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Gerontological RN exam > Chapter 19 Disorders Of The Integumentary Systemi > Flashcards

Chapter 19 Disorders Of The Integumentary Systemi Flashcards

0
Q

The three most common inflammatory skin problems of older adults are?

A

Seborrheic dermatitis, intertrigo, Psoriasis.

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1
Q

Name three common benign skin lesions of older adults.

A

Cherry angioma: 1 to 5 mm red or deep purple dome shaped lesions that usually occur on the trunk
Seborrheic Keratosis: Scaly brownish black lesions that have a stuck on appearance, Appear on sun exposed areas.
Acrochordon: Skin tags that usually occur on the neck eczema breasts and growing

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2
Q

Some treatments for seborrheic Dermatitis?

A

Shampoo with ketoconazole, Hot oil treatments with peanut oil, Low to moderate potency hydrocortisone ointment, T-cell modulators such as pimecrolimus.

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3
Q

Treatment for intertrigo (a dermatitis that results from friction of skin surfaces).

A

Weight loss, keeping the skin clean and dry, topical antifungal’s, in rare cases, topical hydrocortisone

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4
Q

Treatment for psoriasis is?

A

Topical steroids or coal tar preparations
Topical vitamin D3 for moderate cases
Topical retinoids For more severe cases
Ultraviolet a light therapy plus oral or topical psoralen

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5
Q

This is a chronic inflammatory dermatitis. affected individuals often will have a history of atopy. This is characterized by dry, pruritic skin. Dermatologist often refer to this disorder of the skin as the itch that rashes because of the intense itching.

A

Eczema

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6
Q

What are the patients who classically present with eczema?

A

Men with a history of dry skin. Patients will have coin shaped lesions.

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7
Q

Treatment for eczema includes?

A

Avoidance of irritants and use of emollients, and low to medium potency topical steroids.

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8
Q

Nursing assessment and intervention for eczema.

A

Be alert for bacterial and fungal supra infection in these patients
Education about the chronic nature of this disease
The importance of preventing excessive dryness of skin

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9
Q

This is an eruption caused by reactivation of latent varicella virus in the dorsal root ganglia. The virus remains in the dorsal root ganglia after an earlier episode of chickenpox.

A

Herpes zoster

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10
Q

Varicella virus a.k.a. herpes zoster recurs because of depression of immune response. Causes of this immunosuppression that can lead to shingles includes?

A

Age, stress, fatigue, radiation, HIV/AIDS, any malignancy, chemotherapy, and steroids.

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11
Q

Herpes zoster is not infectious except in individuals?

A

Individuals age 6 months or older who have not had chickenpox or the vaccine for chickenpox. Until age 6 months, infants have maternal antibodies to protect them.

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12
Q

Shingles most commonly occurs on what part of the body?

A

The thorax, however, it can be seen in the cervical and lumbar areas or in the ophthalmologic areas. Herpes zoster in the ophthalmologic branch of the trigeminal nerve is a true medical emergency as these individuals can develop blindness

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13
Q

What are symptoms of the prodrome prior to an eruption of herpes zoster?

A

Patients will have pain, burning, paresthesias, and itching along the affected dermatome. 3-5 Days later patients will have an eruption of the vesicles. These lesions will follow one to two dermatomes and they will not cross the midline.

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14
Q

The average case of shingles last how many weeks?

A

Three weeks.

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15
Q

Complications of shingles includes?

A

Bacterial superinfection and postherpetic neuralgia, which consists of chronic, lancinating pain and persists after the lesions of cleared.

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16
Q

What should shingles be treated with?

A

The virus should be treated with antivirals within 72 hours of the rashes appearance in an attempt to decrease the incidence of PHN.

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17
Q

One of the most effective topical agents for the pain of shingles is?

A

Domeboro soaks

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18
Q

This vaccine reduces the occurrence of both the shingles and PHN, and should be administered to all older adults except those who have a weekend in immune system Even if they have had shingles in the past.

A

Zostavax

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19
Q

This skin condition is caused by a might that burrows under the skin and causes inflammation and severe itching. In older adults the presentation often is muted; patients will experience a chronic mild itching of the hands, wrists, and genitalia.

A

Scabies

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20
Q

The incubation period for scabies is?

