week 2: integumentary Flashcards
vit d production
- UV rays absorbed as vit D3/from diet–> Vit D3 circulates the blood—> liver(converts vit d3 into another form—> kidney—> either : ca2+ reabsorption, differentiation, immunity or: proliferation, inflammation, angiogenesis
layers of skin:
epidermis: most superficial ( chemo control, protection)
dermis: houses sensory receptors, follicles glands, papillary/reticular dermis)
subcutaneous layer: adipose tissue, muscle, & bone
ezcema:
- common in kids
- looks red/patchy/itchy skin ( can have flare ups)
Psoriasis:
raised lesions that look like white patches, chronic autoimmune disorder
Contact dermatitis:
irritation from contact w an irritant, red itchy, raised bumps
Scabies:
caused by mites under the skin, red and contagious.
heat rash:
caused by blocked sweat ducts, red raised bumps/rash
what systemic diseases have skin signs:
liver, diabetes, internal cancers, Obstructive cardiomyopathy, cardiac dysrhythmias
Sarcoidosis
inflammation of the skin tissues of the body.
life-threatening skin conditions:
- pemphigus Vulgaris (PV), Toxic Epidermal Nercrolysis (TEN), AKA Stevens Johnsons syndrome
-DRESS- drug rash w eosinophillia systemic symptoms syndrome - Toxic Shock Syndrome
-meningoccocemia - rocky mountain spotted fever
- Necrotizing Fasciitis: bacteria enters through breaks in the skin.S/s: fever, redness, swelling, hypotension, severe pain (POOP/POEM)-spreads fast
osteomies:
surgery of opening the abdo wall from the bowels or urinary tract, ex: cancer
what is the leading cause in death with burns?
smoke inhalation(50-80% of fire related deaths)
CO poisoning
Co= greater affinity than O2 for hemoglobin–> severe hypoxia
-s/s: throbbing headache starting in the temples, alt mental status, N/V, tachycardia/pnea, coma/seizures,
tx: Hyper oxygenate for >30mins, vent access prn, hyperbaric chamber prn ( if exposure>30mins)
Hx: how long exposed, what was burning, was the space enclosed, any LOC?
hyperbaric chamber:
uses pressure to displace CO off hemaglobin so O2 can bind
- daltons law: +pressure=+amount of dissolved O2
- machine uses + atmospheric pressure to 2.5x that of normal
functions of skin:
retaining moisture, temp control, protection, pain/sensory receptors
Epidermis:
- outermost layer, no blood supply, strata granuolum= basal layer
dermis
-middle layer, vascularized and has collagen, ct, sweat glands, hair follicles, pain receptors, etc.
Subcutaneous layer
adipose tissuem loose CT between underlying organs & muscles
burns patho:
rupture cell membranes, blood cagulates, proteins denature, histamine= relasedsed–> cappillary D–> leaks blood plasma–> interstitialspace –> hypovolemia, edema, ,mass fluid shift.
Jackson’s theory of Thermal burns:
outer zone= red, zone of hyperremia
Middle zone= less red/orange= zone of stasis
inner most= yellow/white, Zone of coagulation
3 stages of burns:
1.emergent:
- immediate pain response, catecholamine release, tachy/cardia/pnea, mild anxiety
2. fluid shift
- 18-24hrs after, inflmmatory response initiated(+bf to the site, intravascular fluid—> extravascular space, leaky capillaries, massive edema)
3.resolution
- days to weeks after, general rehab/progression back to normal function
Eschar?
dead tissue that is leather like & black. can lead to compartment syndrome! results from full thickness burns. Skin denatures/dies over the wound, edema limits BF to area–>die
(code 4/CTAS1/LOAD & GO)
what are the first steps of Tx for burn pt….
- stop the burning process: w sterile water/NS
2 reasses damage–> remove clothing/jewerly - cover w a sterile burn sheet
- Irrigate the area (10-30 mins dependent on thickness and SA)
- dress area w dry dressings if : greater than 15% of BSA, 2nd degree or full thickness ( full thickness always gets dry!)
- give fluids ( extreacellular space will fill uo w K+–> affects heart/hypovolemia)fluids ++ osmotic pressure
