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NUR 141 > 2.7b Integument > Flashcards

2.7b Integument Flashcards

1
Q

The basics of structure & function

A

EPIDERMIS
Five layers: mostly dead cells
Melanin: color of skin
Keratin: strength of skin

DERMIS
Capillaries & pain/touch receptors
Blood vessels, sweat/sebaceous glands, collagen fibers

SUBCUTANEOUS (HYPODERMIS): fat layer, insulation

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2
Q

Skin Assessment (history):

A 
Onset/Duration of problem
Characteristics: pain, pruritus, paresthesia
Course
Severity
Precipitating/relieving factors: meds, travel, stress, diet etc
Timing and circumstances
History of associated Illness: e.g.DM 
Presence of risk factors: occupation
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3
Q

Physical assessment:

A

Physical examination

Private exam room (temp and lighting)

Patient comfort in gown that allows access to all areas of skin

Systematic head to toe

Compare symmetry

General inspection

Lesion-specific inspection

  • Measure with metric system
  • Appropriate terminology
  • Remove cosmetics, oils
  • Location, distribution, color, pattern, edges, size, elevation, exudate
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4
Q

primary lesions

A

Caused directly by disease
Present at onset of the disease

Example:
Vesicles RT chicken pox
Nodules RT RA

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5
Q

secondary lesions

A

Result from changes over time caused by disease progression, manipulation, or treatment.

Example:
Crusted, excoriated or infected lesion caused by scratching the vesicle. 
Vascular ulcers RT PVD
Pressure ulcers
Scars, keloids
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6
Q

Pathological terms
Types of skin lesions
Macule?

A

Macule: flat, nonpalpable change in color

port-wine stains, freckles, petechiae, vitiligo

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7
Q

Pathological terms
Types of skin lesions
Papule?

A

Papule: small elevated, solid mass, <0.5 cm (patch

moles, warts, psoriasis <0.5cm mass

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8
Q

Pathological terms
Types of skin lesions
Plaque?

A

Plaque: raised, flat lesion – groups of papules

groups of papules that form lesions >0.5

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9
Q

Pathological terms
Types of skin lesions
Nodule?

A

Nodule: larger than a papule (more than 1 cm) raised solid lesion extending deeper into the dermis.
nodules are 1-2cm

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10
Q

Pathological terms
Types of skin lesions
Vesicle?

A

Vesicle: elevated, fluid-filled, thin wall (called bullae if >0.5cm

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11
Q

Pathological terms
Types of skin lesions
Pustule?

A

Pustule: elevated, pus-filled

Pimple

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12
Q

Pathological terms
Types of skin lesions
Cyst?

A

Cyst: elevated, encapsulated in the SQ, fluid or semi-solid

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13
Q

Pathological terms
Types of skin lesions
Ulcer?

A

Ulcer: deep, irregularly-shaped area of skin loss, dermis or SQ

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14
Q

What are the normal changes in skin RT aging?

A

Decreased thickness of epidermis

Hyperplasia of melanocytes (liver spots, aging spots)

Decreased Vitamin D production

Decreased vasomotor response

Elastin fibers degenerate

Proliferation of capillaries

SQ layer thins
Adipose redistribution

Decreased Sweat & sebaceous glands

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15
Q

What are some common lesions in the older adult?

A

Skin tags
Keratoses: scaly patches on top layer of skin, horney growth
Lentigines (liver spots)
Angiomas; look like small blood blister
Telangiectases: group of broken blood vessels
Photoaging
Venous lakes: larger blood blister looking, usually in/on the mouth or ears

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16
Q

Pruritus

A

Variable size of area
Itch-scratch-itch cycle

Trigger stimulates receptors in junction between epidermis and dermis and can also trigger release of inflammatory mediators

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17
Q

Pruritus

Causes:

A 
Causes:
May or may not be associated with rash
Environmental factors & allergies
Emotional distress
Secondary to systemic disease
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18
Q

Pruritus

Management:

A 
Management:
Identify & eliminate cause
Meds to manage itch?
Secondary effects
Box 16-1
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19
Q

