Exam 2 (Ch. 24 & 25) PPT Flashcards
Skin Structures
What are the layers of the skin?
From outermost to deepest
- Epidermis:
Structure: The outermost layer, composed primarily of keratinized stratified squamous epithelium. It’s avascular (lacks blood vessels). Layers include the stratum corneum, lucidum (only in thick skin), granulosum, spinosum, and basale. - Dermis:
Structure: The middle layer, composed of connective tissue containing collagen and elastic fibers, blood vessels, nerves, hair follicles, and glands. Has two layers: papillary (superficial) and reticular (deep). - Subcutaneous Tissue (Hypodermis):
Structure: Deepest layer, composed mainly of adipose (fat) tissue and some connective tissue.
Skin Structures and Functions
What is the function of the epidermis?
Protection (against pathogens, water loss, abrasion), melanin production (for UV protection), and vitamin D synthesis.
Skin Structures and Functions
What is the function of the dermis?
Provides strength and elasticity, supports the epidermis, regulates temperature (via blood vessels), and provides sensation (via nerves).
Skin Structures and Functions
What is the function of the subcutaneous tissue (Hypodermis)?
Insulation, energy storage, and cushioning.
Skin Structures and Functions
What are the functions of the following skin appendages?
Nails
Hair
Sweat Glands
Sebaceous Glands
Nails: Protective plates of keratin.
Hair: Composed of keratin, provides some warmth and protection.
Sweat Glands: Produce sweat for thermoregulation (cooling). Types include eccrine (all over body) and apocrine (axillary and genital areas).
Sebaceous Glands: Produce sebum (oil) that lubricates skin and hair.
A client reports dry, itchy skin. Which of the following interventions would be appropriate to recommend to the client?
A. Use hot water when bathing.
B. Apply a fragrance-free moisturizer immediately after bathing.
C. Use a harsh, abrasive scrub when cleansing the skin.
D. Increase the frequency of bathing to remove irritants.
E. Use a humidifier in dry environments.
B, E
Rationale: Options B and E address the issue of dry skin by promoting moisture retention. Options A, C, and D would further dry or irritate the skin.
A client is diagnosed with a condition that causes decreased sebum production. Over time, what trends would the nurse expect to observe in this client’s skin?
A. Increased oiliness of the skin
B. Increased risk for skin infection
C. Increased hydration of the skin
D. Increased risk for skin breakdown and dryness
D
Rationale: Sebum helps lubricate and protect the skin. Decreased sebum leads to dryness and potential breakdown.
Which of the following are functions of the subcutaneous tissue (hypodermis)?
A. Producing new skin cells
B. Providing insulation
C. Storing energy
D. Providing sensation
E. Anchoring the skin to underlying tissues
B, C, E
Rationale: The subcutaneous tissue is primarily for insulation, energy storage, and connecting the skin to deeper structures. The epidermis produces new skin cells, and the dermis contains sensory receptors.
Functions of the Integumentary System
What are the functions of the integumentary system?
5
Protection
Insulation: The subcutaneous fat layer provides insulation, helping regulate body temperature.
Sensory Perception: The skin contains various sensory receptors that detect touch, pressure, temperature, and pain.
Control of Heat Regulation
Synthesis of Vitamin D: Vitamin D is synthesized in the skin when exposed to UV light. It plays a crucial role in calcium absorption and bone health.
Functions of the Integumentary System
What are the types of protection the integumentary system provides?
Physical Barrier: The skin acts as a barrier against abrasion, cuts, and other physical trauma.
Chemical Barrier: Skin secretions (sebum, sweat) create a slightly acidic environment that inhibits bacterial growth. Melanin protects against UV radiation.
Biological Barrier: Langerhans cells in the epidermis are part of the immune system and help fight pathogens.
Barrier from Bacteria and Viruses: The intact skin acts as the first line of defense against most pathogens.
Functions of the Integumentary System
What are some forms of heat regulation controlled by the integumentary system?
Sweat Production: Evaporation of sweat cools the body.
Vasodilation/Vasoconstriction: Blood vessels in the skin can dilate (to release heat) or constrict (to conserve heat).
Which of the following are ways in which the integumentary system contributes to thermoregulation?
A. Producing sweat for evaporative cooling.
B. Synthesizing vitamin D.
C. Dilating blood vessels to increase heat loss.
D. Constricting blood vessels to conserve heat.
E. Secreting sebum to lubricate the skin.
A, C, D
Rationale: Sweat glands and blood vessels in the skin play direct roles in temperature regulation. Vitamin D synthesis and sebum production are not directly involved in thermoregulation.
A client has a condition that reduces the number of functioning Langerhans cells in the epidermis. What trend would the nurse expect to observe in this client?
A. Increased risk of skin infections
B. Decreased ability to regulate body temperature
C. Increased sensitivity to touch
D. Decreased production of vitamin D
A
Rationale: Langerhans cells are immune cells in the skin. A reduction in their number would increase the risk of infection.
Assessment of the Integumentary System
When does the general assessment beigns?
With first contact with the patient and continues through the exam
Note overall condition of skin & hair
Assessment of the Integumentary System
What are some key aspects to note during the assessment?
Skin Color
Moisture
Temperature
Texture
Turgor
Integrity
Hair
Nails
See PPT for what to assess/inspect for each
During the initial assessment of a client’s integumentary system, which of the following actions would be most important for the nurse to perform?
A. Evaluate skin turgor.
B. Observe the client’s skin color and hair distribution.
C. Inspect the nails for capillary refill.
D. Ask the client about their history of skin problems.
E. Measure the client’s blood pressure.
A, B, C, D
Rationale: All options except measuring blood pressure are direct components of an integumentary assessment.
A client has been experiencing excessive sweating (diaphoresis) for several days. What trends would the nurse anticipate related to the client’s integumentary system?
A. Increased skin turgor
B. Potential for skin breakdown
C. Decreased risk of infection
D. Increased oiliness of the skin
B
Rationale: Excessive moisture can increase the risk of skin maceration and breakdown.
Subjective Data (Integumentary Focus)
What is some important subjective health information to obtain from the client?
Health History (EX: Past skin problems (e.i. eczema, psoriasis, acne, allergies, infections, etc.) History of skin cancer, Changes in skin, hair, or nails, and any Symptoms (itching (pruritus), pain, burning, tingling, numbness, etc.))
Medications (Prescription and over-the-counter medications used on the skin, Systemic medications that might affect the skin, & Recent use of antibiotics)
Surgery or Other Treatments (Surgeries or procedures involving the skin (e.g., mole removal, biopsies) or Radiation therapy or other treatments that could affect the skin)
Functional Health Patterns (Skin care habits (how often do they bathe, what products do they use), Sun exposure habits (use of sunscreen, tanning beds), Occupational or recreational exposures that could affect the skin, Nutritional status, & Changes in self-care practices related to skin or hair)
Which of the following statements by a client would be considered subjective data related to the integumentary system?
A. “My scalp has been really itchy lately.”
B. “I’ve noticed a dark spot on my arm that’s getting bigger.”
C. “I use a tanning bed several times a week.”
D. “My blood pressure is 130/80.”
E. “I’ve been using a new moisturizer that seems to be helping.”
A, B, C, E
Rationale: These are all based on the client’s perceptions, experiences, or habits related to their skin. Option D is a measurement (objective data).
A client reports a history of psoriasis. What trends would the nurse anticipate when gathering subjective data from this client?
A. Reports of joint pain or stiffness
B. Reports of decreased sensitivity to sunlight
C. Reports of improved skin texture and reduced scaling
D. Reports of decreased need for topical medications
A
Rationale: Psoriasis is an autoimmune disease that can affect the joints, causing psoriatic arthritis. Joint pain or stiffness is a common symptom reported by clients with psoriasis.
Objective Data (Integumentary Focus)
What is the critical factor in assessment of the skin?
Change
Objective Data (Integumentary Focus)
What should the general inspection of the integumentary envolve?
