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Integumentary System - Lecture Note s
Skin Health Promotion
● Avoid Hazards: Irritants, allergens, excessive sun exposure, radiation ● seek treatment and checks
X-rays are valuable in diagnosis and therapy but can cause side effects to skin such as
● edema ● hypopigmentation and hyperpigmenation (over/under production of melanin) ● Erythmema- A skin disorder characterized by a rash that can appear as target lesions (red spots with a lighter center-It's a sign of inflammation or irritation, resulting from the dilation of small blood vessels near the skin's surface. ● Dry desquamation presents as dry, peeling skin, while moist desquamation involves skin breakdown, blistering, and oozing, with the potential for infection.
Breaking the itch cycle:
Sleep is restorative to the body.
Pruritic (itching)skin diseases often interfere with sleep.
Sleep helps with tolerace for irritability, which hels with breaking the itch cylce
- Adequate rest increases the ability to tolerate itching, therefore decreasing skin damage.
~~~Hygiene ~~~
practices are influenced by:
● skin type ● lifestyle ● culture ● age ● gender
…... The use of mild, moisturizing soaps (ivory) and lipid-free cleansers, as well as avoiding hot water and vigorous scrubbing, can noticeably decrease local irritation and inflammation.
● Maintain Good Habits Adequate sleep, exercise, hygiene, and nutrition
Integumentary Diagnostic
Health history is primary care and would be primary prevention as most people with a 1st line relative have a what skin disease… in slides
Visual examination aka Inspection in the assessment stage this is vital for physical examination is mainly used to diagnosis patients
Dermatoscopy : Magnified skin analysi s -examination of the skin through a lighted instrument with a optical magnification
Biopsy: most common sample skin analysis.
techniques include: Punch Excisional shave
Stains & Cultures:
Identifies infections: bacteria fungi viral
Patch Testing: Identifies allergic reactions- used in evaluation of allergic dermatitis and photoallergic reactions
- When a photoallergen is exposed to UV light, it becomes chemically reactive. This reactive substance binds to proteins in the skin, triggering an immune response. Symptoms:
● Redness, swelling, and itching
● Blisters or hives
● Eczema-like rash
● Pain or burning sensation
Allergic Dermatologic Problems
● Common Triggers: Allergies, hypersensitivity, environmental exposure like UV
● Systemic antihistamines can provide relief while the underlying cause for the patients puritis is diagnosed and treated.
● Care Strategies:
○ !!Use tepid water for bathing cool environment may cause vasconstriction and decrease itching, hydration, and wet compresses, and moisturizers are helpful.!! ○ Topical corticosteroids to numb the itching ○ Avoid vigorous rubbing!! ○ Moisturize after bathing while pores are open, do not dry fully ○ Avoid hot environments, alcohol, spicy foods- vasodilation which impares blood circulation due to increase of bleeding and widing of blood vessels ○ -avoid situations that cause vasodilation -overly warm environment -ingestion of alcohol, hot foods, liquids ○ Reinforce perscribed therapetic regimen ○ educate on self care
Skin Cancer- Most common cancer
● Major risk factor: Sun exposure
● Prevention:
○ Use sunscreen and Avoid tanning & excessive sun exposure
○ Perform regular skin checks/inspections -ensure baseline
ABCDE Rule for Melanoma Detection- particularly moles or lesions that won't heal
● Asymmetry
● Border irregularity
● Color variation (blue)
● Diameter > 6mm
● Evolving shape- sudden changes in size or shape
Elderly: worried of age spots, should see dermatologist to get skin baseline, nurse practitioner will do an assessment
Atypical/Dysplastic Nevus- an abnormal nevus pattern of moles or lesions called dysplastic nevus syndrome identifies an individual at an increased risk of melanoma. Approximetly 2% to 8% of the white population has moles classified as atypical or dysplastic nevi. Or DN
-dysplastic nevi or DN syndrome is atypical moles that are larger than 5mm across with irregular boarders and various shades of colors, less pronounced.
Nonmelanoma Skin Cancers (basal cell or squamous cell carcinoma)
Actinic Keratosis: is a type of Premaligmanet skin lesions aka Precancerous lesions but is also
non-cancerous
-plaques or papules occurring in sun exposed areas
-affect nearly all of the older white population
-clinical appearance: irregular shape, flat, slightly erythematous papule, indistict boarders, overlying hard scale or horn : plaques
-treatment is aggressive but nonsurgical is 1st line treatment
Basal Cell Carcinoma:
-nonmelanoma skin cancer, locally invasive, develops in sites of ealier trauma such as scarring,
thermal burns, and injuries, Most common, least deadly
- never spreads beyond skin Shiny, waxy nodule that may be gray/yellow
SIGNS
-Apearr flat, wont heal and may bleed
-Rarely metastasizes but often recurs after you've had one
Risks: immunosupresion, sundamage, smoking
Basal Cell Carcinoma
- Basal cell carcinoma (BCC), the most common type of skin cancer, -develops from basal cells in the epidermis (OUTTER LAYER) -often appears as a slow-growing, painless bump or sore on sun-exposed areas, like the face and neck.
