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integumentary system > diagnosis sxs / ddx / characteristics > Flashcards

diagnosis sxs / ddx / characteristics Flashcards

1
Q

Epidermal burn / first degree burn characteristics

A 
damage to epidermis only
pink or red appearance
no blistering
minimal edema 
tenderness / delayed pain
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2
Q

superficial partial thickness burn / second degree burn

A 
epidermis and upper layers of dermis damaged
bright pink or red appearance
blanching with brisk capillary refill
blisters, moist surface, weeping
moderate edema
painful, sensitive to touch
temperature changes
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3
Q

deep partial thickness burn / second degree burn

A

severe damage to epidermis and dermis with injury to nerve endings, hair follicles, and sweat glands
mixed red or waxy white appearance
blanching with slow capillary refill
broken blisters, wet surface
marked edema
sensitive to pressure but insensitive to light touch and soft pin prick

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4
Q

full thickness burn / third degree burn

A 
complete destruction of epidermis, dermis, subq tissues and can extend into muscle
white, charred, tan or black appearance
no blanching, poor distal circulation
parchment like, dry leathery surface
depressed area
little pain / nerve endings destroyed
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5
Q

subdermal burn / fourth degree burn

A

complete destruction of epidermis, dermis, and involvement of subq and muscle tissues
charred appearance
destruction of vascular system and may lead to additional necrosis

often from electrical burns or prolonged contact with flame

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6
Q

Pressure sore / decubitus ulcers etiology

A

result of prolonged pressure, necrosis of tissues often over bony prominences

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7
Q

pressure sore / decubitus ulcers risk factors

A 
Primary = immobility
decreased sensation
moisture
friction / shearing forces
decreased arterial perfusion
abnormally high or low BMI
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8
Q

most common places for pressure ulcers

A 
heels
plantar surface of foot
malleoli
trochanters
ischial tuberosities
sacrum
scapulae
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9
Q

Stage 1 pressure/ decubitus ulcer

A

intact skin
nonblanchable erythema
reversible with intervention.
discoloration, warthm, edema, induration

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10
Q

stage 2 pressure /decubitus ulcer

A 
partial thickness skin loss
epidermis and dermis involvement
abrasion, blister, shallow crater
red or pink wound bed
Intact or ruptured blister or shiny or dry shallow ulcer 
No slough or bruising
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11
Q

stage 3 pressure/ decubitus ulcer

A

full thickness skin defect extending into fat layer but not through fascia (no bone, tendon or muscle exposure)
Slough present but not obscure depth of tissue loss
Undermining and tunneling possible

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12
Q

stage 4 pressure /decubitus ulcer

A

full thickness skin defect extends beyond facia into muscle
tendon, capsule often exposed
may extend to and include bone destruction

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13
Q

unstageable pressure ulcer

A

term is used if wound is covered with necrotic tissue

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14
Q

arterial insufficiency ulcer etiology

A

Secondary to inadequate circulation of oxygenated blood BBC of :
arteriosclerosis obliterans
frequent in patients with diabetes

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15
Q

arterial insufficiency characteristics

A 
irregular but smooth edges
minimal to no granulation
deep and painful
location = lateral malleolus and toes, anterior tibial area
decreased or absent pulses
trophic skin changes
pallor on elevation, rubar on dependency
no drainage
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16
Q

venous insufficiency ulcer etiology

A

valvular incompetence
venous hypertension
venous thrombosis
varicose veins

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17
Q

venous insufficiency ulcer characteristics

A 
painless
superficial w/ good peripheral pulses
hemosiderin stains 
location = medial side of ankle and distal lower leg
large amounts of exudate
edema
good granulation
normal temperature
no gangrene
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18
Q

diabetic foot ulcer etiology

A

caused by repetitive trauma on insensitive skin secondary to diabetes progression (peripheral vascular disease and neuropathy )

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19
Q

diabetic foot ulcer characteristics

A

often on plantar aspect of foot
typically not painful secondary to periph neuropathy
pulses may be present or diminished
absent ankle jerks with neuropathy

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20
Q

dermatitis (eczema) causes

A

allergic or contact dermatitis - poison ivy, adhesive tapes, chemicals, etc
actinic - photosensitivity, reaction to sunlight/UV
atopic - allergic reaction, psychologic disorders, hereditary

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21
Q

acute dermatitis

A

red, oozing , crusting rash

extensive erosions, exudate, pruritic vesicles

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22
Q

subacute dermatitis

A

erythematous skin
scaling
scattered plaques

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23
Q

chronic dermatitis

A

thickened skin
increased skin marking secondary to scratching
fibrotic papules

24
Q

cellulitis

A

inflammation of cellular or connective tissue in or close to the skin

poorly defined and widespread
common with staph and strep infection and can be contagious
skin is hot red, edematous

25
Q

herpes zoster causes

A

varicella-zoster virus (chicken pox)

reactivation of virus lying dormant in cerebral ganglia or ganglia of posterior nerve roots

26
Q

herpes zoster characteristics

A

pain and tingling in spinal or cranial dermatome
red papules along distribution of affected nerve
progression to vesicles
accompanied by fever, chills, malaise, GI disturbances

