Med surg integumentary

squamous cell carcinoma

Type of skin cancer more serious than basal cell carcinoma; often characterized by scaly red papules or nodules. Invasive and mets by blood or lymph system, mets account for 75% of deaths from it

assessing rash

gently stretch skin, penlight might be helpful, skin texture, boarders of the rash (circular? disffuse? spreading?), mouth and ears, temp, lymph nodes

palms, soles, lips

hair is everywhere except?

assessment

health hx, skin allergies, previous skin problems, skin cancer, names of cosmetics, soaps, shampoos if recent change, specific onset of s/s, location, duration, pain, itching, rash, discomfort, tattoos

TEN & Stevens-Johnson Syndrome risk factors

immunocompromised, abnormal metabolism of medication

precursor for melanoma: atypical/dysplastic nevus

indicates increased risk for melanoma, white population, TX: biopsy and surgical removal, know ABCDE

cellulitis

inflammation to subq area, secondary to infection, s/s hot, tender, erythema, edema, possible systemic symptoms, Tx: moist heat, immobilize, evaluation, antibiotics, admission if severe

B

irregular Boarder

vitamin synthesis

skin exposed to UV light can convert substances that are needed to make Vit D, helps prevent osteoporosis and rickets, function of the skin

confluent

skin lesions that merge together

assessment of skin

skin should be warm, includes mucous membranes, scalp, hair, nails, observe temp, moisture, skin texture, lesions, vascularity, mobility, condition of hair and nails, color, touch the skin

Psoriasis management

slow rapid turnover, no known cure, decrease stress, photo chemotherapy, pharmacologic therapy, follow up with MD, psychological component- could be lonely, people may feel they are contagious

vesicle

small, clear, fluid filled blisters less than 0.5 mm in diameter, ex: varicella, herpes zoster, second degree burn, primary skin lesion

telangiesctases

spider veins

striae

stretch marks, elastic fibers in the reticular dermis rupture

environmental hazards

sun- premature aging of the skin (decrease in thickness of dermis), irritants and allergens: patch testing, OTC meds, radiation: erythema, dry skin, edema, hypopigmentation, hyperpigmentation- goes through the skin

hypodermis

the layer of skin beneath the dermis, which serves as a storage repository for fat

functions of the skin

thermoregulation, body is always producing heat, heat leaves through the skin, > blood flow to the skin will decrease the temp and vice versa, could lose 2-4L/hr in hot environments, emotional stress can cause excessive sweating

dermis

thickest layer, made up of fibroblast cells, contains nerve endings, sensory receptors, capillaries and elastic fibers

Lichenification

tightly packed set of papules that thickens skin; caused by prolonged intense scratching, secondary skin lesion

Merkel cells

transmit stimuli, situated next to sensory nerve endings, slow adapting

assessing wound edges and margins

undermining or tunnelling

asymmetric

unilateral distribution

assessing skin lesions

vary in size, shape and cause, primary (disease), secondary (scratching, trauma, infections), darker skinned: may be black, maroon, purple or grey, lighter skin: tan or red, how the lesions look: scabies vs shingles

C

veriegated Color

diffuse

widely spread out

jaundice

yellowing skin, elevation of serum bilirubin and is first seen in sclerae and mucous membranes, Icterus: yellowing of sclerae

keratinocytes

The most abundant epidermal cells, they function mainly to produce keratin. Form in basal layer and work their way up to the top where they die

keloid

Thick scar resulting from excessive growth of fibrous tissue, secondary skin lesion

eccrine glands

found in most areas of the body, Fx: cool the body by evaporation, excrete waste products, and moisturize, temp regulation, not smelly

assessing wound size

centimeters, diameter and depth of the wound and surrounding erythema

how a scar is formed

clot forms, fibroblasts are attracted to it, break down clot and replace it with collagen, it is not functional skin, and sweat glands and hair follicles are not able to grow

grouped

clusters of lesions

assessing surrounding skin

color, suppleness and moisture, irritation, induration, and scaling

assessment of skin cont

color: ranges from person to person and different areas, almost every process involving skin will have a skin change, hypopigmentation vs hyperpigmentatoin, pink or reddish hue: vasodilation, pallor: best observed in the conjunctivae or around mouth, or palms and soles of dark skinned people, dark skin: melanin is more and produces faster

psoriasis

common, chronic, noninfectious, inflammatory dz, hereditary defect causes overproduction of keratin, cyclin in nature

TEN & Stevens-Johnson Syndrome manisfestations

conjunctival burning or itching, fever, cough, sore throat, HA, extreme malaise, rapid onset of erythema, large bullae develop in some areas, others have sheets of epidermis that slough off, finger/toenails, eyebrows and eyelashes may be shed, skin is excrutiatingly tender

management for impetigo

contact isolation, topical antibiotic after removal of crust, maintain meticulous hygiene

TEN & Stevens-Johnson Syndrome managment

control fluid and electrolyte balance, prevention of sepsis, prevention of ophthalmic complications, treated in burn center

keratin

dead cells have this fibrous protein that forms the outer barrier of the skin, it has hardening ingredient of hair and nails

malignant melanoma management

depends on level and depth of lesion, surgical excision, regional lymph node dissection (helps prevent cancer from traveling), chemo/radiation for mets, chemo directly to site S/E- nausea, tired

D

diameter > 6mm

papule

elevated lesions usually less than 0.5 mm in diameter that can be felt or palpated, Ex: wart, elevated moles, lipoma, basal cell cancer, primary skin lesion

Nodule, tumor

elevated, solid, palpable mass with irregular border- may be malignant (cancerous) or benign, primary skin lesion ex. tumor

Pustule

elevated, usually yellow topped lesions that contain pus, acne, impetigo, primary skin lesion

basement membrane

epidermis and dermis are separated by this

nonmelanoma skin cancer management

eradicate the tumor, once determined, may need additional surgery, possibly radiation

E

evolution/elevation

lipoma

fatty tumor, below skin (harmless)

immune response function

function of the skin, langerhans cells

TEN & Stevens-Johnson Syndrome complications

sepsis, conjunctival retraction, scars, and corneal lesions

solitary

single lesion

diagnostic evaluation

skin biopsy, patch testing, skin scrapings, clinical photographs

functions of integumentary system

-Protection -Barrier from bacteria and viruses -Insulation -Sensory perception -Control of heat regulation -Aesthetic function -Fluid balance

generalized

Diffuse distribution

bulla

Large blister containing watery fluid, primary skin lesion

epidermis

Outer layer of skin, has 5 layers

cyanosis

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood. light colored skin: lips fingertips, and nail bells, dark skin: may appear blue or dull, central cyanosis: mucous membranes, peripheral cyanosis: vasoconstriction, cold, clammy, etc, look at conjunctivae for pallor to petechiae, go from peripheral to central when assessing for cyanosis

wheal

firm, edematous, and irregularly shaped area, sizes vary, may last only a few hours, Ex: insect bite, urticaria, angioedema, primary skin lesion

macule

flat, nonpalpable lesion usually less than 0.5 mm in diameter, red, blue, or brown, ex: freckles, petechiae, measels, flat mole (nevus), vitiligo, primary skin lesion

sweat glands

found all over but highly concentrated in palms of hands and soles of feed

Herpes Zoster Pathophysiology

after chickenpox runs its course the virus lies dormant inside nerve cells, later can become active again effect peripheral nerves to the skin where you see a rash of small fluid filled vesicles, about 10% of adults get shingles during their lifetime

herpes zoster management

antiviral within 72 hours, pain may continue when when skin lesions disappear (postherpetic neuralgia- persistent pain patterns, may need analgesics and systemic corticosteroids

scar, cicatrix

areas of fibrosis, become thickened and raised, Ex: surgical incision, healed wound, secondary skin lesion

psoriasis complications

asymmetric rheumatoid factor-negative arthritis of multiple joints occurs in about 5% of people with it, relationship is not understood

A

asymmetry

Impetigo

bacterial skin infection characterized by isolated pustules that become crusted and rupture, vesiculopustular, honey colored crust, surrounded by erythema, pruritus, primarily on face

Zosteriform

bandlike distribution along a dermatome area

symmetric

bilateral distribution

Malignant melanoma manisfestation

biopsy, H&P, chest x ray, blood count, liver function tests, CT scan, tumor staging- T- tumor size, N- Nodal involvement, M-metastasis

petechiae

broken capillaries or platelet abnormalities

herpes zoster (shingles)

caused by varicella zoster virus, painful vesicular eruption along the area of distribution of the sensory nerves from one or more posterior ganglia, follows a nerve pathway, if it's in/around your eyes it is a medical emergency

melanocytes

cells that produce melanin, provides protection against UV light

scars

keloid goes outside the boarder, hypertrophic does not

ecchymoses

large bruised area

vericose vein

larger bulging veins

apocrine glands

larger, found in axillae, anal region, scrotum, and labia majora, associated with puberty, bacteria is what gives us the odor

integumentary system

largest organ of the body, 12% of body weight, responsible for temp, maintenance of fluid and electrolytes, protection from infection and environment, is made up of skin, hair, nails, sweat and sebaceous glands

psoriasis manisfestations

lesions appear red, raised patches, and covered with silvery scales, if scales are scraped away a dark red base of the lesion is exposed, producing multiple bleeding points, may be pruritic ---> scratching ---> increased risk of infection, more likely to happen at scalp, elbows, knees, lower part of back, and genitalia, usually bilateral, nails may also be affected

localized

limited areas of involvement that are clearly defined

ulcer

loss of epidermis and at least part of the dermis, Ex: pressure injury, chancre

basal cell carcinoma (BCC)

malignant tumor of the basal layer of the epidermis; the most common type of skin cancer, can happen in sun and sun protected areas, rarely metastases, recurrence common

gerontologic considerations of skin

many skin changes and lesions are normal

nevi

moles

assessing wound bed

necrotic, slough, granulation, exudate, color, and odor

sebaceous glands

oil, associated with hair follicles

herpes zoster manifestations

pain, usually around the nerve that is affected or itching and tenderness, early vesicles contain serum, later can be purulent, inflammation is usually unilateral, lasts 1-3 weeks, may have eye pain if ophthalmic nerve involved

Plaque

palpable lesions greater than 0.5 mm in diameter that are elevated or depressed compared to the skin surface, may be flat topped or rounded, Ex: psoriasis, seborrheic and actinic keratoses, primary skin lesion

assessing skin lesions cont

palpation, moisture, temp, texture, turgor, nails: lines through nails, paronychia (inflammation), clubbing: straightening of the normal angle- chronic low O2

nonmelanoma skin cancer

papules and plaques on sun exposed areas, older white population, most common precancerous skin lesion, Tx: surgery, meds, dermabrasion, biopsy if needed

langerhans cells

play a role in the skin immune system reactions, traffic controllers, regulate immune responses, decide whether youre going to have a full body or local reaction

Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS)

potentially fatal skin disorders, both are triggered by a reaction to meds, sulfa drugs, anticonvulsant agents, NSAIDS are the most frequent cases, your skin sloughs off, you are treated in a burn center

subcutaneous tissue

primarily adipose tissue, source of energy, cushions and insulates, promotes skin mobility, molds body contours, temp regulation

Psoriasis pathophysiology

primary cause unknown, evidence suggest immunologic basis, stress and anxiety aggravate it as well as trauma, infections, and seasonal and hormonal changes, epidermal cells are produced 6-9 times faster than normal, profuse scales or plaques

patch

primary skin lesion

erythema

redness of the skin, look for increased warmth or smoothness or hardness

providing skin care, health promotion

rest and sleep, exercise, hygiene, nutrition, self treatment- teach to follow OTC directions, protect skin, prevent infection, reverse inflammation

hair, nails, and glands

root is formed in dermis and hair shaft that comes out, grows in a hair follicle, cycles of growth and rest, if hair follicle and stem cells are destroyed, hair does not grow, shaving doesn't change its thickness, color or rate, eyebrows, lashes, nose and ear hair filters out particles, pigment gives you color, white or gray means no pigment

cyst

sac containing fluid, primary skin lesion

seborrheic keratosis

scaly patches, on oily places on the body

crust

secondary skin lesion

erosion

secondary skin lesion

fissure

secondary skin lesion, a linear crack in the skin extending from the epidermis to the dermis, Ex: athletes foot, chapping, eczema

scales

secondary skin lesion, heaped up keratinized cells, flakey exfoliation, irregular, thick or thin, dry or oily, and variable in size, Ex: flaking of skin after a drug reaction or sunburn

atrophy

secondary skin lesion, thinning of the skin, which may appear dry, and wrinkles, and resembling ciggarette paper, Ex: aged skin, striae

discrete

separate from other lesions