Skin Integrity Flashcards
1
Q
Who has the responsibility to assess & monitor the skin?
A
The nurse
2
Q
What is the purpose of skin?
A
protection
sensory
Vitamin D synthesis
Fluid balance
natural flora
3
Q
How should we assess the skin?
A
inspect entire body
visual & tactile
assess any rases or lesions
note hair distribution
skin color
blanch test
4
Q
What should we pay special attention to on the skin?
A
where there are bony prominences
5
Q
During the skin assessment what should we identify?
A
the pt’s risk
signs/symptoms of impaired skin or wound healing
6
Q
What should we examine skin for?
A
Actual impairment
7
Q
What are the focuses we should have when looking at the skin?
A
level of sensation, movement, & continence
8
Q
When should we assess the skin?
A
when pt is admitted
once per shift after admission
9
Q
How often we should assess high-risk pt’s?
A
assess every 4 hrs or more often
10
Q
Where should we palpate skin?
A
on areas of redness to determine if skin is blanchable
11
Q
What areas should we pay special attention to?
A
bony prominences
medical devices
areas with adhesive tape
12
Q
Braden scale sensory perception: What does 1. Completely limited mean?
A
unresponsive
limited ability to feel pain over most of the body
13
Q
Braden Scale sensory perception: What does 2. Very limited mean?
A
painful stimuli
cannot communicate discomfort
sensory impairment over half the body
14
Q
Braden Scale Sensory perception: What does 3. Slightly limited mean?
A
verbal commands
cannot always communicate discomfort
sensory impairment 1-2 extemities
15
Q
Braden scale sensory perception: What does 4. no impairment mean?
A
verbal commands
no sensory deficit
16
Q
Braden scale moisture: What does 1. Constantly moist mean?
A
perspiration, urine, etc
always
17
Q
Braden scale moisture: what does 2. very moist mean?
A
often but not always
linen changed @ least once per shift
18
Q
braden scale moisture: what does 3. occasionally moist mean?
A
extra linen changed qday
19
Q
braden scale moisture: what does 4. rarely moist mean?
A
usually dry
20
Q
Braden scale activity: what does 1. bedfast mean?
A
never oob
21
Q
braden scale activity: what does 2. chairfast mean?
A
ambulation severely limited to non-existent
cannot bear own wt - assisted to chair
22
Q
braden scale activity: what does 3. walks occasionally mean?
A
short distances daily w/ or w/o assistance
majority of time in bed or chair
23
Q
braden scale activity: what does 4. walks frequently mean?
A
outside room 2 x per day
inside room q 2 hrs during waking hrs
24
Q
braden scale mobility: what does 1. completely immobile mean?
A
makes no change in body or extremity position
25
braden scale mobility: what does 2. very limited mean?
occasional slight changes in position
unable to make frequent/significant changes independently
26
braden scale mobility: what does 3. slightly limited mean?
frequent slight changes independently
27
braden scale mobility: what does 4. no limitation mean?
major & frequent cahnges w/out assistance
28
Braden scale nutrition: what does 1. very poor mean?
never eats complete meal, very little protein
NPO, clear liquids, IV >5 days
29
Braden scale nutrition: what does 2. probably inadequate mean?
rarely eats complete meal, some protein
occasionally takes dietary supplements
receives less than optimum liquid diet
30
braden scale nutrition: what does 3. adequate mean?
eats over 1/2 of most meals, adequate protein
usually takes a supplement
tube feeding or TPN probably meets nutritional needs
31
braden scale nutrition: what does 4. excellent mean?
eats most of meal, never refuses, plenty of protein
occasionally eats b/w meals
does not require supplements
32
braden scale friction & shear: what does 1. problem mean?
moderate to maximum assistance in moving
frequently slides down in bed or chair
spasticity, contractures or agitation leads to almost constant friction
33
braden scale friction & sheer: what does 2. potential problem mean?
moves feebly, requires minimum assistance
skin probably slides against sheets
relatively good position in chair or bed w/ occasional sliding
34
braden scale friction & sheer: what does 2. potential problem mean?
moves feebly, requires minimum assistance
skin probably slides against sheets
relatively good position in chair or bed w/ occasional sliding
35
braden scale friction & sheer: what does 3. no apparent problem mean?
moves on bed & chair independently
sufficient muscle strength to lift up completely during move
good position in bed or chair
36
Braden scale scores: low risk 15-18 are what components?
regular turning schedule
enable as much activity as possible
protect heels
mange moisture, fiction & sheer
37
braden scale scores: moderate risk 13-14 are what components?