- Observation of the skin’s color, moisture, & integrity
- Assessment of hair distribution, thickness, & texture
- Inspection of nails for color, shape, & capillary refill
- Note any obvious deformities or abnormalities
Objective Data (Integumentary Focus)
What are Primary Skin Lesions?
- These are lesions that develop directly from the disease process.
- Examples: macules, papules, patches, plaques, wheals, nodules, tumors, vesicles, bullae, pustules.
- Document: location, size, color, shape, and arrangement.
Objective Data (Integumentary Focus)
What are secondary skin lesions?
- These are lesions that result from changes in primary lesions or are caused by external factors (e.g., scratching, infection).
- Examples: scales, crusts, erosions, ulcers, excoriations, fissures, scars, atrophy, lichenification.
- Document: location, size, color, shape, and arrangement.
Which of the following findings would be considered objective data related to the integumentary system?
A. Client reports itching on their arms.
B. Nurse observes a 2 cm round, red lesion on the client’s leg.
C. Client states they have been using a new soap.
D. Nurse measures capillary refill in the client’s toes.
E. Client reports a history of psoriasis.
B, D
Rationale: Options B and D are observations or measurements made by the nurse. Options A, C, and E are based on the client’s report or history (subjective data).
A client has developed small, fluid-filled blisters on their hands. What trends would the nurse anticipate when gathering objective data about these lesions over the next few days?
A. The blisters will likely decrease in size and number.
B. The blisters may rupture and form crusts or scales.
C. New blisters are not likely to appear.
D. The surrounding skin will remain unaffected.
B
Rationale: Vesicles (small blisters) often rupture, leading to secondary lesions like crusts or scales.
Objective Data: Integumentary Palpation
What are the 4 key aspects of palpation?
- Temparture
- Turgor
- Moisture
- Texture
Other Palpation Findings: Lesions, Edema, & Mobility
See PPT for further explanation of each key aspect
Which of the following techniques are utilized when palpating the skin to assess temperature?
A. Using the palmar surface (palm) of the hand.
B. Using the dorsal surface (back) of the hand.
C. Comparing temperature between different body sites.
D. Noting if the skin feels warm, cool, or hot.
E. Gently pinching the skin to assess turgor.
B, C, D
Rationale: The dorsa of the hands are most sensitive to temperature. Comparing temperature between sites and noting the sensation (warm, cool, hot) are essential parts of the technique. Pinching the skin assesses turgor, not temperature.
A client has dependent edema in their lower extremities. What trends would the nurse anticipate when palpating the affected areas?
A. The skin will feel warm to the touch.
B. The skin will exhibit poor turgor.
C. Pressure on the skin will leave a temporary indentation.
D. The skin will feel rough and dry.
C
Rationale: Dependent edema is characterized by fluid accumulation in the lower extremities, leading to pitting when pressure is applied.
Describing Skin Lesions
What does lesion distribution refer to?
Refers to how the lesions are spread out over the body. Is it localized to one area, scattered, or generalized (all over)?
- Localized: Confined to a specific area (e.g., the elbow, the back).
- Regional: Affecting a specific region of the body (e.g., the entire arm, the groin).
- Generalized: Widespread throughout the body.
- Symmetric: Appearing equally on both sides of the body.
- Asymmetric: Appearing unequally or only on one side of the body.
Describing Skin Lesions
What doess configuration describe?
Describes the pattern or shape of the lesions themselves.
- Solitary: A single lesion.
- Grouped/Clustered: Lesions clustered together.
- Linear: Lesions forming a line.
- Annular/Circular: Ring-shaped lesions.
- Arciform: Lesions forming a partial ring or arc.
- Reticular/Net-like: Lesions forming a network or lace-like pattern.
- Target/Bull’s-eye: Concentric rings of color.
- Serpiginous: Snake-like or wavy lesions.
Which of the following terms describe the distribution of skin lesions?
A. Annular
B. Localized
C. Linear
D. Generalized
E. Symmetric
B, D, E
Rationale: Localized, generalized, and symmetric refer to how the lesions are spread over the body. Annular and linear describe the configuration or pattern of the lesions.
A client presents with a rash that is scattered across their entire back and chest. What term would the nurse use to document the distribution of this rash?
A. Localized
B. Regional
C. Generalized
D. Symmetric
C
Rationale: “Scattered across the entire back and chest” indicates a widespread distribution, which is described as generalized.
Assessment of Dark Skin
Where is color assessed?
Where the epidermis is thinnest
* Sclera of the eye
* Conjunctiva
* Mucous membranes
* Nail beds
* Palms and soles: These areas may be lighter and can provide a clearer picture of color changes.
Assessment of Dark Skin
What are you looking for when assessing color?
Pallor: May appear ashen gray or yellow-brown.
Cyanosis: May appear bluish or purplish, often best seen in mucous membranes.
Jaundice: Look for yellowing in the sclera and mucous membranes.
Erythema: May be difficult to visualize; rely on warmth, swelling, and tenderness.
Assessment of Dark Skin
How might rashes be assessed?
Through palpation
* Rashes may be more difficult to see in dark skin. Use palpation to feel for changes in texture, elevation, or warmth.
Assessment of Dark Skin
What are some predisopositions for dark skin?
Keloids: Thickened scars that develop due to excessive collagen production.
Vitiligo: An autoimmune disorder causing loss of skin color in patches.
When assessing a client with dark skin for jaundice, where would the nurse prioritize inspection?
A. Sclera of the eye
B. Nail beds
C. Mucous membranes
D. Palms and soles
E. Forearm
A, C, D
Rationale: The sclera, mucous membranes, and palms/soles are areas where color changes are often more visible in dark-skinned individuals. Nail beds can be helpful, but capillary refill may be difficult to assess due to nail pigmentation. The forearm is not typically the best place to assess for jaundice.
A dark-skinned client with a history of asthma presents with a cough and shortness of breath. What additional assessment findings would be most concerning for the nurse?
A. Bluish tinge to the mucous membranes
B. Warm skin temperature
C. Rough skin texture
D. Reports of itching
A
Rationale: A bluish tinge to the mucous membranes (cyanosis) is a concerning sign of respiratory distress and decreased oxygenation.
What are some diagnostic studies of the integumentary system?
Inspection and History
Dermatoscopy
* A technique using a dermatoscope (a magnifying lens with a light source) to examine the deeper layers of the skin.
* Helps in the early detection of melanoma and other skin cancers.
Biopsy
* Removal of a small piece of skin tissue for microscopic examination.
Types include: shave biopsy, punch biopsy, excisional biopsy, incisional biopsy, & puncture
Stains and Cultures:
* Stains: Used to identify specific types of cells or microorganisms in skin samples.
* Cultures: Used to grow and identify microorganisms from skin lesions or samples.
Immunofluorescence:
* A technique used to detect antibodies or antigens in skin tissue. Helps diagnose autoimmune diseases and other conditions.
Puncture biopsy is a diagnostic procedure where a small tissue sample is removed from a specific area of the body using a needle or other sharp instrument.
Which of the following diagnostic studies involve the removal of skin tissue for examination?
A. Dermatoscopy
B. Biopsy
C. Stains and cultures
D. Immunofluorescence
B
Rationale: A biopsy involves removing a skin tissue sample. Dermatoscopy is a visualization technique; stains and cultures analyze skin samples but don’t involve tissue removal; immunofluorescence detects antibodies or antigens.
A client has a history of suspected autoimmune disease with skin manifestations. What trends would the nurse anticipate in the diagnostic workup for this client?
A. Increased use of dermatoscopy
B. Possible orders for immunofluorescence studies
C. Routine biopsies of all skin lesions
D. Frequent orders for skin scrapings and cultures
B
Rationale: Immunofluorescence is helpful in diagnosing autoimmune diseases affecting the skin.
Skin Care: Environmental Hazards (Sun Exposure)
What are some types of sun exposure?
4
- Visible Light and Ultraviolet (UV) Light: Sunlight includes both visible light and invisible UV radiation.
