Level I W2013

• Protects underlying tissues/organs
• Maintains body temp
• Excretes salts, H2O, organic wastes
• Sensation to touch, pressure, pain, and temperature (sensors in Dermis)
• Synthesizes Vitamin D for calcium use
• Unique identifiers: birthmarks & fingerprints

• Epidermis thins, elastic fibers degenerate, 'sagging'
• Loss of subcutaneous fat
• Decreased perception of pain
• Decreased circulation to skin
• Diminished function of skin structures

• thinner, more fragile, decreased turgor - skin tears
• decreased elasticity - wrinkles, sagging
• senile pruritus: most common skin affliction - dry itchy skin r/t reduction of sweat and oil glands
• Senile lentigo: 'liver spots' - areas of localized hyperpigmentation
• Keratoses: raised hyperpigmentation lesions - may become malignant
• Skin tags, gray hair, thinning hair, thickened nails

• Age:
• infants & toddlers - yeast, allergic, bacterial
• children - bacterial, fungal, parasitic
• 13-26 yrs: fungal infections, acne
• 25-60 yrs: psoriasis, lupus, fungal infections
• older adults: basal cell carcinoma
• Sex: males have more skin pathology
• Race: dark skinned-keloid formation, light skinned-skin cancers, psoriases

• Onset: when
• Location: general/local
• Quality: superficial/deep
• Setting: work, home, play
• Timing: day/night, menses, w/ certain foods
• Associated manifestations: rashes, lesions, edema,systemic disease
• Aggravating factors: chemicals, sunlight, stress, climate, clothes
• Alleviating factors: diet changes, meds, baths, UV therapy

• color
• bleeding
• ecchymosis
• vascularity
• moisture
• temperature
• texture
• turgor
• edema

bluish tone through skin reflects reduced (deoxygenated) hemoglobin

Paleness may be a sign of anemia, chronic disease, edema, or shock

redness may be the result of increased blood flow from climatic conditions, local inflammation, infection, skin irritation, allergy

large, diffuse areas, usually black and blue in color, are caused by hemorrhage of blood into skin; are typically result of injuries

small, distinct pinpoint hemorrhages 2mm or less; can denote some type of blood disorder

yellow staining of the skin and white sclera usually caused by bile pigments

• Inspection: color, lesions, odor
• Palpate: temp, texture, moisture

• Lesion: pathological change in tissues
• Location: start and spread
• Quantity: grouping arrangement
• Quality: morphology

• primary lesions: arise in previously normal skin, column 1
• secondary lesions: arise from primary lesions usually as a result of rubbing, scratching, medication or healing, column 2

• Bacterial: cellulitis, impetigo, MRSA
• Fungal: athlete's foot, ringworm
• Yeast: "thrush", candida
• Viral: chicken pox, herpes simplex, herpes zoster, warts, Hand-Foot-Mouth

• itching, common symptom
• increased itching = histamine action, warmth, vasodilation

• Skin/wound culture & sensitivity
• Potassium hydroxide exam & fungal culture - encourages hyphae growth
• Scabies scraping
• Wood's light exam - blacklight blue fungus
• Patch testing: testing for allergens - stop corticosteroids/anti-histamines 48hr prior, hx of allergies, explain procedure, instruct in self-care, follow up appt
• Biopsy

• arise in previously normal skin
• column 1
• generally non-palpable, may be slightly raised
• less than 0.5cm

• arise from primary lesions usually as a result of rubbing, scratching, medication, or healing
• column 2
• palpable
• crusting over

• Etiology: Strep pyogenes, Staph aureus, Staph epidermis
• Risk Factors: moisture, obesity, atopic dermatitis, chronic disease, systemic corticosteroids, antibiotics
• Prevention: good hygiene practices and good health

• skin infection into dermis & subQ fat
• pain, edema, erythema
• 1st Culture & sensitivity-strep pyogenes
• Risks: malnourished, previous wound, diabetes, steroid therapy
• ND: control itching, increase circulation, elevate, cleansing
• Assess: personal hygiene, VS-temp, LOC, hypertension

• skin infection
• very contagious: hand, neck, mouth
• Pustular vesicles - honey crusted
• Tx: bacitracin, antibiotic, ivory/dial soap, teaching

• skin infection Staph aureus
• Patho: superficial infection of upper portion of the follicle, small pustules at hair follicle (folliculitis) - deeper (furuncle/boil)
• Very contagious: direct contact
• vancomycin

• tinea pedia (dermatophyte on the foot)
• macerated tissue with scaling borders
• very itchy & painful
• Dx: potassium hydroxide

• skin folds
• Tx: clean washcloth/towel dry
• expose to air
• avoid tight clothes
• "plaques"

• "pustule"
• 'thrush' in children - mouth
• white, cheesy
• caused by candida or monilia yeast
• invades axillae, under breasts, groin, perineal
• Skin: exudative patches, beefy red, pruritic
• S/Sx: itching, burning & irritation

• varicella zoster: systemic
• papules
• respiratory & touch - droplet precautions

