Week 12- Integumentary System Flashcards
True or false: The skin is not the largest organ in the body
False
(it is lol)
The skin constitutes _____% of the body weight
15-20
The skin consists of ____ layers
3
Primary function of the skin
To protect underlying structures from external injury and harmful substances
Other functions of the skin
-Holding the organs together
-Sensory perception
-Contributing to fluid balance
-Controlling temperature
-Absorbing UV radiation
-Metabolizing vitamin D
-Synthesizing epidermal lipids
Two types of lesions
Primary and secondary
First lesion to appear on the skin and has a visually recognizable structure
Primary lesion
Macule, papule, plaque, nodule, tumor, wheal, vesicle, pustule
Primary lesion
When changes occur in a primary lesion
Secondary lesion
Scale, crust, thickening, erosion, ulcer, scar, excoriation, fissure, atrophy
Secondary lesion
True or false: Many factors affect the progression of a skin lesion to an open wound and the individual’s subsequent ability to heal
True
(ex: tobacco use, psychosocial status, and nutritional status)
Lab values to understand for skin lesions
-Prealbumin (indicate nutritional status)
-Glucose
-Hemoglobin
-Hematocrit (monitor wound healing)
True or false: The skin does not undergo numerous changes throughout the life span
False
(it does)
Changes the skin undergoes throughout the life span
-Gray hair, balding, loss of secondary sexual hair, increased facial hair
-Lax skin, vascular changes (e.g., decreased elasticity of blood vessel walls, angiomas), dermal or epidermal degenerative changes, and wrinkling
The most obvious changes occur first during __________ and again during older ___________
-Puberty
-Adulthood
True or false: Women may experience balding after menopause
True
During adolescence and adulthood, the use of birth control pills or pregnancy may result in temporary changes in __________ patterns or ____________ of the cheeks and forehead known as melasma or pregnancy mask
-Hair growth
-Hyperpigmentation
Structural and functional changes that occur in the skin
-Diminished pain perception
-Increased vulnerability to injury
-Decreased vascularity
-Weakened inflammatory response
__________ within the reticular dermis are reduced in number, and the walls are thinned
Blood vessels
The reduction and thinning of blood vessels result in the compromise of __________. The individual appears to have ___________ and impaired capacity to ____________, a possible contributing factor to the increased susceptibility of older individuals to ____________ and ___________.
-Blood flow
-Pale skin
-Thermoregulate
-Hypothermia
-Hyperthermia
A primary factor in the loss of protective functions of the skin is the diminished barrier function of the ____________.
Stratum corneum
As the stratum corneum becomes thinner, the skin becomes _____________ and ____________, reacting more readily to minor changes in humidity, temperature, and other irritants
-Translucent
-Paper thin
Fewer melanocytes results in decreased protection against ______________
UV radiation
A reduction in Langerhans cells represents a loss of ___________ and an increased risk of ___________
-Immune surveillance
-Skin cancer
The epidermis is one of the body’s principal suppliers of ___________
Vitamin D
Aging contributes to ____________ deficiency, which plays a role in bone mass and thus is linked to ____________
-Vitamin D
-Osteoporosis
The skin is rich in _________, __________, and __________, all of which are extremely sensitive to the oxidation damage or process
-Lipids
-Proteins
-DNA
Common skin disorders
-Atopic Dermatitis
-Contact Dermatitis
-Eczema and Dermatitis
-Stasis Dermatitis
-Environmental Dermatoses
-Rosacea
-Incontinence-Associated Dermatitis
Bacterial infections
-Impetigo
-Cellulitis
Viral infections
-Herpes Zoster
-Warts (Verrucae)
Fungal infections (dermatophytosis)
-Ringworm (tinea corporis)
-Athlete’s Foot (tinea pedis)
-Yeast (candidiasis)
Parasitic infections
-Scabies
-Pediculosis (Lousiness)
Types of skin cancer
-Benign lesions
-Premalignant lesions
-Malignant nonmelanoma carcinoma
-Malignant melanoma
-Kaposi sarcoma
Benign lesions
-Seborrheic keratosis
-Nevi (moles)
Premalignant lesions
-Actinic keratosis
-Bowen disease
Malignant nonmelanoma carcinomas
-Basal cell carcinoma
-Squamous cell carcinoma
Skin disorders associated with immune dysfunction
-Psoriasis
-Lupus erythematosus
-System sclerosis
-Polymyositis and dermatomyositis
Injuries that result from direct contact with or exposure to any thermal, chemical, electrical, or radiation source
Burns
Burn severity is determined by…
-depth of injury
-total body surface area (TBSA)
The resulting depth of injury is a function of…
-Temperature
-Source of energy (ex: radiation)
-Duration of exposure
Other factors of burn severity include…
-Burn location
-Age of patient
-General health status
-Risk of infection
-Presence of inhalation injury
SLIDES 20-21
Of patients admitted to burn centers, ___% are male; ____% occurred at home
-68
-73
True or false: Older adults are most vulnerable to burns
False
(Children)
Thermal burns account for approximately ___% (___% flame or fire; ___% scalding) of all burn center admissions
-75
-43
-34
This is also called road rash
Friction burns
Involves household cleaning agents and various chemical used in industry, agriculture, and the military
Chemical burns
Burn that happens when electricity comes into contact with your body
Electrical burns
Sunburn from prolonged exposure to UV rays
Radiation burns
Burn risk factors
-Age
-Lack of smoke detectors, psychomotor disorders (e.g., impaired judgment, impaired mobility, drug or alcohol use)
-Smoking
-Rural location
-Low socioeconomic status
-Occupation
-Fireworks
_________ have a higher risk, owing to inadequate supervision and abuse with scald injuries
Children
Risk of burns is highest for individuals at the extremes of age (the very ________ and the very ________), __________ regarding prevention of burn accidents is especially important in these populations
-Young
-Old
-Education
Inflammatory response can be ____________ or _____________ burns
-Local
-Systemic
Local burns are…
Small burns
Systemic burns are…
Extensive burns
Major systems affected
-Cardiovascular
-Renal and GI
-Immune
_____________ (i.e., catecholamines, histamine, serotonin, leukotrienes, and prostaglandins) are released from injured tissue immediately, causing an increase in capillary ___________.
