Skin/Burn - Unit 5 Flashcards
What is xerosis?
Dryness
What makes dryness worse?
Heat, harsh lotions.
What is pruritus?
Itching!
What is the itch-scratch-itch cycle?
The more you scratch, the more you itch!
What should we do for itching?
Avoid drying agents, keep fingernails trimmed short, make a cool sleeping environment, topical steroids, etc.
What are urticaria?
Hives
How do we treat urticaria?
Removal of triggering substances, antihistamines, avoid overexertion, alcohol consumption, warm environments, etc.
What is a pressure ulcer?
Skin and underlying soft tissue compressed between a bony prominence and an external surface for an extended period.
What is pressure?
Gravity.
What is shear?
Skin is stationary but muscle moves.
What do we look at during the wound assessment?
Location, size, color, extent of tissue involvement, cell types in the wound base and margins, exudate, condition of the surrounding tissues, presence of foreign bodies, etc.
Stage 1 Pressure ulcer - what happens?
Skin intact - redness does not blanch. Red/pinkness.
What happens in a stage 2 pressure ulcer?
Partial thickness loss into epidermis or dermis - abrasion, blister or shallow crater.
If the ulcer is fluid filled, it’s okay to pop it. T/F?
FALSE - do not pop it.
What happens in a stage 3 pressure ulcer?
Full thickness loss, no exposure of bone, tendon or muscle, though - but it has a deep crater that may tunnel!
What happens in a stage 4 pressure ulcer?
Full thickness loss of exposed muscle, tendon, or bone - tunneling, slough and eschar (dead, black) present
What are some surgical management options for pressure ulcers?
Debriedement, pedicle flap (maintains blood flow and is sutured down)
What is folliculitis?
Superficial infection involving the upper portion of the follicle (pimple, pustule) - usually caused by strep or staph!
Furuncle - what is it?
Boil - much deeper infection of the follicle.
Cellulitis - def
generalized infection with either staph, strep, or H flu involving deeper connective tissue. Usually has a border and will be red and tender. Treatment includes moist heat, antibiotics, and to elevate the legs.
What causes MRSA?
Long-term use of unnecessary antibiotics.
What are symptoms of MRSA?
small, red bumps
deep, painful abscesses on skin. If it burrows, it can cause sepsis.
What med treats mrsa?
Vancomycin.
What is herpes simplex virus 1?
A cold sore - red base around mouth or nose…it’s contagious!
What is herpes simplex virus 2?
Genital herpes.
What is the herpes zoster?
Shingles.
Shingles - what is it? How long does it last? Symptoms?
Reactivation of the dormant varicella zoster virus in patients who had chickenpox. Lasts several weeks with fever and malaise. Postherapeutic neuralgia - means pain can last for a long time - use gabapentin to treat! It can be contagious, too.
Tinea pedis =
Tinea corporis =
Tinea capitis =
Tinea cruris =
Tinea pedis = athlete’s food.
Tinea corporis = ring worm.
Tinea capitis = on the head.
Tinea cruris = jock itch.
Candida albicans (yeast infection) what should we avoid?
Warm, moist environments - watch skin folds, keep them clean/dry/open to air, etc.
What is burow’s solution for viral lesions?
Astringent/dries it out
What causes anthrax?
Bacillus anthracis
How do we diagnose anthrax?
Appearance of lesions/blood cultures.
Who is at risk for anthrax?
Farm workers.
How do we treat anthrax?
Oral antibiotics for 60 days (cipro, doxy, vibramycin)
What is contact dermatitis?
Inflammatory skin reaction - poison ivy, etc. SS = itching, hives, plaque, etc.
Contact dermatitis - should those patients avoid oil based products?
Yes - but take antihistamines and give compresses and baths.
Psoriasis - what is it?
increased epidermal growth that then shreads - it’s over the lifetime!
Which is the most often seen form of psoriasis?
Psoriasis vulgaris
How do we treat psoriasis?
Corticosteroids, UV light therapy, biologic agents, cytotoxic agents (watch for liver function here), immunosuppressants (humira affects the immune system!), emotional support.
What are cysts?
Firm, flesh colored nodules.
What are seborrheic keratoses?
Something older people get - papule that’s rough/dry and yellow/brown
What’s a keloid?
Overgrowth of scar tissue - usually in darker skinned people. Removing can actually causing more scar tissue :(
What is actinic karatoses cancer?
Rough, scaly patch of skin cancer
What does actinic lead to?
Squamous cell.
Squamous cell carcinomas - cancer of the ___. Can it be malignant?
epidermis. Can be malignant, found by ears, lips, genitalia, likely to spread, etc.
Basal cell carcinomas - least or most common skin cancer?
Most common.
Melanomas - deadly?
YES. some genetic parts to it, UV (artificial) increases risk. common on back, legs, head and neck (for men_)
What are some treatment options for skin cancer?
