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NRSG 102: Med Surg 1 > Exam 4: Chapter 60 - Assessment of Integumentary Function > Flashcards

Exam 4: Chapter 60 - Assessment of Integumentary Function Flashcards

1
Q

Skin is the largest

A

organ in the body

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2
Q

Skin functions?

A

Forms barrier between internal and external environment protecting the body from pathogens, helps regulate temperature and water loss, and provides sensory input

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3
Q

Skin composed of what three layers

A

Epidermis, dermis , and subcutaneous tissue

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4
Q

Epidermis consists of which two main types of cells?

A

Melanocytes and Kertinocytes, which randomly migrate upwards. These dead cells contain Keratin that form the outer barrier of the skin

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5
Q

What do Melanocytes do?

A

Special cells of the epidermis that are involved in producing the pigment melanin, which colors the skin and hair

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6
Q

What two other cells are in the Epidermis?

A

Merkel Cells and Langerhans Cells

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7
Q

What are Merkel Cells?

A

Have a role as receptors that transmit stimuli to the aon through a chemical synapse

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8
Q

What are Langerhans Cells?

A

Believed to play significant role in cutaneous immune system reaction

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9
Q

What are Rete Ridges?

A

Undulations and furrows that appear at the lower edge of the epidermis at the dermal junciton where these two skin layers are cemented together

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10
Q

The interlocking between the dermis and epidermis produces what on the skin?

A

Ripples, which are also called fingerprints

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11
Q

What is the Dermis?

A

Provides strength and structure in the form of collagen and elastic fibers.

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12
Q

What two layers make up the Dermis?

A

Papillary and REticular

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13
Q

Subcutaneous made primarily of

A

adipose and connective tissue, which is a cushion between the skin layers and the muscles and bones.

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14
Q

Dermis makes up

A

the largest portion of the skin

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15
Q

What is located in the DErmis?

A

Blood Vessels, Nerves, Sweat Glands, and Lymph, If this portion damaged, so will all of these.

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16
Q

As we age, what happens to the subcutaneous tissue?

A

It breaks down and allows more injuries to occur such as osteomyelitis. Nerve endings are located here and as we age, these will move to the top

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17
Q

Alopecia is

A

the general loss of hair caused by various factors

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18
Q

Chemotherapy and Radiation Therapy with Alopecia?

A

Cause reversible hair thinning or weakening of the hair shift

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19
Q

What autoimmune disorders cause hair loss?

A

Systemic Lupus Erythematosus and Alopecia Areta

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20
Q

Folliculitis of the scalp will cause

A

inflammation of the hair roots and may result in scarring alopecia

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21
Q

How should you get your Vitamin D?

A

Through a healthy diet an supplementation rather than intentional sun exposure

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22
Q

What physiologic changes occur with aging?

A

Decreased dermal thickness

Degeneration of Collagen

Decreased sebum production

Increased Vascular Fragility

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23
Q

What medications are photosensitizing and increase damage that results from sun exposure?

A

Antihistamine
Antibiotic
Diuretic Agents

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24
Q

Visible Changes of skin of older adults?

A

Dryness
Wrinkling
Uneven Pigmentation
Various Proliferative Lesions

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25
Q

Cellular Changes with Aging?

A

Thinning at the junction of the dermis and epidermis

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26
Q

What is thought to contribute to declining sebaceous gland function?

A

Reduced Androgen Levels

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27
Q

With aging, the epidermis is shrunk and under more stress. This causes what?

A

It to shed away. Patients in rehab have to repositioned. They stick to the sheet and gravity pulls them down

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28
Q

Hair growth grgadually diminishes, especially over the

A

lower legs and dorsum of the feet

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29
Q

Thinning is common in the

A

scalp, axillae, and pubic areas

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30
Q

Other functions affected by normal aging include

A

the barrier function of skin,

sensory perception

thermoregulation

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31
Q

What two techniques are commonly used in examining the skin?

A

Inspection and Palpation

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32
Q

General appearance of the skin is assessed by observing

A

color, temperature, moisture, or dryness, skkin texture (rough or smooth) , lesions, vascularity, mobility, and the condition of hair and neails

Skin turgor, or possible edema and elasticity assessed by palpation

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33
Q

What should you do for the preparation of the patient?

A

Explain purpose, provide privacy , and coverings

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34
Q

What parts of the body should you insepct?

A

the enitre body, including mucosa, scalp, hair and nails

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35
Q

What should you do when you come across a lesion?

A

Palpate and Measure

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36
Q

Why are Photographs useful to document nature and extent of skin conditions?

A

This can be doe to monitor progress and so we are ale to tracg its progreess

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37
Q

What is hypopigmentation (loss of pigmentation) caused by?

