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Health and Illness Concepts II Nursing: N2310 > Sensory/Integumentary System (Exam One) > Flashcards

Sensory/Integumentary System (Exam One) Flashcards

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1
Q

Describe repair wound healing.

A

The healing of connective tissue that is already present

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2
Q

What is primary intention wound repair?

A

The initial closure of a wound by some type of suture

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3
Q

The edges of a wound are approximated with what type of wound repair?

A

Primary intention

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4
Q

List the types of wound repair.

A
  • Primary
  • Secondary
  • Tertiary
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5
Q

Describe secondary intention wound repair.

A

Wound is cleaned and then left open to heal itself from the inside out

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6
Q

What type of wounds require secondary intention repair?

A
  • Wounds with wide irregular margins
  • Wounds with extensive tissue loss
  • Wounds with infection
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7
Q

The edges of a wound cannot be approximated in what type of wound repair?

A

Secondary intention

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8
Q

Describe tertiary intention wound repair.

A

Wounds that are initially left open and later closed by some type of suture

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9
Q

Why is closure of a wound delayed with tertiary intention wound repair?

A

Due to contamination or infection

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10
Q

What must be done before a tertiary intention wound can be closed with sutures?

A

Control the infection

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11
Q

What two factors determine how well a wound will heal?

A
  • Shape

- Location

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12
Q

List factors of the body that make wounds harder to heal.

A
  • Body parts that have constant pressure

- Moving body parts

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13
Q

What is dehiscence?

A

Wounds that split or burst open

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14
Q

What is the primary risk factor for wound dehiscence?

A

Obesity

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15
Q

List the complications of wound healing.

A
  • Steroid use
  • Diabetes
  • Poor nutrition
  • Smoking
  • Age
  • Anemia
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16
Q

What is hypertrophic scarring?

A

Overabundance of scar tissue following the same size and direction of the wound

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17
Q

What is keloid scarring?

A

Overabundance of scar tissue that is raised

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18
Q

What population is most at risk for keloid and hypertrophic scarring?

A

African Americans

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19
Q

What is the main difference between keloid scarring and hypertrophic scarring?

A

Keloid scars do not follow the same size and direction of the original wound

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20
Q

How should a wound bed appear?

A
  • Moist

- Pink

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21
Q

What happens if the wound bed is dry?

A

Prevents the wound from granulizing and healing properly

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22
Q

Why are antibiotics not used with most wounds?

A
  • Want to avoid killing good bacteria

- Superinfection may occur with overmedicating

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23
Q

What is the main building block of skin and promotes wound healing?

A

Protein

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24
Q

What hormone will delay wound healing?

A

Cortisol

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25
Q

The nurse should educate the patient to avoid being outside during what time?

A

10 AM to 2 PM

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26
Q

What environmental factor is the most damaging to the skin?

A

Sun

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27
Q

What type of ultraviolet rays are known for causing skin cancer?

A

UVB

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28
Q

List medications that cause photosensitivity.

A
  • Antibiotic medication

- Psychiatric medication

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29
Q

What antibiotic is highly photosensitive?

A

Tetracycline

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30
Q

List risk factors for developing skin cancer.

A
  • Fair skin
  • Blonde/Red hair and blue eyes
  • Outdoor sunbathing
  • Tanning booths
  • High altitudes
  • History of skin cancer
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31
Q

In order to determine if a skin lesion is malignant or non-malignant, what must be done?

A

Biopsy

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32
Q

If a patient is prescribed topical 5FU, what education should the nurse provide?

A

Pain and burning sensations are common side effects of this medication

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33
Q

Which skin cancers are very common amongst older adults?

A
  • Actinic keratosis

- Seborrheic keratosis

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34
Q

How is seborrheic keratosis differentiated from melanoma?

A

Biopsy

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35
Q

Squamous cells are which layer of skin?

A

Top layer

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36
Q

Basal cells are which layer of skin?

A

Middle layer

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37
Q

Where are melanocytes found?

A

Underneath the squamous and basal cell layers

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38
Q

Which type of skin cancer is the most common?

A

Basal cell carcinoma

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39
Q

Where does basal cell carcinoma most commonly occur?

