integumentary Flashcards
congenital integument disorders
-birthmarks (vascular birthmarks and pigmented birthmarks)
-skin anomalies that present at birth or shortly thereafter
-most are harmless and shrink w age
-can sometimes be treated w laser therapy or surgery (moles)
-may be flat or raised, have regular or irregular borders, and are of diff colors
what are the 2 types of congenital integument disorders?
vascular birthmarks and pigmented birthmarks
macular stains (vascular)
-consist of blood vessels that have not formed correctly
-macular stains: also called salmon patches, angel kisses, and stork bites
-most common
-faint red marks often occurring on the forehead, eyelids, posterior neck, nose, upper lip, or posterior head
-most fade on their own by 2 years of age, although they may last into adulthood
hemanigiomas (vascular)
-“strawberries”
-bright red patch of extra blood vessels in the skin
-may be superficial or deep
-deep hemangioma may be bluish bc they involve deeper blood vessels
-grow during the first year of life and then usually recede
-most are benign, but can cause complications if they interfere w sight, feeding, breathing, or other bodily functions
port wine stain (vascular)
-discolorations that look like wine was spilled on the skin
-most often occur on face, neck, arms, and legs
-can be any size, but they grow only as the child grows
-tend to darken and thicken over time (bruise looking)
-will not resolve spontaneously
-those occurring near the eye should be assessed for possible complications
café au lait spots (pigmented)
-very common
-color of coffee w milk
-can be anywhere on the body and sometimes increase in number w age
-one spot alone is not usually a concern, but several spots larger than a quarter can be neurofibromatosis
mongolian spots (pigmented)
-flat, bluish-gray patches
-often found on the lower back or buttocks
-more common on those w darker skin tones
-usually fade, often completely, by school age w out treatment
albinism (disorders of melanin)
-recessive condition that results in little or no melanin production
-melanin deficits cause a lack of pigment in the skin, hair, and iris
-skin changes: color ranges from white to nearly the same as relatives
-hair changes: color can range from very white to brown; ppl of African or Asian descent may have hair color that is yellow, reddish, or brown
-eye changes: color ranges from light blue to brown; irises are semitranslucent; some eyes appear red
melanin
-pigment that provides color and protection
-plays a role in the development of the retina
what forms cause problems w eye development and function in melanin
-nystagmus
-near/farsighted
-photophobia
vitiligo (disorders of melanin)
-rare condition characterized by small patchy area of hypopigmentation
-occurs when the cells that produce melanin die or no longer form melanin, causing slowly enlarging, irregularly shaped white patches on the skin
-affects ppl of all races but may be more noticeable in those w dark skin tones
-may affect any area, but usually develops on sun-exposed areas first
-can start at any age, but often first appears btwn 10-30 yrs of age
cause of vitiligo
-the exact cause is unknown; causes may include autoimmune melanocyte destruction, reduced melanocyte survival , and primary melanocyte defects
skin changes w aging
-decreased sensations of pain. vibration, cold, heat, pressure, and touch
-increase the risk of injury including falls, decubitus ulcers, burns and hypothermia
-decreased elasticity, integrity, and moisture
-environmental factors, genetic makeup, and nutrition contribute to these changes, especially sun exposure
-blue-eyed, fair-skinned ppl show more of these changes
-sebaceous glands produce less sebum
-difficult to maintain skin moisture
skin changes w aging in the epidermis
-appears thin, pale, and translucent
-epidermis thins even though the number of cell layers remains unchanged
-melanocyte numbers decrease but increase in size
skin changes w aging in the dermis
-changes in the connective tissue reduce the skin’s strength and elasticity
-blood vessels become fragile, leading to bruising
skin changes w aging in the subcutaneous
-the subcutaneous fat layer thins
-increases risk of skin injury and reduces the ability to maintain body temp
dark spots/sun spots (skin changes w age)
-large pigmented spots (lentigos) may appear in sun-exposed areas
skin tags (skin changes w age)
-benign, flesh-colored masses
-usually occur on the neck
