Integumentary System Flashcards by Caroline Sparks

What is the largest organ of the body?

skin

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How much BW does the skin consist of?

15-20%

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Primary fxn of integumentary

protect underlying structures from external injury and harmful substances

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Other fxns of the integumentary system

holding organs together

sensory perception

fluid balance

controlling temp

absorbing UV

metabolizing vit D

synthesizing epiderminal lipids

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Primary lesion vs Secondary Lesion

Primary - first lesion to appear, visually recognizable

Secondary - when changes occur in primary lesion (scale, crust, erosion, ulcer, atrophy)

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Signs and Symptoms of skin disease

rash, Pruritus (itching), urticaria (hives), blisters, xeroderma (dry skin)

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Lab values to look for

prealbumin (indication of nutritional status(

glucose, hemoglobin, hematocrit (monitor wound healing)

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What are some general changes with aging and the integumentary system?

gray hair, balding and loss of secondary hair, increased facial hair,

lax skin, vascular changes (decreased elasticity) dermal or epidermal degenerative changes and wrinkling

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When does the most of the obvious chnages to the skin occur?

First during puberty because of HORMONES

then again in older adulthood

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What integumentary change might women experience after menopause?

balding

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The use of BC or pregnancy may result in what?

changes in hair growth an hyperpigmentation of the cheeks and forehead known as melasma or pregnancy mask

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Structural and functional changes in the skin result in

diminished pain perception

increased vulnerability to injury

decreased vascularity

weakened inflammatory response

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With again, blood vessels within the ___ are reduced in number and the walls are ____

reticular dermis (deeper layer of dermis)

thinned

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The decrease in blood flow and thinner walls with aging contribute to what?

pale skin and impaired ability to thermoregulate = increased susceptibility of older individuals to hypothermia and hyperthermia

(get colder or hotter easier)

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Why does the protective function of the skin diminish with aging?

diminished barrier function of the stratum corneum

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When the stratum corneum becomes thinner, what does this make older adults more sensitive to?

skin becomes more translucent and paper thin, reacting more readily to minor changes in humidity, temperature, and other irritants

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With aging, fewer melanocytes result in

decreased protection against UV radiation

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With aging, a reduction in Langerhans cells represent what?

a loss of immune surveillance and increased risk of cancer

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The epidermis is one of the body’s principal suppliers of _____

Therefore, aging contributes to _____ deficiency. What does this result in?

Vitamin D

Vitamin D deficiency

altered bone pass and osteoporosis

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The skin is sensitive to

oxidation damage or process

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Bacterial Infections

impetigo
cellulitis

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Viral infections

Herpes Zoster
Warts (Verrucae)

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Fungal Infections (Dermatophytosis)

Ringworm Tinea Corporis)

Athletes Foot (Tinea Pedis)

Yeast (candida)

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Other Parasitic Infections

Scabies
Pediculosis

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Benign Lesion

seborrheic keratosis Nevi (moles)

Premalignant Lesions

actinic keratosis Bowen disease

Malignant Nonmelanoma Carcinomas

basal cell carcinoma squamous cell carcinoma

Other skin cancers

malignant melanoma kaposi sarcoma

What skin disorders are associated with immune dysfunction?

psoriasis lupus system sclerosis polymyositis and dermatomyositis (know generally each)

Burn severity determined by

depth of injury and total body surface area (TBSA) Depth determined - the temperature and source of energy and duration of exposure

TBSA Wallace arms head anterior thorax legs genital

9% each arm 9% head 18% anterior thorax 18% each leg 1% genital

Who is especially vulnerable to burns

children (extremes of both ends - children and older adults)

Thermal burns account for approx __ of all burn center admissions

75%

4 types of burns

friction burns (road rash, turf burns) chemical burns electrical burns radiation burns (prolonged UV exposure)

General risk factors for burns

age, lack of smoke detectors, psychomotor disorders (impaired judgement/mobility/drug/alcohol), smoking, rural location, low SES, ocupation and fireworks

Why are children at higher risk for burns?

