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NPTE > Random Review INTEGUMENTARY > Flashcards

Random Review INTEGUMENTARY Flashcards

1
Q

Herpes zoster AKA

A

Shingles

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2
Q

Symptoms of shingles

A
  • Painful, blistering skin rash
  • One-sided pain, tingling, or burning followed by development of a rash
  • Can also occur post-surgery
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3
Q

Tapotement

A

brisk percussive movements, goal is to increase alertness or stimulate airway clearance

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4
Q

Effleurage

A

slide or glide over the skin w/ continuous motion; increases relaxation and venous/lymphatic drainage

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5
Q

Petrissage

A

compression of soft tissue through kneading, wringing, rolling, and picking up techniques for muscle fibrosis

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6
Q

Friction massage

A
  • direct circular or cross-fiber massage applied to increase mobility of scar tissue
  • Breaks adhesions
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7
Q

Myofascial massage

A

Stretch forces applied across fascial planes

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8
Q

Types of wounds

A
  • Acute
  • Ulcers
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9
Q

Types of acute wounds

A
  • Abrasion
  • Avulsion
  • Incisional wound
  • Laceration
  • Penetrating
  • Puncture
  • Skin tear
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10
Q

Types of ulcers

A
  • Arterial insufficiency
  • Venous insufficiency
  • Neuropathic
  • Pressure
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11
Q

Arterial insufficiency ulcers

A
  • Wounds from lacking circulation of oxygenated blood
  • Recommend rest, limb protection, education, leg/feet inspection daily, avoid leg elevation, avoid heating pads, and wear good-fitting shoes
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12
Q

Venous insufficiency ulcers

A
  • Wounds from impaired venous function lacking circulation
  • Recommend limb protection, education, leg/foot inspection, compression, elevate legs, attempt active exercise, good-fitting shoes
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13
Q

Neuropathic ulcers

A
  • Wounds secondary to ischemia and neuropathy. Can also be associated w/ DM
  • Recommend limb protection, education, leg/foot inspection, compression, good-fitting shoes
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14
Q

Pressure ulcers

A
  • Result from prolonged pressure on tissues and subsequent ischemia
  • Recommend reposition every 2 hours, management of excess moisture, off-loading, inspect skin daily, limit shear/traction/friction
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15
Q

Location of arterial insufficiency ulcers

A

Lower 1/3 of leg, toes, web spaces

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16
Q

Appearance of arterial insufficiency ulcers

A
  • Smooth edges, well defined
  • Lack granulation tissue
  • Tends to be deep
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17
Q

Exudate of arterial insufficiency ulcers

A

Minimal

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18
Q

Pain of of arterial insufficiency ulcers

A

Severe

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19
Q

Pedal pulses of arterial insufficiency ulcers

A

Diminished or absent

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20
Q

Edema of arterial insufficiency ulcers

A

Normal

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21
Q

Skin temperature of arterial insufficiency ulcers

A

Decreased

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22
Q

Tissue changes of arterial insufficiency ulcers

A
  • Thin and shiny
  • Hair loss
  • Yellow nails
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23
Q

Impact of leg elevation w/ arterial insufficiency ulcers

A

Leg elevation increases pain

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24
Q

Location of venous insufficiency ulcers

A

Proximal to the medial malleolus

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25
Q

Appearance of venous insufficiency ulcers

A

Irregular shape; shallow

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26
Q

Exudate of venous insufficiency ulcers

A

Moderate/heavy

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27
Q

Pain of venous insufficiency ulcers

A

Mild to moderate

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28
Q

Pedal pulses of venous insufficiency ulcers

A

Normal

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29
Q

Edema of venous insufficiency ulcers

A

Increased

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30
Q

Skin temperature of venous insufficiency ulcers

A

Normal

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31
Q

Tissue changes of venous insufficiency ulcers

A

Flaking, dry skin; brownish discoloration

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32
Q

Impact of limb elevation on pain w/ venous insufficiency ulcers

A

Leg elevation lessens pain

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33
Q

Location of neuropathic ulcers

A

Areas of the foot susceptible to pressure or shear forces during weight bearing

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34
Q

Appearance of neuropathic ulcers

A
  • Well-defined oval or circle
  • Callused rim
  • Cracked periwound tissue
  • Little to no wound bed necrosis w/ good granulation
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35
Q

