nursing integumentary system

Integumentary systemIntegumentary systemRuby Ruth Roces, R.N., Ruby Ruth Roces, R.N.,

M.D.M.D.

Anatomy and PhysiologyAnatomy and Physiology EpidermisEpidermis

B-asaleB-asaleS-pinosumS-pinosumG-ranulosumG-ranulosumL-ucidum-found in regions w/ thick L-ucidum-found in regions w/ thick corneumcorneumC-orneumC-orneum

- Cells of the epidermis are composed - Cells of the epidermis are composed of keratinocytes, melanocytes, of keratinocytes, melanocytes, langerhans cell, merkels cellslangerhans cell, merkels cells

DermisDermis Hypodermis-fastens skin to Hypodermis-fastens skin to

underlying structuresunderlying structures

Cutaneous appendagesCutaneous appendagesA.A. Eccrine sweat glands-not viscous, Eccrine sweat glands-not viscous,

controlled by cholinergiccontrolled by cholinergicB.B. Appocrine sweat glands-vicous,odor-Appocrine sweat glands-vicous,odor-

producing, controlled by adrenergic, producing, controlled by adrenergic, do not function till pubertydo not function till puberty

C.C. Sebaceous glands- functions for Sebaceous glands- functions for lubrication of hair and skin, hormonal lubrication of hair and skin, hormonal contolcontol

HairsHairs NailsNails

History and AssessmentHistory and Assessment C-haracterC-haracter L-ocationL-ocation I-ntensityI-ntensity T-imeT-ime A-asso. factorsA-asso. factors A-ggravating factorsA-ggravating factors

Macule-flat, circumscribed ,different colorMacule-flat, circumscribed ,different color Patch- macule>2 cmPatch- macule>2 cm Papule-elevated, circumscribed,<1 cmPapule-elevated, circumscribed,<1 cm Nodule->1 cmNodule->1 cm plaque,-elevated, flat topped,>1 cmplaque,-elevated, flat topped,>1 cm Vesicle-sharply marginated,elevated,w/ Vesicle-sharply marginated,elevated,w/

fluid, <1 cmfluid, <1 cm Bullae- vesicular lesion > 1cmBullae- vesicular lesion > 1cm

Scale- flaky accumulation of excess Scale- flaky accumulation of excess keratinkeratin

Crust- collection of inflammatory Crust- collection of inflammatory cells and dried serumcells and dried serum

Excoriations- linear, angular Excoriations- linear, angular erosions,2 to scratching, loss of erosions,2 to scratching, loss of epidermisepidermis

Ulcer- deeper erosion, loss of Ulcer- deeper erosion, loss of epidermis and papillary dermisepidermis and papillary dermis

Lichenification-thickening of skin 2 to Lichenification-thickening of skin 2 to chronic rubbingchronic rubbing

Diagnostic TestsDiagnostic Tests

1)1) Skin BiopsySkin Biopsy Punch, excisional, incisional & Punch, excisional, incisional &

shaveshave

Nursing InterventionsNursing InterventionsPreprocedure - Secure consentPreprocedure - Secure consent

- clean site- clean site

Postprocedure – place specimen in a Postprocedure – place specimen in a clean container & send to pathology clean container & send to pathology laboratorylaboratory – – use aseptic technique for use aseptic technique for biopsy site dressing, assess site for biopsy site dressing, assess site for bleeding & infectionbleeding & infection – – instruct px to keep dressing in instruct px to keep dressing in place for 8hrs & clean site dailyplace for 8hrs & clean site daily

