Integument Flashcards
1
Q
Risk Factors associated with potential skin conditions
A
- Loss of mobility
- Infection
- Diabetes
- Impaired Sensation
- Medication
- Age
- Smoking
2
Q
Layers of Skin
A
- Epidermis
- Protects from infection
- Assists with heat regulation
- Dermis
- Subcutaneous Tissue
- Adipose cells; energy storage; protection
3
Q
Epidermis Layer
A
- Protection
- Avascular
4
Q
Dermal Layer
A
- Sensation and blood supply
- “True Skin”
- Infection and vascular changes here
- Sensation
5
Q
Skin Observation
A
- Skin Discoloration
- Skin Temperature
- Skin Integrity – Turgor (Hydration and Resilience)
- Skin Resilience
- Edema/Effusion
- Hair and Nail Beds
- Sensation
Consultation is any of these are new findings OR become more prevalent/progress
6
Q
Hemosiderin Staining
A
- Rusty brown darkening of the skin
- Mid-calf and down
- Commonly lower extremity
- Could indicate venous insufficiency in LE
7
Q
Cyanosis
A
- Low O2 in blood
- Common in fingers and toes
- Central cyanosis: pulmonary disease or congenital heart defect (heart failure)
- Could indicate subject is extremely cold, low hemoglobin levels, vasomotor
8
Q
Pallor
A
- Loss of skin pigment (pale white)
- Whole Body: Vasoconstriction (shock-Activate EMS), blood abnormality (anemia)
- Local: Blood circulation disorder (diabetes or Raynaud’s)
9
Q
Erythema
A
- High O2 in blood (red)
- In people with darker skin, may appear or dark blue or purple
- Central: fever
- Local: Infection, Blood Clot
- Do a cardiopulmonary screen, take temperature, and vitals
10
Q
Jaundice
A
- Excess plasma. concentration of bilirubin (yellow)
- Associated with liver failure/disease
11
Q
Ecchymosis
A
- Bruising
- Cognition issues, sensation issues, falls
- Treat musculoskeletal
12
Q
Surface Temperature
A
- Increase: Possible infection
- Global: Systemic infection
- Palpate lymph nodes
- Decrease: reduction in local circulation (arterial occlusion)
- Global: vascular insufficiency
- Local: May be associated with swelling
13
Q
Skin Elasticity - Turgor
A
- (Poor Hydration)
- Assess skin turgor for hydration
- Hydration & Release
- Changes with age (elderly have reduced thirst feeling)
- May change in healed wounds
- Susceptible for abrasions and wounds
- Traumatic
- Pressure Sores
- Test
- Pinch back of skin, skin should return back to normal within one second
14
Q
Skin Resilience
A
- Skin thickness and dryness
- Changes as people age
- Skin permeability – diminished barrier
- Lowered immune response
- Impaired wound healing
- Decreased elasticity of epidermis and increased wrinkling
- Less Vitamin D production
- Changes as people age
- Changes following injury and healing
- Scar formation – less resilient and/or mobile
15
Q
Edema/Effusion
A
- Effusion - CONSULT
- Contained within the joint capsule – Intra-articular
- Structure within the joint injured
- Infection or inflammation in the joint
- Analogy of water balloon
- Example
- Injury, Infection, Unknown cause
- Edema – CONSULT
- “Extra-articular”
- Commonly associated with systemic conditions (Ex: heart disease, vascular disease)
- Pitting vs non-pitting
- Pitting
- Push and indentation remains
- Non-pitting
- Push and rebounds
- Pitting
- Concerned if new and changes
16
Q
Hair Appearance
A
- Local loss of hair due to
- Arterial insufficency (Usually associated with coldness)
- Infections
- Medications (chemo)
- Global loss of hair due to disease (thyroid)
- Other condition of less concern (not health concern haha)
- Benign Alopecia
- Male pattern baldness
- Benign Alopecia
17
Q
Fingernails
A
Different finger nail appearances are unique with occult disease
18
Q
Onycholysis
A
