Chapter 27: The Integumentary System (Skin Health) Flashcards
Outer layer of the skin
Epidermis
Small, light-colored (gray or brown) benign lesions on epidermis. (Can be pre-cancerous)
Keratosis
Epidermal cells that give skin its color
Melanocytes
Irregular, dark areas (resembling bruises) that may be found on the buttocks, lower back, and to a lesser extent on the arms, abdomen, and thighs; more prevalent in persons of African, Asian, or Native American backgrounds
Mongolian spots
___ (solar elastosis): skin changes resulting from exposure to ultraviolet rays
Photoaging
Localized damage to skin and/or underlying soft tissue resulting from pressure or pressure combined with shear or friction
Pressure injury
Itching
Pruritus
Elasticity
Turgor
__, __, and __ are the most obvious constant reminders of the aging process.
Lines and wrinkles, thicker nails, and graying hair
ABCDE’s in detecting unhealthy moles:
A: asymmetry B: border irregularity C: color D: diameter E: Elevation in height
A—Asymmetry: If a mole is ____, it could be a sign of melanoma.
not round or symmetrical, or one half of the mole is not similar to the other half
B—Border Irregularity: Cancerous moles have irregular borders that may be __, __, __, or __.
uneven, ragged, notched, or blurred.
C—Color: The typical color of a mole is consistently __ throughout. A mole that has changed color over time or is varied in a shade of brown, tan, and black may be cancerous.
brown
D—Diameter: Cancerous moles can be more than __ in diameter (about ¼ in. or the size of a pencil eraser).
6 mm
If melanoma in a mole has progressed, the mole may become ___
red, blue, or white.
Other mole variations that may indicate melanoma include:
- elevation in height from the skin surface both horizontally or vertically
- a change in feeling, such as itchiness, tenderness, or pain
- the tendency to bleed if scratched.
The most common dermatologic problem among older adults is __.
pruritus
pruritus can be precipitated by any circumstance that ___
dries the person’s skin, such as excessive bathing and dry heat
___, also referred to as actinic or solar ___. CAN BE PRE-CANCEROUS
Keratoses
Keratin may be accumulated in these lesions, causing the formation of a cutaneous horn with a slightly ___
reddened and swollen base.
Freezing agents and acids can be used to destroy the ___ ___, but electrodesiccation or surgical excision ensures a more thorough removal
keratotic lesions (keratoses)
__ __ are dark, wart-like projections on the skin. Body locations: trunk, face, neck. BENIGN LESIONS!!!!!!!!
Seborrheic keratoses
There are three major skin cancers that are common in late life:
basal cell carcinoma, squamous cell carcinoma, and melanoma.
____, the most common form of skin cancer, grows slowly and rarely metastasizes.
Basal cell carcinoma
__ __ __ can develop in scar tissue and is also associated with suppression of the immune system. These CANCERS typically appear as firm, skin-colored or red nodules.
Squamous cell carcinoma
Squamous cell carcinoma usually stays in the ___ but can metastasize
epidermis
The __ is a common site of metastasis.
lower lip
___ tends to metastasize, or spread, more easily than the other forms of skin cancer, making it more deadly if not caught early
Melanoma
3 classifications of melanoma:
lentigo maligna melanoma
superficial spreading melanoma
nodular melanoma
This black, brown, white, or red pigmented flat lesion occurs predominately on sun-exposed areas of the body. With time, it enlarges and becomes progressively irregularly pigmented. The mean age at diagnosis is 67.
lentigo maligna melanoma
Most melanomas are of this type. The lesion appears as variable pigmented plaque with an irregular border. It can occur on any area of the body. Its incidence peaks in middle age and continues to be high through the eighth decade.
superficial spreading melanoma
This melanoma can be found on any body surface and presents as a darkly pigmented papule that increases in size over time
nodular melanoma
T/F: Age-related changes can weaken the walls of the veins and reduce the veins’ ability to respond to increased venous pressure
true
Weakened vessel walls cause __ __
varicose veins
As the poorly nourished legs accumulate debris, inadequately carried away with the venous return, the legs gain a __, __, and __ appearance
pigmented, cracked, and exudative
An inflammatory condition associated with chronic venous insufficiency. Inflammation of skin due to blood “staying” in one spot. (pooling)
Stasis dermatitis
These ulcers, known as __ ulcers, often appear on the medial aspect of the tibia above the malleolus and, prior to skin breakdown, present as a dark discoloration of the skin.
stasis
Any part of the body can develop a pressure injury, but the most common sites are the __, __, and __.
sacrum, greater trochanter, and ischial tuberositie
Older adults are at high risk for pressure injury because they:
Have skin that is fragile and damages easily
Are often in a poor nutritional state
Have reduced sensation of pressure and pain
Are more frequently affected by immobile and edematous conditions, which contribute to skin breakdown
Some older patients may develop signs of pressure injuries, even with a turning schedule of every 2 hours, and require more __ __.
frequent repositioning
Redness of the skin appears quickly and can disappear quickly if pressure is removed
Hyperemia.
Redness of the skin develops from up to 6 hours of unrelieved pressure and is often accompanied by edema and induration.
Ischemia
Unremitting pressure extending over 6 hours can cause ulceration with a necrotic base.
Necrosis
If pressure is not relieved, necrosis will extend through the fascia and potentially to the bone, which is called __ __ __.
Deep tissue damage.
Reverse staging of a pressure injury should not be done. As the injury heals, refer to it as a “healing stage (whatever number)” and ___
state the highest stage at which the injury was assessed to be.
Components of physical examination of skin:
- skin surface
- lesions
- turgor
- pressure
- tolerance
- temperature
Some people are repositioning themselves less than every __ hours
2
Topical ___ is a treatments for pruritus.
Zinc oxide
Which is a benign lesion?
Seborrheic keratosis or keratoses?
seborrheic keratosis
Description of Appearance:
- small, done-shaped covered by small blood vessels.
- Resemble small benign flesh-colored moles w/ “pearl” appearance
- May appear more dark than shiny w. melanin pigments in growth
basal cell carcinoma
Age-related change: weakened vein walls
Reduce ability of veins to respond to increased venous pressure
Obesity and hereditary factors compound problem
vascular lesions
Pathophysiology of vascular lesions? (3)
varicose veins
lower extremity edema
pigmented appearance
PU: A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved
Non-blanchable so normal skin color appears if you push on the ulcer/injury
stage 1
PU: A partial-thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister, or shallow crater
stage 2
PU: A full thickness of skin is lost extending through the epidermis and exposing the subcutaneous tissues; presents as a deep crater with or without undermining adjacent tissue
Measure depth of this during wound assessment
stage 3
PU: A full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone, or both; presents as a deep crater that may include necrotic tissue, exudate, sinus tract formation (tunneling), and infection.
stage 4
PU: Full-thickness loss of tissue with base covered by slough (yellow-mucousy covering on wound) and/or eschar (black unhealthy tissue). Stage cannot be determined until sough or eschar is removed to expose the base and actual depth of wound
unstageable
PU: Localized area of non-blanchable deep red or purple discoloration with a dark wound bed or blood-filled blister due to intense or prolonged pressure or shearing force. Skin may be intact or non-intact
These are unstageable, bc once the tissue dies and come off, you really don’t know how deep it is and what stage it is with the slough and necrosis on it.
deep tissue injury
Many patients lose their life to stage __ pressure ulcers if it is not aggressively treated and taken care of
4
