Integument Flashcards
1
Q
Skin Changes in Older Adult
A
- Loss of subcutaneous tissue
- Dermal thinning
- Decreased elasticity causes wrinkles and sagging
- Turgor decreased
- Inability to respond to heat and cold quickly
- Increased risk for heat stroke and hypothermia
- Loss of oil and sweat gland causes dry itchy skin
- Flat brown macules on hands and arms
“Liver spots”
2
Q
Skin Changes in Older Adult
A
- Keratosis caused by hyperpigmentation
- Seborrheic keratosis
- Dark raised lesions
- Actinic keratosis
- Reddish raised plaques on areas of high sun exposure can become malignant
- Skin tags
- Hair and nail growth decreases
3
Q
Lesions
A
- Characteristics of lesions helpful in diagnosing
- Can be cause by systemic diseases or infections, allergies
- Location, length of time present, and any changes occurring help with diagnosis
4
Q
Skin Colour
A
- Can be a sign or symptom of an number of disorders
- Result of varying levels of pigmentation
- Exposure to sun causes a buildup in melanin, causing light skin to tan which can impair changes
5
Q
Skin Colour
A
Erythema
- Reddening of skin
- Caused by blushing, fever, inflammation, hypertension
Cyanosis
- Bluish discoloration of skin and mucous membranes
- Results from poor oxygenation of hemoglobin, lack of adequate RBCs or hemoglobin
6
Q
Skin Colour
A
Jaundice
- Yellow to orange color visible in skin and mucous membranes
- Usually results from a liver disorder
Pallor
- Paleness of skin
- Caused by shock, fear, anemia, anger, or hypoxia
7
Q
Integumentary System: Diagnostic Tests
A
Biopsy Culture and sensitivity Skin scraping Patch test Wood’s light examination Blood work Photographs
8
Q
Bacterial Infections
A
- Primary infection – relate to resident flora
- Secondary infection- developing in wounds or lesions
- Often arise from the hair follicle where bacteria accumulate and grow to cause a localized
infection - Systemic infection if invade into deeper tissue
- Many nosocomial infections of wounds or open lesions are often the result of bacteria (staph aureus-MRSA)
9
Q
Foliculitis
A
- Often caused by Staphylococcus aureus
- Infection begins at the skin surface and extends
into hair follicle - Bacteria release enzymes and chemicals that cause inflammation
- Commonly seen on the scalp and extremities, face of bearded men, legs of women who shave, eyelids (stye)
Contributing factors include: poor hygiene, nutrition, prolonged moisture, trauma
10
Q
Furuncle (boil)
A
Infection of the hair follicle - Carbuncle—group of infected hair follicles - Often from Staphylococcus aureus - Deep red nodule that gets larger and becomes a cyst. - May cause fever, chills, or malaise - Contributing factors include: poor hygiene, skin trauma, excessive moisture, and systemic diseases (diabetes)
11
Q
Cellulitis
A
- Localized infection of the dermis and subcutaneous layers
- May occur following a wound or an extension of furuncles
- Spreads as a result of spreading factor substance called “hyaluronidase” from the organism
- Breakdown of fibrin network and other barriers
- Cellulitis is red swollen, painful
- May also experience : fever, chills, malaise, headache,
swollen lymph glands
12
Q
Acute Necrotizing Fasciitis
A
- Highly virulent Group A beta hemolytic streptococcus
- Also termed “Flesh Eating Disease”
- Rapid tissue invasion resulting from the secretion of proteases & enzymes that destroy the tissue. They also produce toxins that cause toxic shock.
13
Q
Acute Necrotizing Fasciitis
A
- Often a history of minor trauma or infection in the skin and subcutaneous tissue of an extremity.
- Surperficial facia in the subcutaneaous tissue and
fascia surrounding the skeletal muscle become edematous and necrotic with occlusion of small blood vessels leading to gangrene
14
Q
Acute Necrotizing Fasciitis
A
- S&S : Infected area is inflamed, painful and increases in size rapidly as dermal gangrene occurs.
- Systemic toxicity develops with fever, tachycardia, hypotension, mental confusion and disorientation
- Possible organ failure
- Mortality rate 40 -60%
15
Q
Fungal Infections
A
- Fungi are plantlike organisms that live in soil, on animals, on humans
- Dermatophypes are fungi that live on stratum corneum, hair, and nails and cause superficial skin infections.
- Superficial fungal skin infections are often referred to as ringworm or tinea.
