Integumentary System and Wound Care

Pigmentation and Melanin

• Sunlight promotes melanin production.

• Melatonin, produced with sunlight exposure, can cause sleepiness.

Dermis

• Strong connective tissue layer.

• Contains sweat glands, hair follicles, and blood vessels.

Subcutaneous Fat

• Subcutaneous tissue.

Integumentary System

• Includes hair and nails (fingernails and toenails).

• Hair follicle: root attaching hair to skin.

• Subcutaneous glands produce oils and sweat.

• Excessive subcutaneous gland activity may require Botox injections to reduce sweating.

Age-Related Skin Changes

• Pruritus: Medical term for itching, often due to drying of the skin.

• Skin pales as melanin production decreases.

• Age 40: Men start losing hair.

• Age 80s: Most men are bald.

• Age 50: Gray hair appears.

• Women experience thinning scalp hair and increased facial hair.

• Nose never stops growing.

• Nail beds flatten, becoming dry and brittle; toenails thicken and calcify.

Skin Irritation and Changes

• Discomfort, color changes, new conditions, changes in moles, slow-healing sores, itchiness, dryness, scaliness, excessive bruising, and rashes.

Environmental Factors

• Changes in living environment can impact skin.

• Malnourishment, lack of cleanliness, and inadequate hygiene.

• Stress and anxiety negatively affect the immune system, leading to excess cortisol production.

Skin Color and Oxygenation

• Darker skin: Lack of oxygen appears as a dusty gray tone.

• Lighter skin: Lack of oxygen appears as a lighter pale tone.

• Dehydration presents differently depending on skin color.

Checking Lips for Oxygenation

• Inner part of the lips should be checked for color.

• Healthy: Moist pink.

• Lack of perfusion: Pale or white.

Rashes

• Assess the location and appearance of rashes.

• Determine if fungal or open (wound).

• Rashes in areas exposed to air differ from those in dark, moist areas (e.g., under belly folds).

• Fungi thrive in dark, moist environments.

Skin Assessment

• Palpate skin for moisture, turgor, and edema.

• Assess hair for oiliness and texture.

• Oily hair can cause scalp pain due to oil buildup in follicles.

Infestations (Lice and Scabies)

• Head-to-toe assessment includes checking for infestations like lice and scabies.

• Lice: Parasites that cause intense itching.

  • Scratching can lead to open wounds and infections.

  • Lice are highly contagious, spreading through close contact or shared items.

  • Treatment: Wash all items (pillows, blankets, hats, jackets). Use fine-tooth comb (nitpicker after using shampoo).

• Scabies: Burrow into the skin and can survive on surfaces for days.

  • Cause intense itching.

  • Require prescription medication.

Personal Anecdotes and Experiences

• Personal story about son contracting lice and subsequent cruise ship issues.

• Discusses experiences with lice in family and treatment methods.

Differentiating Lice and Scabies

• Lice live on the surface and spread easily.

• Scabies burrow under the skin and can survive on surfaces.

Skin Lesion Terminology

• Macule: Flat, slightly discolored spot.

• Papule: Raised, hard bump.

• Plaque and Wheal: Raised areas, with wheals more raised.

• Pustule: Filled with pus (e.g., pimple).

• Cyst: Extends deeper, under the next layer of skin.

• Scales and Crust: Scales are on the surface; crusts are cracked.

• Ulcer: Deeper than erosion

• Fissures: Tunneling into a digger

Skin Biopsies

• Removal of skin for testing.

• Shave biopsy: Removes the top layer of skin.

• Punch biopsy: Uses a punch to remove a deeper sample.

• Incisional biopsy: Removes a piece of the entire one.

Wound Care: Wet to Dry

• Using sterile saline to moisten gauze pads.

• Packing the wound with wet gauze and covering with dry gauze.

• Initial and date tape after dressing change.

• Document wound appearance, measurements, and exudate.

Wound Vacs (Negative Pressure Wound Therapy)

• Spongy material cut to the size of wound.

• Specialized tape and gauze layers.

• Machine applies negative pressure, drawing out exudate and increasing blood flow.

• Promotes faster healing by increasing oxygen and blood vessels.

• Negative Pressure \rightarrow Increased Blood Vessels \rightarrow Faster Healing

Importance of Comprehensive Skin Knowledge

• Need to know both textbooks for skin: concepts and the detail.

Pruritus (Itching)

• Triggers: Dryness, irritation.

• Conditions: Cirrhosis, eczema, dermatitis.

• Management: Steroid lotions, saltwater/Epsom salt baths, calamine baths, local anesthetics.

