integument Flashcards
Epidermis
outer layer of mostly dead skin cells-stratum corneum. provides protective hardened layer of keratin.
what is our first line of defense?
Intact skin.
dermis
“true skin” consists of connective tissue, blood vessels, hair follicule, sweat glands, elastic fibers, nerves.
subcutaneous tissue.
layer of tissue that attaches to muscle and bone. connective tissue and fat cells.
what gives skin color
melanin
production of melanin is determined by what gland
pituitary
the more melanin the darker the skin
know
protection is the most important thing
know
areas of intense friction causes a ___ usually has fluid underneath it
blister.
Temperature regulation is done by which four ways
radiation, conduction, evaporation, convection.
sensory processing
helps our body process warning signs. Monitors outside enviorment. Specialized nerve endings that respond to pressure, pain, heat and cold.
our skin helps us sythesize certain chemicals of mainly vit d we need UV light so sun exposure is needed
for healthy bones and teeth
where are hair follicles located
in the dermis
humans have hair everywhere but
the palms of their hands, soles of feet, nipples, lips, penis and labia.
hair is formed by hundreds of strands of keratin with amino acids.
scalp hair grows the fastest.
when does hair life slow down and texture change?
midlife.
decreased melanin production results in
gray hair
we inherit our hair type.
know
age, nutrition, wellness, illness, and hormonal levels affect hair production
know
Sebum
lubricates skin and hair from drying out and cracking
sebaceous glands can become blocked. Mostly during puberty.
blockage can appear to be light then later dark. Black head and can turn into a pestual and can be inflammed and cause acne.
finger and toe nails are considered an organ in the integumentary system.
hardened layers of kertain, provide protection, all use them as tools to grasp and pick things up.
assess color, texture and distrubution. know if there is any lesions present and measure them, chart location. Look for abnormal findings like lice or scaling skin.
look at nails and nail beds. note any kind of changes in the color of the nail bed and capillary refill time.
most useful tools when assessing skin and risks is the BRADEN SCALE
it is scored by numbers then add the numbers with a total and will help you design interventions
Pressure sore staging
Stage 1
redness
Pressure sore staging
Stage 2
blistering or skin tear.
Pressure sore staging
Stage 3
shallow crater with drainage.
pressure sore staging
Stage 4
deeply ulcerated tissue, exposed muscle and bone, sepsis.
Assessing nails will give us an idea of
Oxygenation
clubbing indicates
a long term condition that leaves them with poor oxygenation
Integumentary diagnostic tests
C&S visual inspection allergy test Woods light test potassium hydroxide test fungal cx skin biopsy.
Wood’s light exam
a type of blacklight that will show us 10% of types of fungal inf. that can be in the hair and scalp but can be used for other areas.
potassium hydroide test
for fungal inf. they do a scraping of the inf skin and bathe it with potassium hydroxide and itll produce heat and itll dissolve itself and itll show filament threads between cells to show type.
Drug therapy.
Corticosteroids, antihistamines antibiotics, antiseptics scabiecidies, pediculocides antiseborreic agents keratolytics standard precautions when applying topical med over impaired skin.
Wet dressings
cooling soothing effect.
sterile procedure for broken skin
dry gauze placed on area, saturated with prescribed solution.
left in place until dry as a method of debridement.
Therapeutic baths
no soap, warm water. Gentile application to submerged parts. Inflammation and itching relief. aid in removal of crusts and scales. products used: oatmeal, cornstarch, baking soda, mineral oil.
surgical excision
laser therapy
can reduce highly pigmented undesireable areas. can coag vessels to stop bleeding, to remove tattoos. to remove excessive hair.
LASER acronym
LIGHT AMPLIFICATION STIMULATION EMISSION RADIATION
when present for the removal of lesions be sure your wearing a
mask
eye protection
to prevent ploom in the air so you dont contract a fungal inf.
cryosurgery
liquid nitrogen used to remove lesions.
