Exam 1 | Integumentary System Flashcards
1
Q
HPI Common S&S ppl present w/ include…
A
- Rashes
- Many contagious diseases (like rubeola, rubella, varicella) present w/ skin rashes
- Lesions
- Pruritus
- Ecchymosis (bruising)
- Nevi (moles)
2
Q
General Skin Inspection includes…
A
- Color: depends on race/ethnicity
- Acanthosis nigra: skin condition that causes flat, rough area of hyperpigmentation (Possible sign for increased risk of type 2 diabetes)
- Uniformity
- Thickness
- Symmetry
- Hygiene: can be sign of psycho-social distress being manifested
- Odors
- Pressure injuries
- Ppl w/ decreased mobility, hospitalized, emaciated, elderly, neurologically impaired ⇒ susceptible to skin damage and ulceration
- primary lesions: macule, papule, wheal, pustules, vesicles, nodule
3
Q
Macule
A
flat, small, discolored
4
Q
Papule
A
raised, small, round, no fluid
5
Q
Wheal
A
bigger than papule, irregularly shaped, fluid-filled, redness around skin
6
Q
Pustules
A
raised, small, fluid-filled w/ pus, round
7
Q
Vesicles
A
raised, clear, fluid-filled, round
8
Q
Nodule
A
raised, solid, bigger & deeper than papule
9
Q
Blanching lesions
A
erythematous and suggests inflammation
10
Q
Infant specific abnormalities:
A
- Congenital dermal melanocytosis: mongolian spot (normal presentation of flat benign birthmark, not a bruise, may go away in future)
- Physiologic jaundice: managed via increased breastfeeding, sunlight therapy, monitored before it can cause irreversible brain damage
- Milia: “baby acne”
11
Q
Pregnancy specific abnormalities:
A
- Linea nigra: line down pregnant stomach
- Palmar erythema: caused by increased blood flow ⇒ both palms turn red
- Stretch marks: depends on genetics
- Melasma: brown or gray patches on face (common)
12
Q
Geriatric specific abnormalities:
A
- Highly vascularized hands: veins may tend to roll and become rigid
- Cherry angiomas: raised, blood-filled, red-brown spots, non-dangerous
- Lentigo: “age spots,” benign, dark brown or black spots caused by sun damage
- Lack of fat ⇒ turgor and tenting not done on arm bc lack of fat = skin stays up = false positive for dehydration
13
Q
SARS-COV-2 dermatologic manifestations
A
- Maculopapular rash
- Urticaria (hives)
- Vesicular rash
- Heterogenous presentations
- Covid toes
- Multisystem inflammatory syndrome (MERS)-C
14
Q
Viral Exanthems (eruptive skin rash that is often related to a viral infection)
A
- varicella (chicken pox)
- rubeola (measles)
- herpes zoster
15
Q
Varicella (chicken pox)
A
- Generalized vestibular rashes w/ fever
- Can lead to pneumonia, encephalopathy, scarring, death
16
Q
Rubeola (measles)
A
- Highly contagious, outbreaks occur frequently
- Can lead to hearing loss
17
Q
Herpes zoster
A
- Caused by varicella zoster virus
- Varicella virus (chicken pox) remains dormant for yrs & can re-emerge as “shingles” if IS weakens and virus takes advantage
- Not contagious but can give varicella (chicken pox) to others
- Presents along dermatomal lines
- Painful, usually lasts 2-3 weeks
18
Q
Genetic skin disease: Epidermolysis Bullosa (EB)
A
- Group of genetic blistering connective tissue disorders
- Types: differs by mutations but all of them makes skin sensitive
- Simplex: dominant gene affecting keratin 5 or 14 mutation
- Dystrophic: dominant or recessive gene affecting collagen 7 mutation
- Junctional: recessive gene affecting collagen, integrin, lamina mutations
19
Q
Palpate skin for
A
- moisture:
- Dryness ⇒ may indicate hypothyroidism
- Oiliness ⇒ associated w/ acne
- Dry skin ⇒ w/ parched cracked lips, dry mucous membranes, lack of tears indicates dehydration
- temperature: may indicate infection
- texture:
