Integument

Question 1

Risk Factors associated with potential skin conditions

Answer 1

• Loss of mobility
• Infection
• Diabetes
• Impaired Sensation
• Medication
• Age
• Smoking

Question 2

Layers of Skin

Answer 2

1. Epidermis
   
   1. Protects from infection
   2. Assists with heat regulation
2. Dermis
3. Subcutaneous Tissue
   
   1. Adipose cells; energy storage; protection

Question 3

Epidermis Layer

Answer 3

• Protection
• Avascular

Question 4

Dermal Layer

Answer 4

• Sensation and blood supply
• “True Skin”
• Infection and vascular changes here
• Sensation

Question 5

Skin Observation

Answer 5

• Skin Discoloration
• Skin Temperature
• Skin Integrity – Turgor (Hydration and Resilience)
• Skin Resilience
• Edema/Effusion
• Hair and Nail Beds
• Sensation

Consultation is any of these are new findings OR become more prevalent/progress

Question 6

Hemosiderin Staining

Answer 6

• Rusty brown darkening of the skin
  
  • Mid-calf and down
  • Commonly lower extremity
  • Could indicate venous insufficiency in LE

Question 7

Cyanosis

Answer 7

• Low O2 in blood
• Common in fingers and toes
• Central cyanosis: pulmonary disease or congenital heart defect (heart failure)
• Could indicate subject is extremely cold, low hemoglobin levels, vasomotor

Question 8

Pallor

Answer 8

• Loss of skin pigment (pale white)
  
  • Whole Body: Vasoconstriction (shock-Activate EMS), blood abnormality (anemia)
  • Local: Blood circulation disorder (diabetes or Raynaud’s)

Question 9

Erythema

Answer 9

• High O2 in blood (red)
• In people with darker skin, may appear or dark blue or purple
• Central: fever
• Local: Infection, Blood Clot
• Do a cardiopulmonary screen, take temperature, and vitals

Question 10

Jaundice

Answer 10

• Excess plasma. concentration of bilirubin (yellow)
  
  • Associated with liver failure/disease

Question 11

Ecchymosis

Answer 11

• Bruising
  
  • Cognition issues, sensation issues, falls
  • Treat musculoskeletal

Question 12

Surface Temperature

Answer 12

• Increase: Possible infection
  
  • Global: Systemic infection
  • Palpate lymph nodes
• Decrease: reduction in local circulation (arterial occlusion)
  
  • Global: vascular insufficiency
  • Local: May be associated with swelling

Question 13

Skin Elasticity - Turgor

Answer 13

• (Poor Hydration)
• Assess skin turgor for hydration
• Hydration & Release
  
  • Changes with age (elderly have reduced thirst feeling)
  • May change in healed wounds
• Susceptible for abrasions and wounds
  
  • Traumatic
  • Pressure Sores
• Test
  
  • Pinch back of skin, skin should return back to normal within one second

Question 14

Skin Resilience

Answer 14

• Skin thickness and dryness
  
  • Changes as people age
    
    • Skin permeability – diminished barrier
    • Lowered immune response
    • Impaired wound healing
    • Decreased elasticity of epidermis and increased wrinkling
    • Less Vitamin D production
• Changes following injury and healing
  
  • Scar formation – less resilient and/or mobile

Question 15

Edema/Effusion

Answer 15

• Effusion - CONSULT
  
  • Contained within the joint capsule – Intra-articular
  • Structure within the joint injured
  • Infection or inflammation in the joint
  • Analogy of water balloon
  • Example
    
    • Injury, Infection, Unknown cause
• Edema – CONSULT
  
  • “Extra-articular”
  • Commonly associated with systemic conditions (Ex: heart disease, vascular disease)
  • Pitting vs non-pitting
    
    • Pitting
      
      • Push and indentation remains
    • Non-pitting
      
      • Push and rebounds
  • Concerned if new and changes

Question 16

Hair Appearance

Answer 16

• Local loss of hair due to
  
  • Arterial insufficency (Usually associated with coldness)
  • Infections
  • Medications (chemo)
• Global loss of hair due to disease (thyroid)
• Other condition of less concern (not health concern haha)
  
