Integumentary System Part 1 Flashcards
The Skin
Largest organ in the body
3 Layers: Epidermis, dermis, and hypodermis (subcutaneous/fatty tissue)
Provides us with protection from the environment, mechanical and chemical assaults
Provides immunity and protection against infection
***Helps to regulate our body temperature
Infection is the most important complication: HANDWASHING!
Fluid loss/Electrolyte Imbalances are also major
Skin Layers (Epithelial)
Epidermis is the outermost layer of the skin and it contains epithelial cells which reproduce and regenerate every 28 days (epithelialization)
Skin Appendages (hair, nails, and glands) arise from the epithelial level and receive their nutrients, electrolytes, and fluids from the dermis. 2 Major types of glands:
Sebaceous (secretes sebum around hair follicles to prevent dryness and bacteriostatic action)
Sweat glands (apocrine located in the axillae, breast areola, umbilical, and anogenital areas secrete milky substance that become odoriferous with bacteria and the eccrine sweat gland secretes watery solution composed of salts, ammonia, urea.
Burns Types: Thermal
Thermal burns caused by exposure to flame or a hot object produce micro vascular and inflammatory responses within minutes of the injury.
Substances released by damaged cells increase vascular permeability, causing fluid, electrolytes, and proteins to leak into the interstitial space.
In large burns, this fluid shift from intravascular to interstitial spaces may cause a hypovolemic shock state (burn shock).
Burns Types: Chemical
Chemical burns are the result of exposure to acid (many household cleaners), alkali (oven and drain cleaners, fertilizers), or organic substances (phenols such as chemical disinfectants or petroleum products such as gasoline).
The extent of injury depends on the concentration of the substance, the amount, the duration of exposure, and the mechanism of chemical action.
Immediately remove the burning agent and profusely irrigate the skin and eyes if involved.
Chemical Burns cont.d
Acid substance results in a coagulation necrosis with an eschar covering that prevents continued tissue damage beneath the layer of eschar.
Alkali substance cause more damage then acid since it causes protein hydrolysis & liquefaction producing a soupy wound, which allows continued tissue damage into deeper structures until the pH is WNL.
Organic substances may be absorbed systemically producing renal and hepatic toxicity. Inhalation can cause direct lung injury with pulmonary and cardiovascular effects.
Tissue injury may continue for up to 72 hours after a chemical injury
Burns Types: Electrical
Electrical burns result from the conversion of electrical energy into heat.
The extent of thermal injury depends on the type of current, the pathway of current flow, local tissue resistance, and the duration of contact.
Tissue resistance depends on its thickness and amount of moisture (fat and bone offer the most resistance, nerves and blood vessels the least).
“Iceberg effect”- most of the damage is below the skin and the extent (vital organs effected) is difficult to determine.
Things to consider for Electrical burns
Risk of dysrhythmias up to 24 hours after injury (monitor).
Risk of ATN due to released myoglobin pigments (from the injured muscle tissue and damaged RBCs).
Risk of Cervical spine injury (power line fall?) - use collar and leave on until intact spine has x-ray verification
Burns Types: Radiation
Radiation burns result from radiant energy being transferred to the body resulting in production of cellular toxins. Usually the result from radiation therapy or from a lab incident.
The greater the exposure, the more significant the damage. Effect mostly evident on cells that reproduce rapidly (skin, blood vessels, intestinal lining and bone marrow)
Burns: Associated Areas
Inhalation injuries occurs with inhalation of hot air or noxious chemicals that damage respiratory tract tissues.
Vocal cords and glottis protect lower airways.
3 Types of smoke inhalation injuries:
1) Carbon Monoxide poisoning displaces O2 on the hemoglobin molecule causing hypoxia and carboxyhemoglobinemia and death (skin color is cherry red). Treat with 100% humidified O2. GET ABG TO ASSES PAO2
2) Above glottis (thermal - hot air, steam, smoke) produces edema and eventual obstruction (medical emergency). S/S includes facial burns, singed nasal hairs, hoarseness, stridor, dyspnea, dark sputum.
3) Below the glottis (chemical) injury to lower resp. tract related to duration of exposure can result in pulmonary edema (ARDS) 12-24 hours after insult.
Inhalation Injuries: Symptoms
Singed Nasal Hairs, Blackened Mucosa
Restlessness/ Confusion
Hoarseness, Stridor, Dyspnea, Wheezing
Carbonaceous sputum
Crackles in first few hours-poor prognosis
Inhalation Injury: upper & lower airway
Physiology Increased capillary permeability Sub-alveolar edema Bronchioles susceptible Surfactant loss
Mortality
Without thermal injury 5-8%
With major thermal injury and ARDS >50%
Treatment Oxygen Intubation if needed Pulmonary Toilet: turning, coughing, deep breathing, etc ABG/CXR Monitoring
Inhalation Injuries RED FLAGS
Confined area incident Singed nasal hairs Oral or pharyngeal mm burns Perioral area or neck burns Carbonaceous sputum Voice changes
Burn Classifications
According to the American Burn Association (ABA) severity determined by depth of burn, extent of burn calculated in % of total body surface area (TBSA), location of burn, and patient risk factors.
Burns: 1st degree
Superficial involves the avascular epidermis and appears red from blood vessel dilatation.
Area is erythema, blanches, painful, minimal edema, no blisters, dry skin (i.e. sunburn or a brief scald from a hot liquid)
Heals in 3 to 6 days, some sloughing of the epidermal layer
No scarring
Cold compress/Ice/Tylenol/Aloe with Lidocaine
