Transcript integumentary

INTEGUMENTARY
UNIT 3
MUSCULOSKELETAL
SKIN
•Functions ??
–Protection
–Temp Regulation
–Secretions
–Sensation
–Synthesis of Vit D
–Blood Resevoir
Age-Related Changes
•Lentigines
–AKA Liver Spots
•Senile Purpura
•Senile Angiomas
•Seborrheic Keratoses
•Acrochordons (tags)
Purpura
Lentigines
Seborrheic Keratoses
Acrochordons
DATA COLLECTION
•Objective Signs
•Subjective Signs
OBJECTIVE SIGNS
–Must be able to
describe what you
see, feel
•Macule ex freckle
•Papule ex. mole
•Nodule / Tumor
OBJECTIVE SIGNS
•Vesicle ex. herps
•Bulla ex. blister
•Pustule ex. acne
•Wheal ex. bite
•Plaque
OBJECTIVE SIGNS
•Scale
•Crust
•Fissure
•Ulcer
OBJECTIVE SIGNS
•Abrasion
•Desquamation
•Excoriation
•Purpura
SUBJECTIVE
•Listen to pt.
–Pruritis
–Pain
–Numbness
–Tingling
–Bruising tendency
SUBJECTIVE
•Chief Complaint
•Past History
•Review of Systems
•Data Collection helps
determine cause
SKIN / BODY SYSTEMS
•CIRCULATORY
•URINARY
•NERVOUS
•DIGESTIVE
•HYDRATION LEVEL
PERSONS OF COLOR
•Cyanosis = Grayish tone
•Jaundice = Check Sclera
•Erythema = purple or
dark gray
•Rashes – better seen by
shining light at angle or
stretching skin
DIAGNOSTIC TESTS
•Microscopic Exam
–Fungal, Viral, Mites
•Wood’s Light Exam
–Pigmentation
–Superficial Infections
DIAGNOSTIC TESTS
•Patch Testing
–Allergy
•Biopsy
Shave, Punch,
Excision
MEDICAL TX.
•Dressings
•Negative Pressure
Wound Therapy
•Soaks and Wet Wraps
•Phototherapy
Drug Therapy
•Keratolytics
•Topical Antibacterials
•Antivirals
•Topical Antifungals
•Topical Anti-inflam.
Drug Therapy
•Vitamin A Derivatives
•Pediculocides and
Scabicides
•Antipsoriatics
•Photosensitivity Drug
SURGICAL TX.
•Plastic surgery
•Debridement
•Skin and tissue graft
–Free graft
–Pedicle graft
Pruritis
•Common Symptom
– of skin and systemic
disorders
•Treatment
–Aimed at cause (if known)
Pruritis
•Symptom treatment
–Avoidance of Irritant
–Avoid temp. extremes
–Less frequent and
cooler baths
–Emollients
Pruritis
•Medication
–Topical Agents
–Systemic
Antihistamines
–Corticosteroids
–Antianxiety
Skin Conditions
•Urticaria - hives
–Sudden appearance of
wheals that itch and
burn
–Causes
–Watch for angioedema
•Hives - Treatment
–Cool water
–Cool compresses
–Antipruritic lotions
–Antihistamines
•Benadryl
–Epinephrine
•Vitiligo
–Lacking pigmentation
•Dermatitis / Eczema
–Small vesicles
–Pruritic, reddenend skin
–May see crusts from
oozing vesicles
Psoriasis
•Red patches covered
with silvery scales
that shed
•On outside of elbows,
knees
•On scalp & lower back
Psoriasis Treatment
• No cure
• Reduce scaling and itching
–Therapeutic baths
–Wet dressings
–Lubrication
–Coal tar preps
–UV light
INFECTIONS - VIRAL
•WARTS - verrucae
•Papules - flesh colored,
yellow, brown
•Cause: HPV
•Tx: electrodesiccation,
curettage
•HERPES SIMPLEX
•Fever blisters / cold
sores
•Painful vesicles on
face, lips
•Cause: HSV - type 1
•Tx:  spread by good
personal hygiene,
acyclovir
HERPES ZOSTER
•AKA Shingles
•Varicella zoster
virus
–Same virus as
chickenpox
HERPES ZOSTER
• Reactivation of viral
cells residing in
ganglion cells
• Vesicular eruption
following sensory
nerves
•Painful
Shingles Treatment
•Analgesics
•Systemic Antivirals
•Glucocorticoids
•TOPICALS antiviral, etc.
