Exam 2 Content Flashcards
Skin layers superficial -> deep
epidermis, dermis, hypodermis (subcutaneous)
layer of the skin that is avascular, and contains keratin & melanin
Epidermis
Layer of the skin that contains nerves, blood vessels, and sensory receptors.
Dermis
Layer of the skin that contains connective tissues, fat cells, macrophages, fibroblasts, nerves, and large blood vessels
Hypodermis (subcutaneous)
Cause of goose bumps
Arrector pili muscle associated with hair follicle
Ways to control body temperature
Vasodilatation and increased sweating
what do sebaceous glands produce and what does it inhibit?
sebum, inhibits bacterial growth
Functions of the skin
first line of defense controls body temperature synthesizes vitamin D active in sensory perception prevents excessive fluid loss
causes of lesions
systemic disorders
systemic infections
allergies to food or drug
exposure to toxins
test that detects malignancy
biopsy
example of blood test
Scratch test (antigens injected on back to find out what you’re allergic to)
Caused by direct irritation of skin
Contact dermatitis
Examples of contact dermatitis
poison ivy, latex, adhesives
Releases histamine and result is hives scattered all over. Highly pruritic.
urticaria
How to decrease immune response to Type I Hyersensitivity
drug- antihistamine and steroids
Inherited hay fever, pollen and asthma
Inherited tendency
Atopic Dermatitis
Eczema
Characterized by dry, scaly, lichenification skin on the flexor areas (elbow and knee) in adults
Atopic Dermatitis (Eczema)
Characterized by pruritic lesions that are moist, red, vesicular, and covered with crusts in children
Atopic Dermatitis (Eczema)
Onset in the teen years
Results from abnormal T-Cell activation
Lesions
Psoriasis
Lesions start as red papule, progresses to silvery plaque. Commonly found on the face, scalp, elbows, and knees
Psoriasis
Treatment of Psoriasis
Glucocorticoids
Tar preparations
Antimetabolite
Infection of dermis and subcutaneous tissue, area is red, swollen, painful with red streaks running up lymph vessels.
Cellulitis
Bacterial Infections
Cellulitis
Foruncles (Boils)
Impetigo Contagiosa
Acute Necrotizing Fasciitis
Boils in the nasal cavities can result in…?
thrombi or infection can spread to brain
Inflammatory Disorders
Contact Dermatitis
Urticaria
Atopic Dermatitis (Eczema)
Psoriasis
Usually caused by Staph. aureus Begins at hair follicles Common on the face, neck, and back Frequently drains large amounts of puss Squeezing them can result in the spread of infection to other areas
Foruncles (Boils)
Transmission of this bacterial infection may occur through close physical contact or through fomites. Is characterized by lesions that begin as small vesicles that rupture to form yellowish-brownish crusty masses.
Impetigo Contagiosa
Flesh Eating Disease
Acute Necrotizing Fasciitis
Characterized by rapid tissue invasion that begins with a minor trauma/infection, then bacteria secrete enzymes that destroy tissue and toxins that cut off blood supply to tissues.
Acute Necrotizing Fasciitis
Occlusion of small blood vessels leads to….?
gangrene
Delay in treatment of Acute Necrotizing Fasciitis can cause …?
Potential Amputation
Greater tissue loss
higher mortality
Acute Necrotizing Fasciitis can be confused with what minor bacterial infection?
Cellulitis
Acute Necrotizing Fasciitis can cause what in systemic toxicity?
Fever
Tachycardia
hypotension
possible organ failure
treatment of Acute Necrotizing Fasciitis
Aggressive antibiotic therapy
Excision of all infected tissue
Hyperbaric chamber treatment
The test that detects malignancy
biopsy
usual cause of cold sores or fever blisters ?
HSV1
Type of chronic inflammation that has an inherited tendency and is a response to allergens
Eczema
The substance that provides water proofing to the body
Keratin
Type of wart that is caused by HPV 1-4 and is seen on the bottom of the foot
Plantar
Type of fungi that causes thrush or vaginal yeast infection
candida
Electrolyte that should by maintained at level 3.5-5.0 in the blood
Potassium
Mass of sebum, Keratin and debris blocking the opening of a hair follicle
Comedone
Tinea Unguium causes infection in this part of the body
Nails
Medication used to treat herpes infections
Acyclovir
If allergic to this substance, the Gardasil immunization is contraindicated
Yeast
What is released with a hypersensitivity reaction that causes urticaria and pruritis.
