Care of the Patient with Skin Problems (exam 1) Flashcards
What type of medical history can lead to xerosis (dry skin)?
- liver diseases
- kidney diseases
- autoimmune diseases
What are some suggestions to prevent xerosis?
- adequate hydration
- fewer hot showers
- moisturizer
- mild soaps
- humidifier in winter time
__ is dry skin and __ is itchy skin.
xerosis, pruritis
What are the phases of wound healing?
- inflammatory phase (3-5 days)
- proliferative phase ( day 4- 1-4wks)
- maturation phase (3wks- year or more)
Which phase of wound healing begins at time of injury or cell death and lasts 3-5 days?
inflammatory
What happens during the inflammatory phase?
- immediate response is vasoconstriction and clot formation
- after 10 mins vasodilation occurs with increased capillary permeability and leakage of plasma and plasma proteins into surrounding tissue
- WBCs mirgate into the wound (especially macrophages)
- clinical manifestations of local edema, pain, erythema and warmth
What happen during proliferative phase?
- fibrin strands form a scaffold or framework
- mitotic fibroblast cells migrate into the wound and stimulate the secretion of collagen
- collagen, together with ground substance build tough and inflexible scar tissue
- capillaries in areas surrounding the wound form buds that grow into new blood vessels
- capillary buds and collagen deposits from the granulation tissue in the wound and the wound contracts
- epithelial cells grow over the granulation tissue bed
What happens during maturation phase?
- collagen is reorganized to provide greater tensile strength
- scar tissue gradually becomes thinner and paler in color
- the mature scar is firm and inelastic when palpated
Which process of wound healing is an aseptically made wound with minimal tissue destruction and minimal tissue reaction, approximated by close sutures or staples, no open areas for infection?
first intention
Which process of wound healing is an infected or chronic wound or one with tissue damage so extensive that the edges cannot be smoothly approximated, usually left open and allowed to heal from the inside out, healing is prolonged, cavity like defect
second intention (granulation and contraction)
Which process of wound healing is a potential infected surgical wound, may be left open for several days, if no sign of infection wound is then closed surgically, deep, delayed primary closure?
third intention (delayed closure)
What are the mechanisms of wound healing?
- partial thickness wounds (re-epithelialization)
2. full thickness wounds (granulation and contraction)
In what phase of wound healing does re-epithelialization occur?
proliferative
Full thickness wounds would typically require ___ for closure.
skin grafts
What are some barriers to wound healing?
- diabetes
- vasculitis
- crush injuries
- thrombosis
- aspirin
- corticosteroids
- necrotic tissue
- wound infection
- aging
- heart failure, hypovolemia, pulmonary insufficiency
- cyotoxic drugs
- nutritional deficiencies (protein, vitamins, minerals, water)
Stages of pressure ulcers
stage 1= skin not broken
stage 2= skin loss of epidermis or dermis (partial thickness)
stage 3= tissue exposed (full thickness)
stage 4= bone, muscle or tendon exposed (full thickness)
unstageable= eschar that covers bottom so that we can’t judge depth (full thickness)
What tool is used to assess for pressure ulcers?
Braden score
15-16= mild risk
12-14= moderate risk
11= severe risk
What are some ways to prevent pressure ulcers?
- turn schedule
- collaborate with wound care
- ambulate patient
- keep dry
- heels off of bed
___ is a lifelong scaling disorder with underlying dermal inflammation.
psoriasis (cells shed every 4 to5 days)
What is the clinical presentation of psoriasis?
plaque like with sliver cover
What are the risk factors for psoriasis?
- infection
- skin trauma, recent surgery
- genetics
- stress
- seasons
- hormones (puberty or menopause)
- medications (beta blockers, lithium, antimalarials, indocin)
What are the 3 types of psoriasis?
- psoriasis vulgaris (plaque like lesions) most common
- exfoliative psoriasis ( eruptive and inflammatory)
- Palmoplantar pustulosis PPP (pustules on palms of hands and soles of feet, not sliver in appearance)
What corticosteroids are used for psoriasis?
