MS Lecture 08.04.2015 Integument Flashcards
skin problems
xerosis: dry skin
pruritus: itching
urticaria: hives
process of wound healing
review first, second, and third intention of wound healing
first: edges brought together with skin lined
partial-thickness wounds vs full-thickness wounds
full thickness: have scar tissue that causes contracture of skin
look up
pressure ulcers
- compression of skin and underlying soft tissue between bony prominence and external surface for extended period
- mechanical forces create ulcers (pressure, friction, shear)f
pressure relieving techniques
wedge, pillows, rolled up blankets, specialty beds, boots, sacral pads, criticaid paste,
position changing for pressure ulcers
every 2 hours
review stages of pressure ulcers
stage 1: skin intact, area usually over bony prominence, does not blanch with external pressure
- observable pressure
stage 2: skin not intact, partial-thickness skin loss of epidermis or dermis
- ulcer is superficial, may appear as abrasion, blister, or shallow crater
- bruising not present
stage 3: full thickness skin loss, subq may be damaged or necrotic, damage extends to underlying fascia, NOT EXPOSED: bone muscle tendon
stage 4: full thickness with exposed muscle tendon or bone
wound assessment components
exudate, location, size color, extent of tissue involvement, cell types in wound base and margins
wound contamination
always contaminated but not always infected
contamination: presence of organisms without infection
infection: pathogenic organisms grow
wound management: nonsurgical
a) dressings (most common is wet-to-dry)
b) physical/drug/nutrition therapies
c) electrical stimulation
d) VAC
e) HBO
f) topical growth factors
g) skin substitutes
h) mist therapy:
wounds can be surgically managed
- debridement - want to be really careful with patient movement, do not disturb until surgeon’s say it’s appropriate
- skin grafting for large areas
know terms to describe skin stuff
like ferruncle, folliculitis, cellulitis
for 24 hours how much urine should we take
1 to 3 L per day
tests for urine
a) urinalysis: evaluate renal system and disease
b) urine culture and sensitivity
c) specific gravity : 1.005 - 1.030
diagnostic tests for renal stuff
a) creatinine: increase occurs when at least 50% of renal function is lost, reflects GFR; 0.6-1.2 ish or something
b) glomerular filtration rate (GFR): 125ml/min; estimates how much blood passes through tiny filters in kidneys each minute (the glomeruli)
c) BUN (blood urea nitrogen) - levels indicate the extent extent of renal clearance of urea nitrogenous waste products
- increase may occur from dehydration, high protein diet, infection, stress, corticosteroid use, GI bleed, factors that cause muscle breakdown
d) creatinine clearance: 24hr urine specimen and serum creatinine collection, determines how ewell kidneys excete creatinine
infectious disorders
1) urinary tract infections
a. lower tract - urethritis, cystitis, prostatitis
b. upper tract - pyelonephritis (kidney); usually begins in lower urinary tract
2) site of infection and specific type of bacteria determines treatment
3) risk factors
4) cystitis: inflammation of bladder
- infectious cystitis: most common UTI commonly from bacteria (90% E. Coli - intestinal tract) can lead to pyelonephritis and sepsis (urosepsis)
manifestations of a bladder infection/cystitis/UTI
lower abdominal discomfort, fever,burning on urination, foul odor to urine
recommendations for UTI
- try cranberry juice/acidify your urine
- remove foley immediately
- empty bladder after intercourse
- clean front to back
- increase fluid intake (2-3L)
how are UTIs treated
antibiotics
types of incontinence (look up treatment therapies)
1) stress incontinence: loss of small amounts of urine while coughing, sneezing, lifting, exercising
- common after childbirth and postmenopausal b/c lower estrogen levels lead to think/weak baginal, urethral, and pelvic floor muscles
2) urge incontinence: large amounts of urine released (eg overactive bladder, inability to relax the detrusor muscle leading to a stronge urge to void and often leakage of large amounts of urine)
3) mixed incontinence:
4) functional incontinence: due to loss of cognitive function
- women: intravaginal pessary: device supports the uterus and vagina and helps maintain the correct position of the bladder
urolithiasis
- presence of calculi (stones) in the urinary tract
a) nephrolithiasis: formation of stones in the kidney
b) ureterolithiasis: formation of stones in the ureter
risk factors: urinary stasis, retention, immobility, and dehydration (incidence higher in men)
manifestations: sharp excrutiating pain that pt can n/v
complications
a) hydroureter: ureter dilation may occur if the stone occludes the ureter and blocks the flow of urine
b) hydronephrosis: enlargement of the kidney with urine due to a blockage in the lower tract
- oliguria (100-400 ml/d) or anuria (