Diagnostic TestsDiagnostic Tests

2)2) Skin CultureSkin Culture Used for microbial studyUsed for microbial study Viral culture is immediately placed Viral culture is immediately placed

on iceon ice Obtain prior to antibiotic Obtain prior to antibiotic

administrationadministration

3) 3) Wood’s Light ExaminationWood’s Light Examination Skin is viewed through a Wood’s Skin is viewed through a Wood’s

glass under UVglass under UV

Nursing InterventionsNursing InterventionsPreprocedure – darken roomPreprocedure – darken roomPostprocedure – assist px in adjusting Postprocedure – assist px in adjusting

to lightto light

Diagnostic TestDiagnostic Test

4)4) Skin TestingSkin Testing Administration of an allergen by Administration of an allergen by

patch, scratch, or ID techniquespatch, scratch, or ID techniques

Nursing InterventionsNursing InterventionsPreprocedure – d/c systemic Preprocedure – d/c systemic

steroids or antihistamines 48steroids or antihistamines 48º º prior, consent, ready prior, consent, ready resuscitation equipmentsresuscitation equipments

Postprocedure Postprocedure – – keep skin-patch area drykeep skin-patch area dry

– – instruct to avoid activities instruct to avoid activities which can increase sweating if which can increase sweating if doing a patch testdoing a patch test – – record site, date, time of test, record site, date, time of test, ff-up & readingff-up & reading

INTEGUMENTARYINTEGUMENTARYDISORDERSDISORDERS

Skin cancerSkin cancer

EtiologyEtiology : :– – chronic friction, irritation & exposure chronic friction, irritation & exposure

to UVto UV

TypesTypes::1. basal cell – most common1. basal cell – most common2. squamous cell 2. squamous cell 3. malignant melanoma – most fatal3. malignant melanoma – most fatal

Squamous cell CarcinomaSquamous cell Carcinoma

Risk factors:Risk factors: UV raysUV rays RadiationRadiation Actinic keratosisActinic keratosis ImmunosuppressionImmunosuppression Industrial carcinogensIndustrial carcinogens

Squamous cell CarcinomaSquamous cell Carcinoma

History and Assessment:History and Assessment: Slowly evolvingSlowly evolving AssymptomaticAssymptomatic Occassionaly bleeding and painOccassionaly bleeding and pain Exophytic nodules w/ varying degree Exophytic nodules w/ varying degree

of scaling or crustingof scaling or crusting

Squamous cell CarcinomaSquamous cell Carcinoma

Diagnosis:Diagnosis: Biopsy- irregular masses of Biopsy- irregular masses of

anaplastic epidermal celss anaplastic epidermal celss proliferating down to the dermisproliferating down to the dermis

Squamous cell CarcinomaSquamous cell Carcinoma

TreatmentTreatment Surgical excisionSurgical excision Mohr’s micrographic surgeryMohr’s micrographic surgery RadiationRadiation prevention-prevention-

Basal Cell CarcinomaBasal Cell Carcinoma

Risk factors:Risk factors: UV raysUV rays May take several forms: nodular, May take several forms: nodular,

ulcerative, pigmented ad superficial ulcerative, pigmented ad superficial

Basal Cell CarcinomaBasal Cell Carcinoma

Hx and Assessment:Hx and Assessment: Usually asymptomatic unless Usually asymptomatic unless

secondarily infected in advanced secondarily infected in advanced diseasedisease

Pearly-colored PAPULE Pearly-colored PAPULE External surface - fine telangiectasia External surface - fine telangiectasia

and is translucentand is translucent

Basal Cell CarcinomaBasal Cell Carcinoma

Diagnosis:Diagnosis: Biopsy- basophilic palisading cellsBiopsy- basophilic palisading cells

Basal Cell CarcinomaBasal Cell Carcinoma

Treatment:Treatment: CurettageCurettage SurgicalSurgical CryosurgeryCryosurgery RadiationRadiation preventionprevention Mohr’s micrographic surgeryMohr’s micrographic surgery

MelanomaMelanoma

Risk factors:Risk factors: Sun exposureSun exposure Fair skinFair skin Positive family historyPositive family history Presence of dysplastic neviPresence of dysplastic nevi

MelanomaMelanomaHx and Assessment:Hx and Assessment: Usually asymptomatic until lateUsually asymptomatic until late Pruritus or mild discomfortPruritus or mild discomfort Recent changed in a previous skin Recent changed in a previous skin

lesionlesion A- asymetryA- asymetry B- border irregularityB- border irregularity C- color variationC- color variation D- diameter(large)D- diameter(large)

