Adult Health Chapter 3: Integumentary System and Burns
Learning Objectives and Study Resources
The information provided serves as a comprehensive summary of Chapter 3 in the adult health curriculum. However, students maintain responsibility for all content within the textbook chapter.
Students should utilize the following resources to ensure mastery and comprehension:
EAQ (Elsevier Adaptive Quizzing)
Evolve online resources
Accompanying textbook study guide
Therapeutic Baths
Primary Reasons for Use: Therapeutic baths are administered to soothe the skin, reduce inflammation (pruritus), cleanse the surface, and promote healing of dermatological lesions.
Specific Application for Pruritus Dermatitis:
Supplies Needed: Use of medicated additives such as colloidal oatmeal (Aveeno), cornstarch, or sodium bicarbonate (baking powder).
Patient Teaching and Best Practices:
Water temperature should be maintained as tepid (lukewarm) rather than hot to prevent further irritation or vasodilation.
Instruct the patient not to rub the skin dry with a towel; instead, the skin should be gently patted dry to preserve the integrity of the barrier and keep the medication on the skin.
The bath typically lasts between and minutes.
Viral Infections: Herpes and Impetigo
Herpes Zoster (Shingles):
Identification and S/S: Characterized by painful, vesicular eruptions that follow a specific nerve pathway (dermatome). It is a reactivation of the Varicella-Zoster virus (VZV).
Importance of Early Recognition: Early diagnosis is critical to initiate antiviral therapy (e.g., acyclovir) within of symptom onset to reduce the severity and duration of the illness.
High-Risk Groups: Individuals at high risk for complications like postherpetic neuralgia include the elderly, the immunocompromised, and those with chronic underlying health conditions.
Differential Diagnosis of Common Conditions:
Chickenpox (Varicella): Generalized pruritic rash with vesicles in various stages of healing; usually accompanied by fever and malaise.
Herpes Simplex Type 1 (HSV-1): Commonly presents as "cold sores" or "fever blisters" on the lips or mouth; vesicles eventually rupture and crust over.
Impetigo: A highly contagious bacterial infection (often streptococcal or staphylococcal) characterized by "honey-colored crusts" on an erythematous base, often found around the nose and mouth.
Diagnostic Procedures and Skin Assessment
Woods Lamp:
Description: A specialized diagnostic tool using ultraviolet (UV) light filtered through a Wood’s filter.
Purpose: Used to identify specific fungal and bacterial infections.
Identification: Under the lamp, certain organisms (e.g., Microsporum in Tinea capitis) will fluoresce (glow) a specific color, such as bright green or blue-green, allowing for rapid identification.
The PQRST Mnemonic for Skin Lesion Assessment:
P (Provocation/Palliation): What causes the lesion or pain, and what makes it better or worse?
Q (Quality/Quantity): What does the lesion look like? What is the nature of the pain (aching, burning, itching)?
R (Region/Radiation): Where is the lesion located, and does the discomfort spread to other areas?
S (Severity): How severe are the symptoms on a scale of to ? Does it interfere with daily activities?
T (Timing): When did the lesion first appear? How long has it been there? Is it constant or intermittent?
Classification of Skin Lesions
Macules: Flat, circumscribed areas of skin color change, typically less than in diameter (e.g., freckles, flat moles).
Plaques: Elevated, firm, and rough lesions with a flat top surface, often greater than in diameter (e.g., psoriasis).
Wheals: Elevated, irregular-shaped areas of cutaneous edema; they are solid and transient with variable diameters (e.g., insect bites, hives/urticaria).
Vesicles: Elevated, circumscribed, and superficial fluid-filled (serous) blisters, typically less than in diameter (e.g., varicella, herpes zoster).
Dermatology Pharmacology: Isotretinoin
Medication Use: Primarily used for severe, recalcitrant cystic acne.
Patient Teaching Requirements:
Teratogenicity: The drug is highly teratogenic; female patients must use two forms of contraception and participate in the iPLEDGE program.
Monitoring: Periodic blood tests are required to monitor liver function and lipid levels.
Side Effects: Patients should report symptoms of depression or suicidal ideation immediately. Dryness of the skin, lips (cheilitis), and eyes is common.
Benign and Malignant Skin Growths
Angioma: A benign tumor consisting of a mass of blood vessels or lymphatic vessels (e.g., cherry angioma).
Keloid: An hypertrophic scar that extends beyond the borders of the original injury; more common in individuals with darker skin pigmentation.
Melanoma: A malignant tumor of the melanocytes; it is the most lethal form of skin cancer. Risk factors include fair skin, history of sun exposure/blistering sunburns, and a family history of the disease.
Nevus: Commonly known as a mole; a circumscribed skin lesion that can be congenital or acquired. Changes in a nevus (ABCDE criteria) should be evaluated for malignancy.
Comprehensive Burn Management
Fluid Loss and Life-Threatening Complications:
Greatest Risk Period: The first to after a major burn is the period of highest risk for fluid shift and hypovolemic shock.
Pathophysiology: Increased capillary permeability leads to "third-spacing," where fluid, electrolytes, and proteins leak from the intravascular space into the interstitial space.
Phases of Burn Care:
Emergent Phase (Resuscitative): From the time of injury to approximately to post-burn. The primary concern is airway management and preventing hypovolemic shock.
Acute Phase: Begins when the patient is hemodynamically stable (diuresis starts) and ends when the wounds are closed or grafted. Focus shifts to wound care and infection prevention.
Rehabilitation Phase: Focuses on restoring function and cosmetic appearance.
Types of Burns:
Electrical Burns: The primary concern is cardiac monitoring; electrical current can cause life-threatening dysrhythmias and hidden internal tissue damage not visible on the surface.
Calculating Percentage of Burned Body Surface Area (Rule of Nines):
Entire Head and Neck:
Each Entire Arm:
Anterior Torso (Chest/Abdomen):
Posterior Torso (Back):
Each Entire Leg:
Perineum/Genitalia:
Long-Term Risk Factors (Weeks Post-Injury):
Curling’s Ulcer: A stress-induced gastroduodenal ulcer. A classic sign is a patient vomiting bright red blood (hematemesis) several weeks after the initial burn injury.
Treatment Methods:
Open Method: The burn wound is left exposed to the air without a dressing. This allows for easy visualization but requires strict environmental controls (protective isolation) to prevent infection.
Pressure Sore Staging and Care
Stage 1: Intact skin with non-blanchable redness, usually over a bony prominence.
Stage 2: Partial-thickness loss of dermis; presents as a shallow open ulcer involving the epidermis and/or dermis, or as an intact or ruptured serum-filled blister.
Stage 3: Full-thickness tissue loss; subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed.
Stage 4: Full-thickness tissue loss with exposed bone, tendon, or muscle; often includes undermining and tunneling.
Unstageable: Full-thickness tissue loss where the base of the ulcer is covered by slough or eschar; the true depth cannot be determined until the debridement occurs.
Dressing Types: Use of hydrocolloids, foam dressings, or transparent films depending on the stage and presence of exudate.
Additional Integumentary Conditions
Tinea Corporis: A fungal infection of the body (ringworm) characterized by a ring-like, erythematous lesion with a clear center.
Dermatitis Venenata: Also known as contact dermatitis (e.g., poison ivy or oak); results from hypersensitivity to an external plant or chemical substance. Treatment involves identifying the irritant and using topical or systemic corticosteroids.