Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Health Assessment > Midterm- Skin/Hair/Nails > Flashcards

Midterm- Skin/Hair/Nails Flashcards

1
Q

epidermis

A

outer layer. thin. tough.

DEPENDS on the DERMIS for nourishment

stratified into zones

major ingredient= KERATIN

MELANOCYTES- gives our skin the color

the epidermis is made from dead keratinized cells

we shed ONE POUND of skin/year

the entire epidermis is replaced every 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dermis

A

vascular, inner supportive layer

consists mostly of CONNECTIVE TISSUE AND COLLAGEN

dermis is tough, fibrous protein that allows the skin to RESIST TEARING

dermis is resilient!! elastic tissue that allows stretching with movement

the dermis is home to nerves, blood vessels, sensory receptors, and lymphatics

includes hair follicles, sebaceous glands, and sweat glands that are embedded into the dermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

subcutaneous layer

A

this is ADIPOSE tissue!

subq layer anchors the dermis to the muscle and bones

consists of lobules and fat cells. stores fat for energy!!

provides insulation (temperature control), cushioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

hair follicles

A

embedded in dermis layer

the growth is cyclic, and each follicle functions independently

hormones can influence growth of hair (pregnancy- shiny and soft, postpartum- hair loss, thinning…)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 types of hair

A

VELLUS hair: short, fine, light, covers most of the body. think arms and abdomen…

TERMINAL hair: course, thicker, and pigmented. on head, eyebrows, pubic area, axillae (face and chest on males)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

nails

A

GREAT indication of overall health!! (especially nutrition)

if nails are growing= getting enough protein!

hard plates of keratin, found on dorsal edge of fingers and toes

growth inhibited by illness or to the elderly

average growth=1 mm/week

takes 3 months to restore a fingernail (3x as long for toenails)

lateral nail fold- where ingrown nails occur

nail matrix and nail bed (where nail arises from)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

sebaceous glands

A

lubricates the skin and hair

produces lipid substance sebum, secreted thru hair follicles

found everywhere BUT the palms and soles

most abundant in the scalp, forehead, face, and chin (why you have more acne in these places)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

sweat glands

A
  1. ECCRINE

2. APOCRINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

eccrine sweat glands

A

coiled tubes that open directly onto the skin, produce a dilute saline solution: SWEAT

aid in temperature control (via evaporation)

children and the elderly can easily become overheated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

apocrine sweat glands

A

produce thick, milky secretions, open directly into hair follicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

locations of apocrine sweat glands

A

axilla, anogenital, nipples, and the navel

become active with puberty

when bacterial flora reacts with apocrine sweat, you have BODY ODOR!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

variations in skin color

A

pallor (fear, anxiety, anemia, shock)

erythema (high emotion, CO poisoning, polycythemia)

cyanosis (decreased perfusion, hypoxemia, congenital heart disease)

jaundice (hepatitis, cirrhosis, sickle cell disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

dysplastic melanocyte

A

atypical mole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

congenital giant nevus

A

lot of different sizes/darkness/shapes of moles

they are concerning because they can become dysplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

normal physiologic jaundice in infants

A

1/2 of all newborns, appears on 2/3rd day

peaks at day 5

**disappears within one week of birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pathologic jaundice in infants

A

appears within first 24 hours

related to hemolytic disease of the newborn

**JAUNDICE THAT PERSISTS BEYOND 2-3 WEEKS SHOULD BE OF CONCERN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

miliara rubra in infants

A

scattered vesicles on an erythematous base- sweat gland obstruction, disappears within one week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

erythema toxicum in infants

A

looks like flea bites!