MelanomaMelanoma

Diagnosis:Diagnosis: Biopsy- melanocytes w/ marked Biopsy- melanocytes w/ marked

cellular atypia and melanocytic cellular atypia and melanocytic invasion of the dermisinvasion of the dermis

MelanomaMelanoma Treatment:Treatment: Surgical excisionSurgical excision Chemotherapy- metastasisChemotherapy- metastasis

Skin CancerSkin Cancer

InterventionsInterventions: : a.a. preventive measurespreventive measuresb.b. monitoring of any lesionmonitoring of any lesionc.c. have moles or lesions removed if they have moles or lesions removed if they

are subject to chronic irritationare subject to chronic irritationd.d. avoid contact with chemical irritantsavoid contact with chemical irritantse.e. use of sunscreenuse of sunscreenf.f. avoid too much sun exposureavoid too much sun exposure

Actinic KeratosisActinic Keratosis

Risk Factor:Risk Factor: Sun exposureSun exposure

Hx and assessment:Hx and assessment: Asymptomatic unless irritatedAsymptomatic unless irritated Discrete, rough scaling patches and Discrete, rough scaling patches and

papulespapules

Actinic KeratosisActinic Keratosis

Diagnosis:Diagnosis: Biopsy- dysplastic squamous Biopsy- dysplastic squamous

epithelium w/o invasionepithelium w/o invasion

Treatment:Treatment: Topical 5-FuTopical 5-Fu CryosurgeryCryosurgery CurettageCurettage Chemical peelChemical peel preventionprevention

Contact dermatitisContact dermatitis

Etiology:Etiology: – – inflammatory response to contact inflammatory response to contact of an allergenof an allergen- any substance w/c the patient has - any substance w/c the patient has been previously sensitizedbeen previously sensitized

Contact DermatitisContact Dermatitis

Hx and AssessmentHx and Assessment: : a.a. PruritusPruritusb.b. BurningBurningc.c. EdemaEdemad.d. ErythemaErythemae.e. signs of infectionsigns of infectionf.f. vesicles with drainagevesicles with drainage

Contact DermatitisContact Dermatitis Diagnosis:Diagnosis:1.1. Hx and PEHx and PE2.2. Biopsy- eosinophilsBiopsy- eosinophils3.3. Patch testPatch test

Contact DermatitisContact Dermatitis Treatment:Treatment:1.1. AntihistaminesAntihistamines2.2. Prophylactic antibioticsProphylactic antibiotics3.3. Topical steroidsTopical steroids

InterventionsInterventions: : a.a. elevate to reduce edemaelevate to reduce edemab.b. Cold compressCold compressc.c. prevent scratchingprevent scratchingd.d. assist in skin testingassist in skin testinge.e. use hypoallergenic materialsuse hypoallergenic materialsf.f. administer antibiotics, administer antibiotics,

antipruritics, steroidsantipruritics, steroids

psoriasispsoriasis

Etiology:Etiology: – – chronic, non-infectious chronic, non-infectious inflammation involving keratin inflammation involving keratin synthesis caused by stress, trauma synthesis caused by stress, trauma & infection& infection

Koebner’s phenomenonKoebner’s phenomenon – – development of a lesion at a site of development of a lesion at a site of injury e.g. scratchinjury e.g. scratch

