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Integumentary Mind Map - Coggle Diagram
Integumentary Mind Map
Malignant Melanoma: Arises from the melanocytes. Differ in size and shape and may arise from dysplastic nevi or new molelike growths. Slightly raised and brown or black in color. Can appear anywhere on the body and may be slowly or rapidly growing.
- cancerous lesion arising from epidermal melanocyte cells
- most commonly arise from existing mole (nevus)
- nevus is a benign aggregation of melanocytes
- nevus with a diameter of 6 mm or greater, is considered highly suggestive for developing malignant melanoma
- most common are the superficial spreading; pattern of tumor growth is horizontally along the skin
Physical Assessment:
- Description and comprehensive skin history reveal sun exposure and change of the lesion’s appearance in its symmetry, diameter, color, or border.
- Melanoma ABCDE rules:
-- A: Asymmetry
-- B: Irregular border
-- C: variable color
-- D: Diameter
-- E: Evolving
- The general skin examination shows evidence of sun exposure.
Diagnosis: Biopsy, with assessment of spread of disease if the biopsy is positive
Signs and Symptoms:
- Patient presents with a lesion that has changed in size, shape, and appearance.
- Lesion is usually asymptomatic, but occasionally pruritus is observed.
- Cosmetic concerns about appearance of the lesion are frequent.
- Skin cancers may appear suddenly or develop over time.
Treatment:
- Surgery with a wide excision.
- Cryosurgery, radiation, and chemotherapy
- Yearly skin checkup by a dermatologist.
- Monthly skin self-assessment by patient.
- Advice about protection from sun rays.
Prognosis:
- depends on extent of metastasis, initial lesion site and depth, lesion thickness, stage of disease process
- intial lesions on the extremities have the most favorable prognosis.
- lesions located on the trunk, head, neck have the poorest prognosis.
- Lesions over 4mm thick carry the poorest prognosis
- 10 year survival rates have increased, but mortality rate continues to increase
- 5 year survival rates are best for nonmetastatic lesions that are diagnosed and treated early.
Basal Cell Carcinoma: Arises from the nonkeratinizing cells of the basal layer of the epidermis. It is nonmetastasizing.
- most common sites are areas of skin exposed to the sun (face and neck)
- sun exposure and age are the most common risk factors
- UV light exposure creates DNA mutations in the p53 gene which allows cancer cells to grow and become more aggressive
Physical Assessment: Begins as a nodular-cystic, small, pearly, flesh-colored, smooth nodule that enlarges over time.
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Signs and Symptoms:
- Lesion often appears on the face, particularly the nose.
- Sun-exposed areas are the most common regions of basal cell carcinoma.
- growth rate is slow
- as the lesions grow, it frequently ulcerates
- usually the center of the lesion is depressed
Treatment: Surgery to remove lesion—often needs a very deep excision, radiation therapy
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Prognosis:
- good with early diagnosis and treatment; metastatic spread is rare
Superficial Burns: Injury is limited to the outermost layer of the skin (epidermis). Tissue damage is minimal; the protective barrier is not impaired. Overexposure to the sun is the most common cause of injury.
Physical Assessment:
- Skin is tender and appears pink, red, and dry.
- blisters common
- peeling skin
- no break in the epidermal layer of the skin
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Signs and Symptoms:
- Painful erythema of the skin. Extremely tender to the touch.
Treatment:
- Treatment limited to analgesics and moisturizers.
- The area heals within 3 to 5 days, with no scarring.
Squamous Cell Carcinoma: A more serious epidermal cancer that is aggressive, invasive, and often develops from actinic keratosis.
- malignant tumor of the epidermis
- grow more rapidly than basal cell tumors
- can metastasize
- tumors can localized or invasive and spread through the lymph
- tumors are firm
- surface is elevated with a granular quality that easily bleeds
- most arise from skin lesions
- cause unknown, but sun exposure and aging are the most common risk factors
- mutation of the p53 gene is considered part of the mechanism
Physical Assessment: Presents as red, scaly, slightly elevated lesions with irregular borders.
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Signs and Symptoms: Lesion often appears on face or lips, or can be an oral lesion inside the mouth or on the tongue. Sun-exposed areas are the most common regions of SCC.
Treatment:
- Surgery to remove lesion.
- Radiation or chemotherapy may be necessary.
Prognosis:
- remains confined at the epidermis for a long time
- invasive squamous cell carcinoma can be slow or fast growing with metastasis
- prognosis is good
- cure with early diagnosis and treatment.
Superficial Partial-Thickness Burns: The injury involves the epidermis and limited dermis. The protective barrier is impaired, causing heat and fluid loss. Scalds or brief contact with hot objects is the usual cause of injury.
Physical Assessment:
- Skin is bright red, pearl-pink, painful, wet, or blistered.
- dermis is exposed
- extremely tender
Diagnosis:
- Depending on how much BSA is involved, CBC, electrolytes, urinalysis, arterial blood gas, CPK, and carboxyhemoglobin level may be needed.
- If infection occurs, one may need to culture the exudate.
Signs and Symptoms:
- Painful redness of the skin and exposure of dermal tissue beneath the epidermis.
- blisters
Treatment:
- Topical agents used on the wound area.
