Integumentary Exam #2 Flashcards
1
Q
What is dermatitis?
A
Superficial inflammatory response of the epidermis caused by infections, allergies, irritating substances.
2
Q
What is the primary nursing goal with dermatitis?
A
Relieve pruritis
3
Q
What is Seborrheic Dermatitis?
A
Dandruff
4
Q
What causes dandruff?
A
overproduction of sebum by sebaceous glands of scalp and irritation from a yeast
5
Q
What are Sx of seborrheic dermatitis?
A
oiliness, erythema, yellow greasy scales, ITCHY
6
Q
What is Tx for seborrheic dermatitis?
A
dandruff shampoo, topical steroids, olive oil
7
Q
What is contact dermatitis?
A
condition in which skin becomes red, sore and inflamed after direct contact with a substance. Can be irritant or allergic
8
Q
Inflammation intensity for contact dermatitis is R/T to:
A
- concentration of irritant
- exposure time
- repeated use
9
Q
What is the diff between an irritant & allergic reaction?
A
irritant needs no prior exposure
10
Q
How many days after exposure to allergen does reaction occur?
A
2-7 days after contact
11
Q
How can you Dx allergic contact dermatitis?
A
visual assessment
patch testing
12
Q
What is rhus-dermatitis?
A
allergic reaction to plants (ie poison ivy)
13
Q
When do Sx occur after contact with rhus-dermatitis?
A
24-48 hours
14
Q
What is Tx for rhus-dermatitis?
A
ASAP: wash skin, antihistamines, steroids
15
Q
What does an acute allergic contact dermatitis reaction look like?
A
papules, vesicles or bulla
16
Q
What does a chronic allergic contact dermatitis reaction look like?
A
Thick & scaly, like atopic dermatitis
17
Q
What are some common allergens causing allergic contact dermatitis?
A
topical ABX, jewelry, latex, poison ivy, oak & sumak
18
Q
What is atopic dermatitis?
A
Eczema, exaggerated response to environmental allergens characterized by remissions & exacerbations
19
Q
What causes atopic dermatitis?
A
chronic & inherited immunological abnormality- elevated IgE
20
Q
What is Xerosis?
A
dry skin
21
Q
When is eczema worse?
A
in childhood
22
Q
What does acute atopic dermatitis look like?
A
Bright red, oozing vesicles, very itchy!
23
Q
What does subacute atopic dermatitis look like?
A
Scaly plaques
24
Q
What does chronic atopic dermatitis look like?
A
Thickened skin, lichenification
25
When is lichenification?
thickened skin which appears "bark-like"
26
What are causes of exacerbations of eczema?
excess washing, temp/humidity, irritating substances, emotional stress
27
What is Tx for eczema?
no Tx! only control of Sx
| topical steroids, relieve pruritis, phototherapy (severe cases)
28
What are s/e of long-term use of topical steroids?
skin atrophy, increased risk for ulcers
29
What is Exfoliative dermatitis?
scaling, erythematous dermatitis that progresses to desquamation of skin & mucous membranes
30
What are examples of exfoliative dermatitis?
Steven-Johnson Syndrome & TENS
31
What are common causes of exfoliative dermatitis?
severe allergic reaction to meds (often ABX) & pre-existing skin conditions (psoriasis or eczema)
32
What are complications of exfoliative dermatitis due to skin loss?
Dehydration, protein loss, hypothermia & infection
33
What % of skin is lost with SJS & TENS?
```
SJS = less than 10%
TENS = 30-100%
```
34
What are S/Sx of SJS & TENS?
begin w flu-like Sx, then diffuse painful & burning rash, bulla (blisters), erosion & crusting, Mucous membranes affected in over 90% of cases
35
How long after drug ingestion does exfoliative dermatitis occur?
1-3 weeks
36
What are urticaria?
hives, immediate post-allergen exposure
37
How do you Tx urticaria?
antihistamines
38
What is angioedema?
allergic response, severe swelling, esp of face & resp tract, abrupt onset
39
What are common causes of angioedema?
ACE inhibitors, shellfish & peanuts
40
What are primary concerns with angioedema?
airway & anaphylactic shock
41
Tx for angioedema?
antihistamines, epi, steroids
42
What is acne vulgaris?
Acne, disease of pilosebaceous unit
43
When does acne vulgaris begin?
during puberty
44
What is non-inflammatory acne?
plug of keratin, sebum & bacteria = white heads & black heads
45
What is inflammatory acne?
papules & pustules
46
What is Tx for non-inflammatory acne?
Vit A retinoic acid
47
What is Tx for inflammatory acne w papules, pustules & cysts?
benzoyl peroxide
48
What is Tx for severe nodulocystic acne?
accutane
49
What is psoriasis?
chronic, non-contagious skin disorder caused by excessive growth of epidermal keratinocytes & rapid turnover of epidermal cells
50
Mild psoriasis vs severe psoriasis?
```
mild= at least 3% of body
severe= over 10% of body
```
51
Which season is psoriasis better? worse?
worse winter, better summer
52
What does psoriasis look like?
red patches covered with silver scales (heaped up dead skin cells)
53
What is the Keobner Isomorphic Phenomenom?
psoriasis spreads along skin injury
54
S/Sx of psoriasis?
silver scales & pitting nails
| can also cause joint pain
55
What is Tx for psoriasis?