PsoriasisPsoriasis

AssessmentAssessment: : a.a. PruritusPruritusb.b. silvery white scales on a round silvery white scales on a round

reddened plaque usually affecting reddened plaque usually affecting scalp, knees, elbows, extensor scalp, knees, elbows, extensor surfaces of arms & legs & sacral surfaces of arms & legs & sacral regionsregions

c.c. Joint inflammation with Psoriatic Joint inflammation with Psoriatic arthritisarthritis

psoriasispsoriasis

ManagementManagement: : a.a. Topical pharma therapy Topical pharma therapy

(tar,anthralin, salicylic acid, (tar,anthralin, salicylic acid, retinoid compound, corticosteroid)retinoid compound, corticosteroid)

b.b. Intralesional therapy Intralesional therapy (triamcinolone acetonide)(triamcinolone acetonide)

c.c. Systemic therapy (methotrexate, Systemic therapy (methotrexate, cephalosporins)cephalosporins)

d.d. Photochemotherapy (psoralens + Photochemotherapy (psoralens + UV light)UV light)

Bacterial Bacterial ViralViral

FungalFungalparasiticparasitic

Lyme DiseaseLyme Disease

Etiology:Etiology: – – spirochete Borrelia burgdorferi spirochete Borrelia burgdorferi (tick bite)(tick bite)

Assessment:Assessment:11st stagest stage

- Small red pimple- Small red pimple- Ring shaped- Ring shaped- Flu-like symptoms- Flu-like symptoms

InterventionsInterventions: : a.a. daily soaks & tepid H20 compressdaily soaks & tepid H20 compressb.b. remove scalesremove scalesc.c. use of emolientsuse of emolientsd.d. instruct px not to scratch areainstruct px not to scratch areae.e. check s/sxs of infectioncheck s/sxs of infectionf.f. use light cotton clothinguse light cotton clothingg.g. Assist in ways to reduce stressAssist in ways to reduce stress

22ndnd stage stage- Neuro complications- Neuro complications- Cardiac complications- Cardiac complications- Joint pain- Joint pain33rd stagerd stage

- Large joints involved- Large joints involved- Arthritis progress- Arthritis progress

Diagnosis:Diagnosis:- Hx and PEHx and PE- Antibody testAntibody test

- Treatment:Treatment:- PenicillinPenicillin

ImpetigoImpetigo

Etiology:Etiology:- Staphylococcus or B-hemolytic Staphylococcus or B-hemolytic

streptococcusstreptococcus

ImpetigoImpetigo Assessment:Assessment:- papule---pustule---vesicles---crustpapule---pustule---vesicles---crust- Characteristic honey colored crustsCharacteristic honey colored crusts- feverfever

ImpetigoImpetigo

Treatment:Treatment: topical antibioticstopical antibiotics Oral antibioticsOral antibiotics

InterventionsInterventions Keep area cleanKeep area clean Implement contact precautionImplement contact precaution Administer meds as prescribedAdminister meds as prescribed

Erysipelas & CellulitisErysipelas & Cellulitis

Erysipelas Erysipelas – – inflammation, acute, superficial, rapidly inflammation, acute, superficial, rapidly spreading caused by B-hemolytic spreading caused by B-hemolytic StreptococcusStreptococcus

Cellulitis Cellulitis – – inflammation/infecton of deeper dermis inflammation/infecton of deeper dermis usually caused by usually caused by StreptococcusStreptococcus & & StaphylococcusStaphylococcus

Assessment:Assessment:- Swelling or edemaSwelling or edema- RednessRedness- Pain or tendernessPain or tenderness- FeverFever

Treatment:Treatment:- IV antibiotics ( penicillin, cloxacillin)IV antibiotics ( penicillin, cloxacillin)- antipyreticsantipyretics- Elevate affected areaElevate affected area

Staphylococcal infectionsStaphylococcal infections Folliculitis- infection of hair follicleFolliculitis- infection of hair follicle FuruncleFuruncle CarbuncleCarbuncle

Staphylococcal infectionsStaphylococcal infections Assessment:Assessment:- Papule, pustule, nodule, node, cyst- Papule, pustule, nodule, node, cyst- Fever- Fever- Pain and tenderness- Pain and tenderness

Staphylococcal infectionsStaphylococcal infections

Treatment:Treatment:- Incision and drainageIncision and drainage- AntibioticsAntibiotics- antipyreticsantipyretics

