derm

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  1. Structure and Function
    • Integumentary system is made up of skin, hair, nails
    • skin is largest organ in body
    • - 15-20% of body weight
    • primary defense mechanism when intact
    • intergral to self- image, self esteem
    • 3 layers- epidermis, dermis, and subcutaneous
  2. Epidermis
    • thin, avascular, outer layer
    • four distinct cell types
    • keratnocyte- major protective barrier
    • melanocyte- pigment producing cell, protects the skin from ultraviolet rays
    • merkel's- sensory information
    • langerhan- macrophages of immune sys
  3. dermis
    • dense layer
    • fibrous connective tissue, hair follicles, sweat and sabaceous glands, macrophages, vascular and nerve
    • separate subcuteous from dermis
    • provides nutrition to epidermis
  4. Subcutaneous tissue
    • connective tissue/fate cells- stores fate
    • good storage space from certain drugs- insulin releasing slowly
    • insulation from heat, regulation of temp
    • cushion to trauma
    • anatomic distribution varies
    • contains larger blood vessels
  5. function of skin
    • protection
    • maintains homeostatis
    • thermoregulation
    • sensory reception
    • vitamin synthesis- vit d
    • consmetic adornment
  6. effects of aging
    • uneven pigmentation, dec melanocytes- inc skin cancer
    • fewer immune cells
    • dec vitamin synthesis
    • dec sensory perception
    • inc dry skin
    • dec elasticity, inc wrinkles
    • the above life changes can be influenced by individual lifestyle, diet (eat good), genetics and other personal habits.
    • thin skin
    • bruising easily
  7. Assessment
    • History
    • - chief complaint
    • - presenting sympt, onset**, location, description
    • - primary/secondary
    • symptoms analysis- pruritis, dryness, rash, lesions, ecchymoses, masses
    • PMH
    • - systemic/previous illnesses
    • - childhood illness
    • - meds: OTC, herbs
    • - immunization- tdap
    • - allergies- seasonal as well
    • what is going- cc subjective
    • systemic lupus- butterfly rash
  8. Assessment- fam hx
    • genetic or lifestyle predisposition psychosocial hx
    • occupation- construction workers
    • habits- people pick on skin- nervousness,
    • social hx- alcoholics, smoking
    • cultural consideration- hos does this cultural see this issue
    • environment- exposure
  9. Physical assessment
    • well lit room
    • thorough inspection, palpation of hair, scalp, nails, mucous membranes, skin
    • primary/secondary lesion
    • location, distribution, size, arrangement, color, configuration. drainage, consistency, mobility, tenderness, blanchable
  10. criteria for diagnosis/care
    • description of lesion
    • - primary results from a dx process, have not been altered by manipulation, tx, natural course of dx
    • - sec. altered by outside manipulation, tx, natural course of dx
    • distribution of lesion (shape)
  11. Common diagnostic test
    • KOH ( potassium hydroxide solution)- fungal culture scrap part of infected skin area, place on a clean slide, add 2-3 gtts of koh- observe microscope
    • scabies scraping- unscratched papule shave off, place on slide, microscope
    • a wood's light exam
    • - black light- UV light
    • - detects superficial fungal and bacterial infection
  12. common diagnostic test cont'd
    • patch testing- for allergic responses
    • - suspected allergic subs are applied to pts skin with adhesive patches- examine for reaction- what is pt reacting too
    • biopsy- for histologic assessment
    • - shave, dermal punch, surgical excision
    • - postop- keep area clean
    • - abx, DSD
    • - monitor for bleeding
    • - teach pt s/s of infection
    • - f/u for suture removal
    • educate pt to
    • - avoid touching
    • - wash hands
    • - redness, pain, drainage
  13. Common dermatological disorders
    • pruritis
    • dermatitis/exzema
    • psoriasis vulgaris
    • cellulitis
    • folliculitis
    • furuncles
    • carbuncles
  14. Pruritis
    • most common manifestation of skin problems
    • sympt, not a disease
    • causes- protective response, systemic disease (kidney), drug hypersensitivity, transfusion reaction, age related, emotional response
  15. pruritis- management
    • ID cause & solve
    • promote skin hydration
    • - humidfy air
    • - tepid H2O- avoid hot water
    • - avoid frequent bathing
    • - avoid soap or use only mild soap- dove
    • - colloidal oatmeal baths (aveeno)
    • - occlusive ointment, apply to damp skin: eucerin, aquaphor (wet skin- can hold this in)
    • - encourage fluids: water H2O, cond
  16. Pruritis- management 2
    • prevent skin irritation- clothing (cotton), short nails, mittens
    • cool soaks
    • systemic or topical antihistamines