-Vasoactive substances
-Permeability
Extensive burns result in generalized body ______ in both burned and nonburned tissues and a decrease in ______________
-Edema
-Circulating intravascular blood volume
__________ increases in response to catecholamine release and hypovolemia
Heart rate
______________ and death may result when heart rate increases in response to catecholamine release
Hypovolemic (burn) shock
This decreases in the beginning, returns to normal and then increases about 24 hours after the injury (with intensive care) to meet the increased metabolic needs of the body
Cardiac output
When a person gets burned, the body responds initially by ______________ from the kidneys and intestines
Shunting blood
This happens in the renal and GI systems when a person gets a burn
-Oliguria (decreased urine output)
-Intestinal dysfunction (paralytic ileus)
True or false: A patient becomes immunosuppressed after they get a burn
True
True or false: Immunosuppression increases the risk of infection and life-threating sepsis
True
True or false: Injury may occur secondary to inhalation of carbon monoxide, poisoning resulting from inhalation of toxins contained in smoke, and/or thermal burns to the pulmonary airways
True
Electricity travels through the body, resulting in internal tissue damage and potential multisystem injury
Electrical burns
In electrical burns, entrance wounds tend to be __________ compared with _________, more explosive exit wounds
-Smaller
-Larger
True or false: In electrical burns, cutaneous wounds may be negligible, whereas soft tissue and muscle damage can be extensive, particularly in high-voltage electrical injuries
True
___________ is more dangerous than ___________ and is more often associated with cardiopulmonary arrest, ventricular fibrillation, and tetanic muscle contractions
-Alternating current
-Direct current
These burns may be deep, as they often continue to burn until neutralized
Chemical burns
__________ usually result in comparatively less extensive burns compared with alkalis
Acids
___________ chemicals tend to result in deeper burn injuries
Alkaline
True or false: Burn location does not influence injury severity
False
(it does)
Burns of the ________ and _________ can result in permanent physical and vocational disability
-Hands
-Joints
_____________ burns may produce a tourniquet-like effect and lead to compartment syndrome or total occlusion of circulation
Circumferential
In full-thickness burns, _____________ are destroyed, rendering these specific burned areas of skin painless
Nerve endings
Most full-thickness burns occur in conjunction with surrounding _______________ in which nerve endings are intact and expose
Superficial and partial-thickness injuries
True or false: As peripheral nerves regenerate, painful sensation returns, creating increased pain with healing for some patients
True
The most common and life-threatening complication of burn injuries
Infection
Individuals with ___________ and in whom _________ is difficult to achieve are at the greatest risk for infection and other complications
-Extensive burns
-Wound closure
Other complications associated with burns
-Respiratory failure
-Pneumonia
-Sepsis
-Hypertrophic scarring
Associated with considerable morbidity and potential lifelong disfigurement
Hypertrophic scarring
The clinical course for a patient with a major burn admitted to a burn unit can be divided into ___ overlapping phases
3
Phases of a patient admitted to a burn unit
-Emergent phase
-Acute phase
-Rehabilitative phase
Phase that focuses on:
-Fluid resuscitation
-Ventilatory management
-Assessment of the extent of the burn
-Early wound management
Emergent phase
Phase that focuses on:
-Burn wounds management and infection prevention
-Debridement and skin grafting
-Physical therapy
Acute phase
Phase that focuses on return to maximal independence and function
Rehabilitative phase
Types of skin transplantations
-Autograft (person’s own skin)
-Allografts (homografts)
-Xenografts (heterografts)
-Biosynthetic grafts
Skin transplantation used to treat a full-thickness burn and permanently close the burn injury
Autograft
Skin transplantation that uses cadaver skin
Allografts
Skin transplantation that uses pigskin
Xenografts
Skin transplantation that is a combination of collagen and synthetics
Biosynthetic grafts
3 classic determinants of burn mortality
-TBSA
-Age
-Inhalation injury
Factors that further complicate burn recovery and increase mortality rates in adults
