Week 1 Lecture Integ Flashcards
Largest organ of the body is the
SKIN
Name the functions of skin
Protection
Sensation
Fluid Balance
Temperature regulation
Vitamin D production
Immune Response
Absorption
Elimination
Psychosocial
Keratine forms a barrier protecting internal organs from the environment. This is example of
Protection
CNS=
Touch, pressure, and temperature
ANS =
Blood vessel, sweat and oil glands.
Fluid Balance
Sweat through skin loss of H20 and NA+, poor skin turgor indicates dehydration
Temperature is regulated by
Convection, conduction, radiation, and evaporation
Hypothalamus is responsible for
Sweat and goosebumps
Synthesis of cholecalferol in skin from cholesterol is dependent on UV radiation
Vitamin D
UVB Radiation is need from sunlight for about
5-20 min
Darker skin= More time
Food sources= salmon, sardines, tuna eel, mushrooms, and eggs
Name the cells of immune response
Langerhans cells
Macrophages
T lymphocytes
Cytokines
Leukocytes
Mast Cells
Absorption
Meds
topical
creams lotions
ID- TB tests, allergy tests
Sub Q- Insulin, lovenox, epi,
Tanning- melanin
Elimination- Eccrine Seat glands
Excessive sun exposure can cause
Hyperpigmentation
Epidermis
Several Layers of stratified squamous epithelium
Basal Layer- Innermost layer
Basal cells are constantly being pushed up, moving older cells to the surface
Melanocytes give color to skin- melanin
Squamous layer is the outermost layer
Importance of Normal Flora
Constitute a protective host defense mechanism by occupying ecological niches
Normal Bacteria living in harmony
Dermis
Connective Tissue Layer
Contains:
Blood and lymph vessels
Nerves and nerve endings
glands
Hair follicles
Network of elastic and collagen fibers gives skin elasticity and toughness
Subcutaneous Layer
Loose connective tissue and adipose tissue
Name Normal Aging Changes
Thinning of skin ( Atrophy)
Uneven Pigmentation
Wrinkling, skin folds, and decreased elasticity
Dry Skin
Diminished Hair
Increased fragility
Reduce Healing ability
Decreased Collagen
Decreased Skin Turgor- Tenting
Assessment of Skin
Preparation of the pt.: explain the purpose, provide privacy, and coverings
Assessment Questions
Inspect entire body, including mucosa ( mouth and eyes) scalp, hair, and nails, between fingers and toes, heels, behind ears, coccyx region, and under skin folds
Photographs must be taken of all pressure wounds
If abnormal tell the pt
Assessment of the Skin
Wear gloves as appropriate
Wounds and lesions may require measurements
Photographs may be used to document nature and extent conditions and to document progress resulting from treatment. Photographs to track moles.
Erythema
Redness
Rash
Irritated or swollen skin
Cyanosis
Deoxygenation; peripheral - fingers and toes
Jaundice
Liver disease that involves the sclera
Vitamin A
Beta Carotene Toxicity
Carrots, sweet potatoes, kale, and spinach - stored in adipose tissue
Pruritus
Itching
Central Central
Diminished arterial oxygen saturation
On Skin and Mucous Membranes, tongue, lips, cheeks, etc
Clubbing and polycythemia
Warm
Cyanosis Remains
Cyanosis decreases with breathing problems
Peripheral
Diminished flow of blood to the local part
On Skin only
Not associated
Cold
Cyanosis abolished
Cyanosis persists
Macule
Primary
Circular, flat discoloration- red, brown, blue
Mongolian Spot or hypopigmented
Hypopigmented Diseases
Epstein Barr virus, syphilis, HIV, German Measles, and rubella
Papule
Primary
Raised Skin greater than 0.5 cm
Solid skin color, red, white, impacted oil gland
Plaque
Primary
Raised skin greater than 1 cm
Solid and flat Psoriasis
Bulla
Primary
Raised skin greater than 1 cm filled with serous or sero purulent fluid
2nd Degree burn
Vesicle
Primary
raised skin less than 1 cm filled with serous fluid
chicken pox
Wheal
Primary
Irregular round shaped, pallor in middle
Hives and allergic reaction
