Derm/Burns Flashcards

Question

Telangiectasia

Answer 1

-2ndary lesion -widely open (dilated) blood vessels in the outer layer of the skin EX: spider veins

Answer 2

-2ndary lesion -thickening/roughening of the skin or accentuated skin marks secondary to repeated rubbing, irritation or scratching. EX: contact derm.

Answer 3

-2ndary lesion -hypertrophied scar tissue secondary to excessive collagen formation during healing. Elevated, irregular, red; greater incidence among AA EX: ear piercing

Answer 4

-2ndary lesion -replacement connective tissue after injury EX: surgical incision

Answer 5

-2ndary lesion - abrading or wearing off the skin EX: chafing

Answer 6

-2ndary lesion -thin, dry transparent appearance of epidermis; loss of surface markings; secondary to loss of collagen and elastin; underlying vessels may be visible EX: aged skin

Answer 7

- linear - annular and arciform (circular or arcing) - zosteriform (linear along a nerve route) - grouped (cluster) - discrete (separate and distinct) - confluent (merged)

Answer 8

Port-wine stain

Answer 9

-can be a result of sun injury

Answer 10

-can be caused by a fungal infection, eczema, or vitiligo

Answer 11

anemia, shock, arterial insufficiency, albinism, vitiligo

Answer 12

hyperemia, inflammation, fever, ETOH, blushing, polycythemia, carbon monoxide poisoning, venous stasis

Answer 13

chronic heart and lung diseases, arterial desaturation, exposure to cold, anxiety

Answer 14

increased bilirubin, increased carotene, uremia

Answer 15

itching usually related to primary skin disease; essential pruritus = itching without a rash/lesion

Answer 16

Addison's, café au lait spots

Answer 17

obtains tissue for microscopic examination via scalpel or punch of nodules, plaques, blisters & other lesions to rule out malignancy and establish diagnosis

Answer 18

- direct detects autoantibodies on skin | - indirect detects specific antibodies in PT serum

Answer 19

- allergy testing - weak + = redness, fine elevations or itching - moderate + = fine blisters, papules or severe itching - strong + = blisters, pain or ulcerations

Answer 20

- fungal testing; microscopic examination

Answer 21

Test used to examine cells from blistering skin conditions (herpes, varicella, pemphigus); stained and examined under microscope

Answer 22

special lamp that produces long wave UV waves that appear dark purple. Examination takes place in a dark room where hyper/hypopigmentation is differentiated. -lesions without any melanin increase in whiteness with the light

Answer 23

- objectives of therapy are to prevent additional damage, prevent 2ndary infection, reverse inflammatory processes, and relieve symptoms - nursing care: administration of topical and systemic medications, wound care and dressings, and providing for patient hygiene - nursing care also needs to address educational, emotional, and psychosocial needs of the patient

Answer 24

- superficial infection of the skin caused by staph, strep, or multiple bacteria - bullous impetigo is more deeply seated infection caused by S-aureus & present with large bullae that rupture - Body, hands, neck, and extremities most often affected - Contageous - R/T poor hygiene, malnutrition; often follows head lice, scabies, herpes, insect bites, poison ivy or eczema - Systemic antibiotic therapy or topical antibiotic therapy prescribed - seen mostly in kids - HONEY COLORED SERUM VESICLES!!!

Answer 25

- Folliculitis is an infection of bacterial or fungal origin in hair follicles (shaving bumps) - Only tx is to avoid shaving or use lotions - Furuncles are boils in an acute inflammation deep in a hair follicle that spreads into the surrounding dermis. Often appear as a small, red, raised, painful pimple. Tenderness eventually leads to a yellow or black center with a point. - Carbuncles are abscesses of the skin and SQ tissue that represent an extension of a furuncle that has invaded several follicles and is large and deeply seated. Usually caused by staph, most commonly seen on the neck and buttocks. - Furuncles and carbuncles are most likely in PTs with systemic diseases such as those on immunosuppressive therapy or with DM.

Answer 26

- viral infection - shingles - unilateral - an infection caused by varicella-zoster viruses - painful vesicular eruption along area of distribution of sensory nerves - pain, itching, tenderness, malaise and inflammation are unilateral - common complication is postherpetic neuralgia - antiviraly such as acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir) are started within 24 hours of initial eruption. - systemic corticosteroids may be prescribed for PTs older than 50 to reduce neuralgia risk.