regular turning schedule
enable as much activity as possible
protect heels
manage moisture, frictio & sheer
position pt @ 30 degree lateral incline w/ wedges or pillowa
38
braden scale scores: high risk 12 or less are what components?
regular turning schedule
enable as much activity as possible
protect heels
manage moisture, friction & sheer
position pt @ 30 degree lateral incline
make small shifts in position frequently
pressure redistribution surface
39
How often should we reposition pt's?
frequently
40
How long should pt's sit in the chair?
no more than 2 hours if not contraindicated
41
What other interventions can help prevent pressure injures?
keeping HOB @ 30 degrees & keeping a schedule of repositioning
42
What is a stage 1 wound characteristics?
nonblanchable redness
43
What is a stage 2 wound characteristics?
partial thickness
44
What is a stage 3 wound characteristics?
full-thickness skin loss
45
What is a stage 4 wound characteristics?
full-thickness tissue loss
46
What are unstageable/unclassified wound charateristics?
full-thickness skin or tissue
loss-depth
unknown
47
What is the depth of a suspected deep pressure wound?
unknown
48
What is our early intervention protocol acronym?
CHANT
49
What does C in CHANT stand for?
Cleanse
50
What does H in CHANT stand for?
hydrate (& protect) skin
51
What does A stand for in CHANT?
alleviate pressure
52
What does the N stand for in CHANT
nourish
53
What does the T stand for in CHANT?
treat
54
What should we do for a red/excoriated peri/rectal area to intervene for wounds?
cleanse
dry throughly
moisture barrier daily & prn
55
How can we intervene in wound prevention when we see redness/excoriation b/w skin folds?
cleanse
dry throughly
place inner dry or dry AG textile in skin folds
56
How can we intervene in wounds for red heels?
position pressure off heels
elevate on pillows
sage boot
reduce friction
57
How can we intervene in wounds for a red sacral/coccyx area?
change positions q 1-2 hrs
HOB <30 degrees unless contraindicated
avoid excess moisture
frequent peri care
wrinkle free linen
58
What are nursing priorites for skin?
assessing & monitoring skin integrity
identifying risks for skin problems
identifying present skin problems
planning, implementing, & evaluating interventions to maintain skin integrity
59
Inflammatory response: what is sequential response to cell injury?
neutralizes & dilutes inflammatory agent
removes necrotic materials
establishes an environment suitable for healing repair
60
Does inflammation equal infection? Why or why not?
No, inflammation is always present w/ infection, but infection is not always present w/ inflammation
61
Which conditions can an inflammatory response occur?
surgical wounds, other skin injuries
allergies
autoimmune diseases
skin infection
62
What does wound mean?
any disruption of the integrity & function of tissues in the body
63
What is important for wound healing?
wound assessment & classification
64
What can cause an inflammatory response in the first 24 hrs?
tissue trauma
65
Is the mechanism the same for inflammatory response regardless of the injury?
yes
66
What does the intensity of the inflammatory response depend on?
extent & severity of the injury
reactive capacity of the injured person
67
What is the vascular response to inflammation?
increased capillary permeability, fluid moves into tissue spaces
Results in redness, heat, & swelling @ site of injury & surrounding areas
68
What are local responses to inflammation?
redness
heat
pain
swelling
loss of function
69
What are systemic response to inflammation?
increased WBC count
Malaise
Nausea & anorexia
Increased pulse & RR
Fever
70
What can cause systemic response to systemic response to inflammation?
complement activation & release of cytokines
71
Types of inflammation: Acute
healing in 2-3 wks, no residual damage
neutrophils predominant cell type @ site
72
Types of inflammation: subacute
same feature as acute but lasts longer
73
Types of inflammation: chronic
may last for years
injurious agent persists or repeats injury t site
predominate cell types are lymphocytes & macrophages
may result from changes in immune system
74
How do we promote good health with wounds?
prevention
adequate nutrition
early recognition of injury/inflammation
immediate treatment
75
What is the final phase of inflammatory process?
wound healing
76
What two major components are part of healing?
regeneration & repair
77
What does regeneration mean?
replacement of lost cells & tissues w/ cels of the same type
78
What does repair mean?
healing as a result of lost cells being replaced by connective tissue, results in scar formation
- more common
- more complex
- occurs by primary, secondary, or tertiary intention
79
What 3 phases are apart of healing by primary intention?
initial phase
granulation phase
maturation phase
80
What does the initial phase mean?
