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Health Assessment LECT | Quiz/Exam 1 > Exam 1 | Integumentary System > Flashcards

Exam 1 | Integumentary System Flashcards

1
Q

HPI Common S&S ppl present w/ include…

A
  • Rashes
    • Many contagious diseases (like rubeola, rubella, varicella) present w/ skin rashes
  • Lesions
  • Pruritus
  • Ecchymosis (bruising)
  • Nevi (moles)
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2
Q

General Skin Inspection includes…

A
  • Color: depends on race/ethnicity
    • Acanthosis nigra: skin condition that causes flat, rough area of hyperpigmentation (Possible sign for increased risk of type 2 diabetes)
  • Uniformity
  • Thickness
  • Symmetry
  • Hygiene: can be sign of psycho-social distress being manifested
  • Odors
  • Pressure injuries
    • Ppl w/ decreased mobility, hospitalized, emaciated, elderly, neurologically impaired ⇒ susceptible to skin damage and ulceration
  • primary lesions: macule, papule, wheal, pustules, vesicles, nodule
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3
Q

Macule

A

flat, small, discolored

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4
Q

Papule

A

raised, small, round, no fluid

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5
Q

Wheal

A

bigger than papule, irregularly shaped, fluid-filled, redness around skin

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6
Q

Pustules

A

raised, small, fluid-filled w/ pus, round

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7
Q

Vesicles

A

raised, clear, fluid-filled, round

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8
Q

Nodule

A

raised, solid, bigger & deeper than papule

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9
Q

Blanching lesions

A

erythematous and suggests inflammation

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10
Q

Infant specific abnormalities:

A
  • Congenital dermal melanocytosis: mongolian spot (normal presentation of flat benign birthmark, not a bruise, may go away in future)
  • Physiologic jaundice: managed via increased breastfeeding, sunlight therapy, monitored before it can cause irreversible brain damage
  • Milia: “baby acne”
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11
Q

Pregnancy specific abnormalities:

A
  • Linea nigra: line down pregnant stomach
  • Palmar erythema: caused by increased blood flow ⇒ both palms turn red
  • Stretch marks: depends on genetics
  • Melasma: brown or gray patches on face (common)
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12
Q

Geriatric specific abnormalities:

A
  • Highly vascularized hands: veins may tend to roll and become rigid
  • Cherry angiomas: raised, blood-filled, red-brown spots, non-dangerous
  • Lentigo: “age spots,” benign, dark brown or black spots caused by sun damage
  • Lack of fat ⇒ turgor and tenting not done on arm bc lack of fat = skin stays up = false positive for dehydration
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13
Q

SARS-COV-2 dermatologic manifestations

A
  • Maculopapular rash
  • Urticaria (hives)
  • Vesicular rash
  • Heterogenous presentations
  • Covid toes
  • Multisystem inflammatory syndrome (MERS)-C
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14
Q

Viral Exanthems (eruptive skin rash that is often related to a viral infection)

A
  • varicella (chicken pox)
  • rubeola (measles)
  • herpes zoster
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15
Q

Varicella (chicken pox)

A
  • Generalized vestibular rashes w/ fever
  • Can lead to pneumonia, encephalopathy, scarring, death
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16
Q

Rubeola (measles)

A
  • Highly contagious, outbreaks occur frequently
  • Can lead to hearing loss
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17
Q

Herpes zoster

A
  • Caused by varicella zoster virus
  • Varicella virus (chicken pox) remains dormant for yrs & can re-emerge as “shingles” if IS weakens and virus takes advantage
  • Not contagious but can give varicella (chicken pox) to others
  • Presents along dermatomal lines
  • Painful, usually lasts 2-3 weeks
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18
Q

Genetic skin disease: Epidermolysis Bullosa (EB)

A
  • Group of genetic blistering connective tissue disorders
  • Types: differs by mutations but all of them makes skin sensitive
    • Simplex: dominant gene affecting keratin 5 or 14 mutation
    • Dystrophic: dominant or recessive gene affecting collagen 7 mutation
    • Junctional: recessive gene affecting collagen, integrin, lamina mutations
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19
Q

Palpate skin for

A
  • moisture:
    • Dryness ⇒ may indicate hypothyroidism
    • Oiliness ⇒ associated w/ acne
    • Dry skin ⇒ w/ parched cracked lips, dry mucous membranes, lack of tears indicates dehydration
  • temperature: may indicate infection
  • texture:
    • Roughness ⇒ may be finding w/ hypothyroidism
    • Velvety texture ⇒ may indicate hyperthyroidism
  • turgor and mobility:
    • If skin stays up = dehydrated
    • If skin falls fast = hydrated
    • Decreased mobility ⇒ finding w/ edema and scleroderma
  • edema
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20
Q

