T1 - Care of Patient with Skin Probs (Josh) Flashcards
Which type of past medical history can lead to Xerosis (dry skin)?
Liver Disease
Renal Disease
Autoimmune Disease
What are some suggestions to prevent Xerosis?
Adequate hydration
Fewer hot showers
Moisturizer cream
Milder soaps
Humidifier in winter time
— is dry skin.
— is itching skin.
Xerosis
Pruritis
What are the different phases of wound healing?
Inflammatory Phase (3-5 days)
Proliferative Phase (day 4 - 2-4 wks)
Maturation Phase (3 wks - year or more)
Which phase of wound healing?
Begins at time of injury or cell death and lasts 3-5 days?
Inflammatory Phase
Phases of Wound Healing:
What happens in inflammatory phase?
Immediate response is VASOCONSTRICTION and clot formation
After 10 mins, VASODILATION ooccurs with increased capillary permeability and leakage of plasma (and plasma proteins) into surrounding tissue
WBCs (esp. microphages) migrate to wound
Phases of Wound Healing:
What are the clinical manifestations of the Inflammatory Phase?
local edema
pain
erythema
warmth
Phases of Wound Healing:
What happens in the Proliferative Phase?
Fibrin strands form a scaffold or framework
Fibroblast cells migrate into wound, attach to framework, divide, and stimulate the secretion of collagen
Collagen builds tough and inflexible scar tissue
Capillaries in areas surrounding the wound form buds that grow into new vessels
Capillary buds and Collagen deposits form the granulation tissue in the wound that contracts
Epithelial cells grow over the granulation tissue bed
Phases of Wound Healing:
What happens in the Maturation Phase?
Collagen is reorganized to provide greater tensile strength
Scar tissue gradually becomes THINNER and PALER in color
Mature scar is firm and inelastic when palpated
Wound Intention:
Which type of wound is well-approximated (ex: like an incision that is sewn up)?
First Intention
Wound Intention:
Which type of wound has a cavity-like defect (ie: loss of tissue)?
Second Intention
Wound Intention:
Which type of intention requires that healing come from the bottom up (ie: inside out)?
Second Intention
Wound Intention:
Which type of intention is intentionally left open for a time to irrigate and prevent infection from occurring?
Third Intention
Wound Intention:
Which type has loss of tissue?
Which type has no loss of tissue?
Second Intention = tissue loss (ie: cavity)
First and Third Intention = no tissue loss
Mechanisms of Wound Healing:
When would re-epithelialization occur?
2nd Phase of Wound Healing (Proliferative Phase)
Mechanisms of Wound Healing?
In — —, re-epithelialization occurs.
In — —, granulation occurs.
Partial-Thickness Wounds
Full Thickness Wounds
Explain the Mechanism of Wound Healing in a Full Thickness Wound?
Granulation occurs
Contraction (edging of wounds lean in towards each other) occurs
T or F: A Full Thickness Wound will most likely NOT close on its own.
True
likely will require a skin graft
Pressure Ulcer Staging:
How many stages?
4
Stage 1 – skin NOT broken
Stage 2 – skin broken
Stage 3 – tissue exposed
Stage 4 – bone exposed
***Unstageable – eschar that covers bottom so that we can’t judge depth
Which tool is used to assess for Pressure Ulcers?
Braden Score
15-16 = mild risk
12-14 = moderate risk
less than 11 = severe risk
— is a scaling disorder with underlying dermal inflammation.
Psoriasis
What is the clinical presentation of Psoriasis?
Plaque with silver color
What are risk factors for Psoriasis?
Infections
Skin Trauma, Recent Surgery
Genetics
Stress
Seasons (warm weather IMPROVES symptoms)
Hormones (puberty or menopause)
Meds
- lithium
- beta blockers
- antimalarials
- indocin
What are the three types of Psoriasis?
Psoriasis Vulgaris (most common)
Exfoliative Psoriasis
Palmoplantar Pustulosis (PPP)
Psoriasis:
Which type will NOT be silver in appearance?
Exfoliative Psorasis
Palmoplantar Pustulosis (PPP)
Psoriasis:
Which type is most common and is silver in appearance?
Which type is not very common and is eruptive and inflammatory?
Which type is not very common and has pustules on palms of hands or soles of feet?
Psoriasis Vulgaris
Exfoliative Psoriasis
Palmoplantar Pustulosis (PPP)
Meds for Psoriasis:
What are the corticosteroids and what should we know?
triamcinolone acetonide
- observe for thinning skin, striae, or hypopigmentation
- avoid on face or in skin folds
- take periodic med vacations
Meds for Psoriasis:
What are the Tar Preparations and what should we know?
coal tar and anthralin
- used for moderate psoriasis
- short wave ultraviolet B light is often used in conjuction (remove creams first)
- may stain skin and harir
- may stimulate growth of skin cancers
- Antralin can not stay on longer than 2 hrs or will cause chemical burns
- SMELLS BAD
Meds for Psoriasis:
Because tar prep meds stink, what should we advise?
apply at night and cover areas of body with old pajamas, gloves, and socks
Meds for Psoriasis:
Why are most of these meds a problem if your pregnant?
most work by suppressing cell division
Meds for Psoriasis:
What is calcipotriene and what should we know?
synthetic form of Vit D
- not for older adults and breastfeeding moms because it reduces accelerated development of epidermal cells
- monitor for HYPERCALCEMIA (symptoms are muscle weakness, fatigue, and anorexia)
Meds for Psoriasis:
What is tazarotene and what should we know?
derivative of Vit A
- TERATOGENIC
Meds for Psoriasis:
What should we teach client about Calcipotiene and Tazarotene?
