Midterm 202

functions of the integumentary system

• Protection against infection, injury, and UV rays

• Regulation of body temperature

• Sensory perception

• Synthesis of vitamin D

• Excretion of waste products

skin and vitamin d metabolism

UV light exposure converts 7-dehydrocholesterol in the skin to vitamin D3 (cholecalciferol), which is then processed in the liver and kidneys to become active vitamin D

skin changes in patients

• Type 2 Diabetes Mellitus: Delayed wound healing, increased risk of infection, diabetic dermopathy (brown, scaly patches), and acanthosis nigricans (dark, velvety skin patches).

• Liver Disease: Jaundice (yellowing skin), spider angiomas, palmar erythema, and pruritus (itchiness)

cyst

closed sac filled with fluid or semi-solid material

macule

flat, discolored spot (freckle)

nodule

solid, raised lesion >1cm

papule

elevated, firm lesion <1cm

plaque

raised, flat-topped lesion >1cm

pustule

elevated lesion containing pus

vesicle

elevated, fluid filed lesion <1cm

annular

ring-shaped (ringworm)

linear

line formation (shingles)

polymorphous

varied shapes and sizes

satellite

smaller lesions near a larger central lesion

Braden Scale

• Purpose: Assesses pressure ulcer risk

• Factors Considered: Sensory perception, moisture, activity, mobility, nutrition, friction/shear

• Score Ranges: 6-23 (Lower scores indicate higher risk)

aging and skin changes

thinner skin, reduced elasticity, slower wound healing, and increased dryness

xerosis

dry, itchy, scaly skin commonly seen in older adults

psoriasis

• Pathophysiology: Autoimmune disorder causing rapid skin cell production

• Clinical Manifestations: Red patches with silvery scales, itching, burning

• Treatment: Topical corticosteroids, vitamin D analogs, phototherapy, biologics

diagnostic test

• Wound/Bacterial Infection: Wound culture and sensitivity test

• Fungal Infection: Potassium hydroxide (KOH) test

malignant skin growth indicators

Asymmetry, border irregularity, color variation, diameter >6mm, evolving characteristics (ABCDE rule)

staphylococcus skin infection

Clinical Manifestations: Redness, swelling, warmth, pain, and possible drainage

herpes simplex virus (hsv-1 and hsv-2)

• Clinical Manifestations: Painful blisters or sores on lips (HSV-1) or genitals (HSV-2)

• Treatment: Antiviral medications (e.g., acyclovir)

• Cure: No cure; managed with medications

• Spread: Direct contact with infected skin or fluids

• Patient Teaching: Avoid sharing utensils, lip balm, or towels; practice safe sex

tinea infections

• Pathophysiology: Fungal infection affecting skin, nails, or hair

• Clinical Manifestations: Itchy, red, scaly patches; cracked or peeling skin

• Treatment: Antifungal creams, oral antifungals

• Patient Teaching: Keep skin dry, avoid sharing personal items

plaque psoriasis

• Pathophysiology: Chronic autoimmune skin condition

• Clinical Manifestations: Thick, red patches with silvery scales

• Treatment: Topical agents, phototherapy, systemic medications

• Cure: No cure; managed with treatment

• Patient Teaching: Moisturize regularly, avoid triggers

wound closures

• Primary: Immediate closure with sutures or staples

• Secondary: Healing through granulation (left open)

• Tertiary: Delayed closure after infection resolution

actinic keratosis

• Description: Precancerous skin lesion caused by sun exposure

• Potential Progression: Can develop into squamous cell carcinoma

• Common Locations: Face, scalp, ears, and back of hands

basal cell carcinoma

Slow-growing skin cancer often appearing as a pearly nodule or ulcerated lesion

skin cancer risk reduction

Use broad-spectrum sunscreen, wear protective clothing, avoid tanning beds, and regularly examine skin for changes

MRSA (methicillin-resistant staphylococcus aureus)

Skin Conditions: Abscesses, cellulitis, and boils

bacterial skin/soft tissue infection

• Clinical Manifestations: Redness, warmth, swelling, pain

• Complicated Infection: Fever, chills, and systemic symptoms

acute vs. chronic

• Acute Pain: Sudden, short-term, and resolves with healing

• Chronic Pain: Persistent pain lasting longer than 3 months

allodynia

pain from non-painful stimuli

analgesic

pain-relieving medication

antipyretic

fever-reducing medication

hyperalgesia

increased sensitivity to pain

pain tolerance

maximum pain level a person can endure

OPQRST-AAA Pain Assessment

• Onset, Provocation, Quality, Region/Radiation, Severity, Time

• Associated symptoms, Aggravating factors, Alleviating factors

numeric pain intensity scale

rates pain 0-10

verbal rating scale

describes pain as a mild, moderate, or servere

visual analog scale

marking pain on a 10cm line

visual analog thermometer

thermometer-like pain indicator

wong-baker scale

faces scale for children and non-verbal patients

NSAIDs

• Common Examples: Ibuprofen, naproxen

• Help with both pain and inflammation

• Antipyretic properties reduce fever

• Acetaminophen (Tylenol) is not an NSAID; it reduces pain and fever but lacks anti-inflammatory effects

• Side Effects of NSAIDs: GI irritation, kidney damage, cardiovascular risks

opioids

• Common Drugs: Morphine, oxycodone, hydrocodone

• Side Effects: Drowsiness, constipation, respiratory depression

• Dangers: Risk of dependency and overdose

• Patient Teaching: Use only as prescribed; avoid alcohol

• Monitoring Parameters: Respiratory rate, pain level, sedation score

pain documentation

Always document the patient's reported pain score, not your perceived severity

heat application contraindications

Avoid if the patient has active bleeding, an acute injury, or lacks sensation

pain management

• Pharmacological: Medications

• Nonpharmacological: Massage, relaxation techniques, heat/cold therapy

WHO three-step ladder for pain management

1. Non-opioids (e.g., NSAIDs)

2. Mild opioids (e.g., codeine) with or without non-opioids

3. Strong opioids (e.g., morphine) for severe pain