- UVA: Primarily associated with tanning. UVA rays penetrate deeply into the skin and can contribute to premature aging and some types of skin cancer.
- UVB: Primarily associated with sunburn. UVB rays are stronger than UVA rays and are a major factor in sunburn, blistering, and increasing the risk of skin cancer (including melanoma).
- Cumulative Damage: The damage caused by UV radiation builds up over time. Repeated sun exposure throughout life increases the risk of skin cancer and premature aging.
Skin Care: Environmental Hazards (Sun Exposure)
What are some types of sun protection?
Protective Clothing: Wearing tightly woven, light-colored clothing (long sleeves, pants, hats) can help shield the skin from the sun’s rays.
Sunscreen: Applying broad-spectrum sunscreen with an SPF of 30 or higher is crucial for protecting against both UVA and UVB rays.
Which of the following statements about sun exposure and skin health are accurate?
A. UVA rays are primarily responsible for sunburn.
B. UVB rays are a major factor in the development of skin cancer.
C. Damage from sun exposure accumulates over a lifetime.
D. Tanning is a healthy way to prepare the skin for sun exposure.
E. Sunscreen should protect against both UVA and UVB rays
B, C, E
Rationale: UVB rays are strongly linked to skin cancer. Cumulative damage from the sun is a significant factor in skin aging and cancer. Broad-spectrum sunscreens protect against both types of UV radiation. UVA rays are more associated with tanning, but tanning itself is not healthy and still causes skin damage.
A client reports using tanning beds regularly. What trends would the nurse anticipate when assessing this client’s skin health over time?
A. Decreased risk of premature aging
B. Increased risk of skin cancer
C. Reduced likelihood of sunburn
D. Improved vitamin D production
B
Rationale: Tanning beds emit UV radiation, which significantly increases the risk of skin cancer, including melanoma.
Skin Cancer Risk Factors
What are some skin cancer risk factors?
Fair Skin
Blonde or Red Hair, Blue Eyes
Outdoor Sunbathing
Living Near the Equator or High Altitudes
History of Skin Cancer
Outdoor Occupation or Outdoor Recreation
Indoor Tanning
See PPT for whys
Additional Factors: Age, Family History, Weakend Immune System, Previous Burns or Skin Injuries, Certain Skin Conditions (like xeroderma pigmentosum), & Gender (Men more than Women)
Which of the following are established risk factors for skin cancer?
A. Dark skin color
B. History of indoor tanning
C. Living at high altitudes
D. Family history of skin cancer
E. Use of sunscreen with SPF 15
B, C, D
Rationale: Indoor tanning, high altitude living, and family history are all established risk factors. Dark skin is associated with a lower risk, and SPF 15 is lower than the recommended SPF 30 or higher for optimal protection.
A fair-skinned client with a family history of melanoma asks the nurse about their risk for developing skin cancer. What trends would the nurse discuss with the client?
A. Their risk is lower due to their fair skin.
B. Their risk is increased due to both fair skin and family history.
C. Their risk is not significantly different from the general population.
D. Their risk is primarily related to sun exposure during childhood.
B
Rationale: Both fair skin and a family history of melanoma increase the client’s risk for skin cancer.
Nonmelanoma Skin Cancers
What is the description, prevalence, etiology, & clinical significance of Actinic Keratosis (Solar Keratosis)?
Description: Most common precancerous skin lesion.
Prevalence: Affects a large portion of the older white population.
Etiology: Sun exposure is the primary contributing factor.
Clinical Significance: Difficult to distinguish from squamous cell carcinoma; aggressive treatment is recommended to prevent progression.
Nonmelanoma Skin Cancers
What is the description, prognosis, & population of Basal Cell Carcinoma (BCC)?
Description: Most common type of skin cancer.
Prognosis: Least deadly form of skin cancer; rarely metastasizes.
Population: Typically affects middle-aged to older adults.
Nonmelanoma Skin Cancers
What is the description & risk factors of Squamous Cell Carcinoma (SCC)?
Description: Can be aggressive and has the potential to metastasize.
Risk Factors:
* Sun exposure is a major risk factor.
* Immunosuppression (e.g., after organ transplant) significantly increases risk.
* Smoking (pipe, cigar, cigarette) contributes to SCC on the mouth and lips.
Which of the following statements about actinic keratosis are correct?
A. It is the most common type of skin cancer.
B. It is considered a precancerous lesion.
C. Sun exposure is a key contributing factor.
D. It is easily distinguishable from squamous cell carcinoma.
E. Aggressive treatment is recommended.
B, C, E
Rationale: Actinic keratosis is a precancerous lesion caused by sun exposure, and aggressive treatment is needed to prevent its progression. It is not the most common type of skin cancer (that would be basal cell carcinoma), and it can be difficult to distinguish from squamous cell carcinoma.
A client who is immunocompromised due to an organ transplant asks the nurse about their risk for skin cancer. What information should the nurse provide?
A. Their risk is decreased due to the medications they are taking.
B. They are at increased risk for developing skin cancer, especially squamous cell carcinoma.
C. Their risk is primarily related to sun exposure.
D. They should focus on preventing basal cell carcinoma.
B
Rationale: Immunosuppression after organ transplant significantly increases the risk of skin cancer, particularly squamous cell carcinoma.
What type of skin cancer causes the most deaths? Why?
Melanoma
due to its ability to metastasize.
Melanoma can spread (metastasize) to any organ in the body, including vital organs like the brain and heart
Notes on Melanoma
What are some factors that play a role in causing melanoma?
Environmental Factors: UV radiation exposure (sunlight, tanning beds) is a major environmental risk factor.
Genetic Factors: Family history of melanoma significantly increases the risk, indicating a genetic predisposition.
While the exact cause isn’t fully understood, both environmental and genetic factors play a role.
Notes on Melanoma
What are the ABCDEs of Melanoma Detection?
Early Detection is Crucial: Melanoma is highly treatable if detected and removed early. Later stages are much more dangerous.
Asymmetry: One half of a mole or lesion doesn’t match the other half.
Border: The edges are irregular, ragged, notched, or blurred.
Color: The color is uneven. Shades of black, brown, and tan may be present. There may be areas of white, gray, red, pink, or blue.
Diameter: A change in size, especially if larger than ¼ inch (about 6 mm).
Evolving: The mole is changing in size, shape, or color.
Which of the following statements about melanoma are accurate?
A. It is the least deadly form of skin cancer.
B. It can metastasize to vital organs like the brain and heart.
C. Family history is a significant risk factor.
D. Exposure to UV radiation increases the risk.
E. Early detection and treatment are crucial for survival.
B, C, D, E
Rationale: Melanoma is the deadliest form of skin cancer, can spread to any organ, and is linked to both genetic and environmental factors. Early detection is vital for successful treatment.
A client with a family history of melanoma asks the nurse about reducing their risk. What primary prevention strategies would the nurse emphasize?
A. Regular skin self-exams and annual dermatologist visits
B. Avoiding sun exposure and using sun protection measures
C. Maintaining a healthy diet and exercising regularly
D. All of the above
B
Rationale: While all options contribute to overall health, avoiding sun exposure and using sun protection are the most direct ways to reduce the risk of melanoma.
Malignant Melanoma Risk Factors
What are some risk factors of melanoma?
Red or Blonde Hair: Typically have less melanin, making them more susceptible to sun damage.
Blue or Light-Colored Eyes: Often indicate less melanin and increased sun sensitivity.
Light-Colored Skin that Freckles: Freckling is a sign of sun sensitivity and indicates that the skin is more prone to sun damage.
Chronic UV Exposure: Prolonged or frequent exposure to ultraviolet (UV) radiation from the sun or tanning beds significantly increases the risk of melanoma.
Family History: A family history of melanoma, especially in a first-degree relative (parent, sibling, child), is a strong risk factor, indicating a genetic predisposition.
A client with red hair and blue eyes is concerned about their risk for melanoma. What trends would the nurse discuss with this client regarding their risk and prevention?
