Primary Skin Lesions, Pressure Injury, Burns

Where is red color of oxyhemoglobin best assessed

fingertips, lips, mucous membranes

where should you examine dark skin

palms and soles

where to look for central cyanosis

lips, oral mucosa, tongue

where to look for jaundice

sclera- eye

primary skin lesion:

those that develop as a direct result of disease process

secondary skin lesion:

those that that evolve from primary skin lesion or develop as a consequence of pt activity

ex: scratching

What should be noted and documented after you have classified lesion primary/secondary

number, size, shape, color, texture, symmetry, anatomic location, distribution

which lesions are not palpable?

macule if <1cm, can be any color

patch if >1cm ex: vitiligo

which lesions are raised and solid

papule if <1cm

plaque if >1cm, well defined

which are fluid filled

vesicle if <1cm, thin and transparent walls

bullae if >1cm

both can arise from cleavage at various lvls of skin

what’s a wheal

localized dermal edema that comes and goes

usually reflects localized mast cell degranulation within the skin (release histamine)

can be round, flat, pale red papule or plaque

changes rapidly in size and shape

Ex: Urticaria

what’s a nodule

palpable, solid, round or ellipsoidal

may involve epi,derm, or subcut tissue

can develop as a result of a benign or malignant process

tumor:

any mass lesion

larger than nodule

benign or malignant

ex: lipoma

lesion w purulent exudate

Pustule

exudate are neutrophils are keratin

white, yellow, greenish yellow or hemorrhagic

cyst

encapsulated collection of fluid or semisolid material

fixed or mobile

most require excision of cyst in total or it’ll come back

erosion vs ulcer vs fissure

loss of epidermis

loss of skin through epidermis and results in scar

split in all epidermal layers

pressure injury

localized damage from unrelieved pressure, shearing forces, friction, moisture

Decubitis

pressure injury when lies or sits in one position for a long period of time

stage 1 pressure injury

acute inflammatory response primarily in the epidermis

skin is red and does not blanch

reversible

stage 2 pressure injury

inflammatory and fibroblastic response going through the epidermis into the dermis

skin loss involved

stage 3 pressure injury

pressure sore on subcutaneous layer

tissue loss through dermis to involve subcutaneous tissue

damage/necrosis extends down but not through underlying fascia/muscle

stage 4 pressure injury

pressure extending beyond deep fascia almost always to bone

skin loss w extensive tissue necrosis and damage to m, b, and sup str

Unstageable pressure injury

occurs when there is full thickness skin and tissue loss in which the extent of tissue damage w/i ulcer cannot be determined

ulcer is obscured by slough or eschar

Thermal injury

what are the 2 stages

source of massive tissue injury and destruction that has wide reaching effects on all organ systems

burn is genetic term used to describe injury caused by thermal chemical, or electrical causes

Immediate: result of direct cellular injury

Delayed: occurs as a result of progressive dermal ischemia

what determined the degree of tissue/cell in burns

duration of exposure and the temp to which the skin was exposed

what are the 4 classifications of thermal injuries

first degree-superficial

second degree- aka superficial and deep partial thickness

third degree- full thickness

fourth degree- full thickness w bone or muscle involvement

extent of thermal injury refers to the

Total Body Surface Area (TBSA) burned that calculate using the Rule of 9s

how do you measure thermal injury of pediatric population

what’s important regarding their weight

Modified Lund and Browder chart

due to disproportional weigh to body surface area, fluid losses are larger

children w burns should be transferred to a burn center verified to treat children

what are the 2 mechanisms of fluid loss due to burns

loss of skin integrity at wound site

capillary leak due to deep burns and systemic effects of inflammatory response

what’s an essential part of acute burn management

restoration of pt’s circulating volume

Parkland Formula

vs

Brook Formula

most widely used formula to guide fluid resuscitation w/i 24 hrs

Current recommended to now START w this formula and increase as neeeded

Production function of skin

endogenous production of vitamin D3, necessary to synthesize Vitamin D

Esthetic function of the skin is

providing the individual identity of a person

Burn Center Transfer Criteria

>10% BSA

involved face, hands, feet,genitalia,perineum,major joints

third degree

electrical,chemical,inhalation

complex comorbidities

high risk of morbidity/mortality

pediatruc

social,emotional,rehab intervention requirements