Integumentary System Flashcards
What are the functions of the Epidermis (6)
- protection from injury
- stops proliferation of microorganisms
- prevents dehydration and electrolyte loss
- temp regulation controlled by sweat glands
- transmits tactile stimulation by neuroreceptors
- synthesizes Vitamin D
What are the functions of the Hypodermis (2)
- protects from injury by absorbing mechanical shock
- temperature regulation by fat cells
what are the Indications for Topical Antimicrobials?
Treatment of bacterial, fungal or viral infections of the skin
The following drugs are classified as?
Bacitracin
Neomycin
Mupirocin
Antibacterials
The following drugs are classified as?
Clotrimazole,
Ketoconazole,
Miconazole,
Nystatin
Antifungals
What are the Indications for Topical Corticosteroids?
- Inflammation
- redness
- Itching
The following drugs are classified as?
Triamcinolone,
Hydrocortisone
Topical Corticosteroids
Lesion
Area of tissue that has suffered damage
Primary Lesion is caused by?
result of a disease process
Pruritus
Itching
Secondary Lesion is caused by?
developed by consequence of a clients activity
Urticaria
Hives
Lichenified
Thickened
Annular
Ringlike with raised boarders about flat centers of normal skin
Circinate
circular
Circumscribed
Well defined, sharp boarders
Clustered
Several lesions grouped together
Diffuse
Widespread
Linear
Occurs in a straight line
Macular
Flat
Papular
Raised
Macule
Discoloration of the skin that is flat and level with the skin
- Primary Lesion
Fissure
Cleft or groove in the skin
- Primary Lesion
Nodule
Small, node-like structure that is solid and elevated
- Primary Lesion
Papule
Small, solid and raised caused by thickened epidermis
- Primary Lesion
Vesicle
Small bladder or blister containing clear fluid
- Primary Lesion
Polyp
Growth that forms on mucous membrane or other surface inside the body
- Primary Lesion
Cyst
Closed pouch under the skin that contains a fluid of a semisolid substance
- Primary Lesion
Pustule
Small elevated on the skin containing pus
- Primary Lesion
Wheal
Area of the skin slightly raised and appears either redder or paler then the surrounding skin
- Primary Lesion
Scales
Flakes of cornified Skin
-Secondary Lesions
Crust
Dried exudate on Skin
- Secondary Lesions
Ulcer
Areas of destruction of the epidermis
- Secondary Lesions
Scar
Area with excess collagen formation present after an injury has healed
- Secondary Lesions
Dermatitis
Inflammation of the dermis
Contact dermatitis
Hypersensitivity when exposed to a certain allergen
Atopic dermatitis (eczema)
- Intense itching, red, dry, scaly skin.
- Can have flare ups
- More common in children and people with allergies
Psoriasis
- Chronic autoimmune T-cell mediated inflammatory skin disease
- Periods of exacerbations and remissions
- Thickening of epidermis and dermis
Scaly, erythematous, pruritic plaques
Stevens-Johnson Syndrome
- Cytotoxic T-cell drug reaction
- Keratinocyte cell death
- Causes extensive blistering
Psoriasis Interventions
- Light therapy
- Systemic therapy
-> Methotrexate
-> Folic acid
-> Systemic retinoids
-> Infliximab
Stevens-Johnson Syndrome Treatment
- Stop all possible medications
- Fluids
- Nutrition
- Wound care
- Pain control
- Corticosteroids
Cellulitis
Bacterial Skin Infections
- Diffuse infection of dermis and hypodermis
- Red, warm, swollen, and painful skin
- Most common cause - staph, MRSA, or group B strep
- Systemic treatment with antibiotics needed
Impetigo
Bacterial Skin Infections
- Bullous or ulcerative
- Cause - staph or strep
- More common in children
Methicillin-resistant Staphylococcus Aureus (MRSA)
Bacterial Skin Infections
- Ranges from mild to moderate
- Contact precautions
HSV
Viral Skin Infections
- Type 1- mouth and face
- Type 2 - Genital lesions
- Groups of vesicles on an erythematous base
-> Vesicles can turn into pustules, rupture, and form crusts
-> Last 2 to 6 weeks
- Topical/oral antiviral drugs
Herpes Zoster
Viral Skin Infections
- Grouped lesions with weeping and crusting
-> Unilaterally along segment of skin that follows a cranial nerve
- Pain and paresthesia
- Antiviral drugs
- Vaccination
Tinea
Fungal Skin Infections
- Classified by location
-> Tinea pedis (Athlete’s foot)
-> Tinea corporis
-> Tinea capitis
- Annular patches with elevated borders and scaling
- Client education: keep areas clean and dry, no public showers or pools, don’t share footwear
- Topical antifungal therapy
Candidiasis
Fungal Skin Infections
- Yeast like fungal infection
- Erythematous macular eruption with isolated pustules at the border
- Burning and itching
- Common in skin folds
- Oral lesions (thrush) are creamy white
Squamous cell carcinoma (Cancer)
- Very top layer of the epidermis grows out of
- Form on areas of the body exposed to sun (Face, Ears, Neck)
- Treatment: Removal
- More likely to grow into deeper layers of the skin
Basal cell carcinoma (Cancer)
- Most common type of skin cancer
- Start in the basal cell layer (bottom layer) of the epidermis
- Form on areas of the body exposed to sun - head, face, neck
- Slow growing and rarely spread
- Treatments
○ Surgery
○ Local therapies
§ Cryotherapy
□ Topical chemotherapy
□ Immune response modifiers
□ Laser surgery
□ Chemical peeling
§ Radiation
§ Chemotherapy
§ Targeted therapy
Immunotherapy
Melanoma (cancer)
- Melanocytes grow out of control
- The cells that produce melanin
- Less common; more dangerous - can spread more easily
- Appearance: dark brown or black
○ The cells are making lots of melanin!