Acne vulgarisAcne vulgaris

Etiology:Etiology:- Propiniobacterium acnePropiniobacterium acne

Assessment:Assessment:- PapulePapule- PustulePustule- nodulenodule

Acne vulgarisAcne vulgaris

Management:Management: TopicalTopical- Benzoyl peroxide- Benzoyl peroxide- Retinol- Retinol Intralesional therapyIntralesional therapy systemicsystemic- Tetracycline- Tetracycline- clindamycin- clindamycin

ChickenpoxChickenpox

EtiologyEtiology VZVVZV Mode of transmission- droplet or skin Mode of transmission- droplet or skin

lesion contactlesion contact Incubation- 10-20 daysIncubation- 10-20 days

ChickenpoxChickenpox Hx and AssessmentHx and Assessment Hx of exposureHx of exposure Prodrome of malaise, fever, HA and Prodrome of malaise, fever, HA and

myalgia- 24 hrs before onset of rshmyalgia- 24 hrs before onset of rsh Pruritic lesions in cropsPruritic lesions in crops Pink-red macules---central vesicles---Pink-red macules---central vesicles---

crustingcrusting

ChickenpoxChickenpox Treatment:Treatment: Self-limited in healthy childrenSelf-limited in healthy children Adults- uncomplicated- oral acyclovirAdults- uncomplicated- oral acyclovir Immunocompromised- IV acyclovirImmunocompromised- IV acyclovir Vaccine- preventionVaccine- prevention

HZ (Shingles)HZ (Shingles)

Etiology:Etiology: – – VZV, reactivation of VZV from the VZV, reactivation of VZV from the dorsal root gangliadorsal root ganglia

HZ (shingles)HZ (shingles)AssessmentAssessment: :

a.a. dermatomal distribution of vesiclesdermatomal distribution of vesiclesb.b. NeuralgiaNeuralgiac.c. FeverFever

HZ (shingles)HZ (shingles)

DiagnosisDiagnosis: Culture: CultureInterventionsInterventions: :

a.a. IsolateIsolateb.b. assess neurovascular statusassess neurovascular statusc.c. Keep area clean and dryKeep area clean and dryd.d. Give analgesics as orderedGive analgesics as ordered

Herpes SimplexHerpes Simplex

EtiologyEtiology Oral form- HSV 1Oral form- HSV 1 Cenital form- HSV 2Cenital form- HSV 2

Herpes simplexHerpes simplex

Hx and Assessment:Hx and Assessment: 1 Eruption- more severe, longer-1 Eruption- more severe, longer-

lastinglasting- Acccompanied by LAD, fever, - Acccompanied by LAD, fever, malaise and edemamalaise and edema

Recurrent- limited to mucocutaneous Recurrent- limited to mucocutaneous are innervated by involved nerveare innervated by involved nerve- Tingling, burning sensation - Tingling, burning sensation precedes the lesionprecedes the lesion

Herpes simplexHerpes simplex Grouped vesicle on an erythematous Grouped vesicle on an erythematous

basesbases

Herpes simplexHerpes simplex

Diagnosis: Diagnosis: Culture- definitiveCulture- definitive tzanck smear- multinucleated giant tzanck smear- multinucleated giant

cellscells

Treatment:Treatment: TopicalTopical Oral/IV acyclovirOral/IV acyclovir

Molluscum ContangiosumMolluscum Contangiosum

Etiology:Etiology: PoxvirusPoxvirus Common in young children and in Common in young children and in

AIDS patientsAIDS patients

Molluscum ContangiosumMolluscum Contangiosum

HX and Assessment:HX and Assessment: Asymptomatic unless inflamedAsymptomatic unless inflamed Discrete dome-shaped, shiny pauples Discrete dome-shaped, shiny pauples

w/ central umbilicationw/ central umbilication 2-5 mm in diameter2-5 mm in diameter In children- trunkIn children- trunk In adults- perianal and perigenital In adults- perianal and perigenital

areas areas

Molluscum ContangiosumMolluscum Contangiosum

Diagnosis:Diagnosis: Giemsa or wright’s stain- large Giemsa or wright’s stain- large

inclusion or molluscum bodiesinclusion or molluscum bodies Ask Hx of AIDSAsk Hx of AIDS

