Cyndi - Week 14 - Exam 7 Flashcards
what is important to do for skin protection?
Use sunscreen, lip balm, protective clothing from birth to death for skin
protection
where should you assess a dark person’s skin? what is a characteristic of those with light skin?
In darker skin people, assess oral membranes, conjunctiva, palms and soles
***those with light skin are more likely to have skin problems
how do medications affect skin?
Medications can potentiate sun sensitivity and skin changes
what are the characteristics of an older person’s skin?
Older persons have dry skin, with increased fragility
• Sagging
• Slower to show turgor
• Easier to bruise or tear
what are the risk factors for skin cancer?
- Fair skin
- Sun exposure
- Radiation exposure
- Family history
what are the three types of skin cancer?
- basal cell carcinoma
- squamous cell carcinoma
- malignant melanoma
what are the characteristics of basal cell carcinoma?
- small, waxy
what are the characteristics of squamous cell carcinoma?
- rough, thick
what are the characteristics of malignant melanoma?
- tumor arising in melanocytes
- ABCDE
what does ABCDE stand for?
- asymmetry
- border (uneven)
- color (multiple)
- diameter ( >1/4 inch)
- evolving (change in size, shape, and color)
what is malignant melanoma?
neoplastic growth of melanocytes
- radical growth
- vertical growth
where does malignant melanoma metastasize to?
- lymph, heart, brain, lung, liver, or organ
what are the characteristics of malignant melanoma?
- existing nevi/mole - larger > 5 mm diameter, “blue nevi”
- often dark brown or black
- most lethal of skin cancer
what are the locations of melanoma occurrences?
- skin (90%)
- eyes
- remote internal site
- unknown
- mucous membranes
what are the diagnostic tests and treatments for skin cancer?
- skin biopsies
- lymph biopsy - remove enlarged lymph node
- lactate dehydroogenase (LDH) - inc with malignancy
- CT or MRI to r/o mets
what are the different types of skin biopsies?
- Shave biopsy-shaves off the top layers
- Punch biopsy-tiny round cookie cutter deep sample
- Incisional biopsy – removes full thickness
- Excisional biopsy -removes entire tumor
what are the post procedure education for diagnostic tests/tx?
- Surgical excision
- Signs and symptoms of infection
- Pain management
what are the mechanism of injury for burns?
•Thermal (heat) - Smoke Inhalation - Cold (Frostbite) •Chemical •Electricity •Radiation
what is the severity determination of burns?
• Burn Depth - Superficial to full-thickness skin depth • Extent - percent of total body surface area burned (TBSA) • Location of burn • Risk of inhalation compromise • Patient factors
what are the three types of burn depth?
- superficial, deep, full-thickness
what is a superficial thickness burn? 1st degree burn
- Epidermis and small portion of dermis involved
- Red, swollen, painful, possible blisters
- Capillary refill, hair follicles mostly intact
what is a deep partial thickness (2nd degree)?
- Injury extends to deeper dermal area
* Blisters, severe pain, mild to moderate edema
what is a full thickness (3rd/4th degree)?
- 3rd - fat, muscle & tendon
- 4th - bone & nerves
- Necrotic tissue forms – healing dry, waxy, leathery
- Loss of sensation
what is total body surface area (TBSA)?
Total body surface area (TBSA) of burn used
to calculate patient’s fluid needs and extent of
injury
what are the characteristics of TBSA calculation?
•TBSA calculation - takes age into account
• Rule of nines chart
• Lund-Browder chart
• Superficial partial-thickness not represented
• Tracks only deep partial-thickness and full thickness
injury
It’s important to suspect smoke inhalation injury wherever there is: ???
- Indoor smoke or fire exposure, or entrapment
- Carbon stain or singed hair on face or neck
- Hoarse voice or dark sputum
- Carbon monoxide poisoning
- Clues for suspicion of injury
- Damage to the respiratory tract from heat or chemicals
- Injury above glottis
- Injury below glottis
T/F: Control airway proactively as swelling may prevent intubation later
TRUE
what is the basic lab tests for burns?