Exudate of neuropathic ulcers

A

Low/moderate

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36
Q

Pain of neuropathic ulcers

A

None, however dysesthesia may be reported

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37
Q

Pedal pulses of neuropathic ulcers

A
  • Diminished or absent
  • Unreliable ankle-brachial index w/ diabetes
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38
Q

Edema of neuropathic ulcers

A

Normal

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39
Q

Skin temperature of neuropathic ulcers

A

Decreased

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40
Q

Tissue changes of neuropathic ulcers

A
  • Dry, inelastic, shiny skin
  • Decreased or absent sweat and oil production
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41
Q

What mechanism with nerves is lost in patients w/ neuropathic ulcers

A

Loss of protective sensation

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42
Q

Wound classification by depth of injury

A
  • Superficial wound
  • Partial-thickness wound
  • Full-thickness wound
  • Subcutaneous wound
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43
Q

Superficial wound

A

Trauma to the skin w/ epidermis staying intact

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44
Q

Partial-thickness wound

A

Through the epidermis and into (not through) the dermis

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45
Q

Full-thickness wound

A

Extends through the dermis into deeper structures like subcutaneous fat

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46
Q

Subcutaneous wound

A

Through integumentary tissues and involve deeper structures like fat, muscle, tendon, or bones

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47
Q

Pressure injury stages

A
  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4
  • Unstageable
  • Deep Tissue Pressure Injury
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48
Q

Stage 1 pressure injury

A
  • Non blanchable erythema of intact skin
  • Changes in sensation, temperature, or firmness may precede visual changes
  • Color changes do not include purple or maroon
  • Discoloration (indicates deep tissue pressure injury)
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49
Q

Stage 2 pressure injury

A
  • Partial-thickness skin loss w/ exposed dermis
  • Wound bed viable, pink or red, moist
  • Intact or ruptured serum-filled blister
  • Adipose (fat) not visible
  • Deeper tissues not visible
  • Granulation tissue, slough, and eschar not present
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50
Q

Stage 3 pressure injury

A
  • Full-thickness skin loss
  • Adipose (fat) is visible in the ulcer
  • Granulation tissue and rolled wound edges often present
  • Slough and/or eschar may be visible
  • Depth of tissue damage varies by anatomical location
  • Fascia, muscle, tendon, ligament, cartilage and/or bone not exposed
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51
Q

Stage 4 pressure injury

A
  • Full-thickness skin and tissue loss
    -Exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer
  • Slough and/or eschar may be visible
  • Rolled wound edges, undermining, and/or tunneling often occurs
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52
Q

Unstageable pressure injury

A

obscured full-thickness skin and tissue loss

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53
Q

Deep Tissue Pressure Injury

A

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

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54
Q

Serous exudate

A
  • Clear, light color (maybe light yellow tint) w/ thin, watery consistency
  • Normal in a healthy healing wound
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55
Q

Sanguineous exudate

A
  • Red w/ thin, watery consistency
  • Red due to presence of blood, which indicates new blood vessel growth or disruption of blood vessels
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56
Q

Serosanguineous exudate

A
  • Light red or pink color w/ thin watery consistency
  • Normal in a healthy healing wound
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57
Q

Seropurulent exudate

A
  • Cloudy or opaque, w/ yellow or tan color; thin, watery consistency
  • May be an early warning of impending infection
  • ALWAYS abnormal
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58
Q

Purulent exudate

A
  • Yellow or green color w/ thick, viscous consistency
  • Indicates wound infection
  • ALWAYS abnormal
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59
Q

Eschar

A
  • Hard or leathery, black/brown, dehydrated tissue
  • Firmly adhered to the wound bed
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60
Q

Gangrene

A

Dead and decaying tissue, can include the presence of bacterial infection

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61
Q

Hyperkeratosis

A
  • Callus
  • Typically white/gray, can vary in texture from firm to soggy
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62
Q

Slough

A
  • Moist, stringy or mucinous
  • White or yellow
  • Tends to be loosely attached in clumps to the wound bed
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63
Q

What is the Red-Yellow-Black system for wound healing interventions?

