Lecture 1 Flashcards
three layers of the skin are?
epidermis
dermis
subcutaneous tissue/hypodermis
larges portion of the skin, connective tissue between the epidermis and subcutaneous tissue
dermis
involved in producing the pigment melanin (brown) which colors the skin and hair?
melanocytes
roles as receptors that transmit stimuli to the axon
merkel cells
role in cutaneous immune system reactions and protects against microorganism against injury
langerhans cells
function of the dermis includes:
Provides strength and structure in the form of collagen and elastic fiber
Strength and structure in the form of collagen and elastic fiber
subcutaneous tissue functions
innermost layer of the skinprimarily composed of adipose and connective tissue
provides a cushion between the skin layers and the muscles and bones
protects the nerve and vascular structures that transect the layers
subcutaneous tissues and the amount of fat deposited are important factors in body temperature regulation
Hair growth from most rapid:
- beard
- hair on scalp
- axillae
- thighs
- eyebrows
term for excessive hair growth
hirsutism
term for hair loss
alopecia
glands associated with hair follicleslubricating the hair and rendering the skin soft and pliable
sebaceous glands
Thin, watery secretion calledsweatis produced in the basal coiled portion of the eccrine gland and is released into its narrow duct
eccrine glands
Regeneration of the nails:
how long for fingernails and toenails?
Fingernails – 6 months
Toenails – 18 months
Growth is faster in fingernails than toenails and tends to slow with aging
functions of the skin
Protection
Sensation
Receptors in the skin are to sense temperature, pain, light touch, and pressure
Fluid balance
[prevents dehydration] –> Epidermis—has the capacity to absorb water, thereby preventing an excessive loss of water and electrolytes
Severe burn, large quantities of fluids and electrolytes may be lost rapidly
Temperature regulation
Vitamin Production
Immune response function
Bluish discoloration that results from a lack of oxygen in the blood
cyanosis
Purple, black which fades to green, yellow, or brown hues over time;most often seen following trauma
ecchymosis
Redness of the skin caused by the dilation of capillaries
erythema
Yellowing of the skin
jaundice
Inflammatory response
-A sequential reaction to cell injury.
-Neutralizes and dilutes the inflammatory agent, removes necrotic materials, and establishes an environment suitable for healing and repair.
Inflammationis not similar with infection.
-Inflammation is always present with infection, but infection is NOT always present with inflammation
- Mechanism of inflammation is basically the same regardless of the injuring agent
- Intensity of the response depends on the extent and severity of injury and on the injured person’s reactive capacity
Inflammatory response can be divided into
Vascular response
Cellular response
Formation of exudate
Healing.
Results from outpouring of fluid. Seen in early stages of inflammation or when injury is mild ex. Skin blisters, pleural effusion
serous
Found during the midpoint in healing after surgery or tissue injury
Composed of RBCs and serous fluid, which is semi-clear pink and may have red streaks ex. surgical drain fluid
serosanguineous
Occurs with increasing vascular permeability and fibrinogen leakage into interstitial spaces
Excessive amounts of fibrin that coats tissue surfaces may cause them to adhere.
fibrinous
Results from rupture or necrosis of blood vessel walls
hemorrhagic
Consists of WBCs, microorganisms (dead and alive), liquefied dead cells, and other debris
purulent (pus)
Found in tissues where cells produce mucus
Mucus production is accelerated by inflammatory response
catarrhal
cause of manifestation of redness
Hyperemia from vasodilation
cause of manifestation heat
Increased metabolism at inflammatory site
ex. vasodilation
cause of manifestation of pain
Change in pH. Nerve stimulation by chemicals (e.g., histamine, prostaglandins). Pressure from fluid exudate
cause of manifestation of swelling
Fluid shift to interstitial spaces. Fluid exudate accumulation
loss of function
swelling and pain ex. calf enlarged -> compartment syndrome
localized area of necrotic soft tissue that occurs when pressure applied to the skin usually a bony prominence
pressure ulcer
Braden Scale used for Predicting Pressure Injury Risk
Sensory Perception, Moisture, Activity,Mobility,Nutrition
Most common site for pressure ulcers
- sacrum
2. heels
Intact skin with non-blanchable redness of a localized area
Area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue.
pressure ulcer stage 1
Partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough
May also present as an intact or open/ruptured serum-filled or serosanguineous-filled blister
Presents as a shiny or dry shallow ulcer without slough or bruising
pressure ulcer stage II
Full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed
May include undermining and tunneling
stage III
Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present.