- Triamcinolone acetonide (observe for thinning skin, striae or hypo-pigmentation, avoid on skin or in skin folds, take periodic med vacations
What are Tar preparations used for psoriasis.
messy, smelly (apply at night, cover with old pjs, glovesor socks), not commonly used, used in conjunction with UVB (take off med first)
Other med used for psoriasis
- anthralin (topical, no more than 2 hr duration, used in conjunction with UVB but take off first
- calcipotriene (synthetic form of vitamin D, not for older adults or breastfeeding moms, monitor for hypercalcemia- muscle weakness, fatigue and anorexia
- tazarotene (derivative of vitamin A, teratogenic
Psoriasis medications are trying to suppress _____
cell division
Which meds burn?
calcipotiene and tazarotene
What is PUV therapy?
photosensitizing med + UV light (psoralen- 2 hrs before) used for severe cases
___ ___ is a chronic inflammation and scaling of scalp, face, underarms and chest.
seborrheic dermatitis
Risk factors for seborrheci dermatitis…
- genetics
- stress
- hormones
What is the treatment for seborrheic dermatitis?
- topical corticosteriods
2. antiseborrheic shampoo (selenim sulfide, sulfur, salicylic acid)
What are the 4 types of skin cancer?
- actinic keratoses
- squamous cell carcinomas
- basal cell carcinomas
- melanomas
Skin cancer: scaly commonly called pre-cancerous
actinic keratoses
Skin cancer: rough, scaly lesions with central ulceration and crusting
squamous cell carcinomas
Skin cancer: small, waxy nodule with superficial blood vessels, well defined borders
basal cell carcinomas
Skin cancer: new mole or change in existing mole
melanomas
What can look like skin cancer but is not?
seborrheic keratosis
How do we assess possible skin cancer?
using ABCDE
What are some risk factors for skin cancer?
- sun damage
- lighter skin
- age
- high altitudes
- lower altitudes
- exposure to arsenic (farm)
- family history
Skin Cancer: What is TSSE?
Thorough Self Skin Examination ***teach clients to do this regularly
Skin Cancer: What are ways we can treat with surgery?
- Cryosurgery
- Curettage (remove part) 3. Excision, biopsy for small lesions
- Moh’s Surgery (horizontal thin layers removed)
- Wide Excision (needs sutures)
Drug therapy of skin cancer…
topical or systemic chemotherapy
Skin Infections fall under three categories. What are they?
- Bacterial
- Viral
- Fungal
What are the 4 types of Bacterial Infections we talked about?
- Folliculitis
- Furuncles
- Cellulitis
- MRSA
Skin Infections: What are the Viral Skin Infections we mentioned?
- Herpes Simplex, Type 1 (oral), Type 2 (genital)
2. Herpes Zoster (chicken pox, shingles)
Skin Infections: What are the Fungal Infections we talked about?
- Tinea Pedis (athlete;s foot)
- Tinea Cruris (jock itch)
- Tinea Capitis (ringworm)
- Tinea Corporis (ringworm)
- Candida Albacans (yeast infection)
What should we monitor with Candida Albacans (yeast infection)?
skin folds (yeast like dark, moist places)
Acute Skin Disorders: Which two did we mention? (lst action is to stop drug)
- Toxic Epidermal Necrolysis (TEN)
2. Stevens-Johnson Syndrome
What is TEN?
Toxic Epidermal Necrolysis - rare drug reaction - diffuse, large blister formation
What is Stevens Johnson Syndrome?
drug reaction, similar to TEN mix of vesicles, erosions, and crusts can be mild or severe ***PHENYTOIN (dilantin) can cause
What is the major risk factor with Cutaneous Anthrax?
contact with an infected animal
What is the clinical presentation of Cutaneous Antrax
- Raised vesicle on arms or legs
2. Center of vesicle sinks and becomes hemorrhagic 3. Necrosis and ulceration forms
How would Cutaneous Anthrax be diagnosed?
- Appearance
- Culture of site
- Anthrax antibodies in blood
What is typical treatment for Cutaneous Anthrax?
Oral Antibiotics for 60 DAYS!!! - Ciprofloxacin - Doxycycline
