Polyps and Cysts

• A POLYP is an abnormal growth of tissue (tumor) projecting from a mucous membrane. If it is attached to the surface by a narrow elongated stalk it is said to be pedunculated. If no stalk is present it is said to be sessile. Polyps are commonly found in the colon, stomach, nose, urinary bladder and uterus. They may also occur elsewhere in the body where mucous membranes exist like the small bowel.

• A CYST is a closed sac having a distinct membrane and developing abnormally in a cavity or structure of the body. Cysts may occur as a result of a developmental error in the embryo during pregnancy or they may be caused by infections. However, they sometimes arise spontaneously with no apparent cause. Cysts may often be dangerous as they may have negative effects (for instance, compression) on the nearby tissue. They may contain air, fluids, or semi-solid material. A collection of pus is called an abcess, not a cyst.A cyst may also be a sack that encloses an organism during a dormant period, such as in the case of certain parasites. The cyst may protect a parasite from the churning acid of the stomach so it can pass through to the intestines where it can then break out.Cystic fibrosis is an example of a genetic disorder whereby cysts develop in lung tissue and release mucus into the lungs (Alveoli) reducing lung capacity and causing persistent coughing.
• A cyst is a deep-seated mass filled with liquid or semisolid material and surrounded by a capsule (an enveloping layer of tissue). A cyst may be as small as a pinhead or as large as a fist. Most cysts result from a blockage of follicular ducts or glandular structures. Cysts appear in very severe acne.

Skin Assessment II

SKIN LESIONS

1. Macule: a flat lesion; it is not elevated and it is not depressed. The macule is recognizable as a skin lesion because it is a different color than the surrounding normal skin. White, brown, and red are the most common color changes seen in macules. Macules appear in many shapes. When a macule is larger than 5mm in diameter, it is called a patch. A freckle is an example of a macule.
2. Papule:  solid raised lesion that has distinct borders and is less than 1 cm in diameter. Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as crusts or scales.
3. Nodule:  raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or subcutaneous tissue.
4. Vesicle:  raised lesions less than 1 cm. in diameter that are filled with clear fluid.
5. Pustule :  are circumscribed elevated lesions that contain pus. They are most commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis).
6. Wheal:  an area of edema in the upper epidermis. more: A wheal is a rounded or flat-topped, firm elevated lesion that results from edema (swelling) of the dermis. Wheals are often pink with a whitish center. The wheal is the classic lesion of hives.
7. Plaque  an elevated, flat-topped lesion greater than 0.5cm in diameter. Plaques are often described as being shaped like a plateau. Plaques covered with silvery scales are common lesions in psoriasis.
8. Erosion: slightly depressed areas of skin in which part or all of the epidermis has been lost.
9. Ulcer: Complete loss of dermis

Skin Assessment

1. Color of skin:

• pallor (whiteness), flushing (redness) jaundice (yellow), ashen (grey), or cyanotic (blue)

2. Skin discolorations

• Ecchymosis : “a bruise, bleeding under skin” : small, flat, hemorrhagic patch, or even fancier definition: a collection of blood greater than 1 cM in size outside the vascular tree, and within tissue.
• Petechiae : is a small red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels)
• Purpura: Spontaneous bleeding into the skin usually appears as a rash known as purpura, Petechiae is the term given to the individual small red or red-blue spots about 1 to 5mm in diameter which make up the rash. They are caused by a small local amount of bleeding within the skin. Deeper bleeding beneath the skin may be seen as bruises (ecchymoses).The difference between petechiae and abnormally prominent blood vessels can be shown by applying pressure to a red spot. If it is caused by an abnormal blood vessel the redness disappears temporarily. By contrast when pressure is applied to purpura the spots do not pale. Happens in platelet disorders, coagulation disorders.

• Erythema: “reddish skin” :Erythema is redness of the skin caused by increased blood flow to the capillaries, often a sign of inflammation or infection…

3. Evaluate skin temperature

4. Assess Turgor, skin sensation

5. Nutrition (rough, dry scaly skin, pigmented or irritated, bruising)

6. Cleanliness

7. Skin Integrity (intact or not) observe for lesions (broken skin) or ulcers.