unknown etiology

disappears within one week after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

pustular melanosis in infants

A

seen in AA infants

can last several months

small vesiculopustular over a brown macular base

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

milia in infants

A

pinhead, smooth, white raised areas without surrounding erythema

on nose, chin, forehead

retention of sebum in sebaceous gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

abnormal texture of skin

A

rough- hypothyroid

velvet- hyperthyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

cherry angiomas

A

small, smooth, slightly raised red dots

commonly appear on trunk of adults

this is not significant

think red mole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ecchymosis

A

should be CONSISTENT with trauma

bruising above the knee or below the elbow is SUSPICIOUS

bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

bruising cycle

A

0-5 days: red, blue, purple, and tender

5-10 days: greenish yellow

> 10 days: brown

2-4 weeks: healed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

salmon patch in infants

A

nervus simplex

40% of all newborns have this

flat, irregular, light pink patches

nape of neck: stork bite

almost all disappear by age 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

darkish purple lesions on face/extremities in infants

A

port wine stains

does not fade

laser removal to help reduce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

elevation of lesions

A

pedunculated

rises off a stalk, think skin tags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

pattern and shape of lesions

A

annular- ring shape

grouped- all together with no outliers

confluent- throughout

linear- line

discrete- couple of small areas

gyrate- serpentine

iris

polycyclic- round

zosteriform- follows a dermatome (herpes zoster)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

fitzpatricks sign

A

positive when dimpling and retraction of the skin lesion beneath the skin with lateral compression

seen with DERMATOFIBROMAS

ex: when you squeeze a pimple, it sinks down

nodules derived from mesodermal and dermal cells

FIRM, RAISED PAPULES, PLAQUES, OR NODULES that very in size (3-10 mm in diameter)

color- brown, purple, red, yellow, pink…

multiple (>15) on a person may be associated with an autoimmune disorder

usually asymptomatic

NEEDS TO BE INVESTIGATED! TO MAKE SURE ITS NOT MELANOMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

abnormal hair distribution can be related to what things?

A

aging, PCOS, thyroid (hypo/hyper)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

abnormal inspection of nails:

A

spoon nails- anemia

dirty- poor self care, job

bitten- anxiety

clubbing- O2 insufficiency

paronychia- red, swollen nail folds, VERY tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

paronychia

A

red, swollen nail folds, VERY tender

acute- bacterial infection (manicure with not sterile tools)

chronic- fungal infection (think someone who works as a dishwasher)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

onycholysis

A

separation of nail plate from nail bed

yellow nails

white nail syndrome (leukonychia)

koilonychia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

yellow nails

A

can indicate lung disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

white nail syndrome (leukonychia)

A

arsenic poisoning

chronic renal failure

heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

koilonychia

A

iron deficiency

spooning

thin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

indications of pits, grooves, lines in nails

A

nutritional deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

brown linear nail streaks in light skinned people

A

melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

splinter hemorrhages of nails

A

occur with endocarditis

working with hands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

beau’s lines in nails

A

visible line on nail due to nail stop growing

can happen during serious illness

think ICU patient

body trying to preserve its work- stops producing nail

can be traced to high fever, infection, ICU stay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

macule

A

primary lesion

flat, circumscribed, nonpalpable

small (up to 1 cm)

color change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

examples of a macule

A

freckles, measles, nevus, solar lentigos

solar lentigos (sunspots)- sun induced, well circumscribed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

patch

A

primary skin lesion

this is a macule that is >1cm

example: mongolian spot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

vitiligo

A

a type of patch (primary skin lesion)

absence of melanocytes

autoimmune

M=F

cafe au lait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

with vitiligo, you are at increased risk of…

A

thyroid disease

DM

pernicious anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

papule

A

a type of primary skin lesion

solid, elevated, circumscribed

> 1cm!!

example: elevated nevus (mole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

elevated nevus (mole)

A

a type of papule (primary skin lesion)

molluscum

wart (verruca)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

molluscum

A

a type of elevated nevus (mole) (which is a papule)

solid skin-colored papules with central umbilication

self-limited vital infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

wart (verruca)

