Exam 4 Integument and Cancer

Question 1

What are the functions of the skin?

Answer 1

-Protection from excess water loss
-Barrier to bacteria and viruses, mechanical injury or trauma/exposure to the environment
-Regulation : primarily an insulator - temperature control
-Sensory perception (pain, touch, vibration, and pressure)
-Excretion and Lubrication : sweat glands and sebaceous
- Emotional expression
-Attraction to others : aroma

Question 2

What are sweat glands composed of?

Answer 2

Water, salts, ammonia, urea, and other wastes

Question 3

How many mL of fluid loss through the skin?

Answer 3

600-900 mL/day

Question 4

Does skin help with nonverbal communication?

Answer 4

Yes, is provides facial expressions that is a result from muscles pulling on the skin of the face.

Question 5

What are some large skin alterations sequelae?

Answer 5

-Increased infection potential
-Alteration in comfort
-Temperature regulation problems
-Need for increased body fluids, especially if lots of weeping
-Needs for increased protein in the diet to promote skin repair
-Growth and development alterations r/t loneliness, sensory deprivation, restraints, semi-isolation
-Disturbed body image
-Pain
-Isolation/mobility

Question 6

Types of isolation

Answer 6

Contact - gown and gloves (MRS.WEE)
Airborne - gown, gloves, mask-N95, in negative pressure room (My Chicken has TB)
Droplet - gown, gloves, mask, goggles (spread through coughing, sneezing, talking)

Question 7

Reverse isolation

Answer 7

Used to protect patient from other germs from other people as opposed to protecting ourselves from the patient

Question 8

Normal skin changes in children

Answer 8

-Heal quickly
-Bleed
-Susceptible to sun
-Greater exposure environmental
-Epidermis not well bonded to dermis
-Larger surface area/wt

Question 9

Normal skin changes in elderly

Answer 9

-Skin thinner
-Less Vascular
-More brittle nails
-Inadequate nutrition
-Wrinkling
-Alopecia
-Decreased melanin
-Declined ability to repair damage
-Decrease in SQ fat
-Atrophy apocrine and eccrine sweat glands

Question 10

How to keep normal skin healthy?

Answer 10

-Rest and sleep
-Exercise
-Hygiene
-Nutrition
-OTC (over the counter medication)

Question 11

What are key nutritional elements elderly tend to not get?

Answer 11

Protein, calories, and vitamins

Question 12

Eccrine sweat glands

Answer 12

Located - found on most of body, except the lips, ear canals, nail beds, labia minora, glans penis, and prepuce.
Function - cools body by evaporation, excrete waste products, and moisturize surface cells
Type -simple sweat gland

Question 13

Apocrine sweat glands

Answer 13

Location - mainly found in the axillary, genital, and breast areas
Function - secrete a thick milky substance that is naturally odorless, odor occurs when skin surface bacteria alter the secretions
Fact - they are always connected to a hair follicle, these glands enlarge and active at puberty because of reproductive hormones

Question 14

Incubation

Answer 14

No signs or symptoms

Question 15

Prodromal

Answer 15

Vague general symptoms

Question 16

Illness

Answer 16

Most severe signs and symptoms

Question 17

Decline

Answer 17

Declining signs and symptoms

Question 18

Convalescence

Answer 18

No signs or symptoms

Question 19

Most reportable diseases

Answer 19

Measles(rubella), plague

Question 20

Varicella Zoster - Chicken pox

Answer 20

-AKA - herpes virus
-Highly contagious
-Lifelong immunity once exposed
-Incubation 2-3 wks
-Prodromal - low grade fever, malaise, anorexia about 24 hrs before rash
-Contact, airborne, droplet objects
-Infectious from 1-2 days before lesion to all lesions crusted over (5-6 days)
-SE: secondary skin infections, CNS encephalitis, scaring, meningitis, Reye syndrome(avoid aspirin)
-Goal: Don’t remove crust (increases scaring), cut nails, mittens for itching, apply pressure to itch area, cool sponge bath, calamine lotion, fluids, baking soda, diphenhydramine or antihistamine if needed
-Most common in late winter, early spring
-Acute phase : lesions begin a red maculopapular rash, turns almost immediately to vesicles with erythemic base, vesicles ooze and crust, new crops continue 3-5 days, pruritis outstanding sx, pain