Uritcaria caused by cellular substance Histamine
Nodule
Primary
Raised 1 cm extends to the Dermis irregular growth of skin cells may be tumorous
Cyst
Primary
Sac filled with fluid, blood, serous, purulent, or gas
Abscess, ganglion cyst, ovarian cyst, vartholin cyst
Atrophy
Secondary
Thinning of skin, appears shinier or translucent
arterial insuffiency
Erosion - Loss of epidermis or vesicle
Ulcer
Secondary
Loss of epidermis and dermis layer
Venous Stasis, diabetes, pressure
Fissure
Secondary
Linear opening in the epidermis, skin splits
dry skin, cracking- heel fissures
Crust
Secondary
Dry blood over damaged skin
Scabbing
Erosion
Secondary
Loss of epidermis aftered ruptured bulla or vesicle
Scar
Secondary
Thick fibrous tissue replacing damaged dermis, white, pink, red - healed wound
Keloid
Secondary
Raised Scar
Lichenfication
Secondary
Thickened or roughened skin
rubbing, scratching- Eczema, chronic dermatitis
Scales
Accumulation of dead skin cells
ichthyosis vulgaris- fish scale disease
Vascular Skin Lesions
Petechiae- Red or purple spots, minor bleeding into the skin- broken capillary vessels, use of the blood pressure cuff
Purpura- Purple colored spots, damaged blood vessels, and blood pooling
Thrombocytopenic Purpura- Low Platelets
Spider Angioma
Swollen Blood Vessels in the epidermis
Contains central red spot
Vascular lesion of dilation of end vasculature found just beneath the skin surface
Lesion contain a central red spot and extends out like a spider’s web
Cherry Angioma
Collection of small blood Vessels
Also Known as senile angioma or Campbell de Morgan Spot
Telangiectasia
Venous star
Dilated veins due to increased IV pressure
Varicose Veins
Enlarged Swollen and twisting superficial veins that are seen just beneath the skin , often appearing blue or dark
Happen when faulty valves in the vein allow blood to flow in the wrong direction or to pool
What is Lichen Planus?
Autoimmune Disease that affects the skin
Treat with Corticosteroids - Prednisone
Immunosuppressive Drugs - Cyclosporine
Antihistamines- Hydroxyzine
What is Tinea Corpis ?
Ringworm
Annular and arciform circular or arcing
Treat with topical miconazole
What is Herpes Simplex?
Grouped clustered contagious sores
Treat with acyclovir and prednisone
Herpes Simplex can cause?
Bells Palsy
Facial symptoms mimic a stroke
Speech and swallowing may be altered
Eye of affected side may need a patch
Bells Palsy deficits may be permanent or may improve
Varicella Chicken Pox
Cause d by Varicella Zoster virus
Blister rash, itching, tiredness, and fever
Chicken Pox can be prevented by
Vaccine Varicella Zoster
Treatment usually involves relieving symptoms
Pain Relievers
Anti Itch
Colloidal Oatmeal
High risk groups may receive antiviral medications
Herpes Zoster also known as
Shingles
Linear along a nerve route - C Zosertiform
Treat with acyclovir and prednisone
Can Cause Bell’s Palsy
Scabies
Found between the fingers and wrists
Also found top of back, elbows, buttocks, armpits, abd, knees, and perineal area.
Treat with insecticide- Permethrin
Topical
Varicella
Treat with acyclovir and antihistamines
Blister like rash
EGR is
Erythema Gyratum Repens
Systemic Lupus Erythematous
Treat with Immunosuppressive
Hydrochloroquine used to treat with malaria
Bulls Eye shape lesion is known as
Lyme Disease
Treat with topical steroids
SJS
Steven Johnson Syndrome
S/S fever, skin pain, red or purple skin rash that spreads blisters on your skin and the mucous membranes of your mouth, nose, and genitals
Skin sheds within days
Cases of SJS and Toxic Epidermal Necrolysis
Caused by a reaction to a drug
Most often Sulfa and Antibiotics, anticonvulsants,
Allopurinol and piroxicam
TEN
Widespread of erythema, necrosis, and bullous detachment of the epidermis and mucous membranes resulting in exfoliation and possible death.
