Lecture 12: Integumentary System Flashcards
What is the largest organ in the body?
The skin
* Constituting 15-20% of the body weight and consisting of three primary layers
The overall primary function of the skin is to protect underlying structures from external injury and farmful substances
Other functions:
* Holding the organs together
* Sensory perception
* Contributing to fluid balance
* Controlling temperature
* Absorbing ultraviolet UV radiation
* Metabolizing vitamin D
* Synthesizing epidermal lipids
The skin helps metabolize vitamin D. Why do we need vitamin D?
Contributes to strong bones
Skin 3 layers
Epidermis
Dermis
SubQ
Some lab values that are important for the integumetary system / would healing - what are the values
:
* Per albumin - value norms / closely realted to
* Albumin - value norms / closely related to
* Glucose
* Glycosylated hemoglobin (HbA1c)
Per-albumin: 20-40 mg/dL and
* Closely related to malnutirtion - ICD code (priamry diganosis)
Albumin: 3.5-5.5g/dL
* Closely related to malnutirtion - ICD code (primary diagnosis)
Glucose: 70-115 mg/dL (fasting)
* This is a pin prick
Glycosylated hemoglobin (HBA1c): 4-6%
* This is a pin prick
KNOW: 1 in every 4 people will consult a physician for a skin lesion
What is the primary lesion?
The first leasion to appear
5 s/s of skin disease?
1) Pruritus
2) Urticaria
3) rash
4) Blisters
5) Xeroderma
Pruritus means
Itching
Urticaria means?
Hives
Xeroderma
Dry skin
KNOW: dry skin and itching often go together
Superficial inflammation of the skin
* Clinical manifestations
* tx?
Dermatitis
* more of blanket statement
Clinical manigestations:
* Vesicles
* Redness, edema, oozing
* Crusting, scaling
* Itching - puritis
Topical medications are used
NOTE: someone w/ more melinin might not show obvious s/s even though its actually there
6 types of dermatitis (remember its a blanket term)
1) Atopic dermatitis
2) Contact dermatitis
3) Eczema (dry crusty skin)
4) Statis dermatittis
5) Environmental dermatoses
6) Incontinence Associated dermatitits
Development of areas of very dry, thin skin and sometimes shallow ulcers of the lower legs primarily as a result of venous insufficiency (often coupled w/ venous insufficiency)
* Clinical manigestations
* Tx
Stasis dermatisis - skin condition that occurs when blood pools in the venins of the LE due to poor cirulation (i.e., stasis)
Clinical manigestations
* Itching
* Feeling of heaviness in legs
* Brown stained skin
* Open shallow lesion - because this is in the venous system and is superficial to the arterial system
Tx:
* Reducing venous hypertension (with chronic venous insufficiency valves arent working well and the blood starts pooling in the veins - this is what cuases this)
Stasis = not moving / staying still/ static
* Blood not moving = infestation of blood not moving
Environment Dermatoses causes
1) Irritant and allergic dermatitis - think rubbing up against something that you’re allergic to or is irriatting
2) Rosacea: more common in woemn - due to hormone flucuations - think red powdery mask over face
3) Acne legions
4) Pigmentary changes
5) Photosensitivity reactions - walking out in the suddent and suddenly turning red (sometimes not all the time)
6) Systemic sclerosis - abnormality of collagen (talked about this in lungs lecture)
7) Infectious disorders - cause some skin abnoramilties
8) Cutaneous malignancy - think abnormal moles
Chronic facial disorder of middle-aged and older people. May be due to hormones. No known cause or factor has been identified to explain the pathogensis of this disorder
Rosacea
KNOW: An acneiform rosacea can occur with papules, pustules, and oily skin (basically saying it looks like acne sometimes)
harder to identify on african american - looks like acne
Skin damage resulting from chronic urine or feces exposure
Incontience-Associated Dermatitis
KNOW: Characterized by pink or red discoloration with erythema-may have skin erosion and maceration
* think of it as a diaper rash for babies
* can happen to heavier set that arent taken care of
* maceration = skin is in contact w/ too much moister = milky foggy foam around it = easier to tear
* this can also be a sign of neglect / abuse
What are the two bacterial skin infections?
1) Impetigo
2) Cellulitis
Cellulitis:
* What is it?
* Assocaited w/?
* s/s (3)
* Tx (1)
Bacerial skin infection
Associated w/ lymphodema but can occur in the absence
* major risk factor
red, swollen, hot painful skin - think s/s of infection
needs antibotics
NOTE: it moves super quick - type of dermatitis that becomes inflammaed
can happen anywhere where bacteria can get in
What is Impetigo?
* Where does it occur?
* is it contagious
* What does it look like?
Bacterial infection of skin
Occurs in superficial layers of the skin
Erythematous plaques with a yellow crust and may be itchy or painful
What is this?
* is it bacterial or viral
Warts
Viral skin infection
What is this?
* is it bacterial or viral?
Shingles
Viral skin infection
notice how its following nerve root
* more common if you had chicken pox and over age of 60
* can occur in any part of body
Is Herpes Zoster a bacterial or viral skin infection?
