Integumentary Disorders Flashcards
What are some functions of the skin?
- protection
- homeostasis
- temperature regulation
- sensory organ
- vitamin synthesis
- psychosocial
What are some important assessments to make for the skin?
- color
- lesions
- primary: initial reaction to a problem that alters the structure of the skin
- secondary: lesion that forms over time
- edema
- moisture
- vascular changes
How do you assess a pt for skin cancer?
– ABCD:
- asymmetry of shape
- border irregularity
- color variation within one lesion
- diameter > 6mm
What is petechiae? What is ecchymoses?
– petechiae: tiny, brown/purple spots that appear on the skin due to bleeding under the skin
– ecchymoses: bruising
What is the purpose of palpation?
- determines size of lesions
- determines whether macular or papular
- macular: flat
- papular: raised
- determines temperature – use back of hand
- determines turgor – tent/pinch skin
What are the main hair assessments?
– inspect and palpate for:
- cleanliness
- distribution
- quantity
- quality
Define dandruff and hirsutism.
– dandruff: accumulation of patchy or diffuse white or grey scales on the scalp
- severe dandruff can result in subsequent alopecia
– hirsutism: excessive growth of body hair
- manifestation of hormonal imbalance
- common with Cushing’s
What are the main nail assessments?
- dystrophic nails – abnormal nails
- color
- depends on
- thickness
- transparency
- blood flow
- pigmentation
- depends on
- perfusion
- shape changes
- lesions
- thickness
- consistency
- paronychia – inflammation of skin around the nail
What is the difference between acute and chronic paronychia?
– acute paronychia: inflammation around the nail due to acute infection
– chronic paronychia: infection that persists for months; common in constant water exposure
- common on feet of surfers
- can see in immunocompromised pts
How do assessments change for pts with darker skin?
– look at lips, tongue, nail beds, and eyes for:
- pallor
- cyanosis
- inflammation
- jaundice
- bleeding
What are the 4 types of skin biopsies?
- punch biopsy: used for sampling possible cancers, tumors, and inflammatory skin conditions
- shave biopsy: horizontal shave of the skin lesion with only superficial portion of the dermis
- excisional biopsy: complete lesion removed with margin of normal skin down to adipose tissue
- incisional biopsy: cross-section wedge of tissue through center of lesion
How is a Wood’s lamp used for skin inspection?
UV light that is used to examine the skin; some infections produce a different color under Wood’s lamp
What is xerosis? What population commonly experiences xerosis? What are some complications that may result from xerosis?
– xerosis: dry skin; fine flaking of stratum corneum
– common in older pts
– results in generalized pruritus
- scratching may result in
- lesions
- excoriations
- lichenification – thickening and leathering of skin (callosing)
- infection
What are some interventions for xerosis?
- rehydration to relieve itching
- moisturizing soaps, oils, lotions
- water to soften skin layers
- creams and lotions to seal in moisture
What is a sunburn? How is it treated?
– first degree, superficial burn that results from excessive exposure to UV light
– treatments:
- cool baths
- soothing lotions
- antibiotic ointments for blistering/infected skin
- topical corticosteroids for pain
What is urticaria? How is it treated?
– urticaria: hives; white or red edematous papules or plaques of varying sizes
– treatment:
- removal of triggers
- antihistamines
- avoid things that can worsen symptoms
- overexertion
- alcohol consumption
- warm environments
What are the 3 phases of wound healing?
- inflammatory phase – 3 - 5 day window after trauma
- fibroblastic/connected tissue repair – formation of clot and tissue repair
- maturation/remodeling – collagen is reorganized to provide greater strength
What are the 3 types of intention in wound healing?
- first intention – results in a thin scar
- second intention – granulation and contraction; results in a deeper tissue injury or wound
-
third intention – delayed closure; much larger scar
- high risk for infection
What is a full thickness wound? How are full thickness wounds healed?
– full thickness wound: damage which extends into the lower layers of the dermis and subcutaneous tissue
– healed by removing damaged tissue so granulation tissue can fill the space and heal
- results in wound contraction
What is a pressure ulcer? What are 3 mechanical forces that can cause pressure ulcers?
– pressure ulcer: tissue damage caused when the skin and soft tissue and compressed between a bony prominence and another surface for an extended period
– 3 mechanical forces:
- pressure
- friction
- shear
What is the difference between contamination and infection?
– contamination: presence of organisms without any manifestations of infection
– infection: contamination with pathogenic organisms to the degree that growth and spread cannot be controlled by the body’s immune defenses
– an exposed wound is always contaminated but not always infected
What are some nonsurgical therapies for wound care?
- mechanical debridement
- natural chemical debridement
- hydrophobic material
- hydrophilic material
- physical therapy – whirlpool/hydro therapy to clean the wound
- drug therapy – antibacterial agents
- nutrition therapy – high protein diet
- technologies
- electrical stimulation
- wound vacs
- hyperbaric oxygen (HBO) – 100% oxygen at sea level to stimulate healing; increases oxygen concentration
- topical growth factors – biologically active substances that stimulate cell growth and movement
- skin substitutes – skin grafts; provide temporary or permanent wound closure
What are the 3 types of bacterial infections?