Xerosis (dry skin)

A

Common in older adult due to decrease lubrication & reduced moisture retention

Sun exposure—
Cumulative and damaging
Loss of elasticity, thinning, wrinkling, drying

Major factor in precancerous and cancerous lesions

Actinic keratosis, basal cell carcinoma, squamous cell carcinoma, malignant melanoma associated directly or indirectly with sun exposure

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20
Q

Xerosis (dry skin)

Management

A 
Management:
Creams
Lotions
Ointments
Antibiotics
Corticosteroids
Anesthetics
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21
Q

nevi

A

Nevi are some of the most common growths that occur on the skin.
moles, beauty spots or birthmarks.

Macules and papules with defined borders

Arise from melanocytes early in life & migrate up

Dysplastic nevi – can become malignant

Management: monitor for changes in size, thickness, color, bleeding or itching

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22
Q

Moles

A

Moles
Flat or raised macules, papules, with rounded well-defined borders
Small tan to deep brown and grow in groups

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23
Q

Melanocytic nevi

A

Melanocytic nevi can be present at birth or around the time of birth.
These tend to be larger moles and are referred to as congenital nevi.
During childhood “regular moles” may begin to appear.
Typically they are skin color to dark brown, flat to dome shaped growths that can appear anywhere on the skin.
The average person has 15-20 melanocytic nevi.
Genetic predisposition
Continue to develop throughout life
Non-contagious

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24
Q

keratoses

A

Generally benign overgrowth and thickening of epithelium
Adults >50 yrs old
Tan, waxy, can appear greasy, commonly on face or trunk
Seborrheic ketatoses: waxy or warty, uneven pigment; can be malignant (25%)

