Integumentary & Burns Flashcards
epidermis
inhibits proliferation of microorganisms, prevents dehydration and electrolyte loss, sweat glands allow for temp regulation, synthesizes vitamin D, stimulation through neuroreceptors
Cells of the epidermis include
keratinocytes
melanocytes
components of dermis
connective tissue, hair follicles, sweat and oil glands, blood vessels, nerves, lymphatic vessels
hypodermis
absorbs shock to protect from injury, temp regulation (fats cells insulate and retain body heat)
types of lesions
primary and secondary
primary lesion
direct result of a disease process
secondary lesion
develop as a consequence of the clients activities
pruritus
itching
urticaria
hives
lichenified
thickened
annular
ring like with raised borders around flat centers of normal skin
circinate
circular
circumscribed
well defined, sharp borders
diffuse
wide spread
macular
flat
papular
raised
macule
discolouration of the skin that is salt and level with the skin
fissure
cleft or groove in the skin
module
small, node like structure that is solid and elevated
papule
small, solid and raised caused by thickening of epidermis
vesicle
small blister that contains clear fluid
polyp
growth that forms on a mucus membrane or other surface inside the body
cyst
closed pouch under the skin that contains a fluid or a semisolid substance
pustule
a small elevation on the skin that contains pus
wheal
area of all that is slightly raised and appears either redder or paler than the surrounding skin
secondary lesions include
scales, crust, ulcer, scar
risk factors for pressure ulcers
lack of mobility, exposure to excessive moisture, undernourishment, aging skin
blanchable
returns back to pink/red from white when area pushed on
non-blanchable
does not turn white when area is pushed on; means no perfusion
stage 1 pressure ulcer
non blanchable
tissue has started to become damaged
decreased perfusion
skin intact
stage 2 pressure ulcer
skin is no longer intact
wound bed visible
exposed dermis
stage 3 pressure ulcer
exposed dermis and hypodermis
slough, eschar, tunneling, adipose tissue, granulation tissue
damaged or necrotic subcu tissue
stage 4 pressure ulcer
all the way through hypodermis
can through integ system into MSK system
unstageable pressure ulcer
cannot see base of wound; covered with slough or eschar
eschar
dry, thick, leathery, brown/tan/black
slough
yellow/tan/green/brown, moist, loose, stringy
deep tissue injury
localized deep red/maroon area that is non-blanchable, no circulation, skin is intact, cannot see how far down it goes
to prevent shearing of skin do not elevate head of bed above
30 degrees
donut shaped pillow can damage
capillary beds and increase tissue necrosis
for clients that cannot reposition themselves they should be turned and repositioned every _____ hours
2
dermatitis
inflammation of dermis
contact dermatitis
hypersensitivity when exposed to certain allergen
atopic dermatitis is also known as
eczema
eczema S&S
intense itching, red, dry, scaly, skin
occur in flare ups
immune system is attacking dermis
Psoriasis
chronic autoimmune T-cell mediated inflammatory skin disease; exacerbations and remissions; scaly, erythematous, pruritic plaques
Psoriasis Tx
no cure because it’s autoimmune; for symptoms can do light therapy, methotrexate, folic acid, systemic retinoids, infliximab
stevens-johnson syndrome
cytotoxic T cell drug reaction; T cells are killing keratinocytes in epidermis causing extensive blistering; is a response to a drug reaction
stevens johnson syndrome treatment
stop all possible medications
fluids
nutrition
wound care
pain
prevent infection
corticosteroids
cellulitis
bacterial infection of skin in dermis and hypodermis
cellulitis S&S and causes
red, warm, swollen, painful skin
staph, MRSA, group B strep
cellulitis tx
systemic abx
impetigo
bullous or ulcerative; caused by staph or strep
impetigo is more common in
children
MRSA
staph infection resistant to abx; contact precautions
HSV type 1 and 2
type 1 mouth and face
type 2 genitals
HSV presentation
groups of vesicle on erythematous base and can turn into pustules, rupture, and form crusts