A

4 to 6 weeks. Diagnosis is confirmed by skin scraping.

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21
Q

Treatment for scabies is?

A

Local application of 5% permethrin cream to the entire body at bedtime. The following morning, all bed linens and bedclothes must be washed in hot water to eradicate the mite.

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22
Q

This premalignant lesion is commonly seen in fair complexion people and they occur because of exposure to the sun. They begin in vascular areas as a reddish macules or papules with a rough, yellowish-brown scale.

A

Actinic keratosis

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23
Q

The concern for premalignant lesions such as AK is that they may progress to what?

A

Squama cell cancer.

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24
Q

The most common cancerous lesion found in older adults is?

A

Basal cell cancer

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25
Q

This lesion most commonly seen in fair skinned, blonde, or redheaded individuals who have had marked sun exposure. This cancer commonly occurs on the face and scalp and areas of scarring or chronic irritation.

A

Basal cell cancer

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26
Q

Characteristics of basal cell cancer?

A

These lesions do not metastasize for the most part and are slow growing. They usually appear as pearly papules with depressed centers, But on occasion can have a different appearance.

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27
Q

How are basal cell cancer lesions removed?

A

Cryotherapy if they are small or incision.

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28
Q

This is the second most common skin cancer in older adults. This cancer arises from the epidermis. Lesions are commonly found on the scalp, helix and pinna of the ears, dorsum of the hands and lower lip. This cancer can develop in chronic leg ulcers. Approximately 20% of this type of cancer will metastasize

A

Squamous cell carcinoma

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29
Q

What is the appearance of squamous cell carcinoma?

A

This lesion usually has an ulcerated or crusted Center. On occasion these lesions look like a common wart or skin tag, the base maybe inflamed, Reddened, or bleeding, or it may appear as a totally benign growth.

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30
Q

This type of skin cancer originates from the pigment forming cells, the melanocyte. These lesions, which are capable of metastasizing at an early age, are becoming more common throughout United States because of the use of tanning booth and recreational sun exposure.

A

Malignant melanoma

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31
Q

What is the typical demographic of a person who develops malignant melanoma?

A

It occurs in fair skinned individuals who have a tendency to sunburn. In addition people with red or blonde hair who have multiple moles, and those with a tendency to freckle are thought to be at high risk.

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32
Q

What is the physical appearance of a malignant melanoma?

A

Appears as an irregularly shaped mole, papule, or plaque that has recently appeared or changed in color or size.

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33
Q

What is the ABCD’s of skin assessment created by the American Cancer Society?

A

Asymmetry
Border irregularity
Color variation: red, white, blue, gray.
Diameter greater than 6 mm

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34
Q

As a melanoma advances it may begin to what?

A

Itch or bleed

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35
Q

Melanoma prognosis is determined by what?

A

By how much vertical growth has occurred.

36
Q

How are melanomas treated?

A

Melanomas are treated with wide and deep excisions in hope of getting skin margins that are free of tumor

37
Q

Will Medicare reimburse for hospital acquired pressure ulcers?

A

No, pressure ulcers present on admission will qualify for reimbursement but not hospital acquired pressure ulcers.

38
Q

What must be documented if a patient comes in with a pressure ulcer?

A

The presence of a pressure ulcer on admission must be identified, coded, and noted in the chart, with documentation by the admitting physician.

39
Q

This is the sliding of parallel surfaces that will cause stretching and occlusion of the arterial supply of fascia and muscle.

A

Shearing

40
Q

This is the rubbing of the skin against another surface and can cause a superficial abrasion of the epidermis and dermis.

A

Friction

41
Q

These are thought to be major contributors to pressure ulcer formation.

A

Friction and shearing

42
Q

Patients who have a serum albumin of less than what are at increased risk of ulcer development and poor wound healing?

A

<3.5g/dL

43
Q

What physiologic changes put an older adult at higher risk for ulcer development?

A

Thin dermis with less elasticity. Age causes vessel the degeneration and reduced blood flow to the skin appendages. Healing is slowed with normal aging, as is the immune response.

44
Q

What is the most important factor in wound healing and prevention?

A

Adequate oxygenation, whether in the form of pressure reduction or elevation of blood pressure. Also, make sure the patient is properly hydrated.

45
Q

Patients who are at risk for pressure ulcers include?