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25
keratoses
Benign, genetically determined superficial growths - Found in increasing number with age - Irregularly round of oval, flat-topped papules or plaques - Surface often verrucous - Well-defined shape - Appearance of being “stuck on” - Increase in pigmentation with age of lesion - Usually multiple and possibly itchy - Removal by curettage or cryosurgery for cosmetic reasons or to eliminate source of irritation - Minimal scarring -May be removed for biopsy
26
psoriasis
Chronic, immune characterized by raised, red, round, circumscribed plaques covered by silvery white scales. Most common lesions on elbows, knees, scalp Associated problems: pruritus, fissures, infections
27
psoriasis | triggers?
Triggers: sunlight, stress, seasonal changes, hormones, trauma to skin Meds that trigger: steroid withdrawal, beta blockers, lithium
28
psoriasis | medication treatment?
MEDS: steroids (topical, oral, injectable) decrease inflammation & mitotic activity of lesions, delay keratin migration, rarely cause lasting remission topical: tar preps calcipotriene (Dovonex) safe effective ST and LT treatment inhibits proliferation in epidermis
29
psoriasis | phototherapy
PHOTOTHERAPY: UVB: decreases the growth rate of epidermal cells PUVA: administer psoralen to make skin more sensitive to UVA (penetrates deeper) Gradually increasing exposure times 3X/wk with eye shielding Risk of burns, delayed response
30
psoriasis | photochemotherapy
PHOTOCHEMOTHERAPY | UVA rays activates methoxsalen
31
Bacterial infections: hair follicles | Furuncle?
Furuncle: inflammation of hair follicles Deep, firm, read, painful nodule 1-5 cm → cystic nodule Contributing factors: trauma, poor hygiene, systemic disease **These are usually Staph aureus
32
Bacterial infections: hair follicles | Carbuncle?
Carbuncle: group of infected hair follicles Multiple openings to skin surface, firm mass in SQ/dermis Common on neck, upper back, and thighs S/S: swelling & pain, systemic: chills, fever, malaise **These are usually Staph aureus
33
Bacterial infections: cellulitis
- Localized infection of dermis & SQ tissue - Spreading factor: excreted by causative organism and breaks down fibrin network and barriers in tissue - Area is red, swollen, & painful, diffuse borders - Systemic S/S; fever, chills, HA, swollen lymph nodes -MRSA: HA-MRSA, CA-MRSA, 1/3 population+ is colonized Box 16-3 MRSA prevention
34
cellulitis treatment:
``` Culture to identify correct antibiotic Assess local and systemic S/S Cover draining lesions with sterile dressing Handwashing & isolation (if indicated) Moist heat Immobilize & elevate Hospitalize if severe Can progress to gangrene or sepsis ```
35
cellulitis treatment: | meds
Cloxacillin; cephalosporins, MRSA-Bactrim, minocin, doxycycline, cleocin.
36
Fungal/yeast Skin Infections
Skin fold appear moist and beefy red or brown, | itch, may have pustules on edge
37
Fungal/yeast Skin Infections | Types?
Vaginal and oral candidiasis Tinea corporis (body-”ringworm”) Tinea pedis- (athlete’s foot) Tinea cruris (jock itch)
38
Fungal/yeast Skin Infections | Teaching?
Teaching: Contagious Keep skin cool and dry Breathable coverings, cotton underwear
39
Candidiasis:
Candidiasis: - Mouth—white, cheesy plaque, resembles milk curds - Vagina—vagtinitis with red, edematous, painful vaginal wall, white patches; vaginal discharge, pruritis; pain on urination and intercourse - Skin—diffuse papular erythematous rash with pinpoint satellite lesions around edges of affected area
40
Candidiasis: | Treatment?
Treatment Nystatin or other specific medication as vaginal suppository or oral lozenge Abstinence or use of condom Eradiation of infection with appropriate medication Keep skin clean and dry Mycostatin powder effective on skin lesions
41
Tinea Corporis | treatments
Tinea Corporis—cool compresses; topical antifungals for isolated patches; creams or solutions of miconazole, clotrimazole, and butenafine
42
Tinea Pedis | treatments
Tinea Pedis—topical antifungal cream, gel, solution, spray or powder
43
Viral skin infections | Warts
Warts: (verucca) Caused by HPV Genital or nongenital Transmitted through skin contact Tx: meds, cryotherapy, electrodesiccation, curettage
44
Viral skin infections | Plantar warts
Plantar warts On bottom of foot Usually treatment is liquid nitrogen Frequent paring Followed by application of patches of impregnated chemicals to decrease regrowth Overaggressive destruction may result in painful, hypertrophic scar
45
Most common viral infection of the skin are caused by?
Most common viral infection of the skin ``` Caused by HPV Multiple treatments including surgery Blunt dissection with scissors or curette Liquid nitrogen therapy Blistering agent Salicylic acid CO2 Laser destruction ```
46
Viral skin infections | Herpes simplex:
Caused by herpes virus (HSV1 (oral) & HSV2 (genital) Burning, tingling then erythema, vesicle forms & pain Can have systemic manifestations (fever, sore throat etc) Virus lives in nerve ganglia & can recur Most often found on lips, face, mouth Treatment: antivirals
47
Viral skin infections Herpes simplex: transmitted?
Transmitted: physical contact, kissing, oral sex