A

Skin disruptions or scarring

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40
Q

Basal cell carcinoma is most commonly associated with what?

A

Repeated sun exposure

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41
Q

People with these conditions are most likely to develop squamous cell carcinoma?

A

Immunosuppressed/immunocompromised patients (i.e. transplant patients)

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42
Q

Squamous cell carcinoma may develop inside of the mouth due to what?

A

Smoking

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43
Q

Which non-melanoma skin cancer is most likely to metastasize?

A

Squamous cell carcinoma

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44
Q

Which individuals are most at risk for developing malignant melanoma?

A
  • Genetically predisposed

- Fair skinned with blonde/red hair and blue eyes

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45
Q

Describe the ABCDE rule for identifying malignant skin neoplasms.

A
  • Asymmetrical
  • Border irregularity
  • Color change
  • Diameter >6 mm
  • Evolving in appearance
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46
Q

What is the top priority intervention measure for preventing malignant melanoma?

A

Educating the patient

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47
Q

Describe a Moh’s procedure.

A

Layers of the skin are removed very slowly until no more cancer cells are visible under a microscope

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48
Q

What is the survival rate if malignant melanoma is discovered during Stage 3 or Stage 4?

A

10%

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49
Q

What is the survival rate if malignant melanoma is discovered during Stage 0?

A

100%

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50
Q

What tool is used to measure and stage skin cancer?

A

Breslow Measurement

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51
Q

What does the thickness of a lesion determine?

A

Prognosis

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52
Q

What happens if a patient with contact dermatitis is prescribed antibiotics?

A

Skin flora will be destroyed

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53
Q

Corticosteroids may cause what skin condition? What does this put patients at risk for?

A
  • Thinning of the skin

- Skin breakdown

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54
Q

Describe Steven Johnson syndrome.

A
  • Systemic inflammatory reaction that spreads over the entire body
  • Blisters will form, burst, and skin will fall off
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55
Q

What is the main nursing priority for a patient with Steven Johnson syndrome?

A

Maintaining airway

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56
Q

What causes Steven Johnson syndrome?

A

Drug reaction

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57
Q

When is Red Man syndrome most likely to occur? Is this the same as Steven Johnson syndrome?

A
  • When vancomycin is pushed too quickly

- No

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58
Q

How would the nurse treat swelling caused by a Moh’s procedure?

A

Ice

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59
Q

Burns are highly ________.

A

Systemic

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60
Q

What is the most common type of burn injury?

A

Thermal burns

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61
Q

What are the causative agents of thermal burns?

A
  • Flame
  • Flash
  • Scald
  • Contact with hot object
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62
Q

Chemical burns are typically caused by what type of solution?

A

Alkaline solutions

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63
Q

Why are alkaline chemical burns more difficult to manage?

A

Cause protein hydrolysis and melting

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64
Q

What is the universal solvent? Can this solvent be used on all chemical burns?

A
  • Water

- No

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65
Q

Where should the nurse look for a list of safe solvents?

A

Medical Safety Data Sheet (MSDS)

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66
Q

What is the primary nursing priority for a patient with a smoke inhalation injury?

A

Maintaining airway

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67
Q

A patient with smoke inhalation injury will need what type of assessment?

A

Rapid initial and frequent, continuous assessments

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68
Q

List the three types of smoke inhalation injury.

A
  • Upper airway injury
  • Lower airway injury
  • Metabolic asphyxiation
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69
Q

Describe metabolic asphyxiation.

A

Inhaled chemicals change the chemistry of the blood in the body impairing oxygen delivery to tissues

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70
Q

List the signs and symptoms of metabolic asphyxiation.

A
  • LOC
  • Mental status changes
  • Hypoxia
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71
Q

Upper airway smoke inhalation injuries involve what structures?

A
  • Mouth
  • Oropharynx
  • Larynx
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72
Q

List the signs and symptoms of an upper airway smoke inhalation injury.

A
  • Redness
  • Blistering
  • Edema
  • Soot around mouth and nose
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73
Q

Upper airway smoke inhalation injuries will cause what type of ABC problem?

A

Airway

74
Q

Lower airway smoke inhalation injuries involve what structures?

