This document discusses the integumentary system and response to altered integumentary function. It covers 11 unit outcomes related to factors influencing skin health, assessment of the integumentary system across the lifespan, health promotion behaviors, psychosocial impacts of skin conditions, pharmacologic and nonpharmacologic management of skin disorders, surgical management of impaired skin integrity, and nursing diagnoses for integumentary problems. Key topics include assessment, safety and prevention, nursing implications of various treatments, and nursing management of clients with altered skin integrity.
Presentation by Peter G. Hovland, MD, PhD. Presented at the 2018 Eyes on a Cure: Patient & Caregiver Symposium, hosted by the Melanoma Research Foundation's CURE OM initiative.
Presentation by Peter G. Hovland, MD, PhD. Presented at the 2018 Eyes on a Cure: Patient & Caregiver Symposium, hosted by the Melanoma Research Foundation's CURE OM initiative.
History and physical assessment of integumentary systemSiva Nanda Reddy
this topic describes the assessment of integumentary system, history and physical examination in relation to integumatary system was described in detail
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Skin cancers or cutaneous malignancies including Basal cell carcinoma, Squamous cell carcinoma and Melanoma and with a brief introduction of skin as an organ itself.
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Definition
Epidemiology
Causes and Risk Factors
Clinical Presentation
Types
Diagnosis
Treatment
Prognosis
Case Scenario
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History and physical assessment of integumentary systemSiva Nanda Reddy
this topic describes the assessment of integumentary system, history and physical examination in relation to integumatary system was described in detail
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We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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2. RESPONSE TO ALTERED INTEGUMENTARY FUNCTION
Unit Outcomes: Upon completion of this unit of study, the student will be able to:
• Safe Effective Care Environment:
• 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
• 2 . Perform thorough dermatological assessment throughout the life span.
• Health Promotion and Maintenance:
• 3. Identify healthy behaviors by the client and family ( screening exams, limiting risk taking behaviors).
• Psychosocial Integrity:
• 4. Discuss psychosocial impact of client’s altered dermatological condition ( acne, burns, rashes, tumors).
• Physiologic Integrity:
• 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
• 6. Develop plan of care for client with impaired skin integrity.
• 7. Explain the eight parameters of assessing a lesion.
• 8. Describe common lesions and rashes utilizing proper terminology.
• 9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
• 10. Select nursing diagnoses most likely to be utilized with clients with integumentary problems.
• 11. Discuss etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin
disorders.
7. Thorough History
• Dx & Tx – realm of practice
– Difficult due to similarities in lesions and sx
• Differential dx requires clues
8. Assessment: Subjective Data
– Past Medical History
• Trauma
• Surgery
• Prior skin disease
• Jaundice
• Delayed wound healing
• Allergies
• Sun exposure
• Radiation treatments
10. Assessment: History
• Surgery
– Cosmetic
– Biopsy
• Diet
• Health Practices
– Hygiene, products
– Sunscreen, SPF
– Complementary &
alternative medicine
• C/O symptoms
• Known exposure to
carcinogens, chemical
irritants, allergens
• Family
– Alopecia (bald)
– Psoriasis
– Skin cancer
12. • Privacy
• Carefully describe:
– Obvious changes in color and vascularity
– Presence or absence of moisture
– Edema
– Skin Lesions
– Skin integrity
• Document properly
Assessment
13. Parameters of General Skin Assessment
• color, temperature, moisture, elasticity,
turgor, texture, and odor.
14. Assessment: Inspection
• Consider Cultural and Ethnic variations
– Dark skin
• rates - skin cancer
• Difficult to assess flushing; cyanosis; jaundice
• Rashes difficult to observe
• Pseudofolliculitis
• Keloids
• Mongolian spots
15. • Inspection of hair
– Distribution
– Texture
– Quantity
• Inspection of nails
• Iggy page 474-475; Wilkinson 370
– Grooves
– Pitting
– Ridges
– Curvature
– Shape
Malnutrition
Anorexia nervosa
Anxiety
Hygiene
Depression
Hormones
Living conditions
Circulatory status
Chronic disease
Assessment: Inspection
16. Lesion Description
• Size
– Metric
• Shape
– Circumscribed
– Irregular
– Round
• Texture
– Rough
– smooth
• Configuration
– Annular
• “relating to, or
forming a ring”
– Linear
– Concentric rings
– Clustered
– Diffuse
• Effect of pressure
17. Lesion Description
• Distribution
– Asymmetric vs. Symmetric
– Confluent
• “flowing or coming together; also : run together”
– Diffuse
– Localized
– Solitary
– Zosteriform
• “resembling shingles”