-
folliculitis: superficial infection involving only the upper potion of the follicle
- usually Staph infection
-
furuncle: boil; much deeper infection in the follicle
- usually Staph infection
-
cellulitis: generalized infection involving deeper connective tissue
- either Staph or Strept
What are the 4 manifestations of herpes simplex virus (HSV)?
- type 1 (HSV-1): classic recurring cold sore
- type 2 (HSV-2): genital herpes
- herpes zoster/shingles: reactivation of dormant varicella-zoster virus in pts who have previously had chickenpox
- herpetic whitlow: form of herpes infection occurring on the fingertips of medical personnel who have come into contact with viral secretions
How does shingles present? What is one potential complication of shingles?
– presents as multiple lesions in a segmental distribution on the skin area innervated by the infected nerve
– complication is postherpetic neuralgia: chronic pain even after lesions resolve due to damage to the nerves from the virus
What are dermatophytes? What are some types of fungal infections?
– dermatophytes: fungal infections of the skin (require keratin for growth)
– types of fungal infections:
- Tinea infections – ringworm
- Candida albicans
Why is eczema unique? What other condition often accompanies eczema?
– eczema presents differently from pt to pt
– asthma often goes hand-in-hand with eczema
What are 3 diagnostic tests that can be used for skin conditions?
- Tzanck smear: exam for viral infections
- swab culture: exam for bacterial infections
- KOH test: exam for fungal infections
What are some interventions for skin conditions?
- skin care – proper cleansing
- warm compresses – helps folliculitis and furuncles
- heat
- isolation precautions
- drugs
- antibacterial drugs
- antifungal drugs
- anti-inflammatory drugs
- Burrow’s solution – for viral infections
In what population do parasitic disorders of the skin occur most often? What are some examples of parasitic disorders? What is the recommended treatment?
– occurs most often in pts with poor hygiene
– examples:
- pediculosis – human lice
- scabies – mites
- bedbugs
– treatment = eradication
What is the most common symptom for pediculosis? What are the treatments?
– symptom = pruritus
– treatments:
- drugs
- laundering of clothing and bed linens
What is scabies? How is it transmitted? How is it identified and confirmed? How is scabies treated?
– scabies: contagious skin disease caused by mites
– transmitted by close and prolonged contact or infested bedding
– identified by examination of the skin between fingers and on the palms (these areas are very common sites for infestation) and is confirmed by examination of a scraping of a lesion under a microscope
– treatment:
- topicals
- laundering
What is the difference between contact dermatitis and atopic dermatitis?
– contact dermatitis: acute or chronic rash caused by direct irritants
– atopic dermatitis: rash that often occurs when accompanied by respiratory allergens
What are some interventions for dermatitis?
- steroids
- avoidance of oil-based products
- antihistamines
- compresses
- baths
What is psoriasis? What is the most common type of psoriasis? What is exfoliative psoriasis?
– psoriasis: lifelong disorder with exacerbations and remissions; scaling disorder with underlying dermal inflammation; potentially autoimmune
– most common = psoriasis vulgaris
– exfoliative psoriasis: explosively eruptive and inflammatory form of psoriasis
How is psoriasis treated?
- corticosteroids
- tar – reduces inflammation
- topical therapies
- UV light therapy
- biologic agents – can make the pt more immunocompromised
- cytotoxic agents – Methotrexate
- immunosuppressants
- emotional support
What are the 4 types of benign tumors?
- cysts: flesh colored, can move around
- seborrheic keratoses: wart-like appearance but benign
-
keloids: overgrowth of scar tissue
- common in POCs
- can remove but risk of it coming back worse
- can get steroid injections to thin it out, but could become irritated and enlarge
- nevi: moles; well-defined borders, uniform in color
What are the 4 types of skin cancers?
-
actinic keratoses: pre-malignant lesions
- can progress into squamous cell carcinomas
- results from sun exposure
- use a punch biopsy to test malignancy
-
squamous cell carcinoma: cancerous lesions in squamous cells
- likely to metastasize if not treated
-
basal cell carcinoma: cancerous lesions in basal cells (deeper layer than squamous)
- linked to UV exposure
-
melanomas: highly metastatic cancer
- diagnose by ABCDs
- arise from melanin-producing cells
- survival depends on early diagnosis and treatment
What are the 5 surgical ways to treat skin cancer?
- cryosurgery: freezing of the lesion
- curettage and electrodesiccation: scrape off lesion until there are no remnants, place electrical probe to kill anything microscopic that remains
- excision: biopsy of lesions
- Mohs’ surgery: excision by layers to treat carcinomas
- Wide excision: treatment of melanomas; deeper and wider area of removal than other surgeries
What are some nonsurgical treatments for skin cancers?
- drugs
- systemic
- topical
- radiation
- limited effectiveness and use – pts with larger carcinomas or with more malignant carcinomas are not candidates
What is the most common form of skin biopsy?
punch biopsy
