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Tissue Integrity Flashcards

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1
Q

What are the three layers of skin?

A

The skin has three distinct layers: the epidermis, the dermis, and the subcutaneous fatty layer that separates the skin from the underlying tissue (

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2
Q

What is the hypodermis?

A

Subcutaneous tissue.

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3
Q

What is Karatin?

A

Keratin is a fibrous, water-repellent protein that gives the epidermis its tough, protective quality.

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4
Q

What is Melanine?

A

Melanin forms a shield that protects the keratinocytes and the nerve endings in the dermis from the damaging effects of UV light. Melanocyte activity probably accounts for the difference in skin color in humans.

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5
Q

What should a nurse do when assessing a patient with darker skin tones? What specific considerations should he/she bear in mind?

A

Skin color can vary between ethnicities in conditions such as jaundice, pallor, and some rashes. When assessing patients with darker skin for alterations in oxygenation, it is important to examine the least pigmented areas, such as the buccal mucosa, lips, tongue, nail beds and palms of the hands, or soles of the feet (Yoost & Crawford, 2015). Pallor may present in darker skinned patients as a yellowish-brown tinge or an ashen gray color. Cyanosis may be more prevalent in the nail beds, lips, and buccal mucosa. Nurses should also take care not to confuse jaundice (a yellowish tinge) with the normal yellow pigmentation in the sclera of darker skinned patients. If jaundice is suspected, the palms of the hands and soles of the feet can also have yellow discoloration and should be assessed for this alteration. It is important for a baseline skin color to be established, and the examiner should not rely on skin tone alone.

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6
Q

What are two skin disorders that are more common in those with dark skin? Postinflammatory hyperpigmentation, vitiglio

A

Some skin disorders are more common among specific ethnic populations. For example, a major skin disorder among the African American population is postinflammatory hyperpigmentation, in which inflammatory processes affect either the synthesis or release of melanin as a result of injury, or following treatment from certain electromagnetic devices, such as ultrasound (Schwartz, 2016a). African Americans also experience a disproportionate amount of vitiligo, a loss of skin color in blotches or sections that occurs when the cells that produce melanin die or stop functioning (Purnell, 2013).

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7
Q

How would a nurse vary his/her approach when assessing for skin ulcerations in dark-skinned patients?

A

ndividual skin color should also be considered when evaluating pressure points for early signs of skin breakdown or when assessing an existing wound for color changes that could indicate healing or worsening of infection. Patients with lighter skin normally have an identifiable blanch response indicating adequate tissue perfusion, whereas patients with darker skin rarely have the same response to light skin pressure. This makes it difficult to determine when a darker skinned patient may be at risk for pressure ulcers. In patients with darker skin, pressure ulcer assessment should include the application of light pressure and observation for an area that is darker than the surrounding skin or that is taught, shiny, or indurated (Everett, Budescu, & Sommers, 2012).

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8
Q

What is melasma?

A

In addition, patients with darker skin tones are prone to a condition called melasma, in which too much melanin is produced. This condition causes discolored patches on areas of the face that receive excessive sun exposure, including the cheeks, the upper lip, the chin, and the forehead. Patients may be sensitive or embarrassed about these areas and seek to cover them with makeup or treat them with bleaching creams. These treatments may irritate the skin or negatively interact with topical medications (Lyford, 2016).

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9
Q

What characterizes infectious skin disorders?

A

Caused by bacterial, fungal, viral, or parasitic agents. Examples include impetigo (bacterial), athlete’s foot (fungal), chickenpox (viral), and lice (parasitic).

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10
Q

What characterizes inflammatory skin disorders?

A

Inflammatory
Caused by pathologies such as acne, burns, eczema, dermatitis, and psoriasis. Examples include atopic, seborrheic, and stasis dermatitis.

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11
Q

What characterizes neoplastic skin disorders?

A 
Neoplastic
Caused by skin cancers. Examples include squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. Melanoma is the most serious type of neoplasm. (For further discussion of skin cancer, see the exemplar on Skin Cancer in the module on Cellular Regulation.)
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12
Q

What are skin lesions?

A

Skin lesions are observable changes from normal skin structure.

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13
Q

What is the difference between primary and secondary skin lesions?

A

Primary lesions arise from previously healthy skin and include macules, patches, papules, nodules, tumors, vesicles, pustules, bullae, and wheals. Secondary lesions result from changes in primary lesions. They include crusts, scales, lichenification (thickening of the skin), scars, keloids, excoriation, fissures, erosion, and ulcers. It is important for the nurse to be able to identify and describe the primary and secondary skin lesions and understand their underlying cause and treatment.

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14
Q

What are primary skin lesions?

A

Primary lesions arise from previously healthy skin and include macules, patches, papules, nodules, tumors, vesicles, pustules, bullae, and wheals.

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15
Q

What are secondary skin lesions?

A

Secondary lesions result from changes in primary lesions. They include crusts, scales, lichenification (thickening of the skin), scars, keloids, excoriation, fissures, erosion, and ulcers.

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16
Q

What is a macule, patch

A

Flat, nonpalpable change in skin color. Macules are smaller than 1 cm, with a circumscribed border, and patches are larger than 1 cm and may have an irregular border.

Examples: Macules: freckles, measles, and petechiae. Patches: Mongolian spots, port-wine stains, vitiligo, and chloasma.

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17
Q

What are freckles, measles, and petechiae. Mongolian spots, port-wine stains, vitiligo, and chloasma EXAMPLES of?

A

patches or macules

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18
Q

What is a papule or plaque?

