Assessment of the Integumentary

- synthesis of cholecalciferol (Vit. D3) in skin from cholesterol - dependent on UVB radiation from sunlight - 5 to 20 minutes per day - darker skin = more time; food sources - salmon, sardines, tuna, eel, mushrooms, eggs

-Vitamin D


The transfer of thermal energy by the circulation or movement of a liquid or gas


The direct transfer of heat from one substance to another substance that it is touching.

known as true skin
�blood and lymphatic vessels
�nerves and nerve endings
�hair follicles
�network of elastic and COLLAGEN fibers (gives skin elasticity and toughness)


superficial redness of skin
; Peripheral - fingers and toes; Central - mucous membranes, tongue; Carbon monoxide posioning - CO has higher affinity to Hgb than O2 (fire smoke, exhaust, natural gas, paint and varnish fumes)
Jaundice - liver disease which i


Rash - irritated or swollen skin


Cyanosis - deoxygenation


circular, flat discoloration - red, brown, blue (Mongolian spot) or hyopigmented - Epstein Barr virus, syphilis, HIV, German measles, rubella


raised skin < 0.5cm, solid, skin color, red, white - impacted oil gland


raised skin > 1cm, solid, flat - psoriasis


raised > 1 cm, extends into dermis - irregular growth of skin cells, may be tumorous


sac filled with fluid, blood, serous, purulent, or gas - abscess, ganglion cyst, ovarian cyst, bartholin gland cyst


loss of epidermis after ruptured bulla or vesicle


Thinning of skin, appears shinier or translucent - arterial insufficiency


loss of epidermis and dermis layer - venous stasis, diabetes, pressure


linear opening in epidermis, skin splits - dry skin, cracking - heel fissures,


thickened or roughened skin - rubbing, scratching - Eczema, chronic dermatitis


red or purple spots, minor bleeding into skin - broken capillary vessels, use of blood pressure cuff


purple-colored spots, damaged blood vessels, blood


ITP - Idiopathic Thrombocytopenic Purpura - low Platelets


swollen blood vessel in epidermis, contains central red spot. It is a vascular lesion characterized by anomalous dilatation of end vasculature found just beneath the skin surface. The lesion contains a central, red spot and reddish extensions which radiat

Spider angioma

collection of small blood vessels - Also known as senile angioma or Campbell de Morgan spot

Cherry angioma

dilated veins due to increased intravenous pressure

Venous Star

autoimmune disease that affects skin
Treat with Corticosteroids (Prednisone) Immunosuppressive drugs (Cyclosporine) and Antihistamines (Hydroxyzine)
Linear appearance and is a flat rash

Lichen Planus

Herpes simplex can cause Bell's palsy - facial symptoms mimic a stroke - speech and swallowing can be altered - the eye of affected side may need eye patch; extremity strength equal with no other neurological deficits - virus has affected facial nerve - t


is a very contagious disease caused by the varicella-zoster virus (VZV). It causes a blister-like rash, itching, tiredness, and fever.


�Chickenpox can be prevented by a vaccine
�Treatment usually involves relieving symptoms
�Pain relievers
�Colloidal Oatmeal


Follows a dermatone usually linear along the nerve route
Treat with Antiviral (Acyclovir)and Corticosteroid (Prednisone)

Shingles (Herpes Zoster)

Treat with Insecticide (Permethrin)
itchy mite


Treat with
(used to treat malaria

Erythema gyratum repens (EGR)

first signs/sympstoms are: fever, unexplained widespread skin pain, red or purple skin rash that spreads blisters on your skin and the mucous membranes of your mouth, nose, eyes and genitals. Shedding of your skin within days after blisters form.

Steven-Johnson Syndrome

About half the cases of Stevens-Johnson syndrome and nearly all the cases of toxic epidermal necrolysis are caused by a reaction to a drug, most often sulfa and other antibiotics; anticonvulsants, such as phenytoin and steven carbamazepine; and certain ot


is a potentially life-threatening dermatologic disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis and/or death

Toxic epidermal necrolysis (TEN)

are severe cutaneous hypersensitivity reactions. Steven-Johnson Syndrome (SJS) has skin changes that affect less than 10% of body surface area while greater than 30% of body surface area in toxic epidermal necrolusis (TEN); involvement of 15 to 30% of bod

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)

Polycyclic lesions
Treat with
Immunosuppressive (Enbrel)


hives; an eruption of wheals on the skin accompanied by itch
hypersensitivity (allergic Rx)
epipen and corticosteroids treatment if severe


Viral Infection that presents with a painful rash that can form blisters
Very Contagious
reatment: NSAIDs, supportive care for symptoms

Hand-Foot-Mouth (Coxsackievirus)

nail fungus (onychomycosis)

�Treat with Antifungal (Lamisil)

�Treat with
�Oral Nystatin (swish and swallow)

Candida Albicans (Oral Thrush)

candida albicans is Common after course of broad spectrum antibiotics - why

because broad spectrum antibiotics kills normal flora. normal flora is our good bacteria that helps us fights pathogens.

chronic low levels of oxygen in blood for prolong periods of time.

Nail clubbing

resistant to several antibiotic
Treat with
Bactrim DS


�Treat with
�High dose Ampicillin

VRE (Vancomycin-Resistant Enterococci)

Which can cause hyperpigmentation of the skin?

Sun injury
Hyperpigmentation can be a result of sun injury.

Hypopigmentation may be caused by

a fungal infection, eczema, or vitiligo.

What would be considered a normal finding in the skin assessment of an older adult?
A.Elastic skin
B.Uneven pigmentation
C.Cherry angiomas

Uneven pigmentation
Older adults have thin, nonelastic skin that is fragile and easily injured. Uneven pigmentation is an expected finding from sun damage and the normal aging process.

Skin biopsy

detect cancer


detect antibodies

Tzanck smear

blistering skin conditions

Patch testing


Skin scrapings

collect skin cells

Wood's light examination

black light illuminates bacteria and fungus

Is the following statement true or false?
Tzanck smear is a test used to examine cells from blistering skin conditions.

Tzanck smear is a test used to examine cells from blistering skin conditions.