Integument Flashcards
1
Q
Risk Factors associated with potential skin conditions
A
- Loss of mobility
- Infection
- Diabetes
- Impaired Sensation
- Medication
- Age
- Smoking
2
Q
Layers of Skin
A
- Epidermis
- Protects from infection
- Assists with heat regulation
- Dermis
- Subcutaneous Tissue
- Adipose cells; energy storage; protection
3
Q
Epidermis Layer
A
- Protection
- Avascular
4
Q
Dermal Layer
A
- Sensation and blood supply
- “True Skin”
- Infection and vascular changes here
- Sensation
5
Q
Skin Observation
A
- Skin Discoloration
- Skin Temperature
- Skin Integrity – Turgor (Hydration and Resilience)
- Skin Resilience
- Edema/Effusion
- Hair and Nail Beds
- Sensation
Consultation is any of these are new findings OR become more prevalent/progress
6
Q
Hemosiderin Staining
A
- Rusty brown darkening of the skin
- Mid-calf and down
- Commonly lower extremity
- Could indicate venous insufficiency in LE
7
Q
Cyanosis
A
- Low O2 in blood
- Common in fingers and toes
- Central cyanosis: pulmonary disease or congenital heart defect (heart failure)
- Could indicate subject is extremely cold, low hemoglobin levels, vasomotor
8
Q
Pallor
A
- Loss of skin pigment (pale white)
- Whole Body: Vasoconstriction (shock-Activate EMS), blood abnormality (anemia)
- Local: Blood circulation disorder (diabetes or Raynaud’s)
9
Q
Erythema
A
- High O2 in blood (red)
- In people with darker skin, may appear or dark blue or purple
- Central: fever
- Local: Infection, Blood Clot
- Do a cardiopulmonary screen, take temperature, and vitals
10
Q
Jaundice
A
- Excess plasma. concentration of bilirubin (yellow)
- Associated with liver failure/disease
11
Q
Ecchymosis
A
- Bruising
- Cognition issues, sensation issues, falls
- Treat musculoskeletal
12
Q
Surface Temperature
A
- Increase: Possible infection
- Global: Systemic infection
- Palpate lymph nodes
- Decrease: reduction in local circulation (arterial occlusion)
- Global: vascular insufficiency
- Local: May be associated with swelling
13
Q
Skin Elasticity - Turgor
A
- (Poor Hydration)
- Assess skin turgor for hydration
- Hydration & Release
- Changes with age (elderly have reduced thirst feeling)
- May change in healed wounds
- Susceptible for abrasions and wounds
- Traumatic
- Pressure Sores
- Test
- Pinch back of skin, skin should return back to normal within one second
14
Q
Skin Resilience
A
- Skin thickness and dryness
- Changes as people age
- Skin permeability – diminished barrier
- Lowered immune response
- Impaired wound healing
- Decreased elasticity of epidermis and increased wrinkling
- Less Vitamin D production
- Changes as people age
- Changes following injury and healing
- Scar formation – less resilient and/or mobile
15
Q
Edema/Effusion
A
- Effusion - CONSULT
- Contained within the joint capsule – Intra-articular
- Structure within the joint injured
- Infection or inflammation in the joint
- Analogy of water balloon
- Example
- Injury, Infection, Unknown cause
- Edema – CONSULT
- “Extra-articular”
- Commonly associated with systemic conditions (Ex: heart disease, vascular disease)
- Pitting vs non-pitting
- Pitting
- Push and indentation remains
- Non-pitting
- Push and rebounds
- Pitting
- Concerned if new and changes
16
Q
Hair Appearance
A
- Local loss of hair due to
- Arterial insufficency (Usually associated with coldness)
- Infections
- Medications (chemo)
- Global loss of hair due to disease (thyroid)
- Other condition of less concern (not health concern haha)
- Benign Alopecia
- Male pattern baldness
- Benign Alopecia
17
Q
Fingernails
A
Different finger nail appearances are unique with occult disease
18
Q
Onycholysis
A
- Separation of nail from its bed
