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
What are our 4 kinds of wounds
1) Pressure Injuries (new term for pressure sores - done because they arent as perventable as we thought they were - do not have to have wound formation to be pathological)
2) Arterial Insufficiency Ulcers - little bit deeper, due to PAD
3) Venous insufficiency Ulcers - more superficial - due to chronic venous insurfficancty = venous hypertension
4) Diabetic Foot Ulcers - glucse in there breaking down NS/artical system - which provides nutritents and sensation to the foot - something irttates skin before it staarts breaking down (think small cut)
Prolonged pressure, necrosis of tissues?
* where in the body does it foten occur
* Common sites
* Risk factors (6)
Pressure injuries
* when you have prolonged pressure you get ischemia in that area which leads to necrosis
* more things go into it than just lying in one position (think malnutirtion / albumin levels)
Often occur over boney areas
Common sites: Heels, lateral malleoli, tochanters, ischial tuberositites, sacrum, scapulae, ears - NPTE
Risk factors:
* Immobility
* Decreased sensation - they won’t be able to feel which will lead them to not shift = more pressure in one area
* Moisture - any type
* Friction or shearing forces - rodo pegs are little blocks that help counter act friction between layers of skin - this thins as we get older - these shearing forces act more at this point
* Decreased arterial perfusion - if arteries arent going to the area enough = trophic issues = more at risk
* Abnormal BMI - too low because of malnutrition or too high due to malnutirtion and improper absorption and storage of adipose = increased pressure
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
Arterial Insufficiency Ulcers:
* Caused by
* What does it feel like
* What does skin look like
* Where do wounds develop? (2)
caused by atherosclerosis obliterans
* Arteries are not working properly and so trophic changes happen
Deep and painful wounds
* Deeper because of the location of the arterial system
* Painful because arterial system provides blood to NS which gets painful if it doesnt have blood
Skin is cold and pale, hairlessness - due to trophic changes
Wounds develop over the lateral malleolus and toes - because of the way the arterial system runs
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)
Prognosis for venous insufficiency ulcers
* if they’ve had more than 1 year what is the recurrence rate
* How much fibrin% = worse prognosis?
* Ankle brachial pressure index less than what = bad prognosis
* What tretment yeilds bad prognisis
recurrance rate w/ more than a year w/ the wound = 70%
Larger wounds = worse prognosis
Fibrin in >50% of wound surface = worse prognosis
* we don’t want the fibrin in there
Ankle-Brachial pressure index <0.8
Hx of venous stripping/ligation
* Going into vein and inserting shit
* However, if you develop wounds this is not the best thing
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
Treatment for wounds
1) Prevention of additional ulcers
2) Decreasing pressure on wound
3) Wound management
4) Surgical intervention
5) Improving the nutritional status (think getting enough protein to speed up healing process)
Skin Cancer:
The American Cancer Society estimates that skin cancers are the most prevalent form of cancer, eventually affecting nearly all Caucasian people older than 65 years old
Solar radiation causes most skin cancers, and protection from the sun during the first two decades of life significantly reduces risk of skin cancer
Two Benign Lesion types
Seborrheic Keratosis
Nevi (Moles)
* as long as they are not changing you’re okay
2 Premalignant Lesions
Actinic Keratosis (moles) - due to many years od exposure to UV light
Bowen Disease - does not always turn into a malignant lesion
Two Malignant Nonmelanoma Carinoms?
1) Basal Cell Carinoma
2) Squamous cell carinomas
Whats the most common malignant nonmelanoma carcinoma?
* Does it grow quickly?
* Does it metastize easily?
Basal cell carcinoma
Grows slowly, rarely metastasize
second most common malignant nonmelanoma carcinomas
* does it metastasize?
* Does it grow quickly
Squamous cell carcinoma
2nd most common
Has the potential to metastasize and grows faster
What causes Malignant Melanoma?
* where do they occur (5)
* Who gets it more
* Clinical manigestation?
Occurs from sun expsoure but can be found in the oral cavity, anus, vagina, esophagus and eye
Men > women
Clinical manifestation
* 70% arise from preexisting moles
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
Chronic disease of skin w/ erythematous (red) plaques covered w/ a silvery scale
* Risk factors (6)
* How fast is skin turn over
* Clinical manigestations?
* Tx? (2)
Psoriasis - chroni, noncontagious autoimmune disease that causes raised, inflamed, red skin patches that can be itchy or painful.
Risk: - its an autoimmune disease / affected by diet that you keep (certain dies can reduce the plaques)
* Psoratic arthritis
* Rx use
* Stress
* Excessive alc use
* Smoking
* Injury to the skin
Skin turn over is 3 to 4 days versus the normal 26-28 days
* You have increased skin cells, which increases that hard plaque
Manigestations:
* Scales appear mainly in scalp, knee, elbows, and genitalia (they appear where there is hair)
Tx: Long wave UV light & ora drugs
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
Chronic, diffuse disease of connective tissue causing fibrosis of the skin, joints, blood vessels, and internal organins
* What causes it
* What other disease can it occur to
* What two things being expsoed to can cause this
* Other risk factor (1)
* Clinical manifestation?
Scleroderma (effects lungs as well)
* systemic sclerosis
Autoimmune
Can occur w/ Raynauds phenomena
Expsure to silica / chemical exposure (both can trigger that auto immune response)
Smoking can affect the severity
Clinical Manigestations:
* Cutaneous ulcerations, esophageal dusmobility
* Skin thickening, contractures, joint pain, GI complications
* Late stage = Pulmonary artery HTN, MSK pain, heart lung, and kidney involvement
Idiopathic inflammatoy disease of the muscle (2)
* How does it progression
* What cases it
* Clinical manigestations
Polymyositis and Dermatomyositis
Idiopathic inflammatory disease of the muscle tissue
Progress slowly, with frequent exacerbations and remissions (much like RA)
Caused by: Unknown / autoimmune pathogensis
Clinical manigestations:
* Weakness of pelvis, neck, and pharynx
* Malaise
* Weight loss
* Fatigue and muscle wasting
its an inflammatory disorder - so you will have to dose exercise specifially to that pt to avoid an inflammatory response
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)
Burns: Exposure to any thermal, chemical, electrical or radiation source
What are:
* Zone of coagulation?
* Zone of status? (time frame)
* Zone of hypermia?
Zone of coaguation: cells are irreversibly damaged (can’t bring them back)
Zone of status: Injured cells may die within 24-48 hrs w/o treatment
Zone of hyperemia: site of minimal cell damage
* think just the redness after a minor burn
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
What layer of skin do superficial burns only affect
* Another name for these kinds of burns
* how long do they last
* are the cells fully dead
* is there blister formation?
Only affect the epidermis
also called first degree burns
Discomfort lasts 48 hrs - cells not fully dead
No blister formation
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
Full thickness burn reaches what layer of skin?
* Other name for it?
* are they painful?
reaches the SubQ
Third/Fourth degree burn
Due to prolonged exposure
Little to no pain because nerve ends are burned off
What happens in pigmentary disorders?
hyper/hypo pigmentation
What do we do for blistering diseases?
* Do we pop them?
We do wound care for them
Don’t pop the blisters - can introduce bacteria into the wound that can cause issues
Cutaneous Sarcoidosis
* Nonnecrotizing granulomas, inflammatory lesions
* Less common unless in wound care center
What to do for skin lesions
Many of these skin disorders are contagious and require careful handling by all health care progessionals to avoid spreading the infection and becoming contaminated themselves
Skin infections
quiz here
