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Adult health II final > Exam 1: Skin assessment/problems and Burns > Flashcards

Exam 1: Skin assessment/problems and Burns Flashcards

1
Q

Risk factors for pressure ulcers

A

Use the Braden Scale

  • Sensory perception
  • Moisture
  • Activity
  • Mobility
  • Nutrition
  • Friction and shear
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2
Q

Care for pressure ulcers

A
  • Pressure relief devices
  • Turning the patient
  • Skin care
  • Skin cleaning
  • Nutrition (fluid, protein and calories
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3
Q

Skin Cancer Assessment: Actinic keratoses

A

Scaly, commonly called pre-cancerous

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4
Q

Skin Cancer Assessment: Squamous cell carcinomas

A

Rough, scaly lesion with central ulceration and crusting

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5
Q

Skin Cancer Assessment: Basal cell carcinomas

A

Small, waxy nodule with superficial blood vessels, well defined borders

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6
Q

Skin Cancer Assessment: Melanomas

A

New mole or change in existing mole

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7
Q

Skin Cancer Patient Education

A

Risk factors

  • Sun damage
  • Lighter skin
  • Age
  • High altitudes
  • Exposure to arsenic
  • Severe skin injury
  • Immunosuppression therapy
  • Chronic skin irritation/scars/burns
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8
Q

Skin Cancer Secondary prevention (ABCDE guide for melanoma)

A
  • Asymmetry
  • Border
  • Color variation
  • Diameter > 6 mm
  • Evolving, changing
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9
Q

Superficial Burns

A
  • Epidermis
  • Severe erythema
  • Blanches
  • Red, pink, dry
  • No Blister
  • Painful but decreases with cooling
  • Hyperesthetic (higher sensation)
  • Tingling

Examples: Sunburns and Minor steam burns

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10
Q

Superficial Partial Thickness Burns

A
  • Large, thick walled blister
  • Cherry red, edema
  • Mottled red base
  • Broken epidermis
  • Wet shiny, weeping
  • Blistered
  • Painful
  • Sensitive to cool and air

Examples: Brief contact with flames, hot liquids, exposure to dilute chemicals

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11
Q

Deep Partial Thickness Burns

A
  • No blisters
  • Red , patchy white areas that blanch with pressure
  • Moderate edema
  • Painful

Examples: Contact with hot liquids or solids, intense radiant energy

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12
Q

Full Thickness Burns

A
  • Pale white, charred
  • Deep red, black, brown
  • Dry leathery surface
  • Severe edema
  • Fat exposed
  • Tissue disrupted
  • No blisters
  • Little if any pain
  • Incapable of self reepithelialization
  • Hematuria (hemolysis of blood)
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13
Q

Deep Full Thickness Burns

A
  • Black
  • No edema
  • All layers of skin. Extends to muscle, tendons, bones
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14
Q

Burn Types: Thermal

A

Steam, scalds, fire injuries

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15
Q

Burn Types: Electrical

A
  • Low voltage or high voltage current
  • Lightening strike
  • fluids to have clear urine. 100 mL an hour output
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16
Q

Burn Types: Chemical

A
  • Alkalis
  • Acids
  • Do not make vomit
  • Fluid Resuscitation
17
Q

Burn Types: Radiation

A
  • Industrial equipment

- Medical treatment

18
Q

Inhalation Injury

A
  • SOB, dyspnea
  • Hoarseness
  • Stridor
  • Flaring
  • Tachypnea
  • Burns to face, neck, mouth
  • Sooty sputum
  • Singed facial hair
  • Swelling of face, neck, trachea
19
Q

Inhalation injury Treatment

A
  • 100% FiO2 ASAP
  • EARLY intubation
  • Rest
  • Maintain airway
  • May need PEEP
20
Q

Phases of Burn Care characteristics: Resuscitation phase:

A
  • Emergent/Fluid shifts

- Lasts until plasma volume is restored

21
Q

Phases of burn care characteristics: Acute care phase

A
  • Spontaneous diuresis
  • Return capillary integrity
  • Mobilization of extracellular fluid
  • Wound healing, closure, and prevention of complications
22
Q

Phases of burn care characteristics: Rehabilitation phase

A
  • Begins at admission
  • Long Term
  • Mobility and function
  • Psychological recovery
23
Q

Resuscitation Phase Goals:

A

Hemodynamic stability

  • Goal: Keep UOP 0.5-1 ml/kg/hr, SBP> 90
  • ECG: Monitor for changes associated with electrolyte imbalance
  • Fluid resuscitation
24
Q

Parkland formula (amount of fluid needed in resuscitation phase)

A

4 ml LR x %TBSA burned (rule of nines) x weight in kg

  • Give half of this amount in 1st 8 hours
  • 25% over the next 8 hours
  • 25% over the next 8 hours

Example:
70 kg client with 60% burn

4ml x 60 x 70 = 16,800 total

25
Q

Acute care phase Goals:

A
  • Prevent infection
  • Wound Care (Skin Grafting)
  • Nutrition
26
Q

Rehabilitation phase Goals:

A
  • Prevent contractures and control pain
  • Gain maximal function, physical and emotional healing

Overlaps all phases

  • Start rehab immediately
  • May last several years
27
Q

Skin Grafts: Homografts (Allograft)

A
  • Temporary
  • Human (Cadaver)
  • Body rejects in 2 weeks
28
Q

Skin Grafts: Heterograft (Xenograft)

A
  • Temporary
  • Another species
  • Body rejects in 5-7 days
29
Q

Skin Grafts: Artificial, Synthetic skin

A
  • Integra®, Epicel®, Dermagraft®, Alloderm®
  • Cultured epithelial autograft (CEA)
  • Varying percentage of rejection rates
  • Evolving research
  • Expensive
30
Q

Skin Grafts: Autograft (from self)

A
  • Permanent
  • Split thickness grafts
  • Mesh or sheet form
  • Graft site care
  • Immobilize, dressing
  • Check for adherence and infection
    Donor site care
    —–Check donor site for infection and pain
31
Q

Skin Grafts: Current research

A

Stem cells

32
Q

Skin Grafts: Cultured Skin

A
  • Grown from a epidermal cells

- Cell sheets costly

33
Q

Rule of nines

A

Head total- 9%

  • Front of head- 4.5%
  • Back of head- 4.5%
  • Anterior truck (front abdomen/chest)- 18%
  • Posterior truck (back)- 18%

Each arm- 9%

  • Back of arm- 4.5%
  • Front of arm- 4.5%

Each leg- 18%

  • Front of leg- 9%
  • Back of leg- 9%
  • Perineum- 1%

Adult health II final (14 decks)

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