– Satellite
18. Assessment: Palpation
– Edema
– Moisture
– Temperature
– Turgor
– Texture
Fever
C-V status
Respiratory status
Hormones
Hydration
Rash/ Lesion
Nutritional status
19. Skin cancer - most common cancer!
• Risk factors
– Fair skin
– Blue/green eyes
– Blond/red hair
– History chronic sun exposure
– Family history
– Living near the equator
– Very high/low altitudes
– Working outdoors
– Age > 60 (damage is cumulative)
20. Non-melanoma Skin Cancers
• Basal Cell Carcinoma
– Most common type of skin cancer
– Easily treated
– Doesn’t metastasize
– Middle age to older adults
– Symptoms
• Small slow growing papule
• Semi translucent or “pearly”
• Erosion/ulceration of center
22. Non-Melanoma Skin Cancer
• Squamous cell
– Less common than BCC
– High cure rate with early detection
– Can be aggressive, metastasize & be fatal
– Common on lips, mouth, face and hands
• Pipe, cigar, & cigarette smoking
– Symptoms
• Firm nodule
• Scaling/ulceration
• Opaque
23. Squamous cell carcinoma
Medical Tx
• Excision
• Radiation
• Moh’s surgery
(see slide #33)
• 5 FU or methotrexate intralesional
– (see slide #34)
24. Diagnostic & Surgical Therapy
• Simple Excision
• Excision
– Moh’s micrographic surgery
• Microscopically controlled removal of lesion
• Removes tissue in thin layers
• Can see all margins of specimen
• Preserves normal tissue
• Produces smallest wound
25. Drug Therapy: Topical Fluorouracil (5-FU)
– Selective toxicity for sun damaged cells (cytotoxic)
– Indications
• Premalignant skin disease (esp. actinic keratosis)
• Systemic absorption minimal
It causes painful eroded area within 4 days and must
use 1-2 times daily 2-4 weeks.
Healing up to 3 weeks after med stopped
Is photosensitizing - avoid sunlight during treatment
Will look worse before it gets better
26. Non-Melanoma Skin Cancers
• Actinic Keratosis (AKA Solar keratosis)
– Most common precancerous lesion
– Premalignant form of squamous cell carcinoma
– Symptoms
• Hyperkeratotoc papules/plaques on sun exposed areas
• Varied appearance
– Irregular shape
– Flat
– Indistinct borders
– Overlying scale
27. Actinic Keratosis
(AKA Solar keratosis)
Medical Tx:
•Cryosurgery
(see slide #37)
•5 FU
•Surgical removal
•Retin A
•Chemical peels
28. Cryosurgery
– Subfreezing temps for surgery (liquid nitrogen)
• Lesion becomes red & swollen, blisters, then scabs; falls off
in 1-3 weeks
• Minimal scarring
– Indications
• Genital warts
• Seborrheic keratosis
• Actinic keratosis
29. Malignant Melanoma
• 1/3 of all melanoma occur in existing nevi
or moles
– Any sudden or progressive change in size,
color or shape of a mole should be checked
30. Malignant Melanoma
• Can metastasize anywhere
• Most deadly of skin cancers
• Causes
– UV radiation
– Skin sensitivity
– Genetic
– Hormonal
– Sun exposure
– Mutation of gene (B-RAF) 70%
31. A B C D’s of Melanoma
Asymmetry
Border irregular, edges ragged
Color varied pigmentation
• Tan, brown, black, red
Diameter > 6mm
32. Melanoma
Medical Tx
Depends on site, stage, age and
general health of client
– Surgery
– Chemotherapy
– Biologic Therapy
• Interferon, interleukin
– Radiation therapy
34. Sunburn: Education
(Protect, Protect, Protect)
• Same precautions as for skin cancer.
• Don’t let clouds or cool air fool you –
Florida sun is damaging then too.
• Get out of the sun before you turn red!
• Cool skin off. Immediately!
• Hydrate!
35. Sunburn
• Superficial burn
• Excessive exposure to ultraviolet rays injures
dermis.
• Dilated capillaries = red, tender, edema,
blisters
• Large area = nausea, fever
36. Sunburn
• Redness & pain begin within a few Hours.
• Intensity may increase before subsiding.