Hair inspection for…

A
  • Color: depends on race/ethnicity
  • Distribution: abnormalities include…
    • Vellus hair: short, fine, inconspicuous, relatively unpigmented
    • Terminal hair: coarser, thicker, more conspicuous, usually pigmented
  • Quantity: abnormalities include…
    • Thinning– need baseline for thickness/thinness of pt’s hair before inspection or Sx onset
    • Sparse, coarse hair ⇒ may occur w/ hypothyroidism
    • Fine, silky hair ⇒ may occur w/ hyperthyroidism
    • Alopecia: hair loss (diffuse, patchy, or total that can be caused by chemotherapy, stress, and/or genetics)
  • Dandruff
21
Q

Inspect Nails for…

A
  • Pigmentation of nails and bed
  • Length
  • Symmetry
  • Ridging, pitting, peeling (can be caused by nutritional deficit)
  • Clubbing angle ⇒ can be caused by chronic hypoxia
  • Onychomycosis (nail fungus)
  • Ingrown toenail
22
Q

Palpate proximal and lateral Nail folds for…

A
  • Redness related to infection but often related to biting
  • Swelling
  • Pain
  • Exudate
  • Warts, cysts, tumors
23
Q

Melanoma

A
  • Arising from pigment-producing melanocytes in epidermis that give skin its color
  • High rate of metastasis
  • High rate of mortality at advanced stages
24
Q

Basal Cell Carcinoma

A
  • Arising in basal lvl of epidermis in exposed areas
  • Pearly white
  • Near translucent
  • Tend to grow slowly
  • Rarely metastasize
25
Q

Squamous Cell Carcinoma

A
  • Arising in upper layer of epidermis
  • Crusted
  • Scaly w/ red, inflamed, ulcerated appearance
  • Can metastasize
26
Q

Red Flags of ABCDE–EFG for early recognition of possible melanoma:

A
  • Asymmetry
  • Borders
  • Color
  • Diameter
  • Evolving
  • Elevated
  • Firmness
  • Growing passively?
27
Q

Melanoma Risk Factors

A
  • Personal/Family Hx of previous melanoma
  • Atypical/Dysplastic moles that change in size or color
  • Male
  • 50+ common moles
  • Have red or light hair
  • Light eye or skin color, esp skin that freckles or burns easily
  • Have actinic keratosis (horny overgrowth of skin) and/or solar lentigines (acquired brown macules on sun-exposed areas)
  • UV from heavy sun exposure, sun lamps, tanning booths
  • Severe blistering sunburns, esp in childhood
  • Congenital melanocytic nevi (moles present at birth, esp large moles)
  • Have immunosuppression
28
Q

Basal Cell Carcinoma Risk Factors

A
  • UV
  • Tanning beds
  • Arsenic exposure
  • Immunosuppression
  • Genes
29
Q

Squamous Cell Carcinoma Risk Factors

A
  • UV
  • Fair skin
  • Male
  • Older age
  • Immunosuppressed state
  • Genes
30
Q

health education related to reducing the risk of skin cancers

A
  • Avoiding UV and tanning beds
  • Regular use of sunscreen
  • SPF 30+ preferred
  • Skin cancer screening
  • Patient screening: approximately half of melanomas are initially detected by pts or their partners
  • Inspecting moles: use ABCDE–EFGs
31
Q

Infections/Inflammation (Other Lesions)

A
  • herpes simplex
  • contact dermatitis
  • psoriasis
  • impetigo
  • drug eruption
32
Q

Herpes simplex

A
  • painful blisters or ulcers
  • Viral infection caused by HIV
33
Q

Contact dermatitis

A
  • red rash, bumps, blisters, swelling that’s itchy, uncomfortable
  • Caused by exposure to chemicals or physical agents
34
Q

Psoriasis

A
  • inflamed, scaly skin patches
  • Chronic, non-contagious autoimmune disease
35
Q

Impetigo

A
  • red sores that burst and leave yellow-brown crust
  • Bacterial skin infection, highly contagious commonly affecting children
36
Q

Drug eruption

A
  • skin rashes, like pink or red spots
  • Adverse skin rxn to drugs like NSAIDs, chemotherapy, antimicrobials, etc.
37
Q