A. Their risk is lower due to their hair and eye color.
B. They should avoid all sun exposure to eliminate their risk.
C. They have an increased risk and should focus on sun protection and early detection.
D. Their risk is primarily determined by their family history.
C
Rationale: Red hair and blue eyes increase the risk, so the focus should be on protection and early detection. While family history is a risk factor, it’s not the only determining factor.
Which of the following characteristics of a skin lesion would be a reason for concern and warrant further evaluation by a healthcare professional?
A. The lesion is symmetrical.
B. The lesion has an irregular border.
C. The lesion has a uniform brown color.
D. The lesion is larger than 6 mm in diameter.
E. The lesion has recently changed in size.
B, D, E
Rationale: Irregular borders, large diameter, and any change in a lesion are all potential signs of melanoma and should be evaluated. Symmetry and uniform color are generally associated with benign moles.
Malignant Melanoma Diagnosis
What are some methods of melanoma diagnosis?
Dermoscopy: A technique using a dermatoscope (a magnifying lens with a light source) to examine the deeper layers of the skin.
Excisional Biopsy: This is the preferred method for diagnosing melanoma.
Tumor Thickness: Measurement of the depth of melanoma invasion. This is a critical prognostic factor.
- Breslow Measurement: A standardized measurement of tumor thickness from the granular layer of the epidermis to the deepest point of tumor invasion.
Malignant Melanoma Interprofessional Care
What does the treatment of malignant melanoma depend on?
Site of original tumor & stage of the cancer
Malignant Melanoma Interprofessional Care
What are some components of malignant melanoma treatment?
Wide Surgical Excision: width depends on melanoma thickness
Adjuvant Therapy
* Immunotherapy: Stimulates the body’s immune system to attack cancer cells.
* Targeted Therapy: Drugs that target specific characteristics of cancer cells.
* Radiation Therapy: May be used in certain situations, such as when the melanoma has spread to lymph nodes or other areas.
* Chemotherapy: May be used in advanced melanoma.
* Sentinel Lymph Node Biopsy: Removal and examination of the first lymph node(s) to which the melanoma may have spread.
A client undergoes excisional biopsy of a suspicious skin lesion. What trends would the nurse anticipate in the subsequent plan of care based on the pathology results?
A. If melanoma is diagnosed, further treatment may be needed based on the tumor’s characteristics and stage.
B. If the lesion is benign, no further treatment will be necessary.
C. Regardless of the pathology results, the client will need regular follow-up appointments.
D. All of the above.
D
Rationale: The pathology results will guide further treatment (if melanoma) or confirm no further treatment is needed (if benign). Follow-up is important in either case for monitoring and early detection of any changes.
Malignant Melanoma: Staging
Melanoma is staged from 0 (in situ) to IV, based on what? Prognosis?
Staging System:
* Tumor Size (Thickness): Measured using the Breslow depth.
* Nodal Involvement: Presence of cancer in nearby lymph nodes.
* Metastasis: Spread of cancer to distant sites (e.g., lungs, liver, brain).
Prognosis:
* Stage 0: Nearly 100% curable with excision.
* Advanced Disease (Stage IV): 5-year survival rate is significantly lower (around 27% as stated in the image, but this can vary depending on the specific circumstances and advancements in treatment).
Malignant Melanoma: Interprofessional Care
What are some types of immunotherapy for malignant melanoma?
Immunotherapy: Boosts the body’s immune system to fight cancer cells.
Cytokines: Interferon alfa-2b and interleukin-2.
PD-1 Inhibitors: Pembrolizumab and Nivolumab.
CTLA-4 Inhibitors: Ipilimumab.
Malignant Melanoma: Interprofessional Care
What is targeted therapy, examples? When is radiation therapy used?
Targeted Therapy: Drugs that target specific abnormalities in cancer cells.
* BRAF and MEK Inhibitors: Used in melanomas with specific BRAF gene mutations (e.g., Vemurafenib, Dabrafenib, Trametinib, Cobimetinib).
Radiation Therapy: May be used to treat melanoma that has spread to lymph nodes or the brain.
Match the treatment type with its mechanism of action:
Treatment:
1. Immunotherapy
2. Targeted therapy
3. Radiation therapy
Mechanism of Action:
A. Uses high-energy radiation to kill cancer cells
B. Boosts the body’s immune system to fight cancer
C. Targets specific abnormalities in cancer cells
1-B, 2-C, 3-A
A client with Stage IV melanoma is starting immunotherapy. What trends would the nurse anticipate related to this treatment?
A. Potential for immune-related side effects
B. Guaranteed cure from the immunotherapy
C. No need for other treatments
D. Rapid shrinkage of all tumors
A
Rationale: Immunotherapy can cause side effects as it stimulates the immune system, which can sometimes attack healthy tissues. It doesn’t guarantee a cure and may be used in combination with other treatments. Responses to immunotherapy can vary.
atypical/dysplastic nevi
What makes atypical/dysplastic nevi different from other moles
Nevi-Moles
They’re not your typical, run-of-the-mill moles.
They’re often bigger than normal moles.
Irregular edges: Instead of a smooth, round border, the edges might be uneven, notched, or blurry.
Mixed colors: A normal mole is usually one even color. A dysplastic nevus might have different shades of brown, tan, red, or even black within the same mole.
atypical/dysplastic nevi
Why might dysplastic neiv be tricker to identify than melanoma using the ABCDEs? Why might this be a problem?
Ther are less prononced than true melanoma.
Having dysplastic nevi means you have a higher chance of developing melanoma compared to someone with only regular moles. It doesn’t mean you will get melanoma, but it’s important to be aware.
Skin Infections and Infestations
What are some types of bacterial infections?
Staphylococcus aureus Infections:
* Impetigo: Honey-colored crusts, often seen in children.
* Folliculitis: Inflammation of hair follicles, often caused by shaving or hot tubs.
* Furuncles (Boils): Painful, red, raised bumps with pus.
* Carbuncles: Multiple furuncles clustered together.
* Cellulitis: Spreading infection of the skin and subcutaneous tissues, characterized by redness, warmth, swelling, and pain.
* Methicillin-Resistant Staphylococcus aureus (MRSA): A strain of staph that is resistant to many antibiotics.
Streptococcus pyogenes Infections:
* Erysipelas: A superficial form of cellulitis with well-defined borders, often affecting the face or legs.
Skin Infections and Infestations
What are some types of viral infections?
Herpes Simplex Virus (HSV):
* Oral Herpes (HSV-1): Cold sores or fever blisters.
* Genital Herpes (HSV-2): Causes sores on or around the genitals.
Varicella-Zoster Virus (VZV):
* Chickenpox: A common childhood illness with itchy, fluid-filled blisters.
* Shingles (Herpes Zoster): A reactivation of the chickenpox virus, causing a painful rash along a nerve pathway (dermatome).
Human Papillomavirus (HPV):
* Warts: Common, benign growths on the skin.
* Genital Warts: Affect the genital and anal areas.
Skin Infections and Infestations
What are some types of infestations/insect bites?
Scabies: Caused by the Sarcoptes scabiei mite, resulting in intense itching and a rash with small, raised bumps or burrows.
Pediculosis (Lice):
Head Lice (Pediculus humanus capitis): Live on the scalp and lay eggs (nits) on hair shafts.
Body Lice (Pediculus humanus corporis): Live in clothing and infest the body.
Pubic Lice (Pthirus pubis): Infest the pubic area.
Bed Bugs: Cause itchy, red welts, often in a linear pattern.
Tick Bites: Can transmit Lyme disease or other infections.
Skin Infections and Infestations
What are some types of fungal infections?
Tinea Infections (Dermatophytoses):
* Tinea Capitis: Affects the scalp.
* Tinea Corporis (Ringworm): Affects the body.
* Tinea Cruris (Jock Itch): Affects the groin area.
* Tinea Pedis (Athlete’s Foot): Affects the feet.
* Tinea Unguium (Onychomycosis): Affects the nails.
