INTEGUMENTARY SYSTEM Flashcards
T/F: skin is 25-30% of body weight
F (15-20%)
How many layers make up the skin? What are they?
3: epidermis, dermis, & subcutaneous tissue
What type of lesion consists of macule, papule, plaque, nodule, tumor, wheal, vesicle, & pustule?
Primary
What type of lesion consists of scale, crust, thickening, erosion, ulcer, scar, excoriation, fissure, & atrophy?
Secondary
How do secondary lesions appear?
When there’s changes to primary ones
Which lab value indicates nutritional status?
Prealbumin
Which lab value monitors wound healing?
Hematocrit
What is the term for hives?
Urticaria
What does pruritus mean?
Itchy
What does xeroderma mean?
Dry skin
The most obvious changes occur first during __________ due to hormones & again during older adulthood.
Puberty
What can lead to temporary changes in hair growth patterns or hyperpigmentation of cheeks & forehead?
- BC pills
- Pregnancy
What are other terms for hyperpigmentation of cheeks & forehead?
- Melasma
- Preg mask
Blood vessels within the reticular dermis are reduced in _____________
Number
When blood vessels become less in # & their walls thin, how does this appear?
- Pale skin
- Impaired capacity to thermoregulate
A primary factor in loss of protective functions of skin is diminished barrier function of the ___________ ___________
Stratum corneum
When the stratum corneum becomes thinner, the skin becomes ____________ & paper thin.
Translucent
T/F: a reduction in melanocytes lead to less immune surveillance & increased risk of skin cancer
F (langerhans cells)
The ____________ is one of the body’s principal suppliers of vitamin D.
Epidermis
The skin is rich in lipids, proteins, & DNA which are sensitive to _____________ damage.
Oxidation
What type of infection are impetigo & cellulitis?
Bacterial
What type of infection are herpes zoster & warts (verrucae)?
Viral
What type of infection are ringworm (tinea corporis), athlete’s foot (tinea pedis), & yeast (candidiasis)?
Fungal
What type of infection are scabies & pediculosis?
Parasitic
What type of lesions are seborrheic keratosis & nevi (moles)?
Benign
What type of lesions are actinic keratosis & bowen disease?
Premalignant
What type of carcinoma are basal cell & squamous cell?
Malignant nonmelanoma
What are some skin disorders associated w/ immune dysfunction?
- Psoriasis
- Lupus
- System sclerosis
- Polymyositis & dermatomyositis
What are the 4 sources that can lead to burns?
- Thermal
- Chemical
- Electrical
- Radiation
Burn severity is determined by ___________ of injury & total body surface area (TBSA).
Depth
Depth of injury is a function of ____________ or source of energy & duration of exposure.
Temperature
Describe where 1st, 2nd, 3rd & 4th degree burns occur.
- 1st: Epidermis
- 2nd: Dermis
- 3rd: Subcutaneous
- 4th: Subcutaneous
Which degree burn develops blisters?
2nd
T/F: there’s little/no pain in 3rd/4th degree burn bc nerve endings are destroyed
T
Describe the breakdown in wallace rule of nines for TBSA.
- 9% Head
- 9% Each upper extremity
- 18% Each thorax (anterior & posterior)
- 18% Each lower extremity
- 1% Genital
T/F: males are more commonly admitted to burn centers
T
Thermal burns account for approx ____% of all burn center admissions.
75
Inflammatory response can be local (small burns) or _____________ (extensive burns).
Systemic
What are the major systems affected by burns?
- CV
- Renal & GI
- Immune
What type of substances are released from injured tissue immediately which increases capillary permeability?
Vasoactive (catecholamines, histamine, serotonin, leukotrienes, & prostaglandins)
T/F: extensive burns will result in edema in only burned tissue
F
What increases in response to catecholamine release & hypovolemia?
HR
How does CO change w/ cutaneous burn?
- Decreases in beginning
- Returns to normal
- Increases about 24 hrs after injury
Where does the body shunt blood from during initial response?
Kidneys & intestines
What is the term for decreased urine output?
Oliguria
What is paralytic ileus?
Intestinal dysfunction
Electricity travels through body resulting in internal tissue damage & potential ____________ injury.
Multisystem
T/F: entrance wounds for electrical wounds tend to be larger than exit wounds
F
What kind of wounds in electrical burns may be negligible compared to soft tissue & muscle damage?
Cutaneous
T/F: alternating current is more dangerous than direct current
T
Out of acids & alkalis, which one results in deeper burn injuries?
Alkalis
Burns of the hands & ____________ can result in permanent physical & vocational disability.
Joints
What type of burns may produce tourniquet-like effect & lead to compartment syndrome or total occlusion of circulation?
Circumferential
What do most full-thickness burns occur in conjunction w/?
