Skin

Health & Medicine Business

Integumentary System
Med Surg Certification
Amy Dunbar RN, MSN, CWOCN
6-2-05

Objectives
Identify the functions of the skin
Identify the nursing assessment of the
skin
Identify common pathophysiologic
events associated with skin
Determine ostomy care

Appendages
Hair
Sebaceous glands
Exocrine Glands
Aprocrine Glands
Nails

Changes with Aging
Epidermal turnover increases
Skin is drier
Decreased skin elasticity
Changes in thermoregulation
Decreased melanocytes

Skin Assessment
Itching
Pain
Rash
Dry, rough, scaly
Blisters
Hot/cold spots

Objectives
Inspection Palpation

*color *turgor

*hair *moisture

*lesions *temperature

Psoriasis
No cure
Treated with
topical steroids
and photo
therapy

Scleroderma

Usually treated
with steroids
and cholinergics

Shingles
Contagious
when exudate
from blisters is
present

May benefit
from antiviral

Skin Cancer

Malignant
melanoma can
metastasize
Prevention

Rule of 9’s
-Head = 9
-Each arm = 9
-Front of trunk = 18
-Back of trunk = 18
-Each leg = 18

Concerns
impaired gas exchange

fluid replacement

Interventions
Skin Grafts
-may be autologous
-additional wound will be present

Fasciotomy
-relieves pressure when edema is extreme

Post Operative considerations
Stoma appearance
Pouch maintenance
Releasing gas
Pouch emptying

Summary
Skin/Wound is complex
Nursing assessment and intervention
crucial
Ostomy care is daily

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Role of Vascular Biomarkers in Cardiovascular Risk Assessment The use of cardiovascular biomarkers in conjunction with risk scores is expected to refine the risk stratification of an individual subject and to guide his therapy. Biomarker is a characteristic that is objectively measured and that reflects early functional and structural changes in cardiovascular system, before overt disease manifestation. Vascular biomarkers may be particularly informative, as they detect organ damage in different parts of vascular bed, are measurable in a noninvasive way, and reflect both aging process and adverse impact of established cardiovascular risk factors, like plasma lipids, smoking, high blood pressure, diabetes, inflammation1-2. Nowadays, several vascular biomarkers have been proposed. According to a position paper from the European Society of Cardiology Working Group on peripheral circulation, the choice of vascular biomarker or a combination depends on the clinical setting and present comorbidities, and may differ for each individual patient3.

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Objective: To systematically study peripheral nerve morphology in patients with transthyretin (TTR) amyloidosis and TTR gene mutation carriers using high-resolution ultrasonography (US). Methods: In this prospective cross-sectional study we took a structured history, performed neurological examination, and measured peripheral nerve cross-sectional areas (CSAs) bilaterally at 28 standard locations using US. Demographic and US findings were compared to controls. Results: Peripheral nerve CSAs were significantly larger in 33 patients with familial amyloid polyneuropathy (FAP) compared to 50 controls, most dramatically at the common entrapment sites (median nerve at the wrist, ulnar nerve at the elbow), and in the proximal nerve segments (median nerve in the upper arm, sciatic nerve in the thigh). Findings in 21 asymptomatic TTR gene mutation carriers were less marked compared to controls, with CSAs being larger only in the median nerve in the upper arm. Nerve CSAs correlated with abnormalities on nerve conduction studies. Conclusion: Using US, we confirmed previous pathohistological and imaging reports in FAP of the most pronounced peripheral nerve thickening in the proximal limb segments. Significance: Similar to US findings in diabetic and vasculitic neuropathies these predominantly proximal locations of nerve thickening may be attributed to ischaemic nerve damage caused by poor perfusion in the watershed zones along proximal limb segments. https://www.linkedin.com/pulse/ultrasonographic-study-peripheral-nerves-bulgarian-mitja-dobovi%C4%8Dnik?trk=mp-author-card

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