CN 8 involvement - eye pain and corneal damage
CN 10 involvement- loss of vision

27
Q

Discoid lupus erythematosus characteristics

A

only skin
flare ups with sun exposure
lesions can cause atrophy, permanent scarring, hypopigmentation, hyperpigmentation

28
Q

lupus erythematosus

A

chronic progressive autoimmune inflammatory disorder of connective tissue

red rash with raised, red, scaly plaques

29
Q

systemic lupus erythematosus characteristics

A

affects multiple organ systems including

  • skin
  • joints
  • kidneys
  • heart
  • nervous system
  • mucous membranes

commonly affects young women
fever, malaise, butterfly rash, skin lesions, chronic fatigue, arthralgia, arthritis, skin rash, photosensitivity, anemia, hair loss, raynauds

30
Q

slceroderma characteristics

A

chronic autoimmune disease of connective tissues causing fibrosis of skin, joints, blood vessels, internal organs

often w/ Raynauds phenomenon

skin is taut, firm, edematous, firmly bounds to subcutaneous tissues

31
Q

limited systemic sclerosis/scleroderma

A

symmetrical skin involvement of distal extremities and face
slow progression of skin changes
late visceral and pulmonary hypertension involvement

32
Q

diffuse systemic sclerosis /scleroderma

A

symmetrical widespread skin involvement of distal and proximal extremities, face, trunk, rapid progression of skin changes with early appearance of visceral involvement

33
Q

polymyositis characteristics

A

connective tissue disease - autoimmune
edema, inflammation, degeneration of proximal muscles with symmetrical distribution
rapid, severe onset often requiring vent support

34
Q

Complications of burn injury

A

infection
shock
pulmonary complications (esp if smoke inhale) - restrictive lung dis from burns on trunk or pneumonia
metabolic complications
cardiac and circulatory problems secondary to fluid loss (dec cardiac output)
integumentary scars (keloids, etc)

35
Q

inflammatory phase characteristics of wound healing

A

days 1-10
platelet activation and clotting cascade
mast cells, neutrophils, leukocytes kill bacteria

36
Q

proliferation phase of wound healing

A

days 3-21
formation of new tissue = prolif phase
capillary buds and granulation tissue fill wound bed
keratinocytes, endothelial cells, and fibroblasts are active to form collagen matrix

37
Q

maturation phase / remodeling phase of wound healing

A

begins at 7days up to 2 years

when granulation tissue and epithelial differentiation begin to appear in wound bed

38
Q

how age affects wound healing

A

epidermis thins and flattens making it more fragile and susceptible to injury from friction and shear

decreased metabolism also correlated w/ decrease in overall rate of wound healing

39
Q

how co morbidities affects wound healing

A

cardiopulm disease, vascular conditions, diabetes delay the wound healing process

often due to poor tissue perfusion limiting celluar activity required for adequate wound healing

also some comorbidities suppress immune system and can alter inflammatory response and increase risk for infection

40
Q

how does edema affect wound healing

A

increased tissue pressure from excessive edema affects tissue perfusion and removal of celluar waste.

this decreases available oxygen and nutrients and delays healing and inc risk for infection

41
Q

how does harsh or inappropriate wound care (ie whirlpool) affect wound healing

A

damages peripheral and granulating tissue therefore delays or reverses the process of healing

42
Q

how does infection affect wound healing

A

because the immune response now is trying to take care of the infection and not the wound therefore healing is slowed

also the infection itself could cause further tissue damage secondary to toxins

43
Q

how does smoking affect wound healing

A

limits blood oxygen carrying capacity causing hypoxia nd slowing healing process

could also allow for infection

44
Q

zone of coagulation

A

area of burn that received most severe injury

irreversible cell damage

45
Q

zone of stasis

A

area of less severe injury that possesses reversible damage and surrounds the zone of coagulation

46
Q

zone of hyperemia

A

area surrounding zone of stasis

presents with inflammation but will fully recover without any intervention or permanent damage

47
Q

Abraision

A

Combo of friction and shear forces Over rough surface resulting in scraping away the skins superficial layers

48
Q

Avulsion

A

“Degloving”
Results from tension
Causes skin to become detached from underlying structures

49
Q

Incisional wound

A

Created intentionally by sharp object

50
Q

Laceration

A

Wound or irregular tear of tissues associated with trauma

Result from shear, tension, or high force compression

51
Q

Penetrating wound

A

Wound that enters interior of an organ or cavity

52
Q

Puncture wound

A

Sharp object penetrates skin and underlying tissue
Relatively little tissue damage beyond wound tract
Risk of contamination and infection high

53
Q

Supine bony prominence often associated with ulcer formation

A 
Occiput 
Spine of scapula 
Inf angle of scapula 
Spinous processes 
Med epicondyle humerus 
Post iliac crest
Scrum
Coccyx
Heel
54
Q

Prone bony prom associate with ulcer

A 
Forehead 
Anterior portion acromiom 
Anterior head of humerus 
Sternum
Asis 
Patella 
Dorsum of foot
55
Q

Sidelying bony prominences assoc with ulcer

A 
Ears
Acromium
Lateral humeral head
Lat epicondyle of humerus 
Greater trochanter
Head of fibula 
Lat/med malleolus
56
Q

Sitting bony prom assoc with ulcer

A

Spine of scapula
Spinous process
Ischial tuberosities

integumentary system (3 decks)

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