Chapter 41 - Disorders Of Integument

Question 1

Pressure ulcers are from

Answer 1

Unrelieved pressure, shearing forces, friction and moisture

Question 2

Decubitus ulcers

Answer 2

When pressure interrupts normal blood flow to skin and underlying tissues

Question 3

Risks for ulcer formation

Answer 3

-immobilization
-prolonged moisture exposure
-neurological disorder (spinal cord)
-malnutrition or dehydration

Question 4

Prolonged pressure =

Answer 4

Tissue reddens and will return to normal with repositioning or stimulation

Question 5

If pressure continues and blocks blood flow =

Answer 5

Hypoxia = shearing or friction and detachment of tissues = inc risk of necrosis

Question 6

Stage 1 pressure ulcer

Answer 6

Skin unbroken but inflamed, can still prevent ulcerations with repositioning

Question 7

Stage 2 pressure ulcer

Answer 7

Skin breaks open or wears away, site is tender and painful, epidermis and dermis are involved

Question 8

Stage 3 pressure ulcer

Answer 8

Below dermis, fat tissue involved

Question 9

Stage 4 pressure ulcer

Answer 9

Muscle bone ligaments or tendons visible

Question 10

TX for pressure ulcer

Answer 10

-early detection and prevention
-frequent assessment, repositioning, promoting independent movement
-special beds to prevent friction and eliminate moisture
-nutrition and hydration

Question 11

First degree burn

Answer 11

No TX needed
-some minor nausea and vomiting
-heals within 3-5 days, no scarring

Question 12

Who is vulnerable to a first degree burn

Answer 12

Young and old, experiencing dehydration

Question 13

Second degree burn: superficial partial thickness

Answer 13

Fluid filled blisters, that develop within minutes of injury
-pain sensors remain intact
-wound heals 3-4 weeks, scarring is unusual

Question 14

Second degree burn: deep partial thickness

Answer 14

Waxy white look that takes weeks to heal
-necrotic tissue may be present and will need to be surgically removed
-graph of own skin required
-hypertrophic scarring (thick and raised)

Question 15

Third degree burn

Answer 15

Full thickness causing a dry leathery appearance
-loss of derma elasticity
-required escharotomy
-Eschar
-all nerve endings destroyed

Question 16

escharotomy

Answer 16

Cutting through burned skin to release pressure and prevent compartment syndrome

Question 17

Eschar

Answer 17

Dead tissue that forms over healthy skin

Question 18

Fourth degree burn

Answer 18

Requires skin grafting or reconstructive surgery
-surgery requires rule of 9’s f

Question 19

Which burns are considered medical emergencies?

Answer 19

Three and four

Question 20

Burn rule of 9’s

Answer 20

Used to estimate percentage of body burned
-all the parts of the body are 9%, except for groin area which is 1%

Question 21

Burn shock phase

Answer 21

Combination of CV hypovelmia and cellular hypovolemia causes massive fluid loss and increased capillary permeability so fluid shifts to interstitial spaces

Question 22

Result of burn shock phase

Answer 22

Decreased blood volume, decreased cardiac output

Question 23

Integumentary and pulmonary damage will result in (burn shock phase)

Answer 23

Loss of ability to regulate water evaporation = loss of several litres of fluid due to evaporation each day

Question 24

Ebb phase

Answer 24

Blood is shunted away from liver, kidney and gut in the first 24 hours
-after that, there begins resortation of capillary integrity, and edema begins to resolve (end of burn shock phase)

Question 25

Flow phase

Answer 25

State of hyper metabolic response = inc catchecholamines, cortisol, glucagon
-hyperglycaemia with inc insulin resistance and muscle loss
-can last up to two years

Question 26

Goal of TX for burns

Answer 26

Fluid resuscitation and nutrition

Question 27

The first ___ hours in a burn injury is critical

Answer 27

24

Question 28

TX for burns

Answer 28

-IV to restore fluids (monitor to prevent fluid overload)
-parkland formula
-ringers lactate

Question 29

Parkland formula

Answer 29

4mL of ringers lactate per kilogram of body weight per %TBA burned
-one half to be given during first 8 hours after injury and rest in next 16 hours = volume required in 24 hour period

Question 30

Ringers lactate

Answer 30

IV fluid for dehydration, having surgery or reciting IV medications

Question 31

Frostnip

Answer 31

Superficial frostbite, pain inc during tissue rewarding

Question 32

Chillblains

Answer 32

Partial thickness frostbite
-purple tone
-can develop vasculitis (inflammation of bv)

Question 33

Frostbite

Answer 33

Tissues freeze
-ice crystals form
-whiteness of tissue
-numbness with no pain
-potentially reversible

Question 34

Flash freeze

Answer 34

Rapid formation of ice crystals, associated with contact with cold metals or volatile liquids