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NRSG 102: Med Surg 1 > Exam 4: Chapter 60 - Assessment of Integumentary Function > Flashcards

Exam 4: Chapter 60 - Assessment of Integumentary Function Flashcards

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1
Q

Skin is the largest

A

organ in the body

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2
Q

Skin functions?

A

Forms barrier between internal and external environment protecting the body from pathogens, helps regulate temperature and water loss, and provides sensory input

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3
Q

Skin composed of what three layers

A

Epidermis, dermis , and subcutaneous tissue

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4
Q

Epidermis consists of which two main types of cells?

A

Melanocytes and Kertinocytes, which randomly migrate upwards. These dead cells contain Keratin that form the outer barrier of the skin

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5
Q

What do Melanocytes do?

A

Special cells of the epidermis that are involved in producing the pigment melanin, which colors the skin and hair

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6
Q

What two other cells are in the Epidermis?

A

Merkel Cells and Langerhans Cells

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7
Q

What are Merkel Cells?

A

Have a role as receptors that transmit stimuli to the aon through a chemical synapse

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8
Q

What are Langerhans Cells?

A

Believed to play significant role in cutaneous immune system reaction

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9
Q

What are Rete Ridges?

A

Undulations and furrows that appear at the lower edge of the epidermis at the dermal junciton where these two skin layers are cemented together

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10
Q

The interlocking between the dermis and epidermis produces what on the skin?

A

Ripples, which are also called fingerprints

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11
Q

What is the Dermis?

A

Provides strength and structure in the form of collagen and elastic fibers.

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12
Q

What two layers make up the Dermis?

A

Papillary and REticular

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13
Q

Subcutaneous made primarily of

A

adipose and connective tissue, which is a cushion between the skin layers and the muscles and bones.

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14
Q

Dermis makes up

A

the largest portion of the skin

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15
Q

What is located in the DErmis?

A

Blood Vessels, Nerves, Sweat Glands, and Lymph, If this portion damaged, so will all of these.

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16
Q

As we age, what happens to the subcutaneous tissue?

A

It breaks down and allows more injuries to occur such as osteomyelitis. Nerve endings are located here and as we age, these will move to the top

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17
Q

Alopecia is

A

the general loss of hair caused by various factors

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18
Q

Chemotherapy and Radiation Therapy with Alopecia?

A

Cause reversible hair thinning or weakening of the hair shift

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19
Q

What autoimmune disorders cause hair loss?

A

Systemic Lupus Erythematosus and Alopecia Areta

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20
Q

Folliculitis of the scalp will cause

A

inflammation of the hair roots and may result in scarring alopecia

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21
Q

How should you get your Vitamin D?

A

Through a healthy diet an supplementation rather than intentional sun exposure

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22
Q

What physiologic changes occur with aging?

A

Decreased dermal thickness

Degeneration of Collagen

Decreased sebum production

Increased Vascular Fragility

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23
Q

What medications are photosensitizing and increase damage that results from sun exposure?

A

Antihistamine
Antibiotic
Diuretic Agents

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24
Q

Visible Changes of skin of older adults?