SJS and TEN
SJS - SKin surface less than 10%
TEN- skin surface greater than 30%
15- 30 overlap between the two
Psoriasis
Polycyclic Lesions
Treat with corticosteroids and NSAIDS
Immunosuppressive
ENBREL
Uritcaria
Confluent- merged
Kawasaki Disease Strawberry Tongue
Treat with NSAID
Immunoglobulin
Coxsackivirus
Hand Foot Mouth
Manage Symptoms
NSAID
Virus infections present as a rash
Parasites
Shave the head or excessive heat kills eggs
Treat with permethrin shampoo
Tinea Pedis
Athletes foot
Treat with antifungal Clotrimazole
Onychomycosis
Treat with antifungal
Lamisil
CHronic low levels of oxygen in the blood is
Hypoxemia
Nail Clubbing
Low levels of O2 high levels of CO2.
Candida Albicans
Oral thrush
Treat with Fluconazole
Oral Nystatin
Why is it common after broad scope antibiotics? Healthy bacteria killed off that control the yeast.
Staphylococcus Aureus
Causes MRSA
Treat with Bactrim DS
Clindamycin
Doxycycline
Vancomycin
Pustules may occur
VRE
Vancomycin Resistant Enterococci
Treat with
Doxycycline
Chloramphenicol
Rifampin
High Dose Ampicillin
Nitrofurantoin
Linezolid
Unasyn
What are common sites for contact dermatitis ?
Bottom heel
Middle of top foot
Above eyebrow
Cheek below the eye
Seborrheic Dermatitis Common Sites
Top Chest
Middle of the abdomen
Peri area
Top of Back
Lower back
Acne
Face to Chest
Top back to middle back
Shoulder to middle of elbow
Common Sites for scabies
Armpit area
Wrists
Peri Area
Line across abd umbilicus
Herpes Zoster
Upper face
Alternates opposite shoulder
Striations across sides lateral
lateral striations on the legs
Skin Biopsy detects what
Cancer
Immunofluorescence
Detect Antibodies
Patch Testing’s
Allergies
Skin Scrapings
Collect Skin Cells
Tzanck Smear
Blistering Skin Conditions
example Pemphius Vulgaris
Autoimmune Disorder
Woods Light Examination
Black light illuminates bacteria and fungus
Dermatologic Therapy
Applied topically to skin, mucous membranes for LOCAL effect
When Systemic absorption is undesirable
Purposes:
Improve barrier function, soften, remove scaly lesions
Alter skin inflammation, blood flow
Exert antimicrobial effects, affect proliferating cells
Name the Types of Dermatologic Drugs
Antimicrobials
Antibiotics
Antifungals
Antivirals
Antiseptics
Corticosteroids
Immunosuppressants
Emollients and Moisturizers
Enzymes Keratolytic
Retinoids
Name the forms of Dermatologic Therapies
Topical Transdermal
Creams
Lotions
Suspensions
Powders
Gels
Pastes
Ointment
Sprays
Surgical
Systemic Oral and Intravenous
Goals of Dermatologic Therapy
Relieve Symptoms
Eradicate or improve lesions
Promote healing and repair
Restore Skin Integrity
Prevent Recurrence
Specific Goals depend on the condition being treated
Prevention
Aware of environment
Sunscreens
Lotions
Good Hygiene
Good nutrition
Mobility
Proper Hydration
Handwashing
Strong Immune System
Nursing Diagnosis
Acute Pain
Impaired Skin Integrity
Disturbed Body Image
Deficient Fluid Volume
Deficient Knowledge
Superficial Vs Deep Laceration
Superficial- Outside of skin
Deep Laceration inside the body and tissue
Avulsion
Action of pulling or tearing away.
How to bring a wound together
Stitches
Steri Strips
Staples
Bacitracin
Bacteriostatic ointment commonly applied to closed wounds as these decrease bacterial growth on skin around wound area.
Abrasion
Falls against rough surface
Puncture
Nails, GSW, and stabbing
Excoriation
From scratching
Shearing Forces
Poor skin integrity. Older adults
Types of Burns
1st Degree
2nd Degree
3rd Degree