A

a type of elevated nevus (mole) (which is a papule)

anal

plantar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

plaque

A

a type of primary lesion

papules that are >1cm

plateau like, disc shaped

confined to superficial dermis

may result from confluence of papules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

lichen planus

A

a type of plaque

acute/chronic inflammatory dermatosis

salmon colored base

small amount of scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

nodule

A

solid, elevated, hard/soft

> 1cm

extends deeper into the dermis than a papule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

examples of a nodule

A

xanthoma, fibroma, carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

tumor

A

solid, elevated, hard/soft

> 2cm!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

examples of a tumor

A

lipoma (fatty tumor)

hemangioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

wheal

A

superficial, raised, transient

erythematous and irregular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

examples of a wheal

A

insect bite

allergic reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

urticaria

A

wheals coalesce to form extensive reaction- pruritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

vesicle

A

elevated cavity with free fluid

up to 1 cm

clear serum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

examples of vesicles

A

herpes simplex

varicella

herpes zoster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

bulla

A

elevated cavity with free fluid

> 1cm

thin walled

ruptures easily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

examples of a bulla

A

friction blister

2nd degree burn

contact dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

pustule

A

circumscribed, elevated

filled with pus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

examples of a pustule

A

impetigo

folliculitis

acne

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

acne

A

a type of pustule

closed with comedomes= white head

open comedomes=black heads - oxygen turns it black

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

erosions

A

a type of secondary lesion

scooped out, shallow depression

superficial epidermis loss

moist, doesn’t bleed

heals without a scar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

fissure

A

a type of secondary lesion

linear cracks, EXTENDS INTO THE DERMIS**

dry or moist

68
Q

examples of fissures

A

cheilosis

athletes foot

eczema

69
Q

excoriation

A

a type of secondary lesion

self-inflicted abrasion

superficial

from intense itching

70
Q

causes of excoriation

A

insect bite

chicken pox

scabies

71
Q

scabies

A

ITCHY!

highly contagious

web of hands and feet=classic

mites

72
Q

ulcers

A

type of secondary lesion

deep depressions, extends into dermis and beyond

irregular shape

may bleed

leaves a scar

73
Q

causes of scar of ulcers

A

stasis, pressure chancre

74
Q

scar

A

a type of secondary lesion

connective tissue (collagen) that replaces healed damaged normal tissue

75
Q

lichenification

A

a type of secondary lesion

prolonged, intense itching THICKENS the skin

increased visibility of skin furrows

leathery-like skin

76
Q

keloid

A

a type of secondary lesion

hypertrophic scar

elevated, invasive

77
Q

surface debris

A

scale

crust

atopic dermatitis

seborrhea dermatitis

seborrheic keratosis

78
Q

scale

A

a type of surface debris

compact desiccated flakes on skin

dry or greasy

from shedding of dead excess keratin cells

79
Q

examples of a scale

A

psoriasis

sebhorric dermatitis

dry skin

80
Q

crust

A

a type of surface debris

thickened, dried out exudates LEFT WHEN PUSTULES BURST AND DRY UP, color depends on fluid ingredients

81
Q

examples of crust

A

impetigo- dry honey colored

weeping eczema

scab after abrasion

82
Q

atopic dermatitis

A

a type of surface debris

ECZEMA

erythematous papules/plaques

itching!!

weeping and crusting can occur

TRIAD OF A

stress and cold weather are triggers

83
Q

triad of A

A

atopic dermatitis

asthma

allergies

84
Q

seborrhea dermatitis

A

a type of surface debris

dandruff

erythematous papules and plaques, greasy appearance

yellow crust and scales

occurs in hair and non-hairy skin

85
Q

seborrheic keratosis

A

a type of surface debris

MOST COMMON NONCANCEROUS SKIN GROWTH!!!

common in older adults

brown/black/pale growth

face, chest, shoulders, back

round/oval, warty, scaly appearance

single or multiple

“stuck on” look

86
Q

vascular lesions

A

cherry angioma

spider angioma

petechiae

venous star/spider vein

erysipelas

dermoid cysts

secondary syphilis

rosacea

nikolsky’s sign

purpura

MRSA

87
Q

cherry angioma

A

a type of vascular lesion

bright red- ruby

1-3 mm

round/flat, raised no pulse!!

may blanch

on trunk/extremities

88
Q

what is the significance of a cherry angioma?

