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Chapter Four Integumentary System Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 1 Quote “Genius is one percent inspiration and ninety-nine percent perspiration” –Thomas Edison Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 2 Functions and Specialties Function First line of defense Temperature regulation Sensation Synthesis of vitamin D Elimination of waste Specialties Dermatology Specialtist Dermatologist Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 3 Skin (derm/o, dermat/o, cutane/o, cut/o) Diagram of the skin Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 4 Layers of the Skin Layers (strata) Epidermis Dermis/corium Hypodermis/ subcutaneous layer Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 5 Epidermis Composition of the epidermis Keratinocytes Stratified squamous (squam/o) epithelium • Basal (bas/o) layer: stratum germinativum • Stratum corneum (corne/o) Keratin Melanocytes Melanin Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 6 Dermis Composed of vascular connective tissue Structures Blood and lymphatic vessels Nerves Hair follicles (follicul/o) Sebaceous (sebac/o) and sudoriferous glands (sudor/i) Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 7 Hypodermis/Subcutaneous Tissue Adipose tissue (adip/o) Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 8 Clicker Question The hair follicles are located in the: A. dermis B. epidermis C. subcutaneous tissue Answer: A. dermis Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 9 Glands Sudoriferous glands (hidraden/o) Pores Perspiration (hidr/o) Locations: Apocrine, Eccrine Apocrine- axilla, groin Eccrine- all over body Sebaceous glands Sebum (seb/o) Enlarged pores Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 10 Hair and Nails Hair Follicle Hair (trich/o, pil/o) Follicles (follicul/o) • Shaft • Papilla (papill/o) Nails (onych/o, ungu/o) Nail body Nail root Nail bed Lunula (looks like a white moon!) Eponychium (cuticle) The nail Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 11 Did You Know? Did you know that as the ability to see smaller and smaller body structures became possible, early anatomists named them according to what they resembled that was already named. For example, the nipple was the first structure called a papilla. Later, the term papilla was also used to name the projecting capillaries at the bottom of a hair shaft, the conicalshaped entrance to the optic nerve, and the taste buds on the tongue. Be Careful! Do not confuse papill/o, meaning papilla or “nipple,” with papul/o, meaning pimple. Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 12 Clicker Question Which layer of the skin is largely avascular? A. epidermis B. dermis C. Subcutaneous Answer: A. epidermis Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 13 Terms Related to Skin Lesions Definition of lesion Primary Any visible, localized abnormality of the skin Ones that initially occur as the result of trauma or disease Secondary Those that have evolved from their primary form Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 14 Terms Related to Primary Lesions Nod/-ules Cysts Nodule filled with a semisolid material Tumors Palpable, solid lesion less than 2cm Nodule more than 2cm Hemat/-omas Collection of extravasated blood trapped in the tissues palpable to the examiner Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 15 Terms Related to Primary Lesions (cont’d) Petechia Ec-chym/-osis Tiny ecchymosis within the dermal layer (found around eyes after vomiting) Hemorrhage or leaking of blood into the subcutaneous tissue Purpur/-a Massive hemorrhage into the tissues under the skin Ecchymosis From Moll: Rheumatology, ed 3, Churchill-Livingstone Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 16 Terms Related to Primary Lesions (cont’d) Macules Papules Flat blemish or discoloration less than 1cm (freckles) Raised solid skin lesion less than 1cm (pimple) Wheals Circumscribed, elevated papule caused by localized edema (bug bite) Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 17 Terms Related to Primary Lesions (cont’d) Vesicles/bullae Pustules Circumscribed, eleveated lesion containing fluid and smaller than 1/2cm (bug bite) Superficial, elevated lesion containing pus (acne) Tel/angi/-ectasia Permanent dilation of groups of superficial capillaries and venules Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 18 Terms Related to Secondary Lesions A-troph/-y Cicatrix Dried serum, blood, and/or pus Fissure Keloid A scar that is an overgrowth of tissue at the site of an injury Eschar A scar (from a bug bite or similar) Keloid Paper thin wasted skin (seen in elderly) From Habif: Clinical dermatology, ed 4, Mosby Cracklike lesion