Viral
3 Fungal infections
1) Ringworm (Tinea Corporis)
2) Athletes Foot (Tinea PEdis) - dry itchy red on feet
3) Yeast infection (Candidiasis)
What is this?
Yeast infection in the neck
What is this?
Ringworm on scalp
* often due to transmision from animals
What are our 2 parasitic infections?
1) Scabies
2) Pediculosis (Lousiness) (lice)
How do most people get lice
Sharing hats
How do scabies enter body?
Burror into skin
Which stage of pressure injuries has unbroken skin and appears as a bruse
* what does it not reach at this stage
Stage 1
* is stage 1 if skin is unbroken
* However, you can’t really tell how deep it goes
* usualy does not reach subQ area
Blanceable vs Non Blanchable
* What does it mean if its non blanchable?
* What stage pressure injuries is this often tested in?
Blanchable - if you push down on the skin it should pale and then come back to normal.
Non-Blachable - Never gets pale - just stays that bruised area
* Indicitive that its gone through deeper layers
NOTE: this is often tested in stage 1 pressure injuries
Notice the pale spot on blanchable
What stage of pressure injury actaully breaks the skin and is in the dermis?
Stage 2 pressure injuries
* have not reached subQ
Which stage of pressure injuries has reached the SubQ layer
Stage 3
NOTE: theres only fat that stands between the outside world and the muscle
NOTE: the white in there is bad
Which stage of pressure injury has reached bone?
* what are they at risk for
Stage 4
at risk for osteomyolitis = bone infection - requires antibiotics
Can you tell what stage a deep tissue injury is?
* Often confused w/
Nope, its unstageable
From the top you can’t tell how deep the wound is because the skin isnt broken
* However, its normally black
Its non-blanchable
**Often confused w/ a stage 1 compression injury
* dilinate w/ blanching test (stage 1 should be blanchable)
* Also a stage 1 is more red while this is a blacker color
* Theres so much ischemia there is tissue death, it just hasnt opened
**
This is proper positioning to place a pt for pressure injuries
* can float heels if pt is supine (often done wrong nothing should be touching the heels)
To turn from supine they’re going to need to be in this position
* can use wedge or buildup pillows
Venous Insufficiency Ulcers:
* causes
* What do the wounds feel like
* Do they have a pulse?
* Symptoms (3)
* Where do wounds develop?
causes: anything that causes venous hypertension
* Venous thrombosis
* Varicose veins
* Otehr venous problems
Painless and superficial wounds, good peripheral pulses
* So the arteries are what cause the pulse not the veins
* This is a good way to deliniate the two
Symptoms:
* Edema present
* Hemosiderine staining (darkening of skin)
* Inverted champne bottle look (think upside champign bottle)
Wounds develop over medial side of ankle, gator region (above the medial malleolius)
Eschar means
Black, dried out, dead tissue
kind of looks like gangreen
however, its stable and the wound is closed
* good if its dry - we don’t want these wet
Slough means
Liquified or wet dead tissue, yellow
* causes bad smell
* Will cover the wound bed - we actaully want to scrape this off
UNdermining means
Bigger area of tissue that ends under the edge, like a shelf
* Ends of the wound curling in - well you have that tissue underneath that has the undermining in it
* Leads to tunneling
* Bad and can lead to bacterial formation and can open up other areas of the body
Tunneling means
Tracts extending out from the wound
larger than a pencil errasor is problem
Connective tissue malignancy that manifests as a skin or mucous membrane disorder - has 4 types
* what is this and what are the 4 types
* Risk factors
* Pathogensis
* Clinical manigestations
* How do you help it
Kaposi Sarcoma
Risk:
* Ummunocompromise (transplants)
* AIDS
Pathogensis: Associated w/ herpes virus
Clinical manigestations: Itching and painful lesions can impinge on nerves or organs
* dont just grow on surface but internally so they can impinge the nerve roots as well
Help by: Prevent skin breakdown and wound management
* keep it dry - don’t let the skin stab or break
Lupus erythematosus
* what causes
* What organ does it affect
autoimmune
affects the kdineys - so it has systemic issues as well
red connective inflammatory tissue is common. Looks like rosasia - however, it has systemic pathologies
Cutaneous LupusErythematosus
* Chronic inflammatory disorder of the connective tissue
* clinical manifestations = discoid lesions
Cold injuries: - applys to our modalitties
over expsoreu to cold air or water
Frostbite
Use to be a military problem
Oathogensis and clinical manifestations
Do not rub or massage the area
Pain meds and anti-infalmmatory medications, rapid rewarming (will turn red)
What does the rule of nines tell us?
how much of a % of the body is burned
Burns to 50% of body would be very extreme
* used a lot in burn realm
Partical thickness burns go down to what layer of skin?
* another name for this kind of burn?
* Is there blister formation?
Goes down to the dermis
Second degree burn
Blister formation covering an extensive area
Sensitivity to cold air
What to do for skin lesions