3-5 days, acute inflammation response
81
What does the granulation phase mean?
fibroblasts secrete collagen, wound pink & vascular, risk for dehiscence, resistant to infection
82
What does the maturation phase mean?
this is where scar formation occurs
begins 7 days after injury, continues for months/yrs, fibroblasts disappear, wound becomes stronger, mature scar forms
83
What does healing by secondary intention mean?
wounds from trauma, ulceration, & infection have large amounts of exudate & wide, irregular wound margins w/ extensive tissue loss
edges cannot be approximated
84
How do can wounds with secondary intention heal?
healing process is same as primary, but inflammatory reaction may be greater, wound may need to be debrided before healing can take place
85
How does tertiary wound intention occur?
delayed primary intention due to delayed suturing of wound
occurs when a contaminated wound is left open & sutured closed after infection is controlled
86
Partial thickness wounds: What are the 3 components of healing?
inflammatory response
epithelial proliferation & migration
reestablishment of epidermal layers
87
Full-thickness wounds: What are the 4 components of healing?
hemostasis
inflammatory phase
proliferative phase
maturation
88
How do full-thickness wounds that extend into the dermis heal?
heal by scar formation
89
What factors influence wound healing?
nutrition
tissue perfusion
infection
age
90
How does nutrition impact wound healing?
Protein, Vitamins (ESP. A & C), & trace minerals of zinc & copper
Adequate calories
91
How does tissue prefusion impact wound healing?
oxygen fuels cellular functions
92
How does infection impact wound healing?
prolong the inflammatory stage, delays collagen synthesis,. prevents epithelialization, increases cytokine production
93
How does age impact wound healing?
decreased function of macrophage leads to delayed inflammatory response in older adults
94
What are complications of wound healing?
hemorrhage
hematoma
infection
dehiscence
evisceration
95
What does hemorrhage mean?
abnormal internal or external blood loss may be caused by suture failure, clotting abnormalities, dislodged clot, infection or erosion of a blood vessel (tubing, drains) or infection process
96
What does hematoma mean?
extravasation of enough size to cause visible swelling
97
What does infection mean?
occurs when a pathogen invades the body multiplies, & produces disease, usually causing harm to the host
98
What dose dehiscence mean?
separation & disruption of previously joined wound edges
usually occurs when a primary healing site bursts open
99
What does evisceration mean?
occurs when wound edges separate to the extent that intestines protrude through wound
usually needs immediate surgical treatment
100
How are wounds classified?
by cause & depth
surgical or non-surgical; acute or chronic
superficial, partial thickness, full thickness
101
What is a skin tear?
wound caused by shear, friction, &/or blunt force
can be partial thickness or full thickness
common in older adults & those critically/chronically ill
102
When should we assess skin?
on admission & every shift
103
What should we include when documenting a wound?
location, size, condition of surrounding tissue, & wound base
any drainage - consistency, color, odor
104
What else should nurses consider when examining a wound?
if there are any factors that may delay healing
105
What determines the care we do for a wound?
extent, character, & phase of healing
106
What do we need for cleaning wounds?
may need cleansing & some type of wound closure (adhesive strips, sutures, staples)
various dressings can be used to keep wound clean & moist
107
What are surgical wounds allowed to be covered with and when can this be removed?
covered with sterile dressing & remove in 2-3 days
108
What is an enemy of wound healing?
dryness
109
What can damage new epithelium & delay healing?
antimicrobial & antibacterial solutions should not be used in a clean granulating wound
110
What can surgical wounds have that may help get rid of fluid?
Drains
Ex. Jackson-Pratt drain (JP)
111
What must be converted to a clean wound before healing can occur
a contaminated wound
112
What is debridement and what is it for?
debridement is removal of dead tissue & debris
it is for cleaning contaminated wounds
113
what is available that can absorb exudate & clean the wound?
dressings
114
what is the purpose of dressings?
protects from microorganisms
aids in hemostasis
promotes healing by absorbing drainage or debriding a wound
supports wound site
promotes thermal insulation
provides a moist environment
115
what type of dressings do we have?
gauze
transparent film '
hydorcolloid
hydrogel
foam
composite
116
when changing dressings what should we know?
what type of dressing is needed, if there are any drains/placement of said drains, & equipment needed
117
How do we prep for a pt dressing change?
review previous wound assessment
evaluate pain &, if indicated, admin analgesics
describe procedure
gather supp
recognize normal signs of healing
answer q's about the procedure or wound
118
what are comfort measures we can utilize when doing the dressing change?