Candida albicans Infections:
* Oral Candidiasis (Thrush): A yeast infection of the mouth.
* Cutaneous Candidiasis: Affects the skin, often in warm, moist areas.
* Vulvovaginal Candidiasis: A vaginal yeast infection.
A client is diagnosed with MRSA cellulitis. What trends would the nurse anticipate in the treatment plan?
A. Use of oral antiviral medication
B. Need for wound debridement
C. Use of specific antibiotics effective against MRSA
D. Isolation precautions to prevent spread
C, D
Rationale: MRSA requires specific antibiotics to which it is susceptible. Isolation precautions are important to prevent the spread of MRSA to others. Antiviral medications are not used for bacterial infections. Debridement is not typically needed for cellulitis unless there is abscess formation or necrosis.
Patient Education: Bacterial Skin Infections
What should you emphasize to a patient with a bacterial skin infection?
These infections are very contagious
- drainage from bacterial skin infections is contagious and can spread to other parts of the body or to other people.
- Don’t share personal items like towels, combs, or razors.
- Bathe daily with antibacterial soap.
Patient Education: Bacterial Skin Infections
What should you tell your patient about lesion care of bacterial skin infections?
Avoid squeezing furuncles/boils or pimples as this can disrupt the protective wall that localizes the infection and lead to spread.
Warm, moist compresses can help promote drainage and healing.
Which of the following instructions should be included in the patient education for someone with a bacterial skin infection?
A. “Apply a thick layer of antibiotic ointment to the lesion without removing any crusts.”
B. “Wash your hands thoroughly before and after touching the infected area.”
C. “Avoid sharing towels or personal care items with others.”
D. “Squeeze any pimples or boils to help them drain.”
E. “Continue taking antibiotics until the lesion is completely healed, even if you feel better.”
B, C, E
Rationale: Proper hand hygiene and avoiding sharing items can prevent the spread of infection. Completing the full course of antibiotics is crucial. Crusts should be removed before applying topical medication, and squeezing lesions is discouraged.
A client is diagnosed with a recurrent bacterial skin infection. What factors would the nurse explore to identify potential causes of recurrence?
A. Adherence to antibiotic regimen
B. Hygiene practices
C. Sharing of personal items
D. All of the above
D
Rationale: All of these factors can contribute to recurrent infections. Inconsistent antibiotic use can lead to resistant bacteria, poor hygiene can promote reinfection, and sharing items can transmit the bacteria to others or back to the original patient.
Patient Education: Viral Infections
What are the cause, symptoms, treatment, & additional care for herpes zoster?
Herpes Zoster- Shingles
Cause: Reactivation of the varicella-zoster virus (chickenpox virus).
Symptoms: Painful vesicles (fluid-filled blisters) that follow a dermatomal pattern (along a nerve pathway).
Treatment:
* Antiviral Medications: Acyclovir (Zovirax), Valacyclovir (Valtrex), or Famciclovir (Famvir). Most effective if given within 24 hours of the initial eruption.
* Anti-inflammatory Medications/Steroids: To reduce inflammation and pain.
Lesion Care: Appropriate dressings and topical medications as prescribed.
Hand Hygiene: Frequent hand washing to prevent the spread of the virus.
Patient Education: Viral Infections
What are the types, treatment, & prevention of Herpes Simplex Virus (HSV)?
Types:
* Type 1: Typically affects the mouth, lips, and tongue (oral herpes).
* Type 2: Typically affects the genital area (genital herpes).
Treatment: Antiviral medications can help reduce the severity and frequency of outbreaks.
Prevention: Measures to reduce the spread of infection, including avoiding contact with active lesions and practicing safe sex. Important considerations for pregnant women with genital herpes to prevent transmission to newborns.
Patient Education: Viral Infections
What causes plantar warts?
HPV (Human papillomavirus)
Which of the following instructions should be included in the patient education for someone with herpes zoster (shingles)?
A. “Apply a dry dressing to the lesions.”
B. “Take antiviral medication as prescribed, ideally within 24 hours of the rash appearing.”
C. “Wash your hands frequently, especially after touching the lesions.”
D. “Use over-the-counter pain relievers as needed.”
E. “Avoid contact with pregnant women and people with weakened immune systems.”
B, C, E
Rationale: Antiviral medication is most effective when started early. Hand hygiene is essential to prevent spread, and contact with vulnerable populations should be avoided when lesions are active. Dry dressings are not typically used; consult with a healthcare provider for appropriate lesion care. Pain management should be addressed with appropriate medications as prescribed.
A pregnant woman with a history of genital herpes asks the nurse about the risk of transmitting the virus to her baby during childbirth. What information should the nurse provide?
A. The risk is minimal, and no special precautions are needed.
B. The risk is significant, and a cesarean delivery may be recommended.
C. The risk can be reduced by taking antiviral medication during pregnancy.
D. Both B and C.
D
Rationale: There is a risk of transmission to the neonate during childbirth with active lesions, and a cesarean section may be recommended. Antiviral medication can help reduce the risk of outbreaks during pregnancy and delivery.
Fungal Infections
What are the clinical manifestations of Candidiasis?
Mouth: White, cheesy plaque, resembles milk curds
Vagina: Vaginitis with red, edematous, painful vaginal wall, white patches. Vaginal discharge. Itching. Pain on urination and intercourse
Skin: Diffuse, popular, red rash with pinpoint satellite lesions around edges of affected area
Fungal Infections
What are the treatments for Candidiasis?
Azole antifungals (e.g., fluconazole, ketoconazole) or other specific medication such as vaginal suppository or oral lozenge
Sexual abstinence or use of condom
Skin hygiene to keep area clean and dry
Powder is effective on nonmucosal surfaces of skin to prevent recurrence
Fungal Infections
What are the clinical manifestations of Tinea Corporis?
Typical annular (ring-like) scaly appearance, well-defined margins
Reddened
Fungal Infections
What are the treatments for Tinea Corporis?
Cool compresses
Topical antifungals for isolated patches. Creams or solutions of miconazole, ketoconazole, clotrimazole, butenafine
Fungal Infections
What are the clinical manifestations of Tinea Cruris?
Well-defined scaly plaque in groin area
Does not affect mucous membranes
Fungal Infections
What are the treatment for Tinea Cruris?
Topical antifungal cream or solution
Fungal Infections
What are the clinical manifestations of Tinea Pedis?
Interdigital scaling and maceration
Scaly plantar surfaces sometimes with redness and blistering
May be itchy and painful
Fungal Infections
What are the treatment for Tinea Pedis?
Topical antifungal cream, gel, solution, spray, powder
Fungal Infections
What are the treatments for Tinea Unguium (Onychomycosis)?
Oral antifungal (terbinafine [Lamisil], itraconazole [Sporanox])
Topical antifungal cream or solution (minimal effectiveness) if unable to tolerate systemic treatment
Thinning of toenails if needed
Nail avulsion (removal) is an optionMay affect only a few nails on 1 hand
Patient Education: Fungal Infections
What should you teach your patient about fungal infection medications?
Oral and Topical Agents & Shampoos: Emphasize the importance of using medications exactly as prescribed (duration, frequency). Explain the rationale for both oral and topical treatments when prescribed in combination (oral often used for widespread or severe infections, topical for localized). If medicated shampoos are prescribed, provide instructions on how to use them (e.g., how long to leave on the scalp).
Patient Education: Fungal Infections
What should you teach your pt. with a fungal infection about hygiene?
Clean Towels and Washcloths Daily: This prevents reinfection and spread to other areas.
Avoid Sharing: Don’t share towels, combs, razors, or other personal items.
Keep Skin Folds and Feet Dry: Moisture promotes fungal growth. Pay special attention to drying between toes and in skin folds (groin, under breasts, etc.).
Clean, Dry, Cotton Clothing: Cotton breathes and helps absorb moisture.
Avoid Synthetic Fabrics, Tight Clothing, Wet Swimsuits, Plastic Shoes: These create a warm, moist environment conducive to fungal growth.
