Integument Flashcards
Risk Factors associated with potential skin conditions
- Loss of mobility
- Infection
- Diabetes
- Impaired Sensation
- Medication
- Age
- Smoking
Layers of Skin
- Epidermis
- Protects from infection
- Assists with heat regulation
- Dermis
- Subcutaneous Tissue
- Adipose cells; energy storage; protection
Epidermis Layer
- Protection
- Avascular
Dermal Layer
- Sensation and blood supply
- “True Skin”
- Infection and vascular changes here
- Sensation
Skin Observation
- 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
Hemosiderin Staining
- Rusty brown darkening of the skin
- Mid-calf and down
- Commonly lower extremity
- Could indicate venous insufficiency in LE
Cyanosis
- 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
Pallor
- Loss of skin pigment (pale white)
- Whole Body: Vasoconstriction (shock-Activate EMS), blood abnormality (anemia)
- Local: Blood circulation disorder (diabetes or Raynaud’s)
Erythema
- 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
Jaundice
- Excess plasma. concentration of bilirubin (yellow)
- Associated with liver failure/disease
Ecchymosis
- Bruising
- Cognition issues, sensation issues, falls
- Treat musculoskeletal
Surface Temperature
- 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
Skin Elasticity - Turgor
- (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
Skin Resilience
- 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
Edema/Effusion
- 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
Hair Appearance
- 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
Fingernails
Different finger nail appearances are unique with occult disease
Onycholysis
- Separation of nail from its bed
- Associated with Psoriasis, Dermatitis of hand, fungal infection
Beau’s Lines
Patient has had a history of severe systemic insult (high fever, infection, renal disease, hepatic disease)
Nail Clubbing
- 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
Cyanosis
- Bluish discoloration
- Hypoxia
Sensation Tests
- General sensory deficit vs specific patterns of sensory deficits
- Differentiate systemic condition
- Light touch
- Sharp/Dull
- Cold/Hot
Three most common skin cancers
- Basal Cell Carcinoma (Most common)
- Squamous cell carcinoma
- Malignant melanoma (most deadly)
ABCs - Skin Cancer
- A = asymmetry
- B = Borders
- C = Color
- D = Diameter (>6mm)
- E = Evolution
Characteristics of Malignant Cancer
- Shape: Asymmetrical
- Borders: Irregular
- Color: Varied/black
- Diameter: >6mm
- Rate of Change: Slow or rapid
- Consistency: Firm to hard
- Ulceration: Often
- Mobility: Mobile/Nonmobile
Why do we screen for melanoma?
- 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
When should we be concern with a mole?
Any mole that undergoes rapid changes in size, shape, color, symptom or integrity (bleeding) is reason for referral soon
Basal cell carcinoma
- 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
Squamous cell carcinoma
- Crusty, elevated, scaly
- Borders hard to identify
Malignant melanoma
- Brown, black or multicolored
- Irregular outline
- May crust or bleed
- Concern: Can metastasize to lymph system and other organs
Infections/Inflammation
- Soft tissue inflammation
- Fungal infections:
- Athletes foot, ringworm oval
- Viral infections:
- Warts, fever blisters, shingles, cold sores
- Bacterial Cellulitis
Bacterial Cellulitis
- 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
Cellulitis
- Swollen glands (lymph nodes near or proximal to the affected area)
- Spreading
Pressure Ulcers Risk Factors and Common Sites
- Decreased mobility
- Shear forces
- Altered sensation
- Moisture
- Age
- Most common sites
- Spine/sacrum/coccyx
- Bony prominences of the lower an upper extremity
Stage 1 Pressure Ulcer
- Pressure Mark
- Intact skin which is altered in observable way – color, consistency or sensory response – the change is not transient)
Neuropathic Ulcers
- 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
Post Surgery Wounds and Scars
Consult if:
- Open Wound
- Signs of Infection
- Drainage
- Fever
Scars (benign)
- Assess soft tissue mobility and symptoms with palpation
- Keloid = overproduction of collagen
Inspection and palpation of glands and lymph nodes
- Glands to palpate
- Thyroid
- Parotid
- Submandibular
- If abnormal – CONSULT
- Acute infection
- Slow to moderate growing mass
Two things associated with aging
- Wrinkling
- Osteoarthritis (wrinkles in your joint – arthritis doesn’t cause pain unless very advanced)