A

Immobile, protein calorie malnourished, incontinent, frail, disabled, nutritionally compromised, mentally compromised.

46
Q

This scale is used to assess the risk of skin integrity issues.

A

Braden scale

47
Q

What score on the Braden scale indicates the patient is at risk for skin breakdown?

A

15 to 18

48
Q

What score on the Braden scale indicates a patient is at moderate risk for skin integrity problems?

A

13 to 14

49
Q

This score on the Braden scale indicates the patient is at high risk

A

10 to 12 indicate high risk and less than 9 indicate very high risk

50
Q

Should a nurse massage over bony areas that are reddened on their patients?

A

No, as the action may worsen the damage. Turning patients every two hours or more frequently is mandatory. Patient should be turned at a 30° oblique angle, and a pillow should be put under the calves to keep the heels and feed off the bed.

51
Q

A group one device is used for what level of risk for pressure ulcer development

A

It is used for patients were at low risk for pressure ulcer development. They are static devices and include air, foam, Gel, and water overlays or mattresses.

52
Q

What are group 2 devices and what level of risk for pressure ulcers are they used on?

A

Group 2 devices are for patients were moderate high risk for pressure ulcers or have full thickness pressure ulcers. These devices are powered by electricity or a pump.

53
Q

Group 3 devices are used for what risk for pressure ulcer and what type of devices are they?

A

Group 3 devices also dynamic, our air fluidized beds. These beds are electric and contain silicone coated beads. When Air is pumped through the bed the beads become liquid. These beds are used for patients at very high risk for pressure ulcers

54
Q

Other interventions to prevent ulcer formation include?

A

Avoid sharing friction, monitor nutritional status, ensure adequate hydration.

55
Q

Patients should be weighed how often and at what percentage loss of their ideal body weight should interventions be taken?

A

Patients should be weighed monthly, as weight changes slowly in most individuals. Intervention should be taken for patients who lose 5 to 10% of their ideal body weight. If the patient loses one third of their ideal body weight the healthcare team should view this as an ominous sign.

56
Q

What are the three major stages of wound healing?

A

Inflammation, proliferation, and maturation

57
Q

In this stage of wound healing the wound is red, warm, and painful. This inflammation stabilizes the wound through platelet activity that stops bleeding. The immune systems heavily involved, sending neutrophils, macrophages and monocytes to the site to control bacteria and cleanup debris’s. The stage Lasts 4 to 5 days

A

The inflammatory stage

58
Q

This stage of wound healing begins within 24 hours of injury and can last up to three weeks. During this time three important processes occur: epithelialization, neovascularization or granulation, and collagen synthesis.

A

The proliferative stage or granulation stage

59
Q

Can a wound that is covered in eschar be staged?

A

No, Wounds cannot be staged when they are covered with eschar

60
Q

Basic principles of pressure ulcer management include?

A

Eliminate or minimize pressure, friction, and sharing.
Monitor and optimize nutrition.
Create and maintain a clean, moist woundbed.
Ensure adequate circulation and oxygenation.

61
Q

A non-blanchable area on the skin is an example of what stage of pressure ulcer?

A

Stage one

62
Q

This stage of a pressure ulcer includes an abrasion, blister, or shallow crater. It is an extension through the epidermis.

A

Stage two

63
Q

This stage of a pressure ulcer is a full thickness one involving subcutaneous tissue. An example would be a deep crater with or without undermining

A

Stage III

64
Q

This stage of pressure ulcer is a full thickness wound with extension into muscle, bone, or supporting structures. It is a deep wound and usually involves undermining and sinus tracts.

A

Stage 4

65
Q

In this stage of the wound the bases are covered with slough and or eschar.

A

Unstageable

66
Q

This wound can be purple or maroon discolored intact skin or a blood-filled blister. Surrounding skin is painful, firm, mushy, boggy, warmer, or cooler compared to adjacent tissue.

A

Suspected deep tissue injury or unstageable

67
Q

Wounds that are not infected should be cleansed with what?

A

Normal saline. Other topical therapies should only be used when wound beds are infected, because they kill healthy granulation tissue’s.

68
Q

Antiseptic solutions To clean infected wounds such as Betadine, acetic acid, hydrogen peroxide, or sodium hypochlorite (dakins) should be discontinued when?

