INTEGUMENTARY

SYSYTEM
Normal bacterial flora

Gram +ve and gram-ve staphylococi

Pseudomonas spcs
Streptococcus sps
Ph -4.2 -5.6 halts
Phases of wound healing

Inflammatory
: 3-5 days-
edema/warmth/pain

Fibroblastic
4-4weeks
scar/granulate in tissue bed

Maturation 3weeks after injury-scar

thins/inelastic
Diagnostics

Skin biopsy:
If suture can remove 7-10 days
Keep dressing in place 8hours.
Skin /wound c/s :
Scrap/punch

Woods light
Diascopy
Candida albicans

Or yeast/oral thrush
Risk: HIV
CANCER PTS
LONG TERM ANTIBITICS
DM
OBESE

COMMONLY: pernium,under
breast,oral
Candida albicans

Assess: skin: red itcheses/irritates

Mucous :whitish patches
Treat:
Teach skin fold areas to keep clean .
Frequent mouth care
Antifungal
Provide food and fluids tepid in
temperature
Herpes zoster /shingles-
contact
Reactivation of chicken pox ||
(varicella zoster virus )
Virus situataes in dorasal nerve in
root of spinal/cranial nerve
Tzanck smear/viral c/c
HSV 1-COLD SORE
HSV 2-GENITAL AREA
BOTH are caontagious
Herpes zoster /shingles

Assess: clustered skin lesion

unilaterally
Fever
Malaise
Paresthesia
Pruritis
Pain like burning
Interventions

Isolation
Bells palsy is complication
Air mattress cool envt,
Cotton dress
prevent scratching
Use astringents
Vaccinate with zostavax
Anti- viral meds
MRSA-contact

Assess :
Foliculitis red
rash/pustules
Furuncles : very
painful raise
bumps
blood cls or wound
Treat:
culture
Maintain SP/IP
Prevent organ
damage
Antibiotic therapy
Erysipelas/cellulitis

Spread
inflammation of
dermis &
lymphatics strep
A
-dermis &
hypodermis
Treat: rest of
infection-cellulitis affected area
Warm compress
Assess: pain &
Abtibacterial
ternder
C/S
Erthyema/warm

Poison ivy

Dermatitis by oak, poison sumac

Assess: papulovesicular lesions
Severe purities
Treat:
Cleanse skin with plant oils
Apply cool /wet compress
Oral/topical steroids
Bites /stings
Spider bites :brown
recluse : skin
lesion ,necrotic
wound or systemic
effects from toxin
Treat with ice,-upto
4daya to relieve
from necrosis and
reduce venom /anti-
septic,antibiotic
cream
Black widow spider

Small red papule

Causes
nephrotoxicity
Ice to inhibit
neurotoxin
Systemic toxicity
sepsis need
hospital treat
Tarantulas
Swells-redness-
numbness-lymph
inflammation-pain
Spider hair should
removed soon with
sticky tape
Then irrigate the bite
area with saline
Affected part to be
elevated
Antihiatamines
/topical/systemic
steroids
TT prophlaxis
Scorpion stings
Bees and wasps :
Wheal &flare
Pain /inflammation reaction
Quick removal of
,systemic
rxns stings
Ice
Treat with
If they allergic to
analgesics
Wound care venom then
Neurotoxicity purities
Swelling of lips
anti-venom
Anaphylaxis
Treat with
epinephrine IM
Snake bite

Extreme systemic illness

Affected part to be immobilized kept
below the level of heart
Constrictive clothing or jewellery to be
removed
No caffeine /OH
Kept warm to reduce absorption of
venom
Anti-venom admn/no I&D
But restrict above the bite area
Frost bite

Damage to tissue s& bloood vessels

Fingers ears ,nose ,face
Assess: 1=white plaques surrounds
hyperremia &edema
Fourth : gangrene amputate
Frost bite
Frost bite
Interventions

Re-warm the affected part 104f to

ao7f to thaw the frozen part
Avoid rub ,dry heat, compression
s/o compartment syndrome
TT,
debridement
Skin cancer
Is a malignant lesion Squamous cell:
of the skin epidermal
Causes: over-
keratinocytes & can
exposure to sun
Genetic
infiltrate lymph
Light skinned race nodes
More thn 60 years
Types : Melanoma: from
Basal cell: arises from birth marks or scars
epidermis basal cell : highly metastasis
metastassis rare, brain,lungs,bone,liv
er
Assessment

Basal:waxy border,papule,red
,central crater

Melanoma : irrgular hues of tan,

black or blue infiltration
Higly metastaic

Squamous cell carcinoma: oozing

,bleeding.large tumours
Interventions

Instruct to monthly SSE,

Advice to remove moles or lesions if
any irritation
Avoid sun exposure
Use sunscreen lotions
Cryosurgery
Electrodessication
Surgical excision of lesion
Psoriasis