Integumentary Flashcards
eczema
dermatitis
atopic-sensitivity to allergens (eg. asthma)
contact-direct contact to allergens (eg. jewelries)
statis dermatitis-areas w/ low blood flow
eczema mgt
-tepid baths from 5 to 1mins
-moisturizers right after
-antihistamines & corticosteroids
-antibiotics for 2nd infxn
-cool wet compresses
-avoid skin irritants
-wash clothes w/ mild detergent
-eliminate scratching/itching
impetigo
-beta hemolytic strep or staph
-during hot humid months
-contact prec, highly contagious
-honey colored crusts
impetigo mgt
-cover lesions w/ gauze
-handwashing
-warm bath w/ antibacterial soap
-wash clothes linens w/ warm water & separate from others
-use separate towels, linens, utensils, dishes
-oral & topical antibiotics
-warm compresses
pediculosis capitis mgt
head lice
-use of pediculide
-one brush per individual; no sharing
-all members might need treatment
-use of extra fine tooth nit comb daily after pediculide (wear gloves)
-discard or soak comb in boiling water for 10min
-wash clothes linens in warm water& dried hot for 20min
-furniture & carpets vacuumed
-clothes toys that cannot be washed or dry cleaned sealed for 2 weeks (life is 7 to 10days)
-beddings changed daily
scabies mgt
itch mite (+ skin burrows)
greyish red lines
common in school children & institutionalized populations
-topical scabicide
*neck down, not head & face esp. lindane shampoo and 💀 below 2yo
*30mins after bath in a dry skin: permethrin cream, no to eyes
-beddings changed daily for 1 week
-laundry separate & wash w/ warm water, dried warm & ironed!
-nonwashables sealed in 4 days
inaccurate estimate of burns in children
rule of nines
extent of burns in children
percentage of total body surface area
A 1/2 head
B 1/2 one thigh
C 1/2 one leg
adequacy of fluid volume checked thru
vs (esp heart rate)
urinary output
capillary refill time
sensorium
pedia considerations of burn victims
-scarring is more severe
-delay in growth may occur -immature immune system presents an increased risk of infection
-higher proportion of body fluid to body mass in a child increases the risk of cardiovascular problems
-Burns involving more than 10% of total body surface area require some form of fluid resuscitation
-at increased risk for protein and calorie deficiencies because they have smaller muscle mass and less body fat
phases of wound healing
- inflammatory
- fibroblastic -forming of scar & granulation tissue
- maturation-scar tissue thinner firm inelastic
healing by intention
1st intention - wound edges easily closed & approximated
2nd intention - tissue loss that require gradual filling w/ connective tissue
3rd intention - with exudates & debris that require irrigation or removal
serous
clear /N° part of healing process
serosanguineous
pink colored (serous + small bloodcells)
N° part of healing process
sanguinous
red drainage from trauma to a blood vessel
may occure during wound cleansing
abN°
hemorrhaging
frank blood from a leaking blood vessel
emergent care
abN°
purulent
yellow, gray or green
due to infxn
abN°
skin biopsy
punch, excisional or shave
keep dressing for 8hrs
antibiotic ointment
skin/wound culture
-taken before antibiotic therapy
-done usually together with a nasal swab
-viral culture placed immediately on ice
wood’s light examination
skin viewed under UV light in a special glass (wood’s light)
-darken the room
-light is not harmful to skin & eyes
diascopy
glass slide pressed over the lesion causing blanching and revealing lesion more clearly
if erythema is:
inflammatory or hemorrhagic (petechiae)
candida albicans
fungal/yeast infxn in skin folds & mouth
oral candidiasis/thrush (red white patches)
-antifungal
-give non irritating foods&fluids
-oral care w/ non irritating products
-keep skin folds clean & dry as well as bed linens
herpes zoster
shingles
+hx of chickenpox, reactivation of varicella zoster
unilateral clustered skin vesicles
contact prec as long as vesicles present
lightweight loose cotton clothes
astringent compresses
💀postherpetic neuralgia: pain even if no more lesions
complication: bells palsy 7th cranial nerve assessment
tzanck test/smear
chickenpox & herpes skin test
MRSA
methillin resistant staphylococcus aureus
*community acquired - contact thru sports, share equipment
*hospital acquired
folliculitis (inflammed follicles) & furuncle (carbuncle is clusters of furuncle)