Question 21

Fifth’s Disease - ParavoVirus B-19

Answer 21

-AKA Erythema infectiosum
-Caused by airborne virus paravovirus B-19
-Droplet or blood
-Mild illness, starts with facial rash “slapped cheeks”, mild fever, HA, sore throat, joint pain
-Adults less rash, joint pain & swelling, flu like sx
-Incubation : 4-14 days, can be up to 21 days
-Rash appears in 3 stages
-1. Cheeks. erythema on face 1-4 d
-2. Maculopapular red spots appear 1 day after rash, symmetry, proximal to distal, last week or more
-3. Rash subsides but skin looks irritated and traumatized (sun, heat, cold, friction) can appear with cold or stress
-Tx= antipyretics, analgesics, anti-inflammatory, blood tx if transient aplastic anemia
-Complications : arthritis, arthralgia, myocarditis(rare)
-At risk children: sickle cell, aplastic anemia crisis
-Isolation not necessary as not infections by time rash on cheeks appears
-Pg women can work around but not care for children with this disease

Question 22

Roseola Infantum

Answer 22

-AKA Human Herpes Virus Type 6
-Contact, saliva of healthy adult
-Children under 3, peak 6-15 months
-Incubation : 5-15 days, passed through saliva of adults, usually unknown contact
-High fever 3-7 days in a child who appears well, then rash occurs
-Discrete rose pink macules or maculopapules first on trunck, then neck, face, and extremeities
-Rash is non-prurtic, fades on pressure 1-2 days
-Cervical, post auricular lymphadenophathy
-Can have inflammed throat, pharynx and cough as well
-Tx fever with antipyretic, fluids
-Complications : febrile seizures, encephalitis, lymphadenopathy

Question 23

Mumps

Answer 23

-AKA ParamyxoVirus
-Transferred saliva : direct or droplet
-Incubation 14-21 days and communicable immediately before and after
-Duration 10 days
-Prodromal low grade fever, malaise, HA, anorexia 24 hr then “earache”
-By day 3, painful enlargement of parotid unilateral/bilateral, so pain behind ear
-Tx analgesic, antipyretics, hot or cold packs, rest, fluid, bland or no chew foods
-Complications r/t infection or ear : meningitis, encephalitis, deafness, or orchitis, warmth, support, poss sterility from orchitis
-MMR vaccine

Question 24

Rubeola

Answer 24

-AKA measles virus
-Source : respiratory tract secretions, blood, urine of infected person
-Direct contact, dropelt, airborne, usu direct contact with droplets in winter
-Incubation 10-20 days, communicable 4 days before and 5 days after rash
-Prodromal (Catarrhal sx) most contagious, isolate from prodrome til 5 days after eruptive stage begins
-Earliest sx fever and malaise, then upper resp with fever, sore throat, URI-3Cs –coryza, conjunctivitis, and cough and koplik spots
-Fever high as 104 w/n 24 h rash
-Progression of rash : shows 3-4 d from promd start, rash is confluent maculopapules of rash trunk and face and discrete on extremities. Goes down face and down body. After 3-4 d of full rash then despquamation occurs
-Tx fever : bedrest, fluids, sleep, tepid baths, vaporizer, meds(children:ibuprophen, tylenol)
-Complications: OM, pneumonia, bronchiolitis, encephalitis, laryngitis
-Live vaccine

Question 25

Rubella

Answer 25

-AKA German Measles virus -Direct and indirect contact : direct through nasopharyngeal secretions, droplet -Person makes antibodies, so if exposed or vaccinated, resistance -Vaccine 12-18 mos, 2nd @ 36 mo -Incubation 14-21 days, communicable 7 days before and 5 days after rash -Prodromal absent in children, sx come with rash, adolescent and adults will have prodromal before rash -Sx in addition to rash: low grade fever for 1-5 days, w malaise, mild c's cough, conjunctivitis, congestion, sore throat, HA, anorexia, lymphadenopathy -Rash starts on face and spreads rapidly down and across body to trunk, arms, legs. Will fade out as it spreads so first day rash gone by day 3 when arms and leg opposite side -Requires no specific RX - antipyretics and analgesics -Isolate from pregnant women -Complications rare : congenital rubella syndrome -MMR vaccine

Question 26

Scarlet Fever

Answer 26

-AKA Beta Hemolytic Strepto A -Sx caused by toxins -Lasting immunity once episode occurs -Direct contact and large droplet -Incubation 2-5 days, communicable during acute phase about 10d -- respiratory -Most common 6-12 year old group, late winter & early spring -1st day = sore throat, abrupt fever(high 103-104), and pharyngitis, tachycardia due to fever, tonsils inflamed, uvula and throat beefy red, may vomit, HA, chills, malaise, abd pain & halitosis - 1st & 2nd days, tongue becomes white and furry - 3rd day papillae enlarge and tongue looks like white strawberry - 4th & 5th day, white coat goes away and "strawberry tongue" - Rash 12h after pharyngeal sx start, rash is enanthematous and exanthematous red pinpoint lesions blanche, rapid spread, face flushed, circumoral pallor. rash 1 wk, then desquamation -Tx : usu appear quite ill=need rest, comfort, soft or liquid diet, analgesic for pain and fever, penicillin or cephalosporin oral 10 days -Complications : otitis media, sinusitis, abscesses, acute rheumatic fever, and acute glomerulonephritis 2-3%