Histamine
This should be given to treat the common side effect of Amphoteracin B- primarily favor/chills
Tylenol
Type of treatment for necrotizing fasciitis
Hyperbaric
type fo lesion that contains purulent exudate
pustule
Increasing mass of collagen resulting from scar formation
keloid
sweat glands located in the axillae
appocrine
only type of drugs that actually destroys virions
immunoglobulins
another name for a boil
foruncle
Used to treat systemic fungal infections
Amphotericin B
Type of cancer cell that grows slowly and has an excellent prognosis if removed quickly
Squamous
Tingling and burning in the extremities are all signs of this
Neurotoxicity
Another name for lozenge
Troche
Another name for Tinea Corpis
Ringworm
Medication given to reduce duration of the flu
Oselatamivir
Thick, dry, leather-like surface
Lichenification
Decreased urine output and elevation of BUN and Creatinine are signs of this
Nephrotoxicity
Palpable lesion; varies in size
Nodule
Prescription medication used to treat more difficult superficial fungal infections
Ketoconazole
Malignant melanoma develops here
Melanocytes
Kaposis sarcoma occurs in individuals with this disease and other immunodeficiencies
AIDS
This may occur with certain types of HPV and is the primary reason Gardasil is given to both boys and girls.
Cancer
Monitor ALT/AST if worried about this organ
Liver
Type of dermatitis caused by irritation of the skin
Contact dermatitis
if acyclovir is taken at the first sign of a recurrent episode of herpes, this may be prevented
Breakout
Condition in which there are areas of hypo-pigmentation on the body
Vitiligo
flat lesion
macule
Time of a woman life in which HPV grows and spreads
Pregnancy
Middle layer of the skin
Dermis
Inflammatory skin condition that has lesions that are covered in silvery plaque
Psoriasis
Medication used to treat Thrush that must be swished and swallowed
nystatin
The vitamin that is synthesized by the skin upon exposure to ultraviolet light
Vitamin D
Non-prescribed drug that can be used for superficial fungal infections
Miconalzole
Infection of Dermis and Subcutaneous tissue secondary to injury
Cellulitis
Following a cold sore, viral particles are present in this fluid for weeks after healing of blister
saliva
Elevated lesion with flat surface topped with scale
Plaque
oily secretion that protects us from bacterial growth
sebum
Small deep linear crack or tear in the skin
Fissure
Oseltamivir must be taken within this many days of symptoms of flu or it will do no good
two
What occurs when the individual with a skin infection spreads the lesions to other parts of the body
Autoinnoculation
type of test done to test for allergies
scratch test
another name for a blister
vesicle
One of the ways our skin controls body temperature
vasodilation
Medicine used to treat vaginal yeast infections- single dose
Fluconazole
Shallow moist cavity in epidermis
Erosion
Warning symptoms that a breakout of genital herpes is occurring
Tingling
Tinea Capitis
infection of scalp
Firm elevated lesion
papule
Cavity with loss of tissue from epidermis and dermis
Ulcer
This is delayed in children taking high doses of steroids
growth
Caused by a shift in protein and fluids into interstitial spaces
Edema
Drug that prevents platelets aggregation
Aspirin
Type of purulent exudate in solid tissue
Abscess
This odor warns patients that aspirin is no longer good to use
Vinegar
Foreign body that causes inflammation
Splinter
Skin and mucous membranes are a type of this first line of immunity
Innate
This may be lost if edema interferes with a joints ability to work
Function
Most widely prescribed oral glucocorticoid drug
Prednisone
This type of mesh forms and isolated injury
Fibrin
Types of diseases that are considered chronic inflammatory conditions
Autoimmune
Induces fever
Cytokines
Caused by pyrogen release
fever
This degree of burn involves the epidermis and part of the dermis with blisters
second
Injectable NSAID
Ketorolac
No not give aspirin to children due to increased risk for this syndrome
Reyes Syndrome
Patients with diabetes will need to increase their dosage of this drug when taking corticosteroid therapy
Insulin
Part of healing of burns
Metabolism
This degree of burn involves the epidermis and the dermis without blisters
first
Functional tissue is replaced by scab tissue in this type of healing
replacement
Type of exudate that contains microorganisms
Purulent
Given with high dose NSAID therapy to protect the stomach against ulcers
Misoprostel
Crisis that may result if steroids are rapidly withdrawn
Addison
Increase in WBC count
Leukocytosis
Dosages such as 650 mg daily or PRN are ordered to relieve this complaint
Pain
Property of NSAID that lowers fever
Antipyretic
Scar formation may result in these that fixate at joint and prevent movement
Contractures
System at risk when COX1 is blocked by NSAID action
GI
Steroids should be discontinued this way
tapered
Type of exudate that increases risk of scar tissue
Fibrinous
Caustic chemical that causes inflammation
Acid
Generic name for a common NSAID
Ibuprofen
Common ending of glucorticoids
-sone
This organ must be watched when patient taking high doses of NSAIDS due to the fact acute failure is a possibility
Renal
Patients should take their steroids at this time of day
Morning
Symptom of adult salicylism
Tinnitus
The process of removing damaged tissue and foreign materials in burns to enhance healing
debridement
This degree of burn has charred skin
third
Fluid, carbon dioxide, and other wastes move across the capillary on the venous end based on this pressure
osmotic
Large doses of steroids may cause retention of this in the body which puts extra workload on the heart
Fluid
Severity of inflammation depends on cause and…?
