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NSG 2321 Theory Exam 1 > Integumentary System > Flashcards

Integumentary System Flashcards

1
Q

How often does the epidermis regenerate itself?

A

28 days

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2
Q

Which is avascular - epidermis or dermis?

A

Epidermis

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3
Q

What layer of the skin does a punch biopsy go into?

A

Goes deeper into subcutaneous tissue - provides full thickness skin

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4
Q

What is an excisional biopsy used for?

A

Safety margin (border of the mole that needs to be taken off) is cut, where the mole and border will be tested in the lab

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5
Q

What is an incisional biopsy used for?

A

individual has a skin tag that is snipped, part of the structure stays - useful for when a larger specimen than a shave biopsy is needed

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6
Q

What is a shave biopsy used for?

A

epidermis and a small amount of the dermis is shaved off

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7
Q

What is a wood’s lamp used for?

A

highlights any areas of concern on the epidermis

Examination of skin with long-wave ultraviolet light causes specific substances to fluoresce

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8
Q

What is the difference between a sublethal and lethal cell injury?

A

Sublethal – alters cell function, without cell destruction (i.e., cellulitis); is reversible if harm is removed

Lethal – irreversible process that causes cell death

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9
Q

What is necrosis?

A

Tissue death that occurs as a result of a traumatic injury, infection, ischemia, or exposure to a toxic chemical that causes a local inflammatory response

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10
Q

Define the mononuclear phagocyte system

A

Recognition and phagocytosis of foreign material such as microorganisms, removal of old or damaged cells from circulation, and participation in the immune response

A defence against injury

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11
Q

Describe the inflammatory response

A

system attacks and neutralizes any threats attacking it, creates an environment suitable for healing

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12
Q

Define the vascular inflammatory response (i.e., blood clotting)

A

Vasoconstriction to stop bleeding, platelets adhere forming a fibrin clot to seal the vessel and release histamines, histamines then cause vasodilation to promote WBC healing and repair, serous fluid may build up (clear) or purulent fluid (yellow fluid)

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13
Q

How will blood work present with inflammatory response?

A

Will first see a high level of neutrophils in the blood, followed by monocytes.

As the healing process continues, you will see an increase to macrophages

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14
Q

What will blood work show with allergic reactions?

A

will show increases to eosinophils and basophils

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15
Q

What is the cellular response to inflammation?

A

Neutrophils have a short lifespan (24-48 hours) and phagocytize bacteria/damaged cells, then the monocytes, followed by macrophages that assist in phagocytosis of the inflammatory debris

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16
Q

Describe the three chemicals that respond to injury

A
  1. Histamines cause vasodilation
  2. Serotonin provides a sense of wellbeing and also causes vasodilation
  3. Kinins cause smooth muscles to contract and tighten to allow blood to go where it needs to be
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17
Q

List the four different types of exudate

A
  1. Serous
  2. Sero-sang
  3. Sanguineous
  4. Purulent
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18
Q

Define serous and sero-sang

A

Serous - clear, normal

Sero-sang - mixture of serous and sanguineous fluid; could be expected or unexpected drainage (blood and serous fluid)

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19
Q

Define sanguineous and purulent

A

Sanguineous – blood; can be expected or unexpected, dependent on the case

Purulent – infection, strong odour, yellow/green in colour

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20
Q

What are systemic symptoms associated with purulent fluid?

A

Patient may present with a fever – good for this healing, elevation in WBC, increased HR, increased ventilation, malaise (abnormally tired, low energy, discomfort, restlessness), anorexia (low appetite), chills, flushing of the face and skin, sweating (diaphoresis)

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21
Q

Describe the difference between acute and chronic inflammation

A

Acute – healing occurs in 2-3 weeks and usually leaves no residual damage

Chronic - wound takes longer to heal and does not heal on a normal pathway

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22
Q

List the 5 defences against injury

A
  1. Mononuclear phagocyte system
  2. Inflammatory response
  3. Cellular
  4. Chemical
  5. Exudate
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23
Q

Define regeneration

A

Lost cells and tissue are replaced with cells of the same type

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24
Q

What type of repair begins the healing process?