Answer 27

- orolabial (fever blisters / cold sores) - genital (type 2) - tingling or burning may precede vesicles by 24 hours - triggers: sunlight, stress, illness - onset may be accompanied y fever, lymphadenopathy and malaise

Answer 28

- Tinea (ringworm)

Answer 29

- athlete's foot - soak feet in vinegar and water solution - griseofulvin or terbinafine (Lamisil) daily for 3 months

Answer 30

-body; itchy clusters; infected pet may be source; topical antifungals or griseofulvin or terbinafine (Lamisil)

Answer 31

-head; common in children; oval scaling patches with papules or pustules; griseofulvin for 6 weeks; shampoo hair 2-3x with Nizoral or selenium sulfide shampoo

Answer 32

- jock itch - small red scaling patches that form circular elevated plaques; itchy; topical antifungal creams or griseofulvin or terbinafine (Lamisil)

Answer 33

- toenails; nails thicken and crumble easily; itraconazole (Sporanox) in pulses of 1 week/month for 3 months - Onychomycosis

Answer 34

- infection of the hair follicle - cause: staph aureus - Proliferates around the opening of follicle followed by distribution into the follicle - pustluse with surrounding erythema

Answer 35

- boils - inflammation of the hair follicles - may develop after folliculitis - Cause: S. aureus - deep, firm, red, painful nodule

Answer 36

- abscess-extension of furuncle | - back of neck, upper back, lateral thighs

Answer 37

- tinea thrive on keratin - superficial fungal infection - typically grow in warm, most places (shower) - typically manifests as a circular, red rash accompanied by pruritus and burning

Answer 38

- impetigo is contagious and may spread to other parts of the body or to other persons - antibiotics, hygiene, skin and lesion care - don't share towels, combs, and so on - bathe daily with antibacterial soap - furuncles, boils, or pimples should never be squeezed

Answer 39

- herpes zoster: instruction regarding prescribed antiviral medications, lesion care, dressings, and hand hygiene - herpes simplex: instruction regarding prescribed antiviral medications and prophylactic medication use, instruction regarding spread of herpes, and measures to reduce contagion of partner or of neonates born to mothers with genital herpes

Answer 40

- instruction regarding medications, use of oral and topical agents, shampoos - hygiene: use clean towels and washcloths q day - do not share hygiene items - keep skin folds and feet dry - wear clean, cry, cotton clothing, including underwear and socks; avoid synthetic underwear, tight-fitting garments, wet bathing suits, and plastic shoes - avoid excessive heat and humidity - hair loss associated with tinea capitis is temporary

Answer 41

-pediculosis (lice): pediculosis capitis, pediculosis corporis (body), pubis (genitals)

Answer 42

- itch mite - sarcoptes scabei: infestation by itch mite - substandard hygienic conditions

Answer 43

- may infest anyone and are not a sign of uncleanliness - use of shampoo (lindane - last resort (Kwell) or pyrethrin (RID)), NiX. - lindane may have toxic effects and must be used only as directed NEUROTOXIC effects- no longer 1st line - wash hot water > 130 degrees or dry clean

Answer 44

- poor hygiene and those living in close quarters - pediuclosis pubis spread chiefly by sexual contact - bath in soap and water - check for coexisting STDs

Answer 45

- mite frequently involves fingers and hands - contact may spread infection - HCW wear gloves - warm, soapy bath; allow skin to cool; and apply prescription scabicide lindane, crotamiton, or 5% permethrin (med of choice) to entire body, not including the face or scalp. Leave on for 12 to 24 hours. Wash after- repeat in 1 week.

