NUR 370 SKIN Flashcards
1
Q
Functions of the skin
A
- immunity
- temperature regulation
- water balance
- excretory organ (urea, water, salt)
2
Q
Epidermis layer
A
- outermost layer of skin
- squamous epithelia
- flat sheets of cells
- outer layer contains 25 sheets of dead cells continuously shed
- melanin and keratin production
3
Q
Dermis layer
A
- middle layer
- dense, irregular connective tissue
- nerves
- hair follicles
- smooth muscle
- glands
- blood vessels
- lymphatic vessels
4
Q
Subcutaneous layer
A
- innermost layer of skin
- soft, fatty tissue
- immune cells
5
Q
Cause of pressure ulcers
A
- pressure
- shear
- friction
- moisture
6
Q
Prevention of pressure ulcers
A
- identify at risk persons
- improve tissue tolerance
- linens dry
- skin dry
- stop chafing
- protect against external mechanical forces
- reduce incidence through education
7
Q
Stage I pressure ulcer
A
- persistent red
- no broken skin
8
Q
Stage II pressure ulcer
A
- partial thickness loss in epidermis/dermis or both
- peri-wound involvement
9
Q
Stage III pressure ulcer
A
- full thickness skin loss
- damage to subcutaneous tissue
- peri-wound involvement
10
Q
Stage IV pressure ulcer
A
- damage to subcutaneous tissue involving muscles, tendon, and bone
11
Q
Unstageable pressure ulcer
A
- necrotic tissue and slough
12
Q
Treatment of pressure ulcers
A
- barrier creams: moisture to maintain skin flexibility
- wound vac
- antibiotic solutions
- heat/cold
- oxygen
- specialized beds
- silver oxide dressings
- surgical debridement
- “black box”: honey, albumin
13
Q
Topical agents for pressure sores
A
- emollients (aquaphor)
- lotions
- antiseptics
- antibiotics
- side effects: local irritation, stinging, burning
14
Q
Birthmarks
A
- skin anomalies present at birth or shortly after
- vascular or pigmented
15
Q
Vascular birthmark
A
- arise from blood vessels that have not formed correctly
- generally red color
- types: macular stains, hemangioma, port-wine stains
16
Q
Macular stain vascular birthmark
A
- “stork bites”
- most common type of vascular birth-mark
- flat
17
Q
Hemangiomas vascular birthmark
A
- “strawberries”
- bright red patch or nodule
- superficial or deep
18
Q
Port-wine stains vascular birthmark
A
- discolorations that look like wine was spilled
- face, neck, arms, legs
19
Q
Pigmented birthmarks
A
- made of a cluster of pigment cells, causing color in the skin
- cafe au lait spots
- mongolian spots
- mole
20
Q
Cafe au lait pigmented birthmark
A
- color of coffee with milk
- anywhere in the body
- if child has > 6 at birth, evaluated for signs of neurofibromatosis
21
Q
Mongolian spots pigmented birthmark
A
- flat, bluish-gray patches often found on lower back or buttocks
- ALWAYS DOCUMENT THESE! if not, can look like child abuse
22
Q
Albinism
A
- recessive condition that results in little or no melanin production
- lack of pigment in skin, hair, and iris of eye
23
Q
Vitiligo
A
- small patchy areas of hypo pigmentation
- cells that produce melanin die or no longer form melanin, causing slowly enlarging white patches of irregular shapes on the skin
- one part of skin or spreading
24
Q
Pharmacotherapy of vitiligo
A
- topical corticosteroid agents
- topical repigmenting agents
- skin graft
- sun safeguards
25
Q
Lentigo
A
- large pigmented spots
- aka age spots
26
Q
Skin tags
A
- benign, soft brown or flesh colored masses that usually occur on the neck, armpit or groin
- more common in persons who are obese or have diabetes
27
Q
Contact dermatitis
A
- acute inflammation reaction from exposure to irritant or allergen-producing substance
28
Q
Common causes of contact dermatitis
A
- latex
- poison oak
- laundry detergent
- soap
- nickel
- jewelry
29
Q
Treatment for contact dermatitis
A
- wet compresses
- avoid soaps (use dove unscented)