- Associated with Psoriasis, Dermatitis of hand, fungal infection
19
Q
Beau’s Lines
A
Patient has had a history of severe systemic insult (high fever, infection, renal disease, hepatic disease)
20
Q
Nail Clubbing
A
- Indicative of chronic hypoxia (emphysema) and lung cancer
- Distal nail phalanx appears bulbous and rounded
- Nail plate is abnormally convex
- Plate angle is greater than 180 degrees
21
Q
Cyanosis
A
- Bluish discoloration
- Hypoxia
22
Q
Sensation Tests
A
- General sensory deficit vs specific patterns of sensory deficits
- Differentiate systemic condition
- Light touch
- Sharp/Dull
- Cold/Hot
23
Q
Three most common skin cancers
A
- Basal Cell Carcinoma (Most common)
- Squamous cell carcinoma
- Malignant melanoma (most deadly)
24
Q
ABCs - Skin Cancer
A
- A = asymmetry
- B = Borders
- C = Color
- D = Diameter (>6mm)
- E = Evolution
25
Q
Characteristics of Malignant Cancer
A
- Shape: Asymmetrical
- Borders: Irregular
- Color: Varied/black
- Diameter: >6mm
- Rate of Change: Slow or rapid
- Consistency: Firm to hard
- Ulceration: Often
- Mobility: Mobile/Nonmobile
26
Q
Why do we screen for melanoma?
A
- More than 80% squamous cell carcinoma in head and neck region
- More than 65% basal cell carcinoma in head and neck region
- Melanomas can reoccur more than 5 years after initial surgery
27
Q
When should we be concern with a mole?
A
Any mole that undergoes rapid changes in size, shape, color, symptom or integrity (bleeding) is reason for referral soon
28
Q
Basal cell carcinoma
A
- An open sore that bleeds or has a discharge that has been open for several weeks
- Reddish patch
- Shiny bump that is pink, red or white
- A scar like tumor that is shiny and aggressive
29
Q
Squamous cell carcinoma
A
- Crusty, elevated, scaly
- Borders hard to identify
30
Q
Malignant melanoma
A
- Brown, black or multicolored
- Irregular outline
- May crust or bleed
- Concern: Can metastasize to lymph system and other organs
31
Q
Infections/Inflammation
A
- Soft tissue inflammation
- Fungal infections:
- Athletes foot, ringworm oval
- Viral infections:
- Warts, fever blisters, shingles, cold sores
- Bacterial Cellulitis
32
Q
Bacterial Cellulitis
A
- Rapid Referral – On the phone getting an appointment for them.
- Color: Red
- Temperature: Hot
- Pain: Resting Pain
- Swelling: Increase in girth
- Drainage: More common with infection and associated with an odor
33
Q
Cellulitis
A
- Swollen glands (lymph nodes near or proximal to the affected area)
- Spreading
34
Q
Pressure Ulcers Risk Factors and Common Sites
A
- Decreased mobility
- Shear forces
- Altered sensation
- Moisture
- Age
- Most common sites
- Spine/sacrum/coccyx
- Bony prominences of the lower an upper extremity
35
Q
Stage 1 Pressure Ulcer
A
- Pressure Mark
- Intact skin which is altered in observable way – color, consistency or sensory response – the change is not transient)
36
Q
Neuropathic Ulcers
A
- Associated with diabetes and other peripheral neuropathies
- Most common in the foot and hand
- Must do a thorough sensory examination to ID if patient is at risk
- Risk Factors:
- Prolonged diabetes
- Poor footwear
37
Q
Post Surgery Wounds and Scars
Consult if:
A
- Open Wound
- Signs of Infection
- Drainage
- Fever
Scars (benign)
- Assess soft tissue mobility and symptoms with palpation
- Keloid = overproduction of collagen
38
Q
Inspection and palpation of glands and lymph nodes
A
- Glands to palpate
- Thyroid
- Parotid
- Submandibular
- If abnormal – CONSULT
- Acute infection
- Slow to moderate growing mass
39
Q
Two things associated with aging
A
- Wrinkling
- Osteoarthritis (wrinkles in your joint – arthritis doesn’t cause pain unless very advanced)
