Integumentary Flashcards
what are wounds
break or opening in the skin
factor sthat delay wound healing
think “ DID NOT HEAL”
drugs infection ischemia diabetes nutrition oxygen toxins hyperthermia/hypothermia ETOH - ethanol acidosis local anesthetics
and then meds and age
- immunosuppressants and corticosteroids
primary intetnion
method of wound healing
used when wound edges can be closed by stitches, staples skin glue or steri strips
secondary intention
method of wound healing
cannot be brought together by wound edges
- example: pressure ulcers
wound healing occurs through slow, gradula filling in lost tissue
tertiary intetnion
when a delay in closing the wound is NEEDED to allow for drainage and swelling to subside
surgical debridement, skin grafts and flaps are additional interventions used for certain wounds
wound management
successful wound management includes:
- removing or eliminating causative factors, preventing infection, using the appropriate type of dressing and ensuring systemic support
maintain adequate hydration and nutrition
what is atopic dermatitis
chronic, inhertied skin disorder
eczema
exacerbated by stress and certain foods
atopic dermatitis manifestation
acute:
- dry skin
- itching
- erythema
- macules
- papules
- pustules and/or vesicles
subacute and chronic stages:
- scaly, dry skin
- skin color changes
- lichentification: thickened or leather like areas
atopic dermatitis diagnostic studies
med history
physical exam
skin biopsy
allergy skin testing
atopic dermatitis nursing management
lubriacation of dry skin
administration of corticosteroids, topical immunomodulators
stress reduction
phototherapy when inflammation is severe
antibiotics for secondary infections
soaking the hands in lukewarm water will debrider the crust and scales and soft the skin
what is seborrheic dermatitis
recurrent inflammatory reaction of the skin that causes flaky, white to yellowish scales to form on oily areas like:
- scalp
- external ear canal
aka: dandruff or “cradle cap” in infants
seborrheic dermatitis manifestation
observe non-pruritic, oily scales on scalap, forehead and eyebrows or behind ears
seborrheic dermatitis nursing management
cradle cap in infants:
- massage baby’s scalp gently with your gfingers or soft brush
- shampoo daily with mld baby shampoo
- use hydrating creams or mineral oils
dandruff:
- recommended OTC or medicated shampoos
- prescription or lotions are available to severe cases
what is incontinence associated dermatitis
aka diaper rash
incotinence associated dermatitis nursing management
maintain perineal skin integrity
minimize episodes of incontinence
treat any underlying cause of loose stools
apply barrier cream.ointment
treat any underlying skin infections
prompt changing of wet, soiled clothing or incontinence products
using a fecal management system if appropriate
ensuring adequate hydration and nutrition
supporting diligent perineal hygiene with pH-based cleansers
what is contact dermatitis
inflammatory reaction of the skin to a chemical substance, whether natural or synthetic
ex: posison ivy
foods, solutions, allergens, plants are factors
contact dermatitis manifestations
irritant:
- dry, inflamed
- pruritic lesions wherever the irritant touched
allergic:
- “weeping blisters” as well as pruritic lesions
contact dermatitis management
topical application like anti-inflammatory and anti-pruritics
- topical corticosteroids are preferred for mild, localized cases of allergic dermatitis
try not to too frequently hand wash because itll become dry
systemic corticosteroids and antihistamines might be required if dermatitis is severe and widespread
exposure to heat or cold may cause or exacerbate symptoms
what is candidiasis
bacteria that causes candidiasis normally live in the body without any problems
its if they grow out of control that can lead to candida albicans
develops in the mouth or throat and is called thrush
in vagina = yeast infection
tends to appear in warm, moist areas and inhales steroids
- commonly seen in cancer and HIV/AIDs people
candidiasis manifestations
white plagues on the tongue, gums or buccal mucosa
- inner lining of the cheeks and back of lips where they touch teeth
ulcerations in oral mucosa
may also complain of itching
candidiasis management
oral anti-fungals will be prescribed
- either use swish and swallow after feeding or through topical application
those who use inhaled steroids should rinse their mouth after to avoid candidiasis
be sure to monitor whether infection has spread to groin or buttocks
can be prescribe prophylactic probiotic
- Florastor
eating products with live cultures of lactobacillus acedophillus like some yogurts can be beneficial
what is acne vulgaris
skin condition in which pores becomes clogged and inflamed
acne breakouts may be exacerbated by emotional stress
sebaceous glands secrete more sebum and pores become more plugged and dilated
acne vulgaris manifestation