admin analgesic meds 30 to 60 mins before
carefully remove tape
gently clean wound edges
carefully manipulate dressings & drains to minimize stress on sensitive tissues
turn & position pt carefully
date & time dressings
document
119
how do we clean the wound?
clean least contaminated top to the surrounding skin
use gentle friction
when irrigating, allow the solution to flow from the least to most contaminated area
120
what else can nurses do for wounds?
clean & drain sites
suture care
staple removal
121
how do we remove sutures?
review policy & orders prior to removing sutures
document how many u removed
clip near skin, opposite of knot
122
how do we remove steri strips?
we dont!
dont pull or create tension with steri strips
teach pt to leave them be & allow them to fall off naturally (about 10 days), pt may shower
123
what can prophylactic doses decrease?
decrease the incidence of infection in certain kinds of surgery
124
When do we observe prophylactic use of antibiotics?
cardiac surgery
peripheral vascular surgery
GI surgery
& OB/GYN surgeries
125
What surgeries use antibiotics as treatments not prophylaxis?
compound fractures
perforated abdominal organs
animal bites
126
when should prophylactic antibiotics be given
prior to surgery
can be redosed if surgery is unusally long
can be given after surgery if needed but is unsusal
127
what are cephalosporins most affective against?
cells undergoing active growth & division
128
are cephalosporins one of the most widely used antibacterial drugs?
yes
129
What are first gen cephalosporins called?
cefezolin, cephalexin
130
What are second gen cephalosporins called?
cefotentan
131
what are thrid gen cephalosporins called?
ceftrixaone (also used for active infections, penetrates CSF)
132
what are pressure ulcers also called?
pressure injuries
133
What are pressure ulcers?
localized injury to skin &/or underlying tissue
134
Where are pressure ulcers usually located?
usually over bony prominences
most common on scrum & heels
135
How are pressure ulcers developed?
results from prolonged pressure or pressure in combination w/ shearing forces
136
what else can we get pressure ulcers from?
can come from medical or other devices
137
When will pressure ulcers heal?
generally by secondary intention
138
Where are the 22 pressure ulcer sites?
occipital bone
scapula
spinous process
elbow
iliac crest
sacrum
ischium
achilles tendon
heel
sole
ear
shoulder
anterior iliac spine
trochanter
thigh
medial knee
lateral knee
lateral edge of foot
posterior knee
139
what is interface pressure?
pressure of body pressing the skin down onto a firm surface
140
How do pressure ulcers form
being in one position for a prolonged period of time
stops capillary flow to the tissues
which deprives tissues of oxygen & nutrients
this cause cell death & necrosis
141
What is pressure intensity
amount of pressure
142
what is pressure duration
length of time pressure is exerted on the skin
143
what is the definition of tissue tolerance
ability of tissue to tolerate the pressure
144
what are the tissue tolerance factors
nutrition
perfusion
co-morbidities
condition of soft tissue
145
what are shearing forces
when skin adheres to a surface & skin layers slide in direction of body movement
146
how does moisture influence skin breakdown
sitting in moisture for a long period of time will eventually cause skin breakdown especially if pt is incontinent or unable to clean themselves
147
who/what factors make people at risk for developing pressure ulcers
advanced age
anemia
diabetes
elevated body temp
friction
immobility
impaired circulation
incontinence
low diastolic bp (<60 mmHg)
mental deterioration
neurologic disorders
obesity
pain
prolonged surgery
vascular disease
148
how are pressure ulcers staged
based on visible/palpable tissue in ulcer bed
149
who makes the guidelines for pressure ulcer staging
national pressure ulcer advisory panel (NPUAP)
150
how many stages are there for classifying pressure ulcers and what is the most minor to most major stage
4 stages
stage 1 minor
stage 4 major
151
what may prevent identification of wounds?
presence of slough or eschar
152
what does a suspected deep tissue injury look like
purple or maroon localized if discolored intact skin or blood-filled blister
153
What does the purple or maroon color indicate?
indicates damage if underlying soft tissue from pressure &/or shear
154
What can precede a deep tissue pressure injury
tissue that is painful, firm, mushy, & boggy
155
what should we know about deep pressure injuries in dark skinned tone people
it may be difficult to detect
156
what should we look for during a skin assessment?
darker areas of skin
skin temp
skin/tissue consistence
pt sensation
157
how do we look for darker areas on the skin
look for areas of skin that are darker than surrounding skin
158
how may darker areas present on the skin
purple
brown
blue
159
how do you assess skin temp?
