Integumentary SystemIntegumentary SystemN210 Fall 2007N210 Fall 2007

Rachel Natividad RN, MSNRachel Natividad RN, MSN

Variations across the lifespan: Variations across the lifespan: InfancyInfancy

MONGOLIAN SPOT

ACROCYANOSIS

JAUNDICE

Variations across the Variations across the lifespan:lifespan:

PregnancyPregnancy AdolescenceAdolescence

Striae

Cherry AngiomaAcneLinea Nigra

Variations across the lifespan: Variations across the lifespan: ElderlyElderly

Changes R/T AgingChanges R/T AgingPhysiological Physiological

changechangePhysical FindingsPhysical Findings

↓ ↓ SQ tissueSQ tissue Thin flat skinThin flat skin

Loss of collagen and Loss of collagen and elastic fiberselastic fibers

wrinkleswrinkles

↑ ↑ Capillary fragilityCapillary fragility purpuraspurpuras

↓ ↓ sweat gland activity sweat gland activity Xerosis (dry skin)Xerosis (dry skin)

Over exposure to sunOver exposure to sun Liver spotsLiver spots

Loss of or inefficiency Loss of or inefficiency of melanocytes of melanocytes

Liver spotsLiver spots

Elderly: Seborrheic Elderly: Seborrheic keratoseskeratoses

Elderly: Senile Lentigines Elderly: Senile Lentigines (Liver spots )(Liver spots )

LIVER SPOTSLIVER SPOTS

WRINKLES

PURPURA

Assessing Skin TurgorAssessing Skin Turgor

AssessmentAssessment

Subjective dataSubjective data Specific Skin ComplaintSpecific Skin Complaint

Objective dataObjective data Physical assessment: Inspection and Physical assessment: Inspection and

palpationpalpation Draw picture or take photo if possibleDraw picture or take photo if possible

Skin Lesions TypesSkin Lesions Types Primary: (Initial lesions) Appear in Primary: (Initial lesions) Appear in

response to external or internal response to external or internal environment of skin.environment of skin.

Vesicle, Bulla

Primary Lesions Primary Lesions

Papule

Nodule

Tumor

Wheal

Vesicle

Bulla

Skin Lesion TypesSkin Lesion Types

Secondary Lesions: Secondary Lesions: Are a result of Are a result of trauma, trauma, chronicity, or chronicity, or infection of infection of primary lesion.primary lesion.

Secondary LesionsSecondary Lesions

Keloid

Fissure

Crust

Scale

Lichenification

Vascular LesionsVascular Lesions: Appear as red : Appear as red pigmented lesion. Could be indicative of pigmented lesion. Could be indicative of bleeding bleeding HemangiomasHemangiomas

port wine stain; strawberry mark-mature port wine stain; strawberry mark-mature hemangiomahemangioma

TelangiectasiasTelangiectasias spider angioma with pregnancy or liver spider angioma with pregnancy or liver

disease; venous lakedisease; venous lake Purpuric LesionsPurpuric Lesions

PetechiaePetechiae EcchymosesEcchymoses purpurapurpura

Skin Lesion TypesSkin Lesion Types

Vascular Lesions- Cont.Vascular Lesions- Cont.HEMANGIOMA

TELANGIECTASIA

Spider Angioma

Petechiae

Ecchymosis

Venous Lake

Vascular Lesions: Vascular Lesions: PurpuraPurpura

Shapes and Shapes and ConfigurationsConfigurations

EXERCISEEXERCISEDocumentation of Skin Documentation of Skin

LesionsLesionsCOLOR COLOR

SHAPE/SHAPE/CONFIGURATIONCONFIGURATION

TYPETYPE

SIZE (L x W x D) in cmSIZE (L x W x D) in cm

DISTRIBUTION/DISTRIBUTION/

PATTERNPATTERN

EXUDATESEXUDATES AmountAmount Color/Color/

consistencyconsistency SerousSerous SerosanguiSerosangui

nousnous SanguinousSanguinous PurulentPurulent

Pattern Injury from Pattern Injury from Physical AbusePhysical Abuse

Lesions due to trauma or Lesions due to trauma or abuse abuse

Bruise or wound whose Bruise or wound whose shape suggests the shape suggests the instrument or weapon that instrument or weapon that caused itcaused it