Phototherapy
UV lights can be used for psorisis.that will dry up itchy scaling skin.
lifestyle changes
stress worsens conditions. Stay out of sun,
a physical force that separates layers of tissue in opposite directions such as seated client slides downward by using a lift sheet and encouraging the use of a trapeze
shearing
a general term that refers to an inflammation of the skin, common sign in skin disorders accompanied by red rash
dermatits.
itching
pruritus.
blackhead
comedome
a method of removing surface layers of scarred skin
dermabrasion
the nose becomes pernamently enlarged, red, nodular, and bulbous
rhinophyma
a chronic, noninfectious inflammatory disorder of the skin that affects both men and women- onset young and middle adult hood
psoriasis
a combo of UV light therapy and photo sensitizing psoralen drug used for severe , diabling psoriasis that does not respond to tx
photochemotherapy
is caused by an infestation with tiny itch mites (sarcoptes scabei)
scabies.
are superficial fungal inf.
Dermatophytoses (tinea) also commonly called ring worm
Dermatophytes (tinea)
are parasitic fungi that invade the skin, scalp, and nails.
also known as shingles, a skin disorder that develops years after an inf with varicella (chicken pox) more frequent with middle aged to older adults as well as those immunocompromised.
herpes zoster.
typically with those who have a darker skin pigment skin tend to form this. its an overgrowth of scar tissue.
keloids.
a dermatologic condition associated with an excessive production of secretions from the sebaceous glands. not always confined to the scalp but usually there.
seborrhea.
___ ___ is red areas covered by yellowish, greasy-appearing scales.
seborrheic dermatitis.
baldness. a condition that affects the hair follicles and results in partial or total hair loss.
alopecia
__ eggs, laid by adult females, are tightly cemented to the side of hair shafts. small yellow-white ovals
nits
is a fungal dermatophyte infection of the fingernails or toenails
Onychomycosis
is the med term for an ingrown toenail.
Onychocryptosis
a professional trained to care for feet. Typically for clients with diabetes or peripheral vascular disease.
podiatrist.
a chronic skin disorder that manifests in a variety of ways, generally a rosy appearance.
Rosacea.
redness of the skin
Erythema
means of removing tissue by applying extreme subfreezing cold with a probe or agent such as liquid nitrogen
cryrosurgery
a procedure that uses electrical energy converted to heat to destroy or remove superficical growths from the skin
electrodessication
an inflammatory disorder that affects the sebaceous glands and hair follicules
acne vulgaris
infestation with lice
pediculosis
practitioner who specilizes in care for feet
podiatrist.
The skin is composed of two layers; epidermis, the outermost layer and the dermis. the epidermis contains an outer layer of dead skin cells, the stratum corneum, that forms a tough protective protein called keratin.
The epidermis is contantly shed and replaced with epithelial cells from the dermis every day. The epidermis is replaced every 35-45 days.
small, brown, pigmented spots known as liver spots form in the hands, and forearms of older ppl.
senile lentigines.
small,yellow or brown pigmented raised lesions that appear on face and trunk-some a precancerous.
senile keratoses
what gland releases water and electrolytes
Eccrine gland
what gland is found around nipples, in the anogenital region, in the eyelids, in the mammary glands of breasts and in the external ear canals-where secretion is called cerumen
Apocrine gland
three things to document during assessment
if they have lesions, how long theyve been present, exposed to new products etc.
assess color, distrubution, and texture.
pressure sores, also known as decubitus ulcer, occurs when capillary blood flow to an area is reduced. may happen when skin over a bony prominence is compressed between the weight of the body and a supporting surface 4 a prolonged period.
common locations is over the coccyx and sacrum in lower spine, the hips, heels, elbows,shoulder blades, ears and back of head. Braden scale determines risk.
elevated, obvious raised boarder, solid
papule
elevated round, filled with serum
vesicle
elevated irregular boarder, no free fluid.
wheal
elevated raised boarder filled with pus
pustule
elevated solid mass extends to deeper tissue
nodule
encapsulated round, fluid filled, or solid mass beneath skin
cyst
two types of dermatitis
+allergic contact dermatitis develops in people who are sensitive to one or more substances such as drugs. fibers in clothes, cosmetics, plants, and dyes.