~Squamous Cell Carcinoma:~~-
Squamous Cell Carcinoma:- like a snake it metastasis and is scaly and bites with its mouth whic you get venom into your blood or lymph sings may look asymetric or bleed!!
Arises from epidermis and sun damaged skin- as do all of these
○ May metastasize - by blood or lymph ○ Risk factors: Smoking, sun damage, immunosuppression leads to increase in incidence ○ Appears as a rough, scaly tumor ○ Smoking increases risk of Squamous cell carcinoma(SCC) ON the LIPS AND MOUTH ○ May be asymmetric or bleed ○ More aggressive than basal cell carcinoma… like how basail cell carcinoma is 1st
○ Wide borders ○ nfiltrated ○ Inflammatory ○ Renal transplant recipients have a 253-fold increase in risk of SCC. ○ A biopsy should be performed with a lesion is suspected for diagnosis
Malignant Melanoma- is a tumor asrising in the meanocytes- can spread to to other organs or body systems due to its ability to metasitize in any organ, including brain or heart
Manifests: as a new skin lesion or growth: cancerous neoplams present in dermis and epidermis
!The most dangerous type
Uv radiation is the main cause!!!!!
Effect: damages dexyribonuleic acid (DNA) in skin cells causing miss-spellings o r mutations in genetic code
Risks
Red/blonde hair, light-colored eyes, fair skin, chronic sun exposure, family history
Genetic disposition toward melanoma, between 5% and 10% of people who develop melanoma have a 1st degree relative who developed melanoma - HISTORY
The use of immunosupressants and a HISTORY of dysplastic nevi increases risk (aytpical moles)
Appearance:
○ Color is Dark, red, blue, or mixed-color lesion ○ Irregular shape, itching, rapid growth, ulceration
Treatment:
○ Surgical excision, chemotherapy
screening -assesement, histroy, biospy, treatment, the msot dangergous type is MALIGMNY MELANOMA: In summary: Mm is an alteration of genetic code due to uv light exposure. can spread to different places of the body via blood stream or lymph
infection. It can rapidly disseminate throughout the body, affecting multiple organs including the skin, lymph nodes, liver, and gastrointestinal tract. It is considered an AIDS-defining malignancy.
Benign Dermatologic Problems
-know how each look and can be defined
● Acne Vulgaris-open or closed comedones (blackheads, whiteheads) ● Contact Dermatitis- itchy rash caused by direct contact with a substance or an allergic reaction to it ex. posion ivy, not contagious ● Eczema (Atopic Dermatitis)-causes dry, itchy, inflamed skin, it is common in young children but occurs at any age, is chronic and can flare up, it can be irritating but not contagious- bumpy
● Psoriasis- is an autoimmune disease, men and women develop at equal rates, all racial group, develops in the ages of 15-35 and at least 1/3rd of those who develop psoriasis have at least one relative with the disease- Lesions are distinct and appear as red, scaling, papules that merge and for plaques, bleeds easlaiy when removed and the effected area is rounded ● Seborrheic Keratosis- ,lproduces irrregualr round or oval, often verrucous papules or plaques which are well defined in shape with the appearance of being stuck on
● Prevention Strategies:
○ Avoid skin hazards, maintain good hygiene & nutrition
○ Regular self-exams & professional skin checks
Skin Infections
Bacterial Infections
● Impetigo (highly contagious skin infection)
Viral Infections
● Shingles (Herpes Zoster):
○ Symptoms appear on one side of the body
○ Pain, burning, rash, fluid-filled blisters
○ Itching, sensitivity to touch
Infestations & Bug Bites
● Insect Bites: Mosquitoes, fleas, lice, scabies
● Hymenopterans: Bees, wasps, hornets, fire ants
Fungal Infections
● Tinea Cruris (Jock itch)
● Tinea Corporis (Ringworm)
● Tinea Capitis (Scalp infection)
● Tinea Pedis (Athlete’s foot)
Integumentary Management & Nursing Care
● S kin Treatments:
○ Wet compresses, baths, topical medications
● Pruritus (Itch) Management:
○ Break itch-scratch cycle
○ Cool environments, hydration, moisturizers
○ Topical drugs
● Infection Control:
2. Checking for Cyanosis in Dark Skin → Lips & oral mucosa (best places to assess) 3. Elderly Skin Care → Use warm water & moisturizing soap (prevents dryness) 4. Melanoma Risk → Tanning booth use (highest modifiable risk) 5. Preventing Infection Spread → Handwashing & proper disposal of dressings (most effective method)
What is another word for moles…
Examples of diseases… type of rash..ect.