A

Based on the color of the tissue we have a description and goals for how to treat the wound

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64
Q

“Red” wound healing intervention description

A

Pink granulation tissue

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65
Q

“Red” wound healing intervention goals

A
  • Protect wound
  • Maintain moist environment
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66
Q

“Yellow” wound healing intervention description

A

Moist, yellow slough

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67
Q

“Yellow” wound healing intervention goals

A
  • Remove exudate and debris
  • Absorb drainage
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68
Q

“Black” wound healing intervention description

A

Black, thick eschar firmly adhered

69
Q

“Black” wound healing intervention goals

A

Debride necrotic tissue

70
Q

Indications for using alginate dressing

A
  • Partial or full-thickness draining wounds
  • Often used on infected wounds due to drainage
71
Q

Indications for using foam dressings

A
  • Provide protection and absorption over partial and full-thickness wounds
  • Varying levels of exudate
72
Q

Indications for using gauze dressings

A
  • Commonly used on infected or non-infected wounds of any size
  • Can be used for wet-to-wet , wet-to-moist, or wet-to-dry debridement
73
Q

Indications for using hydrocolloids

A
  • Partial and full-thickness wounds
  • Can be used effectively w/ granular or necrotic wounds
74
Q

Indications for using hydrogels

A
  • Moisture retention (also donates moisture)
  • Superficial or partial thickness wounds
  • Minimal drainage
75
Q

Indications for using transparent film

A
  • Superficial or partial-thickness wounds
  • Minimal drainage
76
Q

Occlusion

A

More occlusion –> impermeable

77
Q

Dressings from most to least occlusive

A
  • Hydrocolloids
  • Hydrogels
  • Semipermeable foam
  • Semipermeable film
  • Impregnated gauze
  • Alginates
  • Traditional gauze
78
Q

Dressings from most to least moisture retentive

A
  • Alginates
  • Semipermeable foams
  • Hydrocolloids
  • Hydrogels
  • Semipermeable films
79
Q

Zones of a burn injury

A

Zone of:
- Coagulation
- Stasis
- Hyperemia

80
Q

Zone of Coagulation

A

The area of the burn that received the most severe injury w/ irreversible cell damage

81
Q

Zone of Stasis

A

The area of less severe injury that possesses reversible damage and surrounds the zone of coagulation

82
Q

Zone of Hyperemia

A
  • The area surrounding the zone of stasis that presents w/ inflammation
  • Will recover w/o any intervention or permanent damage
83
Q

Superficial burn

A
  • Only outer epidermis
  • Red w/ slight edema
  • Healing occurs w/o peeling or evidence of scarring in 2-5 days
84
Q

Superficial partial-thickness burn

A
  • Involves epidermis and upper portion of the dermis
  • Involved area extremely painful and exhibits blisters
  • Healing occurs w/ minimal to no scarring in 5-21 days
85
Q

Deep partial-thickness burn

A
  • Complete destruction of epidermis and majority of dermis
  • Discoloration w/ broken blisters and edema
  • Damaged nerve endings –> moderate pain
  • Hypertrophic or keloid scarring may occur
  • Healing in 21-35 days
86
Q

Full thickness burn

A
  • Complete destruction of epidermis and dermis
  • Partial damage of subcutaneous fat
  • Typically presents w/ eschar formation and minimal pain
  • Minimal pain
  • Skin grafts required and susceptible to infection
  • Healing ranges from weeks to months
87
Q