- CBC
- Lytes
- CPK
- UA
- ABG
- Carboxyhemoglobin level if indicated
what are the different location of burns?
Hands, feet, face, eyes, ears, joints or perineum, circumferential burns
what are the localized zones of injury?
- Zone of coagulation
- Zone of stasis
- Zone of hyperemia
what are the systemic response of burns?
- Stress response
- Fluid loss
- Hypermetabolic state
- Systemic effects of burns – pulmonary, GI, kidney, immunity systems`
what is the Parkfield Formula?
volume of LR = 4 mL x % BSA x weight (kg)
**1/2 first 8 hrs then 1/2 next 16 hours
what are the phases of burn management?
- emergent phase
- acute phase
- rehabilitation phase
what is the emergent phase?
- until immediate life threatening issues
resolved - up to 72 hours
•Prehospital phase – rescue and transport
•Hospital – emergent care – may be transferred to burn center
what is the acute phase?
- from mobilization of extracellular fluid to wound
stability
what is rehabilitation phase?
recovery
what are the characteristics of the emergent phase?
Onset of injury until fluid resuscitation complete
• ↑ capillary permeability = intravascular volume depletion
•Insensible fluid loss – skin and respiratory
•Electrolyte shifts
• Na+ out of blood - into interstitium and cell
• K+ out of cell - into interstitium and blood
•Inflammation response
•Immune dysfunction
•Chemical burn – flush area with water for 20 min
•Electrical burn – may have other trauma
•Radiation – contain contamination
what does the patient look like in the emergent phase?
•Shock From Pain And Hypovolemia •There may be other injuries and trauma as well •Blisters •Bowel Ileus •Shivering •Frightened •Altered Mental Status ***opioid analgesic before any intervention
what is the treatment of the emergent phase?
- Airway management – watch closely and intubate early
- Fluid resuscitation – Parkland Formula – accurate hourly I&O (F catheter)
- Wound care - decrease infection risk
- Dressing changes, premedicate with pain meds, debridement as needed
- ROM to preserve function of joints
- Medications
- Nutrition
what are the meds given in the emergent phase?
- Treat pain with analgesics (IV, PCA)
- Administer tetanus booster if indicated
- Give antimicrobials
- Administer DVT and ulcer prophylaxis
what are the characteristics of the acute phase?
Begins when extracellular fluid begins to shift back to
normal compartments (48-72 hrs) until wound healed
•Diuresis of extra fluid – continued strict I&O
•Patient more aware, has anxiety, needs emotional support
**Most common cause of death after 72 hours is infection
what is the tx for acute phase?
- Nutritional needs - increased protein, calories, and vitamins
- Bowel sounds return - enteral feeding will keep GI tract healthy
- Dressing changes - strict surgical aseptic technique
- Pain control plan
- Usually not ATBs unless infection or surgery
what are the characteristics of burn wound care?
- early and continuous
• Dressing changes –
• Topical antimicrobial agents
• Silvadene, Acticoat antimicrobial barrier dressing
what kinds of surgeries can burn victims get?
- Escharotomy – fasciotomy
- Grafting – donor and graft sites
- Debridement
- Hydrotherapy
- The skin gun
how can you prevent complications?
Prevent complications! Assess for erythema, odor, and green or yellow exudate •Electrolyte imbalances •Infection •Cardiovascular •Respiratory •Neurologic •Musculoskeletal •Gastrointestinal •Endocrine
what are the characteristics of the rehabilitation phase?
Begins when acute care needs are met
• Goal to return the patient to productive life
• Mobility limitations: positioning, skin care, exercise, ADLs, ambulatio
what is the patient education for the rehabilitation phase?
- Wound care and dressings
- Signs and symptoms of complications
- Exercises
- Clothing and ADLs
- Social skills