A
  • Trachea
  • Bronchioles
  • Alveoli
75
Q

A lower airway smoke inhalation injury may manifest as what?

A

Acute Respiratory Distress Syndrome (ARDS)

76
Q

Pulmonary edema may not appear until how long after a lower airway smoke inhalation injury?

A

12 to 48 hours

77
Q

Lower airway smoke inhalation injuries will cause what type of ABC problem?

A

Breathing

78
Q

What happens to the alveoli during a lower airway smoke inhalation injury?

A

Alveoli become too full of fluid to exchange oxygen

79
Q

List the signs and symptoms of lower airway smoke inhalation injury.

A
  • Facial burns
  • Singed nasal hairs
  • Hoarseness
  • Painful swallowing
  • Carbonaceous sputum
80
Q

Swelling from an inhalation injury can lead to what?

A

Airway obstruction

81
Q

Affected lung tissue from an inhalation injury can lead to what?

A
  • Low gas exchange
  • Hypoxia
  • LOC changes
82
Q

What is the priority nursing intervention for a patient who has electrical burns?

A

Cardiac monitor

83
Q

Do electrical burns appear more internalized or externalized?

A

Internalized

84
Q

Electrical burns are most likely to cause direct damage to what?

A
  • Nerves

- Vessels

85
Q

Are solid organs or hollow organs more likely to be damaged from an electrical burn? Why?

A
  • Solid organs

- Electricity has more surface area to travel through

86
Q

In regard to electrical burns, what type of electrical flow is most detrimental to the patient?

A

Biphasic

87
Q

Electrical burns put patients at an increased risk for what clinical manifestations?

A
  • Dysrhythmias
  • Cardiac arrest
  • Metabolic acidosis
  • Myoglobinuria
  • Anoxia
88
Q

Myoglobinuria caused by electrical burns may result in what other acute conditions?

A
  • Acute tubular necrosis

- Acute kidney injury

89
Q

What areas of the body are most susceptible to cold burns?

A
  • Fingers
  • Toes
  • Nose
90
Q

How does the ABA classify burns?

A

Depth of skin destruction (burn)

91
Q

Superficial partial-thickness burns involve what layer of the skin?

A

Epidermis

92
Q

List an example of a superficial partial-thickness burn.

A

Sunburn

93
Q

Deep partial-thickness burns involve what layer of the skin?

A

Dermis

94
Q

Full-thickness burns involve what layer of the skin?

A
  • All skin elements
  • Nerve endings
  • Fat
  • Muscle
  • Bone
95
Q

Which type of burn is the most painful?

A

Deep partial-thickness burns

96
Q

List the signs and symptoms of deep partial-thickness burns.

A
  • Fluid-filled blisters
  • Severe pain
  • Mild/moderate edema
97
Q

What type of education should the nurse provide to a patient with deep partial-thickness burns?

A

Do not pop the blisters

98
Q

List the signs and symptoms of full-thickness burns.

A
  • Dry
  • Waxy
  • Leathery
  • Insensitive to pain
99
Q

What tool is considered most accurate for determining total body surface area percentage?

A

Rule of Nines

100
Q

Describe the Rule of Nines and the percentage of each body surface area.

A

See Slide 64 of Skin Disorders Powerpoint

101
Q

How is the severity of a burn injury determined?

A

By location

102
Q

If suffering from a burn injury, what locations on the body pose an increased risk for respiratory obstruction?

A
  • Face
  • Neck
  • Chest
103
Q

Which locations on the body would pose self-care difficulty if burned?

A
  • Hands
  • Feet
  • Joints
  • Eyes
104
Q

If burned, which locations on the body are at an increased risk for infection?

A
  • Ears
  • Nose
  • Buttocks
  • Perineum
105
Q

Circumferential burns of extremities can cause circulation problems ________ to the burn area.

A

Distal

106
Q

If a patient has nerve damage to an extremity resulting from a burn, what other condition might they develop?

A

Compartment syndrome

107
Q

Describe third spacing.

A

Movement of body fluid from inside the blood vessels to the interstitial space

108
Q

What happens to the blood if third spacing occurs?

