Integumentory system disorders

• Assessment includes clustered skin vesicles along with peripheral sensory nerves on trunk, thorax and face
• Intervention :- isolate Patient bcz exudate from lesion contains virus
• Bell’s palsy (7th cranial nerve function) is complication of herpes
• Zostavax is vaccination for adults over 60yr of age

Methicillin RESISTANT STPHYLOCOCCUS AUREUS :–

• Skin or wound becomes infected with MRSA
• It is also referred as health care associated infection

 

• Folliculitis is superficial infection of follicles caused by Staphylococcus and preaent as raised red rashes and postules
• MRSA is contagious and can spread to others and other body parts

• It is  an acute superficial rapidly spreading inflammation of dermis and lymphatics caused by grp A streptococcus which enters body via abrasion, bite or trauma.
  

      CELLULITIS :-

• It is an infection of dermis and underlying hypodermis caused by grp A Streptococcus

• Intervention :- promote rest of affected parts

• Apply warm compress to promote circulation

• Apply antibacterial dressing and administer antibiotics

BEE AND WASPS STINGS :-

• Stings causes a wheal and flare reaction
• Emergency care includes quick removal of stinger and application of ice pack
• Stinger is removed by gently scrapping or with the edge of needle. Tiwizers are not used bcz of risk of pinching of venom sack.
• ***If patient is allergic, pt should be given epinephrine (adrenaline) injection immediately to save life

SNAKE BITE:-

• Firstly The victim should be moved to safe place immediately
• Extrimity is immobilized and kept below the level of heart
• Constricting cloth should be removed
• The victim is kept warm and not allow to drink alcoholics and caffeinated item
• The wound is not incised or sucked to remove venom
• ***Ice is not applied to venom

                SKIN  CANCER :-

squamus cell carcinoma

• It is a malignant lesion of skin

Types of skin cancer are :-

1. Basal cell carcinoma :- 

• Waxy border, papule, red central cratoer

• Metastasis is rare
• 
  

2. Squamous cell :-

• Oozing, bleeding crusting lesion metastasis is possible

3. Melanoma :-

• Irregular, circular bordered lesion with hues of tan black or blue
• Highly metastatic
• Instruct patient to avoid sun exposure
• Instruct pt to perform monthly self examination and monitor lesion that not heal

PSORIASIS :-

• It is chronic, noninfectious skin inflammation invloving keratin(fibrous protein forming the main structural constitute of hairs) .
• Psoriasis vulgaris is most common
• Possible cause include stress, trauma, infection hormoneal changes

Koebner phenomenon : 

It is development of psoriatic at a site of injury such as scratched or sunburned area

• Assesment:- pruritis
• Silvery white scales on raised redned, round plaque usually affects scalp knees, elbows etc..
• Provide emotional support
• Instruct patient not to scratch affected areas

Pressure ulcer :-

• Pressure ulcer is impairment of skin integrity
• Risk factor include skin pressure ,Immobility ,bmalnutrition decreased sensory perception

Stages of pressure ulcer :-

• 1. Stage 1st  :- skin is intact
• Area is red and does not blench with pressure
• 2 . Stage 2nd :- skin is not intact
• Partial thickness skin loss of dermis occurs
• 3. Stage 3rd :- full-thickness skin extends into the dermis and subcutaneous tissue
• 4. Stage 4 :- full thickness skin loss is present with exposed bone tendon or muscle
• Turn and reposition the immobilzed patient every 2 hour

                    BURN :-

• Estimation of burn percentage by rule of nine

Superficial partial thickness burn :-

• It involves injury deeper into the dermis and blood supply is reduced
• Large blister and edema is present
• Burn is painful and sensitive to cold
• Heels in 10 to 21 days with no scaring

Deep partial thickness Burn :-

• It extends deeper into the skin dermis
• Blister formation does not occur
• Wound surface is red and dry with white areas in deeper  part
• Heals in 3 to 6 weeks but scar formation occurs
• Skin grafting may necessary

Full thickness burn :-

• It involves injury and destruction of epidermis and dermis
• appears as dry hard  leathery eschar
• Healing may takes weeks to months
• Burn requires removal of eschar skin grafting

Deep full thickness burn :-

• Injury extends beyond skin tissue muscle and bone and tendons are damaged
• Injured area appears black and sensation is absent
• Healing takes month and graft is required

• Extensive band agent in generalized body edema and decrease circulatory intravascular blood volume

• Initially hyponatremia and hyperkalemia in burn

• The haematocrit level increases as a result of Plasma loss and this initial level decreases to below normal by 3rd to 4th day of burn

Management of burn :-

• Remove the patient from source of burn

• Assess Airway breathing and circulation

• Cover burn with sterile or clean cloth

• Insert IV line and transport to emergency department

• Ensure a patent Airway and administer 100% oxygen via tightfitying nonbreather face mask

• Maintain a urine output of 30 to 50 ml per hour

• Urine output is most reliable assessment parameter of cardiac output and tissue perfusion in

• Curling ulcer are common after 72 hours of burn

• If the hemoglobin and hematocrit level decreases and urine output is 50 ml per hour the rate of IV fluid is decreased

• Monitor daily  weight and expect 15to 20 pound wt increase in 72 hrs

• Common fluid resuscitation formula

• ****Half of calculated fluid is given in first 8 hours and rest in 16 hours

• RINGER LACTATE IS COMMONLY USED

• Parkland formula 4ml/kg/%TBSA burn

• Modified parkland 4ml/kg/ TBSA burn +15ml/m2of TBSA

Escharotomy :-

• Lengthwise incision is made through the burning escgar to relieve constriction and pressure and to improve circulation.
• Escharotomy is performed Edward said without any easier because never ending have been destroyed by the burn injury.
• Following escharotomy asses pulses color, movement and sensation of affected extrimity

FASCIOTOMY :-

• An incision is made extending through subcutaneous tissue and fascia
• It is performed under general anaesthesia

Debridement :-

• Debridement is the removal of escahr or  necrotic tissue to prevent bacterial proliferation under the eschar and to promote wound healing.