• Antidepressants: Address body image issues related to skin conditions.

Eczema and Psoriasis

• Triggers: Stress.

• Common locations: Elbows, between fingers.

• Steroid lotions to prevent cracking and bleeding.

General Skin Care Interventions

• Avoid very hot water.

• Administer medications.

• Inspect skin regularly.

• Address body image concerns.

Eczema and Psoriasis Characteristics

• Eczema: Red, oozing, crusting rash; associated with asthma.

• Psoriasis: Silvery appearance; stressors bring it out.

Seborrheic Dermatitis

• Affects areas with hair follicles (scalp, eyebrows, gluteal crease, under breasts).

• Causes itchiness.

• Treatment: Medical diagnosis, topical treatments, prescription shampoos (e.g., Selsun).

Psoriasis Details

• Bright red lesions with silver scales.

• Chronic and autoimmune.

• Management: Corticosteroids to reduce inflammation.

• Diagnostic: Scrape biopsy or testing.

Intertrigo

• Occurs in skin folds (belly folds, under chin, pubic area).

• Irritated, raw skin that may burn.

• Can lead to fungal infections.

• Management: Keep area clean and dry, use barriers.

Fungal Infections

• Tinea: Use names of body parts related to fungus.

  • Pedis: Feet.

  • Manus: Hands.

  • Capitis: Scalp.

  • Barbae: Beard (barber).

  • Cruris: Groin

• Candiasis: Can be mouth, vagina, GI Tract, or lungs.

• Thrush: Oral, fungal infection that can affect the airway.

Herpes

• Herpes Zoster (Shingles): Attacks nerve endings; caused by prior chickenpox.

  • Presents as a butterfly-shaped rash emanating from the spine.

  • Management: Symptom management, antiviral agents.

  • Prevention: Vaccine for those 50 years or older.

• Herpes Simplex 2: Gential Herpes (STI).

Burns

• Rule of Nines: Used to estimate the percentage of body surface area (BSA) affected by burns.

  • Head: 4.5% (front), 4.5% (back).

  • Arms: 4.5% (front), 4.5% (back) each.

  • Legs: 9% (front), 9% (back) each.

  • Torso: 18% (front), 18% (back).

  • Perineum: 1%

• Burn degrees:

  • First Degree: Superficial.

  • Second Degree: Epidermis and Dermis.

  • Third Degree: Deeper into tissue.

• Facial Burns: Inflammation may cause repiratory issues.

• Skin loss results in fluid loss

• Fluid resuscitation for severe burns; Turntable use to promote blood flow.

• Emergent response: Stabilize patients

• Smoke inhalation: Watch for rapid inflamation

• Mortality Factors:

  • 25% BSA for younger than 40

  • 20% or more for 40 or older

• Electrical injuries: Tissue damage, elctrolyte imbalance, leaks fluid.

• Fluid evaporation through wounds.

• Management

  • Airway,breathing,circulation

  • Treat for fluid loss and electrolyte imbalance

  • Infection risk management

  • Escharotomy (to improve blood flow)

  • Wound care and debridement, skin grafting

  • Promote mobility to prevent stiffening during healing

Stages of Healing

• Emergent: Immediate injury, stabilize.

• Acute: 10 percent of wounds are closed

• Rehab: Follow healing

Important actions

• Apply oxygen immediately with burn victims

• Start IV

• Inspect wounds for assessment

• Treat burns with silverdine

*24 hours constant Volume to promote fluids loss

• Dextrose provides glucose content

• Family management (shock)

Wound care

• Debridements (remove to get to normal content)

• Skin grafting: Temporarily of permanently.

• Management heart rate

• Abdomen assessement for movement

Medical cases details

• Hypovolemic shock: Low fluid, heart damaged.

Skin Disorders (Additional Information from Slides)

• Stevens-Johnson Syndrome: Severe allergic reaction causing necrotic tissue and sores.

  • Can affect eyes (leading to blindness), mouth (affecting eating), and skin.

• Eczema vs Psoriasis:

  • Psoriasis: Silvery, scaly patches.

  • Eczema: Oozing and crusting.

• Recognizing the signs and symptoms of certain diseases

• Ringworm vs. parasite. Is it an actual ring?

• Steven Johnsons (Allergic reaction, medication)

  • Necrotic tissue, can't close your ears and mouth

WOUND STAGES. WOUND CARE

Stage one. Does not go away when thumb is placed on and does not turn white.
Stage two. Epidermis has been broken and treatment should be taken.
Stage 3. Treatment needed and fatty protrusion can appear from the tissue.
Stage four. Tissue damage which doesn't hurt for long and you need surgery.