Exam 4: Chapter 60 - Assessment of Integumentary Function Flashcards
Skin is the largest
organ in the body
Skin functions?
Forms barrier between internal and external environment protecting the body from pathogens, helps regulate temperature and water loss, and provides sensory input
Skin composed of what three layers
Epidermis, dermis , and subcutaneous tissue
Epidermis consists of which two main types of cells?
Melanocytes and Kertinocytes, which randomly migrate upwards. These dead cells contain Keratin that form the outer barrier of the skin
What do Melanocytes do?
Special cells of the epidermis that are involved in producing the pigment melanin, which colors the skin and hair
What two other cells are in the Epidermis?
Merkel Cells and Langerhans Cells
What are Merkel Cells?
Have a role as receptors that transmit stimuli to the aon through a chemical synapse
What are Langerhans Cells?
Believed to play significant role in cutaneous immune system reaction
What are Rete Ridges?
Undulations and furrows that appear at the lower edge of the epidermis at the dermal junciton where these two skin layers are cemented together
The interlocking between the dermis and epidermis produces what on the skin?
Ripples, which are also called fingerprints
What is the Dermis?
Provides strength and structure in the form of collagen and elastic fibers.
What two layers make up the Dermis?
Papillary and REticular
Subcutaneous made primarily of
adipose and connective tissue, which is a cushion between the skin layers and the muscles and bones.
Dermis makes up
the largest portion of the skin
What is located in the DErmis?
Blood Vessels, Nerves, Sweat Glands, and Lymph, If this portion damaged, so will all of these.
As we age, what happens to the subcutaneous tissue?
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
Alopecia is
the general loss of hair caused by various factors
Chemotherapy and Radiation Therapy with Alopecia?
Cause reversible hair thinning or weakening of the hair shift
What autoimmune disorders cause hair loss?
Systemic Lupus Erythematosus and Alopecia Areta
Folliculitis of the scalp will cause
inflammation of the hair roots and may result in scarring alopecia
How should you get your Vitamin D?
Through a healthy diet an supplementation rather than intentional sun exposure
What physiologic changes occur with aging?
Decreased dermal thickness
Degeneration of Collagen
Decreased sebum production
Increased Vascular Fragility
What medications are photosensitizing and increase damage that results from sun exposure?
Antihistamine
Antibiotic
Diuretic Agents
Visible Changes of skin of older adults?
Dryness
Wrinkling
Uneven Pigmentation
Various Proliferative Lesions
Cellular Changes with Aging?
Thinning at the junction of the dermis and epidermis
What is thought to contribute to declining sebaceous gland function?
Reduced Androgen Levels
With aging, the epidermis is shrunk and under more stress. This causes what?
It to shed away. Patients in rehab have to repositioned. They stick to the sheet and gravity pulls them down
Hair growth grgadually diminishes, especially over the
lower legs and dorsum of the feet
Thinning is common in the
scalp, axillae, and pubic areas
Other functions affected by normal aging include
the barrier function of skin,
sensory perception
thermoregulation
What two techniques are commonly used in examining the skin?
Inspection and Palpation
General appearance of the skin is assessed by observing
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
What should you do for the preparation of the patient?
Explain purpose, provide privacy , and coverings
What parts of the body should you insepct?
the enitre body, including mucosa, scalp, hair and nails
What should you do when you come across a lesion?
Palpate and Measure
Why are Photographs useful to document nature and extent of skin conditions?
This can be doe to monitor progress and so we are ale to tracg its progreess
What is hypopigmentation (loss of pigmentation) caused by?
May be caused by a fungal infection, eczema, or vitiligo (white patches)
What is hyperpigmentation (increse in pigmentation) caused by?
Can occur after sun injury or as a result of aging
What is Cyanoisis?
The bluish discoloration that results from a lack of oxygen in the blood
What does Cyanosis appear with?
Appear with shock or with respiratory or circulatory compromise
In poeple with light skin, cyanosis manifests as a
bluish hue to the lips, fingeritps, and nail beds
Other indications with Cyanosis of dedcreased tissue perfusion include
cold, clammy skin; a rapid thready pulse; and rapid shallow respirations
Cyanosis: The conjunctivae of the eyelids are examined for
pallor and petechiae (pinpoint red spots that result from blood leakage into skin)
Cyanosis appearance in someone with dark skin?
Assumes a grayish cast. To detect, areas around the mouth and lips and over the chekbones and earlobes should be observed
What is Erythema?
Redness of the skin caused by the dilation of capillaries.
What to do if you detect Erythema?
Palpate the skin for increased warmth and for smoothness or hardness.
Color ofskin for Erythema for a dark skinned person?
Purple-gray cast, but it may be difficult to detect this
What is Jaundice?
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
Erythema: What is Hyperemia?
Increased blood flow through engorged arterial vessels as in inflammation fever alcohol intake or blushing
Erythema: Light skin appearance in hyperemia?
Red, Bright Pink
Erythema: CO Poisioning Color inLight Skin
Bright, cherry red in face and upper torso
Erythema: CO Poisoning Appearance in Dark Skin?
Cheery red nail beds, lips, and oral mucosa
What are primary lesions?
Are the initial lesions and are characteristic of the disease itself
What are secondary lesions?
Result from changes in primary lesions resulting from external causes, such as scratching, trauma, infections, or changes caused by wound healing
What is a Macule paired with?
Patch
What is a Macule
Flat, nonpalpable ski. Color Change (Color may be brown, white, tan, purple, or red)
Examples of MAcules?