Molluscum ContangiosumMolluscum Contangiosum

Treatment:Treatment: CurettageCurettage Liquid nitrogen cryotherapyLiquid nitrogen cryotherapy Tricloroacetic acidTricloroacetic acid

TineaTineaEtiology:Etiology:- dermatophytes, yeasts- dermatophytes, yeasts

Tinea capitis- fungal infection of scalpTinea capitis- fungal infection of scalpTinea corporis- fungal infection of the bodyTinea corporis- fungal infection of the bodyTinea cruris- fungal infection of the inguinal Tinea cruris- fungal infection of the inguinal

areaareaTinea pedis- footTinea pedis- footTinea inguinum- nailsTinea inguinum- nails

Assessment:Assessment:- Circular, annular, plaques,Circular, annular, plaques,- hypo/hyperpigmented hypo/hyperpigmented - Scaling and erythematous plaquesScaling and erythematous plaques- pruriticpruritic

TineaTinea Diagnosis:Diagnosis:- KOH smearKOH smear- Woods light examWoods light exam

- Treatment:Treatment:- Topical/oral antifungalsTopical/oral antifungals

InterventionsInterventions Keep area clean and dryKeep area clean and dry Do not scratch Do not scratch Proper hygieneProper hygiene Cut off nails or trim nails Cut off nails or trim nails

(onychomycosis)(onychomycosis)

Candidal IntertrigoCandidal Intertrigo

Predisposing factors:Predisposing factors: ObesityObesity DMDM Recent antibiotic therapyRecent antibiotic therapy Warm, moist environmentWarm, moist environment

Candidal IntertrigoCandidal Intertrigo

Hx and Assessment:Hx and Assessment: PruritusPruritus PainPain Well-demarcated, beefy-red, Well-demarcated, beefy-red,

erythematous patches surrounded by erythematous patches surrounded by satellite pustulessatellite pustules

Restricted to intertriginous areasRestricted to intertriginous areas In infants- diaper rashIn infants- diaper rash

Candidal IntertrigoCandidal Intertrigo

Diagnosis:Diagnosis: KOH smear of scrapings- KOH smear of scrapings-

pseudohyphae and yeasts formspseudohyphae and yeasts forms

Candidal IntertrigoCandidal Intertrigo

Treatment:Treatment: Topical antifungal +/- low- potency Topical antifungal +/- low- potency

steroidsteroid Reduce moisture Reduce moisture Reduce friction through weight lossReduce friction through weight loss

Pityriasis versicolorPityriasis versicolor Etiology:Etiology: Malassezia furfurMalassezia furfur

Pityriasis versicolorPityriasis versicolor

Hx and assessmentHx and assessment Usually asymptomatic Usually asymptomatic Mild itchingMild itching Small, scaling Macules that enlarges Small, scaling Macules that enlarges

and coalesceand coalesce Pinkish, lightly pigmented, Pinkish, lightly pigmented,

hypopigmentedhypopigmented

Pityriasis VersicolorPityriasis Versicolor

DiagnosisDiagnosis KOH- short, blunt hyphae and small KOH- short, blunt hyphae and small

sporesspores Wood’s light examWood’s light exam

Pityriasis versicolorPityriasis versicolor Treatment:Treatment: Topical antifungal- resolution in 2-3 Topical antifungal- resolution in 2-3

wkswks Seleniium sulfide shampoo- 1-3x/wk; Seleniium sulfide shampoo- 1-3x/wk;

leave for 10 mins and scrub offleave for 10 mins and scrub off Systemic antifungals- sever casesSystemic antifungals- sever cases

ScabiesScabies

Etiology:Etiology: – – caused by parasite Sarcoptes caused by parasite Sarcoptes scabieiscabiei – – there is 1 mos delay from there is 1 mos delay from exposure exposure to onset of pruritusto onset of pruritus