Need to turn patients every 2 hours
- A small papule with a dry, rough scale would be actinic keratosis, which can be a
precancerous skin lesion.
- A firm, nodular lesion topped with crust is usually a sign of squamous cell
carcinoma.
- A pearly papule with a central crater and a waxy border is a lesion expected with
basal cell carcinoma.
- An irregularly shaped lesion is common with melanomas.
PRESSURE ULCERS
Hospital acquired pressure ulcers -one of the most common PREVENTABLE conditions Turn patients every 2 hours
unstagable- full thickness
Skin tares are linner
Atopic dermatitis
● Occurs in flexible locations ● A form of eczema ● Often caused by genetic mutation or propensity for allergy ● Most commonly occurs in age 5 or younger
Contact dermatitis
has 2 types:
Irritant contact dermatitis- is produced by direct chemical injury to the skin
Allergic contact dermatitis- antigen specific, type IV delayed hypersensitivity response.
● Caused by reaction to chemical exposure ● Less common in younger children ● Occurs at the site of chemical exposure
Psoriasis
Chronic, autoimmune, can flare up
- inflammatory diases of the cells which are produced at an abnormal high rate -effects 3.2% of americans, prevalent in caucasians and median age of 28 -aggravated by stress, trauma, seasonal hormonal changes -treatment: baths to remove scales, medications
-scales will bleed
Goals: slow rapid turn over of epidermis, promote resolution of psoriatic lesions, control
disease cycle
Remove scales during bath using soft brush, apply emollient creams after, maintain
routine
Pharmacologic therapy
-Topical
-Phototherapy
-Systemic
Patient education regarding the disease, skin care, and treatment regimen
Measures to prevent skin injury: avoid picking or scratching- reduce stress, promote
sleep
Measures to prevent skin dryness: use of emollients like lotion- avoid excessive
washing, and use warm (not hot) water, pat dry
Use of the therapeutic relationship for support and to aid coping
Bacterial infections and infestations
-impetigo (bacterial)
- Bacterial infection occurs when the balance between the host and microorganisms is
altered.
- A primary skin infection occurs after a break in skin.
- A secondary infection occurs to already damaged skin or as a result of
systemic disease.
- Staphylococcus aureus and group A β-hemolytic streptococci are the major types of
bacteria responsible for primary and secondary skin infections.
•Streptococci cause impetigo, erysipelas, cellulitis, and lymphangitis.
- Viral infections of the skin are difficult to treat. When a virus infects a cell, a skin
lesion may develop.
- Herpes simplex, herpes zoster, and warts are the most common viral infections
affecting the skin.
•The possibilities for exposure to infestations (harboring insects or worms) and insect
bites are numerous.
-insect bites
Shingles is a viral infection that causes a painful rash
-Shingles can occur anywhere on your body.
-It typically looks like a single stripe of blisters that wraps around the left side or the right
side of your torso.
-Shingles is caused by the varicella-zoster virus — the same virus that causes
chickenpox.
-After you've had chickenpox, the virus stays in your body for the rest of your life. Years
later, the virus may reactivate as shingles.
-Shingles isn't life-threatening. But it can be very painful.
Vaccines can help lower the risk of shingles.
Early treatment may shorten a shingles infection and lessen the chance of
complications. -vaccine!!!!
The most common complication is postherpetic neuralgia. This is a painful condition
that causes shingles pain for a long time after your blisters have cleared.
Pain is usually the first symptom of shingles. For some people, the pain can be
intense. Depending on the location of the pain, it can sometimes be mistaken for
problems with the heart, lungs or kidneys. Some people experience shingles pain
without ever developing the rash.
Most commonly, the shingles rash develops as a stripe of blisters that wraps
around either the left or right side of the torso. Sometimes the shingles rash occurs
around one eye or on one side of the neck or face.
- A person with shingles can pass the varicella-zoster virus to anyone who
isn't immune to chickenpox. This usually occurs through direct contact with the
open sores of the shingles rash. Once infected, though, the person will develop
chickenpox rather than shingles
(Mayo Clinic)
Shingrix vaccine is approved and recommended for people age 50 and older,
whether they've had shingles or not. People who've had the Zostavax vaccine in the
past or don't know whether they've had chickenpox may also receive the Shingrix
vaccine.