+irritant dermatitis.
know
factors that contribute to acne vulgaris
rise in androgen hormone levels that occur when secondary sex characterisitics are developing. androgens increase the size and activity of sebaceous glands and provides an ideal area for bacteria overgrowth.
tx for psoriasis
Psoriasis is characterized by patches of erythema covered with silvery scales usually on the exterior surfaces of the elbows, knees, trunk, and scalp. The lesions are obvious and unsighty, scales tend to shed.
The cause is unknown, but a genetic predisposition is likely bc many report a family hx of the disorder. it requires a systemic inf, injury to the skin, vaccination, or inj. also links with immune system.
TX: no cure. symptomatic tx to control scaling and itching
meds for psoriasis
coal tar extract, corticosteroids, or anthralin, and methotrexate.
how to remove head lice
do not shampoo or condition hair before applying the pediculicide. Conditioner coats the hair and protects nits. instruct the client to follow labeled instrutions. leave the chemical on for longer than 10 mins or covering head with a shower cap does NOT increase effectiveness.may increase potential for toxicity.
what can u use to remove head lice
nonprescription shampoos, gels and liquids containing pediculcides are effective. Permethrin liquid NIX kills adult forms of lice. RID, Pronto, A-200 contain pyrethrin K well
factors that promote skin cancer.
increased exposure to UV radiation, esp ultraviolent B UVB or ultraviolet V UVC, harmful components in the spectrum of sun light. fair skin is more at risk thinning ozone layer residense in high altitude areas decreasede melanin in skin prolonged repeated exposure to uv rays
appearance of headlice
lice are brown crawling insects about the size of sesame seed. dont jump or fly. NYMPHs look like moving dandruff, they appear red after feeding
appearance of nits
small yellowish-white ovals
S&S of scabies
itching is intense, esp at night. common affected areas include the webs and sides of fingersand around the wrists elbows, armpits, waists, thighs, genitalia, nipples breasts, and lower buttocks
prevention of reinfestation of scabies
thoroughly wash clothes, bathe, and avoid contact with others with scabies.
cause of scabies
by an infestation of tiny itch mites, anyone can get them but it is to assume ppl with poor hygeine. Skin to skin contact.- rare but they can be got by handling clothing and linen from a recent person
tx of scabies
Scabicides, chemicals that destroy mites. such as lindane (cream or lotion) permethrin cream, crotamiton cream, applied to skin in a thin layer 8-12 hr then removed by washing it off. itching can continue 2-3 wk
S&S of herpes zoster (Shingles), cause, treatment, anatomy affected.
S&S: low grade fever, headache, and malaise, red blotchy appearance that begins to itch or feel numb, 24-48 hours later vesicles appear on the skin along the nerve’s pathway.
- it develops years after an infection with varicella (chicken pox) and it lies dormant in the nerve roots.
- usually the eruptions are unilateral (one side) on the trunk, neck, or head. They become severely painful, and severe itching soon follows. In a few days the lesions rupture and crusts form. Pain and itching can persist for months or as long as 2 years or more.
- viral reactivation produces an inflammatory symptoms in the dermatome, a skin area supplied by the nerve. Raised, fluid-filled, and painful skin eruptions accompany the inflammation.
- Treatment:oral acyclovir (Zovirax), when taken within 48 hours of the appearance of symptoms, reduces their severity and prevents the development of additional lesions. Topical acyclovir can also be used on the lesions. Corticosteroid therapy can reduce the pain. Analgesics and liquid preparations with a drying or antipruritic effect are applied to the area after the crusts fall off. Codeine is often needed the first few days to weeks.
- if youre 60 years old or older you should receive a single dose of Zostavax vaccine regardless if youve had chicken pox or not. The vaccine reduces the risk and severity of shingles and postherpetic neuralgia.
intervention to relieve pruritis
- corticosteroids
- antihistamines
- local (Topical) anesthetics
- emollients, ointments, powders, and lotions
- therapeutic bath
Therapeutic baths and Wet dressings
- **Therapeutic baths
- various solutions, powders, and oils, but no soap, are added to water into which the client’s entire body or a part is submerged. They remove inflammation and itching and to aid in the removal of crusts and scales. Products used: corn starch, sodium bicarbonate (baking soda), oatmeal colloidal bath preparations, and mineral oil. The tub is filled with lukewarm water, then you add the product and stir.
