ASSESSMENT OF INTEGUMENTARY SYSTEM

ASSESSMENT OF INTEGUMENTARY SYSTEM

PATIENT PROFILE

Name                                       :       

Age                                          :       

Sex                                          :       

IP No                                       :       

Unit                                          :       

Ward                                        :

Date of Admission                   :

Religion                                   :       

Marital Status                          :       

Educational                             :

Reason for hospitalization       :

PRESENT HISTORY

C.O.L.D.S.P.A

C       -        Character           

O       -        Onset                  

L        -        Location             

D       -        Duration             

S        -        Severity              

P       -        Pattern               

A       -        Associated factors

SKIN

Current skin problem

          Rashes / LesIon / Dryness / Oilness / Drainage / Bruising / Swelling / Pigmentation increased.

Aggravating factor     :

Relieving factor           :

Change in tattoo or birthmark – color / size / shape.

Change in pain perception / touch / temperature / itching / tingling / numbness.

Body odour: increased / decreased.

Perspiration: increased / decreased.

Hair and Nail:

Hair loss / change in hair condition

Hair loss: Patchy / Generalized

Nail changes: Colour / condition / appearance

PAST HEALTH HISTORY

History of – treatment / surgery / Allergic skin reaction / Medication.

History of – fever / nausea / vomiting / gastro intestinal or respiratory problem.

History of – Pregnancy / Irregular menstrual cycle.

FAMILY HISTORY:

          History of illness in the family – rashes / allergy / other skin problem / skin cancer.

LIFE STYLE & HEALTH PRACTICES:

          History exposure to – chemicals / paints / bleach / cleansing products etc.

          Routine skin care / hair care.

          Dietary History – History of food allergy / Fluid intake.

COLLECTING OBJECTIVE DATA:

PHYSICAL EXAMINATION:

Preparing the client:

          Prepare the client for skin, hair and nail examination ask the client to remove all clothing remove jewellery and wear examination gloves. 

Equipments:

Ø Examination lights

Ø Penlight

Ø Mirror for the clients self examination.

Ø Magnifying glass

Ø Centimeter ruler

Ø Gloves

Ø Woods light

Ø Examination gown drape

Temperature – warm / cold / increased / body temperature

Mobility and Turgor – Pinches easily and return to normal

                                           Loss of turgor / decreased mobility /

Edema – Normal skin rebound / no deepening

                    Edema scale – Trace

                                      1+

                                      2+

                                      3+

                                      4+

SCALP AND HAIR:

          Inspection and Palpation

Hair color – Pale / Black / Patchy grey hair / Copper red hair /

Cleanliness – Dry / oily / dandruff / Excessive scaliness / Raised lesion /

SKIN:

Inspection:

 General skin condition / evenly colored / Discoloration / Pale Albinism / Erythema / Cyanosis – central / Peripheral

Skin integrity:

          Intact / skin breakdown / skin lesion / striae / birthmark / scars.

Colour variation:

          Vitiligo / albinism / rashes / Butterfly rashes /

PALPATION:

Skin texture:

          Smooth / even / rough / Flaky / Dry skin / Very thin /

Skin Moisture:

          Moist / dry /diaphoresis

Hair distribution:

          Equal / unequal / excessive bald / hair loss / Hirsutism

          Hair loss – Equal / Unequal

NAILS

Inspect for

          Grooming – clean / Dirty / broken / jagged finger nails /

          Colour and markings – Pink / longititudinal / ridging / pigmented / Cyanotic / pain / Fungal infection

COMMON LABORATORY AND DIAGNOSTIC STUDIES

Wood’s light Examination:

          Wood light or long ulcer violet light is used mainly in the examination of epidermal pigmentary disorders and cutaneus infection, applying long UV light to the skin in dark room causes epidermal pigment to appear accentuated while dermal pigmentary disorder with normal epidermal finding are obscured.

Micro porium audounis         -        Bright blue green

Micro porium cannis             -        Bright blue green

Micro porium distortum         -        Bright blue green

Tinea tonsurans                    -        Non fluresant

Tinea versicolor                    -        Dull golden yellow

Bacterial

          Erythrasma          -        Brilliant coral, red pink

          Pseudomonas     -        Yellowish green

Surface microscopy:

                  Illuminated and evaluated with magnifier.

         Asymmetry, Border irregularity, color variation, Diameter, Elevation or enlargement.

Scraping:

          Scraping and examination

Culture:

          To identify microbes

Patch Testing:

          To diagnose the allergens

Biopsy:

          To identify the pathology

NUTRITIONAL ASSESSMENT

·       Follow any particular diet

·       History of allergy to any foods like sea foods, eggs, green leafy.

·       History of any new diet before.

·       Dinner outside the home.

·       Take normal nutritional.

         

 

THE CELL

INTRODUCTION

v  The cell is the smallest structural and functional unit of the body.

v  The human body is made up of millions of cells of different types, each with its own form and functions.

v  Human body is made up of 75 trillion cells.

v  The cells are organized in tissues, tissues combine to form organs, and organs work together in organ systems.

v  Cell biology is the study of cellular structure and function.

DEFINITION :

v  A cell is the structural and functional unit of living organism.

v  A cell is a minute (jelly like) mass of protoplasm containing a nucleus held together by a cell membrane.

STRUCTURE OF CELL

    The cell is made up of the following structures.

