Integumentary Flashcards
Function of integumentary system
protective barrier tactile perception temp regulation immune system response homeostasis
Changes in skin/nail beds can be first sign of:
inflammation
infection
immunologic disorders
organ dysfunction
Skin lesions
Scleroderma: autoimmune- inflammation and over production of collagen
can be skin or organs–!! potential life threatening
Poison ivy: contact dermatitis
Bacterial infection: tight, shiny, bright pink
Lupus Butterfly rash: looks like sunburn under eyes
Nail beds
Clubbing: poor O2 in body
sign of lung, inflamm bowel, CV, liver, AIDS
Yellow Nail syndrome: poor O2- respiratory disease
lymphedema- abnormal development
Screening observations to look for
-Changes in skin: cyanosis (blue/grey) jaundice (yellow) pallor (pale- low BP anemic) skin cancer (ABCD)
- Changes in nails
- Changes in hair (brittle)
- Changes in sweating/dryness
- Pruitis (itching)
Integumentary Systems Review
Observations and Palpations
Obs:
- erythema (redness), red streajs
- scar formation, lesions, wounds, callus, maceration
- dry skin, cuts, bruises, rashes, scars, hair follicles, nails
- nonhealing trauma
- drainage
- edema/swelling
Palps:
- skin temp (fever>100)
- presence/absence pulse
- pitting (system overloaded or impaired)/non-pitting edema
- tissue texture
- skin mobility/elasticity
ABCD of skin cancer
Asymmetry: 1/2 is different than other half
Border: irregular notches, uneven, blurred
Color: uneve, shades of brown, tan, black
Diameter: >6mm
Questioning for peripheral edema
subjective interview- guides pathological thought process
observations: assist in narrowing down hypothesis list
test and measures: rule up or down venous, arterial, lymphatic, or systemic causes
determine if PT is appropriate
Definition of Ededma
Imbalance in Starling Law of Equilibrium
Imbalance in filtration and reabsorption rate
Results in excess fluid in interstitial spaces/tissues
can be multi-factorial
impefes healing regardless of etiology
location: localiezed (trauma), unilateral, bilateral, systemic
Potential causes of edema
trauma infection venous/lympatic pathology wound obstruction of lymph nodes medications organ pathology (liver, kidney, cardiac, pancreas, hormonal)
Edema RED FLAGS
- bilateral hands and feet
- sudden onset w/out trama
- w/ fever, sweats, and chills
- progressive edema
- distal edema w/ short breath
- calf pain after trauma
- w/ red streaks
- warm and painful to palpate
- face/arm w/ discoloration of chest, arm/face, loss of carotid pulses, dysphasia, wheezing, chest pain, headaches, dizziness
- total body or quadrant
Physical exam for edema
- pain scale
- ROM
- neurological testing: DTR, sensation, strength
- functional test
- palpation: pitting/non-pit, texture, skin mobility
- circumferential measurements: 10 cm LE, 4 cm UE, figure 8 ankle
- volumetric measurement of extremity/hand
Pitting Scale
record time it takes for pitting to resolve
note quality of edema: presence of fibrosis?
fibrosis= faster resolution (more resistance)
ex: soft, hard, brawny, etc.
if softer: lower protein in interstitial
higher protein stimulates collegen, impedes transport to tissues
Pitting cause
CHF
Venous insufficiency
Lymphedema (as fibrosis develops, pitting is difficult)
Pitting Grading scale
0= absent
1+= minimal 10 sec
2+=moderate 20 sec
3+=severe 30 sec
NOT used for lymphedema
descriptors: easily pits, some pitting, brawny edema, skin mobility, viscosity