Often includes undermining and tunneling
stage IV
Full-thickness tissue loss in which actual depth of ulcer is completely obscured by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in wound bed
unstageable
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.
suspected deep tissue injury
nursing interventions for pressure ulcers:
Relieve Pressure Positioning the patient Use pressure-relieving devices Improve mobility Improve sensory perception
Improve tissue perception Improve nutritional status Reduce friction and shear Minimize moisture Promote pressure injury healing
nutritional deficiences for delaying wound healing
- vitamin c
- protein
- zinc
- inadequate blood suppy
- corticosteroid drugs
factors that delay wound healing include:
- infection
- smoking
- mechanical friction on wound
- advanced age
- obesity
- diabetes mellitus
- poor general health
- anemia
dressing generally composed of polyurethane. transparency allows visualization of the wound.
used for dry, uninfected wounds or wounds with minimal drainage
transparent films
Film-coated gel or polyurethane. Able to hold large amounts of exudate; used for Wounds with moderate to heavy drainage. Often used on new wounds
foam dressing
Gelatin, pectin, or carboxymethylcellulose bonded to a film or sheet. Produce a flat occlusive dressing that forms a gel on wound surface; used for wounds with light to moderate drainage
hydrocolloids dressing
gels, gel-covered gauze, or sheets. Donate moisture to a dry wound and maintain a moist environment. Can rehydrate wound tissue
Dry wounds. Wounds with minimal drainage. Necrotic wounds
hydrogels
**used to soften hard scabs that will help it fall off
Derived from seaweed or kelp. Form a non-sticky gel on contact with draining wound. Easy to use over irregular-shaped wounds
alginates
Wound covers that deliver agents such as silver and iodine, and polyhexamethylene biguanide (PHMB), which have antibacterial properties.
antimicrobials dressing
complications of wound healing
Adhesion Contractions Dehiscence Evisceration Excess Granulation Tissue (Proud Flesh) Fistula Formation Infection Hemorrhage Hypertrophic Scars Keloid Formation
A chronic suppurative folliculitis of the perianal, axillary, and genital areas or under the breasts
Hidradenitis Suppurativa
Management of Hidradenitis Suppurativa
Warm compresses
Loose-fitting clothes over the nodules or lesions
NSAIDs to relieve the pain
Oral antibiotic
Incision and drainage of large suppurating areas
a common disorder affecting hair follicles and sebaceous glands.
acne vulgaris
mangement of acne vulgaris
Nutrition Avoid sugary food products Hygiene Washing twice a day with soap and water Phototherapy Surgical Management
Medication Benzoyl peroxide Topical retinoids Topical antibiotics Oral isotretinoin + oral ATB
Contagious bacterial infection of superficial layers of skin of
honey colored crusts; Lesions common on face, hands, neck, extremities, perineum
impetigo
1-2 mm erythematous papules or pustules, progress to vesicles or bullae which rupture
nonbullous
Contagious bacterial infection of superficial layers of skin of honey colored crusts; Lesions common on face, hands, neck, extremities, perineum
impetigo
management of impetigo
Topical antibiotics if superficial, nonbullous, localized
Oral antibiotics for multiple lesions, spread of infection to family members
Bullous impetigo in infant – parenteral beta-lactamase-resistant antistaphylococcal penicillin
Obtain culture if no response in 7 days
Educate about hygiene
Exclude from day care until treated for 24 hours
clinical findings folliculitis and furuncle
Discrete, erythematous 1-2 mm papules or pustules on inflamed base near follicle
Face, scalp, extremities, buttocks, back
Nodules with furuncles
Pruritus papules, pustules, deep red/purple nodules in areas under swimsuit
HSV 1
Gingivostomatitis
Herpes labialis
Herpetic whitlow
HSV 2
Grouped vesicopustules/ulceration
Vaginal mucosa, labia, perineum, cervix in females; penile shaft and perineum in males
Regional lymphadenopathy
HSV type 1
oral mucosa, pharynx, lips
HSV type 2
neonatal infection, vulvovaginitis or genital infection
Herpetic whitlow
fingers, thumb are swollen and painful
