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