Essentials of Human Diseases and Conditions 4 th edition Seminar 4 Dr. Lena Watson, RN, MBA/HCM

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 1 Learning Objectives  Explain the functions of the skin.  Describe how seborrheic dermatitis affects the skin.  Discuss the common causes of contact dermatitis, atopic dermatitis, and psoriasis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 2 Learning Objectives (cont’d.)  Describe the treatment of acne vulgaris.  Cite examples of classifications of fungal infections of the skin.  List preventative measures for decubitis ulcers.  Name the two most common parasitic insects to infest man and the occurrence.  Name two common premalignant tumors.  Differentiate the three types of skin cancer.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 3 Learning Objectives (cont’d.)  List preventative measures for decubitis ulcers.  Name the two most common parasitic insects to infest man and the occurrence.  Name two common premalignant tumors.  Differentiate the three types of skin cancer.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 4 Learning Objectives (cont’d.)  Describe the guidelines for avoiding excessive sun exposure.  Name some possible causes of alopecia.  State the cause of warts, nail discoloration, and,malformations.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 5 Learning Objectives  List the functions of the normal skeletal system.  Distinguish among the pathologic features of the different types of scoliosis.  Describe the signs and symptoms of the most common form of arthritis.  Explain the importance of early diagnosis and treatment of Lyme disease.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 6 Learning Objectives (cont’d.)  Describe the treatment of bone tumors, both benign and malignant.  Discuss the specifics of a physical examination when fibromyalgia is suspected.  Explain why joint disability results from gout.  Describe the picture of osteomyelitis and explain how it is treated.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 7 Learning Objectives (cont’d.)  Describe the disability that results from advanced osteoporosis.  Explain why osteomalacia is termed a metabolic bone disease.  Distinguish between hallus valgus and hallus rigidus.  Distinguish between a strain and a sprain.  Explain the importance of proper treatment of dislocations.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 8 Learning Objectives (cont’d.)  Describe the cause of shin splints.  List some factors that contribute to the development of plantar fasciitis.  Explain how torn meniscus is treated.  Describe the signs and symptoms of rotator cuff tears.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 9 INTEGUMENTARY SYSTEM Chapter 6

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 10 Components of the Integumentary System Skin and accessory organs:  Hair  Nails  Glands  Skin layers  Dermis  Epidermis  Subcutaneous layer

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 11  cutaneous lesions or eruptions  pruritis (itching)  pain  edema (swelling)  erythema (redness)  inflammation Common Skin Condition Symptoms

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 12 A Few Common Skin Lesions  macule  plaque  cyst  pustule  scale  burrow  papule  nodule  vesicle  crust  fissure  comedo

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 13 Dermatitis  Seborrheic dermatitis  Contact dermatitis  Atopic dermatitis (eczema)  Psoriasis Common Diseases of the Skin

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 14 Common Diseases of the Skin (cont’d.)  Note the differences between seborrheic dermatitis and contact dermatitis:  seborrheic dermatitis – idiopathic condition resulting in overproduction of sebum  contact dermatitis – localized redness and swelling caused by an irritant or allergen

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 15 Clicker Question  One of the most common skin disorders marked by an inflammatory condition of the sebaceous glands is  a. psoriasis.  b. atopic dermatitis (eczema).  c. impetigo.  d. seborrheic dermatitis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 16 Clicker Question  The most common dermatitis during infancy, which is called cradle cap, is a form of:  a. psoriasis.  b. atopic dermatitis (eczema).  c. impetigo.  d. seborrheic dermatitis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 17  Acne vulgaris: an inflammatory disease of the sebaceous glands and hair follicles  Herpes zoster (shingles): an acute inflammatory dermatomal eruption of painful vesicles Common Diseases of the Skin (cont’d.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 18  Chickenpox is a precursor to shingles.  Both are caused by the herpes varicella- zoster virus. Common Diseases of the Skin (cont’d.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 19  Impetigo: contagious, superficial skin infection  Cellulitis: acute, diffuse, bacterial infection of the skin and subcutaneous tissue Common Diseases of the Skin (cont’d.)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 20 Dermatophytoses  Tinea capitis  Tinea corporis (ringworm)  Tinea unguium  Tinea pedis (athlete’s foot)  Tinea cruris (jock itch)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 21 Clicker Question  _____ is a common contagious superficial skin infection caused by either Streptococcus or Staphylococcus aureus.  a. Psoriasis  b. Atopic dermatitis  c. Impetigo  d. Seborrheic dermatitis