- Debridement
- Skin grafting may be needed.
- Burn heals in 10 days to 2 weeks.
- Monitor for infection.
- tetanus booster
Deep Partial-Thickness Burns: Injury involves the epidermis and most of the dermis. Wound is not painful, as the nerve endings are destroyed.
Physical Assessment:
- Deep area of exposed tissue.
- The area appears dry, pale, or whitish-yellow in color.
- May be nontender if nerves are destroyed.
Diagnosis:
- Depending on how much surface area is involved, CBC, electrolytes, urinalysis, BUN, serum creatinine, arterial blood gas, CPK, and carboxyhemoglobin level may be needed.
- Increased risk for infection.
- If infection occurs, may need to culture the exudate.
Signs and Symptoms:
- Deep area of exposed tissue.
- The area appears dry, pale, or whitish-yellow in color.
- May be nontender if nerves are destroyed.
Treatment:
- Topical agents on wound area.
- Healing occurs within 3 to 5 weeks.
- Débridement.
- Skin grafting may be necessary for injuries within the deeper layers of the dermis.
- pain control
- tetanus booster
Full Thickness burns: Injury involves the entire epidermis, dermis, and underlying subcutaneous tissues. Common causes are direct contact with flames, hot liquids, or steam. Fluid and heat loss are related to the loss of the protective layer.
Physical Assessment:
- Skin exhibits a dry, leathery, and white or yellow color that does not blanch with pressure, which indicates it is avascular.
- Nontender because nerves are destroyed.
Diagnosis:
- CBC, electrolytes, urinalysis, BUN, serum creatinine, arterial blood gas, CPK, and carboxyhemoglobin level.
- There is an increased risk for infection.
- Culture of exudate may be needed.
Signs and Symptoms:
- Acutely, the layers beneath the epidermis and dermis are totally exposed.
- Red, raw-appearing wound.
- no pain sensed
Treatment:
- tetanus booster
- Topical agents and wound dressing.
- Burns heal within weeks to months.
- Wounds usually require surgical intervention.
- Débridement and skin grafting.
- Depending on percentage of body surface involved, IV fluids or enteral feedings may be needed.
Cellulitis:
- Bacterial infection of the dermis and subcutaneous tissue
- caused primarily by group A strep or S. aureus
Manifestations:
- found on lower legs, ears, and face appearing a few days after the infectious organism invades the skin.
- local swelling, tenderness, warmth, and pain
- bright red patches or plaques with indefinite borders
- edema at the site
- skin tender and warm
- in later stages, pustules, abscesses and necrosis develop
- secondary infections of the site can also occur
Treatment:
- systemic antibiotics
- resistant strains are treated with vancomycin
- lower extremities should be elevated to reduce swelling
At risk: DIabetes, HIV, neoplasms, pt's on antineoplastic therapy, pt's with poor circulation, pt's with previous trauma to the skin or existing skin ulcers
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Herpes Zoster: Caused by varicella zoster same as chicken pox)
- acute inflammation along a dermatome of the skin
- decline in immunity, stress, or aging may cause a reactivation of latent varicella zoster virus
- initial exposure to chickenpox the virus travels down the nerve fibers to the dorsal ganglion cells where it resides in a dormant state.
- after it is reactivated, it replicates in the affected sensory ganglion
- the virus moves through the sensory nerve pathways and neuronal necrosis cause the intense pain.
Treatment:
- antiviral drugs (zovirax)
- antibacterial cream to prevent secondary infections
- topical anesthetic agents to reduce pain
- narcotics for severe pain
- Amitriptyline (for its sedative effect)
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Manifestations:
- before eruption of the lesions, itching and pain, or tenderness occur at the site.
- Lesions appear "bubbly"; underlying skin is red and swollen
- vesicles usually develop on the posterior surface of the body and move peripherally along unilateral dermatomes to the anterior body surface
- 1-2 weeks, the crusts fall off
- primary sites are facial, thoracic, or cervical nerve roots
- pain is intense
- permanent blindness can result when the virus develops in the opthalmic division of the trigeminal nerve
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Eczema:
- inflammatory skin response to any injurious agent
- clothing, cosmetics, cleaning products, occupational exposure, plants, metal alloys, additives in perfumes and dyes, soap, latex products.
Manifestations:
- vesicle formation, oozing, crusting, itching, erythema, and scaling
- can range from mild (itchy, hot, dry skin) to severe forms with raw, bleeding, and broken skin
Treatment:
- aimed at removing the source of the irritant or allergen
- antipruritic creams or lotions
- topical steroids
- washing the affected areas to remove further contamination by the irritant or allergen
- severe cases = oral histamines, systemic corticosteroids, wet dressings.
Psoriasis:
- common, chronic inflammatory skin disease
- cause uncertain, but thought to be T-cell immune response to an antigen
- skin trauma is a common precipitating factor in individuals predisposed to the disorder
Manifestations:
- areas affected: scalp, hairline, elbows, knees, and sites of trauma
- circular, patchy appearance of all sizes, covered with heavy, dry silvery scales
- erythema
- extent of inflammation determines the size and distribution of the lesions
Treatment:
- goal is to suppress the clinical manifestations
- corticosteroids and emollients are used in mild cases