A

May be caused by a fungal infection, eczema, or vitiligo (white patches)

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38
Q

What is hyperpigmentation (increse in pigmentation) caused by?

A

Can occur after sun injury or as a result of aging

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39
Q

What is Cyanoisis?

A

The bluish discoloration that results from a lack of oxygen in the blood

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40
Q

What does Cyanosis appear with?

A

Appear with shock or with respiratory or circulatory compromise

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41
Q

In poeple with light skin, cyanosis manifests as a

A

bluish hue to the lips, fingeritps, and nail beds

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42
Q

Other indications with Cyanosis of dedcreased tissue perfusion include

A

cold, clammy skin; a rapid thready pulse; and rapid shallow respirations

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43
Q

Cyanosis: The conjunctivae of the eyelids are examined for

A

pallor and petechiae (pinpoint red spots that result from blood leakage into skin)

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44
Q

Cyanosis appearance in someone with dark skin?

A

Assumes a grayish cast. To detect, areas around the mouth and lips and over the chekbones and earlobes should be observed

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45
Q

What is Erythema?

A

Redness of the skin caused by the dilation of capillaries.

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46
Q

What to do if you detect Erythema?

A

Palpate the skin for increased warmth and for smoothness or hardness.

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47
Q

Color ofskin for Erythema for a dark skinned person?

A

Purple-gray cast, but it may be difficult to detect this

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48
Q

What is Jaundice?

A

A yellowing of the skin and is directly relaved to elevations in serum bilirubin and is often first observed in the sclerae and mucous membranes

49
Q

Erythema: What is Hyperemia?

A

Increased blood flow through engorged arterial vessels as in inflammation fever alcohol intake or blushing

50
Q

Erythema: Light skin appearance in hyperemia?

A

Red, Bright Pink

51
Q

Erythema: CO Poisioning Color inLight Skin

A

Bright, cherry red in face and upper torso

52
Q

Erythema: CO Poisoning Appearance in Dark Skin?

A

Cheery red nail beds, lips, and oral mucosa

53
Q

What are primary lesions?

A

Are the initial lesions and are characteristic of the disease itself

54
Q

What are secondary lesions?

A

Result from changes in primary lesions resulting from external causes, such as scratching, trauma, infections, or changes caused by wound healing

55
Q

What is a Macule paired with?

A

Patch

56
Q

What is a Macule

A 
Flat, nonpalpable ski. 
Color Change (Color may be brown, white, tan, purple, or red)
57
Q

Examples of MAcules?

A

Freckles, flat moles, petechia, rubella, vitiligo, port wine stains, ecchymosis

58
Q

Size of a Macule?

A

<1 cm , circumscribed border

59
Q

Size of a Patch?

A

> 1 cm , mayhave irregular border

60
Q

What does a Papule pair with?

A

Plaque

61
Q

What is a papule?

A

Elevated, palpable solid mass with circumscribed border

Patch may be coalesced pepules with flat top

62
Q

Papule size?

A

< 0.5 cm

63
Q

Plaque size?

A

> 0.5 cm

64
Q

Examples of Papules?

A

Elevated nevi, warts, lichen planus

65
Q

Examples of Plaques?

A

Psoriasis, Actinic Keratosis

66
Q

What is a Ulcer?

A

Skin loss extending past epidermis; necrotic tissue loss ; bleeding and scarring possible

67
Q

Ulcer Examples?

A

Stasis ulcer of venous insufficiency, pressure ulcer

68
Q

What is a scar?

A

Skin mark left after healing of a wound or lesion; represents replacement by connective tissue of the injured tissue

69
Q

What are young scars?

A

Appear red or purple

70
Q

What do Mature scars look like?

A

White or glistening

71
Q

Scar examples

A

Healed wound or surgical incision

72
Q

How would you document skin lesions?

A

COlor of the lesion

Any redness, heat, pain, or swelling

Size and location of the involved area

PAttern of eruption

Distribution of the lesion

73
Q

How would you inspect the wound bed?

A

Inspect for necrotic and granulation tissue epithelium, exudate, color, and odor

74
Q

How would you inspect wound edges and margins?

A

Observe for udnermining (extension of the wound udner the surface skin) and evaluate for coniditon of skin

75
Q

How would you check wound size?

A

Measure in cm to determine diameter and depth of the woun dand surrounding erythemma

76
Q

How would you check the surrounding skin?

A

Assess for color, suppleness, and moisture irritiation and scaling

77
Q

What is a Petechia?