48
``` Viral skin infections Herpes zoster (Shingles) ```
Caused by reactivation of varicella zoster (also causes chickenpox) Increased risk for immune compromised Outbreak lasts 2-3 wks, usually won’t recur but can have long-lasting effect Vesicular lesions with erythematous base, usually follows the path of nerve along face, trunk, thorax, unilateral Pain & pruritus
49
Viral skin infections Herpes zoster (Shingles) complications? care?
Complications: : Post-herpetic neuralgia Care: vaccine prevention, antiviral meds, pain management Isolation
50
Viral skin infections Herpes zoster (Shingles) and healthcare workers
Healthcare workers without immunity or vaccination can be contagious from day 8-21 after exposure and should be reassigned from direct patient care during that period. Pregnant women should not be exposed. There is a small risk of catching chickenpox from someone with Shingles which, depending on the time of gestation that infection occurs, can cause problems for baby and mom.
51
Malignant & pre-malignant skin disorders Non-melanoma cancers: Risk factors:
Fair skin, freckles, blond or red hair, blue or green eyes ``` Family hx skin CA Unprotected/excessive exposure to UV radiation Occupational exposures Sunlight chemicals Severe sunburn as a child ```
52
Malignant & pre-malignant skin disorders | Actinic keratosis
Directly RT sun exposure & photodamage 20% convert to squamous cell carcinoma Erythematous, rough macules, shiny or scaly
53
Malignant & pre-malignant skin disorders Actinic keratosi characteristics
Actinic keratoses—sun damage—precursor to squamous cell carcinoma - Flat or elevated, dry, hyperderatotic scaly papule - Possible recurrence even with adequate treatment
54
Malignant & pre-malignant skin disorders | Basal cell:
Epithelial tumor that originates in basal layer bulky tumors that grow by direct extension & destroy all types of surrounding tissues; frequent recurrence Most common, least aggressive – rare metastasis; several classes Superficial: erythema, ulceration, well-defined borders
55
Malignant & pre-malignant skin disorders | Squamous cell
Skin, mucous membranes, eyes Aggressive cancer; invasive, metastasis via lymph Small firm red nodule progressing to ulceration, bleeding, painful, and indurated
56
Malignant & pre-malignant skin disorders Squamous cell treatment
Treatment: Surgical excision: remove surrounding margins, may require grafting Moh’s surgery: excision of thin layers to determine margins, preserves normal tissues Curettage & electrodesiccation: (laser) scrape and cauterize, works best over fixed surface Radiation therapy: for inoperable lesions, or poor surgical risks Local therapy: cryosurgery, topical chemo, phototherapy, IRMS (biologics-targeted), laser
57
Malignant & pre-malignant skin disorders | Squamous cell carcinoma
Squamous cell carcinoma Frequent occurrence on previously damaged skin (from sun, radiation, scar) Malignant tumor or squamous cell of epidermis Invasion of dermis, surrounding skin Metastasis possible Superficial -Thin, scaly erythematous plaque without invasion into the dermis
58
Malignant & pre-malignant skin disorders Squamous cell carcinoma Early and Late?
Early Firm nodules with indistinct borders, scaling and ulceration; opaque Late Covering of lesion with scale or horn from keratinization Most common on sun-exposed areas such as face and hands
59
Treatment of skin cancers
``` Focus on removal of tissue Depends on stage, type, size, location Surgery Curettage & electrodessication Radiation Cryotherapy ```
60
Malignant & pre-malignant skin disorders | Malignant melanoma
10X more common in fair-skinned people Least common but most deadly skin cancer, increasing Wide age range (adolescents to older adults)
61
Malignant & pre-malignant skin disorders Malignant melanoma Risk factors
``` Cause unknown but risk factors are: Moles (lg number or size) Immune suppressant meds Over age 50 Fair skin, blond hair, blue eyes Excessive UV exposure Genetics –dx of melanoma or other specific types of cancers ```
62
Malignant & pre-malignant skin disorders Malignant melanoma Interdisciplinary care?
Interdisciplinary care: Total skin assessment Biopsy Diagnostic workup for metastasis Treatment options: - Surgery: wide excision, can remove lymph nodes, & metastasis - Immunotherapy - Radiation therapy - Biologics: monoclonal Ab, GF, vaccines (direct tumor effect)
63
ABCDs
ABCDs— - Asymmetry—one half unlike the other half - Border irregularity—edges ragged, notched or blurred - Color—varied pigmentation—shades of tan, brown, and black - Diameter: greater than 6 mm
64
Skin cancer patient teaching:
``` Lemone box: 16.5 prevention of skin cancer 16.6 sunscreen information 16.7 skin self-examination “slip, slop, slap, wrap” rule ```
65
Skin cancer patient teaching: | “slip, slop, slap, wrap” rule
Slip on a shirt Slop on sunscreen Slap on a hat Wrap on sunglasses
66
Nursing diagnoses integument problems
- Impaired skin integrity - Acute pain - Disturbed body image - Risk for infection - Anxiety - Ineffective health maintenance - Deficient knowledge - Anticipatory Grieving - Hopelessness

NUR 141 (48 decks)

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