Insect Bites—Flies, Gnats, Mosquitoes, Fleas: Treatment: Use antipruritic agents
and baths.
Administer antihistamines. Prevent secondary infection
Prevention: Avoid contact. Remove focus, as by treating furniture, mattresses, carpets,
and pets where insects may live
Apply insect repellent when exposure is anticipated
Chiggers—Harvest Mites: Treatment—May require systemic steroids for extensive
bites
Prevention: Avoid contact, especially in areas of tall grass and underbrush. Apply
insect repellent when exposure is anticipated. Spray insecticides such as diazinon in
yards
Hymenopterans—Bees, Wasps, Hornets, Yellow Jackets, Fire Ant: Treatment:
Carefully scrape off stinger or pull out stinger as quickly as possible
Cleanse with soap and water. Apply cool compresses. Apply common household
product (e.g., lemon juice, paste made with aspirin or baking soda.) Administer
antihistamines. Severe reactions—Administer epinephrine, corticosteroids; treat
for shock
•Lasers are used for many dermatologic problems. Depending on the type of
laser and the wavelength, lasers serve a wide variety of functions and can
cut, coagulate, and vaporize tissue to some degree.
•Drug therapy
- Antibiotics are used topically and systemically to treat dermatologic problems.
- Corticosteroids are particularly effective in treating a wide variety of dermatologic conditions and are used topically, intralesionally, or systemically.
- Oral antihistamines are used to treat conditions that exhibit urticaria, angioedema, and pruritus, and also may have anticholinergic and/or sedative effects.
Fluorouracil (5-FU) is a topical cytotoxic agent with selective toxicity for
sun-damaged cells and is used to treat premalignant (especially actinic keratosis)
and some malignant skin diseases. Topical immune response modifiers such as
pimecrolimus (Elidel) and tacrolimus (Protopic) are medications used in atopic
dermatitis.
- Wet compresses are commonly used when there is oozing from the skin and to
debride superficial wounds. Wet compresses also provide comfort and treatment
of conditions like poison ivy, insect bites, and skin infections.
Simple tap water or bottled water may be used. Depending on the problem, additives
may be used such as antibacterial solutions containing aluminum acetate (Domboro
powder), silver nitrate, or acetic acid.
- Baths are an appropriate intervention when large areas of the body need
treatment. Baths may be relaxing and will help decrease itching. Agents such as
oilated oatmeal (Aveeno) and sodium bicarbonate can be added directly to bath
water.
•Topical medications: A thin layer of ointment, cream, lotion or solution, or gel should
be applied to clean skin and spread evenly in a downward motion in the direction of hair
growth. An alternative method is for you to apply the medication directly onto a
dressing.
- Pruritus (itching) can be caused by dry skin, almost any physical or chemical stimulus to the skin (such as drugs or insects), and any scaling skin disorder. - The itch/scratch cycle must be broken to prevent excoriation and lichenification. Control of pruritus is also important because it is difficult to diagnose a lesion that is excoriated and inflamed. •A cool environment may cause vasoconstriction and decrease itching. •Hydration, wet compresses, and moisturizers (including antipruritic lotions) are normally helpful.
•Topically applied corticosteroids, menthol, camphor, or phenol can be used to numb the itch receptors.
- Systemic antihistamines may provide relief while the underlying cause of the patient’s pruritus is diagnosed and treated. Wet dressings may also relieve pruritus.
Nursing care:
It is hard to keep a sterile environment so meticulous hand washing to prevent fungal
infections is best practice
- Prevention of spread: Careful hand washing and the safe disposal of soiled
dressings are the best means of preventing the spread of skin problems. The
most common contagious lesions include
● impetigo,
● staphylococcal infections,
● Pyoderma,
● fungal infections,
● primary chancre,
● scabies,
● pediculosis.
•Open skin lesions are susceptible to invasion by other viral, bacterial, or fungal
organisms. Meticulous hygiene, hand washing, and dressing changes are
important to minimize the potential for secondary infections.
- Warn the patient about scratching lesions, which can cause excoriations and
create a portal of entry for pathogens. Trim the patient’s nails short to minimize
trauma from scratching.
•You are often in a position to teach patients skin care after simple dermatologic surgical
procedures, such as skin biopsy, excision, and cryosurgery. In general, your instructions
should include dressing changes, use of topical antibiotics, and the signs and symptoms
of infection.
•A sutured wound may be covered with a variety of dressings. If necessary, a topical
antibiotic is applied and the wound either is covered with a dry dressing or left open to
air.
- Intermittent application of cold (ice packs) over the surgical dressing may
reduce edema. Teach the patient how to differentiate normal inflammation from an
infection.
Steven- Johnson syndrome (SJS) -acute -rare -potentially fatal