• 3-5 days to heal
• Tx: cool bath; soothing lotions; topical
corticosteroids; fluids
38. Infestations: Pediculosis
– Head, body or pubic lice (“crabs”)
– Parasite excrement and eggs on skin
– Nits in hair
• Waxy, don’t fall off easily
• Symptoms
• Tiny red points to papular wheal-like lesions
• Pruritis – check hairline
• Secondary excoriation
39. Pediculosis
Medical tx
• Pyrethrins (Rid), Permethrin (Nix) or if all other
agents fail…Benzene hexachloride (Kwell)
• Contact screening
• l
40. Infestations: Scabies
– Skin reactions due to eggs, feces, & mite parts
– Transmitted by direct contact
• Symptoms
– Severe itching especially at HS
– Usually not on face
– Presence of burrows esp. interdigital webs & flexor
surface of wrists
– Redness, swelling, vesiculation
41. Scabies
Medical tx
– Topical Scabicide
– Antibiotics for 2ndary
infection
– Treat those in close
proximity
– Clothing & linens – hot
water and detergent
43. Plants in FL that irritate skin
• Poinsettia, Croton
• Milky sap can cause skin irritation
• Oleander
– Touching the plant is not dangerous, but prolonged contact can
irritate the skin.
• Poison Ivy , Brazilian Pepper
– Touching the leaves or oil from the plant can cause an itchy rash
with blisters.
46. Drug Therapy
• Topical Corticosteroids
– Anti-inflammatory, antipruritic
• Low potency (hydrocortisone)
– Slower acting
– Can be used longer without serious side effects
– Ointment most efficient
– Higher potency, long term, systemic use is different tx
47. – Intralesional
• Reservoir of med effects lasts several weeks to months
• Indications
– Psoriasis
– Alopecia
– Cystic acne
– Hypertrophic scars and keloids
– Systemic
• Undesirable adverse effects – Lilley 6th ed. Page 869
• Short term therapy – poison ivy
• Long term therapy – chronic bullous diseases
Corticosteroids
Triamcinolone (Kenalog)
48. Bases for Topical Medications
• Powder
– Promotes dryness
– Good for antifungals
• Lotion
– Cooling and drying with residual powder film
– Good for pruritic eruptions
• Cream
– Emulsion of oil and water
– Lubrication and protections
• Ointment
– Oil with water in suspension
– Lubrication
– Most efficient delivery system
• Paste
– Mixture of powder and ointment
– Drying
– Moisture absorption
52. Nursing Management: itch
• Baths
– For large body areas
– Has sedating and antipruritic effect
– Oilated oatmeal (Aveeno), potassium permangenate,
sodium bicarb
– Temp comfortable to client
– Soak 15-20 mins 3-4 times daily
– Pat dry, no rubbing
– apply moisturizers or meds after baths
53. Nursing Management
• Wet dressings
– Indications
• Skin weepy from infection/inflammation
• Relieves itching
• Debrides wound
• Increases penetration of topical meds
• Relieves discomfort
• Enhances removal of scabs, crusts, and exudate
54. Wet dressings
Procedure
•Clean solution and gauze
•Squeeze until not dripping
•Apply to affected area, avoid normal tissue
•Leave in place 10-30 minutes 2-4 times a
day
•Discontinue if skin macerates (“to soften”)
61. Dermatological Interventions
• Phototherapy
– UVA & UVB (UVL)
– Ultraviolet wavelengths cause erythema,
desquamation, and pigmentation
– Enhance with psoralem (photosensitizing)
• Treatment for
• Psoriasis
• Atopic dermatitis
• Vitiligo
62. Phototherapy
• Adverse effects
– Basal or squamous cell Ca
– Burns
– Erythema
– Teach patients to avoid further sun exposure &
photosensitizing drugs
– Wear eye protections as psoralem absorbed by lens of eye
63. Dermatological Interventions
• Radiation Therapy
– Indications
• Cutaneous malignancies
– Advantages
• Produces minimal damage to surrounding tissues
– Adverse effects
• Permanent hair loss (alopecia) to irradiated areas
• Telangiectasia
• Atrophy
• Hyperpigmentation / depigmentation
• Ulceration
• BCC and SCC
y.