whiteheards (close comedones) blackheads (open comedone) papules pustules nodules
red and excoriated skin
acne vulgaris management
good cleansing of the skin
nutrition
avoiding squeezing or picking at lesions
teach about resulting body image users
pharmacological intervention:
- Vit A
- benzoyl peroxide
- antibiotics
- isotretinoin: generic only- available as Accutane
- photodynamic therapy
- dermabrasion or chemical skin peels
what is impetigo
highly contagious, bacterial infections of the skin
infective agents:
- Staph A
- group A beta hemolytic streptococcus
MRSA is becoming a common cause
will invade broken skin are and is highly contagious for 7-10 days
most common in young children
impetigo manifestations
primary phase:
pustules or vesicles
secondary phase: honey-colored crusts for strep clear for staph superficial erosion pustules that easily bleed and itche
skin does tend to heal without scarring unless there is a secondary infection
impetigo diagnostic studies
based on the appearance of skin lesion
maybe skin culture
impetigo nursing management
priority interventions should focus on preventing transmissions:
- careful removal of lesions crusts or debris with warm soapy solution
- cutting childrens fingernails
pharmacological interventions:
- apply topical antibiotics for early small lesions
- systemic antibiotics are treatment of choice
teach caregiver that infection is HIGHLY CONTAGIOUS
good handwashing is essential
- sharing towels and eating utensils should be AVOIDED
what is cellulitis
infection of the dermis and or subcutaneous tissue
causative agents:
- streptococcal bacteria
- Group A strep
- streptococcus pyogenes
- staph aureus
- Haemophilus influenza
cellulitis manifestation
affected area:
- red, edematous
- tender
- occasional discoloration
enlarged lymph nodes
fever
malaise
headache
streaking is frequently seen
cellulitis diagnostic studies
CBC
blood culture
possible skin culture
cellulitis nursing management
administer prescribed antibiotics
apply warm compress
inciision and drainage may be needed
monitor size of area by marking and dating reddened area
monitor for secondary infection and any lateration in skin integrity
if cellulitis is not diagnosed and treated correctly, it can progress to gangrene
what is tinea
ringworm
can be transmitted person to person, through animal contact or through contact with contaminated feces
can be associated with poor hygiene and friction from tight clothing
type of tinea
capitis:
- hair, scalp
corporis:
- body
cruris:
- perineum
pedis “athletes foot”:
- feet or ankles
capitis manifestation
scaly, circular patches "blood dot" alopecia red area pruritus fever
capitis treatment
antifungals, shampoos
corporis sxs
erythematosus
scaling patches
round or oval shaped
corporis treatment
local therapy with antifungal creams or powders
cruris sxs
similar to corporis
pink papules
pruritus in genital fold
cruris treatment
local therapy with antifungal creams or powders
aka jock itch
pedis sxs
lesions
pruritus
maceration between toes
burning sensation
pedis treatment
local thearpy with antifungal spray or lotion
possibly Burow’s solution
tinea management
antifungals meds need to be taken for several week or months
encourage good hygiene products
do not share clothing, hair brushes, linens and towels
avoid overuse of OTC products, esp for their feet
what is pediculosis capitis
head lice
live only humans and are transmitted by direct and indirect contact
other types of lice:
- body lice
- pubic area
- eyebrows and eyelashes
pediculosis capitis manifesation
nits - tiny silvery or grayish white specks
pruritius
rose-colored dermatitis
pediculosis capitis management
topical medicated shampoo or body ointments
- an OTC cream rinse petroleum for infants and children or lindane shampoo
contact precautions
prevent transmission and spread by washing clothes in hot water
o not share clothes or hair brushes
what are scabies
contagious skin infection of mites
causative agent = mites
- female mite s burrow into the epidermis and lay eggs
scabies manifestation
pruritus
burrows - fine grayish brown threadlike lines
intense itching especially at night
papule-like eczema in infants
scabies diagnostic studies
history
clinical symptoms
microscopic visualization of skin scrapings
scabies management
pharmacological interventions:
- topical scabicide medications or creams
- treatment of choice = permethrin
- anti-steroidal creams for itching
- systemic anti-infectives used for secondary infections
wash cloths and bedding in hot water
- all persons in close contact with affected person will need treatment
what is frostbite
occurs when ice crystals form in the tissue causing tissue damage
frostbite manifestations
first degree:
blanching
decreased sensation
mottling
second degree:
blisters with possible bulla
- large blisters that are filled with clear fluid
third degree: cyanosis mottling then red with swelling local necrosis hemorrhagc vessels
