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Pathophysiology

Denver School of Nursing – ADN & BSN Programs No Laboratory component for this class. Pathophysiology. BIO 206 & 308 – Week 11 CH29 & 39 Integument Path. Layers of the Skin. Epidermis Dermis Hypodermis. Layers of the Skin. Layers of the Skin. Dermal appendages Nails Hair

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Pathophysiology

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  1. Denver School of Nursing – ADN & BSN Programs No Laboratory component for this class Pathophysiology BIO 206 & 308 – Week 11 CH29 & 39 Integument Path

  2. Layers of the Skin • Epidermis • Dermis • Hypodermis

  3. Layers of the Skin

  4. Layers of the Skin • Dermal appendages • Nails • Hair • Sebaceous glands • Eccrine and apocrine sweat glands • Blood supply • Papillary capillaries

  5. Nails

  6. Clinical Manifestations of Skin Dysfunction:“language” • Vesicle • Bulla • Pustule • Cyst • Telangiectasia • Scale • Lichenification • Keloid • Scar • Excoriation • Fissure • Erosion • Ulcer • Atrophy • Macule • Papule • Patch • Plaque • Wheal • Nodule • Tumor

  7. Clinical Manifestations of Skin Dysfunction:“language”$ Macule is a circumscribed, flat discoloration that is brown, blue, red, or hypopigmented Papule is an elevated solid lesion up to 0.5 cm in diameter; color varies; papules might fuse to form plaque Vesicle, a circumscribed collection of free fluid up to 0.5cm in diameter Ulcer is a focal loss of epidermis and dermis; ulcers heal with scarrin

  8. Pressure Ulcers • Pressure ulcers result from any unrelieved pressure on the skin, causing underlying tissue damage • Pressure • Shearing forces • Friction • Moisture

  9. Pressure Ulcers

  10. Pressure Ulcers • Stages • SI - Nonblanchableerythema of intact skin • SII - Partial-thickness skin loss involving epidermis or dermis • SIII - Full-thickness skin loss involving damage or loss of subcutaneous tissue • SIV - Full-thickness skin loss with damage to muscle, bone, or supporting structures

  11. Decubitus Ulceration • Stage I Image source: http://www.hollister.com/

  12. Decubitus Ulceration • Stage II Image source: http://www.hollister.com/

  13. Decubitus Ulceration • Stage III Image source: http://www.hollister.com/

  14. Decubitus Ulceration • Stage IV Image source: http://www.hollister.com/

  15. Decubitus Ulceration • Stage IV – Why these locations? Image source: http://www.hollister.com/

  16. Decubitus Ulceration • Images of Decubitus Ulcers were used from Hollister Incorporated. Props to them for helping to educate health care personnel in the critical importance of proper skin care.

  17. $ Braden Scale potential for pressure ulcer • Nutrition • Mobilization • Pressure • Shearing force • Moisture

  18. Pruritus • Itching • Most common symptom of primary skin disorders • Itch is carried by specific unmyelinated C-nerve fibers and is triggered by a number of itch mediators • The CNS can modulate the itch response

  19. Papulosquamous Disorders • Skin disorders including: • Psoriasis • Adult Acne conditions • Lupus erythematosus • Pemphigus

  20. Papulosquamous Disorders • Psoriasis • Shows evidence of dermal and epidermal thickening • Epidermal turnover goes from 26 to 30 days to 3 to 4 days • Cells do not have time to mature or adequately keratinize

  21. Psoriasis

  22. Papulosquamous Disorders • Psoriasis – Non specific skin Inflammation peak onset 15 – 35y/o • Plaque psoriasis • Inverse psoriasis • Guttate psoriasis • Pustular psoriasis • Erythrodermic psoriasis

  23. Papulosquamous Disorders

  24. Papulosquamous Disorders • Acne rosacea • Most common in middle aged women • Red central portion of the face with small erythematous papules surmounted by pinpoint pustules • Acne vulgaris • Inflammatory disease of the pilosebaceous follicles

  25. Papulosquamous Disorders • Lupus erythematosus • Inflammatory, autoimmune disease with cutaneous manifestations • Discoid lupus erythematosus • Restricted to the skin • Photosensitivity • Butterfly pattern over the nose and cheeks • Systemic lupus erythematosus

  26. Discoid Lupus Erythematosus

  27. PapulosquamousDisorders • Pemphigus • Rare, chronic, blister-forming disease of the skin and oral mucous membranes • Blisters form in the deep or superficial epidermis • Autoimmune disease caused by circulating IgG autoantibodies • The antibodies are against the cell surface adhesion molecule, desmoglein in the suprabasal layer of the epidermis

  28. Vesiculobullous Disorders • Pemphigus • Tissue biopsies demonstrate autoantibody presence • Types • Pemphigus vulgaris (most severe) • Pemphigus foliaceus (less severe and has presence of IgA) • Pemphigus erythematosus (symptoms resemble lupus erythematosus)

  29. Infections • Bacterial infections • Folliculitis – inflammation of ? • Furuncles – “boil” – pus filled colonization • Carbuncles – multiple furuncles that often fistula with dermis infections • Cellulitis – Staph / Strep (Dermis & SQ) • Erysipelas – type of Cellulitis- usually caused by Group A Beta hemolytic Strep (Dermis) • Impetigo – Same as cellulitis but NO SQ

  30. Layers of the Skin

  31. Furuncle

  32. Infections • Viral infections • Herpes zoster and varicella

  33. Herpes Simplex VirusHerpes simplex labialis & Herpes zoster

  34. Fungal Infections • Fungi causing superficial skin lesions are called dermatophytes • Fungal disorders are called mycoses; mycoses caused by dermatophytes are termed tinea • Tinea capitis (scalp) • Tinea pedis (athlete’s foot) • Tinea corporis (ringworm) • Tinea cruris (groin, jock itch) • Tinea unguium (nails) or onychomycosis

  35. Fungal Infections • Candidiasis • Caused by Candida albicans • Normally found on the skin, in the GI tract, and in the vagina • C. albicans can change from a commensal organism to a pathogen • Local environment of moisture and warmth, systemic administration of antibiotics, pregnancy, diabetes mellitus, Cushing’s disease, debilitated states, age younger than 6 months, immunosuppression, and neoplastic diseases

  36. Vascular Disorders • Scleroderma • Sclerosis of the skin that can progress to the internal organs • The disease is associated with several antibodies • Lesions exhibit massive deposits of collagen with inflammation, vascular changes, and capillary dilation • Skin is hard, hypopigmented, taut, and tightly connected to underlying tissue

  37. Vascular Disorders • Scleroderma • Facial skin becomes very tight • Fingers become tapered and flexed; nails and fingertips can be lost from atrophy • Mouth may not open completely • 50% of patients die within 5 years

  38. Scleroderma

  39. Benign Tumors • Seborrheic keratosis • Keratoacanthoma • Actinic keratosis • Nevi (moles)

  40. Benign Tumors

  41. Skin Malignancies • Basal cell carcinoma • Squamous cell carcinoma • Malignant melanoma*** • Kaposi sarcoma**

  42. Melanoma

  43. Fake & Bake  Melanoma

  44. MELONOMA Lancet Oncology : Feb 2010 • 75% increase in melanoma with tanning booth exposure before age 30 • FDA recommends tanning for teens only with a signed consent form…by their parents • >1,000,000 new skin cancers per year in USA • Ultraviolet light… sun & tanning booths • Sunless tanning products • Avoid “multiple mutations over time”

  45. Cancer

  46. SKIN – Burns Image Source: googleimages.com

  47. SKIN – Burns Image Source: medscape.com

  48. SKIN – Burns

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