ScabiesScabies

AssessmentAssessment: : a.a. Erythematous papules & pustulesErythematous papules & pustulesb.b. Threadlike brownish linear Threadlike brownish linear

burrowsburrowsc.c. 2ndary lesions (crust, vesicles, 2ndary lesions (crust, vesicles,

nodules & excoriations) nodules & excoriations) d.d. Intense pruritus that worsens at Intense pruritus that worsens at

nightnight

InterventionsInterventions: : a.a. AntihistaminesAntihistaminesb.b. Topical antiscabies (Topical antiscabies (LindaneLindane) – not ) – not

to be used on <2y/o (neurotoxic)to be used on <2y/o (neurotoxic)c.c. Treat close contactTreat close contactd.d. All beddings & clothes should be All beddings & clothes should be

washed in very hot waterwashed in very hot water

FrostbiteFrostbite

AssessmentAssessment: : a.a. NumbnessNumbnessb.b. ParesthesiaParesthesiac.c. PallorPallord.d. severe painsevere paine.e. necrosis & gangrene may developnecrosis & gangrene may develop

InterventionsInterventions: : a.a. rewarm rapidly & continuously for 15 rewarm rapidly & continuously for 15

to 20 mins or until skin flushing occursto 20 mins or until skin flushing occursb.b. Avoid slow thawing, interrupted Avoid slow thawing, interrupted

periods of warmth or massageperiods of warmth or massagec.c. Do not debride blistersDo not debride blisters

BurnsBurns

typestypes:: thermalthermal

chemicalchemicalelectricalelectricalradiationradiation

ClassificationClassification::1.1. Superficial – mild to moderate Superficial – mild to moderate

erythema, no blisters, pain eased by erythema, no blisters, pain eased by coolingcooling

2.2. Partial thickness – (+) blisters, edema, Partial thickness – (+) blisters, edema, painful, injured are sensitive to cold airpainful, injured are sensitive to cold air

3.3. Full thickness – injured space appears Full thickness – injured space appears dry, fat exposed, little or no paindry, fat exposed, little or no pain

DisordersDisorders

Methods of estimating extent of injuryMethods of estimating extent of injuryRule of 9’sRule of 9’s

Head & NeckHead & Neck 9% 9% Anterior trunkAnterior trunk 18%18% Posterior trunkPosterior trunk 18%18% ArmsArms 18%18% LegsLegs 36%36% PerineumPerineum 1% 1%

ManagementManagement::a.a. Emergent phase – time of injury Emergent phase – time of injury

restoration of capillary permeability restoration of capillary permeability (48% – 72%)(48% – 72%)11º goal is prevent hypovolemic shockº goal is prevent hypovolemic shock

Prehospital carePrehospital care 1.1. remove victim from sourceremove victim from source2.2. ABCABC3.3. Assess for traumaAssess for trauma4.4. Cover wounds with clean clothCover wounds with clean cloth5.5. Remove jewelriesRemove jewelries6.6. Need for IV ?Need for IV ?7.7. TransportTransport ERER care care - continuation of care - continuation of care

b.b. Resuscitative phase – initiation of Resuscitative phase – initiation of fluids fluids capillary integrity near capillary integrity near normalnormal- Fluid resuscitation- Fluid resuscitation- pain management- pain management- escharotomy- escharotomy- fasciotomy- fasciotomy- nutrition- nutrition

c.c. Acute phase – hemodynamically Acute phase – hemodynamically stable stable restored capillary restored capillary permeabilitypermeability- wound care- wound care- debridement- debridement- wound closure- wound closure- PT- PT

AutograftingAutograftingcare of graft sitecare of graft sitea.a.Elevate & immobilizeElevate & immobilizeb.b.Keep free from pressureKeep free from pressurec.c.Check for infectionCheck for infectiond.d.Instruct client to protect Instruct client to protect

affected area from sunlightaffected area from sunlighte.e.Use splints & support garmentUse splints & support garment

d.d. Rehabilitative phaseRehabilitative phasegoals – promote wound healinggoals – promote wound healing – – minimize deformitiesminimize deformities – – increase strength & increase strength & functionfunction