of the skin Ulcer Circumscribed craterlike lesion of the skin or mucous membrane resulting tissue death, that can accompany an inflammatory, infectious , or malignant process Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 19 Clicker Question The term for a blister is a/an: A. cyst B. papule C. pustule D. Vesicle Answer: D. Vesicle Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 20 Terms Related to Dermatitis and Bacterial Infections A-top/-ic dermat/-itis Cellul/-itis Contact dermat/-itis Eczema Follicul/-itis Cellulitis of upper leg From Black and Hawks: Medical-surgical nursing, ed 7, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 21 Terms Related to Dermatitis and Bacterial Infections (cont’d) Furuncle Impetigo Pil/onid/-al cyst Seb/orrheic dermat/itis Carbuncle (two furuncles connected by tunnel) Cradle cap Furuncle From Seidel: Mosby’s guide to physical examination, ed 6, Mosby Pruritus Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 22 Terms Related to Yeast and Fungal Infections Candidiasis (also moniliasis) Dermat/omyc/osis Tinea • Capit/is • Corpor/is • Crur/is • Ped/is candidiasis From the CDC Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 23 Terms Related to Parasitic Infestations Pedicul/osis Scabies Lice in the hair From Callen: Color Atlas of dermatology, ed 3, Saunders Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 24 Clicker Question A combining form for fungus is: A. onych/o B. myc/o C. sudor/i D. my/o Answer: B. myc/o Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 25 Terms Related to Disorders of the Hair Follicles and Sebaceous Glands Acne vulgar/-is Comedones Alopecia Hyper-trich/-osis (hirsutism) Kerat/-in-ous cyst Milia (clogged oil glands) Alopecia From Hill: Skin disorders, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 26 Terms Related to Viral Infections Exanthemat/-ous diseases (maculopapular rash) Herpes simplex virus (HSV) Herpes zoster From Callen et al: Color atlas of dermatology, ed 2, Saunders HSV-1 (cold sores) HSV-2 (genital) Herpes zoster Verruca (warts) Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 27 Terms Related to Scaling Papular Diseases Psoriasis Psoriasis From Bork: Skin disease in clinical practice, ed 2, Saunders Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 28 Terms Related to Cornification and Pressure Injuries Callus Corn/clavus Decubitus ulcer/ pressure sore/ bedsore/ pressure ulcer Ichthy/-osis Xeroderma Stage 4 decubitus ulcer From Elkin et al: Nursing interventions and clinical skills, ed 3, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 29 Terms Related to Pigmentation Disorders Albin/-ism Dyschromia Hyperchromia Hypochromia Vitiligo Vitiligo From Lewis: Medical-surgical nursing, ed 7, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 30 Terms Related to Disorders of Sweating Anhidrosis Hidradenitis Hyperhidrosis Miliaria Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 31 Terms Related to Disorders of the Nails Onychia Onychocryptosis Onycholysis Onychomalacia Onychomycosis Paronychia Onychomycosis From Conlan and Snydman: Mosby’s color atlas and text of infectious diseases, 2000, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 32 Clicker Question The term that means an abnormal condition of fungus in the nails is: A. B. C. D. hyperhidrosis onychomycosis trichomycosis onychocryptosis Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 33 Burns Degrees of burns First/superfical thickness Second • Superficial partial thickness • Deep partial thickness Third/full thickness Fourth/deep full thickness Eschar Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 34 Burns: Rule of Nines Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 35 1st degree burn Burns 2nd degree burn 3rd degree burn Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 36 Clicker Question The epidermis only is damaged in which type of burn? A. B. C. D. superficial partial thickness deep partial thickness superficial thickness full thickness Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 37 Terms Related to Benign Skin Growths Angioma Hemangioma Dermatofibroma Lipoma Hemangioma From Habif: Clinical dermatology, ed 4, 2008, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 38 Terms Related to Benign Skin Tumors (cont’d) Dysplastic nevus Nevus Dysplastic • ABCDE Seborrheic keratosis Skin tags/acrochordons Dysplastic nevus From Goldman et al: Cecil textbook medicine, ed 23, Saunders Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 39 Terms Related to Malignant Neoplasms Basal cell carcinoma (BCC) Squamous cell carcinoma (SCC) Malignant melanoma Kaposi sarcoma (KS) (common is pt with AIDS) Squamous cell carcinoma From Damjanov: Pathology for the health professions, ed 