Subdermal burn

A
  • Complete destruction of epidermis, dermis, and subcutaneous tissue
  • May involve muscle and bone
  • May need multiple surgical interventions and extensive healing time
88
Q

Rule of nines for burns (in adults)

A
  • Head + neck = 9%
  • Anterior trunk = 18%
  • Posterior trunk = 18%
  • Bilateral anterior arm, forearm, and hand = 9%
  • Bilateral posterior arm, forearm, and hand = 9%
  • Genital = 1%
  • Bilateral anterior leg and foot = 18%
  • Bilateral posterior leg and foot = 18%
89
Q

Anticipated deformity for burns to anterior neck

A

Flexion w/ possible lateral flexion

90
Q

Anticipated deformity for burns to anterior chest and axilla

A

Shoulder adduction, extension, and IR

91
Q

Anticipated deformity for burns to elbow

A

Flexion and pronation

92
Q

Anticipated deformity for burns to hand and wrist

A
  • Extension or hyper extension for MCP
  • Flexion of IP
  • Adduction and flexion of thumb
  • Wrist flexion
93
Q

Anticipated deformity for burns to hip

A

Flexion and adduction

94
Q

Anticipated deformity for burns to knee

A

Flexion

95
Q

Anticipated deformity for burns to ankle

A

Plantar flexion

96
Q

How to test for protective sensation

A

Monofilament testing

97
Q

Failure to perceive 10 gm monofilament

A

loss of protective sensation

98
Q

Failure to perceive 75 gm monofilament

A

insensate

99
Q

Nevus

A

a benign growth on the skin that is formed by a cluster of melanocytes

100
Q

What does TMN mean when staging cancer?

A

Tumor node metastasis
- T: refers to main tumor and describes its size
- N: refers to the lymph nodes and if the cancer has spread there
- M: if there is a distant metastasis of the cancer

101
Q

Characteristics of psoriasis

A
  • Dry erythematous plaques
  • Silvery scales
102
Q

Characteristics of urticaria

A
  • Hives
  • Red/pink edematous wheals
103
Q

Characteristics of eczema or dermatitis

A
  • Dry, red, itchy patches of skin
  • Begin to weep in severe cases
  • Commonly caused by exposure to some allergen
104
Q

Treatment of dermatitis

A

ID the irritant and remove it

105
Q

Xerosis

A

Dry skin

106
Q

Dermatitis vs cellulitis

A

With dermatitis

  • Swelling is not typical
  • Fever not expected
107
Q

Purpura

A
  • Form when capillaries burst and leak
  • Blood pools beneath the skin
  • Do not blanch w/ pressurre
  • Bigger than petechiae
108
Q

Pruritus

A

Itching of the skin

109
Q

Petechiae

A

Small (<3mm) red or purple spots on the skin due to broken capillaries

110
Q

Guidelines for ROM interventions following a burn injury

A
  • All extremities should be part of the program
  • AROM and AAROM are preferred over PROM
  • Typically safest and most effective when bandages are off to prevent shearing forcecs
111
Q

If the patient requires grafting, when should ROM exercises begin?

A

4-5 days following the graft

112
Q

Why are pillows under the knees contraindicated w/ burn recovery

A
  • Scar bands occur most often on the posterior aspect of the knee
  • Pillows under the knees may lead to knee flexion contractures
113
Q

Where is scar banding most common in the UE?

A

Anterior aspect of the elbow (limits extension)

114
Q

Primary function of the dermis?

A
  • To nourish itself and the epidermis
  • Provide sensation, assist w/ infection control, thermoregulation
115
Q

ABCDE method of detecting melanoma

A

A –> asymmetrical
B –> uneven border
C –> multi-shaded brown, tan, black
D –> diameter 6+ mm
E –> elevated surface or evolving characteristics (changing size, crusting, bleeding, changing color)

116
Q

What is the Braden Scale?