Question 27

Enterovirus genus

Answer 27

-AKA hand, foot, and mouth disease -Including polio, coxsackie, echo, & enteroviruses -Generally under 5y -Starts with fever, reduced appetite, sore throat, and malaise - 1-2 d after fever starts, small red spots that blister (painful) in mouth : can become ulcers - Rash with red spots, and sometimes blisters may develop over 1-2 days on the palms and soles, may appear on knees, elbows, buttocks, or genital area -Transmission : virus found in infected person's nose and throat secretions such as saliva, sputum, or nasal mucus, blister fluid, and feces -Complications : dehydration if unable to swallow, may show no symptoms at all, but still pass virus

Question 28

Disease with droplet precautions

Answer 28

-Adenovirus -Anthrax -Croup -Diphtheria, pertussis -Ebola -Rubella, Rubeola, Mumps -Meningitis -Meningococcemia -Parainfluenza -Parvovirus B19 -Plague -Pneumonia -Rabies -Respiratory syncytial virus -Rhinovirus -Scarlet fever -Streptococcus A

Question 29

Tick borne diseases

Answer 29

-Rocky Mountain Spotted Fever -Lyme disease -Nymph stage ticks most active in spring, and adults ticks in fall -Ticks must feed on host at least 12hrs to spread disease, so quick removal will prevent acquiring -To remove use tweezers as close to skin and pull straight & steady away from skin, treat site with antiseptic, make sure head was removed -Rash and flu like symptoms

Question 30

Rocky Mountain Spotted Fever

Answer 30

-AKA R. rickettsii -Wood, dog, or rabbit tick -Incubation 3-12 days, not communicable one person to another -Child : fever, severe HA, and measle like rash, begins ankles and wrists then palms, soles, back arms, thighs, chest -Bright red macules then hemorrhagic, untreated is FATAL -Tx easy with tetracycline (can stain non erupted teeth) -Infection includes lifelong immunity

Question 31

Lyme Disease

Answer 31

-AKA Spirochete Borrelia burgdorferi -Enters skin and bloodstream through saliva and feces of ticks -Must be on host 36-48 hr to tx spirochete -Bullseye from center of bite -Tips for avoiding : protective clothing when hiking in woods, light colored clothing, inspect skin after, report tick bite for early dx, DEET, clothing in hot dryer - 3 stages 1. 1-4 wks after bite, develop erythema migrans at site 3-30 days, usu 7 d, rash plus HA/flu like sx 2. Bullseye other places, serious systemic with cardiac, neuro and musculoskeletal wks after, bells palsy/cranial nerve VII most common 3. Late, MSK pain, arthritis, memory loss, dementia, neuropathy, -Testing Elisa 1 enzyme -Tx doxycycline children over 8y and amoxicillin under 8 -Allergy to PCN, use cefuroxime or erythromycin -Tx for 14-21 days -If not treated, chronic arthritic joints and debilitating neurologic disease

Question 32

Cimex Lectularius

Answer 32

-AKA bed bugs -Contact isolation -Skin and soft tissue -Can be found on clothing or bedding -Enjoy 60-70 degree weather -Blood sucking insects, injects saliva which contains anticoagulants and anesthetics -Transmitted by animals such as bats, birds, and rodents, but can be by air ducts, luggage, and people -Pruritic small, red, flat or raised bites -Normal laundry will kill -Die by heat (115 degrees)

Question 33

Pediculosis

Answer 33

-AKA Lice Infestation -Severe intense itching, pruritis can intensify 3-4 wks after initial infestation - 3 types : capitits, corporis, pubis -Rare with African American due to hair structure -3 step treatment 1. topical application of pediculicide: OTC pyrethrin or permethrin 2. Comb out lice with special fine toothed comb 3. Retreat 9 days to kill lice that have hatched since initial treatment - Rx : benzyl alcohol, ivermectin, malathion, spinosad lotions