Physical signs with history Physical signs with history that does not match the that does not match the severity or type of injury severity or type of injury indicates abuseindicates abuse

Scalding injury, belt Scalding injury, belt marks, bite marks, marks, bite marks, cigarette burns, deformity cigarette burns, deformity from untreated fracturefrom untreated fracture

Pattern InjuriesPattern Injuries

Pattern Injury: Pattern Injury: DistributionDistribution

Diagnostic TestsDiagnostic Tests

CultureCulture Skin BiopsiesSkin Biopsies

PunchPunch ShaveShave ExcisionalExcisional

Woods LightWoods Light DiascopyDiascopy Skin TestingSkin Testing

Parasitic InfestationsParasitic Infestations

PediculosisPediculosis ScabiesScabies

CauseCause licelice Itch miteItch mite

Symptom & Symptom & Areas Areas affectedaffected

Head, body, Head, body, pubic areapubic area

Finger webs, Finger webs, creases of creases of abd, wrist, abd, wrist, axilla, breastsaxilla, breasts

TreatmentTreatment Pyrethroid Pyrethroid (Rid)(Rid)

Lindane, Lindane, pyrethroidpyrethroid

Parasitic InfestationsParasitic Infestations

CORPORISCAPITIS PUBIS

Infestations cont.Infestations cont.

ScabiesScabies A contagious A contagious

diseasedisease

Transmission: close Transmission: close and prolonged and prolonged contact or infected contact or infected beddingbedding

Infestations Cont.Infestations Cont.

Scabies lesion Scabies lesion distributiondistribution

Pressure UlcersPressure Ulcers

Tissue damage caused by the skin Tissue damage caused by the skin and underlying soft tissue are and underlying soft tissue are compressed between bony compressed between bony prominence and an external surface prominence and an external surface for an extended period.for an extended period.

Pressure Ulcers Pressure Ulcers

Pressure UlcersPressure Ulcers

CAUSES (6)CAUSES (6) RISKS (4)RISKS (4) PREVENTION PREVENTION (5)(5)

Pressure UlcersPressure UlcersCAUSES CAUSES

(6)(6)RISKS (4)RISKS (4) PREVENTION PREVENTION

(5)(5)PressurePressure Mental StatusMental Status

Sensory PerceptionSensory Perception

Pressure ReliefPressure Relief

ShearingShearing ActivityActivity

MobilityMobility

Prevention of Prevention of contracturescontractures

FrictionFriction Friction ReliefFriction Relief

MoistureMoisture IncontinenceIncontinence Skin careSkin care

NutritionNutrition Nutritional Nutritional DeficienciesDeficiencies

Nutritional SuuportNutritional Suuport

CirculationCirculation

Staging of Pressure UlcersStaging of Pressure UlcersPressure ulcers and their features are Pressure ulcers and their features are

classified and assessed in stages:classified and assessed in stages:

StageStage DescriptionDescription

Stage 1Stage 1

Stage 2Stage 2

Stage 3Stage 3

Stage 4Stage 4

UnstageableUnstageable

Stage 1 Pressure UlcerStage 1 Pressure Ulcer

Stage 2 Pressure UlcerStage 2 Pressure Ulcer

Stage 3 Pressure UlcerStage 3 Pressure Ulcer

Stage 4 Pressure UlcerStage 4 Pressure Ulcer

Stage 4 with NecrosisStage 4 with Necrosis

Eschar- unstageableEschar- unstageable

Ulcer AssessmentUlcer Assessment Describe ulcerDescribe ulcer

Stage Stage LocationLocation SizeSize ShapeShape

AppearanceAppearance DrainageDrainage OdorOdor StageStage

Presence of infectionPresence of infection Foul smellFoul smell Purulent drainagePurulent drainage Heat, extreme redness, Heat, extreme redness,

edemaedema