- **Wet dressing
- used to apply a solution to a skin lesion for a cooling and soothing effect. First you apply a dry dressing (dont use cotton), then you saturate the dressing with the prescribed liquid. A moist environment promotes healing, an occlusive hydrocolloid dressing that contributes water to the impaired skin can achieve the same objective.
end chapter questions:
- sweat glands that release water and electrolytes in the form or perspiration? Eccrine glands
type of protein that forms protective layers? keratin
hormone like chemicals that communicate reproductive and social information among species? Pheromones
decubitus ulcers of the skin over bony prominences? Pressure sores
a pigment that determines the color of the skin? melanin
sweat glands that secrete cerumen in the external eat canals? apocrine glands
lubricant that prevents drying and cracking of the skin and hair? sebum
structures that cover the exterior surface of the body, including the skin, hair, and nails? Integument
the “true” layer of skin? Dermis
term meaning to remove damaged tissue from a wound? debridement
a freckles is an example of a? macule
a cyst is an encapsulated, round, fluid filled or solid mass beneath the skin.
a hive is an example of a? wheal
a wart is an example of a? papule
an example of a pustule is a boil.
clients with enlarged lymph nodes are said to have a? nodule
a fluid filled blister is called a? vesicle.
Functions of the skin: protective barrier, temp regulation, chemical synthesis.
Heat loss through the transfer or surface heat within the environment is termed? radiation.
when drying a client after a therapeutic bath the nurse should? pat the skin gently with towel until dry.
a client with stage 4 pressure ulcer on the coccyx, with necrotic tissue? debrid the wound.
a client has a small pressure ulcer of the heel. The tendon and bone are visible and the drainage is copious. What stage is the ulcer? 4
a nurse assesses a client who has yellow tinge to the skin and sclera of the eye. What do you think the problem is? renal disease or liver failure.
if a clients skin is ecchymotic the nurse should assess for? trauma to the area.
a stage 2 pressure ulcer exists when the client has? redness accompanied by blistering or a break in the skin.
concave (spooning) nail shape are a sign of iron deficiency.
clubbing of the nails is indicative of? cardiovascular disease.
acne vulgaris is believed to be related to hormonal changes
carbuncles are usually treated with antibiotic therapy
severe psoriasis is treated with methotrexate (folex)
intense itching of the skin especially at night is symptomatic of scabies.
tinea pedis is best treated wiht topical tolnaftnate (tinactin)
skin is the primary site of cancer in the US
ecchymosis
bruising
Xeroderma pigmentosum (XP) is a very rare skin disorder where a person is highly sensitive to sunlight, has premature skin ageing and is prone to developing skin cancers. Xeroderma pigmentosum is caused by cellular hypersensitivity to ultraviolet (UV) radiation, as a result of a defect in the DNA repair system
vesiculation: the presence or formation of vesicles.
Scleroderma or systemic sclerosis: is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases. Overproduction of collagen. Local or systemic. Tight, shiny skin and dilation of the blood vessels.
Postherpetic neuralgia (PHN): is a painful, chronic condition that can occur following shingles, a viral infection that causes a mildly itchy to intensely painful rash
Which of the following nursing assessment techniques is best for determining the quality of the client’s skin turgor? Grasping a fold of skin over the sternum
An elderly bedridden client frequently slides to the bottom of the bed with the feet touching the footboard. When the nurse analyzes the observation, which one of the following is the most likely outcome of the client’s downward movement in bed? The client is at risk for skin impairment because of shearing forces
During a routine assessment, the nurse notes that a client’s fingernails have a clubbed appearance. What is the nurse’s most valid interpretation regarding this finding? The client may have chronic cardiopulmonary disease.
Which area of health teaching is essential when a female client is prescribed isotretinoin (Accutane) for treating acne vulgaris? Techniques for avoiding pregnancy.
What is the best nursing advice for people who have frequent outbreaks of tinea pedis (athlete’s foot)? Wear different shoes each day.
When a client with shingles (herpes zoster) asks the nurse about what causes the disease, what is the most correct reply? It is caused by the reactivation of a dormant virus.