- Superficial
- Partial-thickness
What is the most common & threatening complication of burn injuries?
Infection
What are the complications due to inhalation injury?
- Respiratory failure
- Pneumonia
- Sepsis
What type of scarring do burns lead to?
Hypertrophic
What are the 3 phases of the clinical course for patient in burn unit?
- Emergent
- Acute
- Rehab
Which phase is associated w/ fluid resuscitation, ventilatory management, assessment of extent of burn, & early wound management?
Emergent
Which phase is associated burn wounds management & infection prevention, debridement & skin grafting, & PT?
Acute
Which type of skin transplantation is from person’s own skin to treat full-thickness burn?
Autograft
Which type of skin transplantation is from cadaver skin?
Allo/homografts
Which type of skin transplantation is from pigskin?
Xeno/heterografts
Biosynthetic grafts are made from a combo of ____________ & synthetics.
Collagen
What are the 3 classic determinants of burn mortality?
- TBSA
- Age
- Inhalation injury
Which skin disorder is caused by neuropathy, vascular insufficiency, radiation, systemic sclerosis, vasculitis, & prolonged pressure?
Integumentary ulcers
What are the types of integumentary ulcers?
- Diabetic ulcers
- Arterial insufficiency ulcers
What are the 2 ways in which neuropathic ulcers may be classified?
- Wagner system
- Site, ischemia, neuropathy, bacterial infection, area, depth (SINBAD) score
Which grade on wagner system is preulcerative lesions, healed ulcers, or presence of bony deformity?
0
Which grade on wagner system is superficial ulcer w/o subq tissue involvement?
1
Which grade on wagner system is penetration through subq tissue, may expose bone, tendon, lig, or jt capsule?
2
Which grade on wagner system is osteitis, abscess, or osteomyelitis?
3
Which grade on wagner system is gangrene of digit?
4
Which grade on wagner system is gangrene of foot requiring disarticulation?
5
Pressure injuries are lesions caused by ____________ pressure resulting in damage to underlying tissue.
Unrelieved
What are old terms for pressure injuries?
- Pressure ulcer
- Decubitis ulcer
- Bed sore
Where do pressure injuries usually occur?
Over bony prominences (ex: heels, sacrum, ischial tubs, greater trochanters, elbows, scaps)
The current staging system of pressure injuries are reflective of range of what?
Skin pigmentation
Which stage of pressure injury is nonblanchable erythema of intact skin?
1
Which stage of pressure injury is partial-thickness skin loss w/ exposed dermis?
2
Which stage of pressure injury is full-thickness skin loss?
3
Which stage of pressure injury is full-thickness skin & tissue loss?
4
Which type of pressure injury is obscured full-thickness skin & tissue loss?
Unstageable
Which type of pressure injury is persistent nonblanchable deep red, maroon, or purple discoloration?
Deep tissue
T/F: wounds can be back-staged
F
Once lesion fills w/ granulation tissue & closes, it should be documented as what?
Healing stage # (# original deepest level documented)
The 2 primary causative factors for development of pressure injuries are ___________ pressure (externally) & pressure w/ shearing forces.
Interface
What is the term for sweating to an unusual degree?
Diaphoresis
What are the categories of the braden scale (1-4)?
- Sensory perception
- Moisture
- Activity
- Mobility
- Nutrition
- Friction & shear
What does continuous pressure on soft tissues b/t bony prominences & hard or unyielding surfaces lead to?
- Compressed capillaries
- Blood flow occlusion
- Ischemia & tissue necrosis
____________ tissue predisposes bacterial invasion & subsequent infection, preventing healthy granulation.
Necrotic
What are the type of patterns pressure injuries appear as?
- Circular
- Shape of objects
- Elongated/irregular
____________ ulcers often large, undermined wounds & extend to bone bc tissue mass there is thin & erodes easily.
Sacral
What are these symptoms evidence of?
- Erythema
- Heat
- Swelling
- Pain
- Purulence
- Delayed healing
- Foul odor
Infection bc of pressure injury
Foul-smelling discharge in pressure injuries are a result of ____________ enzymes from bacteria & macrophages dissolving necrotic tissues.
Proteolytic
T/F: necrotic tissue in pressure injuries are insensate but surrounding tissue has pain
T
What lab values are important for pressure injuries?
- HG
- Hematocrit
- Prealbumin
- Total protein
- Lymphocytes
For a high risk patient that needs frequent position changes, list the time for in bed, sitting, & if can move independently.
- In bed: 2 hrs
- Sitting: 1 hr
- Independently: 15 min
T/F: for repositioning, position the patient at 45 degree oblique angle when sidelying
F
The head of the bed should be elevated no more than how many degrees when patient is supine?
30
