Download Integumentary System Part 2

Integumentary
System
Objective
• Differentiate between decubitus ulcers and
stasis ulcers
Decubitus Ulcer - Pathophysiology
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•
•
•
•
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Pressure 
i Blood flow 
Tissue Hypoxia / ischemia 
Tissue necrosis 
Tissue “sloughs off” 
Open wound
Stasis Ulcer – Pathophysiology
•
•
•
•
•
•
Poor circulation 
i Blood flow 
Tissue Hypoxia / ischemia 
Tissue necrosis 
Tissue “sloughs off” 
Open wound
Stasis Ulcer
• Venous insufficiency 
• Stasis (stagnation)
Stasis Ulcer - Manifestations
• Edema & itching
• h 𝒄 standing
• Skin
Shinny
Brown
Decubitus vs. Stasis Ulcer
How will tx be different?
Decubitus
Stasis Ulcer
• Focus on
• Focus on
Reliving pressure

h circulation
Stasis Ulcers:
What would you expect of healing?
Poor wound
healing!
Stasis Ulcer - Rx
• Anticoagulants
Action
S/E
Stasis ulcer – Prevention
• Compression socks
• Exercises
• Elevate
Objective
• Describe the medical, surgical and nursing
management for the burn patient
Burns:
• Loss of skin 
– Pathogens
– Fluid loss
Burns:
• Fluid shifts:
 Intracellular 
interstitial space
• Hypovolemic shock
 i B/P
 i Cardiac output
If the fluid shifts from
intracellular to interstitial space,
what will happen to the
viscosity of the blood?
A. Blood will become thicker
B. Blood will become thinner
A patient with “thick blood” is at risk
of what?
A.
B.
C.
D.
E.
Hemorrhaging
Blood clots
Oxygen toxicity
Decubitus ulcers
Anemia
Fluid shifts  electrolyte imbalance
• Watch K+ levels
closely!
Burns - Rx
• Morphine (MS)
– Action
• Analgesic
– S/E
• i respiration
PAIN!
Objective
• Describe the types of skin cancer symptoms,
treatment and prognosis of each
Types of Skin Cancer
• Non-melanoma
Basal cell
carcinoma
Squamous cell
carcinoma
• Melanoma
Skin CA – S&S
ABCDE
A.
B.
C.
D.
E.
Asymmetry
Border irregular
Color variations
Diameter >5mm
Evolution
Skin CA - Tx
• Surgery
– Curettage
– Cryosurgery
• Radiation
• Chemotherapy
Objective
• Identify the following common skin
disorders, including etiology, symptoms,
treatment and nursing interventions:
– Acne
Acne
• Disorder of the
sebaceous gland
• Acne vulgaris
 Young adult
Acne
• Disorder of the
sebaceous gland
• Acne vulgaris
 Young adult
• Acne rosacea
 Older adult
Objective
• Identify the following common skin
disorders, including etiology, symptoms,
treatment and nursing interventions:
– Psoriasis
Psoriasis
• Plaque
– Red, raised with silvery
white scales
– Scalp, elbows, knees
• Autoimmune
Psoriasis
• Plaque
– Red, raised with silvery
white scales
– Scalp, elbows, knees
• Autoimmune
Psoriasis
• Plaque
– Red, raised with silvery
white scales
– Scalp, elbows, knees
• Autoimmune
Psoriasis
• Plaque
– Red, raised with silvery
white scales
– Scalp, elbows, knees
• Autoimmune
Psoriasis
• Plaque
– Red, raised with silvery
white scales
– Scalp, elbows, knees
• Autoimmune
Objective
• Identify the following common skin
disorders, including etiology, symptoms,
treatment and nursing interventions:
– Eczema
Eczema
• h histamine
• S&S
– Chronic lichenification
(thickness)
– Erythema
– Scaling
– Pruritus
Eczema
• h histamine
• S&S
– Chronic lichenification
(thickness)
– Erythema
– Scaling
– Pruritus
Eczema
• h histamine
• S&S
– Chronic lichenification
(thickness)
– Erythema
– Scaling
– Pruritus
Objective
• Identify the following common skin
disorders, including etiology, symptoms,
treatment and nursing interventions:
– Impetigo
Impetigo
• S&S
– Blisters on face, neck,
hands, & diaper area
Impetigo
• Pathophysiology
 Streptococcus pyogenes
or
 Staphylococcus aereus
Impetigo
• Pathophysiology
 Streptococcus pyogenes
or
 Staphylococcus aereus
Impetigo
• Pathophysiology
 Streptococcus pyogenes
or
 Staphylococcus aereus
What type of pathogen is
streptococcus?
A.
B.
C.
D.
E.
Bacteria
Virus
Parasite
Fungus
Auto-immune
Objective
• Identify the following common skin
disorders, including etiology, symptoms,
treatment and nursing interventions:
– Pediculosis
Pediculosis - Lice
• Unhatched eggs
– Nits
• Body lice
– Pediculosis corporis
Pediculosis - Lice
• Unhatched eggs
– Nits
• Body lice
– Pediculosis corporis
Pediculosis corporis
Pediculosis corporis
Pediculosis corporis
Pediculosis - Lice
• Unhatched eggs
– Nits
• Head lice
– Pediculosis capitis
Pediculosis capitis
Pediculosis - Lice
• Unhatched eggs
– Nits
• Pubic lice
– Pediculosis pubis
– “crabs”
– STD
Pediculosis pubis
Pediculosis pubis
Objective
• Identify the following common skin
disorders, including etiology, symptoms,
treatment and nursing interventions:
– Scabies
Scabies
• Female mites
• All people, $, age
• Spread
 Skin-to-skin
Scabies
• Location
–
–
–
–
Btw fingers
Inner wrist & elbow
Axillae
Gluteal crease
Objective
• Identify the following common skin
disorders, including etiology, symptoms,
treatment and nursing interventions:
– Lupus erythematosus
Lupus erythematosus
• Auto-immune disease
• Butterfly rash over
cheeks & nose
– h in sunlight
Lupus erythematosus
Objective
• Discuss nutritional needs of the patient with
a skin disorder
Which food groups are most
important for a patient with a
NRS Dx of impaired skin
integrity?
•
•
•
•
Protein
Calories
Iron
Fluids
Objective
• Discuss pharmacological interventions
appropriate in treatment for skin disorders
Pruritus
• Antihistamine
– Diphenhydramine (Benadryl)
– S/E
• Drowsy
Psoriasis
• Corticosteroids
– S/E
• Na+ & H2O retention
Impetigo
• Anti-biotics
Pediculosis
• Topical anti-parasitic agents
Objective
• Discuss factors that affect the emotional
health of the patient with skin disease
Disturbed Body Image
• Est. relationship w/ nrs
• Enc. express feelings
• Enc. interaction with S.O.