itch
Tinea pedis athlete’s foot
Infestations and Insect Bites bees, bedbugs, lice, scabies, ticks
Rash in light skin may be visualized as well as felt. In dark skin not easy to see but can be felt
Common Allergic Conditions of the Skin
Allergic contact dermatitis hypersensitivity reaction, red papules and plaqued, usually puss producing, frequently takes shape of causative agent. TX- topical corticosteroids, antihistamines
Urticaria (hives) (histamine response) spontaneously occurring elevation, varying sizes, multiple, very itchy, can go with dermatitis. Tx- removal of cause, antihistamines, cool compresses
Drug Reaction rash as last as 14 days after cessastion of drug common on face and chest. Tx- dc drug, antihistamine, corticosteroids
Atopic Dermatitis pruritic, oozing, scaly discolored. Usually associated with autoimmune issues (associated with Asthma and allergic rhinitis in children) Tx lubrication of skin, corticosteroids
Common Benign Conditions of the Skin
Acne noninflammatory lesions of skin. Tx- topicaly benzoyl peroxide, accutane
Nevi (moles) hyperpigmented areas of skin. Tx-non necessary
Psoriasis chronic dermatitis, silvery scales. Tx- reduce inflammation, corticosteroids, tars, UV light, immunosuppressants
Seborrhic Keratoses irregularly round or oval papules or plaques. Well defined, itchy. Removal
Acrodhordons (skin tags) small skin colored soft papules. Tx – none necessary
Lipoma benign tumor of adipose tissue. Tx- none
Vitiligo focal amelanosis (loss of pigment). Tx- topical steroids
Lentigo (liver spots) areas of hyperpigmentation Tx. None, but monitor
Pallor in light skin white or ashen. In dark skin underlying red tones are missing and they look ashen or grey.
Created by: 582303342