67. Contact Dermatitis
Medical Tx
– Topical corticosteroids
– Antihistamines
– Skin lubrication
– Elimination of allergen
– Systemic steroids if
severe
http://dermatology.cdlib.org/DOJvol7num1/NYUcases/contact/joe.html
68. Drug Therapy: Antihistamines
• Compete with histamine receptor site
– Oral or Topical
• Cetitizine (Zyrtec)
– PO tabs, syrup QD
– Non-sedating
• Diphenahydramine (Benadryl)
– PO, IM, topical
• Indications
– Urticaria
– Pruritis
– Allergic reactions
69. Drug Therapy: Antihistamines
• Adverse effects
– Anticholinergic
– Sedation (Benadryl)
– Use with caution in older adults
• Indications
– Urticaria
– Pruritis
– Allergic reactions
• Adverse effects
– Anticholinergic
– Sedation (Benadryl)
– Use with caution in older adults
70. Allergic Conditions: Drug Reaction
• Manifestations
– Rash of any morphology
– Red, macular, papular
– Generalized rash with sudden onset
– Pruritic
– Can occur as late as 14 days after drug is stopped
72. Allergic Conditions: Atopic Dermatitis
– Cause unknown
– Begins in infancy and declines with age
• Manifestations
– Scaly, red to re-brown, circumscribed lesions
– Pruritic
– Symmetric eruptions
73. Atopic Dermatitis
– Topical corticosteroids
– Phototherapy
– Coal tar
corticosteroids
– Lubrication of dry skin
– Antibiotics for secondary infections
Medical Treatment
74. Dysplastic Nevus Syndrome
• Abnormal mole pattern
• Increased risk for melanoma
– Doubles with dysplastic nevi
• Atypical moles larger than usual (>5mm)
• Irregular borders, possibly notched
• Various variegated colors
• Most common on back
75. Infections of the skin
• Risk factors
– Imbalance between host and microorganism
– Broken or damaged skin; Trauma
– Systemic disease such as Diabetes
– Moisture
– Obesity
– Systemic corticosteroids, antibiotics
• Prevention
– Proper hygiene
– Good health
76. Infections: Herpes Simplex Virus, Type I
(AKA “cold sores/fever blisters”)
• Contagious
• Dormant – Exacerbation
• Triggers
• Symptoms -- 1st episode 3-7 days after exposure
– Painful local reaction
– Vesicles on erythematous base
– Fever, malaise
77. Herpes Simplex Virus, Type I
Medical Tx
– Symptom management
– Moist compresses
– Petrolatum to lesions
– Antiviral agents (Zovirax,
Famvir, Valtrex) www.treatmentsforhealth.com/.../cold-sores/
78. Infections: Herpes Simplex Virus, Type II
– Genital
“Most genital herpes is caused by HSV-2.” (n.l.m.-n.i.h./ Medline plus)
– Recurrence more common than oral
• Does not mean re-infection
• Symptoms
– Same as Type I
• Treatment
– Same as Type I
Iggy page 1742-1743
79. Infections: Herpes Varicella Virus
(chicken pox)
** Highly contagious
• No chicken pox or vaccination
• Keep those w/active lesions separated until crusted
• Symptoms
– Vesicular lesions in successive crops
• Face , scalp, spreading to trunk and extremities
Protect eyes
Do not squeeze pustules or crusts
• Vesicles > pustules > crusts > scars
• Postherpetic neuralgia
• Self limiting in children
81. Infections: Herpes Zoster
(shingles)
– Activation of varicella zoster virus
– Frequent occurrence in immunocompromised
– Potentially contagious to immunocompromised
• Symptoms
– Linear patches along dermatome
– Grouped vesicles on erythematous base
– Unilateral on trunk
– Burning pain and neuralgia
82. Herpes Zoster
Medical Tx
– Symptomatic
• Wet compresses
• White petrolatum to lesions
– Antiviral agents
83. Drug Therapy: Antivirals
– Acyclovir (Zovirax)
• Suppresses chicken pox, herpes simplex 1 & 2, shingles
• Po, IV, topical
– Valacyclovir (Valtrex)
• Herpes zoster (shingles) & genital herpes
– Vaccines
• Varivax
– Prevention of chicken pox
– Given to children > 12 mo.