use your hand to assess skin
160
how does and ulcer feel temp wise
it may feel warm initially then become cooler with time
161
how do we check skin/tissue consistence
apply gentle pressure to common sites of injury
162
what does boggy or edematous tissue indicate?
a stage 1 pressure ulcer
163
how do we assess pt sensation
pt's may report pain or itchy sensation
164
how do stage 1 pressure ulcers look
intact skin*
non-blanchable redness of a localized area
165
where are stage 1 ulcers commonly found
common over bony prominences
166
how might the ulcers feel when we asses them
firm, soft, warmer, or cooler compared to adjacent tissue
167
what would a pressure ulcer look like on a darker skin tone
it may not have visible blanching but color may differ from the surrounding area
168
what do stage 2 pressure ulcers look like
partial-thickness loss of dermis
shallow open ulcer with red/pink wound
may be intact or ruptured serum filled blister
can be shiny or dry shallow ulcer without slough or bruising
169
What is not visible in the stage 2 pressure ulcers
adipose (fat) & deeper tissues are not visible
170
What is not present during a stage 2 pressure ulcer
granulation tissue, slough, & eschar are not present
171
what qualities does a stage 3 pressure ulcer have
full-thickness skin loss
subcutaneous tissue may be visible
presents as a deep crater w/ possible undermining or adjacent tissue
172
what is not visible in a stage 3 pressure ulcer
bone, tendon, or muscle are not
173
what makes the ulcer depth vary
varies on location, this depends on the depth tissue in that area
174
what are the characteristics of a stage 4 pressure ulcers
full-thickness loss
extends to muscle, bone, or supporting structures
175
What may be visible with stage 4 ulcers
bone, tendon, or muscle
176
can slough or eschar be present with these wounds
yes
177
are undermining & tunneling able to be present/occur
yes
178
what are the characteristics of an unstageable ulcer
full-thickness tissue loss
the ulcer is completely covered with slough or eschar in wound bed
179
what does slough look like
yellow, tan, green, grey, brown
180
what does eschar look like
tan brown or black
181
what needs to happen to classify the wound if it's unstageable
slough & eschar need to be removed
182
what type of eschar should not be removed & what location is it
stable, dry eschar on heels should not be removed
183
what complications can arise from pressure ulcers
infection: leukocytosis, fever, increased ulcer size, odor, or drainage, necrotic tissue, indurated, warm, painful
184
what can untreated ulcers lead to?
cellulitis w/ spread of inflammation/infection to subcutaneous tissue, connective tissue, bone (osteomylitis), can lead to sepsis & death
185
what is the most common complication of pressure ulcers
recurrence of tissue breakdown/repeat pressure ulcers
186
what are the signs that a wound may have an infection
swelling, redness, & foul odor
187
how important is the nurses role in preventing skin breakdown & treatment
it's a critical role
188
When should we assess pt's skin?
assess skin of every pt on admission & every shift
189
how often should we assess a pt that has been admitted
every 12 hours
190
do we want stage 3 & 4 pressure injuries after admission
no
hospital will be liable for pt's stay
191
how can we prevent pressure ulcers
constantly shift wt
keep skin dry
clean incontinent pt's often
reposition pt w/ drawsheet, transfer board, position them @ 3o degrees lateral position, HOB @ 30 degrees or less, trapeze bar
turning schedule
nutrition & fluid intake
192
how can we reposition the pt
w/ drawsheet
transfer board
position them @ 3o degrees lateral position
HOB @ 30 degrees or less
trapeze bar
turning
193
what is the care plan for prevention of a pressure ulcer
prevent deterioration
reduce factors that contribute to pressure & skin breakdown
prevent infection
promote healing
prevent recurrence
194
what do we do if a pt has a pressure injury
document*
take pics if needed for EMR
wound care specialist
surgical treatment
195
what do we document for a wound
stage
size
location
exudate
infection
pain
tissue appearance
196
what do wound care specialists do for the pt's
determine the cleansing protocol
what type of dressings are appropriate
197
what are the general principles for cleaning a wound/how do we clean it before wound care
clean w/ normal saline to avoid damaging cells
keep slightly moist to encourage re-epithelialization
198
what surgical treatments may pt's undergo for wounds
skin grafts
skin flaps
musculocutaneous flaps
199
what should we teach to pt's & caregivers about pressure wounds
