1. Integumentary System

2. Skin anatomy and physiology
Crash course Part 1: 9 min
Part 2: 9 min zXXVwQ

3. Skin functions Protects internal organs from injury
Prevents loss of too much water – cause of immediate death for burn patients
Protects body against bacteria – infections happen if skin is open (broken). Later cause of death for burn patients
Regulates body temperature
Responds to heat, cold, pain, pressure, and touch
Excretes waste products in sweat
Helps with production of vit D

4. Common skin disorders Burns Pressure ulcers Cellulitis (inflammation)
Psoriasis
Scabies
Shingles
Eczema
Fungus
Gangrene
Warts
Skin cancer

5. Burns First degree – redness, pain, affects only epidermis
Second degree – blisters, affect epidermis and dermis
Third degree – affects all the depth of the skin down to muscle and further up to bone
Treatment of second degree burns: 3 min
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Type of burns: 3 minhttps:// /watch?v=Dsvtzwp4nG8

6. Burn surface count
To count small areas use rule of 1 – hand with fingers is 1%
Fatality rate and severity of burns depend on percentage of the body burnt and degree of the burn.

7. First Aid: Burns
Burns in children m/watch?v=AxjjmaK2QA E
Every day First Aid: Burns
m/watch?v=Ns1DPvXVO 6I

8. Pressure ulcers staging and prevention
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9. What do you think would be the cause of death in patient with chronic pressure ulcers?

10. Does this man look familiar?
He was born in 1952, had a brilliant career in Hollywood, but at age 43 was thrown down by the horse and sustain a spinal cord injury. He became quadriplegic for the rest of his life.

11. What would be the cause of death in patient with chronic pressure ulcers?
Despite excellent care he had , he died 9 years later
of multiple complications of infection originated in pressure sores. It went to bones, causing bone marrow infection, then he had reaction to antibiotic he was receiving for the infection, then the immediate cause of death was a heart attack.

12. Psoriasis

13. Psoriasis http://www.youtube.com/watch?v=5fVVRvtoUyU
Is genetic disease.
It is a chronic skin condition in which cells of the skin grow too fast, causing red, white, or silver patches to form, and intensive shedding of the skin cells.
It has some allergic component to it, usually to some foods, cold. It can get worth with stress, cold weather, dry weather, etc.
It can get better with some creams, diet, procedures,bur overall it is not totally curable at current stage of medicine.

14. Psoriasis

15. Eczema
Allergy based skin condition with genetic component, complicated with inflammation of the top layer of the skin – epidermis.
Symptoms – itching, redness, swelling, cracking, and weeping of the skin.
Cause is unknown, but it is presumed to be a combination of genetic and environmental factors (allergens and toxins)
Now, what is the difference between psoriasis and eczema?
What would be NAC responsibility regarding eczema?
Prescribe lotions
Administer medications
Report observed signs of infections?
Draining oozing fluid from the skin

16. Eczema

17. Signs of localized infection:
1. Redness
2. Swelling
3. Warmth
4. Pain
5. Drainage

18. Cellulitis

19. Fungus
Can cause disease in humans with weakened resistance and in certain conditions – skin micro trauma, warm, dark, moisture environment.
In which part of the body fungal infections would occur most often?
Athlete’s foot:

20. Fungal infection after acrylic nails

21. Warts
Molluscum contagenosum - common in children, caused by virus, contagious with close contact, treatable with laser. For more information: CDC site -

22. Herpes simplex virus

23. Warts HPV – human papilloma virus.
HPV is the most common sexually transmitted infection in the United States.
There are many different types of HPV. Some types can cause health problems including genital warts and cancers.
Some health effects caused by HPV can be prevented with vaccines.
CDC Fact Sheet :

24. Gangrene – frost bites, diabetes, anything decreasing circulation in extremities

25. Shingles is a viral infection of the skin caused by varicella zoster virus VZV
VZV is the same virus what cases chickenpox.
Shingles most of the time chronic condition
During remission there are no lesions on
patient’s skin
During acute stage very painful blisters
or vesicles filled with fluid and virus appear
on patient’s skin
Patient should be on contact precaution for the blister period, blisters should be covered, and people who didn’t have chickenpox as a child, or who didn’t have chickenpox vaccination should avoid taking care of the patient.

26. Scabies
Scabies is an itchy, highly contagious skin disease caused by an infestation by the itch mite Sarcoptes scabiei. Symptoms – rash with “tunnels”, intense itching, and sores, what can get infected. Transmitted by close skin-to-skin contact or through sharing clothes like in sports teams. Scabies was very common in WWI and II among soldiers. Treatment is easy, but requires excellent hygiene and clothes and linen disinfection.

27. www.MedicineNet.com slide show on common adult skin problems
deshow/article.htm

28. Skin cancer
Very common type of cancer, starts from changing of form, shape, or color of existing mole. Spreads fast into lymphatic system.
Possible contributing factors – second degree sunburns.

29. Cover ears with a hat or hair to prevent skin cancer

30. Applications
Heat
Cold
Improves blood circulation, which brings more oxygen to the area and takes away waste products.
Also relaxes muscles and relieves pain.
In many facilities only qualified personal can apply heat (PT, RN, very seldom NAC) Check the policy in your facility. Never do it without verifying if it is in your job description.
Constricts blood vessels, minimizing bleeding, swelling, and bruising after trauma.

31. The golden rule of applications?

32. 20 minute rule
Remember to limit cold or warm applications to 20 min at a time
Otherwise it can cause the opposite effect.

33. Time to practice Dressings: Simple dressing to hand Hippocrates hat
Turtle dressing
Slings
Splints
Sterile dressing