Question 34

Parasitic Infections

Answer 34

Pediculosis capitis, corporus, pubis

Question 35

Scabies

Answer 35

-AKA Mite infestation -Transmitted skin to skin direct contact, rare clothing, bedding -HIGHLY CONTAGIOUS -1st infestation no sx first 2-6wks but can spread -Allergic type reaction -Intense pruritis -Treated neck to toes Rx scabicide, 5% permethrin cream is TOC, leave on 8-14 hrs or overnight then wash off -Secondary infections/ sores from pruritus and itching needs antibiotics -Was all bed linens, bath towels, underclothing used 3 days before hot water and dry hot in dryer

Question 36

Fungal infection

Answer 36

-AKA Candidiasis albicans -Most important factor in development of fungal infection is moisture -Normally found on mucous membranes, becomes a pathogen when overgrowth occurs -Increased growth = moisture/warmth, altered skin integrity, hormonal changes, immune suppression -Treat nystatin or mycostatin (cream or powder) -More common in diabetics

Question 37

Oral Candidiasis

Answer 37

-AKA Monoliasis -White patches on the patient's left side of cheek/mouth -Thrush milk curd appearance in mouth -Thrives in warm, moist, -perineum, intertigious areas (skin folds), mouth -Uncircumcised penis = candidiasis is called balantis -Vaginal =itchy, cheesy discharge

Question 38

Dermatophyte Infection

Answer 38

-AKA Tinea, ringworm, mycoses -Causes pruritis and erythema -Tx topical antifungal -Transmitted by direct contact w animals, infected persons and inanimate objects -Diffuse papular erythematous rash w pinpoint lesions edges -Moist areas and use of broad spectrum antibiotics promote infectious process

Question 39

Tinea cruris & Tinea corporis

Answer 39

-AKA fungal infections -Jock itch, groin, may extend to things or buttocks -Keep clean and dry -Use topical antifungal, if it does not work use griseofulvin PO -

Question 40

Tinea Capitis

Answer 40

-AKA fungal infection -"Ringworm" of scalp -More often in children -Hair breaks off, red, scaly area of scalp -Tx usu OTC: antifungal shampoo, topical ointment or spray antifungal (Tinactin)

Question 41

Tinea Pedis & Tinea Unguium

Answer 41

-AKA fungal infection -"Athletes feet" usu pruritis and foul odor -Rx topical antifungal (tinactin) -Not letting feet dry out -Tinea unguium = toenails and fingernails, can also be white or black, difficult to get rid of

Question 42

Folliculitis

Answer 42

-AKA Bacterial Infection -Most staph aureus/ or B hemolytic streptococci -Contributing factors = poor hygiene, poor nutrition, prolonged moisture, rubbing or friction, trauma -Lesions look like pustules surrounded by an area of erythema on skin surface -Beard area, legs, eye -Clean well, meticulous hand washing, antisaph soap, warm moist compress may help -No sharing towels -Topical antibiotic and systemic may be needed -Topical: bacitracin, neomycin, gentimycin, erythromycin -Systemic for fever, malaise, systemic signs/widespread infection -Use systemic antibiotic to that organism (rocephin common) -Nutrition is important

Question 43

Furuncles

Answer 43

-AKA bacterial infection, "Boils" -Infection of the fair follicle, starts at follicle and spreads down into dermis -Contagious -Staph aureus -Red and tender, pain, points up or develops head and center turns yellow -Pain is relieved with drainage -Interventions : frequent warm, wet compresses to bring to head, systemic antibiotics may be ordered -Bandages changed frequently -If boils/carbuncles recur frequently, daily use of an antibacterial soap or cleanser can suppress staph on the skin

Question 44

Carbuncles

Answer 44

-AKA Bacterial Infection, "Abscess" -Larger than boil with one or more openings -Contagious -Staph aureus or streptococcal -Men get it more often -Common on back and nape of neck -Red, irritated, may hurt when touched -Other symptoms : fatigue, fever, malaise, pruritis may precipitate -Antibacterial soap and antibiotics applied on skin or taken by mouth -Squeeze or cut can make infection worse without professional -Resolve 2 wks warm, moist, compress

Question 45

Cellulitis

Answer 45

-AKA bacterial infection -Inflammation of the dermis and subq tissue without sharp borders -Hot, tender, erythematous, swelling, diffuse borders, induration -May have fever, chills, malaise, HA, swollen lymph glands, urticaria -Common lower extremities, though face, arms -Localized = Staph A or streptococcal -Rx : bedrest, immobilize area, elevate, warm compresses, fever control, warm moist compresses -Risk for septicemia

Question 46

Cultural Alterations

Answer 46

- Tattoos, body piercing, cultural practices -Dermatitis -Risk for infection (Staph aureus) -Blood borne pathogens

Question 47

Impetigo

Answer 47

-AKA bacterial infection -Superficial skin infection -Staphylococcus aureus -Contact VERY CONTAGIOUS -Incubation 1-3 days -Communicable for 48 hr after antibiotic is begun -Most often face, can have bullous <2 yr old trunk, arms, and legs -Vessiculo pustular lesion, ruptures honey colored liquid, crusts, pruritis, tender -Scratching will spread -Clean off crusts every day with soap and water -Rx : application of topical antibiotic, wear gloves -Systemic antibiotic if no response = penicillin

Question 48

What is the difference between impetigo and folliculitis?

