42, 43 Integumentary Flashcards
epidermis consists of which kind of epithelium, how does the epidermis receive nutrients
squamous
by diffusion from vessels in the underlying tissue
dermis (the corium),
-is thicker or thinner than the epidermis
-consists of what kind of ct
-contains (bv, n, hf, g, and n)
thicker
dense
blood vessels, nerves, hair follicles, glands, nails
-what glands secret sebum
-what are the functions
sebaceous
keep hair and skin soft, inhibit bacterial growth on surface of skin, helps prevent water loss
What happens to the skin as we age?
Reduced sebaceous gland activity causes what
These two combined reduce what kind of control and lead to which kind of problems
What decreases to turn hair color gray
Thins and becomes more transparent.
Causes dry skin that may itch
Reduce temperature control, may lead to intolerance of cold and susceptibility to heat exhaustion
Decreasing the number of melanocytes at the hair follicle
People with which shade of hair usually have skin that is oilier and less susceptible to drying and irritation
Dark hair
Severe nutritional deficiencies lead to this kind of problem in the skin
Dehydration causes loss of skin, turgor, and predisposes to what type of ulcer
Skin breakdown in the development of sores and ulcers
Pressure ulcers
Too much sun too quickly leads to b and p
Apply sunscreen how many minutes before sun exposure and reapply every how many hours
What hours are sunrays most hazardous
How many hours could it be before a sunburn becomes obvious?
Blistering and peeling
15-30
2
Between 10 AM and 2 PM
6 to 8
Risk factors for skin tears in older adults (10)
-Dry skin with dehydration
-Areas of ecchymosis
-Friction, sharing, or pressure from bed or chair
-impaired sensory perception
-impaired mobility
-taking multiple medications
-Prolonged use of corticosteroids
-Presence of renal disease, congestive heart failure, or stroke impairment
-Incorrect removal of adhesive dressing
-Rough handling will be in bathed dressed, transferred, or repositioned
The Payme-Martin Starr skin care, and international skin tear advisory panel classification system, identifying skin tears
Category, 1 through 3
Category 1- skin tear without tissue loss, edges can be realigned
Category 2- skin tear with partial tissue loss, edges cannot be realigned
Category 3- skin tear with complete tissue loss, epidermal flap is missing
Steps to care for a skin tear
-Cleanse with saline
-Allow area to air dry, or pat dry gently in carefully
-If skin tear flap has dried, remove it using scissors and sterile technique
-if flap is viable, roll back in place, use steri-strips to hold in place
Average days sutures stay in from excisional biopsy
10 days
What is a wood light
What’s it used for
Under Wood light fungal infections and erythrasma are
Special UV light
Diagnose fungal infections of scalp and chronic bacterial infection of skin folds
Fluorescent
Seborrheic keratoses common in which age group, how do they appear?
When skin of a darkly pigmented person is damaged, what might the scar tissue do, forming what
Older adults
wartlike, greasy lesions
Hypertrophy, forming a keloid
When assessing for melanoma check the ABCDs:
Asymmetric
Irregular border
Color change
Diameter change greater than 1/4”
What may be added to the rinsewater to neutralize soap of a patient with severe skin disease?
What’s the ratio?
Vinegar; 1 tablespoon of vinegar per quart of water
Instructions on open dressings
Must be changed repeatedly and never allowed to dry
Need to be re-moisten every 20 to 30 minutes with room temperature or warmer solution
A delayed allergic response involving cell mediated immunity, evident within a few hours or days after exposure to an antigen
S/S
Contact dermatitis
Erythema and swelling, pruritus an appearance of vascular lesions
Also called eczema
Complex activation process, involving mast cells, T lymphocytes, langerhans cells, monocytes, the cells that produce immunoglobulin EE, another inflammatory cells are release histamine, lymphokines and other inflammatory mediators
Seems to have a genetic, allergic association
Atopic dermatitis
Impairment in circulation, generally occurs on the legs as a result of Venus stasis in edema, and a scene in conjunction with varicosities, phlebitis, and vascular trauma
S/S erythema and pruritus occur first,
Been scaling development of petechiae, and hyperpigmentation
Stasis dermatitis
A common inflammation involving the scalp, eyebrows, eyelids, your canals, nasal labial folds, axillae, chest and back. Regions appear as scaly, white or yellow or plaques with mild pruritus
Seborrheic dermatitis
Caution, patience with pruritus to avoid what in regards to temperature & bathing
Becoming hot, bathe in tepid water, and do not puncture vesicles, pat dry skin, not rub
Are typical age of pt with acne rosacea
How is acne rosacea characterize?
