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Integumentary Flashcards

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1
Q

What is the general purpose of the epidermis?

A

Outer most layer (only a max. Of 1.5mm thick)
Protects deeper layers from mechanical, thermal and chemical damage
Protects from pathogen and UV radiation

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2
Q

What are the main layers of the epidermis from superficial to deep?

A

Stratum corneum
Stratum granulosum
Stratum spinosum
Stratum basale

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3
Q

What is the stratum corneum?

A

Outer most layer of epidermis
Comprised of dead skin cells that continually shed and are replaced
Provides waterproofing

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4
Q

What is the stratum granulosum?

A

The second deepest epidermal layer
Comprised of granula cells which provide keratin
Gives structure and integrity

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5
Q

What is the stratum spinosum?

A

Between the granulosum and basale epidermal layers
Has several layers of cells that give support and strength

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6
Q

What is the stratum basale?

A

Deepest epidermal layer
New skin cells (keratinocytes) made here. Undergo keratinisation where they are hardened and pushed up as more new cells are produced
Melanocytes produce melanin

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7
Q

What produces skin tone variation?

A

The ratio of the different forms of melanin in the stratum basale

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8
Q

What is the purpose of keratin in skin?

A

Helps with fluid retention
Healing and repair
Gives shape and structure

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9
Q

Describe the dermis

A

Thick middle layer of skin
Has two layers: superficial papillary dermis and deep reticular dermis
Many capillary networks to provide oxygen and nutrients
Collagen and elastin provide shape and elasticity
Hair follicles, glands, erector pili muscles and nerve endings

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10
Q

Describe the hypodermis

A

Also called subcutaneous tissue (means tissue under the skin)
Comprised of loose connective tissue and adipose tissue
Connects skin to muscle, maintains temperature, adipose stores glucose that can be used for energy and helps with protection

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11
Q

What causes acne?

A

Hair follicle gets clogged with oil and dead skin cells
Influenced by high oil levels, hormones, genetics, bacteria and inflammation

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12
Q

What are the symptoms of acne?

A

Usually on face, black, chest and shoulders
Presents as whitehead, blackhead, pustule, cyst

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13
Q

What is the treatment for acne?

A

Refer to dermatologist or GP
Topical benzoyl peroxide or salicylic acid
Oral hormone, AB or isotretinoin

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14
Q

What causes psoriasis?

A

A chronic autoimmune disease causes mass skin cell production that accumulates on surface of skin

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15
Q

What are the symptoms of psoriasis?

A

Commonly on elbows, knees, scalp and back
Thick silver scales/red patches
Flares up when stressed, infection, injury, weather changes, some medication

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16
Q

What is the treatment for psoriasis?

A

Refer to dermatologist/GP
Topical and oral medication, light therapy

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17
Q

What is skin cancer?

A

Abnormal cell growth due to damaged cell DNA
Usually caused by prolonged UV radiation exposure
Can be BCC is stratum basale, SCC in keratinocytes or melanoma in melanocytes

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18
Q

What is the treatment for skin cancer?

A

Refer to dermatologist/GP
Needs a biopsy
Medication, radiation therapy or excision

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19
Q

How does the body produce and retain its own heat?

A

Heat is produced as a by product of metabolic processes
Skin helps to retain this heat, especially adipose tissue

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20
Q

What might cause the body to overheat?

A

Illness, exertion, hot environment, medication

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21
Q

How does the body thermoregulate when too hot?

A

Dilates capillary beds in the skin so more heat can be transferred out
Sweat is produced (salt and water fro eccrine glands in dermis). It is released onto the skin where heat is transferred into it and then gets evaporated off the body
Negative feedback loop

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22
Q

How does the body thermoregulate when too cold?

A

Constricts capillary networks in the skin so less heat is transferred out.
Activates erector pili muscles in the dermis to cause shivering - metabolic processes produce heat
Negative feedback loop

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23
Q

What is an apocrine gland?

A

Located in armpits and genital areas
Activated at puberty - hormone triggered
Responsible for body odour and pheromones
Specialised forms exist e.g. glands in ear makes earwax, ciliary gland in eye controls tears, mammary helps with milk production

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24
Q

What are eccrine glands?

A

Activate at birth
Produce sweat

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25
What are the symptoms of hypothermia?
Shivering Pale Numb Fatigued Confused Uncoordinated movement and speech Severe cases: unconscious, ectopics, respiratory failure
26
What is the treatment for hypothermia?
Move patient to warm area Get patient dry Insulate them Start gentle re-warming (warm drink, warm blanket) Transport to ED
27
What are the 3 phases of hyperthermia?
Heat cramps: muscle cramp/spasm from dehydration and electrolyte imbalance Heat exhaustion: weak, dizzy, nausea, headache, tachycardia Heat stroke: temp above 40, confusion, agitation, ALOC, hot/dry skin - no sweat
28
In general, how does skin provide sensory information?
There are receptors in the dermis specialised in pressure, touch, heat, vibration and pain which relay information back to the brain when activated. This allows differentiation of stimulus and position. This mechanism diminishes with age
29
What is vitamin D synthesis?
Occurs in the epidermis UV radiation induces a reaction to convert pro vitamin D into vitamin D Important for calcium regulation, cell signalling and DNA repair
30
How does BSA and mass ratio affect thermoregulation?
A low mass:high BSA means heat is exchanged rapidly = get cold quickly and get hot quickly (e.g. a baby) A high mass:low BSA means heat is exchanged slowly = increased disease states and fevers (e.g. an obese person)
31
What is the rule of nines?
A method of calculating BSA Head: 4.5% each side Chest/back: 9% each side Abdomen/lower back: 9% each side Arms: 4.5% each side Legs: 9% each side Groin: 1%
32
What is folliculitis?
Bacterial infection on skin causing inflamed hair follicles. Usually in shaved areas, where clothes rub or high sweat zones SX: Red, itchy, painful pustules TX: warm compress, good hygiene, topical/oral AB
33
What is cellulitis?
A bacterial infection in the deep skin layers and tissue. Usually staph or strep. Commonly occurs in legs and more common in DM and those with reduced circulation SX: red, swollen, warm, painful TX: ABs and wound care
34
What is dermatophytosis?
Ringworm. A fungal infection affecting the skin, scalp or nails SX: red, circular rash with a raised edge and clear centre, itchy, scaly TX: antifungal
35
What is tinea pedis?
Athletes foot. SX: red, itchy/burn, peeling, fissures, blisters TX: good hygiene, antifungals
36
What is candidiasis?
Fungal infection - oral/vaginal SX oral: white patches, pain, bleeding TX: antifungal
37
What is molluscum contagiosum?
A viral skin infection SX: round, firm, painless bumps TR: highly transmissible via contact
38
What is varicellar zoster?
Viral infection causing chicken pox SX: itchy, blister-like rash, fever, fatigue etc TR: highly transmissible via droplet
39
What us herpes zoster?
Viral infection causing shingles. Chicken pox virus stays dormant in ganglia and can reactivate later in life (usually if patient is susceptible) SX: painful, blistering rash in a cluster along a dermatone
40
What is measles?
A viral infection SX: flu SX + blotchy, red rash. Can start as small white spot with blue/white centre inside the cheeks. TR: droplet and contact
41
What is scabies?
Sarcoptes mite burrows in the skin SX: intense itch, rash, commonly on wrist, elbow, fingers, waist and genitals TR: contact TX: permethrin, benzoyl benzoate, hygiene
42
What is pediculosis?
Lice affecting hair, body or pubic area SX: itching, visible lice TR: contact TX: OTC medications and hygiene
43
What are ticks?
Parasite attaches to skin SX: red, itch, swelling, painless, flu SX TX: remove with tool/tweezer
44
What is the management of people with skin issues?
Refer to GP unless systemic symptoms are present
45
What is allergic contact dermatitis?
Immune system reacts to an allergen which comes into contact with skin SX: red, itch, swell, blister, dry, scale
46
What is irritant contact dermatitis?
Direct irritation on the skin without an immune response
47
What is atopic eczema/dermatitis?
Irritated skin Acute SX: red, oedema, scaly Chronic SX: scratching causes dry, hard, thick areas TX: avoid allergen, steroid, AH, moisturiser, care routines
48
What do we need to consider with paediatric skin?
High BSA:mass ratio = rapid heat loss/gain Different BSA calculation is required because of big head (18%) Skin cells are smaller + less collagen so reduced strength and cushioning Skin is less acidic so more prone to infection
49
What do we need to consider with geriatric skin?
Skin layers are less tightly adhered = sagging and lines Hypodermis thin = less protection Reduced healing and skin integrity Less blood vessels and nerves = reduced thermoregulation and sensation
50
What is a pressure injury?
Localised damage to skin and tissue from prolonged, continual pressure Compressive and shearing forces on the skin Circulation gets impaired which reduces oxygen and nutrients to the skin 4 stages
51
What are the 4 stages of a pressure injury?
1: area is red + warm, burn/itch/pain 2: area may be open, scraped or blistered, discoloured, painful 3: area is pitted/cratered 4: large wound involving underlying structures
52
What is the TX for a pressure injury?
Transport if severe otherwise refer to GP or utilise own care network Relieve the pressure May need debridement, wound care, grafting, nutrition support
53
What causes burns?
Heat Electricity Radiation Chemical
54
What is a first degree burn?
Epidermis only SX: red, mild-moderate pain, minor swelling
55
What is a second degree burn?
Superficial: slightly extends into dermis Deep: extends well through the dermis SX: blistered, painful, red/mottled, swelling, oozing
56
What is a third degree burn?
All layers and structures beneath are affected SX: white/charred area, can be painless, dry, leathery
57
What other symptoms can be present with burns?
Shock (tachypnea, tachycardia, weak pulse, pale/clammy) SOB if inhaled Swelling = reduced ROM Infection
58
What is the TX for a first degree burn?
Cold running water for 20 minutes Apply dressing OTC analgesia and topicals Refer to GP/pharm if needed
59
What is the TX for a second degree burn?
Cooling Analgesia Wound cleaning and dressing
60
What is the TX for a third degree burn?
Transport to ED with paramedic support

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