Integ Flashcards
Macule
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)
Papule
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
Vesicle
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
Plaque
Circumscribed, elevated, superficial, solid lesion. >0.5 cm in diameter
Examples: psoriasis, seborrheic and actinic keratoses
Wheal
Firm, edematous, irregularly shaped area. Size varies. May last only a few hours
Examples: insect bite, urticaria, angioedema
Pustule
Elevated, superficial lesion filled with purulent fluid
Examples: acne, impetigo
What SPF should u use?
At least 15
Risk Factors For Precancerous Lesions
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
Premalignant Skin Lesions
Actinic Keratosis &
Dysplastic Nevus Syndrome
Actinic Keratosis
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
chemical burns can be caused by
Results from tissue injury and destruction from acids, alkalines, and organic compounds-exp-cleaners with HCl acid
Phenols
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
Alkaline burns
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
Dysplastic Nevus Syndrome or Atypical
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
Shave biopsy
Single-edged razor blade used to shave off superficial lesions or small samples of a large lesion. Provides thin specimens for diagnostic purposes.
Incisional biopsy
Wedge-shaped incision made in lesion too large for excisional biopsy. Useful when the specimen needed is larger than shave or punch biopsy
Punch biopsy-special biopsy sizes 2, 4. 6
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
Excisional biopsy
Used when good cosmetic results and/or entire lesion removal desired. Skin closed with subcutaneous and skin sutures
Surgery
Electrocoagulation & electrodesiccation
Electrodessication
usually involves more superficial destruction. It uses a monopolar electrode
Electrocoagulation
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).
Curettage
the removal and scraping away of tissue using an instrument called a curette (scooping)
Cryosurgery
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)
Surgical excision
Should be considered if lesion involves the dermis
Complete closure of the excised area typically results in a good cosmetic result
Mohs surgery
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
Chemical peel
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
5 –FU
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
Malignant Skin Cancers
Non – melanoma skin cancers
Basal Cell Carcinoma
Squamous Cell Carcinoma
Malignant Melanoma
Basal Cell Carcinoma
Most common – non – melanoma skin cancer
Often in older adults
Least deadly, slow growing
Basal Cell Carcinoma Commom Appearance
Most common – non – melanoma skin cancer
Often in older adults
Least deadly
Squamous Cell Carcinoma
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
BCC
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
Treatment for Squamous Cell Carcinoma
Surgery is needed
Intralesional chemotherapy
Mohs micrographic surgery
Frequent follow ups are needed
Risk factors for SCC
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
3 Types of malignant melanoma
Superficial
Lentigo
Acral
Superficial
spreading melanoma
Often occurs on sun exposed areas-legs, upper back
Frequently arises from preexisting mole
Lentigo
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
Acral
lentiginous melanoma
Soles, palms, mucous membranes
Nodular melanoma
Found anywhere on body
Assessment ABCDE of malignant melanoma
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
Excisional Biopsy
Any lesion suspected to be melanoma should not be shaved
Breslow Measurement-
indicates tumor depth/thickness in mm
Melanomas with <1mm have a small chance of spreading
Clark Level
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
Pathophysiology of burns
caused by a source of heat, chemicals, radiation, or electricity which is transferred to the skin and the burn occurs
Decreases fluid in blood vessels for perfusion and less oxygen is getting to organs
Decreased urine output
Mental status changes
Ileus
Heart will try and compensate to increase HR and decreases BP/CO
Signs and symptoms of Burns
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)
Classes of burn
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
Thermal burns can be caused by