• Zostivax
– HZU vaccine for adults > 60 y/o
104. Drug Therapy: Acne Preparations
– Isotretinoin (Accutane)
• Pregnancy Category X
– Proven teratogen
– 2 contraceptive methods
– Tretinoin (Retinoic acid, Vitamin A acid, Retin-A)
• Stimulates epidermal cell turnover -> skin peeling
• Adverse effects
– Red edematous blisters, crusted skin, altered skin
pigmentation
• Avoid sun, use sunscreen
• Apply to dry skin
105. Benign Skin Conditions: Moles
Grouping of normal cells
• Manifestations
– Hyperpigmented areas
– Varying form and color
• Treatment
– None necessary
– Cosmetic
– Biopsy for diagnosis
106. Benign Skin Conditions
• Psoriasis
– Chronic dermatitis due to rapid turnover of epidermal cells
– Family predisposition
– Manifestations
– Sharply demarcated scaling plaques of
• Scalp
• Elbows
• Knees
• Palms, soles, and fingernails possible
• Treatment
– Retard growth of epidermal cells
– Topical corticosteroids
– Tar
– Anthralin topical
– Sunlight, UV light
– Alefacept (Amevive) injection
– Antimetabolites (methotrexate) or systemic retinoids for difficult
cases
107. Benign Skin Conditions
• Seborrheic Keratoses
– Irregularly shaped flat topped papules or
plaques
– Warty surface
– Appearance of being stuck on
– Increase in pigmentation
– No association with sun exposure
– Treatment
• Removal
– Curettage
– cryosurgery
108. Benign Skin Conditions: Lipoma
Encapsulated tumor of adipose tissue
Most common 40-60 years of age
• Manifestations
– Rubbery, compressible, round mass
– Variable in size
– Most common on trunk, back of neck, forearms
• Treatment
– Biopsy
– Excision if indicated
109. Benign Skin Conditions: Vitiligo
– Unknown cause
– Genetic connection
– Complete absence of melanocytes
– Non-contagious
• Manifestations
– Complete loss of pigment
– Variation in size an location
– Symmetric and permanent
• Treatment
– Exposure to UVA and psoralens
– Depigmentation of pigmented skin in extensive
disease
– Cosmetics and stains
110. Benign Skin Conditions: Lentigo
• (see fig. 26-7, Iggy page 465)
– AKA liver spots
– Increased number of melanocytes
– Related to aging and sun exposure
• Manifestations
– Hyperpigmented brown to black flat lesion
– Usually in sun exposed areas
• Treatment
– Liquid nitrogen
• Possible reoccurrence in 1-2 years
– Cosmetics
116. References:
• Chickenpox in Pregnancy. (2009). March of Dimes Foundation. Retrieved
9/25/09 from http://www.marchofdimes.com/professionals/14332_1185.asp
• Common Poisonous Plants of Florida (Florida Poison Information
Center/Tampa) @ http://www.poisoncentertampa.org/poisonous-plants.aspx
• Culbert, D. (April 14, 2005). Florida scorpions. UF/IFAS Okeechobee County
Extension Service. Retrieved 6/17/09 from
http://okeechobee.ifas.ufl.edu/News%20columns/Florida.Scorpions.htm
• Groch, J. (August 23, 2006). Guidelines for Preventing Pressure Ulcers Seen
as Suboptimal. MedPage Today. Retrieved 6/12/09 from
http://www.medpagetoday.com/Dermatology/GeneralDermatology/3982
117. References:
• Hembree, D. (July 21, 2008) 10 Poisonous Plants in Florida and
Safety Precautions @
http://www.associatedcontent.com/article/875395/10_poisonous_pla
nts_in_florida_and_pg2.html?cat=11
• “Herpes simplex” (May, 2009). Medline Plus Medical Encyclopedia.
Retrieved 6/15/09 from
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/001324.htm
• Lilly, L.L., Harrington, S, & Snyder, J. (2005) Pharmacology and the
Nursing Process. (4th ed.) Mosby Elsevier. St. Louis, MS.
• Medical Dictionary (2009) Merrium – Webster Inc. Retrieved 6/15/09
from http://www.nlm.nih.gov/medlineplus/mplusdictionary.html
118. References:
• The Medical News. Brain eating amoeba in lake kills sixth victim.
(October 2007). Retrieved 6/16/09 from http://www.news-
medical.net/news/2007/10/07/30863.aspx
• The US Market for Skin Care Products. (May, 2005). Retrieved
6/12/09 from http://www.mindbranch.com/Skincare-Products-R567-
0199/
• Scorpion Sting Treatments. (2008). Orkin. Retrieved 6/17/09 from
http://www.orkin.com/other/scorpions/scorpion-sting-treatments
119. Burns
• Thermal burns
– Flame, flash, scald
• Chemical burns
– Necrotizing substances
• Acids
• Alkali
– Cleaning agents, drain cleaners, lye
• Electrical burns
– Intense heat from electrical current
The
Following
Content –
Burns –
will be
covered in
future
classes!
Save this
information for
future use.
120. Classification: Depth of Burn
See page 522 in Iggy text
• ABA by depth of destruction
– Partial thickness burn
• Epidermis and dermis involved
– Full thickness burn
• “burns reach through the entire dermis and sometimes into
the subcutaneous fat.” (Iggy, page 522)
• Possibly involves muscles, tendons, and bones
• *Skin cannot heal on its own.
121. Classification: Extent of Burn
• Total Body Surface Area (TBSF)
– (Iggy page 531)
• Berkow method
– http://www.umobile.edu/main/notes/Burn.pdf
• Rule of 9’s
– (Iggy page 531)
122. Classification: Location of Burns
• Severity related to location
• Complication risks related to location
• Face, neck, chest
– Respiratory complications
• Hands, feet, joints, and eyes
– Compromise ADLs
• Circumferential burns of extremities
– Circulatory compromise