- Roughness ⇒ may be finding w/ hypothyroidism
- Velvety texture ⇒ may indicate hyperthyroidism
- turgor and mobility:
- If skin stays up = dehydrated
- If skin falls fast = hydrated
- Decreased mobility ⇒ finding w/ edema and scleroderma
- edema
20
Q
Hair inspection for…
A
- Color: depends on race/ethnicity
- Distribution: abnormalities include…
- Vellus hair: short, fine, inconspicuous, relatively unpigmented
- Terminal hair: coarser, thicker, more conspicuous, usually pigmented
- Quantity: abnormalities include…
- Thinning– need baseline for thickness/thinness of pt’s hair before inspection or Sx onset
- Sparse, coarse hair ⇒ may occur w/ hypothyroidism
- Fine, silky hair ⇒ may occur w/ hyperthyroidism
- Alopecia: hair loss (diffuse, patchy, or total that can be caused by chemotherapy, stress, and/or genetics)
- Dandruff
21
Q
Inspect Nails for…
A
- Pigmentation of nails and bed
- Length
- Symmetry
- Ridging, pitting, peeling (can be caused by nutritional deficit)
- Clubbing angle ⇒ can be caused by chronic hypoxia
- Onychomycosis (nail fungus)
- Ingrown toenail
22
Q
Palpate proximal and lateral Nail folds for…
A
- Redness related to infection but often related to biting
- Swelling
- Pain
- Exudate
- Warts, cysts, tumors
23
Q
Melanoma
A
- Arising from pigment-producing melanocytes in epidermis that give skin its color
- High rate of metastasis
- High rate of mortality at advanced stages
24
Q
Basal Cell Carcinoma
A
- Arising in basal lvl of epidermis in exposed areas
- Pearly white
- Near translucent
- Tend to grow slowly
- Rarely metastasize
25
Squamous Cell Carcinoma
- Arising in upper layer of epidermis
- Crusted
- Scaly w/ red, inflamed, ulcerated appearance
- Can metastasize
26
Red Flags of ABCDE–EFG for early recognition of possible melanoma:
- Asymmetry
- Borders
- Color
- Diameter
- Evolving
- Elevated
- Firmness
- Growing passively?
27
Melanoma Risk Factors
- Personal/Family Hx of previous melanoma
- Atypical/Dysplastic moles that change in size or color
- Male
- 50+ common moles
- Have red or light hair
- Light eye or skin color, esp skin that freckles or burns easily
- Have actinic keratosis (horny overgrowth of skin) and/or solar lentigines (acquired brown macules on sun-exposed areas)
- UV from heavy sun exposure, sun lamps, tanning booths
- Severe blistering sunburns, esp in childhood
- Congenital melanocytic nevi (moles present at birth, esp large moles)
- Have immunosuppression
28
Basal Cell Carcinoma Risk Factors
- UV
- Tanning beds
- Arsenic exposure
- Immunosuppression
- Genes
29
Squamous Cell Carcinoma Risk Factors
- UV
- Fair skin
- Male
- Older age
- Immunosuppressed state
- Genes
30
health education related to reducing the risk of skin cancers
- Avoiding UV and tanning beds
- Regular use of sunscreen
- SPF 30+ preferred
- Skin cancer screening
- Patient screening: approximately half of melanomas are initially detected by pts or their partners
- Inspecting moles: use ABCDE–EFGs
31
Infections/Inflammation (Other Lesions)
- herpes simplex
- contact dermatitis
- psoriasis
- impetigo
- drug eruption
32
Herpes simplex
- painful blisters or ulcers
- Viral infection caused by HIV
33
Contact dermatitis
- red rash, bumps, blisters, swelling that’s itchy, uncomfortable
- Caused by exposure to chemicals or physical agents
34
Psoriasis
- inflamed, scaly skin patches
- Chronic, non-contagious autoimmune disease
35
Impetigo
- red sores that burst and leave yellow-brown crust
- Bacterial skin infection, highly contagious commonly affecting children
36
Drug eruption
- skin rashes, like pink or red spots
- Adverse skin rxn to drugs like NSAIDs, chemotherapy, antimicrobials, etc.