-most are painless, but can become inflamed in the presence of constant friction
-can be removed w surgery, cryotherapy, and cautery
repairs itself more slowly
-wound healing may be up to four times longer
-contributes to decubitus ulcer formation and infections
inflammatory integument disorders
-contact dermatitis
-atopic dermatitis
-urticaria-hives
-psoriasis
contact dermatitis
-acute inflammatory reaction triggered by direct exposure to an irritant to allergen-producing substance
-not contagious or life threatening
-varies in severity depending on the substance, area affected, exposure extent, and individual sensitivity
-usually resolves in 2-4 weeks
irritant contact dermatitis
-causes: chemicals, plants, body fluids, rubber gloves, and soaps
-does not involve the immune system, but triggers the inflammatory response
-produces a reaction similar to a burn
-manifestations: erythema, edema, pain, pruritus, and vesicles
allergic contact dermatitis
-causes: metals, chemicals, adhesives, cosmetics, and plants
-sensitization occurs on the first exposure, and subsequent exposures produce a type IV cell-mediated hypersensitivity
-manifestations appears 24-48 hrs after exposure
-manifestations: pruritus, erythema, edema, and small vesicles
atopic dermatitis
-“eczema”
-chronic inflammatory condition
-has an inherited tendency
-may be accompanied by asthma and allergic rhinitis
-most common in infants and usually resolves by early adulthood
-young children: face, scalp, hands, or feet
-older children and adults: knees and elbows
-characterized by remissions and exacerbations
atopic dermatitis cause
-exact cause unknown, but may result from an immune system malfunction (similar to hypersensitivity reaction, [i.e., IgE eleveation present])
atopic dermatitis complications
secondary bacterial skin infections, neurodermatitis (permanent scarring and discoloration from chronic scratiching), and eye problems (e.g., conjunctivitis)
factors that trigger exacerbation for psoriasis
bacteria or viral infections in any location, dry air or dry skin, skin injuries, stress, too little or too much sunlight, and excessive alc consumption
atopic dermatitis manifestations
-may be worsened by environmental factors like food allergens, airborne allergens, Staphylococcus aureus colonization on skin, topical products, sweating, and rough fabrics
-red to brownish-gray skin patches
-pruritus, which may be severe, especially at night
-vesicles
-thickened (lichenified), cracked, or scaly skin
-irritated, sensitive skin from scratching
urticaria - hives
-raised erythematous skin lesions (welts)
-result of a type I hypersensitivity reaction often triggered by food (e.g., shellfish and nuts) and medicine (e.g. antibiotics)
-may also be a result of emotional stress, excessive perspiration, diseases (e.g., autoimmune conditions and leukemia), and infections (e.g., mononucleosis)
-occurs when histamine release is initiated by these conditions
-usually short-lived and harmless
-can impair breathing if around the face and progress to anaphylaxis and shock
bacterial infections
-can be caused by any of the norm flora bacteria
-varies from mild to life-threatening
-Staphylococcus and Streptococcus genera are common culprits
psoriasis
-chronic inflammatory condition that affects keratinocytes life cycle
-cellular proliferation is significantly increased, causing cells to build up too rapidly on the skin’s surface
-normally takes weeks, but occurs over 3-4 days w psoriasis
-buildup leads to thickening of the dermis and epidermis bc dead cells cannot shed fast enough
infectious integumentary disorders
-skin infections are common
-organisms gain access through breach in skin or mucous membrane
-this triggers inflammatory responses
-can occur in any skin layer or structure
-may be acute or chronic and severity varies
-resolves w treatment
psoriasis cause
-the exact cause is unknown, but it is thought to be multifactorial: environmental factors, trauma, infections, excessive alc use, meds, genetic factors, and immunologic factors plays a role
how does psoriasis appear
-pt usually experiences remissions and exacerbations
-severity varies
-may also have arthritis – psoriatic arthritis
-may be severe in persons who have a weakened immune system
-begins as a small, red papule
-papules most often occur on the elbows, knees, and trunk but they can appear anywhere
treatment for bacterial infections
organism-specific antibiotics, wound care, adequate hydration, surgical debridement, drainage
folliculitis