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 22 Clicker Question  ____is a type of inflammation of the skin that tends to occur in persons with a family history of allergic conditions. Hint: AKA Eczema  a. Psoriasis  b. Atopic dermatitis  c. Impetigo  d. Seborrheic dermatitis

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 23 Decubitis ulcers (bed sores): localized areas of dead skin Scabies: infestation by parasitic insects called itch mites Pediculus: infestation by lice; wingless parasites that feed on human blood Other Diseases of the Skin

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 24 Other Diseases of the Skin (cont’d.)  Species that infest the head and body  Pediculus humanus capitis – lice that infest the head  Pediculus humanus corporis – lice that infest the body  Phthirus pubis – pubic lice (crabs)  Sarcoptes scabiei – itch mites

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 25 Benign Tumors Seborrheic keratosis: benign growths originating in the epidermis Dermatofibroma: benign, asymptomatic growths that can be found anywhere on the body Achrochordon (skin tag): common benign skin growths found mainly on the axilla, neck, and inguinal areas of the body

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 26 Clicker Question  Itch mites and lice spread easily from one person to another by close physical contact.  A) True  B) False

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 27 Premalignant Tumors Actinic keratosis: common pre-malignant lesions found on sun-exposed areas of the body  Indications: an area of rough, vascular skin, which later forms a yellow crust.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 28  Non-melanoma skin cancers  Basal cell carcinoma (BCC)  Squamous cell carcinoma (SCC)  Malignant melanomas  The ABCs of malignant melanoma: A = asymmetry A = asymmetry B = border B = border C = color C = color D = diameter D = diameter Skin Carcinomas

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 29 Protection of Skin from the Sun  Avoid exposure 10 a.m.– 3 p.m.  Plan outdoor activities for early morning or late afternoon  Wear protective clothing  Use sunscreen

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 30 Clicker Question  Appearance and location of the lesions confirm the diagnosis of each of the three types of skin carcinoma. A) True A) True B) False

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 31 Clicker Question  The ABCDEs of malignant melanoma include  a. family history, sunburn, large moles, bleeding, and previous cancer.  b. asymmetry, border, color, diameter, and elevation.  c. neither of the above.  d. both a and b.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 32 Abnormal Skin Pigmentation  albinism: inability to produce melanin (inherited)  vitiligo: pale, irregular patches (may be an immune system disorder)  melasma (chloasma): patches of darker skin on the face  hemangiomas: benign lesions of highly vascularized skin; they may be flat (port-wine stains), elevated, or protuberant

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 33 Abnormal Skin Pigmentation (cont’d.)  nevi (moles): small, dark collections of melanocytes  pityriasis: fungal infection; causes patches of flaky, light, or dark skin on the trunk  abnormal suntan: unusual darkening of the skin resulting from properly used medications

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 34 Clicker Question  A precursor to skin cancers is: a. squamous cell carcinoma. b. basal cell carcinoma. c. pityriasis d. actinic keratosis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 35 Clicker Question  _____ is a serious form of skin cancer that often ulcerates, forms a crust, and has a tendency to metastasize if allowed to reach an advanced stage.  a. Squamous cell carcinoma  b. Basal cell carcinoma  c. Malignant melanoma  d. Actinic keratosis

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 36 Causes of Alopecia (Baldness)  heredity  aging process  systemic illness  dermatitis

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 37 Verrucae (warts): warts are elevated growths of the epidermis that result from hyperplasia Deformed or discolored nails: any unusual thickening, color variation, or change in shape of fingernails or toenails More Common Diseases of the Skin

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 38 MUSCULOSKELETAL SYSTEM Chapter 7

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 39 Fibromyalgia: a chronic pain condition associated with stiffness and tenderness that affects muscles, tendons, and joints throughout the body. The cause is unknown. Eighteen tender points used in diagnosis Eighteen tender points used in diagnosis Treatment options Treatment options Stress reduction Stress reduction Physical activity Physical activity Medications Medications Fibromyalgia

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 40 Lordosis: an exaggerated inward curvature of the spine Kyphosis: an abnormal outward curvature of the spine Scoliosis: a lateral (sideways) curvature of the spine Major Spinal Disorders

