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PJs Cards > Integ > Flashcards

Integ Flashcards

1
Q

Macule

A

Circumscribed, flat discoloration that is blue, red, brown, or hypopigmented. <0.5 cm in diameter. If lesion >0.5 cm, it is a patch
freckles, petechiae, measles, flat mole (nevus), café-au-lait spots, vitiligo (complete depigmentation)

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2
Q

Papule

A

Elevated, solid lesion. <0.5 cm in diameter. Color varies. If lesion is >0.5 cm in diameter, it is a nodule
Examples: wart (verruca), elevated moles, lipoma, basal cell cancer

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3
Q

Vesicle

A

Circumscribed, superficial collection of serous fluid. <0.5 cm in diameter. If lesion >0.5 cm, it is a bulla
Examples: varicella (chickenpox), herpes zoster (shingles), second-degree burn

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4
Q

Plaque

A

Circumscribed, elevated, superficial, solid lesion. >0.5 cm in diameter
Examples: psoriasis, seborrheic and actinic keratoses

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5
Q

Wheal

A

Firm, edematous, irregularly shaped area. Size varies. May last only a few hours
Examples: insect bite, urticaria, angioedema

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6
Q
A
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7
Q

Pustule

A

Elevated, superficial lesion filled with purulent fluid
Examples: acne, impetigo

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8
Q

What SPF should u use?

A

At least 15

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9
Q

Risk Factors For Precancerous Lesions

A

Fair skin
Family history
Chronic sun exposure- working out doors (construction and farmers)
Exposure to chemicals-where you live
Geographic area-living near the equator
Behavioral Factors
Blonde or red hair, blue eyes

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10
Q

Premalignant Skin Lesions

A

Actinic Keratosis &
Dysplastic Nevus Syndrome

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11
Q

Actinic Keratosis

A

Most common precancerous lesion
affect most of the older White population
Neoplasm of epidermis
Common cause is sun exposure or artificial UV light
Varied appearance
Common occurrence
Pre malignant form of…etc.
Treatment
nitrogen

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12
Q

chemical burns can be caused by

A

Results from tissue injury and destruction from acids, alkalines, and organic compounds-exp-cleaners with HCl acid

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13
Q

Phenols

A

Found in chemical disinfectants and petroleum products (creosote and gasoline) cause not only external burns but also systemic toxicity
Used for ingrown toenails to kill the growth of the toenail

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13
Q

Alkaline burns

A

Cause liquefaction necrosis, which can be more damaging
Can be more difficult to manage than acid burns because it adheres to the tissue causing protein hydrolysis and necrosis
Damage continues even after neutralization of compound

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14
Q

Dysplastic Nevus Syndrome or Atypical

A

Abnormal mole/nevis pattern
Usually greater than 5mm with irregular border and possibly notched
Varying colors of tan, brown, black, red, or pink within single mole
Most common on the back
Uncommon but can occur on scalp or buttock
Increased risk for malignant melanoma
Doubles with presence of one nevus
12 fold increase with presence of 10 or more

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15
Q
A
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16
Q

Shave biopsy

A

Single-edged razor blade used to shave off superficial lesions or small samples of a large lesion. Provides thin specimens for diagnostic purposes.

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17
Q

Incisional biopsy

A

Wedge-shaped incision made in lesion too large for excisional biopsy. Useful when the specimen needed is larger than shave or punch biopsy

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18
Q

Punch biopsy-special biopsy sizes 2, 4. 6

A

Special punch biopsy instrument of appropriate size used. Instrument rotated to appropriate level to include dermis and some fat. Suturing depends on size and site. Provides full-thickness skin for diagnostic purposes

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19
Q

Excisional biopsy

A

Used when good cosmetic results and/or entire lesion removal desired. Skin closed with subcutaneous and skin sutures

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20
Q

Surgery

A

Electrocoagulation & electrodesiccation

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21
Q

Electrodessication

A

usually involves more superficial destruction. It uses a monopolar electrode

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22
Q

Electrocoagulation

A

Major uses of these therapies are coagulation of bleeding vessels to obtain hemostasis and destruction of small telangiectasias (dilation of groups of superficial capillaries and venules).

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23
Q

Curettage

A

the removal and scraping away of tissue using an instrument called a curette (scooping)

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24
Q

Cryosurgery

A

is the use of subfreezing temperatures to destroy epidermal lesions
Useful for precancerous lesion, skin tags, warts
Forms a blister and scab will fall off in 1-3 weeks-minimal scarring occurs
Topical liquid Nitrogen (dry ice)

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25
Q

Surgical excision

A

Should be considered if lesion involves the dermis
Complete closure of the excised area typically results in a good cosmetic result

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26
Q

Mohs surgery

A

Specific type of excision is most surgery and is microscopically controlled-removal of cutaneous malignancies
Is removed in thin horizontal layers-so 100% of margin can be examined
Any residual tumor not removed by the first excision is removed in serial excisions done the same day
Can go very deep
Consent is needed, may need cauterized after, and need proper wound/dressing care

