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Med-Surg II (ch.26)
Problems of Protection
| Question | Answer |
|---|---|
| Skin, hair, and nails | Integumentary system |
| Skin protects against foreign invasion by providing a first, second, and third lines of defense known as: | The moat, the castle wall, and the knights and soldiers |
| Specialized cells present in the skin that engulf any foreign substances (antigens) that invade the body when the skin is injured and then alert the immune system. | Langerhans' cells |
| The largest organ of the body that plays a major role in homeostasis. | Skin |
| What is the role of skin in homeostasis? | Helps regulate body temperature and maintains fluid and electrolyte balance |
| The 3 layers of the skin | Subcutaneous fat (adipose tissue), dermis (corium), and epidermis |
| The innermost layer of the skin, lying over muscle and bone | Adipose tissue |
| What is the function of fat cells in skin? | energy reserve in event extra calories are needed to power the body; heat insulators; absorb shock; and protect against injury by padding internal structures |
| The layer above the fat layer | Dermis or corium |
| What is the composition of the dermis? | connective tissue that contains no cells; collagen; and elastic fibers that are interwoven to give skin both flexibility and strength |
| Protein formed by dermal cells; the main component of dermal tissue; increases in injured areas and helps form scar tissue | Collagen |
| Dermal cells | fibroblasts |
| A protein lubricant produced by fibroblasts that contributes to the skin's normal suppleness and turgor | Ground Substance |
| The major component of elastic fiber | Elastin |
| Rich in sensory nerves that transmit sensatons of touch, pressure, temp, pain, and itch | Dermis |
| The dermis has capillaries and lymph vessels for the exchange of what two components? | oxygen and heat |
| The outer layer of skin | Epidurmis |
| Finger-like projections that anchor epidermis to dermis tissue | Dermal papillae |
| The fingers of epidermal tissue that project into the dermis | Rete pegs |
| Protective barrier between the body and the environment that is less than 1mm thick | Epidermis |
| How does the epidermis recieve its nutrients? | By diffusion from the blood vessels in the dermal layer through the basement membrane |
| Basal cells attaached to the basement membrane that continuously divide to form new cells | Keratinocytes |
| Older keratinocytes that are pushed upward and flattened to form the stratified layers of the epithelium | Malpighian layers |
| The outermost skin layer; dead cells that are shed from the skin | Stratum corneum or horny layer |
| The protein that makes the horny layer waterproof | Keratin |
| How long does a keratinocyte take to move from the basement membrane to the skin surface | 28 to 45 days |
| Activated in epidermis by UV light | Vitamin D |
| Where does vit D promote uptake of dietary calcium? | Intestinal tract (distributed by blood) |
| Pigment-producing cells found at basement membrane that give color to skin and account for racial differences in skin tone | Melanocytes |
| What causes darker skin tones? | The size of the pigment granules contained in each cell |
| Pigment granules | melanin |
| What is the role of melanin | To protect the skin from damage by UV light |
| Melanin production increases in areas that have what characteristics? | Endocrine changes or inflammation |
| A thick protective pelt worn by most mammals | Hair |
| Located in dermal layer of skin, but are actually extensions of the epidermal layer | Hair Follicles |
| Formed by a round column of keratin within each hair follicle | Hair shaft |
| Tougher than skin keratin | Hair keratin |
| What determines a person's hair color? | genetical determined by rate of melanin production |
| hair growth occurs in _______ | cycles; growth phase followed by resting phase |
| Extensions of keratin-producing epidermal layers of the skin | nails |
| Nails serve as useful tools for ____ and _____ | grasping and scraping |
| The white, cresent-shaped portion of the nail at the lower end of the nail plate | lunula |
| Nail keratin is formed and nail growth begins here | Nail matrix (Lunula) |
| A continuous but slow process | nail growth |
| How long does fingernail replacement take? | 3-4 months |
| How long does toenail replacement take? | up to 12 months |
| A layer of keratin at the nail fold that attaches the nail plate to the soft tissue of the nail fold | Cuticle |
| Distributed over entire skin surface except for the palms and hands of soles of feet | Sebaceous glands |
| A mildly bacteriostatic fat-containing substance that lubricates the skin and reduces water loss from the skin surface; Produced by sebaceous glands | Sebum |
| Eccrine and apocrine glands | Sweat glands |
| Arise from epithelial cells; found over entire skin surface and are not associated with the hair follicle; odorless, colorless, isotonic secretions | Eccrine sweat glands |
| Role of Eccrine glands | Regulation of temperature |
| stimulation of sweat form eccrine glands & resultant water evaporation can cause the body to lose as much as ____ of fluid in a single day | 10-12 Liters /day |
| In direct contact with the hair follicle; interactions with skin bacteria with secretions causes distinctive body odor | Apocrine Sweat glands |
| The single most important factor leading to degeneration of th skin components | chronic sun exposure |
| Can increase risk for skin lesions and delay wound healing | Protein deficiencies, vitamin deficiencies, and obesity |
| Can lead to vitamin deficiencies and related skin changes | fat-free diets and chronic alcoholism |