A

Dryness
Wrinkling
Uneven Pigmentation
Various Proliferative Lesions

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25
Cellular Changes with Aging?
Thinning at the junction of the dermis and epidermis
26
What is thought to contribute to declining sebaceous gland function?
Reduced Androgen Levels
27
With aging, the epidermis is shrunk and under more stress. This causes what?
It to shed away. Patients in rehab have to repositioned. They stick to the sheet and gravity pulls them down
28
Hair growth grgadually diminishes, especially over the
lower legs and dorsum of the feet
29
Thinning is common in the
scalp, axillae, and pubic areas
30
Other functions affected by normal aging include
the barrier function of skin, sensory perception thermoregulation
31
What two techniques are commonly used in examining the skin?
Inspection and Palpation
32
General appearance of the skin is assessed by observing
color, temperature, moisture, or dryness, skkin texture (rough or smooth) , lesions, vascularity, mobility, and the condition of hair and neails Skin turgor, or possible edema and elasticity assessed by palpation
33
What should you do for the preparation of the patient?
Explain purpose, provide privacy , and coverings
34
What parts of the body should you insepct?
the enitre body, including mucosa, scalp, hair and nails
35
What should you do when you come across a lesion?
Palpate and Measure
36
Why are Photographs useful to document nature and extent of skin conditions?
This can be doe to monitor progress and so we are ale to tracg its progreess
37
What is hypopigmentation (loss of pigmentation) caused by?
May be caused by a fungal infection, eczema, or vitiligo (white patches)
38
What is hyperpigmentation (increse in pigmentation) caused by?
Can occur after sun injury or as a result of aging
39
What is Cyanoisis?
The bluish discoloration that results from a lack of oxygen in the blood
40
What does Cyanosis appear with?
Appear with shock or with respiratory or circulatory compromise
41
In poeple with light skin, cyanosis manifests as a
bluish hue to the lips, fingeritps, and nail beds
42
Other indications with Cyanosis of dedcreased tissue perfusion include
cold, clammy skin; a rapid thready pulse; and rapid shallow respirations
43
Cyanosis: The conjunctivae of the eyelids are examined for
pallor and petechiae (pinpoint red spots that result from blood leakage into skin)
44
Cyanosis appearance in someone with dark skin?
Assumes a grayish cast. To detect, areas around the mouth and lips and over the chekbones and earlobes should be observed
45
What is Erythema?
Redness of the skin caused by the dilation of capillaries.
46
What to do if you detect Erythema?
Palpate the skin for increased warmth and for smoothness or hardness.
47
Color ofskin for Erythema for a dark skinned person?
Purple-gray cast, but it may be difficult to detect this
48
What is Jaundice?
A yellowing of the skin and is directly relaved to elevations in serum bilirubin and is often first observed in the sclerae and mucous membranes
49
Erythema: What is Hyperemia?
Increased blood flow through engorged arterial vessels as in inflammation fever alcohol intake or blushing
50
Erythema: Light skin appearance in hyperemia?
Red, Bright Pink
51
Erythema: CO Poisioning Color inLight Skin
Bright, cherry red in face and upper torso
52
Erythema: CO Poisoning Appearance in Dark Skin?
Cheery red nail beds, lips, and oral mucosa
53
What are primary lesions?
Are the initial lesions and are characteristic of the disease itself
54
What are secondary lesions?
Result from changes in primary lesions resulting from external causes, such as scratching, trauma, infections, or changes caused by wound healing
55
What is a Macule paired with?
Patch
56
What is a Macule
``` Flat, nonpalpable ski. Color Change (Color may be brown, white, tan, purple, or red) ```
57
Examples of MAcules?
Freckles, flat moles, petechia, rubella, vitiligo, port wine stains, ecchymosis
58
Size of a Macule?
<1 cm , circumscribed border
59
Size of a Patch?
> 1 cm , mayhave irregular border
60
What does a Papule pair with?
Plaque
61
What is a papule?
Elevated, palpable solid mass with circumscribed border Patch may be coalesced pepules with flat top
62
Papule size?
< 0.5 cm
63
Plaque size?
> 0.5 cm
64
Examples of Papules?
Elevated nevi, warts, lichen planus
65
Examples of Plaques?
Psoriasis, Actinic Keratosis
66
What is a Ulcer?
Skin loss extending past epidermis; necrotic tissue loss ; bleeding and scarring possible
67
Ulcer Examples?
Stasis ulcer of venous insufficiency, pressure ulcer
68
What is a scar?
Skin mark left after healing of a wound or lesion; represents replacement by connective tissue of the injured tissue
69
What are young scars?
Appear red or purple
70
What do Mature scars look like?
White or glistening
71
Scar examples
Healed wound or surgical incision
72
How would you document skin lesions?
COlor of the lesion Any redness, heat, pain, or swelling Size and location of the involved area PAttern of eruption Distribution of the lesion