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27
Q

Chemical peel

A

improves the aged and photodamaged skin along with acne, scarring, freckles, actinic and seborrheic keratosis
May have some loss of melanin and swelling
Should avoid sunscreen or sun immediately after a peel

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28
Q

5 –FU

A

Fluorouracil is a topical cytotoxic agent with selective toxicity for sun-damaged cells
Available in 4 different strengths
Used to treat precancerous lesions (especially AK) and some skin cancers
Patient compliance is essential with use
Teach patient-they will get re, itchy, irritated, and have some pain but it is normal
they will look worse before they lo

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29
Q

Malignant Skin Cancers

A

Non – melanoma skin cancers
Basal Cell Carcinoma
Squamous Cell Carcinoma
Malignant Melanoma

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30
Q

Basal Cell Carcinoma

A

Most common – non – melanoma skin cancer
Often in older adults
Least deadly, slow growing

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31
Q

Basal Cell Carcinoma Commom Appearance

A

Most common – non – melanoma skin cancer
Often in older adults
Least deadly

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32
Q

Squamous Cell Carcinoma

A

A cancer arising from keratinizing epidermal cells– SCC can be aggressive and has the potential to metastasize
May lead to death if not treated early and correctly
Grows more rapidly than BCC

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33
Q

BCC

A

A cancer arising from keratinizing epidermal cells– SCC can be aggressive and has the potential to metastasize
May lead to death if not treated early and correctly

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34
Q

Treatment for Squamous Cell Carcinoma

A

Surgery is needed
Intralesional chemotherapy
Mohs micrographic surgery
Frequent follow ups are needed

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35
Q

Risk factors for SCC

A

Sun/UV exposure-tanning beds
Skin sensitivity-fair skin
10 times more likely in caucasian vs. AA people
People with red or blond hair, blue or light-colored eyes, and light-colored skin that freckles easily
Genetic-prior diagnosis, first degree relative with melanoma
Hormonal / immunologic factors-immunosuppressed
Exposure to herbicides/environmental factors

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36
Q

3 Types of malignant melanoma

A

Superficial
Lentigo
Acral

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37
Q

Superficial

A

spreading melanoma
Often occurs on sun exposed areas-legs, upper back
Frequently arises from preexisting mole

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38
Q

Lentigo

A

Commonly found on face
Often in elderly patients
Flat brown irregular patches that increase in size for many years before they even form into cancer
meligna melanoma

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39
Q

Acral

A

lentiginous melanoma
Soles, palms, mucous membranes

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40
Q

Nodular melanoma

A

Found anywhere on body

41
Q

Assessment ABCDE of malignant melanoma

A

A- asymmetry
Half of mole or birthmark does not match other half
B- border
Edges are irregular (ragged)
C- color
Color is not the same all over
D- diameter
Area is larger than 6 mm or is growing—eraser pencil size
E- Evolving
Changing appearance, such as shape, size, color noted over time

42
Q

Excisional Biopsy

A

Any lesion suspected to be melanoma should not be shaved

43
Q

Breslow Measurement-

A

indicates tumor depth/thickness in mm
Melanomas with <1mm have a small chance of spreading

44
Q

Clark Level

A

indicates number of skin layers involved
The higher the number the deeper the melanoma
Ranges from 1-4
In stage 1, melanoma is confined to 1 place (in situ) in the epidermis

45
Q

Pathophysiology of burns

A

caused by a source of heat, chemicals, radiation, or electricity which is transferred to the skin and the burn occurs

46
Q

Decreases fluid in blood vessels for perfusion and less oxygen is getting to organs

A

Decreased urine output
Mental status changes
Ileus
Heart will try and compensate to increase HR and decreases BP/CO

47
Q

Signs and symptoms of Burns

A

The initial signs are things like redness, blistering, or charring of the skin and depending on the severity it can cause fluid and electrolyte shifts, decreased sodium, increased potassium, and an increased hematocrit level (fluid loss will increase hct due to a larger hct to fluid ratio)

48
Q

Classes of burn

A

Thickness-superficial (sunburn), partial (both epidermis and dermis-painful), and full thickness (involves all layers-no pain due to destroyed nerve endings)
Degrees- 1, 2, 3

49
Q

Thermal burns can be caused by

A

grease fires when cooking, house fires, smoking, and the use of gasoline for cleaning or incineration
Flame
Gas, wood, starter fluid, gasoline, kerosene, heat lamps, propane, charcoal
Flash
Scald
Contact

50
Q

Smoke and inhalation

A

Occur from breathing hot air or noxious chemicals-will harm the respiratory tract

51
Q

Metabolic asphyxiation-

A

Injury from exposure to toxic gases, including carbon monoxide and/or cyanide-

52
Q

what is the blood concentration in metabolic asphyxiation

A

greater than 20%

53
Q

Upper airway injury

A

Above the glottis injury from direct heat or chemicals causing severe mucosal edema-nasal passages