• 1. oral fever blisters or cold sores
• 2. lesions of the genitals
• red base with blister, spread easily

• reactivation of chickenpox
• contagious to those who have not had chickenpox
• fever, burning, neuralgia

• HPV,
• 12-16 yrs of age
• epidermal thickening & keratinosis
• 2/3 disappear in 2 yrs w/o trtmt

• allergic reaction
• transient, pruritic patches or wheals w/ raised borders & blanched centers
• 2-3 days
• allergies to foods & drugs
• 50% unknown cause

• allergic reaction
• eczema: genetic predisposition to react to environmental antigens w/ inflammatory rash (often foods)
• exacerbated by stress
• lichenification - hypertrophied epidermis - leathery

• allergic reaction
• prior contact to sensitizing chemical or material
• pruritic w/ red papules & plaques
• takes shape of causative agent

• inflammation
• appears as dandruff first
• greasy scales on scalp, nasolabial folds
• infants - 'cradle cap'
• frequent in parkinson pt & other neurologic disorders as well as HIV/aids pt

• chronic, hereditary autoimmune disorder w/ rapid skin cell production, improper shedding
• S/Sx: pruritis, shedding, silvery plaques, extensor surfaces (elbows, knees)
• cell turn over in 4 days instead of 28

• Body Image Disturbance
• Impaired Skin Integrity

• Stings: scrape
• Lice: itching, easily spread, feed on skin
• Scabies: easily spread through touch, feed on blood, lesions

• antibacterial
• antiviral
• antifungal
• antiparasitic

• dakin solution
• hibiclens

corticosteroids

benadryl

salicylic acid

coal tar

• tretinoin (retin a)
• accutane (isotretinoin): req. to take to birth control pills

• powder: promotes dryness, lubricates skinfolds; base for antifungal preps
• lotion: oil & water emulsions; cooling & drying; useful in subacute pruritic eruptions
• cream: oil & water emulsions; most common base for topical medications; lubricates & protects
• Ointment: oil & water suspension; prevents dehydration and lubricant
• Paste: mix of powder & ointment; needed drying effect
• Gel: nongreasy propylene glycol & water

• Psychosocial impact: change in body image, social isolation, pain, decrease/loss of employment, costs of medications, hospitalization
• Learning needs: cause of skin disorder, aggravating factors, proper use of prescribed medications, follow-up needed

• body image disturbance r/t presence of lesions
• hopelessness r/t chronicity of problem
• self esteem disturbance r/t cosmetic effects

• Basal cell carcinoma: most common skin cancer, esp. in caucasian males
• Squamous cell carcinoma: tumor of squamous epithelium or mucous membranes, invasive
• Malignant melanoma: esp. light skinned, blue eyed persons, often fatal

Risk factors: chemicals, pollutants, radiation, lack of personal hygiene habits, cosmetics, harsh soaps, long-term steroids or anticoagulants, nutritional deficiency, mod-severe emotional distress, injured areas have risk for infection, manicures/pedicures-hep B

pre-cancerous condition of thick, scaly patches of sun-damaged skin. solar or senile keratosis

• rolled pearly borders
• most common of human cancers
• locally invasive, rarely metastasizes
• develops in areas with high sun exposure
• central ulceration
• epithelial or dermis
• loss of nose, ears, lips
• Yellow, Red, Black

• begins in squamous cell, thin, flat, fish scale
• look similar to basal cell

• Deadliest form of skin cancer 75% of all skin cancer deaths
• tan, black, blue
• irregular, circular borders
• metastasize internally & externally
• begin in melanocytes

• Asymmetry - shape of one half does not match the other
• Border - edges often ragged, notched, blurred, irregular in outline; pigment may spread into surrounding skin
• Color - color is uneven, black, brown, tan, white, grey, red, pink, or blue

there is a change in size, usually an increase. larger than 5mm

change in any feature such as shape, size, color, elevation, itching, bleeding, or crusting

• circumscribed, flat area with a change in color, <5mm
• freckles, petechiae, measles, flat mole, cafe au lait spot, vitiligo - complete depigmentation

• elevated, solid lesion, <5mm
• wart, elevated moles, lipoma, basal cell carcinoma

• circumscribed, superficial collection of serous fluid, <5mm
• chickenpox, shingles, second degree burn

• circumscribed, elevated, superficial, solid lesion >5mm
• psoriasis, seborrheic & actinic keratoses

• firm, edematous, irregularly shaped area, diameter variable
• insect bite, urticaria

• elevated, superficial lesion filled with purulent fluid
• impetigo

• linear crack or break from the epidermis to dermis, dry or moist
• athlete's foot, cracks at corner of mouth

• excess, dead epidermal cells produced by abnormal keratinization and shedding
• flaking skin after drug reaction or suburn

• abnormal formation of connective tissue that replaces normal skin
• surgical incision, healed wound

• loss of epidermis and extending into dermis; crater-like; irregular shape
• pressure ulcer, chancre

• depression in skin resulting from thinning of epidermis or dermis
• aged skin, striae

• area in which epidermis is missing, exposing the dermis
• abrasion, scratch