Integument Flashcards

1
Q

Risk Factors associated with potential skin conditions

A
  • Loss of mobility
  • Infection
  • Diabetes
  • Impaired Sensation
  • Medication
  • Age
  • Smoking
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2
Q

Layers of Skin

A
  1. Epidermis
    1. Protects from infection
    2. Assists with heat regulation
  2. Dermis
  3. Subcutaneous Tissue
    1. Adipose cells; energy storage; protection
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3
Q

Epidermis Layer

A
  • Protection
  • Avascular
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4
Q

Dermal Layer

A
  • Sensation and blood supply
  • “True Skin”
  • Infection and vascular changes here
  • Sensation
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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

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6
Q

Hemosiderin Staining

A
  • Rusty brown darkening of the skin
    • Mid-calf and down
    • Commonly lower extremity
    • Could indicate venous insufficiency in LE
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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
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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)
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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
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10
Q

Jaundice

A
  • Excess plasma. concentration of bilirubin (yellow)
    • Associated with liver failure/disease
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11
Q

Ecchymosis

A
  • Bruising
    • Cognition issues, sensation issues, falls
    • Treat musculoskeletal
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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
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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
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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 following injury and healing
    • Scar formation – less resilient and/or mobile
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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
    • Concerned if new and changes
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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
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
Q

Characteristics of Malignant Cancer

A
  • 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
Q

Why do we screen for melanoma?

A
  • 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
Q

When should we be concern with a mole?

A

Any mole that undergoes rapid changes in size, shape, color, symptom or integrity (bleeding) is reason for referral soon

28
Q

Basal cell carcinoma

A
  • 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
Q

Squamous cell carcinoma

A
  • Crusty, elevated, scaly
  • Borders hard to identify
30
Q

Malignant melanoma

A
  • Brown, black or multicolored
  • Irregular outline
  • May crust or bleed
  • Concern: Can metastasize to lymph system and other organs
31
Q

Infections/Inflammation

A
  • Soft tissue inflammation
  • Fungal infections:
    • Athletes foot, ringworm oval
  • Viral infections:
    • Warts, fever blisters, shingles, cold sores
  • Bacterial Cellulitis
32
Q

Bacterial Cellulitis

A
  • 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
Q

Cellulitis

A
  • Swollen glands (lymph nodes near or proximal to the affected area)
  • Spreading
34
Q

Pressure Ulcers Risk Factors and Common Sites

A
  • Decreased mobility
  • Shear forces
  • Altered sensation
  • Moisture
  • Age
  • Most common sites
    • Spine/sacrum/coccyx
    • Bony prominences of the lower an upper extremity
35
Q

Stage 1 Pressure Ulcer

A
  • Pressure Mark
  • Intact skin which is altered in observable way – color, consistency or sensory response – the change is not transient)
36
Q

Neuropathic Ulcers

A
  • 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
Q

Post Surgery Wounds and Scars

Consult if:

A
  • Open Wound
  • Signs of Infection
  • Drainage
  • Fever

Scars (benign)

  • Assess soft tissue mobility and symptoms with palpation
  • Keloid = overproduction of collagen
38
Q

Inspection and palpation of glands and lymph nodes

A
  • Glands to palpate
    • Thyroid
    • Parotid
    • Submandibular
  • If abnormal – CONSULT
    • Acute infection
    • Slow to moderate growing mass
39
Q

Two things associated with aging

A
  • Wrinkling
  • Osteoarthritis (wrinkles in your joint – arthritis doesn’t cause pain unless very advanced)