Integumentary System N210 Fall 2007 Rachel Natividad RN, MSN

Variations across the lifespan: Infancy MONGOLIAN SPOT ACROCYANOSIS JAUNDICE

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

Variations across the lifespan: Elderly Changes R/T Aging Physiological change Physical Findings ↓ SQ tissue Thin flat skin Loss of collagen and elastic fibers wrinkles ↑ Capillary fragility purpuras ↓ sweat gland activity Xerosis (dry skin) Over exposure to sun Liver spots Loss of or inefficiency of melanocytes Liver spots

Elderly: Seborrheic keratoses

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

Assessing Skin Turgor

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

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

Primary Lesions Papule Nodule Tumor Wheal Vesicle Bulla

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

Secondary Lesions Keloid Fissure Crust Scale Lichenification

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

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

Vascular Lesions: Purpura

Shapes and Configurations

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

Pattern Injury from Physical Abuse Lesions due to trauma or abuse Lesions due to trauma or abuse Bruise or wound whose shape suggests the instrument or weapon that caused it Bruise or wound whose shape suggests the instrument or weapon that caused it Physical signs with history that does not match the severity or type of injury indicates abuse Physical signs with history that does not match the severity or type of injury indicates abuse Scalding injury, belt marks, bite marks, cigarette burns, deformity from untreated fracture Scalding injury, belt marks, bite marks, cigarette burns, deformity from untreated fracture

Pattern Injuries

Pattern Injury: Distribution

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

Parasitic Infestations PediculosisScabies Causelice Itch mite Symptom & Areas affected Head, body, pubic area Finger webs, creases of abd, wrist, axilla, breasts Treatment Pyrethroid (Rid) Lindane, pyrethroid

Parasitic Infestations CORPORIS CAPITISPUBIS

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

Infestations Cont. Scabies lesion distribution Scabies lesion distribution

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

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

Pressure Ulcers CAUSES (6) RISKS (4) PREVENTION (5) Pressure Mental Status Sensory Perception Pressure Relief ShearingActivityMobility Prevention of contractures Friction Friction Relief MoistureIncontinence Skin care Nutrition Nutritional Deficiencies Nutritional Suuport Circulation

Staging of Pressure Ulcers Pressure ulcers and their features are classified and assessed in stages: StageDescription Stage 1 Stage 2 Stage 3 Stage 4 Unstageable

Stage 1 Pressure Ulcer

Stage 2 Pressure Ulcer

Stage 3 Pressure Ulcer

Stage 4 Pressure Ulcer

Stage 4 with Necrosis

Eschar- unstageable

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