Answer 48

Skin vs. hair follicle

Question 49

Impetigo

Answer 49

-AKA bacterial infection -

Question 50

Warts

Answer 50

-AKA viral infection, herpes 1,2, zoster -Transmitted through skin contact -Resolve spontaneously when immunity to the virus develops, may take 5 yrs -Treated Acid therapy, Cryo -Types of benign wart lesions = plantar and common wart

Question 51

Herpes simplex virus I

Answer 51

-AKA viral infection -Fever, blisters, cold sores, genital, eye keratitis, brain encephalitis -Contact -Symptoms 3-7 days from contact -Can be brought out with stress, fever, URI, exhaustion -Rx : Acyclovir (Zovirax), not a cure -Rn wear a mask while working -Soothing moist compress -Virus in nerve ganglia

Question 52

Herpes Zoster

Answer 52

-AKA viral infection -Remains in the dorsal root ganglia -Transmitted contact, air (droplet), shingles not transmitted to other people but if not had chicken pox could get -Risk = immunocompromised -S&S : pain, burning, stabbing or sharp, feel along dermatome prior to eruption of lesions -Last 4-6 wks -Treatment : anti-viral, pain meds -Vaccine -

Question 53

Vital signs for inflammation

Answer 53

-Hyper or Hypothermia, pulse/HR >100 bpm -Labs: albumin and prealbumin -Elevated CRP -Hyperglycemia -WBC both high and low

Question 54

Cancer : Primary

Answer 54

Protect from developing or getting injury. Education, immunization, reduce carcinogens, environment, radon gas, radiation, diet, sunscreen

Question 55

Cancer : Secondary

Answer 55

Catch early, diagnose, intervene. Screening BSE, TSE, mammogram, yearly physical, stop smoking, campaigns, weight reduction, mental health, counseling Goal - halt or slow progress of disease in earliest stages

Question 56

Cancer : Tertiary

Answer 56

Manage long term, QOL, prevent further problem. Asthma camps, child cancer, support groups, rehab treatment, obesity management, chronic pain, anorexia management, special education Goal - prevent further physical deterioration and maximizing quality of life

Question 57

Benign Neoplasm

Question 58

Characteristics of malignant neoplastic cells

Answer 58

proliferation, invasive growth, formation of metastases

Question 59

Intravasation

Answer 59

Break it down

Question 60

Extravasation

Answer 60

It could just be downstream or a chemical attraction may cause the malignant cell to target a specific site. Once established, the cell can multiply and create a metastatic tumor

Question 61

Extravasation

Answer 61

It could just be downstream or a chemical attraction may cause the malignant cell to target a specific site. Once established, the cell can multiply and create a metastatic tumor

Question 62

Types of cancer

Answer 62

-Carcinomas are the most common, originate in epithelial tissues (breast, lung, and colon) -Sarcomas begin in connective tissue such as bones, tendons, cartilage, muscle, and fat -Leukemias bone marrow and lymph -Blastomas immature undifferentiated cells, embryonic -Papillomas benign projection, grows on any surface -Polyps grow on mucosal surface, can be CA or not

Question 63

CAUTION

Answer 63

-Change in bowel and bladder habits -A sore that does not heal -Unusual bleeding or discharge -Thickening or lump breast or other -Indigestion or difficulty swallowing -Obvious change in wart or mole -Nagging cough or hoarseness

Question 64

Cancer grading and staging

Question 65

Diagnosing cancer

Answer 65

-Definitive way cancer can be diagnosed is with biopsy -

Question 66

Nursing role during diagnoses

Answer 66

-Timing of information -Reinforce understanding of information -Encourage active participation -Support -Caution to not use other therapies/nutritionals/CAM without making sure MD knows

Question 67

Nursing INterventions for Malnutrition/Stomatitis

Answer 67

-Vitamins (concern equally people overdo) -Supplement : food - nutrient dense, specific need - Fe, K, Mg, Ca -Anti-emetics before eat -Oral/ throat pain / taste -Moisturizing agents -Medications to aide or for infecti