Summary NURS 3056 Final Info Test 2. Integumentary – Ch. 11,22,23, updated spring 2021 complete guide

Anatomy review • Epidermis-5 layers o Passive circulation from dermis o Cell types in epidermis  Keratinocytes (90%) • Essential for the skin’s protective barrier function  Melanocytes (5%) • Protection against UV sunlight  Langerhans’ • Essential for skin immunity  Merkel cells • Touch receptors • Dermis o Highly vascular o Collagen  Critical in wound healing  Responsible for skin’s mechanical strength o Elastic fibers and reticular fibers • Subcutaneous Tissue o Connective tissue and fat cells o Function:  Insulation  Cushioning  Temp regulation  Energy storage • Glands o Sebaceous  Sebum 1) waterproofs 2) lubricates skin and 3) promotes absorption of fat-soluble substances o Apocrine sweat  Become active at puberty  Located in axillae, breast areola, umbilical and anogenital areas, external auditory canals, eyelids o Eccrine sweat  Widely distributed  Function: Cool body by evaporation, excrete waste products, moisturize surface cells • Hair and nails o Rooted in the dermis o Form from specialized keratin • Nails o Protection Functions of the Skin • Protection • Insulation • Sensation • Fluid balance • Temperature regulation • Vitamin production • Immune response function • Can act as a delivery system for drugs Primary vs. Secondary Lesions • Primary lesions o Develop on previously unaltered skin o Macule  Circumscribed, flat area with a change in skin color, <0.5cm diameter. If lesion is >0.5cm, it’s a patch  Ex. Freckles, petechiae, measles, flat mole (nevus), café-au-lait spots, vitiligo (complete depigmentation) o Papule  Elevated, solid lesion, <0.5cm diameter. If >0.5cm diameter it’s a nodule  Ex. Wart (verruca), elevated moles, lipoma, basal cell carcinoma o Vesicle  Circumscribed, superficial collection of serous fluid. <0.5cm diameter  Ex. Varicella (chickenpox), herpes zoster (shingles), second-degree burn o Plaque  Circumscribed, elevated, superficial, solid lesion. >0.5cm diameter  Ex. Psoriasis, seborrheic and actinic keratoses o Wheal  Firm, edematous, irregularly shaped area, diameter variable  Ex. Insect bite, urticaria o Pustule  Elevated, superficial lesion filled with purulent fluid  Ex. Acne, impetigo • Secondary skin lesions o Change with time o Occur because of secondary factors (scratching, infection, etc.) o Fissure  Linear crack or break from epidermis to dermis, dry or moist  Ex. Athletes foot, cracks at corner of the mouth o Scale  Excess, dead epidermal cells produced by abnormal keratinization and shedding  Ex. Flaking skin after drug reaction or sunburn o Scar  Abnormal formation of connective tissue that replaces normal skin  Ex. Surgical incision, healed wound o Ulcer  Loss of epidermis, extending into dermis, crater-like irregular shape  Ex. Pressure ulcer, chancre o Atrophy  Depression in skin resulting from thinning of the epidermis or dermis  Ex. Aged skin, striae o Excoriation  Area in which epidermis is missing, exposing the dermis  Ex. Abrasion, scratch Lesion distribution Term Description Annular Circular, begins in center and spreads to periphery (tinea corporis - ringworm) Asymmetric Unilateral distribution Confluent Merging together (urticaria - hives) Discrete Distinct individual lesions that remain separate (acne) Gyrate Twisted, coiled spiral, snakelike Grouped Clusters of lesions (multiple vesicles of contact dermatitis) Localized Limited areas of involvement that are clearly defined (confined to one area) Polycyclic Annular (circular) lesions grow together (psoriasis) Solitary Single lesion Symmetric Bilateral distribution Zosteriform Linear arrangement along a dermatome area (herpes zoster) Assessment • Subjective: health history, medications, surgery or other treatments, functional health patterns (ex: nutrition) • Objective – Physical Assessment - inspection and palpation o Nails  Color  Texture  Consistency  Thickness  Shape/angle of nail o Hair  Color  Texture  Distribution  Quantity o Skin  Color  Texture  Turgor  Temperature  Moisture  Lesions?  Vascular changes?  Skin changes can point to other disease processes that we will study throughout this year Effects of Drugs on Integumentary System • Drugs that cause photosensitivity (Table 23-2 for full list) o Examples of common offenders:  Antidepressants: amitriptyline, venlafaxine (Effexor)  Antidysrhythmics: amiodarone  Antihistamines: diphenhydramine (Benadryl), cetirizine (Zyrtec)  Antimicrobials: tetracycline, azithromycin (Zithromax), ciprofloxacin (Cipro)  Antifungals: griseofulvin, ketoconazole  Antipsychotics: haloperidol  Diuretics: furosemide (Lasix), hydrochlorothiazide  Hypoglycemics: glipizide, glyburide  NSAIDS: diclofenac (Voltaren), sulindac Categories Examples Antidepressants amitriptyline, doxepin, venlafaxine Antidysrhythmics quinidine, amiodarone (Cordarone) Antihistamines diphenhydramine, chlorpheniramine, clemastine, cetirizine (Zyrtec) Antimicrobials tetracycline, sulfamethoxazole, azithromycin (Zithromax), ciprofloxacin (Cipro) Antifungals griseofulvin, ketoconazole Antipsychotics chlorpromazine, haloperidol Chemotherapy methotrexate, dacarbazine (DTIC), 5-fluorouracil (5-FU) Diuretics furosemide (Lasix), hydrochlorothiazide Hypoglycemics tolbutamide, glipizide (Glucotrol), glyburide Nonsteroidal antiinflammatory drugs diclofenac (Voltaren), piroxicam (Feldene), sulindac