Duration
Inflammation of a sprain or strain would have ….. timing?
Immediate
Fluids, electrolytes, oxygen and nutrients move across the capillary on the arterial end based on this pressure
hydrostatic
Symptom of child salicylism
drowsiness
Individuals taking high doses of NSAID therapy must discontinue therapy this many weeks in advance of surgery
one
Infection is a cause of…?
Inflammation
After using inhaled corticosteroids, the patient needs to do this to his mouth
rinse
Part of RICE therapy that reduces fluid accumulation
compression
Type of healing that occurs with minimal tissue damage
Resolution
Type of healing in which cells replaced with similar cells
regeneration
Part of RICE therapy that causes vasoconstriction
Ice
Means increased blood flow
Hyperemia
Inflammation related to sunburn would have what timing?
Delayed
This scar is formed by excessive collagen deposits
Keloid
Common ending of inflammatory disorders
-itis
Limit this drug to 3000 mg/day
Acetaminophen (Tylenol)
Do not apply this over Fentanyl patches or may cause an overdose
heat
Ability to withstand pain before taking action
Tolerance
Theory shows us we can modify entry of pain into brain and spinal cord
Gate Control Theory
This syndrome may occur when taking both Tramadol and SSRI’s
Serotonin Syndrome
Nerve endings found in tissues that is responsible for somatic and visceral pain transmission
Nociceptors
Most popular anesthetic used
Lidocaine
The fibers that conduct pain impulses
Afferent
A chemical transmitter of pain and inflammation
prostaglandins
Pain caused by trauma to peripheral nerves
Neuropathic
Drug given to reverse malignant hyperthermia along with supportive care
Dantrolene
Fibers that tell the muscles to move away from pain
Efferent
This adverse reaction of opioid therapy never goes away
Constipation
This drug given for moderate sedation along with Fentanyl that specifically causes amnesia
Midazolam
Type of anesthesia that causes elimination of pain sensation in specific area only.
Local
Drug used to treat acetaminophen overdoses
Acetylcysteine
This hyperthermia may occur during or after general anesthesia is given and involves a very high temp. and muscle rigidity
Malignant
Many drugs work to relieve pain by depressing this system
RAS (Reticular Activating System)
Physical evidence of pain
tachycardia, sweating or pallor, high blood pressure
Somatic pain is best addressed using these medications
NSAIDS
Example of parenteral anesthesia injected into CNS
Epidural
Medication added to local anesthesia to help confine anesthetics to injected area and reduce blood loss
Epinephrine
This type of pain is in the bones
Somatic
Opiate like chemical that makes us feel better
Endorphines
This side effect of morphine is a reaction to histamine release , not allergy
Itching
One of the many symptoms of withdrawal
Diarrhea
Decreases pain tolerance
Fatigue and stress
Naloxone (Narcan) should be administered for respirations less than this number caused by opioids
12
Encourage increase of fluids, activity and this to help with constipation
fiber
Type of dependance that is driven by continued craving for opioids for effects other than pain relief
Psychological
This drug that can never be given to those addicted to opioids or those on chronic opioid therapy for chronic pain
Nalbuphine
avoid this drug when on opioid therapy to avoid additive effects
alcohol
This type of pain is in the organs
Visceral
Neuropathic pain is best addressed when using these medications
Antidepressants + Anticonvulsants (aka Gabapentin)
Depression of this system may lead to respiratory depression
CNS
Pain in lost limb
Phantom
Drug that reverses opioid overdoses
Naloxone
Rotate this when switching transdermal patches
sites
Cause of inflammation due to decreased oxygen
Ischemia
Increases pain tolerance
Diversion, rest, medications
The level of stimulation required for someone to perceive pain
Threshold
Drugs that reduce or eliminate pain by depressing CNS and PNS
Anesthetics
Allows us to determine site of damage after spinal cord injuries. Each spinal nerve conducts pain for specific part of body. Like a fuse box.
