🏩- Integumentary & Respiratory Test Flashcards
Uncomplicated skin and soft tissue infection
Respond to antibiotic therapy alone or surgical drainage with or without antibiotic therapy
Ex: cellulitis, folliculitis, impetigo, boils/abscess
Caused by staph aureus and strep pyogenes
3 main parts of the skin
Epidermis (outer layer) - primary function is protection
Dermis (inner layer) - provide strength, support, blood and nutrients to epidermis
Subcutaneous tissue - anchor dermis, provide insulation and protection
Complicated skin and soft tissue infections
Invasion of deeper tissues and require debridement
Usually cause by polymicrobial
Pathophysiology of non-necrotizing cellulitis
Microorganisms find entry through skin breaches
Pathophysiology of herpes
Occur on skin, mucous membranes, central nervous system and genital tract
Dermatophytes
Aerobic fungi that infect the stratum corneum (top, dead layer of skin) and survive on keratin
Dermatophytes
Aerobic fungi that infect the stratum corneum (top, dead layer of skin) and survive on keratin
Pathophysiology of fungal infections
- superficial cutaneous fungal infections
- don’t spread beyond the epidermis
Can be found living in soil, on animals and humans. Feed on dead keratin of the skin hair and nails
Pathophysiology of fungal infections
- superficial cutaneous fungal infections
- don’t spread beyond the epidermis
Can be found living in soil, on animals and humans. Feed on dead keratin of the skin hair and nails
Potassium hydroxide (KOH) microscopy
Scrape skin from area and view under microscope – presence of hyphae confirm diagnosis
(Fungal infection)
Potassium hydroxide (KOH) microscopy
Scrape skin from area and view under microscope – presence of hyphae confirm diagnosis
(Fungal infection)
Pathophysiology of psoriasis
Immune disorder that causes chronic inflammation of the skin characterized by thick, raised red patches covered with silvery flaking scales
Pathophysiology of psoriasis
Immune disorder that causes chronic inflammation of the skin characterized by thick, raised red patches covered with silvery flaking scales
Psoriasis and weather
Patients do better in warmer climates
UV radiation kills rapidly proliferating skin cells
Psoriasis and weather
Patients do better in warmer climates
UV radiation kills rapidly proliferating skin cells
Psoriasis
More skin cells are made than are actually shed
Psoriasis
More skin cells are made than are actually shed
PsA
Psoriatic arthritis is a common manifestation of psoriasis
PsA
Psoriatic arthritis is a common manifestation of psoriasis
Laceration
Break in the skin caused by penetration of a sharp object
Laceration
Break in the skin caused by penetration of a sharp object
Abrasion
Occurs as a result of friction and shear from external forces , are usually minor injuries involving only the epidermis
Abrasion
Occurs as a result of friction and shear from external forces , are usually minor injuries involving only the epidermis
Excoriation
A superficial abrasion
Usually seen in disorders that cause pruritus (itching) such as insect bites, scabies, chicken pox
Also used to describe the loss of epithelium in response to prolonged exposure to urine and feces in an individual who is incontinent
Excoriation
A superficial abrasion
Usually seen in disorders that cause pruritus (itching) such as insect bites, scabies, chicken pox
Also used to describe the loss of epithelium in response to prolonged exposure to urine and feces in an individual who is incontinent
Friction blisters
Friction is a force that is applied parallel to a surface resulting in rubbing motion
Friction blisters
Friction is a force that is applied parallel to a surface resulting in rubbing motion
Skin tears
Traumatic wounds usually caused by minor trauma that primarily affect older adults
Skin tears
Traumatic wounds usually caused by minor trauma that primarily affect older adults
Normal range of pH for respiratory
7.35 - 7.45
Normal range of PaCO2
35 - 45 mmHg
Normal range of PaO2
80 - 100 mmHg
Normal range of HCO3
22 - 26 mEq/L
Capnography
Continuously monitors the PaCO2 in the airway during inhalation and exhalation and provides a written tracing