A

none

89
Q

spider angioma

A

a type of vascular lesion

fiery red, small (<2cm)

central body with radiating legs

may BLANCH (HAS BLOOD FLOW)

face, neck, arms- r/t hepatic disease, pregnancy, vitamin B deficiency, can be benign too

90
Q

the central body with radiating legs of a spider angioma may do what?

A

may pulse in the spider body

91
Q

petechiae

A

a type of vascular lesion

deep red/reddish purple

1-2 mm, round, flat, no pulsation, no blanching

variable distribution

formed by blood escaping from the vessels

may indicate… BLEEDING TENDENCY

92
Q

venous start/spider vein

A

a type of vascular lesion

bluish in color (venous)

size is variable

shape may vary (spider, linear, irregular)

NO pulsation- DOES NOT blanch

seen on lower extremities near veins and anterior chest

accompanied by an increase in pressure in superficial veins

93
Q

erysipelas

A

a type of vascular lesion

infection caused by: BETA HEMOLYTIC STREP

can be caused by staph aureus

spreading infection of dermal and subq tissue differs from cellulitis because it is raised with a clear edge

94
Q

dermoid cysts

A

a type of vascular lesion

cheese like substance within it

non-cancerous

very common in face/hands

slow growing

95
Q

secondary syphilis

A

a type of vascular lesion

papulosquamous eruption on the trunk

bigger than cherry angiomas

96
Q

rosacea

A

a type of vascular lesion

common (but poorly understood) disorder of facial skin

97
Q

nikolsky’s sign

A

a type of vascular lesion

top layers of the skin SLIP away from the lower layers when slightly RUBBED

documented as + or -

area beneath is pink, moist, tender

98
Q

causes of nikolsky’s sign

A

autoimmune condition (pemphigus vulgaris)

bacterial infection (scaled skin syndrome)

toxic drug reaction

99
Q

autoimmune condition (pemphigus vulgaris) that causes nikolsky’s sign

A

immune system produced antibodies and fights bone between skin cells

leads to formation of blister

meds such as PCN and ACE inhibitors can cause

100
Q

purpura

A

a type of vascular lesion

non-palpable

ecchymosis from trauma or hemorrhage

101
Q

MRSA

A

a type of vascular lesion

people can be carriers!

COMMUNITY ACQUIRED

clusters of infections among athletes, military recruits, children

prevention

presentation

treatment

102
Q

community acquired MRSA

A

considered this if you have not been hospitalized/had a procedure within the last year

103
Q

MRSA clusters of infections among athletes, military recruits, children…

A

pacific islands, alaskan native, native american

homosexual men

prisoners

104
Q

prevention of MRSA

A

good hand hygiene

keep cuts/scrapes clean, cover with a bandage until healed

avoid contact with others who have wounds or bandages

avoid sharing personal items

105
Q

presentation of MRSA

A

furuncle (big, deep pimple)

deep-seated folliculitis

impetigo

abscesses

106
Q

treatment of MRSA

A
  1. culture and sensitivity
  2. **I&D
  3. ABX if needed (such as multiple sites, area difficult to drain, comorbidities)
107
Q

classification of skin lesions

A

flat, nonpalpable

raised, solid palpable

raised, cystic, palpable

depressed

108
Q

flat, nonpalpable skin lesions

A

macules, patches, purpura, ecchymosis, spider angioma, venous spider

109
Q

raised, solid palpable skin lesions

A

papules, plaques, nodules, tumors, wheals, scale, crust

110
Q

raised, cystic, palpable skin lesions

A

vesicles, pustules, bullae, cysts (have stuff in them!!)

