Other Systems Flashcards
Addison’s disease
Primary adrenal insufficiency, hypo function of adrenal gland(cortex)
Sx: dark pigmentation, hypotension, fatigue, hyperkalemia, gi disturbances, weight loss, n\v, arthralgias, hypoglycemia
HgA1c
Normal range 4%- 5.6%
Increased risk for diabetes 5.7-6.4%
Diabetes >6.5%
Signs of hyperglycemia
Thirst , nausea, vomiting, fruit breath, dry crusty membranes .
Dermatitis/ eczema
Red oozing crusting rash or vesicles (acute)
Scaling, scattered plaques (subacute)
Thickened skin, fibrotic papules (chronic)
Avoid use of alcohol
Impetigo
Superficial skin infection (staph/strep)
Inflammation, small pus filled vesicles, itching, contagious.
Cellulitis
Inflammation of cellular or connected tissue in the skin.
Poorly defined and widespread. Skin is hot red And edematous.
Psoriasis
Chronic autoimmune disease, common plaques covered with silvery scales, on years, scalp, knees, elbows, and genitals.
Itching and pain from dry, cracked lesions
Scleroderma
Chronic autoimmune disease, causing fibrosis of skin, joints, blood vessels. Skin is taut, firm, edematous.
Seborrheic keratosis
Proliferation of basal cells leading to raised lesions, typically on trunk of elderly.
Untreated unless causing pain.
Actinic keratosis
Flat, round irregular lesions, covered by dried scale on sun exposed skin.
Pre-cancerous, can lead to Squamous cell carcinoma.
Benign Nevus
Proliferation of melanocytes, round or oval, less than 6 mm flat or raised.
Can change into melanoma.
Basal cell carcinoma
Slow-growing tumor, characterized by raised patch with ivory appearance.
Has rolled border with indented center or thickened area of skin.
Rare metastasis. Common on face in white people (prolonged sun exposure)
Squamous cell carcinoma
Poorly defined borders, flat red area, ulcer, or nodule.
Grows quickly, common on sun exposed areas. Higher risk of metastasis.
Malignant melanoma
Tumor arising from melanocytes.
Lesions may have swelling or redness beyond a border, losing or bleeding, sensation of itching, burning or pain.
Warning: looks like mole.
Kaposi’s sarcoma
Lesions of endothelial cell origin due to human herpesvirus eight.
Red or dark blue macules that progress to nodules or ulcers, itching and pain.
Common in lower extremity, may produce lymphatic obstruction. Increased incidence in aids.
Pruritus
Itching. Common in diabetes, drug hypersensitivity, hyperthyroidism.
Urticaria
Smooth, red elevated patches of skin, hives.
Indicates allergic response to drug or infection
Xeroderma
Excessive dryness of skin with shedding of epithelium. Can indicate deficiency of thyroid function, diabetes.
Burn wound zones
zone of coagulation: cells are irreversibly injured, death occurs.
Zone of stasis: cells are injured, may die without treatment, within 24 to 48 hours usually
Zone of hyperemia: minimal cell injury, cells should recover.
Rule of nines
Head and neck: 9% Trunk: 36% Arm: 9% each Leg: 18% each Perineum: 1%
Critical burn classification
10% of the body with 3rd° burns and 30% or more with second-degree burns
Moderate burn classification
Less than 10% with third-degree burn and 15 to 30% with second-degree burn
Minor burn classification
Less than 2% with third-degree burn and 15% with second-degree burn
Silver sulfadiazine
Common topical agent, avoid at term pregnancy and on infants less than 2 months.
Avoid with sulfa drug allergies.
Sulfamylon
(Mafenide acetate) penetrates through eschar. Avoid with sulfa drug allergy.
Elbow deformity following burn
Flexion and pronation.
Stress extension and supination with posterior arm splint .
Hand deformity following burn
Claw hand aka intrinsic minus position.
Stress wrist extension (15deg), MP Flexion (70deg) and pip/dip extension and thumb abduction (intrinsic plus position with resting hand splint)
Staging of pressure ulcers
Stage 1- nonblanchable erythema
Stage 2- partial thickness skin loss involving epidermis and/or dermis (blister, shallow crater, abrasion)
Stage 3- full thickness skin loss, through dermis, deep crater, extends to subcutaneous tissue
Stage 4- full thickness tissue loss into bone/muscle, undermining or sinus tracts may be present
Indolent ulcer
Ulcer that is slow to heal, is not painful.
Safe and effective irrigation pressure for wound debridement
4-15 psi
Unna boot
Pliable, nonstretchable dressing impregnated with zinc or calamine and gelatin
Normal level of albumin
3.5-5.5 mg/dL, less than 3.5 indicates malnutrition
Adequate nutrition to heal from burn
25-35 kcal per kg of body weight, and 1.5-2.5 gm protein per kg of body weight.
To dry a wound, use:
Foams, alginates, gauze.
To moisten a wound:
Use hydrogel.
Transparent film indications:
Use on stage 1 or 2 pressure ulcers, on wounds with minimal exudate that requires visual inspection; non-absorptive.
Promotes autolytic debridement. CANNOT use in infection.
Hydrocolloid indications:
Use for wounds with mild exudate, for autolytic debridement of necrosis or slough.
Maintain moist environment. Pain free.
Min to moderate absorption.
yellow drainage/odor upon removal is normal!!
Hydrogel indications:
MOISTENs wound bed.
Min to mod absorption. Can macerate wound edges.
Foam indications:
Min to heavy absorption.
Comfortable. Padding, protection and insulation. Can be used to pack wound for extra absorption.
do not use on dry wound!!
Alginates indication:
Use for moderate to large amount of exudate absorption.
Good for wounds that require packing and absorption. Will dry wound bed so do not use on dry bed.
**can use on infected wound beds
Gauze indications:
Absorbing large amounts of exudate.
Good for tunneling, dead space, sinus tracts (tunnels to deeper structures).
Can be used on infected wounds.
Wet to dry mechanical debridement.
*painful on removal! *
Use the following dressings for infected wounds:
Gauze, alginates
Use the following to absorb heavy exudate:
Gauze, alginates, maybe some films
Use to pack a wound:
Gauze, alginates, foams
Use to promote autolytic debridement:
Film, hydrocolloid, hydrogel
CD4 count in those with HIV
500-1200 cells/mm3
HIV symptoms:
Flu like symptoms including recurrent fever, chills, night sweats, swollen lymph glands; loss of appetite, weight loss, diarrhea, persistent fatigue
Most common malignancy following AIDS
Kaposi ‘s sarcoma,followed by non Hodgkin’s lymphoma and primary brain lymphoma
Staging of cancer
Stage 0 - in situ
Stage 1 - localized, has not spread to lymph nodes.
Stage 2- locally advAnced, larger, may or may not be at lymph nodes
Stage 3-spread to lymph nodes
Stage 4- metastasized to other organs in body
Normal platelet count
150,000-450,000
50k-150k some limitations
30k-50k moderate exercise
20k-30k light exercise
Normal white blood cell count
4800-10,800 cells/mm3
> 5000 light or regular exercise
Normal hemoglobin
Women 12-16 g/dL
Men 13-18
> 10 regular exercise
Normal hematocrit
Women 37-48%
Men 45-52%
> 25% light or regular exercise
Metabolic syndrome criteria
- Men at least 40” waist, women 35” 2.at least 150 mg/dL triglycerides or using cholesterol med. 3. Low hdl