Cyrosurgery, curettage and electrodesiccation (small skin lesions only, not melanoma), excision (melanoma), moh’s surgery - the layer one for basal/squam where they remove it layer by layer, laser, etc.
Basal Cell - treated with an ointment called ______
5 Fluoro acid - placed on cancer!
For burn patients, do we worry about F/E loss?
YES
1st Degree burn/stage 1 - info? heal time?
Superficial thickness, heals in 3-6 days - red, mild discomfort. Peels on its own!
2nd degree burn/stage 2 - info, heal time, etc.
Superficial/partial thickness. Heals in 10-20 days, or deep which heals in 2-6 weeks. IT IS VERY PAINFUL. Blanches slowly. All of the epidermis and some of dermis is lost.
Full-thickness/3rd degree - info, heal time, etc.
Charred, brown, leathery. MUST BE GRAFTED. NO PAIN. Will not heal w/o graft.
Size of burn area - % for each.
Head - Arms - Thorax - Legs - Perineum
Head - 9% Arms - 9% EACH Thorax - 18% EACH SIDE Legs - 18% EACH Perineum - 1%
What’s a circumferential burn?
A burn that goes all the way around. It becomes tight and edematous so we have to watch for problems in the area.
What age group is the most at risk for complications from burns?
Ages 0-5 (don’t always have the best immune system, etc.) and Ages 60+ (immune problems, comorbidities, etc.)
When is a smoke and inhalation burn common?
With thermal burns.
What do we assess for smoke/inhalation burns?
Assess blackness around mouth/nares, may have pulmonary injuries, treat with O2, intubate, vent, steroids, etc.
Carbon monoxide binds slowly with Hgb - T/F?
FALSE - it binds slowly!
What happens with a thermal burn? What percent?
Dry, moist, contact. Comes from gas, liquid, or solid. It’s 95%! get them away from flame/source asap.
Chemical burns - what percent, comes from where, what to do, etc.
2%. Contact/inhalation. Comes from direct contact with gas, liquid or solid. You need to neutralize chemical - flush with H2O or other liquid quickly. Acidic chemical is like a heavy metal, alkalitic is like cement, etc.
Electrical burn - what percent? What do we look for?
3%. Look for entrance and exit site. Watch for cardiac changes/arrest. Remove them from the area, but be safe so you don’t get shocked, too.
What’s a radiation burn?
High doses of radioactive energy, it’s very rare though. Patient must be decontaminated before giving care
How does the body compensate for a severe burn injury? (2 things)
- Inflammation - immediate response. Tissues heal from this but causes vessel leakage, which is why people become edematous.
- Sympathetic system increases - so it’s flight or fight.
What’s the biggest intervention we can do for burn patients?
MONITOR AIRWAYS
Should we put heat on the burn or use warm compresses and lotion?
NO. COLD AND NOOOOOOO OINTMENTS AND SHIT
Do we need to do fluid resuscitation for burn patients?
YES
No iv/sub q injections for burn patients. T/F?
True
What’s th emergency phase #1?
First 48 hours, secure airway then do fluid replacement and CV function then prevent infections, maintain body temp, etc.
Parkland equation for burns - what is if?
4mg/kg/percent burn - then you give the first half of the total fluid in the first 8 hours, then 1/4 the next 8, then the final 4th the next 8.
What are some symptoms of carbon monoxide poisoning?
Headache, days ones, nausea, committing, lightheaded-ness and confusion in the later stage.
What are some electrolyte imbalances for burn patients?
Hyperkalemia, hyponatremia, hemoconcentration
For fluid resuscitation, urine output is the best tell for fluid status. T/F ?
True
Fluid resuscitation starts at the time of hospital admission or the burn?
The burn. So if they were burnt two hours ago, you count that and get the fluid in!
Are lactated ringers preferred for fluid status?
Yea.
Are IV narcotics the preferred method for pain relief in burn patients?
Yes
What’s acute phase number 2 in burn injuries?
Begins 36-48 hours after the burn until the wound closure is completed. It can take 6-8 weeks. We focus on maintenance of CV/RR, prevent shock, pain control, psycho social problems, etc.
How do we do a debridment?
Mechanical by water or enzymes.. Or surgical with a knife!
What’s a homograft?
Human cadaver skin (allograft)
What’s an autograft?
Patients own skin, preferred area taken from = the back or thigh.
What’s a heterograft?
Comes from pig skin or another species.
How long does an amniotic membrane graft last?
48 hours.
Should we wear gloves/masks/gowns with burn patients?
Yes, because they are at a high risk for infection.
What are some topical antibiotics for burn patients?
Silvadene (it can decrease leukocytes, and WBC level), flamazine, sulfamylon
Might burn patients need enteral tube feedings or TPN?
Yes
Are contractures a complication for burn patients?
Yes, so get them moving and such.
What’s phase 3 of the burn process?
Rehabilitative. Begins with wound closure and ends with patient returning to highest functioning. Psychosocial, preventing scars, finish cosmetic grafting.
Should patients with burns have increased protein?
Yes yes yes