    • antibiotics with open wounds
  17. dermatitis
    • itchy, inflammation of skin
    • not contagious/dangerous
    • types:
    • - contact allergy
    • - stasis
    • - atopic (eczema)
    • - TEN (toxic epidermal necrolysis syndrome)
  18. dermatitis- 2
    • acute- extensive erosions with serous exudate or intensely pruritic, erythematous papules
    • subacute- erythmatous, excoriated, scaling papules grouped or scattered
    • chronic- thickened skin, inc skin markings, excoriated papules & pigmentation changes
  19. contact dermatitis
    • Inflam response to irritant, chemical or physical allergens
    • manifestation range from mild erythematic to vesicles and ulcerations
  20. Contact dermatitis- diagnostics, management
    • Diagnostics
    • - H&P, patch test
    • Management
    • - find out that cause
    • - avoid exposure to allergen
    • - antihistamine & steriods
    • - wet dressing
  21. stasis dermatitis
    • intense dry skin to lower legs
    • purities
    • r/t circulatory problems
    • cardiac issue
    • take cardiac meds
    • make sure to f.u PCP
  22. Exfoliative dermatitis- TEN (toxic epidermal necrolysis syndrome)
    • life threatening skin disorder xterized by blistering and peeling of skin over large areas of the body
    • fever, chills, malaise
    • vesicles, bullae of epidermis, muccous membranes of the eyes
    • can be confused with Steven Johnson Syndrome (SJS)
  23. Atopic Dermatitis (Eczema)
    • inflammatory, relapsing
    • non contagious and itchy skin disorder
    • ¬†unknown cause- genetic component asso with it mostly with fam hx of asthma, hay fever
  24. patho of eczema
    • mutation of the gene for filaggrin
    • filaggrin is a protein that plays vital role in the retention of water in the epidermis
    • lack of the this leads to;
    • - dec H2o binding capacity
    • - higher water loss
    • - dec H2o content
    • - leaving the skin dry
    • - think dec water...
  25. Eczema manifestations
    • pruritis
    • acute dermatitis as child often becomes chronic as adult
    • mainly on bends of elbows, backs of knees, neckm eyelids, back of hands & feet
    • sec staphy aureus infections
  26. management eczema
    • goal- break inflammatory cycle
    • avoid allergens
    • hydrate lubricate skin
    • - tepid H2o soak, thick greasy moisturizer
    • emollients, topical corticosteroids, tar preparations
    • clothing soft/cotton
    • systemic abx (if infection from scratching), antihistamine (think safety, drowiness)
  27. Xerotic eczema
    • winter itchy
    • patchy, dry, scaling, finely cracked, erythematous skin
    • worsened by drying soap, infrequent use of moisturizers
    • rx with hydration, moisturizers, avoiding irritants, humidifier
  28. Psoriasis vulgaris
    • chronic, disorder xterized by reddish, scaly, plaques of inflam.
    • noncontagious, prutitic
    • cause unknown- ? genetic/environment
    • triggers: immune system, emotional stress, anxiety, meds, smoking, trauma
    • flare ups/remission
  29. manifestations of psoriasis
    • plaques with red slivery scales/demarcated (follow track of it)
    • mild discomfort to severe disability
    • seen in kneed, elbow, scalp, lower back, genitalia, cracks/bleed, swelling/jt pain (psoriatric arthritis)
  30. Psoriasis management
    • psychological & psychosocial implications (isoloation don't want to be seen)
    • mild- sunlight tar preps, topical steriods
    • scalp- tar shampoo, steriods lotions
    • widespread- systemic treatment
    • - methotrexate: s/e infection- supress immune system
    • photosynthesizing therapy
    • - side effects- skin cancer
  31. cellulitis
    • infection of dermis and subcutaneous tissue
    • erythema, edema, tenderness, warm skin, pain, regional lymphadenopathy
    • asso sympt fever, chills, h/a, vomiting
    • no demarcated borders
    • cause: mosting staph aureus or beta hemolytic strep (gram +)
    • management:
    • warm, moist heat, elevate extremity, immobilization, antibiotics (unisen-ampillian & pain med
  32. folliculitis
    • inflam of hair follicles
    • bacterial staph/pseudo, aeruginosa
    • white pustules on forehead, chest, upper back, neck, thighs, groin axillae
    • management: warm, compresses, topical or oral abx
  33. furuncles/carbuncles
    • abcesses that develop when the infection from folliculitis becomes deeper and involved more follicles
    • staph
    • boil, deep, painful, firm mass with pus, fever/chills
    • carbuncles, larger, aggregate/multiple follicles
    • diagnosis- assessment /culture
    • Rx- bactroban, neosporin, I&D, diclozacillin/erytromycin

Card Set Information

Author:
Prittyrick
ID:
330100
Filename:
derm
Updated:
2017-04-05 00:56:56
Tags:
skin
Folders:

Description:
image and self esteem
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