A

Regeneration

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25
Q

Define primary intention and list its stages

A

Takes place when wound margins are neatly approximated, as in a surgical incision or paper cut

  1. Initial inflammation phase
  2. Granulation phase
  3. Maturation phase and scar construction/formation
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26
Q

Describe the initial inflammation phase

A

Lasts for 3 to 5 days, the edges of the incision are aligned and sutured in place. The incision area fills with blood from cut blood vessels and blood clots form and platelets release growth factors to begin the healing process

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27
Q

Describe the granulation phase

A

body producing a high number of cells and reconstructing the cells and tissues - collagen is secreted and helps strengthen the area

lasts from 5 days to 3 weeks

28
Q

Describe the maturation phase and scar construction

A

Begins 7 days after injury - scar is formed

overlaps with the granulation phase and continues over several months or years. Over this time collagen fibers are further organized

29
Q

Define secondary intention

A

Wide and irregular margins, making it difficult for edges to come together and heal

All phases of healing take longer

30
Q

What is slough tissue?

A

nonviable tissue that sits above viable tissue. Needs to be debride – can be done with chemicals, maggots, or surgically

31
Q

Describe tertiary intention

A

wound is left open to ensure infection is not closed into the body (if we close the wound too early), it is too swollen and need to wait for edema to resolve before closing, poor circulatory risk and may not heal if closed

Takes the longest time to heal and leave a deeper scar

Vac therapy is often used

32
Q

What type of intention takes the longest to heal?

A

Tertiary

33
Q

What are the six different ways to classify a wound?

A

By cause, pathology, duration, level of contamination, tissue involved, and wound bed colour

34
Q

Describe wound classification: by cause, pathology, and level of contamination

A

Cause - surgical (purposeful) or non-surgical

Pathology - vascular, pressure, diabetes related
o Vascular – circulatory
o Pressure – patient not turned/repositioned, improper seating

Level of contamination - infection or no infection

35
Q

Describe wound classification: by duration, type of tissue, and wound bed colour

A

Duration - acute or chronic
o Acute – will follow primary method of healing
o Chronic – stalled and delayed healing

Type - superficial, partial thickness, or full thickness
o Partial thickness – extend into the dermis
o Full thickness – through each layer, may be able to see muscle and bone

Colour - yellow, black, red, or mixed colour

36
Q

Describe adhesions and contractures

A
  • Adhesions – bands of scar tissue that form between/around organs
    o May develop in the abdominal cavity or between the lungs and pleura
  • Contractures – shortening of muscle/scar tissue over joints due to excessive fibrous tissue formation
37
Q

Describe dehiscence and evisceration. Which is a medical emergency?

A

Dehiscence - separation and disruption of previously joined wound edges

Evisceration - wound edges separate and intestines protrude

Evisceration is a medical emergency

38
Q

Describe excess granulation tissue and fistula

A

-Excess granulation tissue – protrudes above the wound

-Fistula – abnormal passage between organs and skin

39
Q

Describe hemorrhage and scars

A
  • Hemorrhage – abnormal internal or external blood loss
  • Scars – excessive collagen
40
Q

List the 9 complications of the integumentary injury

A

adhesions, contractures, dehiscence, evisceration, excess granulation tissue, fistula, infection, hemorrhage, and scars

41
Q

What are the four preventative measures for pressure injuries?

A

bed quality (air mattress), frequent turning, diet, and mobilizing (PT/OT)

42
Q

Define blanching

A

The skin becomes white or lighter upon pressure applied - this is normal and if it does not occur there is could be reduced circulation, electrolytes, etc. to the area

43
Q

Define stage 1 of pressure injuries

A

just on the surface of the skin, no breaks to skin

Intact skin with localized area of nonblanchable erythema, changes in sensation, temperature, and firmness

44
Q

Define stage 2 pressure injuries

A

breaks in the skin, dermis has been compromised and broken through

Partial thickness loss of skin with exposed dermis – wound bed is viable, pink or red, moist.