Dermatomes
Part of brain responsible for our emotional response to pain
Thalmus
Age group most sensitive to anesthetics
Elderly
5th vital sign
Pain
Acetaminophen causes damage to this organ if taken in high levels
Liver
Visceral pain is best addressed using these medications
Opioids
Type of pain causes by treatment and disease both
Cancer
Opioid used for severe pain
Morphine
This type of pain occurs in a location other than site of injury
Referred
Acronym used for pain assessment
OLDCARTS
This type of dependance are expected with long term opioid therapy
Physical
Pain that persists more than 6 months
chronic
Type of anesthesia which involves completely loss of consciousness
General
Technique used to relieve pain using Gate Control Theory
Massage + Ice
Somatic pain is best addressed using these medications
NSAIDS + Steroids
Analgesia Recommendations for mild pain (3)
ASA
Acetaminophen (Tylenol)
NSAIDS
Analgesia Recommendations for moderate pain (4)
Codine
Oxycodone
Percocet
Norco
Analgesia recommendations for severe pain (6)
Morphine Methadone Merperidine (Demerol) Oxycontin Hydromorphine (Dilaudid) Fentanyl Patches
Medications that relieve pain without causing loss of consciousness
Analgesics
Mechanism of Action for Opioids
Agonist and Partial Agonist
Extended release forms of Opioid Therapy
Oxycontin
MS contin
Adverse effects of Opioids (4)
CNS Depression (leads to respiratory depression, most serious side effect)
Nausea and Vomiting
Pupil constriction
Constipation
Opioid physical tolerance
Physiological adaptation of the body to the presence of an opioid
Opioid Partial Agonist
nalbuphine (Nubain)
Opioid Antagonist
Naloxone (Narcan)
Opioid withdrawal symptoms (12)
Anxiety Irritability Chills + hot flashes joint pain lacrimation rhinorrhea diaphoresis nausea vomiting abdominal cramps diarrhea confusion
Non-Opioid Analgesic Drugs
Acetaminophen (Tylenol Tramadol hydrochloride (Ultram)
non-opioid analgesic drug that does not have anti-inflammatory effects
Tylenol
Maximum daily dose of Tylenol for elderly, those with liver disease, or heavy alcohol abusers
2000mg/day
Acetaminophen should not be taken in the presence of
Drug allergy
Alcoholism
Liver Dysfunction
Nonpharmacological methods used to treat pain
distraction comfort measures hot or cold packs massage music, pet, art, physical therapies
opioid agonist’s (9)
Codeine Oxycodone Hydrocodone Morphine Dilaudid Meperidine Methadone Oxycontin Fentanyl
Location and characteristics of pain are perceived here
cerebral cortex
Location of stress response to pain
Hypothalmus
Three main pain receptors
Mu, Kappa, Delta
OLDCARTS
Onset Location Duration Characteristics Aggravates Relieves Timing Severity
Characteristics of Visceral pain
cramping, squeezing, pressure, dull and deep
Characteristics of somatic pain
aching, throbbing, constant, dull
characteristics of neuropathic pain
burning, knife-like, numbness or tingling, stick-like, radiating
Type of pain caused by profound loss of blood flow to organ or tissue
Ischemic pain
Symptoms of malignant hyperthermia
elevated body temp, tachypnea, tachycardia, muscle rigidity.
How is malignant hyperthermia caused by general anesthesia treated?
Like a life threatening emergency
cardiorespiratory supportive care
Dantrolene
Used for moderate sedation
Midazolam
Characteristics of moderate sedation
anxiety and sensitivity to pain are reduced
induces amnesia
patient able to respond to verbal commands
patient able to maintain airway
rapid recovery
Side effects of Lidocaine
slurred speech
muscle twitching
restlessness
seizures
Viral Infections
HSV-1
HSV-2
HPV (genital warts)
Influenza
Drug used to treat Herpes
acyclovir (Zovirax)
Used to treat Influenza
Oseltamivir (Tamiflu)
Antifungal used to treat Thrush
nystatin (Mycostatin)
Two forms Nystatin comes in
oral solution or troche
Antifungal Medications (7)
nystatin (Mycostatin) Miconazole (Monistat) Clotrimazole (Lotriman) ketoconazole (Nizoral) Fluconazole (Diflucan) Amphotericin B
Used to treat vaginal yeast infections
Fluconazole (Diflucan)
Large doses of Fluconazole (Diflucan) can cause…?
Altered sexual hormone synthesis (irregular periods)
used to treat systemic fungal infections
Amphotericin B
Adverse effects of Amphotericin B
Neurotoxicity Nephrotoxicity Potassium Loss ( Heart damage) Tachycardia chills faver hypotension headache nausea
Antiviral Meds
acyclovir (Zovirax)
oseltamivir (Tamiflu)