Answer 46

- a chronic, noninfectious autoimmune inflammatory disease of the skin in which epidermal cells are produced at an abnormally rapid rate - improves and recurs; a lifelong condition - may be aggravated by stress, trauma, seasonal and hormonal changes - CM: scaly, thick. silvery, elevated lesions, usually on the scalp, elbows, or knees

Answer 47

- PT education - measures to prevent skin injury: avoid picking or scratching - prevent skin dryness: use of emollients, avoid excessive washing, use warm (not hot) water, pat dry - use of the therapeutic relationship for support and to aid coping - medications: topical, systemic, phototherapy, baths to remove scales and medications. - Biologics (Humera), topical steroids, Coal tar, medicated shampoos, phototherapy - Caution with plastics - don't smoke with plastic wrappings

Answer 48

- group of skin diseases with bullae (blisters) of various sizes, on skin & mucus membranes - types: pemphigus vulgaris, bullous pemphigoid, dermatitis herpetiformis - autoimmune-IgG mediated; blisters from antigen-antibody reaction on the skin - Jewish-Mediterranean descent - may be associated with captopril, PCN, w/ myasthenia gravis - Medical tx: high dose steroids & immunosuppressant

Answer 49

- assessment: appearance of the skin - oral lesions, painful, bleeding, large eroded areas, crusting, oozing. Sloughing and blistering of uninvolved skin w/ pressure or gentle rubbing (Nikolsky's sign) - monitor vs frequently and assess for s/s of infection - pain, pruritus, and discomfort - coping of the patient with condition - note impact of the disease on life and interactions - complications: infection/sepsis, fluid volume deficit and electrolyte imbalance

Answer 50

- oral hygiene - avoid commercial mouthwashes - keep lips moist with lip balm, petroleum or lanolin - cool mist humidified air - cool, wet dressing or baths; hygiene measures - apply powder (nonirritating-cornstarch) liberally to keep skin from adhering to sheets - monitor for and prevent hypothermia - skin care may be similar to that of the PT with extensive burns - measures to prevent 2ndary infections - encourage adequate fluid and nutritional intake

Answer 51

- infection is the leading cause of death r/t blistering disease - meticulous assessment is important - s/s of infection: local & systemic - minor changes may need to be explored b/c steroids can mask the typical s/s of infection

Answer 52

- Steven-Johnsons Syndrome - high mortality rate: fatal - rxn to medications: sulfonamides, NSAIDs, antiseizure, allopurinol - CM: conjunctival burning & itching, skin tenderness, fever, cough, sore throat, malaise, myalgia, erythema of skin & mucous membranes, bulla & epidermis sheds, erosion formation - management: discontinue causative agent, F&E balance, prevent sepsis & hypothermia, prevent ophthalmic complications, pain management, reduce anxiety, burn center - Complications: sepsis, MODS, conjunctival retraction, scars, and corneal lesions (visual impairment)

Answer 53

- Basal cell carcinoma: most common type; located in epidermis - squamous cell carcinoma: epidermal keratinocyte; prognosis depends on presence of metastasis - malignant melanoma - Kaposi sarcoma - frequently r/t sun exposure - incidence is increasing - prevention involves protection from excessive sun exposure

Answer 54

Assessment: inspect skin carefully, ask specific questions about pruritus, tenderness, pain, changes in moles, or new pigmented lesions, assess knowledge level and risk factors, assess coping and anxiety, skin cancer inspection -New pigment lesions

Answer 55

Asymmetry Irregular BORDER Variegated COLOR DIAMETER < 6mm

Answer 56

- 450,000 buns per year; 14% die (4000) - most burns occur in the home - young children and older adults are at high risk for burn injuries

Answer 57

- Prevention education - role of ETOH and cigs., water temp 120F, hair appliances. - fire extinguishers in the home - institution of lifesaving measures for the severely burned person - prevention of disability and disfigurement through early specialized and individualized care - rehabilitation through reconstructive surgery and rehabilitation programs

Answer 58

- superficial: epidermis layer only - burned tissue does not separate from the underlying dermis - Negative Nikolsky's sign: rubbed skin doesn't slough off

Answer 59

- destruction of epidermis and some dermis | - blisters quickly, often the most painful

Answer 60

- full thickness - destruction of all skin layers and SQ tissue. Pain receptors are destroyed - pain may or may not be present - severity of this burn is often deceiving to PTs because they may have no pain in the injury area

Answer 61

- full-thickness & deeper tissue - destruction of epidermis, dermis, underlying SQ tissue, tendons, muscles, and bone. - Pain absent - skin function-absent - black, charred appearance