45
Q

Define stage 3 pressure injuries

A

breaks lay until the subcutaneous tissue

  • Full thickness loss of skin, in which adipose tissue is visible in the ulcer and granulation tissue and rolled wound edges are often present
  • Slough or eschar, or both, may be visible
  • Undermining and tunnelling may occur
46
Q

Describe stage 4 pressure injuries

A

breaks in the skin all the way to the muscle, bone, or tendon

  • Full thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer
  • Slough, eschar, or both may be visible. Rolled edges, undermining, or tunnelling, or a combination of these often occurs
47
Q

Describe an unstageable pressure injury

A

cannot see the wound bed, necrotizing tissue or unviable tissue above the wound bed

48
Q

When is ice used for an integumentary injury versus heat?

A

Ice is used for the first 24-48 hours, then switch to heat therapy

  • Cold promotes vasoconstriction and decreases swelling, pain, and congestion from increased metabolism
  • Heat increases circulation to the inflamed site and subsequent removal of debris, while localizing the inflammatory agents
49
Q

What does RICE stand for?

A

Rest, ice, compression, and elevation

50
Q

How should we compress an injury? Why?

A

Compression should begin distal to proximal because it mimics venous return

51
Q

What is Acetaminophen? Cautions? What tests should be performed prior to administering?

A

Non-opioid analgesic

Overdose; do not exceed 4000 mg/day

Before administering this medication, we need to complete a liver function test (LFT) to determine the liver is capable of handling the medication. In addition, assessing kidney function is important

52
Q

What antidote is used for acetaminophen overdose?

A

Acetylcystine

53
Q

What is Ibuprofen? Cautions/side effects? Contraindications?

A

Non-opioid analgesics

GI bleeding that presents as foul smelling melena stool/tarry stool

Contraindications: PUD

54
Q

What are the fat soluble vitamins?

A

ADEK

55
Q

Define cellulitis

A

deep inflammation of subcutaneous tissues due to enzymes produced by bacteria; may be a primary infection or secondary complication

56
Q

What are the clinical manifestations of cellulitis?

A

hot, tender, erythematous, edematous area with diffuse borders, chills, malaise, fever

57
Q

As a nurse, what four assessments/actions should we do with someone who has cellulitis?

A
  1. Mark a line of demarcation to determine if the swelling/redness moves over time
  2. Continuously assess temperature and moisture
  3. Measuring the diameter of the affected area
  4. Assess dorsalis pedis pulse
58
Q

How is cellulitis treated?

A

Antibiotics - typically penicillin or cephalosporins

59
Q

What does R, I, and S stand for on an antibiotic C&S?

A

o R = resistant
o I = indetermined
o S = susceptible (the antibiotic will work)

60
Q

Define scabies

A

Bug is burrowing under the skin and moving around

Presence of burrows under the skin, usually between the fingers and under the armpits

61
Q

Describe bed bugs

A

Clusters of bites – typically in groups of three

62
Q

How do we treat bed bugs and scabies?

A

Bag their items, patient is put on isolation, administer topical cream (scabies), infection may rise from bed bugs which will require antibiotics

63
Q

What is Penicillin G? Cautions?

A

An antibiotic type of penicillin

Allergies! What happens? Individuals can develop an allergy

64
Q

What are macrolides? Provide one example and the caution with this medication

A

A type of antibiotic for treatment of bacterial infections

An example is erythromycin and our caution is allergy

65
Q

What types of infection are topical antibacterial medications used for?

A

Superficial areas of infection on the skin

66
Q

What is Diphenhydramine? Contraindications? Adverse effects/cautions?

A

Anti-histamine

Contraindications - acute attacks of asthma

Cautions - drowsiness, decreased CNS response and increased risk of falls

NSG 2321 Theory Exam 1 (6 decks)

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