MS Lecture 08.04.2015 Integument

Question 1

skin problems

Answer 1

xerosis: dry skin
pruritus: itching
urticaria: hives

Question 2

process of wound healing

Answer 2

review first, second, and third intention of wound healing

first: edges brought together with skin lined

Question 3

partial-thickness wounds vs full-thickness wounds

Answer 3

full thickness: have scar tissue that causes contracture of skin

look up

Question 4

pressure ulcers

Answer 4

• compression of skin and underlying soft tissue between bony prominence and external surface for extended period
• mechanical forces create ulcers (pressure, friction, shear)f

Question 5

pressure relieving techniques

Answer 5

wedge, pillows, rolled up blankets, specialty beds, boots, sacral pads, criticaid paste,

Question 6

position changing for pressure ulcers

Answer 6

every 2 hours

Question 7

review stages of pressure ulcers

Answer 7

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

Question 8

wound assessment components

Answer 8

exudate, location, size color, extent of tissue involvement, cell types in wound base and margins

Question 9

wound contamination

Answer 9

always contaminated but not always infected

contamination: presence of organisms without infection
infection: pathogenic organisms grow

Question 10

wound management: nonsurgical

Answer 10

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:

Question 11

wounds can be surgically managed

Answer 11

• debridement - want to be really careful with patient movement, do not disturb until surgeon’s say it’s appropriate
• skin grafting for large areas

Question 12

know terms to describe skin stuff

Answer 12

like ferruncle, folliculitis, cellulitis

Question 13

for 24 hours how much urine should we take

Answer 13

1 to 3 L per day

Question 14

tests for urine

Answer 14

a) urinalysis: evaluate renal system and disease
b) urine culture and sensitivity
c) specific gravity : 1.005 - 1.030

Question 15

diagnostic tests for renal stuff

Answer 15

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

Question 16

infectious disorders

Answer 16

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)

Question 17

manifestations of a bladder infection/cystitis/UTI

Answer 17

lower abdominal discomfort, fever,burning on urination, foul odor to urine

Question 18

recommendations for UTI

Answer 18

• try cranberry juice/acidify your urine
• remove foley immediately
• empty bladder after intercourse
• clean front to back
• increase fluid intake (2-3L)

Question 19

how are UTIs treated

Answer 19

antibiotics

Question 20

types of incontinence (look up treatment therapies)

Answer 20

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

Question 21

urolithiasis

Answer 21

• 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 (