Capnometry
Color change to blue at end of ET tube
Nasal cannula
24-44% FiO2
1-6 L/min
Used in chronic lung disease or long term use
(Low flow o2 delivery)
Simple face mask
40-60% FiO2
5-10 L/min
Used short term in emergency or transport
(Low flow o2 delivery)
Partial rebreather mask
50-75%
8-10 L/min
Mixes with room air ; bag 1/2-1/3 full of o2
(Low flow o2 delivery)
Non-rebreather mask
90% FiO2
10 L/min
Has 2 one way valves; doesn’t mix with room air
(Low flow o2 delivery)
Venturi Mask
24-60% FiO2
2-15 L/min
Delivers most accurate o2 concentration
(High flow delivery)
What is the clinical definition of severe hypoxia
PaO2 < 55
SaO2 < 88%
On room air
3 types of home o2 therapy
Compressed gas in a tank or cylinder
Liquid o2 in a reservoir
O2 concentrator
Oxygen concentrator
Machine that removes nitrogen from air to increase the amount of O2 in air
Nitrogen keeps alveoli from collapsing; room air is 78% nitrogen
A too high cuff pressure on a ET tube can cause what
Ischemia
Tracheotomy vs tracheostomy
Tracheotomy - surgical incision into the trachea for the purpose of establishing an airway
Tracheostomy - the stoma, or opening that results from the procedure of a tracheotomy
List 5 possible complications of suctioning
Hypoxia
Tissue (mucosal) trauma
Infection
Vagal stimulation
Bronchospasm
Pulmonary function test
Evaluates pulmonary function by checking:
Lung volume Flow rates Diffusion capacity Gas exchange Air resistance Distribution of ventilation
Name 2 important things not to do before taking a pulmonary function test
- Don’t eat or smoke EIGHT (8) hrs before the test
2. No bronchodilators 4-6 hrs before the test
Thoracentesis
Needle is inserted into the pleural space to remove excess fluid/air
List 5 parts of chest tube management
1 assess for difficulty breathing/effectiveness
2 observe for signs of infection
3 keep drainage system below chest
4 keep tubing kink free
5 don’t strip, milk or clamp chest tube
Influenza
Spread by droplet or direct contact
Infectious for 7-10 days
Manifestations are severe and come on quickly (fever, sore throat, cough, malaise)
Rapid influenza diagnostic tests
Identification of an influenza virus infection can be made in less than 30 minutes via nasopharyngeal/throat swab or nasal washings/aspirate
Tamiflu
Oseltamivir
Is an antiviral used to influenza
What is the body’s first compensatory mechanism to decreased O2 delivery
Tachypnea - increased respiratory rate and depth
What is the body’s second compensatory mechanism for continued impairment of O2 delivery
Tachycardia - raise the heart rate
Respiratory acidosis
Decreased pH increased CO2
List 3 appropriate nursing actions to take in a patient with influenza
Isolation
Administer medications as ordered
Adequate fluid intake
List 3 appropriate nursing actions to take in a patient with influenza
Isolation
Administer medications as ordered
Adequate fluid intake
Why should influenza cultures be obtained BEFORE administration of antivirals
To assess for the presence of bacterial infection before presence is masked by medication administration
Why should influenza cultures be obtained BEFORE administration of antivirals
To assess for the presence of bacterial infection before presence is masked by medication administration
Community acquired pneumonia
Occurs in individuals who have not been recently hospitalized or are living outside of health-care/long term care facilities
Hospital acquired pneumonia
Develops in patients after 48 hours of hospital admission
Health care associated pneumonia
Onset less than 48 hours after admission in those recently treated (last 30-90 days) by a healthcare agency or living in a nursing home/assisted living
Parenchyma
Functional lung tissue
Clinical manifestations of pneumonia
Fever, tachycardia, chills, pleuritic chest pain, fatigue
Severe forms: purulent or blood streaked sputum, dysrhythmias
List 4 ways to diagnose pneumonia
- Elevated WBC (leukocytosis)
- ABGs typically reflect a primary respiratory acidosis with hypoxemia (elevated CO2, decreased PaO2 and decreased pH)
- Sputum cultures
- Imaging
4 ways to treat pneumonia
Oxygen
Hydration