Answer 62

-destruction of dermis only | Example: Sunburn

Answer 63

- destruction of epidermis and dermis | - pale and minimal exudate

Answer 64

-destruction of epidermis, dermis, and SQ layer

Answer 65

- how the injury occurred - causative agent - temperature of agent - duration of contact with the agent - thickness of the skin

Answer 66

total body surface area

Answer 67

- most commonly used - arm 9% - leg 18% - head 9% - anterior chest 18% - posterior chest 18% - groin 1%

Answer 68

- method for estimating TBSA of a person - takes into account age of the PT and various anatomic parts - evaluate patient initially and at 72 hours

Answer 69

- method for estimating TBSA of a person | - size of PTs hand, including the fingers is around 1% of that patient's TBSA

Answer 70

- Coagulation: no homogenous necrosis in center then viable tissue towards the periphery - Stasis: injured cells but may remain viable, still with decreased blood flow becomes necrotic in 24-48 hours - Hyperemia: minimal injury-may recover over time

Answer 71

- Burns less than 25% TBSA produce primarily a local response - Burns more than 25% may produce a LOCAL & SYSTEMIC response and are considered major burns - Systemic response includes release of cytokines and other mediators into systemic circulation - fluid shifts and shock result in tissue hypoperfusion and organ hypofunction

Answer 72

- F&E shifts - Cardiovascular effects - Pulmonary injury: upper airway, inhalation below the glottis, carbon monoxide poisoning, restrictive defects - Renal and GI alterations - Immunologic alterations - Effect on thermoregulation

Answer 73

- Emergent or resuscitative phase: onset of injury to completion of fluid resuscitation; time required to resolve the immediate life threatening problems from the burn - Acute or intermediate phase: from beginning of diuresis to wound closure; wound is covered by tissue at this time - Rehabilitation phase: from wound closure to return to optimal physical and psychosocial adjustment. Most burns have healed, reconstructive and corrective procedures (overlaps acute phase). Goal: maximal independence & function

Answer 74

- Prevent injury to rescuer - Stop injury: extinguish flames remove from the source. Irrigate chemical burns. Electrical: shut off current & separate person from source. Cool the burn, cooling of the injured area within 1 minute helps minimize the depth of damage. Do not use ice-hypothermia and vasoconstriction - ABCs: airway, breathing, circulation - Start O2 and large-bore IVs - Remove restrictive objects and cover the wound with dry clean cloth. - do assessment surveying all body systems and obtain a hx of the incident and pertinent patient history - Note: treat patient with falls and electric as for potential cervical spine injury - patient is transported to ED - ABC-in the ED - Fluid resuscitation is begun-starting point is time of injury not time of arrival - Foley catheter is inserted for I&Os. - patient with burns exceeding 20 to 25% should have an NG tube inserted and placed to suction (paralytic ileus & opioids) - Patient is stabilized and condition is continually monitored - patients with electrical burns should have ECG - address pain; only IV medication should be administered - psychosocial consideration and emotional support should be given to patient and family.

Answer 75

- impaired gas exchange: provide humidified O2, assess breath sounds, and respiratory rate, rhythm, depth, and symmetry. Monitor PT for signs of hypoxemia. Monitor arterial blood gas values, pulse O2, Carboxyhemoglobin levels, prepare to assist with intubation and escharotomies, monitor vented patient's closely. - Ineffective airway clearance - fluid volume deficit - hypothermia - acute pain - anxiety

Answer 76

-Dyspnea, striodor, O2 sats, CXR

Answer 77

- monitor decrease urine output 30-50 mL or 75-100 mL for electrical burns - Assess edema with fluid shifts, adjust fluids - Goal: 0.5 mL/kg/hr - maintain blood pressure of greater than 100 mm Hg - maintain serum sodium at near-normal levels

Answer 78

- urine output, BUN, Cr, assess urine for hemoglobin or myoglobin-predisposes PT to increased risk of kidney failure. - Give fluids to flush renal tubules

Answer 79

- pulses, compare affected with unaffected sides, elevate the extremity, take off bp cuff each time - prepare to assist with escharotomies