A

Used for predicting pressure ulcer risk

117
Q

Subscales of the Braden scale

A
  • Mobility
  • Activity
  • Sensory perception
  • Skin moisture
  • Nutritional status
  • Friction/shear

Score ranges from 6-23 (low = more risk)

118
Q

Split thickness skin graft

A

Involves the epidermis and part of the dermis

119
Q

What does meshing a skin graft accomplish?

A

By placing small cuts throughout the graft, it can be stretched to cover a greater surface area

120
Q

Allograft

A

A cacdaver graft

121
Q

Efficacy differences b/t allo and autografts

A

Allografts may be used for temporary coverage, but they can be rejected since they are foreign tissues

122
Q

A butterfly rash on the face indicates what?

A

Systemic lupus erythematosus

123
Q

Wound dehiscence

A

Wound edges have dissociated

124
Q

Scleroderma

A
  • Chronic, diffuse connective tissue disease
  • Causes fibrosis of the skin, joints, blood vessels, and internal organs
  • Skin becomes firm and edematous
  • Symmetrical involvement of the extremities and face
125
Q

Progression of scleroderma

A
  • Visceral involvement includes lungs, heart, kidneys, and GI tract
  • Involvement of lungs leads to dyspnea in 60% of patients
126
Q

Cellulitis

A
  • Caused by a bacterial infection
  • Often occurs w/ some injury to the extremity (i.e. cut, scrape, or burn)
  • Results in red, swollen skin
  • May present w/ a fever
  • Painful to the touch
  • Can have wounds that appear in the distal LE’s
127
Q

Which layers of the skin are affected by cellulitis?

A

Dermis and subcutaneous tissues

128
Q

Systemic symptoms associated w/ cellulitis

A

Fever, chills, malaise

129
Q

Risk factors for cellulitis

A
  • Obesity
  • Diabetes
  • Alcohol use (weakens the immune system, making infection possible)
130
Q

When do kids use the regular rule of nines for burn calculations?

A

At 9 years

131
Q

Burn area calculation for kids under 1 year

A
  • Head and neck –> 18%
  • Left UE (anterior and posterior) –> 9%
  • Right UE (anterior and posterior ) –> 9%
  • Anterior trunk –> 18%
  • Posterior trunk –> 18%
  • Left LE (anterior and posterior) –> 14%
  • Right LE (anterior and posterior) –> 14%
132
Q

Transition from under 1 year to 9 years old for burn calculation

A

For each year, 1% is given back to the LE’s

133
Q

Stage 1 pressure injury treatment

A
  • Most easily treated by conservative measures (repositioning and education about protection)
  • May not require a dressing when skin is intact (may use one to decrease friction)
  • These interventions are likely insufficient for stage 2 and above
134
Q

When to use electrical stimulation for wound healing

A

Slow healing stage II pressure injury, and for stage III/IV

135
Q

Wagner Classification Scale for Neuropathic Foot Ulcers

A

Grades 0-5

136
Q

Grade 0 Wagner Classification Scale for Neuropathic Foot Ulcers

A
  • no open lesions
  • may have deformity or cellulitis
  • Healed ulcer
137
Q

Grade 1 Wagner Classification Scale for Neuropathic Foot Ulcers

A
  • Superficial ulcer
  • Without subcutaneous tissue involvement
138
Q

Grade 2 Wagner Classification Scale for Neuropathic Foot Ulcers

A
  • Deep ulcer to tendon capsule, or bone
139
Q

Grade 3 Wagner Classification Scale for Neuropathic Foot Ulcers

A

Deep ulcer w/ abscess, osteomyetlitis, or joint sepsis

140
Q

Grade 4 Wagner Classification Scale for Neuropathic Foot Ulcers

A

Localized gangrene

141
Q

Grade 5 Wagner Classification Scale for Neuropathic Foot Ulcers

A
  • Gangrene of the entire foot
  • Requires amputation
142
Q

What causes tunneling in a wound?