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
Smoke and inhalation
Occur from breathing hot air or noxious chemicals-will harm the respiratory tract
Metabolic asphyxiation-
Injury from exposure to toxic gases, including carbon monoxide and/or cyanide-
what is the blood concentration in metabolic asphyxiation
greater than 20%
Upper airway injury
Above the glottis injury from direct heat or chemicals causing severe mucosal edema-nasal passages
Lower airway injury
Below the glottis injury causing airway inflammation and edema resulting in atelectasis and pneumonia
Electrical
Result from the intense heat generated from an electric current→ causes direct damage to muscle and nerves
Cold thermal injury
frostbite
greatest risk for pts with burns
hypovolemic shock
Increased cellular permeability
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
Sodium potassium pump fails
Sodium rapidly shifts to the other tissue spaces decreasing the concentration in the blood (Hyponatremia)
Potassium
decreases due to damaged cells leaking K+ into the blood (Hyperkalemia)
Normal insensible loss
30-50 ml/hr
Wound repair begins
within 6 -12 hrs of injury
Superficial frostbite
involves the skin, sub q tissue-ears, nose, fingers, toes
Deep frostbite
involves muscle, bones, and tendons
tx of frostbite
remove clothing & jewerly immediately
rewarming - immerse in water 99.0-102 up to 108 degrees
if severe damage
may need skin grafts or amputation
Carbon monoxide poisoning tx
Treatment-100% humidified oxygen
Complication Of Burns
AKI or Acute Tubular Necrosis Fluid replacement and diuretics can reverse injury to tubules
Cardiovascular system Complications of Burn
Hypovolemic Shock (burn shock)
hi pulse decreased BP
Hyperkalemia and hyponatremia
Arrhythmias-due to electrolyte fluid shifts
Patient should be on a cardiac monitor due to hyperkalemia (V-tach)
Face, neck, and circumferential torso burns may interfere with
gas exchange
Circumferential leathery eschar can restrict
chest movement
Hand, foot, and joint burns can limit
movement & function
Client will have improved fluid balance as evidenced by a urine output of
75-100ml/hr
Phases of burn care
Prehospital
Emergent (resuscitative)
Acute (wound healing)
Rehabilitation (restorative)
Patient Risk Factors with Burns
Obesity, cardiac and diabetes
Treatment / Nursing Interventions Emergent Phase
Delayed until we ensure there is an adequate airway, circulation, and fluid therapy replacement
Cleansing, debridement
Hydrotherapy tub
Daily shower
Surgical debridement for extensive burns
Escharotomy or fasciotomy in a therapy tank
Dressings
Open-antimicrobial cream—reapplied as needed—increases visualization of the wound
Closed / multiple dressings
Antimicrobial cream cover with sterile gauze—dressings changed daily
Dermatome
Graft: s used to remove the donor skin for grafting
Autograft
is the patient’s skin used for grafting
Allograft
is from cadaveric skin—temporary 3 days to 2 weeks
Silvadene
Topical antimicrobial agent for second and third degree burns
Penetrates eschar
Diuresis occurs
48-72 hours after burn occurs
Healing process begins
Wound will heal from sides and below granulating
Acute phase continues until wound closure is achieved
Hyponatremia
Can develop from excess GI suction, diarrhea, and excess hydrotherapy—pulls sodium from open wound
Hypernatremia
Causes- after successful fluid resuscitation if large amounts of hypertonic solutions were given, EN or inappropriate fluid administration
Hyperkalemia
Causes- occur if the patient has renal failure, adrenocortical insufficiency, or massive deep muscle injury (e.g., electrical burn).
Hypokalemia
Causes- occurs with vomiting, diarrhea, prolonged GI suction, IV therapy without potassium supplementation, and excessive hydrotherapy
Contractures
Joint contractures may develop because of the shortening of scar tissue in the flexor tissues of a joint
Characteristics of the client with full thickness burns
color is black, brown, white or red, no blisters; minimal pain, firm and inelastic outer layer
Characteristics of partial thickness superficial burns
pink to red, painful
partial thickness deep burns
deep red to white ; painful
superficial burns
pink to red; painful
Painless ,black skin with eschar
deep full thickness burn
painless ,brownish, yellow eschar
full thickness burn
superficial partial thickness burn
pink mto red, mild to moderatee edema, pain and blisters