Bronchodilators
Antibiotics
Complications of pneumonia
Necrotizing bacterial pneumonia Pulmonary fibrosis Acute meningitis Bacteremia Atelectasis Septic shock Acute respiratory failure
What is empyema
A collection of purulent material in the pleural space
A possible complication of pneumonia
Pulmonary hygiene
Incentive spirometry Coughing and deep breathing Postural drainage Vibration/percussion Early mobility
Is done in an effort to mobilize respiratory secretions and allow expectoration. This reduces the incidence of atelectasis and worsening pneumonia in hospitalized patients
How should you position patients with pneumonia in one lung
Position the patient with the GOOD LUNG DOWN to maximize the ventilation and perfusion of functional alveolar units
What is activity grouping
In patients with pneumonia approach activities of care with intervals of rest. Fatigue and decreased tissue oxygen delivery limit activity tolerance
A TB induration of 5 mm or greater is considered positive in what 4 groups of people
- HIV infected persons
- A person having recent contact with a person with TB
- Persons with fibrotic changes on chest X-rays consistent with prior TB
- Persons who are immunosuppressive including those with organ transplants
An induration of 10 mm or greater is considered positive in what 7 groups of people ?
- Recent immigrants from high prevalence countries
- IV drug abusers
- Residents and employees of high-risk settings
- Mycobacteriology laboratory personnel
- Persons with clinical conditions that place them at high risk
- Children younger than 4 years
- Infants, children and adolescents exposed to adults in high-risk categories
Induration
Is a raised, hard bump associated with a positive TB result
What are the goals of treatment for TB infection
1 cure the patient
2 minimize the transmission of M. tuberculosis
what is RIPE
A 4 drug combination therapy used to treat TB
Rifampin, isoniazid, pyrazinamide and ethambutol
List 4 ways to identify TB as a result of the bodies inflammatory response
Unexplained weight loss, night sweats, fever and chills
What color sputum is best associated with presence of TB
Blood tinged or rusty colored as a result of the destruction of lung parenchyma tissue
Directly observed therapy
Is in place when trained health-care worker, home health-care nurse, aide or trained individual provides the prescribed TB drugs and watches the patient swallow every dose
Allergic rhinitis
Categorized as perennial or seasonal and is seen in people with allergies to plant pollen, animal dander or dust
Perennially
Throughout the year
Associated with chronic rhinitis
Nonallergic rhinitis
Common cold that doesn’t involve the immune system
What is rhinitis
Inflammation and irritation of mucous membranes lining the nose
What is rhinorrhea
Runny nose
Associated with clinical manifestation of rhinitis
Diagnosis of rhinitis is based on what
History and symptoms
What 3 symptoms are used to diagnose acute rhinosinusitis
Purulent nasal discharge, nasal obstruction and facial pain-pressure-fullness
Primary lesions
May emerge as a direct result of an infectious disease process, an allergic reaction or an environmental cause
Examples: birthmarks, freckles, moles, petechiae, vitiligo, warts, eczema, insect bites, blisters, herpes zoster, chicken pox, acne
Secondary lesions
A transformation of the primary lesion that may be caused by manual disturbance of the site that may develop secondary to itching or picking at the site
Examples: excoriation, fissure, erosion, ulcer, crust, stretch marks, scars
Asthma
Bronchial asthma is an intermittent and reversible airflow obstruction affecting only the airways, not the alveoli
Short acting beta agonist
Rapid short term relief
SE: tachycardia
Ex: ventolin, Proventil, xopenex
Long acting beta agonists
Relax bronchial smooth muscle by binding to and activating pulmonary beta2 receptors
Ex: serevent
Cholinergic antagonist
Inhibits parasympathetic NS, allow sympathetic system to take over and releases norepinephrine that activate beta 2 receptors
Ex: atrovent
SE: dry mouth
Overuse: blurred vision, eye pain, headache, palpitations, tremor