HSV lasts
2-6 weeks
HSV tx
topical/oral antiviral drugs
Herpes zoster
grouped lesions with weeping and crusting; unilaterally along segment of skin that follows a cranial nerve
herpes zoster S&S
appearance of HSV, follows cranial nerve, pain, parenthesia
herpes zoster tx and prevention
antiviral drugs
vaccination
tinea
fungal infection classified by location
tinea pedis is also called
athletes foot
tinea appearance
annular patches with elevated borders and scaling
tinea tx
topical antifungal therapy
candidiasis
yeast like fungal infection
candidiasis S&S
erythematous macular eruption with isolated pustules at the border, burning and itching, common in skin folds (where warm and moist ideal for fungal growth)
oral thrush lesions are
creamy white, white coated
thrush is treated with
nyastatin
squamous cell carcinoma and tx
top layer of epidermis grows out of control, from on areas of body exposed to sun (face, ears, neck), start at top and grow into deeper layers
tx: remove it
basal cell carcinoma
most common type of skin cancer, form on areas of body exposed to sun, start in bottom layer of epidermis , slow growing and really spread
melanoma
melanocytes that grow out of control, more dangerous and can spread easily
melanoma appearance
dark brown or black, most commonly located on trunk or legs
melanoma tx
surgery, immunotherapy, targeted therapy drugs, chemo, radiation
1st degree burn
superficial, skin remains intact, redness, no blisters, can be painful to touch
2nd degree
partial thickness burn, blisters form, affects epidermis and dermis, skin is moist and red, very painful
3rd degree burns
full thickness burn, penetrate all the way into subcu tissue, destroy nerve endings so not as painful, red/tan/black, dry and leathery, area of eschar
4th degree burns
full thickness and involvement of MSK, dry and dull, necrotic tissue
tx of 3rd and 4th degree burns requires
skin graphing because cells that grow new skin cells are destroyed so it cannot heal on their own
3 stages of burn management
emergent, acute, rehabilitative
emergent burn management
first 24-48 hrs, large shift in membrane permeability/ fluids shift from intravascular space to interstitial space, high risk for hypovolemic shock, electrolyte imbalances, renal failure - fluids are priority (parkland burn formula)
acute burn management
48-72 hrs after injury until would heals, membrane permeability is stabilized, focus on healing, preventing infection, pain relief, nutrition, wound care
rehabilitative burn management
burn is now healed, focus on regaining function
rule of 9s
Head 9%
Chest 18%
Abdomen 18%
each arm 4.5%
each leg 9%
genital 1%
rule of 9s
head 9%
chest 18%
abdomen 18%
each arm 4.5%
each leg 4.5%
genitals 1%
complications of burn injuries
hypovolemic shock, renal failure, hyperkalemia, hyponatremia
third spacing is _______ and occurs in _______
plasma moving from intravascular space to interstitial space; hypovolemic shock
decreased intravascular volume = decreased bp = __________
hypovolemia
CVS recognizes hypovolemia and compensates by
increasing HR -> decrease CO -> decrease bp
hypovolemic shock leads to decreased perfusion of
kidneys and renal damage
insufficient urine output is
<30ml/hr
in renal failure ________ will be increased
BUN and creatinine
why does hyperkalemia occur in burn pts and S&S
injury to cells release the potassium into bloodstream; muscle weakness, cramps, nausea, chest pain, arrhythmias, tall peaked t waves
why does hyponatremia occur in burn pts and S&S
due to increased capillary membrane permeability water leaves the intravascular space and sodium follows entering into the interstitial space; headache, confusion, restlessness, irritability, seizures, coma
two electrolyte abnormalities in burn pts
hyperkalemia and hyponatremia
fluid replacement is most crucial in the first ______ in burn pts
24 hrs as this is when slowly is losing largest volume and is at risk for hypovolemic shock
fluid of choice for burns
Lactated ringers
parkland formula for burns
total to be infused = 4ml x TBSA % x weight (kg) -> divide in half -> first half over 8hrs -> second half over 16 hrs
