Selected Integumentary System Diseases & Conditions

1. The SKIN… Wound Infections Wound Dehiscence & Evisceration Pressure Ulcers Arterial and Venous Ulcers Skin Cancer Skin Diseases Lesions/Wounds Rashes Herpes Zoster/ Shingles Selected Integumentary System Diseases & Conditions Part I

2. Trivia Question • How many square feet of skin does the average adult have?

3. Trivia Question • How many square feet of skin does the average adult have? • Answer: ~ 18-20 square feet…… • 5’ • x • 4’

4. Integumentary Diseases • Learning Outcomes: • 1. Use proper terminology to describe different skin lesions and problems • 2. Identify signs of wound infections • 3. Describe the ABCD(E) method of assessing skin cancer • 4. Identify clients at risk for pressure ulcer development • 5. Differentiate between the clinical manifestations for Stage I through Stage IV pressure ulcers, and their treatments. • 6. Identify appropriate treatment for prevention of pressure ulcers. • 7. Compare the clinical manifestations and modes of transmission for bacterial, viral, and fungal skin infections. • 8. Identify the difference between arterial ulcers and insufficiency versus venous stasis ulcers.

5. Key Terminology • angioma • carcinoma • cellulitis • dermatitis • atopic dermatitis • contact dermatitis • eczema • edema • ecchymosis • erythema • eschar • folliculitis • furuncles • granulation • hemangioma • hirsutism • hyperbaric oxygen (HBO) • keloid • lichenification • macule • melanoma • nevus • nodule • papule • paronychia • petechiae • pressure ulcer • pruritis • psoriasis • purpura • pustule • vacuum assisted closure (Wound Vac) • turgor • urticaria • vesicle • wheal • xerosis

6. Wound Infections Wound Dehiscence & Evisceration Pressure Ulcers Arterial and Venous Ulcers Skin Cancer Skin Diseases Skin Lesions / Wounds Rashes Herpes Zoster/ Shingles

7. Raised papule plaque nodule cyst comedo keloid horn wheal Depressed atrophy erosion ulcer sinus striae burrow poikolderma Flat /Macular macule patch erythema erythroderma Surface Change scale crust excoriation eschar lichenification exfoliation ichthyosiform Fluid Filled vesicle bulla pustule abscess furuncle Purpura / Vascular petechiae purpura ecchymosis telangiectasia Configurations linear grouped scattered polycyclic reticular serpinginous targetoid whorled arcuate annular “Beauty is Only Skin Deep…”

8. Raised papule plaque nodule cyst comedo keloid horn wheal Depressed atrophy erosion ulcer sinus striae burrow poikolderma Flat /Macular macule patch erythema erythroderma Surface Change scale crust excoriation eschar lichenification exfoliation ichthyosiform Fluid Filled vesicle bulla pustule abscess furuncle Purpura / Vascular petechiae purpura ecchymosis telangiectasia Configurations linear grouped scattered polycyclic reticular serpinginous targetoid whorled arcuate annular “Beauty is Only Skin Deep…” “But UGLY goes down to the bone!”

9. Raised papule plaque nodule cyst comedo keloid horn wheal Depressed atrophy erosion ulcer sinus striae burrow poikolderma Flat /Macular macule patch erythema erythroderma Surface Change scale crust excoriation eschar lichenification exfoliation ichthyosiform Fluid Filled vesicle bulla pustule abscess furuncle Purpura / Vascular petechiae purpura ecchymosis telangiectasia Configurations linear grouped scattered polycyclic reticular serpinginous targetoid whorled arcuate annular “Skin Changes” Associated Terminology

10. Integumentary Diseases • Review of anatomy & physiology

11. Integumentary diseases • Skin Function: • Skin, hair, and nails are external structures • Serve a variety of specialized functions • Sebaceous and sweat glands cool and lubricate the body and get rid of wastes • The skin, hair, and nails have many vital functions, but the most important is protection. • Once the skin has been pierced or damaged the body is much more susceptible to infection, even from organisms which would not normally be pathogenic, e.g., staphylococci.

13. Integumentary diseases • Wound Infections & Risks • Risks for infection include any pathophysiological states which cause diminished circulation, poor immune response, or delayed repair of tissues These include: • Radiation or trauma • Poor circulation • Immunosuppression, drug induced or disease induced • Impaired oxygenation • Nutritional deficiencies • Coagulation disorders • Immobility • Diabetes, lupus, and other immunodeficiencies

14. Integumentary diseases • Etiology: THINK – WHAT IS CAUSING THIS? And you might learn how to prevent it • For example – If the patient is immobile and starting to break down because they cannot move, how do we prevent the skin from breaking down? • If the patient has an immunodeficiency, how do we prevent skin breakdown? • If the patient has a nutritional deficiency, how do we promote wound healing?

15. Diagnostic Procedures and Nursing Interventions • Wound Culture and Sensitivity (swab cultures and/or wound biopsies): • Definitively identify and quantify wound bacteria. • Complete Blood Count (CBC) with Differential: Assess immune response. • Blood Cultures: Rule out sepsis. • Serum Albumin (normal > 3.5 g/dL) and Prealbumin (normal 17 to 40 mg/dL): • Assess nutritional status (low levels indicate malnutrition).

16. Therapeutic Procedures and Nursing Interventions • Vacuum-assisted Wound Closure (Wound-Vac) – continuous low-level negative pressure is applied to a sponge-covered suction tube for several hours. • Hyperbaric Oxygen Therapy (HBO / HBOT)– administration of high-pressurized 100% oxygen directly over the wound for 60 to 90 min. • Surgical Debridement and / or Wound Grafting – surgical excision of nonviable tissue to promote wound healing and/or grafting of skin from donor sites to clean granulating or freshly excised wound bed.

17. Integumentary diseases • Lesions & Infections • Signs and symptoms of infection include: • Drainage • Odor • Abscess • Fever • Discoloration • Heat / warmth at site • Edema • Erythema • Poor healing

18. Integumentary diseases • Lesions & Infections

19. Integumentary diseases • Lesions & Infections

20. Integumentary diseases • Lesions & Infections

21. Integumentary diseases • Lesions & Infections

22. Integumentary diseases • Rashes – is it macular or papular?

23. Integumentary diseases • Rashes – is it macular or papular? • This rash is actually vesicular, and is herpes zoster, or viral in origin

24. Integumentary diseases • Rashes – is it macular or papular? • This rash is actually vesicular, and is herpes zoster, or viral in origin • “chicken pox”

25. Integumentary diseases • Infected hair &/or nails also count • These are Beau’s lines