- antihistamine to stop itching
- anti-inflammatory creams
30
Q
Atopic eczema
A
- chronic inflammation perhaps due to hypersensitivity of immune system
- may be accompanied by asthma and allergic rhinitis
31
Q
Signs/symptoms of atopic eczema
A
- red to brownish-gray colored skin patches
- pruritus at night
- vesicles
- thickened, cracked, or scaly skin
- irritated, sensitive skin from scratching
- rash will bleed if scratched
32
Q
Treatment of atopic eczema
A
- avoid baths
- avoid scratching
- keep water contact brief
- apply lubricating creams
- antihistamine
- corticosteroid
- antibiotics
33
Q
Urticaria
A
- hives
- raised erythematous skin lesions
- inflammation reaction related to histamine
- often triggered by food or medication
34
Q
Psoriasis
A
- common, chronic inflammatory condition that affects life cycle of the skin cells
- t-cells mistake normal skin as foreign
- skin cells rapidly turn over and slough off skin to make “scaley” cells
35
Q
Signs/symptoms of psoriasis
A
- silvery scales (can often peel them away without bleeding because cells are dead)
- pustules
- pruritus
- joint pain or aching
- severe dandruff on scalp
36
Q
Bacterial folliculitis
A
- infections involving the hair follicles
- tender, swollen areas that form around hair follicies
37
Q
Furuncles
A
- boils
- infections that begin in the hair follicles and spread into the surrounding dermis
- firm, red, painful nodule developing into a large, painful mass draining pus
- face, neck, axillae, groin, buttocks, back
38
Q
Impetigo
A
- infection typically arises from break in the skin from staphylococci
- spread easily through direct contact with skin or contaminated objects
- honey-colored crusts
39
Q
Cellulitis
A
- infection deep in the dermis and subcutaneous layer
- direct invasion of the pathogens through a break in the skin (IV and bites)
40
Q
Symptoms of cellulitis
A
- fever
- leukocytosis
- arthralgia
- swollen, warm, tender area of erythema
- “tracking” - leaking of infection into blood vessels
41
Q
Necrotizing fascitis
A
- “flesh-eating bacteria”
- strain of gram-positive group A, beta-hemolytic streptococcus
- invades through cut or scape
- bacteria releases toxins directly destroying tissue, blood vessels
42
Q
Symptoms of necrotizing fascitis
A
- first signs: small, reddish, painful area
- later: bronze or purple-colored patch
- center lesion becomes black and necrotic
- pus present
- wound may grow in less than an hour
- fever
- tachycardia
- hypotension
- gangrene
- shock
43
Q
Herpes simplex type I virus
A
- cold sore
- viral infection typically affecting the lips, mouth, face
- transmitted by contact with infected saliva
- when active: painful blisters or ulcerations
44
Q
Herpes simplex type II virus
A
- genital herpes
- can transmit to baby if in active state
- “swiss cheese brain” when born under outbreak
45
Q
Herpes zoster
A
- chickenpox or shingles
- hallmark shingles rash will not cross midline of body
- antivirals (for duration), antidepressants/anticonvulsant (relieving neuralgia)
46
Q
Verrucae
A
- warts
- viral infection of skin caused by human papillomaviruses
- transmitted through direct skin contact
47
Q
Treatment of verrucae
A
- freezing
- liquid nitrogen
- large areas - chemo drugs
48
Q
Tinea
A
- parasitic infection occurring anywhere in the body where fungi grows (warm, moist places)
- circular erythematous rash
49
Q
Tinea capitis
A
- infection of the scalp
50
Q
Tinea corporis
A
- ringworm
51
Q
Tinea pedis
A
- athlete’s foot
52
Q
Tinea unguium
A
- infection of the nails, typically toenails
53
Q
Treatment of tinea
A
- anti fungal cream or agent
- griseofulvin
- give with full fat milk or ice cream
54
Q
Candidiasis
A
- yeast infection
- aka thrush
55
Q
How to detect if a baby has thrush?