37
Stages of pressure ulcers
- Stage 1: erythema, unbroken skin, light pink color
- Stage 2: partial thickness skin loss of epidermis/dermis/both, skin is broken open
- Stage 3: full thickness skin loss w/ damage to or necrosis of subQ tissue that can extend to but not thru underlying muscle
- Stage 4: full thickness skin loss w/ destruction, tissue necrosis, invasion to deeper tissue/bone/supporting structures
- Unstageable: obscured full-thickness skin and tissue loss by eschar
- Deep tissue injury– deep injury w/ intact skin: intact or non-intact skin w/ localized area of persistent non-blanchable deep red/maroon/purple/purple, appears deep dark bruise-like colored
38
Risk factors for pressure ulcers
- Decreased mobility, esp accompanied by increased pressure/movement causing friction or shear stress
- Decreased sensation from brain, spinal cord lesions, peripheral nerve disease
- Decreased blood flow from hypotension or microvascular disease like diabetes or atherosclerosis
- Fecal or urinary incontinence
- Fractures
- Poor nutritional status or low albumin
39
Braden scale (SMAMNFS)
- evaluates lvls of risk of injury development in pt
- low score = pt has low functional lvl + high risk for injury formation
- high score = pt has high functional lvl + low risk for injury formation
- SENSORY PERCEPTION: ability to respond to pressure-related discomfort
- MOISTURE: degree to which skin is exposed to moisture
- ACTIVITY: physical activity
- MOBILITY: ability to change and control body position
- NUTRITION: usual food intake pattern
- FRICTION AND SHEAR: ability to move and maintain good position in bed and chair independently and has enough muscle strength to lift up completely during movement
40
Central Vs. Peripheral Cyanosis Definition
- Central cyanosis: low oxygen lvls in arterial blood flow
- Peripheral cyanosis: when cutaneous blood flow decreases and slows ⇒ tissues extract more oxygen than usual from blood (can be response to anxiety or cold environment)
41
Cyanosis Assessment Where
- inspect for bluish cast on nails, hands, feet
42
Central VS. Peripheral Cyanosis Underlying Causes
- Central: advanced lung disease, congenital heart disease, hemoglobinopathies, genetic disorders involving hemoglobin like sickle cell and thalassemia
- Peripheral: anxiety, cold environment, venous obstruction ⇒ decreased blood flow
43
Jaundice (definition, assessment, underlying causes)
- what: Yellow color in skin that can be due to deposition of bilirubin in skin
- assessment: Observe yellowing in sclera, skin, lips, nails, palms, soles
- underlying causes: Liver disease, biliary duct obstruction, or increased destruction of red blood cells increases serum bilirubin ⇒ deposited in skin
44
Edema (definition and types)
- Edema: presence of excess fluid in the interstitial spaces ⇒ Decreases mobility
- Systemic edema: occurs in dependent portions of body, feet, legs, and sacral area
- Pitting edema: mobile interstitial water and can be translocated w/ pressure exerted by finger, degree of pitting measured on scale of 1-4
- Non-pitting edema: serum proteins accumulated in interstitial space w/ water and coagulated, usually seen w/ local infection or trauma and called brawny edema
45
Edema Assessment
- Inspect and palpate for puffy and tight skin, feet, legs, sacral area
- Pitting edema: press finger down on skin → if pit stays for 5-30 sec ⇒ pitting edema, measured on scale of 1-4
- Non-pitting edema: if you press your finger down but it doesn’t stay down like it does for pitting
46
Edema Underlying Causes
- systemic problems:
- congestive heart failure (CHF)
- venous insufficiency
- overhydration
47
Erythema (definition, assessment, underlying causes)
- what: Abnormal redness of skin or mucous membranes
- assessment: Look for skin redness or mucous membrane redness
- underlying causes: Infection, Allergy to med, Deep vein thrombosis (DVT), Fever, Sepsis, Rash
48
Acanthosis nigra
- Flat, rough area of hyperpigmentation
- Possible sign for increased risk of type 2 diabetes
- Cause: increased insulin lvls
- Common in neck and underarms
