integumentary system

epidermis

• most superficial layer

• thin

• replaced q3-4 weeks

dermis

supplies epidermis with nutrition

well supplied with blood

fingerprints

sebaceous glands

produce sebum, fatty substance secreted onto skin surface through hair

present on all skin surfaces except palms and soles

lubricated hair and skin

reduces water loss

sweat gland

eccrine - help control body temperature

apocrine - found in axillary and genital regions, stimulated by emotional stress

acanthosis nigricans

linear streak-like pattern in dark skinned people suggests DM

systemic lupus erthematosus

• butterfly rash

• flat, red, itchy

• worsens with sun exposure

• inflammatory autoimmune disease

vitiligo

depigmentation of skin

may be due to dysfunction of immune system

common and usually benign

alopecia

patchy hair loss

pallor

pale skin resulting from decreased redness in anemia, decreased blood flow in fainting and arterial insufficiency

central cyanosis

indicate advanced lung disease, HD, some genetic disorders

• O2 stat less than 85%

• may present as gray or whitish in dark skined person

clubbing

nails

• congenital or chronic CO2 retention

• common in smokers

spooning

concave curve nail snape

iron deficiency

transverse grooves

nail shape

nutrient deficiency

paronychias

swollen tender nail folds

fungal or bacterial infections

ecchymosis

multiple bruises at different stages of healing can be sign of abuse

platelet count less than 150,000

anticoagulation

petechiae

tiny hemorrhages

round, purple, red, brown

• thrombocytopenia, endocarditis, septicemia

purpura

extensive patches of petechaie and ecchymosis

hematoma

elevated area of bleeding under skin

papules

lesion less than 1 cm

plaque

elevated superficial lesions

greater than 1 cm

macule

flat, colored spot on skin

ex) freckle

papule

small bump or pimple

vesicle

small blister containing serous fluid

ex) herpes

nevus

mole or birthmark

scabies

minute, slightly raised tunnel in epidermis

common found on finger webs and sides of fingers

look for burrow of mite

necrotic tissue

eschar

black, brown, tan tissue that adheres firmly to wound bed or ulcer edges

slough

yellow or white tissues that adheres to ulcer bed in strings or thick clumps

granulation tissue

pink or beefy tissue with shiny, moist, granular appearance (good)

blanching in dark skinned patients

• look for area that is darker than surrounding skin, or taut, shiny, or hardened

• check for skin temp and texture

• early signs included less stiffness increased warmth

• over time will become cooler to touch because of impaired perfusion

unstageable pressure injury

obscured full thickness and tissue loss

extent of tissue damage within ulcer cannot be confirmed because it is obscured by slough or eschar

deep tissue injury

persistant, non blanchable deep red, maroon, purple discoloration

intact or non-intact skin

dark wound bed or blood-filled blister

results from intense or prolonged pressure and shear forces at bone-muscle interface

arterial ulcers

punched out look

• aka ischemic ulcer often due to blocked arteries

• occurs often in areas of feet

• vary in color, often painful and worsens when leg is elevated

• surrounding skin may be hairless, shiny, feel tight or itchy

• minimum drainage

• stop smoking, improve blood flow, revascularizatoin procedures, NPWT, HBOT

venous ulcers

• usually occurs on lower leg above ankel

• large, shallow wound with inflamed base

• irregular or uneven borders, more drainae

• may appear moist

• radiate dull ache through leg

• stasis ulcer

• elevate leg, weight managenent, exercise, compression therapy