Stages of pressure ulcers

A
  • Stage 1: erythema, unbroken skin, light pink color
  • Stage 2: partial thickness skin loss of epidermis/dermis/both, skin is broken open
  • Stage 3: full thickness skin loss w/ damage to or necrosis of subQ tissue that can extend to but not thru underlying muscle
  • Stage 4: full thickness skin loss w/ destruction, tissue necrosis, invasion to deeper tissue/bone/supporting structures
  • Unstageable: obscured full-thickness skin and tissue loss by eschar
  • Deep tissue injury– deep injury w/ intact skin: intact or non-intact skin w/ localized area of persistent non-blanchable deep red/maroon/purple/purple, appears deep dark bruise-like colored
38
Q

Risk factors for pressure ulcers

A
  • Decreased mobility, esp accompanied by increased pressure/movement causing friction or shear stress
  • Decreased sensation from brain, spinal cord lesions, peripheral nerve disease
  • Decreased blood flow from hypotension or microvascular disease like diabetes or atherosclerosis
  • Fecal or urinary incontinence
  • Fractures
  • Poor nutritional status or low albumin
39
Q

Braden scale (SMAMNFS)

A
  • evaluates lvls of risk of injury development in pt
    • low score = pt has low functional lvl + high risk for injury formation
    • high score = pt has high functional lvl + low risk for injury formation
  • SENSORY PERCEPTION: ability to respond to pressure-related discomfort
  • MOISTURE: degree to which skin is exposed to moisture
  • ACTIVITY: physical activity
  • MOBILITY: ability to change and control body position
  • NUTRITION: usual food intake pattern
  • FRICTION AND SHEAR: ability to move and maintain good position in bed and chair independently and has enough muscle strength to lift up completely during movement
40
Q

Central Vs. Peripheral Cyanosis Definition

A
  • Central cyanosis: low oxygen lvls in arterial blood flow
  • Peripheral cyanosis: when cutaneous blood flow decreases and slows ⇒ tissues extract more oxygen than usual from blood (can be response to anxiety or cold environment)
41
Q

Cyanosis Assessment Where

A
  • inspect for bluish cast on nails, hands, feet
42
Q

Central VS. Peripheral Cyanosis Underlying Causes

A
  • Central: advanced lung disease, congenital heart disease, hemoglobinopathies, genetic disorders involving hemoglobin like sickle cell and thalassemia
  • Peripheral: anxiety, cold environment, venous obstruction ⇒ decreased blood flow
43
Q

Jaundice (definition, assessment, underlying causes)

A
  • what: Yellow color in skin that can be due to deposition of bilirubin in skin
  • assessment: Observe yellowing in sclera, skin, lips, nails, palms, soles
  • underlying causes: Liver disease, biliary duct obstruction, or increased destruction of red blood cells increases serum bilirubin ⇒ deposited in skin
44
Q

Edema (definition and types)

A
  • Edema: presence of excess fluid in the interstitial spaces ⇒ Decreases mobility
    • Systemic edema: occurs in dependent portions of body, feet, legs, and sacral area
    • Pitting edema: mobile interstitial water and can be translocated w/ pressure exerted by finger, degree of pitting measured on scale of 1-4
    • Non-pitting edema: serum proteins accumulated in interstitial space w/ water and coagulated, usually seen w/ local infection or trauma and called brawny edema
45
Q

Edema Assessment

A
  • Inspect and palpate for puffy and tight skin, feet, legs, sacral area
  • Pitting edema: press finger down on skin → if pit stays for 5-30 sec ⇒ pitting edema, measured on scale of 1-4
  • Non-pitting edema: if you press your finger down but it doesn’t stay down like it does for pitting
46
Q

Edema Underlying Causes

A
  • systemic problems:
    • congestive heart failure (CHF)
    • venous insufficiency
    • overhydration
47
Q

Erythema (definition, assessment, underlying causes)

A
  • what: Abnormal redness of skin or mucous membranes
  • assessment: Look for skin redness or mucous membrane redness
  • underlying causes: Infection, Allergy to med, Deep vein thrombosis (DVT), Fever, Sepsis, Rash
48
Q

Acanthosis nigra

A
  • Flat, rough area of hyperpigmentation
  • Possible sign for increased risk of type 2 diabetes
  • Cause: increased insulin lvls
  • Common in neck and underarms

Health Assessment LECT | Quiz/Exam 1 (4 decks)

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