○ Most commonly located on trunk or legs - Treatments
○ Surgery
○ Immunotherapy
○ Targeted therapy drugs
○ Chemotherapy
Radiation
1st degree burn
- Most superficial burn
- The skin remains intact; no break in integrity of epidermis
- Redness (erythema)
- No blisters
- Can be painful to the touch
2nd degree burn
- Partial thickness burn
- Blisters form
- Affects the epidermis and dermis
- Skin is moist and red
- These burns are very painful
3rd degree burn
- Full thickness burn
- Penetrate all the way from the epidermis to the dermis and down into the subcutaneous tissue
- Destroy the nerve endings, so are not as painful as 2nd degree burns
- Appear red, tan, or black
- Are dry and leathery
- Areas of eschar
4th degree burn
- Full thickness, plus involvement of bone and muscle underneath
- These burns are dry and dull
- Exposed tissue may include bones and muscles as well as ligaments and tendons
Emergent Burn management
- First 24-48 hours
* Large shift in capillary membrane permeability
○ Capillary membrane becomes more permeable
○ Fluid shifts from the intravascular space into the interstitial space
* Client is at high risk for hypovolemic shock, electrolyte imbalances, and renal failure
* Fluids are the priority intervention
○ Parkland burn formula
Acute Burn management
- 48-72 hours after injury until the wounds heal
* Capillary membrane permeability is stabilized
* Focus on healing
○ Prevent infection
○ Alleviating pain
○ Nutrition
○ Wound care
Rehabilitative Burn management
- Burn is now healed
* Focus is on regaining function
○ Psychosocial care
○ ADL assistance
○ Physio/occupational therapy
Cosmetic correction
Hypovolemic Shock
- Increase in capillary permeability
- Third spacing occurs
○ Plasma moves from the intravascular space, to the interstitial space
○ Sodium
○ Albumin - Decreased intravascular volume = decreased BP = hypovolemia
- Cardiovascular system recognizes hypovolemia - increases HR to compensate
○ Increased HR
○ Decreased cardiac output
○ Decreased blood pressure
Hypovolemic shock leads to decreased perfusion of kidneys and renal damage
Renal Failure
- Decreased perfusion to the kidneys
- Insufficient UOP
- <30 ml/hr
- Increased
- BUN
- Cr
- Monitor UOP closely
- Foley catheter
Fluid adjustments as needed
- Foley catheter
Hyperkalemia
- Most potassium is stored in the cells
- Injury causes lysis of cells, which then release potassium into bloodstream
- Causes hyperkalemia
- K >5.5
- Signs and symptoms:
○ Muscle weakness
○ Cramps
○ Nausea
○ Chest pain
○ Arrhythmias
Tall, peaked T-waves
Hyponatremia
- Water follows sodium
- Sodium is leaving the intravascular space and going to the interstitial space
- Due to increased capillary membrane permeability
- Water follows this sodium and the client becomes hyponatremic
- Na < 135
- Signs and symptoms:
- Headache
- Confusion
- Restlessness
- Irritability
- Seizures
Coma
Fluid Replacement
- Crucial in the first 24 hours
- Due to the increase in capillary permeability, this is when the client is losing large volumes of fluid and is at risk for hypovolemic shock
- Fluids:
- Lactated Ringers
○ Expands the intravascular volume - Colloids
○ Albumin
§ Helps pull fluids back into the intravascular system
- Lactated Ringers
- Monitor urine output
- Fluids are titrated to ensure adequate UOP (30 mL/hr)
- Correction of imbalances
Sodium? Potassium?
Parkland Formula for burns
Total value to be infused:
4ml x TBSA(%) x Weight (Kg)
Pressure Ulcers Stage 1
red, blue, or purplish area first appears like a bruise on the skin. It may feel warm to the touch and burn or itch.
Pressure Ulcers Stage 2
bruise becomes an open sore that looks like an abrasion or blister. The skin around the wound can be discolored. The area is painful.
Pressure Ulcer Stage 3
The sore deepens and looks like a crater. There are often dark patches of skin around the edges.
Pressure Ulcer Stage 4
damage spreads to the muscle, bone, or joints. It can cause a serious bone infection called osteomyelitis. It can also lead to a possibly life-threatening blood infection called sepsis.
Unstageable
covered with black dead tissue (eschar) or creamy yellow, gray/black, or white, thick slimy tissue (slough). It is difficult to see the severity of the injury because of the covering.
Deep tissue injury
very dark red, maroon, or purple colored area of the skin that doesn’t disappear when pressed on or a dark deep wound or blister filled with blood that is seen through a separation in the skin.
Rule of 9s
- chest 9%
- belly 9%
- anterior arm 4.5%
- Posterior arm 4.5%
- anterior leg 9%
- posterior leg 9%
- anterior head 4.5%
- posterior head 4.5%
- penis/vagina 1%
- upper back 9%
- lower back 9%