73
How would you inspect the wound bed?
Inspect for necrotic and granulation tissue epithelium, exudate, color, and odor
74
How would you inspect wound edges and margins?
Observe for udnermining (extension of the wound udner the surface skin) and evaluate for coniditon of skin
75
How would you check wound size?
Measure in cm to determine diameter and depth of the woun dand surrounding erythemma
76
How would you check the surrounding skin?
Assess for color, suppleness, and moisture irritiation and scaling
77
What is a Petechia?
A round red or purple macule
78
Petechia is secondary to
blood extravasation
79
Petechia associated with
bleeding tendencies or emboli of skin (low platelets)
80
What is Ecchymosis
round or irregula rmacular lesion . LArger than petechia
81
Ecchymosis color
varies and changes -- black, tellow and green hues
82
Ecchymosis secondary to
blood extravasation
83
Ecchymosis associated with
trauma, bleeding tendencies
84
What does Beau Lines show in nails?
Its a transverse depression in the nails and may reflect retarded growth of the nail matrix because of severe illness or local trauma
85
What type of nail can indicate anemia?
Spoon-shaped nails
86
Clubbing of the nails is manifested by
a straightening of the normal angle (180 degrees or greater) and softening of the nail base
87
Clubbing is often assocaited with
pulmonary disease and can be a sign of chronic hypoxia. (smoking)
88
Clubbing in early stages vs late?
Early clubbing is raised, while late clubbing is swollen and springy.
89
What other changes may also be visible because of local trauma?
Ridging, hypertrophy
90
What should y ou assess in hair
Color, Texture, Distribution
91
In women with hirsutism, excessive hair may grow on
face ,chest, shoulders, and pubic area
92
Some skin conditions may lead to feelings of
depression, frustration, self-consciousness, poor self-image, and rejection
93
What are some common skin conditions encountered in diabetes?
``` Diabetic DErmopathy Stasis DErmatitis Skin Infections Leg and Foot Ulcers HIV Skin Infections ```
94
What is Diabetic Dermopathy?
Shin spots or pigmented pretibial papules
95
Diabetic Dermopathy lesions found on
the lower anterior legs, forearms, and thighs and over other bony prominences
96
Diabetic Dermopathy thought to be caused by
diabetes associacted changes in the small vessels that supply the skin and trauma.
97
Diabetic Dermopathy: Each spot starts as a
dull red bump, smaller than a pencil erser. Slowly spreads to about 1 inch and becomes scaly and leaves brownish, slightly depressed scar on the skin
98
What is Stasis Dermatitis?
Eczematous eruption that occurs on the lower legs of patients with venous insufficiency
99
What happens in Stasis Dermatitis?
Large vessels are damaged, compromising circulation to the lower arms and legs
100
Skin suffers how in Stasis Dermatitis?
Lack of nutrients, and becomes very dry and fragile. Minor injuries heal slowly and ulcers form easily.
101
Chronic Stasis Dermatitis?
Leads to permanent changes in skin color, hyper or hypopigmentation, and either fragile or thicker skin texture
102
Skin infections may appear as
small pimples around hair follicles.
103
Most frequently affected sites for skin infections include
the lower legs, lower abdomen, and buttocks
104
SOmetimes, skin lesions in skin infections enlarge to become
furuncles or carbuncles
105
What are furuncles?
Begin in a hair follicle, progressively enlarging and invading deeper into tissue to form an abscess
106
What are carbuncles?
Formed by multiple cintiguous lesions.
107
Skin of patietns with diabetes is prone to
bacterial and fungal infections
108
Fungal infectiosn are quite common in areas that remain
moist (breast , upper thigh, axillae)
109
Candida (yeast) infections appear
beefy red and often have small pustules around the border of the area with the skin appearing mosit and red
110
Dermatophyte infections are
dry and only minimally red with more scale. Common sites are the toenails and feet
111
Diabetics: Leg and Foot Ulcers
Often don't feel these injuries. Ulcerations unresponsive to treatment lead to amputations
112
HIV and Skin signs correlate with low
CD4+ counts
113
Some disorders for HIV?
Kaposi Sarcoma Oral Hairy Leukoplakia Facial Molluscum Contagiosum Oral Candidiasis
114
Skin biopsies are performed on
skin nodules plaques blisters other lesions To perform testing such as gram stain for bacterioa
115
What are weak positive reactions for a patch testing?
redness, fine elevations, or itching
116
what are some medium positive reaction for patch testing?
fine blisters, papules, and severe itching
117
what are some strong positive reaction for patch testing?
Bliders, pain, and ucleration
118
How is a Tzanck smear performed?
Used to examine cells from blister skin conditions, such ahherpes, varicella. Applied to glass slide, stained, adn examined

NRSG 102: Med Surg 1 (52 decks)

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