teach prevention techniques & early warning signs of skin breakdown & tissue injury
nutrition
pressure ulcer care techniques
wound care at home
turning schedule
200
what are other skin damage things we can identify
moisture-associated skin damage (MASD) or incontinence associated dermatitis (IAD)
medical adhesive related skin injury (MARSI)
skin tear
201
how do lower extremities develop
related to changes in blood flow to lower extremities to chronic disease processes
202
how are arterial pressure ulcers caused
by Peripheral Artery Disease (PAD) ischemia & nutrition deprivation as a result of decreased circulation
203
how will the skin look for arterial ulcers
thin
shiny
dry
w/ loss of hair on ankles & feet
204
what diseases will people have that can increase their risk for arterial ulcers
atherosclerosis
PVD
diabetes
smoking
hypertension
advanced age
obesity
cardiovascular disease
205
where can arterial ulcers be found
b/w toes
tips of toes
phalangeal head
lateral malleolus
areas w/ rubbing footwear
206
how do arterial ulcers look
even wound margins
punch-out appearance
pale
deep wpund bed
207
do arterial ulcers drain
no/very minimal they are painful
208
how can we help heal an arterial ulcer
revascularize w/ stents to treat ischemia, then topical treatments will help ulcer
209
how does venous insuffiency occur
when blood cannot flow upward from veins in the legs
210
when does chronic venous insufficiency occur
happens when valves are damaged allowing blood to leak backward resulting in venous stasi
211
who are at risk for venous ulcers
those with:
obesity
deep vein thrombosis (DVT), pregnancy
incompetent valves
CHF
muscle weakness
decreased activity
advance age
family history
212
where are venous ulcers found & what do they look like
found in lower legs
have irregular wound margins & superficial ruddy granular tissue
213
howe painful are venous ulcers
PAINLES TO MODERATE
214
how may the surrounding skin look with venous ulcers
rred
scaly
weepy
thin
215
what can prevent blood from pooling
compresion therapy
216
how are diabetic ulcers formed
by peripheral neuropathy in skin & decreased ability to fight infection
217
where are diabetic ulcers found
plantar aspect of foot
over metatarsal heads
under heels
& on toes
218
are diabetic ulcers painful
no
219
how do the wound margins look
even margins
rounded or oblong shape with surrounding callous
220
what can diabetic ulcers easily turn into
cellulitis or osteomyelitis
221
how can we treat these diabetic ulcers
removinf stress/pressure from injured site
debriding wound
antibiotics if infection occurs
222
what is cellulitis
inflammation of subcutaneous tissue
223
how does cellulitis form
from a staph & strep infection & often following a break in skin
deep inflammation caused by enzymes produced by bacteria
224
how does cellulitis look
hot
tender
'erythematous
edematous area w/ diffuse borders
225
what symps can pt with cellulitis look
chills
malaise
fever
226
how do we treat cellulitis
moist heat
immobilization
elevation
systemic antibiotic therapy
hospitilzation if IV therapy warranted (sever infections)
progresses to gangrene if left untreated
227
what is the most important treatment for wounds
prevention
228
what can we treat skin & soft tissue infections with (meds)
cephalosporins
some penicillins (narrow-spectrum pcn)
carbapenems
vancomycin
clindamycin
linezolid
daptomycin
levofloxacin
229
what are the narrow spectrum penicillins called
penicillin g
penicillin v
nafcillin
oxacillin
dicloxacillin
230
how may penicillins be given
PO
IM
IV
231
are penicillins effective against MRSA
no
232
what should penicillins never be mixed w/ in IV solution
aminoglycosides
233
what are the least toxic of all antibiotics
pernicilins
234
how are penicillins metabolized & excreted
kidneys
235
what are the adverse effects of penicillins
allergies
pain & IM injection site
neurotoxicity
236
what should we avoid when doing intra-arterial injections of penicillins
gangrene
necrosis
sloughing of tissue can result
237
what is psoriasis
common, chronic autoimmune inflammatory disorder characterized by plaque formation
238
what does mild psoriasis look like
red patches covered w/ silvery scales on:
scalp
elbows
knees
palms
& soles
239
what does sever psoriasis look like
involve entire skin surface & mucous membranes
superficial pustules
high fever
lekocytosis
painful fissuring of skin
240
what are the two process of psoriasis
accelerated maturation of epidermal cells
excessive activity of inflammatory cells
241
how can we treat psoriasis
topical treatments
systemic treatments
phototherapy
242
what should we avoid w/ psoriasis
scrubbing
long exposure to water
trying to remove scales