111
Q

depressed skin lesions

A

atrophy, erosion, ulcer, fissue

112
Q

tinea corporis

A

ringworm!!

body, feet, head, hands, groin, nails, everywhere!!

they eat keratin to survive, it has a central clearing because they have moved outward to find new keratin to eat

can get from animals

113
Q

other types of tinea (besides corporis)

A

tinea curis- jock itch

tinea pedis- athlete’s foot

tinea scapula- scalp

tinea manus- hand

114
Q

psoriasis

A

hereditary disorder

silvery white scales

sharply demarcated erythematous pupules and plaques of varying size/shape with white overlaying scales

IF YOU REMOVE A SCALE AND THERE IS A DOT OF BLOOD=AUSPITZ SIGN**

M=F

30% psoriasis patients will develop a related form of arthritis: PSORIATIC ARTHROPATHY

115
Q

trigger and risk factors for psoriasis

A

weight gain, smoking, stress

meds such as: beta blockers, lithium

116
Q

fifth’s disease

A

“slapped cheek”

mild rash, most common in children

lacey red rash on FACE, TRUNK, AND LIMBS

rash may itch

low grade fever or a cold a few days before the rash appears

rash resolves in 7-10 days

117
Q

edema

A

palpate for accumulation of fluid in the intercellular spaces

firmly imprint thumb against a dependent portion of the body, release pressure

observe for indentation of skin

legs, feet, and ankles are good places to do this

pitting

non-pitting

angioedema

dependent edema

inflammatory

non-inflammatory

lymphedema

118
Q

degrees of edema

A

0=no pitting

+1= 0-1/2, mild

+2= 1/4-1/2 (moderate)

+3= 1/2-1 (severe)

+4= >1 (severe)

measure circumference

check symmetry

119
Q

pitting edema

A

indention remains on skin when pressure is applied

“my ankles swell in the evening and are better in the morning”

nocturia

120
Q

non pitting edema

A

EDEMA THAT IS FIRM WITH DISCOLORATION/THICKENING OF SKIN

lymphedema

121
Q

angioedema

A

recurring episodes of non-inflammatory swelling of the skin, brain, viscera, MM

onset may be RAPID

r/t reaction of medications

122
Q

dependent edema

A

localized

dependent limb or area (turn the patient, leave a handprint in the buttocks)

123
Q

inflammatory edema

A

swelling d/t extracellular fluid effusion surrounding an area of inflammation

ankle sprain is an example

124
Q

non-inflammatory edema

A

swelling due to mechanical causes

125
Q

lymphedema

A

obstruction of a lymphatic vessel

126
Q

pressure ulcers

A

localized damage to the skin and underlying soft tissue

usually over a bony prominence or related to a medical/other device

injury can present as intact skin to open ulcer

may be painful

impacted by microclimate, nutrition, perfusion, comorbidities, and condition of the soft tissue

causes- pressure, friction, shear, maceration

risks- advanced age, high acuity, immobility, incontinence, poor nutrition

127
Q

stage 1 pressure ulcer

A

PRESSURE INJURY, NON-BLANCHABLE ERYTHEMA OF INTACT SKIN

color changes DO NOT include purple or maroon discoloration

presence of blanchable erythema/change sin sensation, temperature, or firmness may precede visual changes

128
Q

purple or maroon discoloration on a pressure ulcer may indicate what?

A

deep tissue pressure injury

129
Q

stage 2 pressure ulcer

A

PARTIAL THICKNESS LOSS OF SKIN WITH EXPOSED DERMIS

wound bed is viable (pink or red, moist)

may also present as an intact or ruptured serum-filled blister

adipose (fat) NOT visible

deeper tissues not visible

granulation tissue, slough, and eschar do not present

injuries commonly result from adverse microclimate and shear in skin over pelvis and shear in the heel

this stage should not be used to describe moisture associated skin damages (MASD)

130
Q

stage 3 pressure ulcer

A

FULL-THICKNESS SKIN LOSS

ADIPOSE TISSUE VISIBLE

can have granulation tissue (red base)