-Obesity
-Alcoholism
-Cardiac disorders that impair peripheral circulation
PTs are involved throughout the ___________ and ___________ phases of burn care
-Acute
-Rehabilitation
As a PT, you do not have to arrange a session with pain medications
False
(you do lol)
Caused by a variety of underlying disorders, including neuropathy, vascular insufficiency, radiation, systemic sclerosis (SSc), vasculitis, and prolonged pressure
Integumentary ulcers
Neuropathic ulcer in people with diabetes
Diabetic ulcer
True or false: Neuropathic ulcers can occur in anyone with loss of sensation (e.g., alcoholic neuropathy, peripheral neuropathy)
True
____________ may be classified using the Wagner system or the site, ischemia, neuropathy, bacterial infection, area, depth (SINBAD) score
Neuropathic ulcers
SLIDE 40
The lesions caused by unrelieved pressure, resulting in damage to underlying tissue
Pressure injuries
Pressure injuries are also called…
-Pressure ulcer
-Decubitus ulcer
-Bed sore
Pressure injuries usually occur over ______________
Bony prominences
Examples of bony prominences
-Heels
-Sacrum
-Ischial tuberosities
-Greater trochanters
-Elbow
-Scapula
-Under medical devices
Stages of pressure injuries are used to…
Classify the degree (extent) or soft tissue damage observed
The current staging system is reflective of the range of ____________
Skin pigmentation
Stage for Nonblanchable Erythema of Intact Skin
Stage 1
Stage for Partial-Thickness Skin Loss With Exposed Dermis
Stage 2
Stage for Full-Thickness Skin Loss
Stage 3
Stage for Full-Thickness Skin and Tissue Loss
Stage 4
Obscured Full-Thickness Skin and Tissue Loss
Unstageable pressure injury
Persistent Nonblanchable Deep Red, Maroon, or Purple Discoloration
Deep tissue pressure injury
True or false: Wounds can be back-staged
False
(nope lol)
True or false: Once a pressure injury is designated as stage 2, 3, or 4, it will retain this original classification until it has resolved
True
As the lesion fills with granulation tissue and closes via epithelialization, graft, or flap, it should be documented as a healing stage ____
2, 3, or 4
The two primary causative factors for the development of pressure injuries are ________ pressure (externally) and pressure with __________
-Interface
-Shearing forces
Decreased sensation, impaired mobility or activity levels, incontinence, diaphoresis, impaired nutritional status (prealbumin and albumin), and altered levels of consciousness or cognition
Intrinsic factors
Pressure, shear, friction, and moisture
Extrinsic factors
True or false: Bedbound and chairbound patients and patients with impaired ability to reposition themselves should be assessed for additional factors (e.g., above-noted pressure injury risk factors) that increase the risk of developing pressure injuries
True
Anyone with a history of previous pressure injury is considered a __________ patient requiring a prevention protocol
High-risk
SLIDE 47
Continuous pressure on soft tissues between bony prominences and hard or unyielding surfaces compresses capillaries and occludes ___________ causing ischemia and tissue necrosis
Blood flow
___________ predisposes bacterial invasion and subsequent infection, preventing healthy granulation
Necrotic tissue
SLIDE 49
True or false: Infection can’t be localized and self-limiting or can’t progress to sepsis
False
(it can)
Patients who are _________ or who have _________ are often unable to mount a sufficient inflammatory response to start the healing cascade and thus are at greater risk for infection
-Immunosuppressed
-Diabetes
Evidence of infection includes…
-Erythema
-Heat
-Swelling
-Pain
-Purulence
-Delayed healing
-Foul odor
Proteolytic enzymes from bacteria and macrophages dissolve necrotic tissues
Foul-smelling discharge
Necrotic tissue is ________, but surrounding tissue can be _________ in individuals with normal sensation
-Insensate
-Painful
The high-risk patient will need ____________ changes
Frequent position
For repositioning, use all turning surfaces, positioning the patient at a 30-degree oblique angle when ____________
Sidelying
Elevate the head of the bed to no greater than ____ degrees when the patient is supine
30
If the head of the bed is elevated beyond 30 degrees (e.g., for eating, watching television, nursing care, therapy intervention), the duration of this position needs to be limited to minimize both __________ and __________
-Pressure
-Shear forces
