N210 Rachel Natividad RN, MSN, NP Integumentary System N210 Rachel Natividad RN, MSN, NP

Variations across the lifespan: Infancy ACROCYANOSIS MONGOLIAN SPOT JAUNDICE

Variations across the lifespan: Pregnancy Adolescence Striae Acne Linea Nigra Cherry Angioma

Variations across the lifespan: Elderly Changes R/T Aging Physiological change Physical Findings ↓ SQ tissue Loss of collagen and elastic fibers ↑ Capillary fragility ↓ sweat gland activity Over exposure to sun Loss of or inefficiency of melanocytes

Elderly: Seborrheic keratoses

Elderly: Senile Lentigines (Liver spots ) WRINKLES PURPURA LIVER SPOTS LIVER SPOTS

Assessing Skin Turgor

Assessment Subjective data Objective data Specific Skin Complaint Physical assessment: Inspection and palpation Draw picture or take photo if possible

Skin Lesions Types Primary: (Initial lesions) Appear in response to external or internal environment of skin. Vesicle, Bulla

Primary Lesions Wheal Nodule Papule Tumor Vesicle Bulla

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

Secondary Lesions Crust Scale Fissure Lichenification Keloid

Skin Lesion Types Vascular Lesions: Appear as red pigmented lesion. Could be indicative of bleeding Hemangiomas port wine stain; strawberry mark-mature hemangioma Telangiectasias spider angioma with pregnancy or liver disease; venous lake Purpuric Lesions Petechiae Ecchymoses purpura

Vascular Lesions- Cont. HEMANGIOMA Petechiae Ecchymosis Spider Angioma Venous Lake TELANGIECTASIA

Vascular Lesions: Purpura Bleeding disorder Minor trauma

Shapes and Configurations

EXERCISE Documentation of Skin Lesions COLOR SHAPE/CONFIGURATION TYPE SIZE (L x W x D) in cm DISTRIBUTION/ PATTERN EXUDATES Amount Color/consistency Serous (serum) Serosanguinous (serum & blood) Sanguinous (bloody) Purulent (pus)

Pattern Injury from Physical Abuse Lesions due to trauma or abuse Shape suggests the instrument or weapon that caused it Physical signs and history does not match

Pattern Injuries

Pattern Injury: Distribution

Diagnostic Tests Culture Skin Biopsies Woods Light Diascopy Punch Shave Excisional Woods Light Diascopy Skin Testing Wound culture Skin Testing Diascopy Woods Light

Parasitic Infestations CAPITIS CORPORIS PUBIS

Infestations cont. Scabies A contagious disease Transmission: close and prolonged contact or infected bedding

Infestations Cont. Scabies lesion distribution

Parasitic Infestations Pediculosis Scabies Cause Symptom & Areas affected Treatment

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

Pressure Ulcers

Pressure Ulcers CAUSES (6) RISKS (4) PREVENTION (5) Pressure Mental Status Sensory Perception Pressure Relief

Pressure Ulcers CAUSES (6) RISKS (4) PREVENTION (5) Pressure Mental Status Sensory Perception Pressure Relief Shearing Activity Mobility Prevention of contractures Friction Friction Relief Moisture Incontinence Skin care Nutrition Nutritional Deficiencies Nutritional Support Circulation

Stage 1 Pressure Ulcer

Stage 2 Pressure Ulcer

Stage 3 Pressure Ulcer

Stage 4 Pressure Ulcer

Stage 4 with Necrosis Deep, involves tissue, fascia, muscle, bone

Eschar- unstageable Dead tissue. There are two types of dead tissue found in a wound. The first type is called slough. This can be described as moist, loose, stringy dead cells, and appears yellow in color. The second type is called eschar and appears as thick, dry leathery-like tissue, and black in color. Dead tissue interferes with the repair process of our wounds and must be removed (by a qualified practitioner) before healing can take place.

Ulcer Assessment Describe ulcer Appearance Presence of infection Stage Location Size Shape Appearance Drainage Odor Presence of infection Foul smell Purulent drainage Heat, extreme redness, edema

Stage that ulcer!

Stage 4