Lecture 9: Integumentary System Flashcards
1
Q
Skin
A
- largest organ in body
- accounts for 15-20% of body weight
- consists of 3 layers: epidermis, dermis, subcutaneous tissue
2
Q
Function of Skin
A
- protect underlying structures from external injury and harmful substances
- primarily an insulator
- holds organs together
- sensory perception
- fluid balance
- temperature control
- absorption of UV radiation
- metabolism of vitamin D
- synthesis of epidermal lipids
3
Q
Signs and Symptoms of Skin Disease
A
- pruritus
- urticaria (hives): vascular action of skin resulting in elevated patches of skin called wheals
- rash: general term for eruption on skin usually accompanied by itching, can be anything from erythema to macular lesions to raised papules
- blisters (vesicle or bulla): fluid-containing elevated skin lesions with clear watery or bloody contents
- ichthyosis: genetic skin disorder characterized by dry, rough, discolored skin with formation of scaly desquamation
- xeroderma pigmentosum: autosomal recessive genetic disorder of DNA repair in which ability to repair damage caused by UV light is deficient
- unusual spots, moles, cysts, fibromas, nodules, swelling, changes in nail beds
- any unusual spot that has appeared recently or changed since initial appearance should be documented and brought to Dr.’s attention
4
Q
SIFTT About Skin Lesions
A
- blisters of unknown cause may be first sign of underlying malignancy requiring immediate medical evaluation
- when examining and documenting presence of skin disorder note location, size, and any irregularities in skin color, temperature, moisture, ulceration, texture, thickness, mobility, edema, turgor, odor, and tenderness
- note whether lesions are unilateral or bilateral, note whether they are symmetric or asymmetric, and note arrangement of lesions
- blisters should be opened and debrided (with few exceptions); blister fluid impairs normal function of neutrophils and lymphocytes
5
Q
Aging and Integumentary System
A
- wound healing impaired in intrinsically aged skin as compared to young skin that the rate of healing is appreciably slower
- decreased elasticity and blood flow
- both structural and functional changes occur in skin: diminished pain perception, increased vulnerability to injury, decreased vascularity, weakened inflammatory response
- stratum corneum layer (outermost layer of epidermis) becomes thinner and becomes more translucent
- lesions must be examined by a physician
6
Q
Common Skin Disorders: Acne
A
- chronic inflammatory disease of sebaceous glands
- usually associated with high rate of sebum secretion
- sebum carries dead skin cells through follicles to skin surface
- small hair grows through follicle out of the skin
- pimples grow when these follicles get blocked, resulting in an accumulation of oil under the skin
- pathogenesis: androgens stimulate sebum production which is secreted into dilated hair follicles that contain bacteria; bacteria secrete lipase which interacts with sebum to produce free fatty acids which provoke inflammation; hair follicles produce more keratin, which forms a plug with sebun in dilated follicle
- clinical manifestations: a closed comedo (clogged hair follicle) or white head-covered by epidermis, an open comedo or blackhead-not covered by epidermis, inflammation, acne pustules
7
Q
Common Skin Disorders: Atopic Dermatitis
A
- chronic inflammatory skin disease, most common type of eczema, frequently present during first year of life
- etiology, risk factors, and pathogenesis: rubbing and scratching of itchy skin are responsible for clinical changes seen; hands in and out of water makes it worse
- CM: begins as red, oozing, crusting rash
- chronic form results in dry, thickened, and brownish gray skin
- xerosis (dryness) and pruritus are major symptoms
- S. aureus is most common bacterial infection
8
Q
SIFTT for Atopic Dermatitis
A
- patient education to avoid factors that precipitate or exacerbate inflammation
- daily care (hydration and lubrication) of skin including applications (two or three times daily) of emollients that occlude skin to prevent evaporation and retain moisture should be recommended
- older clients should bathe with tepid water using nondrying, non-fragranced soap
- emollients must be applied to body within 5 minutes after showering or bathing especially in dry weather to prevent further drying of skin
9
Q
Common Skin Disorders: Contact Dermatitis
A
- acute or chronic skin inflammation caused by exposure to a chemical, mechanical , physical or biological agent
- commonly appears as sharply demarcated inflammation of skin
- CM: intense pruritus, erythema, blistering, and edema
- may progress to vesiculation, oozing, crusting, and scaling
- clearly defined lesions
- delayed hypersensitivity
10
Q
SIFTT for Contact Dermatitis
A
- always consider clients reactions to external substances
- skin must always be examined before and after intervention
- client should be instructed to report any discomfort or unusual findings during or after treatment to therapist
- use of alcohol-based lubricants or soaps, antifungal or antibacterial soaps without a rinsing agent, lanolin should be avoided
11
Q
Common Skin Disorders: Stasis Dermatitis
A
- development of areas of very dry, thin skin
- usually due to venous insufficiency (usually begins with edema of leg due to slow venous return)
- itching, a feeling of heaviness, and brown stained skin
- lesions are slow to heal due to lack of oxygenated blood
12
Q
Common Skin Disorders: Rosacea
A
- chronic facial disorder of middle aged and older people (form of acne)
- benign: reveals rosy appearance marked by reddened skin on cheeks, nose, and chin
13
Q
Bacterial Infectiosn
A
- normally skin harbors variety of bacterial flora, including major pathogenic varieties of staph and strep-usually enter skin via abrasions or puncture wounds
- follicular lesions should not be squeezed because this will not hasten resolution of infection and may increase risk of making lesion worse or spreading infection
14
Q
Impetigo
A
- superficial skin infection commonly caused by staph or strep
- usually found in infants, kids 2-5 and older people
- close contact in living quarters, poor hygiene, malnutrition, etc
- can be spread by direct contact or arthropod vector
- presents as small macules rapidly developing into vesicles that become pustular
- scratching spreads infection, a process called auto-inoculation
- lesions leave depigmented areas
15
Q
Cellulitis
A
- infection of dermis or subcutaneous tissues that spreads widely through tissue spaces
- not contagious
- RF: diabetes, immunodeficiency, impaired circulation, neuropathy
- patho: streptococcus pyogenes (GAS) or staphylococci are usual cause although others may be responsible; bacteria overwhelm defensive cells
- usually occurs in loose tissue beneath skin, but may also occur in tissues beneath mucous membranes or around muscle bundles
- CM: makes skin look erythematous and edematous, pain and warmth at site, fever
16
Q
Warts
A
- aka verrucae
- common benign viral infection of skin and adjacent mucous membranes caused by HPVs
- transmission is probably through direct contact
- some respond to simple Rx and some disappear spontaneously
17
Q
Fungal Infections (Dermatophytosis)
A
- superficial infections by fungi that live on, not in, skin
- will spread without Rx
18
Q
Ringworm (tinea corporis)
A
- fungal infections of hair, skin, or nails-designated by latin word tinea
- no association with worms but rather is marked by formation of ring-shaped pigmented patches covered with vesicles or scales that often become itchy
- transmission can occur directly through contact with infected lesions or indirectly through fomites
19
Q
Athletes Foot (tinea pedis)
A
- causes erythema, skin peeling, and pruritus between toes that may spread from interdigital spaces to sole
- may have strong odor as well
- causes severe itching and pain on walking