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 41 Clicker Question  A lateral curvature of the spine is known as:  a. kyphosis.  b. lordosis.  c. lumbago.  d. scoliosis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 42  Weight loss  Exercises to strengthen abdomen  Pelvic tilt exercises Lordosis - Treatment Options

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 43  Exercises to strengthen muscles and ligaments  Back brace to stabilize condition  Spinal fusion and temporary immobilization  Vertebroplasty Kyphosis - Treatment Options

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 44  Exercise to strengthen weak muscles  Back brace  Fusion of the vertebrae Scoliosis - Treatment Options

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 45 Osteoarthritis Osteoarthritis: the breakdown and eventual loss of cartilage of one or more joints  Causes:  aging process  heredity  injury  chronic diseases such as diabetes and obesity

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 46 Osteoarthritis (cont’d.)  Signs and symptoms  Spur formations on fingers  Degeneration of spinal vertebrae and pelvic joints  Diagnosis  Radiographic testing to exclude other causes  Treatment  Reduce inflammation, minimize pain

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 47 Lyme Disease  Lyme disease: an infectious bacteriological disease spread by deer tick bites  Caused by the bacterium Borrelia burgdorferi  Characterized by red, itchy rash with a red circle center (“bull’s-eye” rash)  Often characterized by flu-like symptoms such as headache, fever, joint pain, and fatigue

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 48 Lyme Disease (cont’d.)  Treatment  removal of tick  oral antibiotics  intravenous antibiotics  bed rest and physical therapy  Prevention  avoid tick bites by wearing long clothing  inspect clothes and body for ticks

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 49 Osteomyelitis Osteomyelitis: a serious infection of bone that requires aggressive antibiotic treatment  Caused by bacterial organisms, viruses, and fungi  Characterized by inflammation, swelling, redness, pain, localized heat, and tenderness

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 50 Clicker Question  The following statement(s) about fibromyalgia is(are) true.  a. It is a painful debilitating syndrome that causes chronic pain in muscles and soft tissues surrounding joints.  b. The cause is unknown.  c. Diagnosis includes pain at specific tender points.  d. All of the above are true.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 51 Osteomyelitis (cont’d.)  Treatment  long-term antibiotic treatment  increased intake of proteins and vitamins A, B, and C  bed rest  control of chronic conditions  Immobilization of affected part

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 52 Gout  Gout: a chronic disorder of uric acid metabolism that manifests an acute, episodic form of arthritis  Causes  Overproduction or decreased excretion of uric acid  high levels of uric acid in the blood  high levels of uric acid in synovial fluid in joints and tissues

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 53 Clicker Question  A tick-carried bacteria causes _____, which is characterized by symptoms of arthritis, malaise, myalgia, and neurologic and cardiovascular signs.  a. ankylosing spondylitis  b. Lyme disease  c. systemic lupus erythematosus  d. kyphosis

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 54 Gout (cont’d.)  Treatment  bed rest to reduce pressure on affected joints  application of ice to inflamed joints  NSAIDs and corticosteroids  low-purine diet and frequent fluid intake  antihyperuricemic medications

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 55 Musculoskeletal Tumors Bone tumor: any abnormal growth (whether benign or malignant) in the bone  chondrogenic (from cartilage)  osteogenic (from bone)  fibrogenic (from fibrous tissue) Muscle tumor: muscle neoplasms, benign or malignant sarcomas, that may arise at any site in the body

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 56 Musculoskeletal Tumors (cont’d.)  Symptoms  Malignant tumors have characteristic signs  palpable mass; dull, localized pain  pathologic fracture, commonly in acetabulum or proximal femur  Diagnosis  radiographic studies,MRI, CT scan, biopsy  elevated serum alkaline phosphatase  elevated serum calcium  Treatment  surgical excision  chemotherapy/radiation therapy

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 57 Osteoporosis Osteoporosis: a condition characterized by loss of normal bone mass and density due to imbalance between breakdown of old bone tissue and manufacture of new bone

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 58 Osteoporosis (cont’d.)  Symptoms  asymptomatic until bone breaks  spontaneous fractures and loss of height are the most common signs  Treatment  increased intake of calcium and vitamin D  estrogen replacement therapy  bisphosphonate medications  moderate exercise

