1. Chapter 60 Assessment of Integumentary Function

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

3. Anatomic Structures of the Skin

4. 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

5. Aging Skin: Hands

6. 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.

7. Cyanosis Jaundice

8. Primary Skin Lesions

9. 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

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

11. 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

12. 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

13. Primary Skin Lesions

14. 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

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

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

17. Secondary Skin Lesions
Overgrowth of granulation tissue

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

19. Secondary Skin Lesions
Leathery skin from scratching

20. Vascular Skin Lesions
Small hemorrhages
Swollen blood vessels

21. 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

22. 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)

23. 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

24. 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.

25. Anatomic Distribution of Common Skin Disorders—Contact Dermatitis

26. Anatomic Distribution of Common Skin Disorders Seborrheic Dermatitis Acne

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

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

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

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

31. 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.

32. Skin Appearance
Erythema
Rash
Cyanosis
Jaundice
Pruritus: itching

33. 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.

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

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