Freckles, flat moles, petechia, rubella, vitiligo, port wine stains, ecchymosis
Size of a Macule?
<1 cm , circumscribed border
Size of a Patch?
> 1 cm , mayhave irregular border
What does a Papule pair with?
Plaque
What is a papule?
Elevated, palpable solid mass with circumscribed border
Patch may be coalesced pepules with flat top
Papule size?
< 0.5 cm
Plaque size?
> 0.5 cm
Examples of Papules?
Elevated nevi, warts, lichen planus
Examples of Plaques?
Psoriasis, Actinic Keratosis
What is a Ulcer?
Skin loss extending past epidermis; necrotic tissue loss ; bleeding and scarring possible
Ulcer Examples?
Stasis ulcer of venous insufficiency, pressure ulcer
What is a scar?
Skin mark left after healing of a wound or lesion; represents replacement by connective tissue of the injured tissue
What are young scars?
Appear red or purple
What do Mature scars look like?
White or glistening
Scar examples
Healed wound or surgical incision
How would you document skin lesions?
COlor of the lesion
Any redness, heat, pain, or swelling
Size and location of the involved area
PAttern of eruption
Distribution of the lesion
How would you inspect the wound bed?
Inspect for necrotic and granulation tissue epithelium, exudate, color, and odor
How would you inspect wound edges and margins?
Observe for udnermining (extension of the wound udner the surface skin) and evaluate for coniditon of skin
How would you check wound size?
Measure in cm to determine diameter and depth of the woun dand surrounding erythemma
How would you check the surrounding skin?
Assess for color, suppleness, and moisture irritiation and scaling
What is a Petechia?
A round red or purple macule
Petechia is secondary to
blood extravasation
Petechia associated with
bleeding tendencies or emboli of skin (low platelets)
What is Ecchymosis
round or irregula rmacular lesion . LArger than petechia
Ecchymosis color
varies and changes – black, tellow and green hues
Ecchymosis secondary to
blood extravasation
Ecchymosis associated with
trauma, bleeding tendencies
What does Beau Lines show in nails?
Its a transverse depression in the nails and may reflect retarded growth of the nail matrix because of severe illness or local trauma
What type of nail can indicate anemia?
Spoon-shaped nails
Clubbing of the nails is manifested by
a straightening of the normal angle (180 degrees or greater) and softening of the nail base
Clubbing is often assocaited with
pulmonary disease and can be a sign of chronic hypoxia. (smoking)
Clubbing in early stages vs late?
Early clubbing is raised, while late clubbing is swollen and springy.
What other changes may also be visible because of local trauma?
Ridging, hypertrophy
What should y ou assess in hair
Color, Texture, Distribution
In women with hirsutism, excessive hair may grow on
face ,chest, shoulders, and pubic area
Some skin conditions may lead to feelings of
depression, frustration, self-consciousness, poor self-image, and rejection
What are some common skin conditions encountered in diabetes?
Diabetic DErmopathy Stasis DErmatitis Skin Infections Leg and Foot Ulcers HIV Skin Infections
What is Diabetic Dermopathy?
Shin spots or pigmented pretibial papules
Diabetic Dermopathy lesions found on
the lower anterior legs, forearms, and thighs and over other bony prominences
Diabetic Dermopathy thought to be caused by
diabetes associacted changes in the small vessels that supply the skin and trauma.
Diabetic Dermopathy: Each spot starts as 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
What is Stasis Dermatitis?
Eczematous eruption that occurs on the lower legs of patients with venous insufficiency
What happens in Stasis Dermatitis?
Large vessels are damaged, compromising circulation to the lower arms and legs
Skin suffers how in Stasis Dermatitis?
Lack of nutrients, and becomes very dry and fragile. Minor injuries heal slowly and ulcers form easily.
Chronic Stasis Dermatitis?
Leads to permanent changes in skin color, hyper or hypopigmentation, and either fragile or thicker skin texture
Skin infections may appear as
small pimples around hair follicles.
Most frequently affected sites for skin infections include
the lower legs, lower abdomen, and buttocks
SOmetimes, skin lesions in skin infections enlarge to become
furuncles or carbuncles
What are furuncles?
Begin in a hair follicle, progressively enlarging and invading deeper into tissue to form an abscess
What are carbuncles?
Formed by multiple cintiguous lesions.
Skin of patietns with diabetes is prone to
bacterial and fungal infections
Fungal infectiosn are quite common in areas that remain
moist (breast , upper thigh, axillae)
Candida (yeast) infections appear
beefy red and often have small pustules around the border of the area with the skin appearing mosit and red
Dermatophyte infections are
dry and only minimally red with more scale. Common sites are the toenails and feet
Diabetics: Leg and Foot Ulcers
Often don’t feel these injuries. Ulcerations unresponsive to treatment lead to amputations
HIV and Skin signs correlate with low
CD4+ counts
Some disorders for HIV?
Kaposi Sarcoma
Oral Hairy Leukoplakia
Facial Molluscum Contagiosum
Oral Candidiasis
Skin biopsies are performed on
skin nodules
plaques
blisters
other lesions
To perform testing such as gram stain for bacterioa
What are weak positive reactions for a patch testing?
redness, fine elevations, or itching
what are some medium positive reaction for patch testing?
fine blisters, papules, and severe itching
what are some strong positive reaction for patch testing?
Bliders, pain, and ucleration
How is a Tzanck smear performed?
Used to examine cells from blister skin conditions, such ahherpes, varicella. Applied to glass slide, stained, adn examined