fourth degree
complete necrosis
gangrene
loss of affected body part
frostbite nursing management
cover the area immediately but do not apply massage
rewarm the affect part gradually by immersing in water heated to 100 to 108 (38 - 42 degrees celsius)
give analgesics and sedatives for severe pain during rewarming
srugery (escharotomy) may be required
what is hypothermia
when body’s core temp is below 95 degrees celsius
hypothermia manifesations
body’s core temp cools to injurious levels below 95
hypothermia management
3 categories of rewarming
- for mild hypothermia
- passive external rewarming
- place client in a warm environemtn and covered with insulation - active external rewarming
- heat is applied to skin over the trunk of the body only - active core rewarming
- most effective way to rapidly increase core temp
- warm humidified air
- diathermy: ultrasound and low- frequency microwave radiation
extracorporal- most rapid means of rewarming
what is hyperthermia
can occur with exposure to air temp over 85 farneheit (29 celsius) and humidity above 50%
hyperthermia tyeps
heat cramps:
- involuntarily spams of the large muscles of the body
- least severe type of hyperthermia
more common in athletes
heat exhaution
- commonly affects firefighters, construction or factory workers
heat stroke
- least common but most life-threatening
- body’s cooling system fails
hypothermia manifestations
heat cramps
- painful muscle spams, may include abdominal cramps
- face will be red, flushed and sweating
- oral temp can be 98.6 - 100
heat exhaustion
- cool, moist
- pale and ahsen skin
- headache
- nausea
- dizziness
- oral temp: above 100
heat stroke - red skin but without perspiration - rapid but weak pulse - shallow breathing body temp right to 106 farenheit
sunburn management
broad spectrum protection, protect against UVA and UVB rays
SPF 30 or higher
water resistance
avoid exposure to direct sunlight between 10am and 3 pm
factors influencing degree of sunburn
genetic makeup and skin type
season of year, altitude and time of day
whether burn took place through window or glass or cause by light reflected by snow or water
meds
underlying conditions
topcial products
classification of burns
local response: increased capillary permability fluid leaks into interstitial space edema surround burned area pain
systemic response: hypovolemic shock resp distress ARDs anemia aspiration pneumonia decreased bowel sounds possible ileus AKI decreaed level of consciousness encephalopathy seizures coma
it can also cause curlings ulcer
curlings ulcer
stress ulcer that occur within 24 hours of injury
administer proton pump inhibitors to prevent these like: pantoprazole
others that might help prevent these ulcers:
- early enteral feeding
- H2 histamine blaockers
- NSAIDs - should be used with caution
- diuretics: furosemine, bumetianide = CONTRAINDICATED
burns manifestations
1st degree - superficial: localized pain dry surface blanches with pressure redness and possible blisters
2nd degree - partial thickness: open wound very painful denuded skin blistered and moist
3rd degree - full thickness: tough leathery dull and dry with variable pain color may be brown, tan, black or red
4th degree - full thickness:
dull and dry
ligaments, tendons, and bone may be exposed
burns managements
acute phase:
priority is stop the burning process
superficial burns:
- cleanse with solutions ordered and debride loose debris and ncrotic tissue
may receive prophylactive tetanus immunizations and mild analgesics
parkland formula
4 mL x TBSA % x body weight in kg
50% given in first 8 hours
other 505 given in the next 16 hours
risk factors for melanoma skin cancer
fair skin tone blonde or red hair blue or green eyes people who work outdoors age (>50, <30)
immunosuppressant therapy drug therapy history of burns indoor tanning fam history of skin cancer
high altitudes
live in sunny climates
non melanoma skin cancer
basal cell carinoma
squamous cell caricnoma
what is basal cell carcinoma
abnormal, uncontrolled growths or lesions from skin basal cell
cumulative ltraviolet exposure and intense or occasional UV exposure
basal cell carcinoma manifestations
open sore
red patches
pink growth
shiny bumps or scars
basal cell carcinoma treatment
surgery:
- Mohs micrographic surgery
- excisional surgery
- cryosurgery
- curettage and electrodesiccation
radiation
imiquimod - for superifical BCC
5 Fluoruracil
Vismodegib
- ALL 3 HAVE BLACK BOX WARNING
basal cell carcinoma management
skin cancer prevention
what is squamous cell carcinoma
uncontrolled growth of abnormal cells arising in squamous cells
caused by cumulative UV exposure over the course of a lifetime
can be disfiguring and may be deadly if allowed to grow
swuamous cell carcinoma manifestations
scaly red patches
open sores
elevated growth with central depression
occurs on any area exposed to skin
squamous cell carcinoma treatment
surgery: same ones as BCC
radiation
5 Fluorouracil