Environmental Factors:
Avoid Excessive Heat and Humidity: These conditions can worsen fungal infections.
Multiple Choice - Multiple Response (Select all that apply):
Which of the following instructions are appropriate for patients with fungal skin infections?
A. “Dry your skin thoroughly, especially between your toes and in skin folds, after bathing.”
B. “Wear synthetic underwear to wick away moisture.”
C. “Use a clean towel and washcloth every day.”
D. “Share your antifungal cream with family members to prevent spread.”
E. “Continue using the antifungal medication even if the rash seems to be gone.”
A, C, E
Rationale: Thorough drying, using clean towels, and completing the full course of medication are essential. Synthetic fabrics and sharing medications are discouraged.
A client is prescribed both oral and topical antifungal medications for a widespread fungal infection. What teaching points would the nurse include?
A. Explain the rationale for using both medications concurrently.
B. Emphasize the importance of completing the full course of both medications.
C. Provide instructions on how to apply the topical medication and use the oral medication.
D. All of the above.
D
Rationale: All of these teaching points are important for medication adherence and successful treatment.
Infestations and insect bites
What are the clinical manifestations of bedbug bites?
Wheal surrounded by vivid flare
Firm hives transforming into persistent lesion
Severe itching
Often grouped in threes appearing on uncovered parts of body
Infestations and Insect Bites
What are the treatments/prognosis of bedbug bites?
Lesions usually require no treatment
Severe itching may require use of antihistamines or topical corticosteroids
Infestations and Insect Bites
What are the clinical manifestations of bees & wasps bites/stings?
Intense, burning, local pain
Swelling and itching
Severe hypersensitivity may lead to anaphylaxis
Infestations and Insect Bites
What are the treatments/prognosis of bees & wasps bites/stings?
Cool compresses
Local application of antipruritic lotion
Antihistamines if indicated
Usually uneventful recovery
Infestations and Insect Bites
What are the clinical manifestations of pediculosis?
Head Lice, Body Lice, Pubic Lice
Minute, red, noninflammatory
Points flush with skin. Progression to papular wheal-like lesions
Itching
Secondary excoriation, especially parallel linear excoriations in intrascapular region
Nits and eggs firmly attached to hair shaft in head and body
Infestations and Insect Bites
What are the treatments/prognosis of pediculosis?
Head Lice, Body Lice, Pubic Lice
γ-Benzene hexachloride or pyrethrins to treat various parts of body
Spinosad (Natroba) topical suspension 0.9% to treat scalp and hair
Screen and treat close contacts (e.g., bed partners and playmates) as needed
Do not share head gear
Medicated Shampoo: Educate on the proper use of pediculicidal shampoo (e.g., pyrethrin [RID]). Follow the directions carefully, including how long to leave the shampoo on the hair.
Nit Removal: Use a fine-tooth comb (nit comb) dipped in vinegar to remove nits (lice eggs) from the hair shaft. This is a crucial step, as remaining nits can hatch and cause reinfestation.
Infestations and Insect Bites
What are the clinical manifestations of scabies?
Severe itching, especially at night, usually not on face
Presence of burrows, especially in interdigital webs, flexor surface of wrists, genitalia, and anterior axillary folds
Red papules (may be crusted), possible vesiculation, interdigital web crusting
Infestations and Insect Bites
What are the treatments/prognosis of scabies?
5% permethrin topical lotion, 1 overnight application with second application 1 wk later, may yield 95% eradication
Treat all family members, treat environment with plastic covering for 5 days, launder all clothes and linen with bleach
Treat sexual partner
Antibiotics, if secondary infections present
Possible residual itching up to 4 wk after treatment
Recurrence possible if not adequately treated
Infestations and Insect Bites
What are the clinical manifestations of ticks?
Spreading, ring-like rash 3–4 wk after bite
Rash common in groin, buttocks, axillae, trunk, and upper arms and legs
Warm, itchy, or painful rash
Flu-like symptoms
Cardiac, arthritic, and neurologic manifestations possible
Unreliable laboratory test
Infestations and Insect Bites
What are the treatments/prognosis of ticks?
Oral antibiotics, such as doxycycline
IV antibiotics for arthritic, neurologic, and cardiac symptoms
Rest and healthy diet
Most patients recover
Patient Education: Pediculosis (Lice)
What are primary symptom, enviromental measures, & prevention measures of pediculosis (lice)?
Emphasize that having lice is not related to personal hygiene.
Symptoms: Intense itching is the primary symptom.
Environmental Measures:
* Disinfection: All articles of clothing and bedding must be disinfected. Washing in hot water and drying on high heat is effective. Dry cleaning is an alternative.
* Vacuuming: Vacuum furniture and floors frequently to remove any shed lice or nits.
Prevention:
* Avoid Sharing: Do not share combs, hats, scarves, hair accessories, or other personal items.
Treatment of Contacts: All family members and close contacts should be treated simultaneously, even if they are not experiencing symptoms, to prevent reinfestation.
Which of the following instructions should be included in the patient education for someone with pediculosis (lice)?
A. “Use the medicated shampoo as directed, repeating in 7-10 days if instructed.”
B. “Wash all clothing and bedding in cold water.”
C. “Use a fine-tooth comb dipped in vinegar to remove nits.”
D. “Vacuum all furniture and floors thoroughly.”
E. “Avoid sharing hats, combs, and other personal items.”
A, C, D, E
Rationale: These are all important instructions. Hot water, not cold water, is needed for washing clothes and bedding.
Patient Education: Pediculosis Corporis and Pubis
What are the associated factors, treatments, & evironmental measures of body lice?
Pediculosis Corporis - Body Lice
Associated Factors: Often linked to poor hygiene and those living in close quarters (e.g., homeless shelters, refugee camps).
Treatment:
* Hygiene: Emphasize the importance of regular bathing with soap and water.
* Medications: If good hygiene is not effective, prescription scabicides or over-the-counter permethrin (NIX) can be used.
Environmental Measures: Washing all clothing and bedding in hot water or dry cleaning is essential.
Patient Education: Pediculosis Corporis and Pubis
What are the transmission, treatments, & testing of/for pubic lice?
Pediculosis Pubis - Pubic Lice
Transmission: Primarily spread through sexual contact.
Treatment:
* Medications: Similar to body lice, prescription scabicides or over-the-counter permethrin (NIX) can be used.
* Eyelash Involvement: If eyelashes are involved, Vaseline may be applied twice a day for 8 days, and nits should be mechanically removed.
Testing: Schedule a checkup for the patient and partner to assess for coexisting sexually transmitted diseases.
Partner Notification: Treat all family members and sexual contacts and instruct on personal hygiene.
Patient Education: Pediculosis Corporis and Pubis
What are the key differences of pediculosis corporis & pediculosis pubis?
Pediculosis Corporis: Focus on hygiene measures as the primary intervention. Medication is secondary if hygiene alone is ineffective.
Pediculosis Pubis: Emphasize the sexual transmission aspect and the importance of partner notification and testing for STIs.
Which of the following are important patient education points for someone diagnosed with pediculosis corporis?
A. “Practice good personal hygiene, including regular bathing with soap and water.”
B. “All sexual partners need to be treated concurrently.”
C. “Wash all potentially contaminated clothing and bedding in hot water.”
D. “Use a nit comb to remove nits from the hair.”
E. “If hygiene measures are not effective, use a pediculicide medication as directed.”
A, C, E
Rationale: Hygiene is the priority for corporis. Hot water washing is crucial. Medication is used if hygiene fails. Sexual partners are relevant for pubis, and nit combing is more emphasized in capitis and sometimes pubis when eyelashes are involved.
Patient Education: Scabies
What is the mean of tranmission of scabies?
Scabies mites are highly contagious and frequently involve the fingers. Hand contact can easily spread the infection. Healthcare personnel should wear gloves when caring for suspected scabies cases until the diagnosis is ruled out.
