Chapter 60 Assessment of Integumentary Function

Skin Largest organ of the body Functions Protection Sensation Fluid balance Temperature regulation Vitamin D production Immune response

Anatomic Structures of the Skin

Normal Aging Changes Thinning of skin Uneven pigmentation Wrinkling, skin folds, and decreased elasticity Dry skin Diminished hair Increased fragility and increased potential for injury Reduced healing ability

Aging Skin: Hands

Assessment of the Skin Preparation of the patient: explain purpose, provide privacy and coverings Assessment questions Inspect entire body, including mucosa, scalp, hair, and nails Wear gloves Assess any lesions; palpate and measure Note hair distribution Photographs may be used to document nature and extent of skin conditions and to document progress resulting from treatment. Photographs may also be used to track moles.

Cyanosis Jaundice

Primary Skin Lesions

Macule, Patch Macule: <1cm; circumscribed border Patch: >1 cm; may have irregular border Examples: Freckles, flat moles, petechia, rubella, vitiligo (portion on skin loses pigment), port wine stains, ecchymosis

Papule, Plaque Papule: <0.5cm Plaque: >0.5cm Elevated, palpable, solid mass with a circumscribed border Examples: Papules- Warts; Plaques- Psoriasis

Vesicle, Bulla Circumscribed, elevated, palpable mass containing serous fluid Vesicle: <0.5cm Bulla: >0.5cm Examples: Vesicles-Herpes simplex/zoster, varicella, posion ivy, 2nd degree burn (blister); Bulla-contact dermatitis, large burn blisters, impetigo

Wheal Elevated mass with transient borders; often irregular; size and color vary. Caused by movement of serous fluid into the dermis; does not contain free fluid in a cavity, as a vesicle does Example: Urticaria (hives), incest bites

Primary Skin Lesions

Nodule, Tumor Elevated, palpable, solid mass that extends deeper into the dermis than a papule Nodule: 0.5-2cm; circumscribed Tumor: >1-2cm; tumors do not always have sgarp borders Examples: Nodules- Squamous cell carcinoma; tumors-larger carcinomas

Cyst Encapsulated fluid-filled or semisolid mass in the subcutaneous tissue or dermis Example: Sebaceous cyst, epidermoid cysts

Pustule Pus-filled vesicle or bulla Example: Acne, impetigo, furuncles (boils), carbuncles (larger boils or clusters)

Secondary Skin Lesions Overgrowth of granulation tissue

Secondary Skin Lesions Thinning of skin caused by aging and topical steroids

Secondary Skin Lesions Leathery skin from scratching

Vascular Skin Lesions Small hemorrhages Swollen blood vessels

Vascular Skin Lesions small red nodule formed by a dilated vein in the skin. It is caused by increased venous pressure. small, bright red, clearly circumscribed vascular tumor on the skin

Skin Lesion Configurations B. Annular and arciform (circular or arcing) C. Zosteriform (linear along a nerve route) A. Linear (in a line) D. Grouped (clustered) F. Confluent (merged) E. Discrete (separate and distinct)

Which of these would be considered a primary macule skin lesion? Question Which of these would be considered a primary macule skin lesion? Hives Impetigo Port-wine stains Psoriasis

Answer C. Port-wine stains A macule is a flat discoloration or disruption to the normal skin. Other examples of primary macule lesions are “café au lait” patches on the hip and thigh of child, nevi (freckles), flat moles, or petechiae. Hives and impetigo are examples of primary vesicle lesions. Psoriasis would be an example of primary plaque lesion or a secondary scale lesion depending on the stage of the severity of the psoriasis.

Anatomic Distribution of Common Skin Disorders—Contact Dermatitis

Anatomic Distribution of Common Skin Disorders Seborrheic Dermatitis Acne

Anatomic Distribution of Common Skin Disorders Scabies Herpes Zoster Caused by mites Shingles

Which can cause hyperpigmentation of the skin? Question Which can cause hyperpigmentation of the skin? Eczema Fungal infection Sun injury Vitiligo

Answer Sun injury Hyperpigmentation can be a result of sun injury. Hypopigmentation may be caused by a fungal infection, eczema, or vitiligo.

Question What would be considered a normal finding in the skin assessment of an older adult? Elastic skin Uneven pigmentation Cherry angiomas Petechiae

Answer Uneven pigmentation Older adults have thin, nonelastic skin that is fragile and easily injured. Uneven pigmentation is an expected finding from sun damage and the normal aging process. Cherry angiomas can be a normal finding in all ages. Petechiae would not be an expected finding in an older adult and should warrant further investigation into possible bleeding tendencies problems or medication side effects.

Skin Appearance Erythema Rash Cyanosis Jaundice Pruritus: itching

Diagnostic Procedures Skin biopsy Immunofluorescence-Light microscopy Patch testing-Allergens Skin scrapings-Scabies Tzanck smear-Scarping of an ulcer base to look for Tzanck cells, which are found in herpes simples, shingles, varicella, and CMV. Wood’s light examination-Special lamp used in a dark room to diagnose fungal and bacterial skin infections.

Question Is the following statement true or false? Tzanck smear is a test used to examine cells from blistering skin conditions.

Answer True Tzanck smear is a test used to examine cells from blistering skin conditions.