A

A round red or purple macule

78
Q

Petechia is secondary to

A

blood extravasation

79
Q

Petechia associated with

A

bleeding tendencies or emboli of skin (low platelets)

80
Q

What is Ecchymosis

A

round or irregula rmacular lesion . LArger than petechia

81
Q

Ecchymosis color

A

varies and changes – black, tellow and green hues

82
Q

Ecchymosis secondary to

A

blood extravasation

83
Q

Ecchymosis associated with

A

trauma, bleeding tendencies

84
Q

What does Beau Lines show in nails?

A

Its a transverse depression in the nails and may reflect retarded growth of the nail matrix because of severe illness or local trauma

85
Q

What type of nail can indicate anemia?

A

Spoon-shaped nails

86
Q

Clubbing of the nails is manifested by

A

a straightening of the normal angle (180 degrees or greater) and softening of the nail base

87
Q

Clubbing is often assocaited with

A

pulmonary disease and can be a sign of chronic hypoxia. (smoking)

88
Q

Clubbing in early stages vs late?

A

Early clubbing is raised, while late clubbing is swollen and springy.

89
Q

What other changes may also be visible because of local trauma?

A

Ridging, hypertrophy

90
Q

What should y ou assess in hair

A

Color, Texture, Distribution

91
Q

In women with hirsutism, excessive hair may grow on

A

face ,chest, shoulders, and pubic area

92
Q

Some skin conditions may lead to feelings of

A

depression, frustration, self-consciousness, poor self-image, and rejection

93
Q

What are some common skin conditions encountered in diabetes?

A 
Diabetic DErmopathy
Stasis DErmatitis
Skin Infections
Leg and Foot Ulcers
HIV
Skin Infections
94
Q

What is Diabetic Dermopathy?

A

Shin spots or pigmented pretibial papules

95
Q

Diabetic Dermopathy lesions found on

A

the lower anterior legs, forearms, and thighs and over other bony prominences

96
Q

Diabetic Dermopathy thought to be caused by

A

diabetes associacted changes in the small vessels that supply the skin and trauma.

97
Q

Diabetic Dermopathy: Each spot starts as a

A

dull red bump, smaller than a pencil erser. Slowly spreads to about 1 inch and becomes scaly and leaves brownish, slightly depressed scar on the skin

98
Q

What is Stasis Dermatitis?

A

Eczematous eruption that occurs on the lower legs of patients with venous insufficiency

99
Q

What happens in Stasis Dermatitis?

A

Large vessels are damaged, compromising circulation to the lower arms and legs

100
Q

Skin suffers how in Stasis Dermatitis?

A

Lack of nutrients, and becomes very dry and fragile. Minor injuries heal slowly and ulcers form easily.

101
Q

Chronic Stasis Dermatitis?

A

Leads to permanent changes in skin color, hyper or hypopigmentation, and either fragile or thicker skin texture

102
Q

Skin infections may appear as

A

small pimples around hair follicles.

103
Q

Most frequently affected sites for skin infections include

A

the lower legs, lower abdomen, and buttocks

104
Q

SOmetimes, skin lesions in skin infections enlarge to become

A

furuncles or carbuncles

105
Q

What are furuncles?

A

Begin in a hair follicle, progressively enlarging and invading deeper into tissue to form an abscess

106
Q

What are carbuncles?

A

Formed by multiple cintiguous lesions.

107
Q

Skin of patietns with diabetes is prone to

A

bacterial and fungal infections

108
Q

Fungal infectiosn are quite common in areas that remain

A

moist (breast , upper thigh, axillae)

109
Q

Candida (yeast) infections appear

A

beefy red and often have small pustules around the border of the area with the skin appearing mosit and red

110
Q

Dermatophyte infections are

A

dry and only minimally red with more scale. Common sites are the toenails and feet

111
Q

Diabetics: Leg and Foot Ulcers

A

Often don’t feel these injuries. Ulcerations unresponsive to treatment lead to amputations

112
Q

HIV and Skin signs correlate with low

A

CD4+ counts

113
Q

Some disorders for HIV?

A

Kaposi Sarcoma

Oral Hairy Leukoplakia

Facial Molluscum Contagiosum

Oral Candidiasis

114
Q

Skin biopsies are performed on

A

skin nodules
plaques
blisters
other lesions

To perform testing such as gram stain for bacterioa

115
Q

What are weak positive reactions for a patch testing?

A

redness, fine elevations, or itching

116
Q

what are some medium positive reaction for patch testing?

A

fine blisters, papules, and severe itching

117
Q

what are some strong positive reaction for patch testing?

A

Bliders, pain, and ucleration

118
Q

How is a Tzanck smear performed?

A

Used to examine cells from blister skin conditions, such ahherpes, varicella. Applied to glass slide, stained, adn examined

NRSG 102: Med Surg 1 (52 decks)

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