Patient Education: Scabies
What should you tell your pt. with scabies about their treatment?
Take a warm, soapy bath and allow the skin to cool before applying medication.
Medication Application: Apply the prescription 5% permethrin cream to the entire body from the neck down, avoiding the face and scalp (unless otherwise directed by the healthcare provider). Leave the cream on for 12 to 24 hours (or as directed).
Environmental Measures: Wash all clothing and bedding in hot water and dry them on high heat. Items that cannot be washed can be dry-cleaned or sealed in a plastic bag for at least 5 days.
Retreatment: Repeat the permethrin treatment in 1 week to kill any newly hatched mites.
All close contacts should be treated at the same time, even if they are not experiencing symptoms, to prevent ongoing transmission.
Patient Education: Scabies
What should you tell a pt. who continues to complain of itching for several weeks after successful treatment of scabies?
Itching can persist after successful treatment due to the body’s reaction to dead mites and their byproducts. It does not necessarily indicate treatment failure.
Allergic and Benign Skin Conditions
What are the cause, symptoms, & treatments of/for allergic contact dermatitis?
Cause: Inflammatory response to an allergen or irritant. Common culprits include soaps, detergents, heat, cold, and frequent handwashing.
Symptoms: Itching, burning, redness, dryness, peeling, and red papules. The rash often takes the shape of the causative agent (e.g., a band-like rash from a watchband allergy).
Treatment:
* Barrier Creams: Like CeraVe, to protect the skin.
* Topical or Oral Corticosteroids: To reduce inflammation.
* Antihistamines: To relieve itching.
Allergic and Benign Skin Conditions
What are the cause, symptoms, & treatments of/for allergic contact psoriasis?
Cause: Autoimmune basis.
Symptoms: Silvery plaques, often found on elbows, knees, and scalp.
Treatment:
* Removal of Plaques: Baths with oils can help soften and remove plaques.
* Emollient Creams: To moisturize and soothe the skin.
* Corticosteroids: To reduce inflammation.
* UV Light Therapy: Can help slow skin cell growth.
* Methotrexate & Stelara: Systemic medications used for more severe cases.
A client with psoriasis reports experiencing a flare-up of their symptoms. What factors would the nurse assess to identify potential triggers for the flare-up?
A. Recent illnesses or infections
B. Stress levels
C. Changes in medications or skincare routine
D. All of the above
D
Rationale: Infections, stress, and changes in routine can all trigger psoriasis flare-ups.
Contact Dermatitis
How do irritant contact dermatitis & allergic contact dermatitis differ?
Irritant Contact Dermatitis: Caused by direct damage to the skin from chemical or physical irritants (e.g., soaps, detergents, solvents, friction).
Allergic Contact Dermatitis: Triggered by an allergen that causes a delayed hypersensitivity reaction (e.g., poison ivy, nickel, fragrances).
Contact Dermatitis
How is contact dermatitis diagnosed?
Through Patch Testing: Applying small amounts of suspected allergens to the skin to identify specific substances causing the reaction.
Contact Dermatitis
What are some ways to manage contact dermatitis?
Avoid Known Irritants: This is the cornerstone of management. Once identified, strict avoidance is essential.
Symptom Relief: Treatments are similar for both irritant and allergic contact dermatitis and focus on relieving itching and inflammation (e.g., topical corticosteroids, antihistamines, cool compresses).
Which of the following factors are important to consider when assessing a patient for contact dermatitis?
A. Personal history of allergies
B. Family history of allergic conditions
C. Recent exposure to potential irritants or allergens
D. Use of fragrance-free products
E. Presence of silvery plaques
A, B, C
Rationale: Allergies, family history, and exposures are key. Fragrance-free products are a preventative measure, not directly assessed. Silvery plaques suggest psoriasis, not contact dermatitis.
Cutaneous Drug Reactions: SJS and TEN
What are Stevens-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN)?
Description: Severe, potentially life-threatening mucocutaneous reactions, often triggered by medications. TEN is generally considered a more severe form of SJS.
Onset: Typically occurs 4-21 days after starting the offending drug, but can sometimes happen sooner with re-exposure.
Cutaneous Drug Reactions: SJS and TEN
What are some clinical manifestations of Stevens-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN)
Prodrome: Fever, malaise, cough, sore throat, and burning eyes may precede skin lesions.
Skin Lesions: Erythema (redness), bullae (large blisters), and desquamation (shedding of skin) resembling burns. Lesions often start on the face and trunk and spread.
Mucosal Involvement: Affects mucous membranes (mouth, eyes, genitals), causing pain, ulceration, and difficulty eating or drinking.
Systemic Symptoms: Fever, chills, fatigue, and potentially multi-organ involvement (kidneys, lungs).
Cutaneous Drug Reactions: SJS and TEN
What are some treatments for SJS & TEN?
Identify and Stop Offending Drug: This is the priority.
Supportive Care:
* Burn Unit Care: Focused on fluid and electrolyte balance, wound care, etc.
* Pain Management
* Nutritional Support: Oral intake may be limited due to mucosal involvement, so alternative feeding methods may be needed.
* Eye Care
* Infection Control
* Temperature Regulation: Difficulty maintaining body temperature due to skin loss.
Which of the following are characteristic features of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)?
A. Rapid onset of rash immediately after taking a medication.
B. Skin lesions resembling burns with bullae formation and desquamation.
C. Involvement of mucous membranes.
D. Fever and flu-like symptoms preceding skin lesions.
E. Often triggered by viral infections.
B, C, D
Rationale: SJS/TEN presents with burn-like lesions, mucosal involvement, and often a prodrome of fever and flu-like symptoms. While drug reactions are the most common cause, some cases can be due to infections. The reaction typically occurs days to weeks after starting the medication, not immediately.
A patient is diagnosed with TEN. What trends would the nurse anticipate in the patient’s plan of care?
A. Strict isolation due to the contagious nature of the rash.
B. Care similar to that of a burn patient, including fluid management and wound care.
C. Focus on managing pain and providing nutritional support.
D. Both B and C.
D
Rationale: TEN is not contagious, so isolation is not required. However, the skin manifestations are similar to burns, requiring specialized care, along with addressing pain and nutrition.
Interprofessional Care for Dermatologic Problems
What are some examples of interprofession care for dermatologic problems?
Phototherapy
Radiation therapy
Laser technology
Drug therapy
Interprofessional Care for Dermatologic Problems
What kind of drugs are used in drug therapy of dermatologic problems?
Antibiotics
Corticosteroids
Antithistamines
Topical flurouracil
Immunomodulators
A patient is undergoing radiation therapy for skin cancer. What trends would the nurse anticipate in the patient’s care?
A. Monitoring for skin reactions in the treated area
B. Education on protecting the treated area from sun exposure
C. Assessment for signs and symptoms of infection
D. All of the above
D
Rationale: Radiation can cause skin reactions, sun protection is crucial post-treatment, and any break in the skin increases infection risk.
Diagnostic and Surgical Therapy for Skin Conditions
What is the procedure and purpose of the following diahnostic/surgical therapies?
Skin Scraping
Electrodesiccation and Electrocoagulation
Curettage
Skin Scraping:
* Procedure: A small sample of skin is scraped off and examined under a microscope.
* Purpose: To diagnose fungal infections, scabies, and other skin conditions.
Electrodesiccation and Electrocoagulation:
* Procedure: Uses an electric current to destroy tissue.
* Purpose: To treat warts, skin tags, and other benign lesions.
Curettage:
* Procedure: Uses a curette (a sharp, loop-shaped instrument) to scrape away tissue.
* Purpose: To remove superficial skin lesions, such as actinic keratoses or small skin cancers.
Diagnostic and Surgical Therapy for Skin Conditions
What is the procedure and purpose of the following diahnostic/surgical therapies?
Punch Biopsy
Cryosurgery
Excision (including Mohs Surgery)
Punch Biopsy:
* Procedure: Removes a small, circular piece of skin using a punch tool.
