1. Integumentary System N210 Fall 2007 Rachel Natividad RN, MSN

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

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

4. 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

5. Elderly: Seborrheic keratoses

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

7. Assessing Skin Turgor

8. 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

9. 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

10. Primary Lesions Papule Nodule Tumor Wheal Vesicle Bulla

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

12. Secondary Lesions Keloid Fissure Crust Scale Lichenification

13. 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

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

15. Vascular Lesions: Purpura

16. Shapes and Configurations

17. 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

18. 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

19. Pattern Injuries

20. Pattern Injury: Distribution

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

22. 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

23. Parasitic Infestations CORPORIS CAPITISPUBIS

24. 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

25. Infestations Cont. Scabies lesion distribution Scabies lesion distribution

26. 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.

27. Pressure Ulcers

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

29. 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

30. 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

31. Stage 1 Pressure Ulcer

32. Stage 2 Pressure Ulcer

33. Stage 3 Pressure Ulcer

34. Stage 4 Pressure Ulcer

35. Stage 4 with Necrosis

36. Eschar- unstageable

37. 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