- Separation of nail from its bed
- Associated with Psoriasis, Dermatitis of hand, fungal infection
19
Q
Beau’s Lines
A
Patient has had a history of severe systemic insult (high fever, infection, renal disease, hepatic disease)
20
Q
Nail Clubbing
A
- Indicative of chronic hypoxia (emphysema) and lung cancer
- Distal nail phalanx appears bulbous and rounded
- Nail plate is abnormally convex
- Plate angle is greater than 180 degrees
21
Q
Cyanosis
A
- Bluish discoloration
- Hypoxia
22
Q
Sensation Tests
A
- General sensory deficit vs specific patterns of sensory deficits
- Differentiate systemic condition
- Light touch
- Sharp/Dull
- Cold/Hot
23
Q
Three most common skin cancers
A
- Basal Cell Carcinoma (Most common)
- Squamous cell carcinoma
- Malignant melanoma (most deadly)
24
Q
ABCs - Skin Cancer
A
- A = asymmetry
- B = Borders
- C = Color
- D = Diameter (>6mm)
- E = Evolution
25
Characteristics of Malignant Cancer
* Shape: Asymmetrical
* Borders: Irregular
* Color: Varied/black
* Diameter: \>6mm
* Rate of Change: Slow or rapid
* Consistency: Firm to hard
* Ulceration: Often
* Mobility: Mobile/Nonmobile
26
Why do we screen for melanoma?
* More than 80% squamous cell carcinoma in head and neck region
* More than 65% basal cell carcinoma in head and neck region
* Melanomas can reoccur more than 5 years after initial surgery
27
When should we be concern with a mole?
**Any mole that undergoes rapid changes in size, shape, color, symptom or integrity (bleeding) is reason for referral soon**
28
Basal cell carcinoma
* An open sore that bleeds or has a discharge that has been open for several weeks
* Reddish patch
* Shiny bump that is pink, red or white
* A scar like tumor that is shiny and aggressive
29
Squamous cell carcinoma
* Crusty, elevated, scaly
* Borders hard to identify
30
Malignant melanoma
* Brown, **black** or multicolored
* Irregular outline
* May crust or bleed
* **Concern: Can metastasize to lymph system and other organs**
31
Infections/Inflammation
* Soft tissue inflammation
* Fungal infections:
* Athletes foot, ringworm oval
* Viral infections:
* Warts, fever blisters, shingles, cold sores
* Bacterial Cellulitis
32
Bacterial Cellulitis
* Rapid Referral – On the phone getting an appointment for them.
* Color: Red
* Temperature: Hot
* Pain: Resting Pain
* Swelling: Increase in girth
* Drainage: More common with infection and associated with an odor
33
Cellulitis
* Swollen glands (lymph nodes near or proximal to the affected area)
* Spreading
34
Pressure Ulcers Risk Factors and Common Sites
* Decreased mobility
* Shear forces
* Altered sensation
* Moisture
* Age
* Most common sites
* Spine/sacrum/coccyx
* Bony prominences of the lower an upper extremity
35
Stage 1 Pressure Ulcer
* Pressure Mark
* Intact skin which is altered in observable way – color, consistency or sensory response – the change is not transient)
36
Neuropathic Ulcers
* Associated with diabetes and other peripheral neuropathies
* Most common in the foot and hand
* Must do a thorough sensory examination to ID if patient is at risk
* Risk Factors:
* Prolonged diabetes
* Poor footwear
37
Post Surgery Wounds and Scars
Consult if:
* Open Wound
* Signs of Infection
* Drainage
* Fever
Scars (benign)
* Assess soft tissue mobility and symptoms with palpation
* Keloid = overproduction of collagen
38
Inspection and palpation of glands and lymph nodes
* Glands to palpate
* Thyroid
* Parotid
* Submandibular
* If abnormal – CONSULT
* Acute infection
* Slow to moderate growing mass
39
Two things associated with aging
* Wrinkling
* Osteoarthritis (wrinkles in your joint – arthritis doesn't cause pain unless very advanced)