A

When the exudates or signs of infection have abated

69
Q

Some nursing considerations when using Providone iodine on wounds.

A

It can be used short-term if diluted, limit to 3 to 5 days. Never use on healthy granulating tissues.

70
Q

Some nursing considerations for the use of acetic acid with wounds.

A

Can be used on wounds infected with Pseudomonas. Suitable for use for wounds with a malodorous, green drainage.

71
Q

Some considerations for the use of hydrogen peroxide as a wound antiseptic

A

Provides debridement. Do not use in a sinus tract or deep crater.

72
Q

Nursing considerations for the use of Dakin solution or sodium hypochlorite.

A

Can be used for fungal type pathogens. Ideally, solution should be diluted, as it is essentially bleach. Can affect clotting abilities and burn intact skin.

73
Q

This Wound bed description indicates healthy granulation.

A

Beefy red color

74
Q

Exudates and necrotic tissue can interfere with the process of wound healing. This is done to remove necrotic material. In addition dry hard eschar should be removed.

A

Debridement

75
Q

Both necrotic material and eschar delay the healing process and slows the migration of epithelial cells. Debridement is recommended for both with the exception of?

A

Eschar on the heels. Eschar in this location should be left in place as long as it is dry, because it provides a protective shield for the heel. If it becomes soft or mushy it should be removed, because that suggests the fluid has accumulated beneath the eschar.

76
Q

What are the 4 modes of debridement for wounds?

A

Mechanical, autolytic, chemical, and surgical.

77
Q

Mechanical wound debridement is usually carried out in what fashion?

A

Wet to dry dressings or whirlpool.

78
Q

What is autolytic debridement?

A

Hydrocolloid or hydrogel dressings are used to soften it help remove exudate. Uses the bodies own enzymes to provide debridement and cleansing. Cannot be used with infected wounds.

79
Q

What is chemical debridement of wounds?

A

The use of chemicals to remove necrotic areas or tender yellow slough that is difficult to remove surgically. It is used on small wounds.

80
Q

Some general guidelines to remember with evaluating and treating pressure ulcers include?

A

Gently irrigate all wounds with a 1 to 2 ounces of normal saline at each dressing change.
Evaluate the one border for candidiasis with each dressing change.

81
Q

This type of dressing product is useful for debriding and cleaning the wound bed. If one has tumbling or undermining the cavity can be loosely packed with this moistened.

A

Gauze dressing

82
Q

This type of dressing protects the wound bed by leaving the epithelial cells undisturbed. It is used for skin tears skin grafts, or other wounds that require minimum intervention. Topical antibiotics can be used beneath these dressings, which are changed once or twice a day.

A

Nonadherent dressings.

83
Q

This type of absorbent dressing protects ulcers and minimizes maceration. It is useful for wounds with excess drainage or exudates. It can be used under films or other primary dressings. Topicals can be applied beneath it.

A

Foam dressings

84
Q

This type of wound care product facilitates auto lysis. Dressings are semipermeable to allow air exchange. It is used on superficial wounds. Can be used to secure other dressings and protect the vulnerable areas from friction. Usually left on for 3 to 7 days. Can cause fluid buildup beneath dressing.

A

Transparent films such as opsite or Tegaderm

85
Q

This type of wound care product and be used on stage two and stage III wounds. Their sticky non-permeable wafers that contain Hydrocolloid material that melts and combines with natural body fluids to keep the wound bed moist. Usually left on for 3 to 7 days.

A

Hydrocolloids

86
Q

This type of dressing can be used on superficial or deep wounds, as the product can be obtained in sheet or gel that can be spread into deep cavities. Consist primarily of water, help maintain a moist one bed and facilitates healing. Can be left in place for 1 to 7 days. Should not be used on infected wounds. Requires a cover dressing.

A

Hydrogel’s

87
Q

This wound care product is used to manage wounds with exudate. It is made of seaweed, products soak up drainage. It can be used on infected wounds. It is helpful around drainage tubes and wounds that are macerating healthy surrounding tissues.

A

Alginates

88
Q

What should be considered for large or nonhealing wounds?

A

Electrical stimulation, vacuum drains, surgical debridement, and possible skin grafting.

Gerontological RN exam (15 decks)

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