integumentary Flashcards
6 primary skin lesions
- macule
- papule
- plaque
- pustule
- vesicle
- wheal
macule
circumscribed, flat discoloration
blue, red, brown, hypo pigmented
<0.5cm (if >0.5 it is a patch)
examples: freckles, petechiae, measles, flat mole (nevus), vitiligo (complete depigmentation)
papule
elevated, solid lesion
<0.5cm (if >0.5 it is a nodule)
examples: wart, elevated moles, lipoma, basal cell carcinoma
plaque
circumscribed, elevated, superficial, solid lesion
>0.5cm
examples: psoriasis, seborrheic and actinic keratoses
pustule
elevated, superficial lesion filling with purulent fluid
examples: acne, impetigo
vesicle
circumscribed, superficial collection of serous fluid
<0.5cm (if >0.5, it is a bulla)
examples: varicella (chickenpox), herpes zoster (shingles), 2nd-degree burn
wheal
firm, edematous, irregularly shaped area
size varies + may only last a few hours
examples: insect bite, urticaria, angioedema
6 secondary lesions
- atrophy
- excoriation
- fissure
- scale
- scar
- ulcer
atrophy
depression in skin r/t thinning of epidermis or dermis
examples: aged skin, striae (stretch marks)
excoriation
epidermis is missing - dermis is exposed
examples: abrasion, scratch
fissure
linear crack or break from epidermic to dermis
dry or moist
examples: athlete’s foot, chapping, eczema
scale
excess, dead epidermal cells made by abnormal keratinization and shedding
examples: flaking of skin after a drug reaction, sunburn
scar
abnormal formation of connective tissue that replaces normal skin
examples: surgical incision, healed wound
ulcer
loss of epidermis and dermis
crater-like, irregular shape
heals with a scar
ex: pressure ulcer, chancre
cyanosis
blue
late sign of hypoxia
cause: heart or lung disease, cold environment
where: nail beds, lips, base of tongue, skin
pallor
decrease in color
reduced amt of hgb; decreased blood flow
caused by: anemia or shock
where: skin, nail beds, conjunctiva (line of demarcation), lips, face, palms
vitiligo
loss of pigmentation
caused by: congenital autoimmune condition
where: patchy areas on skin over face, hands, arms
jaundice
yellow-orange
increased deposits of bilirubin in tissues
caused by: liver disease, destruction of RBC
where: sclera, mucous membranes, skin
erythema
red
increased visibility of hgb d/t dilation or increased blood flow
caused by: fever, direct trauma, blushing, alc intake
where: face, area of trauma, areas at risk for pressure (sacrum, shoulders, elbows, heels)
tan-brown
increased amount of melanin
caused by: suntan, pregnancy
where: areas exposed to sun (face, arms), areolae, nipples
skin cancer
most diagnosed cancer
classified as non melanoma or melanoma
early detection more common bc of visible lesions
risk factors for skin cancer
-fair skin (blonde/red hair, blue eyes)
-hx of outdoor activities
-living near equator or high altitudes
-fam hx of skin cancer
-work outdoors
-tanning beds
non melanoma skin cancers
basal cell carcinoma
squamous cell carcinoma
basal cell carcinoma
locally invasive cancer from basal cells (erythematous, pearly, sharply defined, barely elevated plaques, depression in middle)
squamous cell carcinoma
comes from keratinizing epidermal cells, can be aggressive (thin, scaly erythematous plaque)
malignant melanoma
*tumors come from melanocytes
*genetic and environmental factors contribute to development –> 5-10% have 1st-degree relative
*treatment depends on depth of lesion (correlation between survival and depth of lesion)
*poor prognosis unless diagnosed and treated early
*may metastasize to any organ, if untreated
lesion > 1.5 mm
would require treatment after surgical removal
how do we evaluate lesions with malignant melanoma?