ROLLED WOUND EDGES

slough (yellow proteins)

eschar (hard, black covering)- keep

deepness varies by location

UNDERMINING AND TUNNELING MAY OCCUR

fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed

IF SLOUGH OR ESCHAR OBSCURES THE EXTENT OF TISSUE LOSS, THIS IS AN UNSTAGEABLE PRESSURE INJURY

131
Q

stage 4 pressure ulcer

A

FULL THICKNESS SKIN AND TISSUE LOSS

WITH EXPOSED, DIRECTLY PALPABLE FASCIA, MUSCLE, TENDON, LIGAMENT, CARTILAGE OR BONE IN THE ULCER

SLOUGH OR ESCHAR MAY BE VISIBLE

epibole (rolled edges), undermining and/or tunneling often occur

depth varies by anatomical location

IF SLOUGH OR ESCHAR OBSCURES THE EXTENT OF TISSUE LOSS, THIS IS AN UNSTAGEABLE PRESSURE INJURY

132
Q

unstageable pressure injury

A

obscured full-thickness skin and tissue loss

if too much slough/eschar

stable eschar

133
Q

what is stable eschar?

A

dry

adherent

intact without erythema or fluctuance

on the hell or ischemic limb

SHOULD NOT BE SOFTENED OR REMOVED

134
Q

deep tissue pressure injury

A

persistent non-blanchable, deep red or maroon or purple discoloration

intact or non-intact skin

CAN RAPIDLY EVOLVE

pain and temperature change often precede skin color changes

caused by pressure

if any necrotic tissue, subcutaneous tissue, granulation tissue etic, can then stage

135
Q

skin cancer

A

most common cancer

1/5 americans will develop by age 70

9500 diagnosed every day

incidence rises yearly

more than 2 people die every your from skin cancer (1 of the 2 from melanoma)

most cancers caused by the skin

having 5 or more sunburns doubles your risk for melanoma!!

136
Q

causes of the rise in skin cancer incidence

A

ozone layer depletion, tanning beds

137
Q

why is important to detect melanoma early

A

5 year survival rate for melanoma is 99%!

138
Q

importance of geographic location to the equator for skin cancer

A

closer to equator (sun)

high altitudes with winter skiing

139
Q

tanning bed/sunlamp use

A

in group 1 with cigarettes, plutonium, solar radiation

DANGER

radiation 10-15x more than the sun

more people develop skin cancer from tanning than develop lung cancer from cigarettes

any history of indoor tanning increases risk of skin cancer (even once)

tan color went from being a sign of lower class to total opposite

140
Q

effect of ethnicity on skin cancer

A

much higher risk of death in african american

blacks, asian americans, and native hawaiians- can be harder to see changes, melanoma most often occurs in non-exposed skin with less pigment

in non-white, plantar part of the foot the most common place

141
Q

genetics effect on skin cancer

A

fair-skin, blue/green eyes, red/blonde hair, easily burn or freckle and tan poorly