INFECTIONS BACTERIAL
•Impetigo
•Vesicles that ooze and
form yellow crust
•Staph, strep
•Very contagious
•Tx: systemic
antibiotics
FOLLICULITIS
•Staph infection of
hair follicle
•Pustules
•FURUNCLE - BOIL
•Firm, red, tender
nodule with pus and
core
•CARBUNCLE - BOILS IN
A CLUSTER
•May drain at multiple
sites
•Dangerous to pick or
squeeze boils
•Tx: warm soaks, I & D
PARASITES
•Scabies
–Caused by mite
burrowing under skin
–Pruritic threadlike red
lines
–Spread by close
personal contact
Scabies
•Tx:
–Topical scabicide
•Repeated in 1 week
–Clothing and Bed
Linen washed in hot
water
LICE
•Difficult to eradicate
due to nits
•Sx: itching & nits
–Seen as tiny white
particles attached to
hair shaft
•Tx:
LICE
–Pediculocide
shampoo / lotion
–Usually needs to be
repeated
–Wash bed linen /
clothing
TICKS
•Can cause lyme ds.
•Take precautions
• Know how to remove:
–Grasp tick near skin with
tweezers and use firm,
steady motion to remove
SEBACEOUS GLAND
DISORDERS
•Sebaceous Glands
–Secrete oil
•Sebaceous cysts
–Plugged gland  hard
nodule
Seborrheic Dermatitis
•Characterized by:
–Fine scales, thick
crusts or oily patches
–Yellow, white or red
scales
–Pruritis common
Seborrheic Dermatitis
•Tx:
–Selenium sulfide / coal
tar preps
–Nizoral (ketoconazole)
–Topical
Corticosteroids
Seborrheic Dermatitis
•TX:
–Low fat diet
–Exercise
–Sunlight
– Stress
–Rest
ACNE
•Affects hair follicles
and sebaceous glands
•Characterized by:
–Comedomes, pustules
and cysts
ACNE
•Etiology / Risk factors
–Androgenic hormones
•Increase sebum / bacteria
–Progesterone in BC pills
–Oil based cosmetics
–High doses of systemic
corticosteroids
BURNS
•Injury caused by
heat
–Thermal
–Chemical
–Electrical
–Radiation
–Inhalation
BURNS
•Leading cause of
accidental death
•75% preventable
•Review Safety and
Emergency Care
BURNS
•Classified by:
–Burn Size
–Burn Depth
–Burn Severity
Burn Size
• RULE OF NINES
–Estimates % of body
burned
•9% - head, arms
•18% - legs & front/ back
of torso
•1% - genitals
Burn Depth
–Superficial (first
degree)
•Like a sunburn
•Pink to red and
painful
Burn Depth
•Superficial Partial
Thickness (second
degree)
–Painful, blistered or
weepy
–Pale to red or pink
Burn Depth
•Deep Partial Thickness
(second degree)
–Large thick walled
blisters or
–Weeping, cherry red
exposed dermis
–Painful
Partial Thickness
Burn Depth
•Full thickness
(third degree)
–Dry, leathery
–May be red, white,
brown or black
–Little pain
Deep Partial & Full Thickness
Full Thickness
Burn Severity
•Based on:
–Size
–Depth
–Location
–General Health
–Mehanism of Injury
Burn Injury Effects
•Fluid Balance
–Fluid and Electrolyte
Loss
–Decrease blood
Volume
Burn Injury Effects
•GI Function
–Dec. blood flow to
intestines
•Ileus common
–Curlings Ulcer
Burn Injury Effects
•Immune System
–Depressed
–Risk for infection
Burn Injury Effects
•Respiratory
–Inhalation Injuries
–Hypoxia
–Pulmonary Edema
–ARDS
Stages of Burn Injury
•Emergent
•Acute
•Rehabilitative
Emergent Care
•ABC’s
•Respiratory Care
•F & E Balance
•Renal Function
•Infection
•Pain
Acute Stage Care
•Wound Care
–Dressings
–Debridement
–Skin Grafting
–Scarring
Rehabilitative Stage
•Months to years
•Prevent Complications
•PT / OT
•Vocational Counseling
•Social Services
Burns
•Nsg. Diagnosis
–What can you think
of ????
–Oh, the possibilities!
SKIN NEOPLASMS
•NONMALIGNANT
–Moles
–Angiomas
–Keloids
MALIGNANT
•Skin is most common
form of CA
•Sun exposure - leading
cause
•  Over 40
• With smoking
ABDC Rule
•Asymmetry
•Border
•Color
•Diameter
SX. OF SKIN CA
•Change in wart or
mole
–Size, shape, color
–Flaking, bleeding
–Sudden elevation
–Hair growth
–Itching or burning
SKIN CA TX.
•Removal by:
–Curettage
–Electrodessication
–Wide excision
–Moh’s surgery
BASAL CELL
CARCINOMA
•Most common skin CA
in whites
• Painless nodular lesion
–has pearly appearance
•Grows slowly
SQUAMOUS CELL
CARCINOMA
• Nodules or red
scaley patches
•Rim of ear, face
lips, mouth
•May metastasize
MALIGNANT
MELANOMA
•Most virulent
• Dark, irregular
pigmented areas
•Tend to be > 6 mm
•Curable in early stages
•Highly metastatic