* Purpose: To diagnose various skin conditions, including skin cancer, inflammatory conditions, and infections.
Cryosurgery:
* Procedure: Freezes tissue using liquid nitrogen.
* Purpose: To treat warts, skin tags, actinic keratoses, and some skin cancers.
Excision (including Mohs Surgery):
* Procedure: Surgical removal of tissue.
* Purpose: To remove skin cancers (melanoma, basal cell carcinoma, squamous cell carcinoma) and other skin lesions.
* Mohs Surgery: A specialized technique for skin cancer removal where tissue is examined microscopically layer by layer during surgery to ensure complete removal of the cancer. Often used for cancers in cosmetically sensitive areas.
Which of the following procedures are used to diagnose skin conditions?
A. Skin scraping
B. Electrodesiccation
C. Punch biopsy
D. Cryosurgery
E. Mohs surgery
A, C
Rationale: Skin scraping and punch biopsy are primarily diagnostic. The other procedures are primarily treatment methods.
Nursing Management for Dermatologic Problems
What are methods of nursing management for dermatologic problems?
Wet Compresses:
Purpose: Can be used to soothe inflamed skin, reduce itching, and promote healing.
Baths:
Purpose: Can help cleanse the skin, soften crusts or scales, and provide relief from itching.
Hygienic Practices:
Importance: Maintaining good hygiene is essential to prevent secondary infections and promote healing.
Topical Medications:
Types: Include a wide range of creams, ointments, lotions, and gels containing corticosteroids, antibiotics, antifungals, or other active ingredients.
A client is being treated for an extensive poison ivy rash. What trends would the nurse anticipate in the client’s plan of care?
A. Use of wet compresses to relieve itching and inflammation
B. Prescription for oral corticosteroids to reduce the allergic response
C. Education on measures to prevent future exposure to poison ivy
D. All of the above
D. All of the above
Nursing Management: Control of Pruritus
What are the goal, strategies, & medications used for control of pruritus
Goal: Break the itch-scratch cycle to prevent skin damage and promote healing.
Strategies:
* Cool Environment: A cool environment can help reduce itching.
* Hydration: Keeping the skin hydrated is essential. This can be achieved through:
- Wet Compresses: Help soothe irritated skin.
- Moisturizers: Apply immediately after bathing to lock in moisture.
Medications:
* Topical and Injectable Corticosteroids: Reduce inflammation, which can contribute to itching.
* Systemic Antihistamines: Block histamine release, reducing itching.
Prevent Lichenification: Lichenification (thickening of the skin due to chronic scratching) can worsen itching. Patient education on avoiding scratching is essential.
Which of the following interventions are appropriate for managing pruritus (itching)?
A. Applying a warm compress to the affected area.
B. Encouraging the patient to scratch the itchy area to relieve the urge.
C. Using moisturizers liberally, especially after bathing.
D. Administering antihistamines as prescribed.
E. Maintaining a cool environment.
C, D, E
Rationale: Moisturizers, antihistamines, and a cool environment can help alleviate itching. Warm compresses can exacerbate itching, and scratching should be avoided as it can worsen the condition and lead to lichenification.
A client with chronic pruritus due to atopic dermatitis (eczema) is being discharged home. What teaching points would the nurse emphasize to help the client manage itching at home?
A. Avoid scratching and keep nails trimmed short.
B. Apply moisturizers liberally immediately after bathing.
C. Use cool compresses or take cool showers as needed.
D. All of the above.
D. All of the above.
Nursing Management: Prevent Spread, 2ndary Infections, & Post-Procedure Care
What are some nursing interventions to prevent the spread of dermatologic problems?
Contact Precautions: For contagious skin conditions (e.g., bacterial infections like MRSA, viral infections like herpes zoster in disseminated form, scabies), use gloves and gowns as appropriate.
Hand Hygiene: Frequent and thorough hand washing is crucial for all skin conditions, especially infections.
Patient Education: Teach patients and families how to prevent the spread of infection (e.g., avoiding sharing personal items, proper hygiene).
Nursing Mana.t: Prevent Spread, 2ndary Infections, & Post-Procedure Care
What are some nursing interventions to prevent secondary infections?
Skin Care: Maintain skin integrity by keeping the skin clean and moisturized. Avoid scratching, which can create open wounds.
Wound Care: If there are open wounds or lesions, follow proper wound care techniques to prevent infection.
Monitoring: Observe for signs of infection (e.g., increased redness, swelling, warmth, pain, purulent drainage, fever).
Nursing Mana.t: Prevent Spread, 2ndary Infections, & Post-Procedure Care
What are some nursing interventions for post-procedure care (dermatologic problems)?
Wound Care: Provide specific instructions on how to care for the wound based on the procedure performed (e.g., biopsy, excision, laser treatment).
Pain Management: Address any pain or discomfort associated with the procedure.
Monitoring: Observe for complications such as bleeding, infection, or delayed healing.
Cosmetic Procedures
What are descriptions of the following cosemtic procedures?
Topical procedures
Injection therapies
Surgical therapies
Topical Procedures:
Description: Application of creams, lotions, or serums to improve skin texture, reduce wrinkles, lighten dark spots, or treat acne.
Injection Therapies:
Description: Injecting substances into the skin to reduce wrinkles, restore volume, or enhance features.
Surgical Therapies:
Description: Invasive procedures to reshape or alter facial features or body contours.
- Laser surgery
- Face lift
- Lipsuction
Nursing Management: Cosmetic Surgery
What are some compents of preoperative management?
3
Informed consent
Realisitic expectations
- Open communication about the achievable outcomes of the surgery is essential.
- Nurse’s Role: Helps the patient understand the limitations of the procedure and manage expectations regarding results.
Patient teaching
Nursing Management: Cosmetic Surgery
What are some compents of postoperative management?
Pain Management
Monitoring for Signs of Infection and Adequate Circulation
Skin Grafts and Related Procedures
What are some uses of skin grafts?
Coverage of wounds: Skin grafts are used to cover areas where skin has been lost due to burns, trauma, surgery, or ulcers.
Improvement of function: They can improve function in areas where scarring restricts movement.
Cosmetic appearance: Skin grafts can improve the cosmetic appearance of scars or areas of skin discoloration.
Skin Grafts and Related Procedures
What are free grafts? Types?
Definition: A section of skin is completely detached from the donor site and transferred to the recipient site.
Types:
* Autograft: Uses the patient’s own skin (from another part of the body). This is the preferred type due to the lower risk of rejection.
* Isograft: Uses skin from an identical twin. This is also associated with a very low risk of rejection but is rarely an option.
* Reconstructive Microsurgery: Involves transplanting skin along with blood vessels and sometimes muscle or bone. This is used for larger or more complex defects.
Skin Grafts and Related Procedures
What are skin flaps? Advantages?
Definition: A section of skin and underlying tissue is moved to a nearby area while still attached to a blood supply.
Advantages: Flaps provide better coverage and thickness than free grafts, making them suitable for weight-bearing areas or areas requiring padding.
Skin Grafts and Related Procedures
What are engineered skin substitutes? Uses?
Definition: Laboratory-grown skin or skin substitutes made from collagen, hyaluronic acid, or other materials.
Uses: Used for burns, chronic wounds, or other situations where donor skin is not available or suitable.
Which of the following are common uses of skin grafts?
A. Coverage of wounds from burns
B. Improvement of function in scarred areas
C. Treatment of skin cancer
D. Enhancement of cosmetic appearance
E. Reduction of wrinkles
A, B, D
Rationale: Skin grafts are used for wound coverage, functional improvement, and cosmetic enhancement. Skin cancer treatment typically involves excision, radiation, or chemotherapy, not grafting. Wrinkle reduction is typically addressed with cosmetic procedures like Botox or fillers, not grafts.
A patient is scheduled for a skin graft after a burn injury. Which type of graft would the nurse anticipate being used if the patient has sufficient donor skin available?
Allograft
Xenograft
Autograft
Engineered skin substitute
The nurse would highlight “Autograft”.