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 59 Osteomalacia Osteomalacia: a disease characterized by a defective mineralization of the bones, causing them to become soft, flexible, and deformed  When osteomalacia occurs in children, it affects the growing skeleton and is called rickets

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 60 Osteomalacia (cont’d.)  Symptoms  general fatigue  muscle weakness  progressive stiffness  tender, painful bones  Treatment  vitamin D supplements  add vitamin D, calcium, and calcitonin to diet  exposure to sunlight

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 61 Hallus Valgus & Hallus Rigidus Hallus Valgus (Bunion): a localized area of enlargement of the inner portion of the metatarsophalangeal (MTP) joint at the base of the big toe Hallus Rigidus (Rigid Big Toe): a stiff big toe that develops as a result of degeneration of the cartilage of the first metatarsophalangeal (MTP) joint

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 62 Hallus Valgus & Hallus Rigidus (cont’d.)  Symptoms  painful bunions  MTP joint becomes stiff, painful, and swollen  Treatment  wearing shoes with more room  application of ice  anti-inflammatory agents  for hallux rigidus, treatment is removal.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 63 Clicker Question  What is another common term for hallux rigidus?  A) Bunion  B) Hammertoe  C) Bone Spur  D) Bone fixation

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 64 Traumatic and Sports Injuries  Fractures (broken bones): caused by stress on the bones resulting from a traumatic insult to the musculoskeletal system, severe muscle spasm, or bone disease

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 65 Clicker Question  A vitamin D deficiency can cause this abnormal metabolic bone disease  a. osteoporosis.  B. osteogenesis imperfecta.  c. osteomalacia.  d. osteoclasis.

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 66 Traumatic and Sports Injuries (cont’d.)  General treatment of fractures depends on location, severity, type, and cause  simple fracture of long bone: reduction and immobilization  compound fracture: cleaning, debriding, reduction, immobilization  internal fixation (open reduction)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 67 Traumatic and Sports Injuries (cont’d.)  Strains: injured tendons, muscles or other tissues resulting from overuse, overstretching, or excessive forcible stretching of the tissue beyond its functional capacity  Sprains: acute partial tears of a ligament

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 68  Elevation and rest of affected limb  Immobilization with elastic bandage  Application of ice  Analgesics and anti-inflammatory agents Treatment of Strains and Sprains

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 69 Traumatic and Sports Injuries (cont’d.)  Dislocation: the forcible displacement of a bone from its joint, causing loss of joint function  Treatment  Proper repositioning of joint within 30 minutes of injury

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 70 Traumatic and Sports Injuries (cont’d.)  Severed tendon: caused by injury or laceration; involves the forearm, hand, calf, or foot. The severed ends snap away from each other.  Symptoms: immediate, severe pain, inflammation and immobility  Treatment: tenorrhaphy (suturing of the two ends of the tendon)

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 71 Traumatic and Sports Injuries (cont’d.)  Shin splints: a painful condition involving inflammation of the periosteum, the extensor muscles of the lower leg, and the surrounding tissues  Symptoms: inflammation, edema, pain on inner aspect of the tibia  Treatment: rest plus applications of ice or heat

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 72 Traumatic and Sports Injuries (cont’d.)  Plantar fasciitis: an inflammatory response at the bottom of the heel bone, generally caused by overuse  Symptoms: pain on bottom of foot  Treatment: application of ice application of ice anti-inflammatory medication anti-inflammatory medication heel pads heel pads cortisone cortisone

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 73 Clicker Question  A strained muscle is more serious than a sprained muscle.  A) True  B) False

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 74 Traumatic and Sports Injuries (cont’d.)  Torn meniscus: a crack or fissure to the meniscus cartilage in the knee joint  Symptoms acute pain when putting full weight on affected leg and knee acute pain when putting full weight on affected leg and knee snapping or clicking on flexion or extension snapping or clicking on flexion or extension  Treatment immobilization and elevation immobilization and elevation surgery surgery

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. 75 Traumatic and Sports Injuries (cont’d.)  The rotator cuff: the four tendons of the rotator cuff, formed by the muscles of the shoulder, partially surround the head of the humerus and stabilize it in the glenoid cavity of the socket  Rotator cuff tears: tears to any of the rotator cuff tendons that limit the function of the shoulder