| Initial reaction to a problem that alters one of the structural components of the skin | Primary lesion |
| Changes in appearance that occur with progression of an underlying disease or in response to a topical or systemic therapeutic intervention | Secondary lesion |
| thickend skin | lichenified |
| ABCD (Skin cancer) | Asymmetry: of shape Border: irregularity Color: variation within one lesion Diameter: greater than 6 mm |
| TSSE | Total skin self-examininatoin (monthly) |
| May reflect problems of excessive moisture | Rashes |
| Freckles, flat moles, rubella; flat lesions of less than 1 cm in diameter; white, red, or brown | Macules |
| Lipomas; elevated marble-like lesions more than 1 cm wide and deep | Nodules |
| vitiligo, cafe au lait spots; macules that are larger than 1 cm in diameter; slight scale or fine wrinkles | Patches |
| sebaceous cysts; nodules filled with either liquid or semisolid material that can be expressed | Cysts |
| Warts or elevated moles; small, firm, elevated lesions less than 1 cm in diameter | Papules |
| acute dermitities; blisters filled with clear fluid; less than 1 cm in diameter | Vesicles |
| second-degree burns; blisters filled with clear fluid; greater than 1 cm in diameter | Bullae |
| psoriasis or seborrheic keratosis; elevated, plateau-like patches more than 1 cm in diameter that do not extend intot eh lower skin layers | Plaques |
| acne, acute impetigo; vesicles filled with cloudy or purulent fluid | Pustules |
| urticaria, insect bites; elevated irregularly shaped, transient areas of dermal edem | Wheals |
| varicella; wider than fissues but involve on the epidermis; often associated with vesicles, bullae, or pustules | Erosions |
| exfoliative dermatitis and psoriasis; visibly thickened stratum corneum; appear dry and usually whitish; seen most often with papules and plaques | Scales |
| stage 3 pressure sores; deep erosions that extend beneath the epidermis and involve the dermis and sometimes the subcutaneous fat | Ulcers |
| eczema, late-stage impetigo; composed of dried serum or pus on surface of skin, beneath which liquid debris may accumulate; frequently result from broken vesicles, bullae, or pustules | crusts and oozing |
| chronic dermatitis; palpably thickened areas of epidermis with accentuated skin markings; caused by chronic rubbing and scratching | Lichenifications |
| athlete's foot; linear cracks in the epidermis, which often extend into the dermis | Fissures |
| Striae, aged skin; characterized by thinning of the skin surface with loss of skin markings; skin is translucent and paper-like; skin depression occurs when dermal layer is involved | Atrophy |
| Ringlike with raised borders around flat, clear centers of normal skin | annular |
| circular | circinate |
| well-defined with sharp borders | circumscribed |
| several lesions grouped together | clustered |
| lesions that merge with one another and appear confluent | coalesced |
| widespread, involving most of th body with intervening areas of normal skin; generalized | diffuse |
| occurring in a straight line | linear |
| with wavy borders, resembling a snake | serpiginous |
| all areas of the body involved, with no areas of normal-appearing skin | universal |
| classified as normal or abnormal, depending on the cause | vascular changes or markings |
| birthmarks, cherry angiomas, spider angiomas, venous stars | normal vascular changes |
| bleeding under the skin that may progress from red to purple to brownish yellew, petechiae, and ecchymoses; abnormal | purpuric lesions |
| small, reddish purple lesions less than 0.5mm in diameter that do not fade or blanch when pressure is applied; indicate increased capillary fragility | petechiae |
| a condition frequently seen in patients who have chronic venous insufficiency | Stasis dermatitis |
| larger areas of hemorrhage that range in size from several millimeters to many centimeters | ecchymoses |
| lice eggs | nits |
| A collecton of patchy or diffuse white or gray scales on the surface of the scalp | Dandruff |
| Excessive growth of body hair or hair growth in abnormal body areas | Hirsutism |
| May occur as a result of circulatory problems and decreased blood flow to extremities | body hair loss, especially on feet or lower legs |
| Abnormal nails | Dystrophic |
| Fungal infection that may cause a "heaped-up" appearance of the toenails | Onychomycosis |
| Required to soften the nail plates before they can be trimmed | warm-water soak or lubrication with petroleum jelly |
| Thin and bend easily with pressure; associated with malnutrition, chronic arthritis, myxedema, and peripheral neuritis | soft nail plates |
| can split; may be caused by repeated exposure to water and detergents, whcih damage the plate over time | brittle nails |
| Separation of the nail plate form the nail bed | Onycholysis |
| Inflammation of skin around the nail that often occurs with a torn cuticle or ingrown toenail | paronychia |
| Lifting or puncturing of the outer surface of a lesion | unroofing |
| A small, circular, cutting instrument ranging in diameter from 2-6 mm; small plug of tissue is cut and removed ; closed with 1-2 sutures or no sutures necessary | Punch Biopsy |
| Remove only the portion of skin elevated above surrounding tissue when injected with loal anesthtic; indicated for superficial or raised lesions; use of scalpel or razor blade | Shave Biopsy |
| Larger or deeper specimens obtained by excision with scapel; sutured | Excisional Biopsy |
| May control bleeding of biopsy site | Topical hemostatic agent |
| A handheld, long-wavelength ultraviolet (black) light | Wood's light |
| A noninvasice and painless techinque that eliminates erythema cause by increased blood flow to the skin | Diascopy |
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