1.   Cell membrane (or) Plasma membrane. 2. Nucleus.  3.Cytoplasm:

 

THE SIMPLE CELL

1. CELL MEMBRANE OR PLASMA MEMBRANE.

v  The cell membrane is a protective sheath of the cell body

v  The cell membrane is the semi permeable membrane. So there is free exchange of certain substances between the extracellular and intracellular fluids.

v  The structure of cell wall is fluid mosaic model.

v  The cell membrane is made up of proteins, lipids and a little amount of carbohydrates.

Function of Cell Membrane:

v  It forms outermost boundary of the organelles.

v  It takes in food materials.

v  It excretes waste products.

v  Some are involved in transport across the membrane.

Cilia and flagella

v  Cilia and flagella are mobile thread-like projections through the cell membrane.

v  Cilia are usually shorter than flagella,

v  The flagellum provides motility, or movement

2. NUCLEUS:

v  It is the largest organelle.

v  It is spherical structure surrounded by a permeable membrane called Nuclear membrane & is similar to the plasma membrane.

v  It has tiny pores through which some substances can pass between it and the cytoplasm.

v  It contains the genetic material which directs all the metobolic activities of the cell.

v  This is built from DNA and proteins called histones coiled together forming a fine network of threads called chromatin.

v  Chromatin resembles tiny strings of beads.

v  During cell division the chromatin replicates and becomes more tightly coiled forming chromosomes.

v  Nucleus consists of 46 chromosomes, which are made from deoxyribonucleic acid (DNA).

v  The functional subunits of chromosomes are called genes.

v  Nucleoli are the staining spherical bodies found within the nucleus.

Functions of Nucleus

v  Controls cellular structure.

v  Directs cellular activities.

v  Produce ribosome in nuclei.

3.  CYTOPLASM

                     Cytoplasm (cell forming material) is the cellular material between the plasma membrane and nucleus.

The cytoplasm contains the following cell organelles:

a)   Endoplasmic Reticulum

b)  Mitochondria

c)   Ribosomes

d)  Golgi apparatus

e)   Lysosomes

f) Peroxysomes

g)   Centrosomes

h)  Cytoskeleton

a)  Endoplasmic Reticulum (ER)

v Endoplasmic reticulum is a series of interconnecting membranous canals in the cytoplasm.

v The endoplasmic reticulum is of two types:

1.      Rough endoplasmic reticulum

2.      Smooth endoplasmic reticulum

       1. Rough endoplasmic reticulum:

v  Endoplasmic reticulum with granular structure (ribosome) on its outer surface called rough endoplasmic reticulum.

           Functions:

v  It helps in synthesis of protein.

      2. Smooth endoplasmic reticulum:

v  The Smooth endoplasmic reticulum does not have ribosomes on its surface.

          Functions:

v  Synthesis of lipids and steroid hormones.

v  Detoxification of drugs & certain pesticide

b) Mitochondria:

v  They are power houses of the cell.

v  They are sausage shaped structure in the cytoplasm.

v  The mitochondia is composed of two layers of membranes:

Ø  An outer layer which is smooth

Ø  An inner layer folded into sheets of tubles  called christae.

v  Both these layers enclose a central cavity called matrix.

v  The mitochondria are made up of proteins, phospholipids and RNA.

    Functions:

v  It helps in oxidation of glucose.

v  Mitochondria are power generating units of cells (synthesis of ATP)

v  It also contains DNA and can synthesis proteins.

a)      Ribosome:

v  Ribosomes are tiny granules composed of RNA and proteins.

v  Some ribosomes are attached to rough endoplasmic reticulum.

v  The remaining are present as free ribosomes in the cytoplasm.

     Function:

v  Synthesis of protein.

b)     Golgi Apparatus:

v  A canal like structure lying next to the nucleus.

      Functions:

v  It involved in the secretary activities of the cell.

c)      Lysosome:

v  They are formed by golgi apparatus.

v  They present throughout the cytoplasm.

v  Lysosomes are filled with variety of hydrolytic enzymes are called lysozymes.  

      Functions:

v  It is capable of digesting proteins and fats.

v  Removal of unwanted damaged substances and foreign bodies like bacteria.

v  Removal of excessive secretory products in the cells of the glands.

d)     Peroxisome::

v  It’s structure is similar to that of lysosomes.

v  They contain oxidase.

v  Peroxisome catalyze reaction generating hydrogen peroxide.

e)      Centrosomes

v  Centrosomes are structures present near the nucleus

v  They are made up of structures called centioles

v  Centrioles are two short cylinders arranged at right angles to each other.

v  It is visible only during cell division.

f)       Cytoskeleton

v  Cytoskeleton is a system of fibres that maintains structure of cell.

v  It permits cell to change its shape

v  It helps in movement of cell.

v  Cytoskeleton is made up of

ü  Microfilaments

ü  Intermediate filaments

ü  Microtubules.           

 FUNCTIONS OF A CELL:

1. Irritability:                                                                                                                                                      The cell has the ability to detect and responds to changes in its environment.
2. Nutrition:                                                                                                                                                         The cell is capable of absorbing fluids and dissolved substances directly through cell membrane and these can be used by the cell growth and repair, to provide.
3. Respiration:                                                                                                                                                     The cell has the ability to use oxygen combined with food substances to form carbon dioxide and water, while releasing energy for intra cellular activity.
4. Excretion:                                                                                                                                                        The cell is able to discharge unused and waste membrane through cell membrane.
5. Growth and Reproduction:                                                                                                                            The cell has the ability to increase in size and when it reaches the limit of its growth it reproduces by dividing into 2 smaller cells.
6. Movement:                                                                                                                                                        Some cells have power of movement.

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