- Fungal disorders are also called Mycoses
- Transmission – direct or indirect
16
Q
Fungal Infections: Contributing Factors
A
- Moist areas
- Use of broad spectrum antibiotics
- Presence of diabetes mellitus
- Immunodeficiencies
- Nutritional deficiencies
- Pregnancy
- Increasing age
- Iron deficiency
17
Q
Dermatophyte (Tinea)
A
Tinea pedis
- Athlete’s foot (soles of feet, toes, toenails. Pruritis and foul odour, mild scaliness to deep fissures)
Tinea curis
- Groin infection (inner thigh and buttocks “jock itch”)
18
Q
Viral Infections
A
- Pathogens that have RNA or DNA cores surrounded by a protein coat
- Depend on live cells for reproduction
- Viruses that cause skin lesions either increase cell growth or cause cellular death
- Increase in viral skin disorders may be related to some commonly used drugs
(birth control, corticorsteroids and antibiotics)
19
Q
Warts
A
- Lesions caused by the Human papillomavirus (HPV)
- Often found on the skin and mucous membranes
- Nongenital warts are considered benign lesions
- Genital warts may be precancerous
- Transmitted through skin contact : viral shedding
- Most are round, raised, rough grey surface.
- Resolve spontaneously
20
Q
Warts: Common Types
A
- Common : anywhere on skin and mucous membranes
- Plantar : on the soles of feet , finger and face
- Condylomata acuminate (venereal warts) : glans of the penis, anal area, vulva (cauliflowerlike pink or purple)
21
Q
Parasitic Infections
A
- Skin invaded by parasites or insects
- Often associated with crowded or unsanitary living conditions
- Most common parasites are mites and lice
22
Q
Pediculosis
A
- Infestation of lice
- Transmission : contact with an infected person or contact with clothing or linen infested with
parasites. - Causes intense itching and skin irritation
- Three types live on humans
- Pediculosis corporis—body lice
- Pediculosis capitus—head lice
- Pediculosis pubis—pubic lice (crabs)
23
Q
Scabies (Sarcoptes scabiel)
A
- Female mite
- Transmission: generally skin to skin contact but the mite can live for 2 days on clothing and linens
- Outbreaks frequently occur in shelters, dormitories and long term care facilities.
- Occurs up to 4 weeks after contact
- Infestation between fingers and inner surfaces of wrist, elbow, axillae, nipple, penis, belt line, and gluteal crease
- Small red mite burrows into skin
- Pruritus common at night; increased risk of infection
24
Q
Infections/ Infestations: Diagnosis
A
- Culture and sensitivity
- Scrapings and microscopic examination
- Ultraviolet light inspection
- Visual inspection
25
Q
Pressure Ulcers
A
- Ischemic lesions of the skin and underlying tissue caused by external pressure the impairs the flow of blood and lymph
- Ischemia causes tissue necrosis and eventual ulceration
- Necrotic tissue elicits an inflammatory response with a possible secondary bacterial infection
- Tend to develop over bony prominences or areas exposed to pressure, friction & shearing
26
Q
Pressure Ulcers: Risk Factors
A
- Older adults
- Limited mobility from injury or hospitalization
- Paralysis
- Incontinence
- Nutritional deficits
- Chronic illnesses (renal failure, anemia)
- Edema
- Infections
27
Q
Patho and Manifestations
A
- Pressure distorts capillaries and interferes with bld flow
- Reactive hyperemia occurs (brief)
- Platelets clump in endothelial cells surrounding capillaries and form microthrombi Ischemia and hypoxia occurs
- Cells and tissue in immediate area die and become necrotic
28
Q
Shearing Forces
A
- One tissue layer slides over another
- Stretching and bending cause injury and thrombosis
- Cause: HOB elevated or pulling
- Skin and superficial fascia remain fixed to bed sheet
- Deep fascia and bony skeleton slide in the direction of movement
29
Q
Contact Dermatitis
A
Caused by exposure to an allergen or direct chemical irritation
30
Q
Atopic Dermatitis (Eczema)
A
- Common in infancy
- May persist into adulthood
- Atopic refers to inherited tendency toward allergic conditions
- Family history of eczema, allergic rhinitis or hay fever, asthma
- Indicates genetic component
31
Q
Atopic Dermatitis: Pathophysiology
A
- Chronic inflammation results from allergens
- Eosinophilia and inc. serum IgE levels indicate allergenic basis