UV light therapy, PUVA (ingestion of photosensitizing agents prior to exposure to UVA light)
56
What are risks of PUVA?
premature aging & increased risk of skin CA
57
What is a port wine stain?
type of angioma, present at birth, usually on face, flat irregular, red/purple patches initially smooth then darken with age and become papular (cobblestone surface)
58
What is best Tx for port wine stain?
argon laser (high energy beam selectively absorbs red pigment of Hgb)
59
What are telangiectasia?
vascular lesions caused by dilated superficial dermal vessels due to increased vessel pressure (ie spider veins)
60
What are cherry angiomas?
round, bright red papule less than 6mm that blanches with presure
61
What are cherry angiomas possible signs of?
HTN, hepatic disease, infection
62
What are lentigo?
sun spots/ liver spots
63
what causes lentigo?
sun damage
64
How do you Tx lentigo?
cryotherapy
65
What are seborrheic Keratoses?
benign growths, not R/T sun exposure, caused by increase in # of pigmented cells (increase with age)
66
What are nevi?
moles
67
What are developmental stages of moles?
junctional
compound
dermal
68
What is the junctional stage of nevi?
occurs in childhood, nevus cells in dermo-epidermal junction
69
What is compound stage of nevi?
some nevus cells migrate into dermis
70
What is dermal stage of nevi?
All nevus cells migrate into dermis. Not cancerous!
71
What is congenital nevi?
birthmark
72
What is a halo nevi?
mole with white ring around it
73
What does UV damage target?
DNA (cell replication)
74
What is UVA responsible for? UVB?
uvA=Aging
| uvB=Burning
75
Which UV is the major contributor of melanoma?
UVB
76
What is the leading cause of skin CA?
sunlight
77
What is dysplastic nevus syndrome?
marker for young onset melanoma, appear in childhood as moles and change at puberty. larger than common moles, mixture of colors within lesion, irregular borders
78
What is actinic keratosis?
rough, scaly papules, premalignant lesions, pre-cursor to SCC
79
What is Tx for actinic keratosis?
surgical removal, cryosurgery, chemical peel
80
What is 5FU topical chemo?
topical chemo that selectively targets sun-damaged skin, works in stages
81
What are the stages of 5FU topical chemo?
Early inflammation- erythema in Tx'ed areas
Severe inflammatory- erythema, edema, burning, stinging, oozing (can last up to 6 wks)
Lesion disintegration- erosion/ulceration, pain, eschar
82
What are the 2 types of nonmelanoma skin cancers?
Squamous Cell Carcinoma (SCC) (more aggressive)
| Basal Cell Carcinoma (more common)
83
Which cells are associated with Squamous Cell Carcinoma?
keratinizing cells of the epidermis
84
What does SCC look like?
firm nodules with indistinct borders, red, inflamed base with thin, scaly plaque
85
What is Tx for SCC?
Electrodessication & curretage
86
What kind of tumor is Basal Cell Carcinoma?
enlarging tumor of the epidermis, rarely metastasizes beyond skin
87
What does BCC look like?
begins as pearly white dome, extends peripherally, center depresses with rolled pearly border, center ulcerates, bleeds, crusts & scales (cycle of ulceration & healing)
88
What is Tx for BCC?
excision
89
What is Moh's procedure?
microscopically controlled surgery, thin layers & margins of skin removed until tumor is removed
90
What kind of cell is associated with melanoma?
melanocytes
91
What does melanoma look like?
usually dark brown or jet black with red around it
92
What are early signs of melanoma?
change in shape and/or color of mole
93
What are late signs of melanoma?
ulceration & bleeding of mole
94
How is melanoma Dx?
excisional biopsy (bc of thickness)
95
How is melanoma staged?
Stage 0= tumor in situ (no spread)
Stage I-II= ulceration possible with extension into dermis (local spread)
Stage III= one or more lymph nodes involved (regional spread)
Stage IV= distant metastasis to lung, liver & brain (in that order)
96
What is primary Tx for melanoma?
wide excision surgery, chemo, radiation
97
What kind of biopsy is used for melanoma?
Excisional biopsy
98
What is blepharoplasty?
removal of loose skin & protruding peri-orbital fat in the upper & lower eye lids
99
What is the major concern with rhinoplasty?
airway
100
What is a rhytidectomy?
face lift
101
What is the purpose of the constrictive dressings after rhytidectomy?
prevent hematoma formation
102
What is hypomastia?
small boobs!
103
Why is dermabrasion performed?
to smooth scars & surface irregularities, remove foreign body tattoos
104
What is dermabrasion?
removal of epidermis & portion of dermis (aggressive exfoliation)
105
Which is a light peel?
AHA
106
Which is medium depth peel?
TCA
107
Which is strongest, deep peel?
Phenol
108
Most important thing to teach pt after chemical peel?
avoid sun exposure!
109
What is botox?
neurotoxin that interferes w neuromuscular transmission (paralyzes small muscle groups)
110
What is botox used for?
to Tx migraines & hyperhidrosis & decrease wrinkles
111
How often does botox need to be repeated?
q 3-6 months
112
What is a free graft?
transfer of tissue
| can be full thickness or split thickness
113
What is a flap?
tissue that is detached from 1 area of body and transferred to recipient area w o terminating the vascular attachment
114
What is a pedicle?
point where flap remains attached to vascular supply
115
What is a homograft?
temporary skin cover, from cadaver
116
What is a heterograft/xenograft?
temporary skin cover, from another species (usually pig)
117
What is an autograft?
permanent skin cover, living tissue transfer from same person
118
What kind of bandage must be used over grafted skin?
non-adhesive!!
119
What is full-thickness skin grafting?
over 1 mm thick, includes all skin layers + blood vessels used for exposed surfaces & friction prone areas (looks good + functions)
120
What is split-thickness skin grafting?
0.2-1 mm, epidermis & part of dermis, for nonexposed areas, more likely to survive
121
What is a dermatome?
tool used to remove skin to be grafted