142
Q

non melanoma

A

due to exposure to UV

genetic predisposition

immunosuppression

chemical exposure

TOBACCO/ETOH: SCC

143
Q

genetic predisposition for nonmelanoma

A

fair skin, blue or green eyes, red/blonde hair, easily burn, freckle, tan poorly

personal history of skin cancer, family history of skin cancer

144
Q

chemical exposure for nonmelanoma

A

arsenic

tar pitch

tar oil

carbon black

crude paraffin and asphalt

145
Q

basal cell carcinoma

A

most common skin cancer

arises from abnormal and uncontrolled growth of basal cells

malignant, slow growing, but can be invasive and destructive

sore that comes and goes but eventually stays

sun exposure sites such as ear, neck, and head

> 40 yo, M>F

146
Q

squamous cell carcinoma

A

second most common

MAINLY CAUSED BY CUMULATIVE UV EXPOSURE OVER THE COURSE OF A LIFETIME

daily year-round exposure to the sun’s UV lights

TANNING BEDS

INTENSE EXPOSURE DURING SUMMER MONTHS

older than 55

men more than women

occupation requiring long outdoor hours

sports

sun exposure sites

147
Q

sports that lead to squamous cell carcinoma

A

golf and skiing

148
Q

sun exposure sites that lead to squamous cell carcinoma

A

ERYTHEMATOUS SCALY PATCH WITH SHARP MARGINS 1 CM OR >

develops central ulcer

solar (actinic) keratosis precancerous for SCC

ANY PERSISTENT (>1 MO) NODULE, PLAQUE, OR ULCER IS SUSPICIOUS

149
Q

solar (actinic) keratosis precancerous for SCC

A

yellow corn looking covering

flat scaly, raised, crusty, rough

actinic cheilitis- variant off lower lip

150
Q

melanoma

A

EXPOSURE TO UV LIGHT/TANNING BEDS

HARMM

melanoma risk assessment tool

only 1% of skin cancers but 75% of deaths

caucasian men over 50 are at the highest risk

darker patients at less risk but doesn’t mean they can’t get

2nd most common cancer for young adults

risk factors

151
Q

exposure to uv light/tanning beds that affects melanoma

A

intense intermittent

H/O 2 OR MORE BLISTERING SUNBURNS BEFORE 20

triggers mutations (genetic defects)

genetic disposition

family history

personal history

NEVI- dysplastic, congenital nevomelanocytic (>1/5mm), numerous acquired nevi

immunosuppression

152
Q

HARMM for melanoma

A

history

age over 50

no regular dermatology appts

male gender

mole changes

153
Q

risk factors for melanoma

A

fair

light eyes/hair

MORE THAN 100 MOLES OR 50 IF UNDER AGE 20

154
Q

ABCDEF melanoma assessment

A

asymmetry in shape- 1/2 unlike others

color is mottled, many shades

diameter is large >6mm (pencil eraser)

elevation is usual- tangential lighting to see

enlargement, evolving- h/o increased size- most important

feeling (presence of sensation, itching, tenderness, pain)

155
Q

melanoma types

A

superficial spreading

lentigo maligna

acral lentiginous

subungal melanoma

nodular

156
Q

superficial spreading melanoma

A

grows along top layer before penetrating

grow out of pre-existing nevi

flat irregular in shape and color, with different shades of black/brown

most commonly in caucasians

most common- 70%

157
Q

lentigo maligna melanoma

A

OFTEN IN SITU- ONE SPOT

sun damaged skin

appear large/flat

tan with areas of brown coloring

found most in the elderly on face/neck/arms

158
Q

acral lentiginous melanoma

A

lesion is flat with irregular margins and pigmentation, becomes raised and nodular

spreads superficially before penetrating

occurs on nails and is more common in african americans and asians

**50% of diagnosed melanomas in asians/individuals with dark skin

159
Q

subungal melanoma

A

rare subtype of acral lentiginous

involve thumb/great toe

no truma with mark

160
Q

nodular melanoma

A

invasive at diagnosis- grows down first

starts as a raised area

dark blackish-blue or bluish red

most aggressive

10-15% of all cases

161
Q

sophie brings in her husband nathan age 72 who is in a wheelchair. on his sacral area he has a deep crater with a full thickness skin loss involving necrosis of subcutaenous tissue that extends down to the underlying muscle. what stage?

A

stage 4

162
Q

you assess a child with a crusted, weeping lesion…

A

impetigo

163
Q

what physical exam finding would lead you to suspect hyperlipidemia?

A

xanthoma of inner canthus

164
Q

you diagnose ms. lime with contact dermatitis. in your description you would most likely note…

A

multiple bulla on right ring finger

165
Q

your patients presents with an area of itchy dry skin that you describe as thickened, normal in color, without drainage, vesicles, edema, it is most likely…

A

lichenification (thickened skin from continual rubbing)

166
Q

you are teaching your patient to note changes in her skin lesions.. you tell her to be alert for all of the following EXCEPT…

A

change in temp.

SHOULD look for change in shape, color, sensation

167
Q

you are describing a lesion noted on mr. smith, a 55 yo male. it is flat, nonpalpable lesion less than 1 cm in size…

A

macule

Advanced Health Assessment (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions