integumentary Flashcards
What is impetigo?
contagious Strep or staph infection associated with poor hygiene
Vesiculopustular lesions surrounded by erythema
Honey colored, crusty
What is the treatment for impetigo?
- warm saline
- soap and water – meticulous hygiene is important!
- systemic antibiotics or topical
What is folliculitis?
bacterial Staph infection in the hair follicle. Common on scalp or beards of men. Small pustule at hair follicle.
Present in areas subjected to friction, moisture, rubbing, or oil. Can be spread from contaminated hot tubs!
Usually does not scar
What is the treatment for folliculitis?
- antistaph soap
- topical antibiotics
- warm compresses
- if severe – systemic antibiotics
What is a faruncle/carbuncle?
Infection around the hair follicle in which purulent material extends through the dermis into the subcutaneous tissue, where a small abscess forms
Carbuncle: multiple furuncles
What is treatment for faruncles (and carbuncles)?
a. I&D (incision and drainage) - Zit Dr!!!
b. antibiotics
c. warm/moist compresses
What is cellulitis?
a bacterial staph or strep infection of the subcutaneous tissue
Manifestation: Hot, tender, reddened area, and has diffuse borders
S/S: chills, malaise, and fever
What is the treatment for cellulitis?
- moist heat
- immobilization
- elevation
- systemic antibiotics
What is Herpes Simplex 1 and 2?
recurrent lifelong viral infections of skin and mucous membranes, appears as a blister or as multiple blisters on or around affected areas - usually the mouth or genitals (Oral (HSV1) or genital (HSV2)). The blisters break, leaving tender sores
It is contagious to those not previously infected
What is treatment for Herpes simplex 1 and 2?
- symptomatic medication
- moist compresses
- antiviral agents,
- and sometimes petroleum (for oral lesions)
What is fungal candidiasis?
a fungal infection caused by Candida Albicans
Presents in warm, moist areas such as groin, oral mucosa, under breasts
Causes: depression of cell-mediated immunity that allows yeast to become pathogenic (antibiotic use), HIV, chemotherapy
S/S: Creamy (cheesy) white patches in mouth, rash/blisters on skin, vaginal itching
What is the treatment of candidiasis?
- antifungal oral or vaginal,
- keep skin clean and dry,
- antifungal powder on skin
What is tinea corporis? and the treatment?
ringworm - has well defined margins, contagious via contact
Treatment
- cool compress
- topical antifungals (miconazole)
What is patch testing?
a test for allergens
What is psoriasis?
a benign disorder of the skin
- Can be intermittent of continuous
- Usually develops before age 40
- Not contagious
What are the S/S of psoriasis?
- Silvery scaly plaques and visible lesions
- Location – scalp, knees, elbows, torso
- Itchy, burning, sometimes painful
- Social issues can develop
What is the treatment for psoriasis?
- topical steroids
2. phototherapy
what is lichenification?
a thickening of skin caused by chronic scratching or rubbing
What are common treatments for skin problems?
phototherapy, radiation therapy, and laser technology
drug therapy
Skin Scraping - Scalpel blade removes cells for microscopic examination
Electrodessication and Electrocoagulation - Electrical energy provides heat that destroys tissue
Curettage – scoop away!
Punch Biopsy – core is removed
Cryosurgery - subfreezing temperatures used to destroy epidural lesions such as warts, tags, benign tumors, etc
Excision
What are drugs used for skin problems?
Antibiotics - topical and systemic
Corticosteriods - topical and systemic; diagnose before using steroids bc they can alter the manifestations
Antihistamines - For itching and swelling
Topical Flurouracil (5-FU) - For sun-damaged cells
Immunomodulators - Most suppress overactive immune system
What are nursing interventions for dermatologic problems?
Wet compresses - Used for superficial skin problems that involve inflammation, itching, and infection (tap water usually fine)
Baths - When large areas need to be treated; 15-20 min, 3-4 X/day
Topical medications
Control of pruritus:
- Avoid vasodilation (heat or rubbing), and dry skin
- Cool environment (vasoconstriction)
- Systemic antihistamines, topical/systemic steroids
What are examples of antibiotic resistant organisms?
MRSA, VRSA, CRE, penicillin resistant streptococcus pneumonia
What is the health care providers contribution to antibiotic resistant organisms?
Administering antibiotics for viral infections
Succumbing to pressures from patients to prescribe unnecessary antibiotic therapy
Using inadequate drug regimens to treat infections
Using broad-spectrum or combination agents for infections that should be treated with first-line medications
What is the patients’ contribution to antibiotic resistant organisms?
Skipping doses
Not taking antibiotics for the full duration
Saving unused antibiotics “in case I need them later”
Limited resources and access to medications make it difficult for some to get adequate treatment for infections
what is patient teaching regarding decreasing the risk for antibiotic resistant infections?
- Do not take antibiotics to prevent illness
a. Prophylactic antibiotics are given for surgery - Wash your hands frequently
- Follow directions when taking antibiotics
- Do not request an antibiotic for flu or colds
- Finish your antibiotic
- Do not take leftover antibiotics
What is a HAI?
Infection acquired in health care setting
- Surgical and immunocompromised patients at highest risk
- Multiple organisms are responsible
1/3 of HAI’s are PREVENTABLE…how?
Handwashing!!!
HAI’s in the elderly. Who is at risk and how does it manifest?
HAIs in elderly 2-3X higher
At risk:
- LTC (long term care) patients
- due to impaired immune function, co-morbidities such as UTIs, pneumonia, skin infections, TB
How does infection manifest in the elderly adult?
**decline in cognitive function and ability to perform ADLs…don’t rely on temperature!!! **
What are CDC guidelines to prevent HAI’s?
standard precautions and transmission based precautions
What are the S/S of influenza?
Onset abrupt, highly contagious
Cough, fever, chills, myalgia (muscle pain), HA, exhaustion
Dyspnea and crackles signs of pulmonary complications
Usually symptoms subside within 7 days
Most common complications:
- Pneumonia – can cause DEATH!
- ear or sinus infection
- High risk: elderly and chronic disease
a. also prone to dehydration
What type of flu vaccine is commonly given?
inactivated vaccine
What is the incubation period for the flu?
Incubation period of 1-4 days, with the peak transmission risk starting at 1 day BEFORE symptoms appear
i.e. Transmissible 24 hrs before symptoms present
What is treatment for the flu?
- Symptomatic therapy
- Antiviral drugs – within 2 days of symptoms for max benefit
- Rest (older adult possible hospitalization)
Prevention: vaccine
What are the modes of transmission for HIV?
Contact with infected body fluids (blood, semen, vaginal secretions, breast milk)
- Sexual intercourse with infected partner* - *most common mode of transmission
- Perinatal (most common route of transmission for children)
- During pregnancy, during delivery, breastfeeding
- Exposure to HIV infected blood or blood products
Can be transmitted within a few days after becoming infected, and continues for life
NOT SPREAD BY:
- HIV is not spread casually (hugging, shaking hands, sharing eating utensils, etc.)
- HIV is not spread by tears, saliva, urine, emesis, sputum, feces, sweat, or respiratory droplet
What are the clinical manifestations of an acute HIV infection?
flu-like syndrome, occurs 2-4 weeks after initial infection, lasts for 1-3 weeks
- Viral load is high during the Acute Phase so measure for it if HIV is a possibility
- MOST infectious during this stage
S/S:
i. Fever
ii. Swollen lymph glands
iii. Sore throat
iv. Headache
v. Malaise
vi. Nausea
vii. Muscle and joint pain
viii. Diarrhea
ix. Diffuse rash
x. Some develop neurologic complications: facial palsy, Guillain-Barre, peripheral neuropathy, aseptic meningitis
What is the window period of HIV infection?
time between infection and development of antibodies; can be several weeks before detection is possible after infected
What are diagnostic tests for HIV?
- CD4 T cell count - detects immune function
- Viral load - detects amount of virus in body; “undetectable” doesn’t mean that virus has been eliminated
also the CBC can be looked at for pancytopenia
What is health promotion regarding HIV?
prevent spread - via intercourse, drug use, perinatal, or work related incidents
delay disease progression -
- Getting nutritional support to maintain lean body mass
- Moderating or eliminating alcohol, tobacco, and drug use
- Keeping up to date with vaccines
- Adequate rest and exercise
- Reducing stress
- Avoiding exposure to new infectious agents
- Counseling
- Support groups
- Relationship with HCP’s/attend regular appointments
What is rheumatoid arthritis?
inflammation of the connective tissue in the synovial joints.
many joints are involved and the lining of the joints (the synovium) is inflamed, damaging all tissues in the joint
The joints are painful and stiff and appear warm, tender, and swollen with fluid
Blood tests confirming RA show widespread inflammation that affects the body in general, often causing anemia, weight loss, and fatigue.
X-ray images in rheumatoid arthritis show bones that are thin and eroded.
What are the clinical manifestations of rheumatoid arthritis?
- at onset -fatigue, anorexia, weight loss, generalized stiffness
- systemic manifestations at onset - then stiffness becomes more localized in the following weeks and months
- Joint symptoms: pain, stiffness, limitation of motion, warm to the touch, swelling, and tenderness
- Joint symptoms occur symmetrically
- May begin in a couple of joints only
- Most frequently attacks the wrists, hands, elbows, shoulders, knees, and ankles
a. Cervical spine may be affected, but not C1 & C2
5 may lead to permanent deformity and disability
What are complications of rheumatoid arthritis?
- deformity and disability
- rheumatoid nodules
- Sjögren’s syndrome
- Felty syndrome
What are common deformities of rheumatoid arthritis?
Ulnar drift Boutonniere deformity Hallux valgus (bunion) Swan neck deformity
What are rheumatoid nodules?
nodules that develop in about half of all pts with RA
Appear subcutaneously as firm, non-tender, granuloma-type masses
Base of spine, back of neck, and even scleral nodules
What is Sjögren’s syndrome?
a syndrome that develops on its own or as part of RA or SLE (lupus)
Autoimmune disease that targets the moisture-producing exocrine glands leading to dry mouth and dry eyes
- Nose, throat, airways, and skin can also become dry
- Other glands can be involved (glands in stomach, pancreas, small intestines)
- Diminished lacrimal and salivary gland secretion
What are S/S of Sjögren’s syndrome?
burning, gritty, itchy eyes, ↓ tearing, photosensitivity
What is the treatment for Sjögren’s syndrome?
Treat symptoms!!
- artificial tears
- surgical punctal occlusion
- increase fluids with meals
- Good dental hygiene important d/t dry mouth
What is Felty syndrome?
a rare autoimmune disease characterized by triad of rheumatoid arthritis, enlargement of the spleen, and too few neutrophils in the blood
What is the pneumonic for Felty’s syndrome?
SANTA splenomegaly anemia neutropenia thrombocytopenia arthritis
What are two general indicators for active inflammation in the body? (used for rheumatoid arthritis)
ESR and C-reactive protein
What is interpersonal care for rheumatoid arthritis?
Education on disease process and home management
Drug therapy: anti-inflammatory medications and others
Nutritional therapy: balanced nutrition
Acute Intervention: primary goals are to have a reduction in inflammation, satisfactory pain management, have minimal loss of functional ability, prevent/minimize joint deformity
Goals met through a comprehensive program of drug therapy, rest (pacing activities), joint protection, heat (chronic stiffness) and cold (acute exacerbation/inflammation) application, exercise, pt and family education
What is nurse teaching for protecting small joints in rheumatoid arthritis given to the patient or caregiver?
- maintain joint in neutral position to minimize deformity. (press water from a sponge instead of wringing)
- Use strongest joint available for any task. (when rising from a chair, push with arms rather than fingers; carry laundry in both arms rather than fingers)
- Distribute weight over many joints instead of stressing a few (slide objects rather than lifting, hold packages close to body for support)
- Change positions frequently (do not hold a book or grip a steering wheel for long periods, avoid grasping a pencil or cutting veggies for long periods)
- Avoid repetitious movements (knitting, rest between rooms when vacuuming, faucets and doorknobs that are pushed not turned)
- Modify chores to avoid stress on joints (avoid heavy lifting, sit on stool when meal prepping)
What is gout?
