2.7b Integument Flashcards
The basics of structure & function
EPIDERMIS
Five layers: mostly dead cells
Melanin: color of skin
Keratin: strength of skin
DERMIS
Capillaries & pain/touch receptors
Blood vessels, sweat/sebaceous glands, collagen fibers
SUBCUTANEOUS (HYPODERMIS): fat layer, insulation
Skin Assessment (history):
Onset/Duration of problem Characteristics: pain, pruritus, paresthesia Course Severity Precipitating/relieving factors: meds, travel, stress, diet etc Timing and circumstances History of associated Illness: e.g.DM Presence of risk factors: occupation
Physical assessment:
Physical examination
Private exam room (temp and lighting)
Patient comfort in gown that allows access to all areas of skin
Systematic head to toe
Compare symmetry
General inspection
Lesion-specific inspection
- Measure with metric system
- Appropriate terminology
- Remove cosmetics, oils
- Location, distribution, color, pattern, edges, size, elevation, exudate
primary lesions
Caused directly by disease
Present at onset of the disease
Example:
Vesicles RT chicken pox
Nodules RT RA
secondary lesions
Result from changes over time caused by disease progression, manipulation, or treatment.
Example: Crusted, excoriated or infected lesion caused by scratching the vesicle. Vascular ulcers RT PVD Pressure ulcers Scars, keloids
Pathological terms
Types of skin lesions
Macule?
Macule: flat, nonpalpable change in color
port-wine stains, freckles, petechiae, vitiligo
Pathological terms
Types of skin lesions
Papule?
Papule: small elevated, solid mass, <0.5 cm (patch
moles, warts, psoriasis <0.5cm mass
Pathological terms
Types of skin lesions
Plaque?
Plaque: raised, flat lesion – groups of papules
groups of papules that form lesions >0.5
Pathological terms
Types of skin lesions
Nodule?
Nodule: larger than a papule (more than 1 cm) raised solid lesion extending deeper into the dermis.
nodules are 1-2cm
Pathological terms
Types of skin lesions
Vesicle?
Vesicle: elevated, fluid-filled, thin wall (called bullae if >0.5cm
Pathological terms
Types of skin lesions
Pustule?
Pustule: elevated, pus-filled
Pimple
Pathological terms
Types of skin lesions
Cyst?
Cyst: elevated, encapsulated in the SQ, fluid or semi-solid
Pathological terms
Types of skin lesions
Ulcer?
Ulcer: deep, irregularly-shaped area of skin loss, dermis or SQ
What are the normal changes in skin RT aging?
Decreased thickness of epidermis
Hyperplasia of melanocytes (liver spots, aging spots)
Decreased Vitamin D production
Decreased vasomotor response
Elastin fibers degenerate
Proliferation of capillaries
SQ layer thins
Adipose redistribution
Decreased Sweat & sebaceous glands
What are some common lesions in the older adult?
Skin tags
Keratoses: scaly patches on top layer of skin, horney growth
Lentigines (liver spots)
Angiomas; look like small blood blister
Telangiectases: group of broken blood vessels
Photoaging
Venous lakes: larger blood blister looking, usually in/on the mouth or ears
Pruritus
Variable size of area
Itch-scratch-itch cycle
Trigger stimulates receptors in junction between epidermis and dermis and can also trigger release of inflammatory mediators
Pruritus
Causes:
Causes: May or may not be associated with rash Environmental factors & allergies Emotional distress Secondary to systemic disease
Pruritus
Management:
Management: Identify & eliminate cause Meds to manage itch? Secondary effects Box 16-1
Xerosis (dry skin)
Common in older adult due to decrease lubrication & reduced moisture retention
Sun exposure—
Cumulative and damaging
Loss of elasticity, thinning, wrinkling, drying
Major factor in precancerous and cancerous lesions
Actinic keratosis, basal cell carcinoma, squamous cell carcinoma, malignant melanoma associated directly or indirectly with sun exposure
Xerosis (dry skin)
Management
Management: Creams Lotions Ointments Antibiotics Corticosteroids Anesthetics
nevi
Nevi are some of the most common growths that occur on the skin.
moles, beauty spots or birthmarks.
Macules and papules with defined borders
Arise from melanocytes early in life & migrate up
Dysplastic nevi – can become malignant
Management: monitor for changes in size, thickness, color, bleeding or itching
Moles
Moles
Flat or raised macules, papules, with rounded well-defined borders
Small tan to deep brown and grow in groups
Melanocytic nevi
Melanocytic nevi can be present at birth or around the time of birth.
These tend to be larger moles and are referred to as congenital nevi.
During childhood “regular moles” may begin to appear.
Typically they are skin color to dark brown, flat to dome shaped growths that can appear anywhere on the skin.
The average person has 15-20 melanocytic nevi.
Genetic predisposition
Continue to develop throughout life
Non-contagious
keratoses
Generally benign overgrowth and thickening of epithelium
Adults >50 yrs old
Tan, waxy, can appear greasy, commonly on face or trunk
Seborrheic ketatoses: waxy or warty, uneven pigment; can be malignant (25%)
keratoses
Benign, genetically determined superficial growths
- Found in increasing number with age
- Irregularly round of oval, flat-topped papules or plaques
- Surface often verrucous
- Well-defined shape
- Appearance of being “stuck on”
- Increase in pigmentation with age of lesion
- Usually multiple and possibly itchy
- Removal by curettage or cryosurgery for cosmetic reasons or to eliminate source of irritation
- Minimal scarring
-May be removed for biopsy
psoriasis
Chronic, immune characterized by raised, red, round, circumscribed plaques covered by silvery white scales.
Most common lesions on elbows, knees, scalp
Associated problems: pruritus, fissures, infections