ABCDE
asymmetry
border irregularity
color
diameter (>6mm)
evolving or elevated
interprofessional care for integumentary problems
skin integrity care
anxiety/coping issues with diagnosis
teach related care of biopsy
annual dermatology checkups
what is most likely to occur for lesions?
biopsy
bacterial skin infections
impetigo + cellulitis
*staph aureus or B-hemolytic streptococci usually responsible
*if exudate present, drainage also infectious
risk factors for bacterial skin infections
excess moisture
obesity
atopic dermatitis (eczema)
systemic corticosteroid or antibiotic use
chronic diseases (T2DM)
cellulitis
inflammation of SQ tissue
manifestations of cellulitis
hot
tender
erythematous area w/ diffused borders
fever and chills
malaise
treatment of cellulitis
localized: moist heat (warm compress to reduce swelling), immobilization, elevation
systemic: antibiotics –> hospitalize if severe; progression to gangrene, if not treated
viral infections
more difficult to treat
lesions can result from inflammatory response to systemic viral infections
systemic viral infections
herpes simplex
herpes zoster (shingles)
HPV (human papillomavirus)
warts
herpes zoster
activation of varicella-zoster virus (chickenpox)
incidence increased with age
potentially contagious if haven’t had chickenpox yet
herpes zoster manifestations
burning pain and neuralgia along dermatome
prevention of herpes zoster
vaccine (Zostavas) to prevent shingles
*one time dose for adults > 60
HPV
human papillomavirus
warts in genital area or anywhere on body
usually preventable with vaccine
fungal infections examples
candidiasis
-mouth
-vagina
-skin
tinea corporis (ringworm)
tinea cruris (jock itch)
tinea pedis (athletes foot)
fungal infections
most are harmless - can be embarassing
skin, hair, nails more susceptible to fungal infections
usually treat with topical anti-fungal creams or solutions
allergic skin problems
irritant or allergic dermatitis –> benign (contact dermatitis) vs life-threatening (Stephen johnson syndrome and toxic epidermal necrolysis)
Stephen Johnson Syndrome and Toxic epidermal necrolysis
rare, LIFE-THREATENING skin conditions
- immune responses are generally due to a severe adverse reaction to medication or infection
- causes acute destruction of epithelium of skin and mucous membranes
Stephen Johnson Syndrome and Toxic epidermal necrolysis: S/S?
fever
cough
HA
anorexia
myalgia
nausea
precede skin and mucous membrane findings by 1-3 days
examples of infestations and insect bites
ex: pediculosis (lice), bed bugs, ticks, scabies
what plays a key role in insect bites?
allergy to venom
sometimes, clinical manifestations are related to eggs, feces, or body parts of invading organism
how to prevent insect bites?
avoid + repellants
what is important to do with insect bites
meticulous hygiene –> hair, skin, clothing, bedding, pets, sexual partners
routine skin inspections –> especially if traveling to high-risk areas (ESP TICK BITES)
psoriasis
benign skin problem
*chronic autoimmune disease
*usually develops in those 15-35
*familial
*up to 40% develop psoriatic arthritis
*can be painful and emotional disabling r/t body image disturbance
most common form of psoriasis
plaque psoriasis
lesions are distinct, red, intact
*located: knees, elbows, hands, lower back
types of psoriasis
plaque (MOST COMMON)
-guttate
-pustular
-inverse
-nail
-psoriatic arthritis
care for psoriasis
phototherapy (UV light) : psoriasis
care for basal/squamoous cell carcinoma
radiation
drug therapy for skin conditions
antibiotics
steroids (NOT long-term)
antihistamines
immunomodulators (suppress overreactive immune system)
therapy for malignant melanoma
diagnostic/surgical therapy (punch biopsy, scraping)
nursing management of skin problems
-wet compresses (room temp tap water w/ possible additive) –> ASSESS for maceration
-baths: tepid (lukewarm) *too hot makes itchy
-hygienic practices: lotions while skin still damp; seals in moisture
-topical meds
-control of itching