A
- take piece of gauze and wipe tongue
- if it comes off it’s milk solids from breast/bottlefeeding
56
Q
Thrush in adults
A
- immunocompromised
- inhaled steroids that aren’t washed out
- HIV virus in men
57
Q
Hallmark of thrush
A
- fire engine red lesions that cross inguinal folds
58
Q
Treatment of thrush
A
- topical/systemic effect (niastatin)
- ointment/oral preparation
- anti-yeast agent (fluconazole)
59
Q
Scabies
A
- result of mite infestation
- “tracks” of light brown streaks in the skin after mite has gone to lay new eggs
- pruritus, erythema
60
Q
Types of traumatic wounds
A
- abrasion
- laceration
- avulsion
- penetrating wound
- burn
61
Q
Burns
A
- skin injury that results from exposure to either a thermal heat or non thermal source
62
Q
First-degree burn
A
- affects only the epidermis
63
Q
Second-degree burn
A
- burns affect epidermis and dermis (partial-thickness)
- erythema, edema, blistering
64
Q
Third-degree burn
A
- burns extend into deeper tissues (full-thickness)
- white or black
- charred skin that may be numb (destroyed nerve endings)
65
Q
Systemic complications with burns
A
- hemodynamic fluid loss from blood vessels (hypotension)
- respiratory distress: inhaling hot air or smoke burns tissues - inflammation)
- hyper metabolic - increase in metabolic/nutrition needs
- sepsis
- local infection
- shock: sepsis or hypovolemia
66
Q
Treatment for burns
A
- wet towel with clean water
- sterile saline or sterile bandage
- maintain normal temperature: losing so much temperature from evaporative losses (usually cold)
- trendelenberg position
- FLUID (4 ml/kg x TBSA in 24 h)
- intubation
- Silvadene
- fasciotomy
- skin graft
- physical therapy
67
Q
Stages of wound healing
A
- inflammatory
- proliferative
- wound contraction
68
Q
Inflammatory phase of wound healing
A
- histamine
- hangman factors
- swelling, redness, heat, pain
- blood clot
- neutrophils
- macrophages after 24 hrs.
69
Q
Proliferative phase of wound healing
A
- building new tissue
70
Q
Wound contraction phase of wound healing
A
- 3 weeks to 6 months
- development and re-modeling of scars
71
Q
Factors that affect wound healing
A
- impaired blood flow/oxygen delivery
- malnutrition
- impaired inflammatory response
- impaired immune response
- infection
- wound separation
- foreign bodies
- age
72
Q
Acne vulgaris
A
- clogging of skin pores with oil, debris, or bacteria
- can develop into a pustule, nodule, or cyst
73
Q
Treatment for acne vulgaris
A
- pH neutral soaps (cetaphil, dove unscented)
- benzoyl peroxide
- retin-a
- accutane
- shampoo hair daily
- comb or pull back hair
- avoid squeezing or rubbing acne
74
Q
Rosacea
A
- chronic, inflammatory skin condition that affects the face
- more common in older population and caucasians
- sweating, stress, wind exposure exacerbates rosacea
75
Q
Actinic keratosis
A
- small patches on sun-exposed parts of body
- premalignant
- asymptomatic
- precursor to squamous cell carcinoma
76
Q
Seborrheic keratoses
A
- benign
- asymptomatic
- beige/brown/black plaques
77
Q
Squamous cell
A
- from actinic keratosis
- firm irregular papule or nodule
- scaly bleeding
78
Q
Basal cell
A
- most common
- slow growing
- waxy “pearly” appearance
- central depression
79
Q
Malignant melanoma
A
- highest mortality rate
- can metastasize to any organ