inadequate supervision and abuse with scald injuries

Cardiovascular response due to burns

increased vascular permeability body edema decreased circulating intravascular blood volume heart rate increases (catecholamines) cardiac output decreases (then normal than increases 24 hours after)

Renal and GI response to burns

shunting blood from kidneys and intestine oliguria (decreased urine output) and intestinal paralytic ileus

Immune System response to burns

immunosuppressed increased risk of infection and life-threatening sepsis

How do electrical burns occur?

electricity travels through body resulting in internal damage and protentional multisystem injury

T/F Entrance wounds of electrical burns are larger more exploitive than exit wounds

F Exit wounds larger

T/F Alternating current i smore dangerous than direct current

true AC associated with cardiopulmonary arrest, ventricular fib, tetanic muscle contractions

Which chemicals burn deeper- acids or alkaline?

Alkaline - continue to burn until neutralized

T/F Burn location influence injury severity

T burns of the hands and joints can result in permanent physical and vocational disability

How is pain with full thickness burns versus partial-thickness injuries?

full-thickness - nerve endings destroyed, painless skin superficial partial thickness injuries - nerve endings intact and exposed

What happens with peripheral nerve regeneration?

increased pain with healing

What is the most common and life-threatening complication of burn injuries?

infection those with extensive injuries or difficult wound closure more at risk

Inhalation injury may lead to

respiratory, pneumonia and sepsis

Hypertrophic scarring

result of burns associated with considerable morbidity and potential lifelong disfiguration

Emergent phase of burn care

fluid resuscitation, ventilatory management, assessment of burn, early wound management

Acute phase of burn management

burn wound management and infection prevention debridement and skin grafting PT**

Rehab phase

return to max independence and function

What type of grafts exist?

autografts (for full thickness burn) allografts - cadaver xenografts - pig skin biosynthetic grafts

What 3 main factors determine prognosis of bruh injury

TBSA, age, inhalation

What phase of burn care are PTs involved in?

acute and rehab

Diabetic ulcers

aka neuropathic ulcers, can occur in anyone with loss of sensation

What system is used to classify neuropathic ulcers

Wagner system SINBAD score (site, ischemia, neuropathy, bacterial infection, area, depth

What are common sites of pressure ulcers?

bony prominences heels, sacrum, ischial tuberosities, greater trochanters, elbows, scapular or under medical devices

Stage 1 pressure injury

nonblanchable erythema of intact skin

stage 2 pressure injury

partial thickness skin loss with exposed dermis

stage 3 pressure injury

full-thickness skin loss

stage 4 pressure injury

full thickness skin and tissue loss

unstageable pressure injury

obscured full thickness skin and tissue loss

Deep pressure injury

persistent nonblanchable deep red, maroon, pr purple discoloration

What does it mean that a pressure injury can not be back staged?

once its classified as a 2 or 3 or 4 it will stay that level until its resolved

What are the primary factors that cause a pressure injury

interface pressure (externally) or pressure with shearing forces

What are some intrinsic factors that cause pressure wounds

What are some extrinsic factors that cause pressure wounds

What do pressure injuries develop? (Pathogenesis)

constant pressure = compresses capillaries an occludes BF causing ischemia and tissue necrosis necrotic tissue predisposes bacterial invasion and subsequent infection, preventing healthy granulation

What pressure wound location is often large and undermined?

sacral because the tissue mass over the sacrum is thin and erodes easily

Who is at greater risk for infection/sepsis progression after a pressure injury or burn

immunosuppressed or diabetics they can mount an inflammatory response to the infection

Evidence of an infection

erythema, heat, swelling, pain, purulence, delayed healing, foul odor

Is necrotic tissue painful?

No, its dead so no sensation but surrounding skin might be painful

What might the PT do to assist with pressure injuries?

establish safe and effective turning schedules

when should you reposition a high risk patient when in bed, sitting and if they can move independently?

in bed - 2 hours sitting - 1 hour move independently - 15 min

the bed should be elevated no higher than ___ when the patient is supine

30 degrees