-involving the hair follicles
-characterized by tender, swollen areas that form around hair follicles,
-often on the neck, breasts, and face
furuncles
-begin in the hair follicles and then spread into the surrounding dermis
-most commonly occur on the face, neck, axillae, groin, buttocks, and back
-start as a firm, red, painful nodule that develops into a large, painful mass, which freq drains large amts of purulent exudate
-carbuncles refer to clusters of furuncles
impetigo
-common and highly contagious
-can occur w out an apparent skin breach, but typically arises from a break in the skin
-lesions usually begin as small vesicles that enlarge and rupture, forming the characteristic honey-colored crust
-typically caused by staphylococci, which produce a toxin that attacks collagen and promotes spread
cellulitis
-occurs deep in the dermis and subcutaneous tissue
-usually results from a direct invasion of pathogens through a break in the skin, or spreads from an existing skin infection
-appears as a swollen, warm, tender area of erythema
-complications: necrotizing fasciitis, septicemia, and septic shock
necrotizing fasciitis
-rare, serious infection
-can aggressively destroy skin, fat, muscle, and other tissue
-typically results from a highly virulent strain of gram-pos, group A, beta-hemolytic Streptococcus that invades through a minor cut or scrape
-the bacteria release harmful toxins that directly destroy the tissue, disrupt blood flow, and break down the tissue
HSV -1 (viral infections)
-cold sores/lesions
-typically affects the lips, mouth, and face
-usually begins in childhood
-can involve the eyes, leading to conjunctivitis
-can result in meningoencephalitis
-transmitted by contact w infected saliva
-the primary infection may be asymptomatic
verrucae (viral infections)
-warts caused by a number of human papillomaviruses
-can develop at any age and often resolve spontaneously
-transmitted through direct skin contact btwn ppl or w in the same person
-the human papillomavirus replicates in the skin cells, causing irregular thickening
-varying color, shape, and texture depending on type
shingles
-“herpes zoster”
-varicella-zoster virus
-caused by the varicella-zoster virus
-appears in adulthood yrs after a primary infection of varicella in childhood
-the virus lies dormant on a cranial nerve or a spinal nerve dermatome until it is activated yrs later
-the virus affects this nerve only, giving the condition its typical unilateral manifestations
shingles manifestations & complications
manifestations: -pain, paresthesia,
-a red or silvery vesicular rash that develops in a line over the area innervated by the affected nerve (one side of the head or torso),
-extremely sensitive skin
-the rash may persist for weeks to months.
complications: neuralgia and blindness
pressure injuries
-soft-tissue injuries that occur as a result of unrelieved mechanical pressure
-results in areas of necrosis and ulceration where the tissue is compressed btwn bony prominences and external hard surfaces
-most common sites for these injuries are the sacrum, ischial tuberosities, trochanters, malleoli, and heels, though can develop anywhere
-An injury can develop in 1–2 hours if pressure is not relieved
pressure injuries risk factors
advancing age, impaired circulation and tissue perfusion, immobilization, malnutrition, decreased sensation, and incontinence
pressure injury complications
challenging mitigating factors;
ulcers can become infected with hospital-acquired, antibiotic-resistant organisms
osteomyelitis
cellulitis
tissue calcification
bacteremia
pressure injury treatment
effort to reduce pressure,
care for the wound, minimize infection,
pain management, antibiotics,
negative-pressure therapy
surgical closure, or skin grafts
Healing typical takes weeks; ____________________________
prevention is critical
pressure injuries stage 1
Stage I: Skin is intact, nonblanchable erythema is present
pressure injury stage 2
Stage II: Erosion or blister with or without true ulcerations, no exposed subcutaneous tissue
pressure injury stage 3
full-thickness skin loss w damage to subcutaneous tissue down to the underlying fascia
pressure injury stage 4
full-thickness kin loss w extensive destruction, tissue necrosis, and damage to exposed supporting structures
deep tissue injury
skin may or may not be intact, and underlying tissue is damaged
unstageable
full thickness skin and tissue loss in which the extent of damage cannot be determined bc it is hidden by slough or eschar