A

Becomes thicker

109
Q

What is a patient as risk for if they have third spacing and thick blood?

A
  • Blood clots due to poor perfusion

- Electrolyte imbalances

110
Q

What will the body do as a reaction to burns?

A
  • Swell

- Third spacing

111
Q

Third spacing may appear as or cause what?

A
  • Exudate
  • Blisters
  • Edema in unburned areas
112
Q

What amount is considered a normal insensible loss?

A

30mL to 50mL

113
Q

Insensible loss will __________ in a severely burned patient.

A

Increase

114
Q

Describe vital sign changes in a patient with third spacing.

A
  • Decreased blood pressure

- Increased heart rate

115
Q

What is hemoconcentration?

A

Ratio of red blood cells are increased compared to the amount of plasma

116
Q

What can hemoconcentration cause?

A
  • High hematocrit

- Blood clots

117
Q

What electrolyte shift will appear first in a burn patient?

A

Potassium

118
Q

Why will potassium be the first electrolyte to shift in a burn patient?

A

Injured cells and hemolyzed red blood cells (RBCs) release potassium into circulation

119
Q

How long will sodium remain in the interstitial spaces on a burn patient?

A

Until edema formation ends

120
Q

What is done to prevent/correct hypovolemic shock in burn patients?

A

Fluid resuscitation

121
Q

What tool is used to tell the nurse how much fluid to give during fluid resuscitation?

A

Parkland (Baxter) formula

122
Q

Describe the Parkland (Baxter) formula and how much fluid to administer during fluid resuscitation.

A

-4mL x kg x %TBSA for first 24 hours

  • 1/2 of total in first 8 hours
  • 1/4 of total in second 8 hours
  • 1/4 of total in third 8 hours
123
Q

What must be secure before giving a patient fluid resuscitation?

A

Airway

124
Q

A central line will be required in a burn patient if what percentage of the total body surface area is burned?

A

More than 20%

125
Q

When would an arterial line be placed in a burn patient?

A

If frequent ABG’s or invasive blood pressure monitoring is needed

126
Q

A nurse who is managing fluid needs on a burn patient should expect the minimum urine output to be what?

A

1mL/kg/hr

127
Q

What vital signs are considered normal in a burn patient?

A
  • MAP of >65
  • HR <120
  • SBP >90
128
Q

A nurse who is managing fluid needs on a burn patient knows what about the relation of fluid input and output?

A

Even though a large amount of fluid is being put in, should not expect to get a lot of fluid out

129
Q

Why is a burn patient at an increased risk for infection?

A

Function of white blood cells (WBCs) is defective

130
Q

List the clinical manifestations of the emergent burn phase.

A
  • Shock
  • Pain
  • Blisters
  • Paralytic ileus
  • Shivering
  • Altered mental status
131
Q

How would the nurse combat shock in a burn patient?

A

Fluid resuscitation

132
Q

List the complications of a burn.

A
  • Dehydration
  • Shock
  • Acute tubular necrosis
  • Infection
133
Q

What surgical procedure may be done to a patient with circumferential burns?

A

Escharotomy

134
Q

What signs and symptoms indicate the acute phase of a burn has begun?

A
  • Mobilization of extracellular fluid

- Diuresis

135
Q

When does the acute phase of a burn end?

A
  • Partial thickness wounds are healed

- Full thickness burns are covered by skin grafts

136
Q

Which phase of the burn process is generally the longest?

A

Acute phase

137
Q

What type of intentional wound healing occurs with partial thickness burns?

A

Secondary

138
Q

What nursing interventions are provided to a burn patient during the acute phase?

A
  • Wound care
  • Pain management
  • Nutritional therapy
139
Q

What should nursing staff do before completing a dressing change on a burn wound that is open and exposed?

A

Don personal protective equipment (PPE)

140
Q

What does scar tissue from a burn do to a patients range of motion (ROM)?

A

Scar tissue thickens and causes contracture’s

141
Q

Why are splints used on a burn patient during the acute phase?

A

Maintain functionality

142
Q

What type of device is used on a burn patient who has limited ROM and contractures?

A

Splint

143
Q

What is an allograft?