- burns when you put it on
- report muscle weakness, fatigue, or anorexia (hypercalcemia is a side effect of tazarotene)
- use sunscreen and avoid sun exposure
- obtain a pregnancy test before taking
Meds for Psoriasis:
Which treatments can be used in conjunction with Ultraviolet B Light Therapy?
Tar Therapy and Anthralin
Meds for Psoriasis:
What is PUVA Therapy?
Photochemotherapy and UV Light
- a psoralen photosensitizing med (methoxsalen) is administered followed by a long-wave UV A ligh tto decrease proliferation of epidermal cellls
- psoralen is given beforehand
- given 2-3 times a week (but NOT on consecutive days)
- eye protection during and 24 hrs afterwards
Meds for Psoriasis:
What are the different types of Systemic Therapy?
Cyclosporine Adalimumab Alefacept Etanercept Methotrexate
— — is a chronic inflammation and scaling of scalp , face, underarms and chest.
Seborrheic Dermatitis
Seborrheic Dermatitis:
What should we teach client?
Keen skin dry
Avoid overheating and sweating
Do NOT scratch lesions
Seborrheic Dermatitis:
What are the Clinical Manifestations?
Chronic inflammation and scaling of scalp, face, underarms, chest, and sacral region
Secondary candida infection may devleop in body folds and creases and requires treatment with KETOCONAZOLE
Waxy, flaky-appearing plaques and scales
Skin lesions primarily on the oily areas of the body (scalp, forehead, nose, axilla, groin)
Seborrheic Dermatitis:
Treatment
Topical Corticosteroids
- avoid getting in eyes or you could get glaucoma or cataracts
- avoid in skin folds
Antiseborrheic Shampoos
- use at least 3 x’s a week
- leave on for 2-3 mins
Types of Skin Cancer:
Name the 4 types we talked about.
Actinic Keratoses
Squamous Cell Carcinomas
Basal Cell Carcinomas
Melanomas
Types of Skin Cancer:
Which type is scaly and commonly called pre-cancerous?
Actinic Keratoses
Types of Skin Cancer:
Which type is rough, scaly lesion with central ulerceration and crusting?
Squamous Cell Carcinomas
Types of Skin Cancer:
Which type is small, waxy nodule with superficial blood vessels and well-defined borders?
Basal Cell Carcinomas
Types of Skin Cancer:
Which type is a new mole or an existing mole?
Melanomas
Types of Skin Cancer:
What can look like skin cancer but is NOT? Has the rough look of a lesion.
Seborrheic Keratosis
Skin Cancer:
How do we assess?
ABCDE
Assymetric Borders not well-defined Colors (multi-colored) Diameter is greater than 6 mm Evolving
Skin Cancer:
What are some risk factors?
Sun Damage
Lighter Skin
Age
High Altitudes
Lower Latitudes
Arsenic Exposure
Family History
Skin Cancer:
What is TSSE?
Thorough Self Skin Examination
***teach clients to do this regularly
Skin Cancer:
What are ways we can treat with surgery?
Cryosurgery
Curettage
Excision, biopsy
Moh’s Surgery (layer after layer removal)
Wide Excision
Skin Infections fall under three categories. What are they?
Bacterial
Viral
Fungal
Skin Infections:
What is Folliculitis?
What is presentation?
Which type is it?
infection of hair follicles
looks like small bumps on skin
Bacterial Skin Infection
Skin Infections:
What is Furuncles?
What is presentation?
Which type is it?
like, folliculitis, it is an infection of hair follicles
A painful, pus-filled bump under the skin caused by infected, inflamed hair follicles. (MORE CENTRALLY LOCATED)
Bacterial Skin Infection
Skin Infections:
What are the 4 types of Bacterial Infections we talked about?
Folliculitis
Furuncles
Cellulitis
MRSA
Skin Infections:
What are the Viral Skin Infections we mentioned?
Herpes Simplex, Type 1, Type 2 (genital)
Herpes Zoster (chicken pox, shingles)
Skin Infections:
Which type of Herpes Simplex is genital?
Type 2
Skin Infections:
With Herpes Zoster, — is more common in kids while — would be seen in adults.
Chickenpox
Shingles
Skin Infections:
What are the Fungal Infections we talked about?
Tinea Pedis
Tinea Cruris
Tinea Capitis
Tinea Cororis
Candida Albacans (yeast infection)
Skin Infections:
What should we monitor with Candida Albacans (yeast infection)?
skin folds (yeast like dark, moist places)
Acute Skin Disorders:
Which two did we mention?
Toxic Epidermal Necrolysis (TEN)
Stevens-Johnson Syndrome
Acute Skin Disorders:
What is TEN?
Toxic Epidermal Necrolysis
- rare drug reaction
- diffuse, large blister formation
Acute Skin Disorders:
What is Stevens Johnson Syndrome?
drug reaction, similar to TEN
mix of vesicles, erosions, and crusts
can be mild or severe
***PHENYTOIN (dilantin) can cause
What is the major risk factor with Cutaneous Anthrax?
contact with an infected animal
What is the clinical presentation of Cutaneous Antrax?
Raised vesicle on arms or legs
Center of vesicle sinks and becomes hemorrhagic
Necrosis and ulceration forms
How would Cutaneous Anthrax be diagnosed?
Appearance
Culture of site
Anthrax antibodies in blood
What is typical treatment for Cutaneous Anthrax?
Oral Antibiotics for 60 DAYS!!!
- Ciprofloxacin
- Doxycycline
