Pathophysiology: Integument System

Skin

___ cancer is the most prevalent form of cancer

1 in 5

___ Americans will develop some form of skin cancer during their lifetime

5 million

___ million individuals are treated annually for skin cancer in the US

tanning beds

>400,000 cases of skin cancer each year are linked to ___

tanning beds

more people develop skin cancer from ___ than lung cancer from smoking

Basal Cell Carcinoma

___ is the most common form of skin cancer

Malignant Melanoma

___ occurs less frequently than other types of skin cancer but has the highest mortality rate

57

1 person dies every ___ seconds

-ultraviolet ray exposure: sun or tanning bed

-fair complexion

-occupational risk: sun exposure

what are the 3 general risk factors for developing skin cancer?

-shade

-avoid exposure to UV rays; avoid sun burns

-sunscreen (UVS/UVB) SPF > 15

-examine skin monthly

what are 4 general guidelines to prevent skin cancer

1. Melanocyte- melanoma

2. Keratinocyte- basal cell and squamous cell

what are the two main types of skin cancer and the different type of cells involved in each?

rapid

metastasis (spreads)

the progress of Malignant Melanoma is ___ and is associated with ___

family

Malignant melanoma may be associated with ___ history

fair

malignant melanoma is more prevalent in ___ skinned individuals

melanocytes

malignant melanoma has malignancy of ___

immune systems

people with impaired ___ are more at risk for malignant melanoma

sun exposed

If an African American were to get malignant melanoma, they would see it more likely on non ___ areas such as palms of hands or roof of the mouth. this is an ethnicity implication.

-A: asymmetry

-B: border irregularity

-C: color variation

-D: diameter > 6 mm

-E: evolving/ rapid enlargement

what are the ABCDE things to remember with early identification of malignant melanoma?

nevi

malignant melanoma usually arises from preexisting ___

black/ brown

what color is malignant melanoma usually?

-raised

-irregular

malignant melanoma is slightly ___ from the level of skin and will have ___ boarders with an uneven surface

red, inflamed, and tender

the perimeter of malignant melanoma may be ___, ___, and ___

ulcerate and bleed

malignant melanoma may tend to ___ and ___

-usually arises from preexisting nevi

-black/ brown color

-slightly raised from level of skin

-irregular boarders ; uneven surfaces

-perimeter may be red, inflamed. and tender

-may tend to ulcerate and bleed

-color may change

what are 7 characteristics of malignant melanoma?

nonkeratinizing cells

Basal cell carcinoma arises from the neoplasm of ___of the basal layer of the epidermis

white

basal cell carcinoma is most common in ___ skinned individuals

metastasize

basal cell carcinoma usually does no ___

-may begin with flesh color or pinky/ pearly color

-may ulcerate and have a shiny, waxy boarder

-may grow as a red, scaly area

-may be darkly pigmented in dark- skinned individual

what are 4 characteristics of basal cell carcinoma?

men

Squamous cell carcinoma is more common in ___

sun exposed areas such as forehead, ear, nose, back of hands, and lower lip

where are common site of squamous cell carcinoma?

-red, scaly

-may have depressed center

-slightly elevated

-may have crust appearance as progresses

what are 4 characteristics of squamous cell carcinoma?

-outer layer of epidermis

-pink erythema (redness), painful, no blisters

-ex. sunburn

-skin maintains function

-heals 3-10 days

what are 5 characteristics about the 1st Degree Burn Superficial

-epidermis and various degrees of dermis

-painful, moist, red, blistered

-skin under blister is sensitive to temp change, air exposure, and touch

-do not burst blister as they serve as a "bandage" and may promote healing

-heals in 1-2 weeks

what are 5 characteristics of 2nd Degree Burn Partial Thickness?

-entire epidermis and dermis

-painful, mottled pink, waxy white areas with blisters and edema

-blisters resemble flat, dry tissue paper

-scar formation is very likely

-heals in 1 month

what are 5 characteristics of 2nd Degree Burn Deep Full Thickness

-involve subcutaneous tissue and may involve muscle/ bone.

-will usually have areas of 2nd degree along with 3rd degree burns

-waxy white, yellow, tan, brown, deep red, or black in color

-hard, dry, and leathery with extensive edema

-NO PAIN: nerve sensors are destroyed

-may require skin grafts, scarring is expected

-healing takes several weeks- months

what are 7 characteristics of 3rd Degree Burn Full Thickness?

total body surface area (TBSA)

the extent of a burn is measured by estimating the ___ involved such as "Rule of Nines"

-thermal/ non thermal sources

-flames

-scalding liquids

-chemical

-electrical

-lightning

what are 6 types/ sources of burns?

-hemodynamic instability (blood pressure problems)

-fluid and electrolyte imbalances

-respiratory dysfunction

-hypermetabolic response (more calorie intake)

-organ dysfunction

-sepsis and immune dysfunction

-pain

-emotional trauma

what are 8 systemic complications of burns?

pressure injury

a ___ is a localized injury to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. the injury can present as intact skin or an open ulcer and may be painful.

-pressure

-shearing

-friction

-moisture

what are 4 mechanisms for development of a pressure injury?

-impaired sensory perception

-urinary/ fecal incompetence

-impaired nutrition

-hydration status

-circulatory status

-immobility

what are 6 contributing factors to pressure injury?

-identify patient at risk

-changing positions

-meticulous skin care

-frequent assessment

-keep dry/ clean

what are 5 ways of preventing a pressure injury?

-necrosis

-infection

-tunneling (passage way under skin)

-undermining (superficial lip on edge of wound)

what are 4 complications of pressure injuries?

Stage 1: Nonblanchable erythema of intact skin

what type of pressure injury is being described:

intact skin with localized area of non blanchable erythema, which may appear differently in darkly pigmented skin.

Stage 2: partial thickness

what type of pressure injury is being described:

partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. it is a superficial open are of the skin and it has some drainage.

Stage 3: Full thickness skin loss

what type of pressure injury is being described:

full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are NOT exposed. may include undermining or tunneling. slough may be present but does not obscure the depth of tissue loss

Stage 4: Full thickness tissue loss

what type of pressure injury is being described:

full thickness tissue loss with exposed bone, tendon, or muscle. often includes undermining or tunneling. slough or eschar may be present.

Unstageable/Unclassified: Full-thickness Skin or Tissue Loss—Depth Unknown

what type of pressure injury is being described:

Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough. Until slough or eschar is removed, the true depth can not be determined but it will either be Stage 3 or 4.

heels

eschar on the ___ serves as the "bodys natural (biological) cover" and should not be removed

Suspected Deep Tissue Injury—Depth Unknown.

what type of pressure injury is being described:

purple or maroon localized area of discolored intact skin or blood filled blister due to damage of underlying soft tissue from pressure and/ or shear.. this area may be mushy/ soft. this may evolve to pressure injury if we lose the top layer

National Pressure Ulcer Advisory Panel (NPUAP)

___ is the national organization that deals with pressure ulcers

-barrier

-1st line of defense

-temp regulation

-pressure and pain touch receptors

-role in regulating fluids and lytes

-role in glucose metabolism

-reflects emotional state and body image

-aids in vitamin D synthesis

what are 8 things that the function of Integumentary System plays a role in?