Between 30 and 50 years
Erythema, papules, pustules, and telangiectases (dilation of capillaries, causing a small red or purple cluster, also known as spider veins), occurs on the face over the cheeks and bridge of nose
Isotrentinonin has been effective in controlling which kind of acne
This used to be under what name
Why was this name discontinued
Cystic acne, that has been resistant to other forms and treatment
Accutane
Black box warnings, G.I. concerns, birth defects, and increased rate of suicide
what happens to the number of elastic fibers and the adipose tissue as we age, causing what
elastic fibers decrease
adipose tissue diminishes in dermis and subcutaneous layers- causing wrinkles and sagging
severe cases of this are commonly prescribed artificial UV radiation and a coal tar product (usually at this point hospitalization is required)
psoriasis
what is PUVA therapy used for
what does it do
psoriasis, drug class psoralens that penetrates the skin with exposure to UV light type A
recommend what to pt’s with psoriasis to keep the air moist, which helps with keeping the skin moist and pliable
humidifier
what does the vaccine Zostavax boost
the immune response to the zoster virus
how do the symptoms of herpes zoster start
how many days after onset do small groups of vesicles appear on skin
fatigue and low-grade fever, possibly loss of appetite, achy or discomfort along the nerve pathway with or without erythema
3 - 5 days
why and when is Famciclovir given
2-3 days of outbreak, shortens duration of chronic pain following shingles
what precautions are recommended for pediculosis and scabies
contact
Nodular malignant melanoma is a type of what
what are the characteristics and prognosis
what to do if spotted
skin cancer
uniformly grayish black colored nodule; resembles a blackberry; may be flesh-colored with specks of pigment around base of nodule;
itching, losing, and bleeding may occur; prognosis less favorable than superficial type
contact pt’s pcp
nutritional increase in what promotes wound healing
examples
calories
protein (chicken, soybeans, tofu, nuts, beans)
zinc (beef, whole grains, dairy)
vit A, C, and E (soybeans, dark green leafy veg, nuts)
bony prominences most susceptible to skin breakdown when pt is lying prone
anterior superior iliac spine
patellae
bony prominences most susceptible to skin breakdown when pt is side-lying
ear
greater tuberosity of humerus
trochanter
head of fibula
lateral malleolus
bony prominences most susceptible to skin breakdown when pt is lying supine
scapulae
vertebrae
sacurm
calcanel
stages of pressure injury:
intact skin with a purple or maroon discoloration
tissue may be firm, boggy, painful, cool, or warm
suspected deep tissue injury
stages of pressure injury:
an area of intact skin that is reddened, deep pink, or mottled that does not blanch
stage 1
stages of pressure injury:
-partial-thickness skin loss involving the dermis and/or epidermis
-skin appears blistered or abraded or has a shallow crater
-the area surrounding the damaged skin is reddened and probably will feel hot or warmer than normal
stage 2
stages of pressure injury:
-skin is ulcerated
-crater-like ulcer
-underlying subcutaneous tissue is involved in the destructive process
-ulcer may or may not be infected
-bacterial infection is almost always present at this stage and accounts for continued erosion of the ulcer and the production of drainage
stage 3
stages of pressure injury:
-deep ulceration
-necrosis involving deeper underlying muscle and possible bone tissue
-ulcer can be dry, black, and covered with a tough accumulation of necrotic tissue, or it can be made up of wet and oozing dead cells and purulent excdates
-depth can be determined
stage 4
stages of pressure injury:
-full-thickness wounds with eschar and/or tissue that obscures depth determination
unstageable
what is the function of whirlpool baths
-mechanical debridement of eschar
-stimulate granulation tissue growth
pressure injury:
how are wound dressings selected
common wound dressing materials
-wound dressing selected according to characteristics of wound
-keeping the ulcer moist and the surrounding skin dry
-moisture-retentive dressings
-hydrogel dressing
-hydrocolloid wafers
-alginates
-biologic dressings
-absorptive dressing
pressure injury:
other treatment methods and what they do
-electrical stimulation, increases rate of healing of pressure ulcers, venous leg ulcers, and diabetic foot ulcers
-increases blood vessel growth
how to document pressure ulcers
measure and document when they are discovered and at least once a week thereafter
document characteristics of the wound and any exudate present
burns:
(evaporation from denuded areas is four times that from intact skin)
when burns are large what does the inflammatory response result in, causing what
massive shift in water, electrolytes and protein into tissues, causing severe edema
burns:
(evaporation from denuded areas is four times that from intact skin)
potassium is released from the damaged cells causing
hyperkalemia
burns:
(evaporation from denuded areas is four times that from intact skin)
stress response and potassium shifts, causing
this causes
hyponatremia
metabolic acidosis
burns:
why should rings, bracelets, and watches be removed as soon as possible
tourniquet effects when swelling occurs
when is the emergent phase of burns
24 to 48 hrs, but can last up to 3 days - starts with fluid loss and edema and ends when edema fluid is mobilized and diuresis begins
burns:
why is it important to get the details of the accident
so a more thorough assessment can be done
knowing the cause of the burn can help determine if there is any possible damage to respiratory tract
burns:
when is a tetanus toxoid injection given
in the ED, it’s the only initial IM injection given
burns:
Parkland formula for fluid resuscitation
when is this given
4mL Ringer’s lactate (RL) x % burn x weight in kg
one-half of required fluid is given within 8 hours of the time of burn
second-half given over next 16 hrs
burns:
an emergency surgical procedure involving incising through areas of burnt skin to release the eschar and its constrictive effects, restore distal circulation, and allow adequate ventilation
escharotomy
burns:
donor skin of another person
allograft
burns:
a tissue graft from a donor of a different species from the recipient
xenograft
burns:
why is it important to ambulate pt 2-3x a day as soon as the fluid shift has stabilized (if pt does not have fractures or serious injuries to feet or legs)
prevent contractures
