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Med-Surg II (ch.26)

Problems of Protection

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
Created by: 118501829