A

Narrow separations of the fascial planes

143
Q

How many “ply’s” can be used to help a prothesis fit better in an amputee?

A

Up to 10-ply socks

144
Q

Complications resulting from burn injuries

A
  • Increased capillary permeability
  • HYPOvolemia
  • HYPOtension
  • Increased metabolism
  • Pulmonary edema
  • Respiratory distress
  • Risk of infection
  • Organ dysfunction
  • Emotional trauma
145
Q

When using electrical stimulation for wound healing, are the electrodes allowed in the wound?

A

Yes it is allowed, either in or adjacent

146
Q

Frequency of electrical stimulation for wound healing

A

Daily is effective, 45-60 minutes

147
Q

Type of current for electrical stimulation for wound healing

A

High-volt monophasic

148
Q

Intensity of electrical stimulation for wound healing

A

Sub-motor

149
Q

Phases of healing

A
  • Inflammatory Phase
  • Proliferative Phase
  • Maturation Phase
150
Q

Characteristics of Inflammatory Phase

A
  • Prepares the wound for healing
  • Characterized by redness, edema, warmth, and pain
  • Typically lasts 1–6 days
151
Q

Characteristics of Proliferative Phase

A
  • Rebuilds damaged structures and strengthens the wound
  • Inflammatory response subsides
  • Epithelialization, collagen production, wound contraction, and neovascularization occur simultaneously
  • Typically occurs between 3 and 20 days after injury
152
Q

Characteristics of Maturation Phase

A
  • Scar is remodeled with changes in size and form
  • Scar tissue matures and strengthens
  • Typically lasts 9 days to 2 years
153
Q

Which kind of collagen would you expect in the proliferation stage?

A

Type III

154
Q

Which kind of collagen would you expect in the maturation stage?

A

Type I (stronger and more mature)

155
Q

Adaptic dressing

A

Designed to minimize wound adherence so pain is minimized during dressing changes

156
Q

Use of collagenase

A

Debride eschar

157
Q

Eczema

A

Skin inflammation caused by an endogenous agent

158
Q

Keloid scar

A
  • Excessive collagen production with
  • Scarring extends beyond the margins of the original wound
159
Q

Hypertrophic scar

A
  • Excessive collagen production
  • Scarring says within the margins of the original wound
160
Q

How often should dressing changes happen w/ negative pressure wound therapy?

A
  • Every 48+ hours for a healthy, clean wound
  • Every 12 hours for infected wounds
161
Q

In what circumstances is negative pressure wound therapy used?

A
  • Acute surgical wounds
  • Slow healing wounds
162
Q

What kind of dressing is appropriate with negative pressure wound therapy?

A

Foam dressing

163
Q

What outcomes can be expected with negative pressure wound therapy?

A
  • Decreased edema
  • Increased oxygen levels
  • Promotes wound closure
  • Increases granulation tissue
164
Q

National Pressure Injury Advisory Panel (NPIAP) classification system description of wound healing

A
  • Stages can be described progressively, but not regressively
  • I.e. stage 3 does not become stage 2 as it improves, but is described as “healing stage 3” with percentage of healing that has occurred
  • Also has measurements and descriptions
165
Q

Standard time interval for repositioning

A
  • 2 hours
  • Less time for patients who have an existing wound
166
Q

Gas gangrene

A

a special type of gangrene caused by infection of injured tissue by one of many species of Clostridium

167
Q

Gangrenous necrosis

A

due to death of tissue and results from severe hypoxic injury, not infection

168
Q

Wet gangrene

A
  • develops when neutrophils invade the site,
  • Causes liquefactive necrosis
  • It is not due to infection
169
Q

Fat necrosis

A
  • cellular dissolution caused by powerful enzymes, called lipases
  • occurs in the breast, pancreas, and other abdominal structures
  • It is not due to infection

NPTE (75 decks)

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