Answer 80

- bowel sounds - NG suction - Monitor abdominal distention

Answer 81

- monitor NG suction for blood and stools | - H2 blockers/ PPIs

Answer 82

- generalized dehydration - reduced blood volume and hemoconcentration - decreased urine output - trauma causes release of potassium into extracellular fluid: hyperkalemia - sodium traps in edema fluid and shifts into cells as potassium is released: hyponatremia - metabolic acidosis

Answer 83

- begins 48 to 72 hours after injury - continue assessment and maintain respiratory and circulatory support - prevention of infection, wound care, pain management, and nutritional support are priorities in this stage

Answer 84

- excessive fluid volume - risk for infection: hydrotherapy equipment. - imbalanced nutrition - acute pain - impaired physical mobility - ineffective coping - interrupted family processes - deficient knowledge

Answer 85

- fluid reenters the vascular space from the interstitial space - Hemodilutions: decreased hematocrit - increased urinary output - sodium is lost with diuresis and due to dilution as fluid enter vascular space: hyponatremia - potassium shifts from extracellular fluid into cells: potential hypokalemia - metabolic acidosis

Answer 86

- HF and pulmonary edema - sepsis - acute respiratory failure - visceral damage (electrical burns)

Answer 87

- rehab is begun as early as possible in the emergent phase and extends for a long period after the injury - focus is on wound healing, psychosocial support, self-image, lifestyle, and restoring maximal functional abilities so the patient can have the best quality of life, both personally and socially. - the patient may need reconstructive surgery to improve function and appearance - vocational counseling and support groups may assist the patient.

Answer 88

- burn pain has been described as one of the most severe forms of acute pain - pain accompanies care and tx such as wound cleaning and dressing changes - Types of burn pain: background or resting, procedural, breakthrough - Analgesics: IV use during emergent and acute phases, morphine, fentanyl, others. - role of anxiety in pain - effect of sleep deprivation on pain - nonpharmacologic measures

Answer 89

- burn injuries produce profound metabolic abnormalities, and patient with burns have great nutritional needs r/t stress response, hypermetabolism, and requirement for wound healing. - goal of nutritional support is to promote a state of nitrogen balance and match nutrient utilization - Nutritonal support is based on PT preborn status and % of TBSA burned - Enteral route is preferred - breathing must be assessed and patent airway established immediately during the initial minutes of emergency burn care

Answer 90

2mL x PT weight in kg x TBSA% = 24 hour total | Give 1/2 amount over 1st 8 hrs and the 2nd 1/2 of 24 hour total over next 16 hours.

Answer 91

- silvadene - most bactericidal agent - minimal penetration of eschar - leukopenia

Answer 92

- Sulfamylon - Broad spectrum - electrical burns; penetrates thick eschar

Answer 93

- bacteriostatic and fungicidal - does not penetrate eschar - monitor serum Na and K - high ability to stain

Answer 94

- broad spectrum, some yeasts and molds | - delivers a uniform, antimicrobial concentration of sliver to the burn wound

Answer 95

- bathing: maintain water and room temp | - hydrotherapy

Answer 96

- removal of dead/contaminated tissue - natural - mechanical (bedside with scalpel) - chemical (topical agents) - surgical

Answer 97

- make sure they are not impeding the circulation | - check pulses frequently

Answer 98

- premedicate the patient - inspect the area and document thoroughly - wound grafting - decreases risk of infection, prevent further loss of protein, F&E. - promotes heat loss - promotes earlier functional ability and reduces wound contractures

Answer 99

- increased capillary permeability - usually persists for 24 hours after burn injury - causes massive fluid, electrolyte, and protein loss into the interstitium from the circulating blood volume. - this leads to hypovolemic shock and edema - decreased cardiac output and contractility = impaired perfusion of vital organs - increased blood viscosity due to loss of fluid = predisposes to increased clotting - decreased perfusion of the viscera = decreased gut barrier function = translocation of bacteria and endotoxemia with sepsis

Answer 100

- tachycardia, hypercapnia, and body wasting develop - increased O2 consumption, increased glucose use, protein and fat wating - tissue hypoxia produces lactic acidosis - peaks 7-17 days post injury

Answer 101

- due to actual burn injuries or due to complications - phagocytosis is impired and cellular and humoral immunity is decreased - pneumonia, UTI - loss of 1st line of defense (skin) and loss of normal flora - inability to deliver inflammation and immune mediators to sites.