  • Benign Alopecia
    
    • Male pattern baldness

Question 17

Fingernails

Answer 17

Different finger nail appearances are unique with occult disease

Question 18

Onycholysis

Answer 18

• Separation of nail from its bed
  
  • Associated with Psoriasis, Dermatitis of hand, fungal infection

Question 19

Beau’s Lines

Answer 19

Patient has had a history of severe systemic insult (high fever, infection, renal disease, hepatic disease)

Question 20

Nail Clubbing

Answer 20

• Indicative of chronic hypoxia (emphysema) and lung cancer
  
  • Distal nail phalanx appears bulbous and rounded
  • Nail plate is abnormally convex
  • Plate angle is greater than 180 degrees

Question 21

Cyanosis

Answer 21

• Bluish discoloration
• Hypoxia

Question 22

Sensation Tests

Answer 22

• General sensory deficit vs specific patterns of sensory deficits
• Differentiate systemic condition
• Light touch
• Sharp/Dull
• Cold/Hot

Question 23

Three most common skin cancers

Answer 23

• Basal Cell Carcinoma (Most common)
• Squamous cell carcinoma
• Malignant melanoma (most deadly)

Question 24

ABCs - Skin Cancer

Answer 24

• A = asymmetry
• B = Borders
• C = Color
• D = Diameter (>6mm)
• E = Evolution

Question 25

Characteristics of Malignant Cancer

Answer 25

* Shape: Asymmetrical * Borders: Irregular * Color: Varied/black * Diameter: \>6mm * Rate of Change: Slow or rapid * Consistency: Firm to hard * Ulceration: Often * Mobility: Mobile/Nonmobile

Question 26

Why do we screen for melanoma?

Answer 26

* More than 80% squamous cell carcinoma in head and neck region * More than 65% basal cell carcinoma in head and neck region * Melanomas can reoccur more than 5 years after initial surgery

Question 27

When should we be concern with a mole?

Answer 27

**Any mole that undergoes rapid changes in size, shape, color, symptom or integrity (bleeding) is reason for referral soon**

Question 28

Basal cell carcinoma

Answer 28

* An open sore that bleeds or has a discharge that has been open for several weeks * Reddish patch * Shiny bump that is pink, red or white * A scar like tumor that is shiny and aggressive

Question 29

Squamous cell carcinoma

Answer 29

* Crusty, elevated, scaly * Borders hard to identify

Question 30

Malignant melanoma

Answer 30

* Brown, **black** or multicolored * Irregular outline * May crust or bleed * **Concern: Can metastasize to lymph system and other organs**

Question 31

Infections/Inflammation

Answer 31

* Soft tissue inflammation * Fungal infections: * Athletes foot, ringworm oval * Viral infections: * Warts, fever blisters, shingles, cold sores * Bacterial Cellulitis

Question 32

Bacterial Cellulitis

Answer 32

* Rapid Referral – On the phone getting an appointment for them. * Color: Red * Temperature: Hot * Pain: Resting Pain * Swelling: Increase in girth * Drainage: More common with infection and associated with an odor

Question 33

Cellulitis

Answer 33

* Swollen glands (lymph nodes near or proximal to the affected area) * Spreading

Question 34

Pressure Ulcers Risk Factors and Common Sites

Answer 34

* Decreased mobility * Shear forces * Altered sensation * Moisture * Age * Most common sites * Spine/sacrum/coccyx * Bony prominences of the lower an upper extremity

Question 35

Stage 1 Pressure Ulcer

Answer 35

* Pressure Mark * Intact skin which is altered in observable way – color, consistency or sensory response – the change is not transient)

Question 36

Neuropathic Ulcers

Answer 36

* Associated with diabetes and other peripheral neuropathies * Most common in the foot and hand * Must do a thorough sensory examination to ID if patient is at risk * Risk Factors: * Prolonged diabetes * Poor footwear

Question 37

Post Surgery Wounds and Scars Consult if:

Answer 37

* Open Wound * Signs of Infection * Drainage * Fever Scars (benign) * Assess soft tissue mobility and symptoms with palpation * Keloid = overproduction of collagen

Question 38

Inspection and palpation of glands and lymph nodes

Answer 38

* Glands to palpate * Thyroid * Parotid * Submandibular * If abnormal – CONSULT * Acute infection * Slow to moderate growing mass

Question 39

Two things associated with aging

Answer 39

* Wrinkling * Osteoarthritis (wrinkles in your joint – arthritis doesn't cause pain unless very advanced)