Type of acute arthritis caused by the elevation of uric acid and the deposit of uric acid in one or more joints
painful flares with long periods without symptoms
Caused by increase in uric acid production, reduced excretion by kidneys, or increase intake of foods containing purine (not usually a problem), can be related to alcohol intake
What are the clinical manifestations of the acute phase of gout?
gouty arthritis may occur in one or more joints (usually less than 4)
- Triggered by trauma, surgery, ETOH ingestion, systemic infection
- Inflammation of great toe-podagra is the most common initial problem
- Dusky, cyanotic joints
- Other affected joints: mid-tarsal area of foot, ankle, knee, wrist
- Onset-occurs at night with sudden swelling and excruciating pain
- Often a low grade fever
What are the clinical manifestations of the chronic phase of gout?
multiple joints, visible deposit of Na urate crystals called tophi
- Chronic inflammation may lead to joint deformity, cartilage destruction which may predispose to OA
- Excessive uric acid may lead to kidney and urinary tract stone formation
- Pyelonephritis
What is the gold standard for gout diagnosis?
Synovial fluid aspiration
- Fluid contains urate crystals
- Pt may benefit with decompression
- Usually not necessary as it can be diagnosed from clinical symptoms
What is collaborative care for gout?
joint immobilization
local application of heat or cold
joint aspiration and intraarticular corticosteroids
dietary avoidance of food/fluids with high purine content (ie anchovies, liver, wine/beer)
drug therapy
purine foods include:
high purine:
sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads
moderate purine:
chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
What is Systemic Lupus Erythematosus (SLE)?
a COMPLEX AND MULTIFACTORIAL multi system inflammatory autoimmune disease in which connective tissue and fibrin deposits collect in blood vessels, on collagen fibers, and on organs.
The deposits lead to necrosis and inflammation in blood vessels, lymph nodes, gastrointestinal tract, and pleura
There is no known cure for the disease
- Most cases in women of childbearing years
- Women 10 times more likely to develop SLE than men
The severity of lupus is ___ and there is ___ in progression.
extremely variable
no characteristic pattern
What are the dermatologic manifestations of lupus?
#1 - Classic Butterfly Rash
Also:
- Cutaneous vascular lesions in sun-exposed areas,
- ulcers of the oral and pharyngeal membranes common,
- patchy hair loss (alopecia) dry, scaly scalp
Can also affect almost every other body system
Lupus causes an increase susceptibility to infections. Therefore:
FEVER SHOULD BE CONSIDERED SERIOUS AND INVESTIGATED
also avoid live vaccines if patient is taking steroids or cytotoxic agents
Acute intervention of lupus includes:
Documentation of patient symptoms and response to therapy
Assess fever pattern, joint inflammation, limitation of movement, location and degree of discomfort and fatigue
Monitor weight and I&O
24-hour urine studies may be ordered
Observe for signs of bleeding
Treatment during pregnancy
- should be considered (spontaneous abortion, stillbirth, and intrauterine growth retardation are common problems with pregnancy)
- Exacerbation is common in the postpartum period
What is patient and caregiver teaching for lupus patients?
- the disease process
- names of drugs, actions, side effects, dosage, and admin
- pain management strategies
- energy conservation and pacing techniques
- therapeutic exercise, use of heat therapy (for arthralgia)
- avoidance of physical and emotional stress
- avoidance of exposure to individuals with infection
- avoidance of drying soaps, powders, household chemicals
- use of sunscreen protection and protective clothing, with minimal sun exposure from 11am-3pm
- regular medical and lab follow-up
- marital and pregnancy counseling as needed
- community resources and health care agencies
Also:
frequent oral care
monitor skin integrity
id contributors to fatigue