54
Q

Lower airway injury

A

Below the glottis injury causing airway inflammation and edema resulting in atelectasis and pneumonia

55
Q

Electrical

A

Result from the intense heat generated from an electric current→ causes direct damage to muscle and nerves

56
Q

Cold thermal injury

A

frostbite

57
Q

greatest risk for pts with burns

A

hypovolemic shock

58
Q

Increased cellular permeability

A

Will cause a massive shift of fluids from the intravascular to interstitial spaces
The progressive loss of protein from the vascular space will reduce colloidal osmotic pressure

59
Q

Sodium potassium pump fails

A

Sodium rapidly shifts to the other tissue spaces decreasing the concentration in the blood (Hyponatremia)

60
Q

Potassium

A

decreases due to damaged cells leaking K+ into the blood (Hyperkalemia)

61
Q

Normal insensible loss

A

30-50 ml/hr

62
Q

Wound repair begins

A

within 6 -12 hrs of injury

63
Q

Superficial frostbite

A

involves the skin, sub q tissue-ears, nose, fingers, toes

64
Q

Deep frostbite

A

involves muscle, bones, and tendons

65
Q

tx of frostbite

A

remove clothing & jewerly immediately
rewarming - immerse in water 99.0-102 up to 108 degrees

66
Q

if severe damage

A

may need skin grafts or amputation

67
Q

Carbon monoxide poisoning tx

A

Treatment-100% humidified oxygen

68
Q

Complication Of Burns

A

AKI or Acute Tubular Necrosis Fluid replacement and diuretics can reverse injury to tubules

69
Q

Cardiovascular system Complications of Burn

A

Hypovolemic Shock (burn shock)
hi pulse decreased BP

70
Q

Hyperkalemia and hyponatremia

A

Arrhythmias-due to electrolyte fluid shifts
Patient should be on a cardiac monitor due to hyperkalemia (V-tach)

71
Q

Face, neck, and circumferential torso burns may interfere with

A

gas exchange

72
Q

Circumferential leathery eschar can restrict

A

chest movement

73
Q

Hand, foot, and joint burns can limit

A

movement & function

74
Q

Client will have improved fluid balance as evidenced by a urine output of

A

75-100ml/hr

75
Q

Phases of burn care

A

Prehospital
Emergent (resuscitative)
Acute (wound healing)
Rehabilitation (restorative)

76
Q

Patient Risk Factors with Burns

A

Obesity, cardiac and diabetes

77
Q

Treatment / Nursing Interventions Emergent Phase

A

Delayed until we ensure there is an adequate airway, circulation, and fluid therapy replacement

78
Q

Cleansing, debridement

A

Hydrotherapy tub
Daily shower

79
Q

Surgical debridement for extensive burns

A

Escharotomy or fasciotomy in a therapy tank

80
Q

Dressings

A

Open-antimicrobial cream—reapplied as needed—increases visualization of the wound

81
Q

Closed / multiple dressings

A

Antimicrobial cream cover with sterile gauze—dressings changed daily

82
Q

Dermatome

A

Graft: s used to remove the donor skin for grafting

83
Q

Autograft

A

is the patient’s skin used for grafting

84
Q

Allograft

A

is from cadaveric skin—temporary 3 days to 2 weeks

85
Q

Silvadene

A

Topical antimicrobial agent for second and third degree burns
Penetrates eschar

86
Q

Diuresis occurs

A

48-72 hours after burn occurs

87
Q

Healing process begins

A

Wound will heal from sides and below granulating
Acute phase continues until wound closure is achieved

88
Q

Hyponatremia

A

Can develop from excess GI suction, diarrhea, and excess hydrotherapy—pulls sodium from open wound

89
Q

Hypernatremia

A

Causes- after successful fluid resuscitation if large amounts of hypertonic solutions were given, EN or inappropriate fluid administration

90
Q

Hyperkalemia

A

Causes- occur if the patient has renal failure, adrenocortical insufficiency, or massive deep muscle injury (e.g., electrical burn).

91
Q

Hypokalemia

A

Causes- occurs with vomiting, diarrhea, prolonged GI suction, IV therapy without potassium supplementation, and excessive hydrotherapy

92
Q

Contractures

A

Joint contractures may develop because of the shortening of scar tissue in the flexor tissues of a joint

93
Q

Characteristics of the client with full thickness burns

A

color is black, brown, white or red, no blisters; minimal pain, firm and inelastic outer layer

94
Q

Characteristics of partial thickness superficial burns

A

pink to red, painful

95
Q

partial thickness deep burns

A

deep red to white ; painful

96
Q

superficial burns

A

pink to red; painful

97
Q

Painless ,black skin with eschar

A

deep full thickness burn

98
Q

painless ,brownish, yellow eschar

A

full thickness burn

99
Q

superficial partial thickness burn

A

pink mto red, mild to moderatee edema, pain and blisters

PJs Cards (3 decks)

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