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

2. Variations across the lifespan: Infancy
ACROCYANOSIS
MONGOLIAN SPOT
JAUNDICE

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

4. 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

5. Elderly: Seborrheic keratoses

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

7. Assessing Skin Turgor

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

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

10. Primary Lesions
Wheal
Nodule
Papule
Tumor
Vesicle
Bulla

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

12. Secondary Lesions
Crust
Scale
Fissure
Lichenification
Keloid

13. 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

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

15. Vascular Lesions: Purpura
Bleeding disorder
Minor trauma

16. Shapes and Configurations

17. 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)

18. 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

19. Pattern Injuries

20. Pattern Injury: Distribution

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

22. Parasitic Infestations
CAPITIS
CORPORIS
PUBIS

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

24. Infestations Cont.
Scabies lesion distribution

25. Parasitic Infestations
Pediculosis
Scabies
Cause
Symptom & Areas affected
Treatment

26. 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.

27. Pressure Ulcers

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

29. 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

30. Stage 1 Pressure Ulcer

31. Stage 2 Pressure Ulcer

32. Stage 3 Pressure Ulcer

33. Stage 4 Pressure Ulcer

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

35. 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.

36. 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

37. Stage that ulcer!

38. Stage 4