Integumentary A and P

1. rashes- temporary
2. primary lesions
3. "suspicious" lesions
4. infected lesions
5. secondary lesions

1. temporary
2. d/t dermatitis
3. d/t urticaria (hives)
4. multiple causes

1. flat (macule, patch)
2. elevated (but solid) (papule, plaque, nodule, tumor, wheal)
3. elevated, fluid-filled (vesicle, bulla, pustule, cyst)

1. rapid growth for a few weeks or months
2. diameter >6 mm
3. changes in pigmentation, including hyper- or hypopigmentation; grey, blue or red discoloration of whole or parts of the lesion
4. inflamed, erythematous margin
5. irregular, ragged borders
6. weeping
7. crust formation
8. bleeding
9. pruritus

- often steph aureus
1. abscess
- furuncle (boil)- raised area; necrotic and purulent tissue
- carbuncle- multiple, interconnected furuncles
2. cellulitis

1. scales
2. scabs (crusts)
3. abrasions (excoriation)
4. fissures
5. erosions (denuded)
6. ulcers
7. scars

1. organ
2. 15-20% of body mass (.5-6 mm thick)
3. 1/3 of resting cardiac output devoted to skin (requiring lots of blood vessels and energy expenditure)

1. mucocutaneous- at the junction of the mucous membrane, hairy skin, lips, and tongue
2. mucous membrane- lining of inside of body orifices
3. glabrous- skin without hair (tends to be thicker)
4. hairy- skin with hair

1. fibers (collagen, elastin, etc.)
2. matrix (ground substance- where most of the water is located in tissue)
3. cells

1. serves as protection from the environment
2. immune function
3. maintains homeostasis
4. provides sensory input

1. protects from UV radiation
2. protects from microbes (mechanical barrier)
3. protects from mechanical stresses

1. physical/chemical barrier
- low pH- acidic; inhospitible; however the pH can be altered with accessive hand washing or diabetes/CRF/etc.
2. langerhans (dendritic) cells- important antigen presenting cells (APC's)

1. helps maintain hydration status (would otherwise lose alot of fluid through evaporation without skin-- example- this is a problem with significant burn patients)
2. thermoregulation
3. helps maintain vitamin D levels (d/t sun exposure)

mechanical and thermosensitive receptors

1. epidermis (.06-.6 mm)
2. dermis (2-4 mm)
3. subcutaneous (variable thickness)
-- glabrous skin tends to have thicker layers (and stratum lucidum)

derived from epidermis but anchored in the dermis
1. hair
2. nails
3. glands (sebaceous and sweat)

1. made of epithelial tissue (the top layers are dead cells)
2. tissue is avascular (relying on diffusion from dermis for nutrients, etc.)
3. cell turnover of this layer is roughly a monthly basis
4. the epidermis is a physical barrier and is key to vitamin D synthesis
5. composed of mostly keratinocytes
6. 4 layers itself
-- stratum corneum (outer layer, composed of dead cells)

callus

1. d/t disease process as well as mechanical stress to area
2. can see ulcer with callous surrounding area

1. keratinocytes
2. melanocytes
- pigmentation, UV protection
- melanin granules secrete in direction of light entrance in order to block light from passing
3. merkel cells
- mechanoreceptors
4. dendritic cells
- prominent in S. spinosum
- antigen presenting cells

1. papillary dermis
2. reticular dermis

1. highly vascular (also have lymphatic vessels)
2. 2 layers (papillary and reticular)
3. made of dense irregular connective tissue (fibers layed down in multiple directions d/t the stress applied to skin)

1. fibroblasts
2. macrophages
3. mast cells (histamine response)

1. sebaceous glands (oils to prevent drying)
2. sweat glands
- eccrine (merocrine)- see all over skin, especially glabrous skin, thermoregulators, cholinergic innervation
- apocrine- found in axilla, scalp, etc.; adrenergic innervation; debatable function (possibly phermones?)

1. mostly adipose tissue (for energy stores and storage of fat soluble vitamins)
2. also fascia (regular and irregular dense connective tissue)
3. larger blood vessels and lymphatics (increased cardiac demand associated with this skin layer)
4. regional differences in thickness

overall decline in function
1. decreased amt of ground subst., elastin, and collagen in dermis
2. reduced epidermal turnover
3. flattened epidermal rete pegs and dermal papillae
4. decreased thickness of dermis and hypodermis
5. decreased vascularity, particularly in the capillary loops of dermal papillae
6. changed sebum composition
7. reduced number of sweat glands
8. reduced skin elasticity
9. compacted collagen tissue
10. increased visibility and prevalence of wrinkles
11. decreased vitamin D production
12. reduced barrier function
13. decreased inflammatory response
14. diminished thermoregulation
15. diminished sensory perception
16. thickened nails
17. reduced moisture content of skin
18. reduced immune function d/t decreased no. of mast cells, langerhan's cells, and active melanocytes

1. Labile
2. ~40% of all cancers are skin cancers, d/t too much replication
3. Malignant Melanoma (only 4% of cancers but 795 of deaths)
4. Basal and Squamous Cell (much more common, but much higher cure rate, especially with early detection)

1. mostly mechanical
2. can be chemical, thermal, electrical, etc.
3. skin integrity is compromised
4. depth is often related to staging

1. Superificial (epidermis only)
2. Partial-thickness (epidermis and dermis)
3. Full-thickness (deeper than dermis)
-- depth is often related to staging (but often wound specific)

1. Inflammation (phagocytosis and debridement)
2. Proliferation (connective tissue synthesis)
3. Remodeling and Maturation (epithelialization and collagen formation)

1. physical approximation of wound edges, following debridement as needed (minimal wound contraction needed; may be delayed)
2. surgical incisions (closing sx, stitches)
-- be careful with dehiscence (wound comes back apart; sutures pull through skin)

1. includes skin grafts
2. edges can't be approximated (d/t size, infection, tissue quality, etc.)
3. more granulation is needed to fill defect
4. more wound contraction is necessary
5. dehiscence can occur here too

1. normal physiology not typically cause for referral to PT (may be treating pts with acute, normal wounds for other reasons)
2. PT interventions are for when things go wrong (mostly for secondary intention)