A

Graft from the patient or self

144
Q

What part of the body is an allograft usually taken from?

A

Thigh

145
Q

What is a homograft?

A

Graft from a donor or cadaver

146
Q

Each patient who suffers from a burn will receive what type of shot? This is considered what?

A
  • Tetanus

- Preventative agent

147
Q

Why might sedatives and anti-anxiety medications be given to burn patients?

A
  • Prevent flashbacks of traumatic event

- Reduce anxiety developed around dressing changes

148
Q

When are antibiotics given to a burn patient?

A

Infection presence is known

149
Q

Why are antimicrobials used on burn patients?

A

Prevent large amounts of bacteria from forming

150
Q

When would systemic antibiotics be given to a burn patient?

A

A diagnosis of sepsis is made

151
Q

Due to burn patients being high risk for developing DVT and blood clots, what medication is given?

A

Low molecular weight heparin

152
Q

What type of nursing interventions should be implemented to decrease risk of blood clots in a burn patient?

A
  • Intermittent pneumatic compression devices

- Graduated compression stockings

153
Q

After fluid needs have been met, what takes priority in a burn patient?

A

Nutrition

154
Q

Does a large inflammatory response increase or decrease patient metabolism?

A

Increase

155
Q

A burn patients metabolism can function _____ to ______ higher than normal.

A

50% to 100%

156
Q

The specific breakdown of protein is known as what?

A

Catabolism

157
Q

Why is early and aggressive nutritional support necessary in a burn patient?

A
  • Decreases complications
  • Decreases mortality
  • Decreases negative effects of hypermetabolism
  • Decreases catabolism
  • Optimizes healing
158
Q

Partial-thickness burns can convert to full-thickness wounds if what is present?

A

Infection

159
Q

What laboratory level is assessed to aid in identifying sepsis?

A

Lactic acid

160
Q

What does a lactic acid level assess?

A

-Oxygen delivery to tissues

161
Q

List the signs and symptoms of sepsis.

A
  • Increased heart rate
  • Hypothermia or hyperthermia
  • Decreased blood pressure
  • Decreased urine output
162
Q

What is a Curling’s ulcer?

A

A burn patient who has an ulcer

163
Q

How do glucose levels affect wound healing?

A

Increased BGLs will slow wound healing

164
Q

What type of therapy might a burn patient be receiving if their blood glucose level is elevated?

A

Insulin drip

165
Q

When does the rehabilitation phase begin for burn patients?

A
  • Wounds have nearly healed

- Patient is engaging in some self-care

166
Q

Often skin _______ regain its original color.

A

Does not

167
Q

When is mature healing reached?

A

12 months

168
Q

Newly healed areas can be ___________ or ___________ to cold, heat, and touch.

A

Hypersensitive or hyposensitive

169
Q

What is the most common complication during the rehabilitation phase for burn patients?

A

Skin and joint contractures

170
Q

List interventions used to minimize skin and joint contractures.

A
  • Proper positioning
  • Splinting
  • Exercise
171
Q

Why should patients with burns involving the face, genitals, hands, feet, and major joints go to a burn center?

A

Maintain functionality

172
Q

Why should patients with electrical burns go to a burn center?

A

Heart and kidney complications

173
Q

Why should patients with inhalation burns go to a burn center?

A

Airway maintenance

174
Q

Why should patients who have burn injuries with concomitant trauma go to a burn center?

A

Due to high stress traumatic events

175
Q

Why should children with burn injuries go to a burn center?

A

Typically more severe

176
Q

List the analgesics and sedatives commonly given to burn patients.

A
  • Morphine
  • Hydromorphone
  • Haloperidol
  • Lorazepam
  • Midazolam
177
Q

How are analgesics and sedatives administered to burn patients? Why?

A
  • IV

- Fastest onset of action

178
Q

List the topical antimicrobial agents most commonly given to burn patients.

A
  • Silver sulfadiazine

- Mafenide acetate

179
Q

What is the normal range for lactic acid?

A

0.6 - 2.2

180
Q

What laboratory level is elevated in a patient with metabolic asphyxiation?

A

Carboxyhemoglobin levels

Health and Illness Concepts II Nursing: N2310 (10 decks)

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