– – provide psychological & provide psychological & emotional supportemotional support

Lichen planusLichen planus

Etiology:Etiology:- unknown, idiopathic, drugs(gold), - unknown, idiopathic, drugs(gold),

HLA asso predispositionHLA asso predisposition

- acute, chronic involving skin & - acute, chronic involving skin & mucous memb.mucous memb.

Assessment:Assessment:4 Ps- 4 Ps- PurplePurple PolygonalPolygonal PruriticPruritic PapulePapule

Treatment:Treatment: cyclosporinecyclosporine steroidssteroids

Erythema multiformeErythema multiforme EM minor- no mucus involvement, EM minor- no mucus involvement,

extensor surfacesextensor surfaces EM major-EM major- SJS and TEN-necrotizing SJS and TEN-necrotizing

tracheobronchitis, renal tubular tracheobronchitis, renal tubular necrosis, meningitisnecrosis, meningitis

Erythema MultiformeErythema Multiforme

Etiology:Etiology:Immune mediated reaction due toImmune mediated reaction due to

DrugsDrugs InfectionInfection VaccinationVaccination pregnancypregnancy

Erythema MultiformeErythema Multiforme

Hx and assessment:Hx and assessment: Mild prodrome- malaise and myalgiaMild prodrome- malaise and myalgia Lesions mat be asso. w/ pain and Lesions mat be asso. w/ pain and

feverfever Mucosal involvement-dysphagia and Mucosal involvement-dysphagia and

dysuriadysuria Pink to red macules, papules, Pink to red macules, papules,

erythematous plaques, target lesions erythematous plaques, target lesions and bullaeand bullae

Erythema MultiformeErythema Multiforme Diagnosis:Diagnosis: Clinical Hx of exposureClinical Hx of exposure Elevated eosinophilsElevated eosinophils

Erythema MultiformeErythema Multiforme Treatment:Treatment: mild cases- resolve spontaneouslymild cases- resolve spontaneously Identify the causeIdentify the cause Severe forms- corticosteroids and Severe forms- corticosteroids and

analgesiaanalgesia SJS- rehydrationSJS- rehydration

3. Steven johnsons syndrome is 3. Steven johnsons syndrome is managed thru managed thru

a.a. AntibioticsAntibioticsb.b. SteroidsSteroidsc.c. Identifying the causeIdentifying the caused.d. All of the aboveAll of the above

4.A 15 y.o. patient was diagnosed w/ 4.A 15 y.o. patient was diagnosed w/ lichen planus. This disorder is lichen planus. This disorder is characterized by exceptcharacterized by except

a.a. A purple papuleA purple papuleb.b. PruritusPruritusc.c. Polygonal lesionPolygonal lesiond.d. patchpatch

5. A patient was involved in a fire 5. A patient was involved in a fire accident and sustained burns. Half of accident and sustained burns. Half of her anterior face and neck, whole left her anterior face and neck, whole left arm and anterior chest was involved. arm and anterior chest was involved. Compute for the estimated burn area Compute for the estimated burn area using rule of nines. using rule of nines.

6. Scabies is caused by a6. Scabies is caused by aa.a. ParasiteParasiteb.b. ProtozoanProtozoanc.c. BacteriaBacteriad.d. fungifungi

8. Management of frostbite includes all 8. Management of frostbite includes all of the ff except:of the ff except:

a.a. rewarm rapidly & continuously for 15 rewarm rapidly & continuously for 15 to 20 mins or until skin flushing occursto 20 mins or until skin flushing occurs

b.b. Avoid slow thawing, interrupted Avoid slow thawing, interrupted periods of warmth periods of warmth

c.c. debride blistersdebride blistersd.d. Avoid massageAvoid massage