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Integ Flashcards

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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
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)
25
Surgical excision
Should be considered if lesion involves the dermis Complete closure of the excised area typically results in a good cosmetic result
26
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
27
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
28
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
29
Malignant Skin Cancers
Non – melanoma skin cancers Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma
30
Basal Cell Carcinoma
Most common – non – melanoma skin cancer Often in older adults Least deadly, slow growing
31
Basal Cell Carcinoma Commom Appearance
Most common – non – melanoma skin cancer Often in older adults Least deadly
32
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
33
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
34
Treatment for Squamous Cell Carcinoma
Surgery is needed Intralesional chemotherapy Mohs micrographic surgery Frequent follow ups are needed
35
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
36
3 Types of malignant melanoma
Superficial Lentigo Acral
37
Superficial
spreading melanoma Often occurs on sun exposed areas-legs, upper back Frequently arises from preexisting mole
38
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
39
Acral
lentiginous melanoma Soles, palms, mucous membranes
40
Nodular melanoma
Found anywhere on body
41
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
42
Excisional Biopsy
Any lesion suspected to be melanoma should not be shaved
43
Breslow Measurement-
indicates tumor depth/thickness in mm Melanomas with <1mm have a small chance of spreading
44
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
45
Pathophysiology of burns
caused by a source of heat, chemicals, radiation, or electricity which is transferred to the skin and the burn occurs
46
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
47
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)
48
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
49
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
50
Smoke and inhalation
Occur from breathing hot air or noxious chemicals-will harm the respiratory tract
51
Metabolic asphyxiation-
Injury from exposure to toxic gases, including carbon monoxide and/or cyanide-
52
what is the blood concentration in metabolic asphyxiation
greater than 20%
53
Upper airway injury
Above the glottis injury from direct heat or chemicals causing severe mucosal edema-nasal passages
54
Lower airway injury
Below the glottis injury causing airway inflammation and edema resulting in atelectasis and pneumonia
55
Electrical
Result from the intense heat generated from an electric current→ causes direct damage to muscle and nerves
56
Cold thermal injury
frostbite
57
greatest risk for pts with burns
hypovolemic shock
58
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
59
Sodium potassium pump fails
Sodium rapidly shifts to the other tissue spaces decreasing the concentration in the blood (Hyponatremia)
60
Potassium
decreases due to damaged cells leaking K+ into the blood (Hyperkalemia)
61
Normal insensible loss
30-50 ml/hr
62
Wound repair begins
within 6 -12 hrs of injury
63
Superficial frostbite
involves the skin, sub q tissue-ears, nose, fingers, toes
64
Deep frostbite
involves muscle, bones, and tendons
65
tx of frostbite
remove clothing & jewerly immediately rewarming - immerse in water 99.0-102 up to 108 degrees
66
if severe damage
may need skin grafts or amputation
67
Carbon monoxide poisoning tx
Treatment-100% humidified oxygen
68
Complication Of Burns
AKI or Acute Tubular Necrosis Fluid replacement and diuretics can reverse injury to tubules
69
Cardiovascular system Complications of Burn
Hypovolemic Shock (burn shock) hi pulse decreased BP
70
Hyperkalemia and hyponatremia
Arrhythmias-due to electrolyte fluid shifts Patient should be on a cardiac monitor due to hyperkalemia (V-tach)
71
Face, neck, and circumferential torso burns may interfere with
gas exchange
72
Circumferential leathery eschar can restrict
chest movement
73
Hand, foot, and joint burns can limit
movement & function
74
Client will have improved fluid balance as evidenced by a urine output of
75-100ml/hr
75
Phases of burn care
Prehospital Emergent (resuscitative) Acute (wound healing) Rehabilitation (restorative)
76
Patient Risk Factors with Burns
Obesity, cardiac and diabetes
77
Treatment / Nursing Interventions Emergent Phase
Delayed until we ensure there is an adequate airway, circulation, and fluid therapy replacement
78
Cleansing, debridement
Hydrotherapy tub Daily shower
79
Surgical debridement for extensive burns
Escharotomy or fasciotomy in a therapy tank
80
Dressings
Open-antimicrobial cream—reapplied as needed—increases visualization of the wound
81
Closed / multiple dressings
Antimicrobial cream cover with sterile gauze—dressings changed daily
82
Dermatome
Graft: s used to remove the donor skin for grafting
83
Autograft
is the patient’s skin used for grafting
84
Allograft
is from cadaveric skin—temporary 3 days to 2 weeks
85
Silvadene
Topical antimicrobial agent for second and third degree burns Penetrates eschar
86
Diuresis occurs
48-72 hours after burn occurs
87
Healing process begins
Wound will heal from sides and below granulating Acute phase continues until wound closure is achieved
88
Hyponatremia
Can develop from excess GI suction, diarrhea, and excess hydrotherapy—pulls sodium from open wound
89
Hypernatremia
Causes- after successful fluid resuscitation if large amounts of hypertonic solutions were given, EN or inappropriate fluid administration
90
Hyperkalemia
Causes- occur if the patient has renal failure, adrenocortical insufficiency, or massive deep muscle injury (e.g., electrical burn).
91
Hypokalemia
Causes- occurs with vomiting, diarrhea, prolonged GI suction, IV therapy without potassium supplementation, and excessive hydrotherapy
92
Contractures
Joint contractures may develop because of the shortening of scar tissue in the flexor tissues of a joint
93
Characteristics of the client with full thickness burns
color is black, brown, white or red, no blisters; minimal pain, firm and inelastic outer layer
94
Characteristics of partial thickness superficial burns
pink to red, painful
95
partial thickness deep burns
deep red to white ; painful
96
superficial burns
pink to red; painful
97
Painless ,black skin with eschar
deep full thickness burn
98
painless ,brownish, yellow eschar
full thickness burn
99
superficial partial thickness burn
pink mto red, mild to moderatee edema, pain and blisters

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