*nasal swab
erysipelas vs cellullitis
e: superficial than c but red marks is well demarcated
dermis & lymphatics
c: depeer than e and red marks are scattered
dermis up to hypodermis only
rest in affected area and warm compress
poison ivy, oak & sumac plants
contains irritant urushiol also found in MANGOES
result to dermatitis
cold wey compress
topical or oral corticosteroids
topical ointments for itching
spider bites
-brown recluse (necrotic area/loxoscelism)
-black widow spider (neurotoxicity
*both ice applied immediately
-tarantula
*elevate & immobilize, use of sticky tape to remove hair & nss irrigation if reached the eye
*tetanus prophylaxis for all
bark scorpion stings
venom neurotoxic, emergency
bees & wasps
-stings usually cause a wheal and flare reaction
-Emergency care involves quick removal of the stinger and application of an ice pack
-The stinger is removed by gently scraping or brushing it off with the edge of a needle or similar object; tweezers are not used because there is a risk of pinching the venom sac
-If the victim is allergic to the venom of a bee or wasp, a severe allergic response can occur (hives, pruritus, swelling of the lips and tongue) that can progress to life-threatening anaphylaxis; immediate emergency
-Individuals who are allergic should carry an epinephrine autoinjector for self-administration of intramuscular epinephrine if a bee or wasp sting occurs. After use of the epinephrine autoinjector, the individual should seek emergency medical attention. Persons should have 2 injectors available and obtain a replacement as soon as possible.
snake bites
should rest to decrease venom circulation
-extremity is immobilized and kept below the level of the heart
-Constricting clothing and jewelry are removed before swelling
-kept warm and is not allowed to consume caffeinated or alcoholic beverages, which may speed absorption of the venom
-if unable to seek emergency medical attention promptly, a constricting band may be applied proximal to the wound to slow the venom circulation; monitor the circulation frequently and loosen the band if edema occurs
-wound is not incised or sucked to remove the venom; ice is not applied to the wound
-Emergency care in a hospital is required as soon as possible; an antivenom may be administered along with supportive care
-the snake should not be transported with the victim for identification purposes unless it can be safely placed in a sealed container during transportation.
frostbite
-Rewarm the affected part rapidly and continuously with a warm water bath or towels to thaw the frozen part
-Handle the affected area gently and immobilize.
-Avoid using dry heat, and never rub or massage the part
-rewarming process may be painful; analgesics may be necessary
-Avoid compression of the injured tissues and apply only loose and nonadherent sterile dressing
-Monitor for signs of compartment syndrome
-tetanus prophylaxis is necessary, and topical and systemic antibiotics may be prescribed
-Debridement of necrotic tissue may be needed; amputation may be necessary if gangrene develops.
seborrheic vs actinic keratosis
me vs hr foldenauer
seborrheic is benign
for actinic
-caused by chronic exposure to the sun and appear as rough, scaly, red, or brown lesions that are usually found on the face, scalp, arms, and backs of the hands
-Lesions are considered premalignant, and there is risk for slow progression to squamous cell carcinoma
-medications, excision, cryotherapy, curettage, and laser therapy
skin cancer major types
squamous cell
basal cell
melanoma
squamous cell cancer
-rough scaly patch or wartlike growth
-oozing bleeding crusting lesion
-2nd most common
-in the epidermal keratinocytes and can infiltrate surrounding structures and metastasize to lymph nodes.
basal cell cancer
-most common
-small shiny bump or red scaly patch, pearly borders, res central crater
-rarely spreads, locally invasive
melanoma
-irregular, circular, bordered w/ hues of tan black or blue
-usually a new or changing mole or pigmented area
-occur any place on the body, especially where birthmarks or new moles are apparent
-highly metastatic to the brain, lungs, bone, and liver, with survival depending on early diagnosis and treatment
skin CA mgt
-Instruct to avoid sun exposure between 10 a.m. and 4 p.m.