3, Saunders Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 40 Clicker Question A fatty tumor is a/n: A. dermatofibroma B. dysplastic nevus C. acrochordon D. lipoma Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 41 Age Matters Pediatrics Impetigo Acne Seborrheic dermatitis Cellulitis Pediculosis Burns Geriatrics Corns Calluses Pressure sores Eczema Actinic keratosis Cellulitis Fungal infections Neoplasms Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 42 Terms Related to Biopsies (Bx) Excisional biopsy Exfoliation Incisional biopsy Needle aspiration Punch biopsy Youtube link: http://www.youtube.c om/watch?v=7CzDE ok8Wmo Punch biopsy Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 43 Terms Related to Laboratory Tests Bacterial analyses Fungal tests Sweat tests Tuberculosis (TB) skin tests Sweat test From Mosby's medical dictionary, ed 6, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 44 Terms Related to Laboratory Tests (cont’d) Tzanck test (hsv cells) Viral culture Wood’s light examination Wound and abscess cultures From Wilson: Health assessment for nursing practice, ed 3, Mosby Wood’s light examination Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 45 Clicker Question Which type of examination technique is used to determine if a patient has either herpes simplex or herpes zoster? A. B. C. D. viral culture wound and abscess culture Tzanck test Wood’s light examination Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 46 Terms Related to Grafting Techniques Skin grafting (SG) Dermatome Graft sources • Autograft • Allograft • Xenograft Types of grafts • Flap • Split-thickness skin graft (STSG) • Full-thickness skin graft Autograft From Black and Hawks: Medical-surgical nursing, ed 7, Saunders Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 47 Terms Related to Other Therapies Laser therapy Occlusive therapy Psoralen plus ultraviolet A (PUVA) therapy Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 48 Terms Related to Tissue Removal Cauterization Cryosurgery Curettage Debridement Youtube link: http://www.yo utube.com/w atch?v=6sJ_ p5zNl3M Curettage From HabifL Clinical dermatology, ed 4, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 49 Decubitus Ulcers Inflammation, ulcer, or sore in the skin over a bony prominence. Most often seen in ages, debilitated, cachectic, or immobilized patients; pressure ulcers or sores are graded by stages of stages Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 50 Terms Related to Tissue Removal (cont’d) Escharotomy Incision and drainage (I&D) Mohs surgery Shaving/paring Escharotomy From Monahan et al: Phipp’s medical-surgical nursing, ed 8, Mosby Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 51 Terms Related to Cosmetic Procedures Blepharoplasty Chemical peel Dermabrasion Dermatoplasty Dermabrasion From Fewkes et al: Illustrated atlas of cutaneous atlas, Churchill-Livingstone Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 52 Terms Related to Cosmetic Procedures (cont’d) Lipectomy Liposuction Rhytidectomy Liposuction Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 53 Clicker Question What is the destruction of tissue by burning? A. B. C. D. cauterization cryosurgery débridement Mohs surgery Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 54 Pharmacology, Routes of Administration Hypodermic (H) Intradermal (ID) Subcutaneous Topical Transdermal therapeutic system (TTS) From Ignatavicius: Medical-surgical nursing, ed 5, Saunders ID injection Subcutaneous injection Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 55 Pharmacology Anesthetics Antibacterials Antifungals Antihistamines Antiinflammatories Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 56 Pharmacology (cont’d) Antipsoriatics Antiseptics Antivirals Emollients Immunomodulators/immunosuppressants Keratolytics Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 57 Pharmacology (cont’d) Pediculicides Protectives Retinoids Scabicides Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 58 Pharmacology (cont’d) Aloe vera Tea tree oil Aloe plant Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 59 Clicker Question Which type of medication is used to treat lice? A. B. C. D. retinoids scabicides pediculicides antivirals Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 60 Sort these terms into their correct categories. Terms Categories 1. clavus 2. paronychia 3. melanin 4. xenograft 5. needle aspiration __ A + P __ Pathology __ Diagnostic Procedures __ Therapeutic Interventions Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 61 Parting Thought “Pleasure in the job puts perfection in the work.” –Aristotle Mosby items and derived items © 2010, 2006, 2003, by Mosby, Inc., an affiliate of Elsevier Inc. 62