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NUR372 > Integ > Flashcards

Integ Flashcards

1
Q

epidermis

A

outer layer

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2
Q

dermis

A

middle layer that has a lot of collagen and elasticity

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3
Q

subcutaneous tissue

A

fat tissue

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4
Q

Age Related Change

A

color and texture changes, thinning of layers, loss of elasticity, impaired wound healing, pressure changes

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5
Q

What does this mean in terms of nursing interventions and patient teaching?

A

limit tears, paper tape, adhesive removal help

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6
Q

ABCDE assessment

A 
A-asymmetry
B-Border irregularity
C- Color variation
D- diameter
E- Evolving/changing features
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7
Q

Hirsutism

A

Excessive growth of body hair due to hormonal imbalance or side effect of drug therapy

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8
Q

punch biopsy

A

small circle of tissue is removed (only a few mm)

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9
Q

shave biopsy

A

remove only part that rises above the surrounding tissue

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10
Q

Excisional biopsy

A

for large deep specimens and closed up with sutures (less common)

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11
Q

Skin trauma

A

goal is to restore skin tissue integrity

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12
Q

First intention

A

Edges brought together with skin lined up in approximated position

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13
Q

Second intention

A

Granulation and contraction; deeper tissue injury or wound

don’t approximate the edges ourself

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14
Q

Third intention

A

Delayed closure; high risk for infection with resulting scar

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15
Q

Partial-Thickness Wounds

A

Damage to epidermis, upper layers of dermis

Heal by re-epithelialization within 5 to 7 days

injury followed by local inflammation

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16
Q

Full-Thickness Wounds

A

Damage extends into lower layers of dermis, underlying subcutaneous tissue

heals from bottom up

contraction develops in healing process

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17
Q

Pressure Ulcers or Pressure Injuries

A

Compression of skin and underlying soft tissue between bony prominence and external surface for extended period

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18
Q

3 mechanical forces for pressure ulcers

A

pressure
friction
shear

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19
Q

capillary closing pressure

A

with a certain amount of pressure these collapse

reduce blood flow to that area

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20
Q

patients with pressure ulcers need what kind of diet to help

A

high protein diet

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21
Q

Pressure Ulcer Prevention

A

Identify high-risk patients earl

Implement aggressive intervention of prevention with pressure relief devices

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22
Q

braden scale

A

likelihood to get pressure ulcers

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23
Q

Pressure-Relieving Techniques

A

rotate
floating heels
sliding board
positioning- move frequently

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24
Q

Dynamic systems

A

alternate inflation and deflation

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25
Static devices
constant state of inflation
26
Stage 1 pressure ulcer
skin intact reddening, does not blanch(turn white) discoloration feel for texture change
27
Stage 2 pressure ulcer
Skin not intact | partial thickness skin loss
28
Stage 3 pressure ulcer
no bone, tendon, or muscle should be exposed may have undermining and tunneling full thickness skin loss
29
Stage 4 pressure ulcer
Bone, tendon, muscle exposed slough and eschar often present crater like appearance
30
contamination
Presence of organisms without infection | always contaminated, not always infected
31
infection
Pathogenic organisms grow and spread, cannot be controlled by body’s immune defenses
32
If a patient has a wound what should be increased?
calories fluid protein
33
nonsurgical management
dressings, nutrition therapies, VAC
34
Pruritis
itching break the itch-scratch-itch cycle caused by allergic reactions, systemic disorders
35
Treatment for pruritis
Cool sleeping environment Fingernails should be trimmed short Antihistamines Topical steroids Prevent dry skin—apply lotion or emollients after bath/shower Patient teaching: DON’T SCRATCH
36
Urticaria(hives)
presence of white or red edematous papules or plaques of varying sizes
37
Treatment for urticaria
Removal of triggering substance Antihistamines helpful Avoid overexertion, alcohol consumption, and warm environments, which can worsen symptoms
38
Folliculitis
superficial infection involving only upper portion of follicle
39
furuncle(boil)
much deeper infection in the follicle
40
Cellulitis
generalized infection with staph or strep involving deeper connective tissue can lead to sepsis
41
MRSA
contact precautions wash hands before and after contact don't share items wash clothes in hot water vancomycin, clindamycin, zyvox
42
Cutaneous Anthrax
Caused by spores of bacterium Bacillus anthracis treat with oral antibiotics: 60 days most likely seen with people who work with animals
43
How is a anthrax diagnosed?
positive culture | presence of anthrax antibodies
44
Herpes simplex virus (HSV)
cold sores, raised vesicles | most common on lips and mucous membranes, can occur on hands
45
Herpes Zoster(shingles)
varicella zoster lives in your nerves and comes out later most often its older adults contagious to people who have not had the vaccine or has not had chicken pox
46
Dermatophyte infections
"tinea"
47
tinea capitis
infection of the scalp
48
Interventions for Common Skin Infections
skin care with proper cleansing contact precautions(MRSA, shingles) drug therapy
49
candida
yeast
50
Parasitic disorders
Pediculosis (lice) Scabies Bedbugs
51
Pediculosis
``` Infestation of LICE Head lice (capitis) Body lice (corporis) ``` wash all clothes and linens permethrin 5% is effective to get rid of lice contagious
52
scabies
linear burrow | ointment
53
Contact dermatitis
Acute or chronic rash caused by direct contact with irritant or allergen causing immune reaction "don't buy cheap jewelry"
54
Atopic dermatitis
Chronic rash occurring with allergies made worse by dry skin, chemicals, or stress severe reaction, happens more quickly
55
Psoriasis
Chronic autoimmune disorder affecting skin; exacerbations and remissions for life raised plaque formation
56
Exfoliative psoriasis
eruptive inflammatory form that is much more rare
57
psoriasis is the overstimulation of the immune system that causes
increased cell division and plaque formation
58
treatment for psoriasis
``` Corticosteroids Tar preparations Ultraviolet light therapy Systemic therapy Emotional support ```
59
Skin Cancer
HEALTH PROMOTION AND PREVENTION limit exposure to sunlight occupational exposure
60
What is needed to confirm malignancy in a tumor?
Biopsy
61
What do we teach patients about skin cancer?
self examine using ABCDE guide
62
Skin cancer treatment nonsurgical
``` chemo radiation(doesn't respond well) ```
63
Skin cancer treatment surgical
Cryosurgery(freeze off) Curettage and electrodessication (electricity) Excision(cut the whole thing out) Wide excision(take the whole area and more skin around it)
64
sunburn
Superficial burn to the skin caused by UV exposure
65
sunburn interventions
Cool baths Lotions, aloe Antibiotic ointments to protect from infection if blistering is present WEAR SUNSCREEN
66
Toxic Epidermal Necrolysis (TEN)
RARE, acute drug reaction | Peeling of skin and mucous membranes
67
what do we do to treat Toxic Epidermal Necrolysis (TEN) and stevens-johnson syndrome?
STOP THE DRUG treat it like a burn prevent infection
68
Stevens-Johnson syndrome
RARE, acute drug reaction | Macular rash that spreads and blisters, sheds, then heals
69
drugs thats cause TEN
chemo therapy sulfas barbituates

NUR372 (13 decks)

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