-Advise to have moles or lesions that are subject to chronic irritation removed
-Advise to avoid contact with chemical irritants
-Instruct to wear layered clothing and use and reapply sunscreen lotions with an appropriate sun protection factor when outdoors.
-Assist with surgical management, which may include cryosurgery, curettage and electrodessication, or surgical excision of the lesion
psoriasis
noninfectious skin inflammation
*some also develop arthritis
no scratching
light clothing
no OTC drugs
koebner phenomenon
development of psoriatic lesions after a skin injury (scratch, new tattoo etc)
clean the injury as often as possible to prevent or lessen
acne vulgaris
-no scrubbing the skin
-no squeeze prick pick the lesions
-noncomedogenic, water based makeups and less oil based
stevens johnson syndrome SJS
medication induced skin reaction
*nsaids
*sulfonamides
*antiseizure
*allopurinol
common in immunocompromised
initial: flu like symptoms + erythema
serious: +lesions in larynx esophagus & bronchi
toxic epidermal necrolysis TEN
medication induced skin reaction
severe form of SJS
more than 30% of the body have burn like lesions
eschar
dead skin tissue around pressure ulcer injuries
pressure ulcer stage 1
transparent dressing
hydrocolloid
pressure ulcer stage 2
composite film
hydrocolloid
hydrogel
pressure ulcer stage 3
hydrocolloid
hydrogel w/ Foam Dressing
gauze
growth factors
pressure ulcer stage 4
hydrogel w/ Foam Dressing
calcium alginate
gauze
pressure ulcer unstageable
Adherent film
Gauze with a prescribed solution Enzymes
frostbite s/s
before thawing
white or blue color; the skin will be hard, cold, and insensitive to touch
after thawing,
flushing of the skin, the development of blisters or blebs, or tissue edema appears
bentoquatam
poison ivy, oak and sumac
PREVENTIVE LOTION (murag off lotion)
poison ivy oak sumac
calamine
hydrocortisone
zinc acetate
oatmeal baths
topical immunosuppressants
tacrolimus & pimecrolimus
*treated areas should be shaded from the sun
-increase risk of contracting varicella zoster
-increased risk to skin cancer
systemic immunosuppressants
Azathioprine ▪ Cyclosporine ▪ Methotrexate ▪ Oral glucocorticoids
topical glucocorticoids
-wash area
-wear gloves
-thin film, rub gently
-avoid occlusive dressing (may increase absorption)
-check plasma cortisol levels
actinic keratosis meds
*Diclofenac sodium 3% gel - may take up to 3 mos to be effective
*Fluorouracil - results are seen after 2 weeks
*Imiquimod 5% cream - also used for venereal warts
*Ingenol mebutate - can cause development of herpes zoster
sunscreen
-should be at least spf 15
-applied 30min before sun exposure
and reapplication every 2-3hrs
-UV light greatest at 10am to 4pm
-wear sunglass, protective clothing & hat
psoriasis meds
Topical Medications
Calcipotriene (vit d analog)
Coal tar
Glucocorticoids
Keratolytics (topical salicylic acid; sulfur)
Tazarotene (vit a derivative)
Systemic Medications
Acitretin (teratogenic)
Cyclosporine (last resort)
Methotrexate (teratogenic)
Systemic Biological Medications Adalimumab,Brodalumab,Etanercept Guselkumab,Infliximab,Ixekizumab
Ustekinuma,Secukinumab
Phototherapy
Coal tar and ultraviolet B irradiation Photochemotherapy (psoralen and ultraviolet A therapy)
burns meds
silver sulfadiazine (check for WBC)
mafenide acetate (can lead to acidosis)
apply 1/16inch
cover always
salicylic acid toxicity
tinnitus
dizziness
psychological disturbance
can increase triglyceride levels
isotretinoin
highly permeable areas
scalp, axilla, face, eyelids, neck, perineum, genitalia
low permeable areas
soles, palms, back