A

Papules, plaque are elevated, solid, palpable mass with circumscribed border. Papules are smaller than 0.5 cm; plaques are groups of papules that form lesions larger than 0.5 cm.

Examples: Papules: elevated moles, warts, and lichen planus. Plaques: psoriasis, actinic keratosis, and lichen planus.

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19
Q

What is the difference between papule and plaque?

A

Papules are smaller than 0.5 cm; plaques are groups of papules that form lesions larger than 0.5 cm.

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20
Q

Elevated moles, wars and lichen planus are examples of _____________ kind of skin lesions.

A

Elevated moles, wars and lichen planus are or can be examples of papule skin lesions.

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21
Q

psoriasis, actinic keratosis, and lichen planus can be examples of what type of skin lesions?

A

psoriasis, actinic keratosis, and lichen planus can be plaques. (Dependent on side)

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22
Q

What are nodules or tumors?

A

Elevated, solid, hard or soft palpable mass extending deeper into the dermis than a papule. Nodules have circumscribed borders and are 0.5–2 cm; tumors may have irregular borders and are larger than 2 cm.

Examples: Nodules: small lipoma, squamous cell carcinoma, fibroma, and intradermal nevi. Tumors: large lipoma, carcinoma, and hemangioma.

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23
Q

What is the difference between a nodule and a tumor?

A

Nodules have circumscribed borders and are 0.5–2 cm; tumors may have irregular borders and are larger than 2 cm.

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24
Q

What are examples of nodules?

A

Small lipoma, squamous cell carcinoma, fibroma and intradermal nevi are nodules.

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25
Q

What are examples of tumors of the skin?

A

Large lipoma, carcinoma and hemangioma are tumors of the skin.

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26
Q

What is a cyst?

A

A cyst is an elevated, encapsulated, fluid-filled or semi-sold mass originating in the subcutanous tissue or the dermis. Usally it is 1cm or larger.

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27
Q

What are examples of cysts?

A

Sebacous cysts and epidermoid cysts.

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28
Q

What are vesicles and bulla?

A

Elevated, fluid filled, round or oval shaped palapable mass with thin, translucent walls and circumscribed borders. Vesicles are smaller than 0.5 cm; bullae are larger than 0.5 cm.

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29
Q

What is the difference between vesicles and bulla?

A

Vesicles are smaller than 0.5 cm; bullae are larger than 0.5 cm.

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30
Q

What are examples of vesicles?

A

Vesicles: herpes simplex, zoster, early chickenpox, poison ivy, and small burn blisters.

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31
Q

What are examples of bullae?

A

Bullae: contact dermatitis, friction blisters, and large burn blisters.

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32
Q

What are wheals?

A

Wheales are elevated, often reddish area with irregular border caused by diffuse fluid in tissues rather than free fluid in a cavity, as in vesicles. Size varies.

Examples: Insect bites and hives (extensive wheals).

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33
Q

What are examples of Wheals?

A

Examples: Insect bites and hives (extensive wheals).

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34
Q

What are pustules?

A

Elevated, pus-filled vesicle or bulla with circumscribed border. Size varies.

Examples: Acne, impetigo, and carbuncles (large boils).

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35
Q

What are examples of pustules?

A

Examples of pustules are acne, impetigo, caruncles (large boils)

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36
Q

What are the types of primary skin lesions?

A

pustule, wheal, bulla, vesicle, cysts, nodule, tumor, papule, plaque, macule patch

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37
Q

Are the following primary or secondary skin lesions?

A

pustule, wheal, bulla, vesicle, cysts, nodule, tumor, papule, plaque, macule patch are all PRIMARY

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38
Q

What are examples of SECONDARY skin lesions?

A

atrophy, ulcers, erosion, fissure, lichenification, scales, crust, keloid, and scars

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39
Q

What is atrophy?

A

A translucent, dry, paperlike, sometimes wrinkled skin surface resulting from thinning or wasting of the skin due to loss of collagen and elastin.

Examples: Striae and aged skin.

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40
Q

What is erosion?

A

EROSION: Wearing away of the superficial epidermis causing a moist, shallow depression. Because erosions do not extend into the dermis, they heal without scarring.

Examples: Scratch marks and ruptured vesicles.

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41
Q

Scratch marks and ruptured vesicles are examples of what kind of lesions? Are they secondary or primary?

A

Scratch marks and ruptured vesicles are examples of secondary lesions called erosion.

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42
Q

What is lichentification?

A

Lichenification is rough, thickened, hardened area of epidermis resulting from chronic irritation such as scratching or rubbing.

Examples: Chronic dermatitis.

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43
Q

What kind of lesion is chronic dermatitis? Is it primary or secondary?

A

Chronic dermititis is an example of a secondary lesion called lichenification. It results from chronic irritation from scratching or rubbing.

44
Q

What are scales?

A

Scales are secondary lesions. Shedding flakes of greasy, keratinized skin tissue. Color may be white, gray, or silver. Texture may vary from fine to thick.

Examples: Dry skin, dandruff, psoriasis, and eczema.

45
Q

What type of lesion is eczema an example of? Is it primary or secondary?

A

Eczema along with dry skin, dandruff, and psoriasis are secondary lesions. They are called SCALES.

46
Q

What are CRUSTS?

A

The secondary lesions called crusts: Dry blood, serum, or pus left on the skin surface when vesicles or pustules burst. Crusts can be red-brown, orange, or yellow. Large crusts that adhere to the skin surface are called scabs.

Examples: Eczema, impetigo, herpes, or scabs following abrasion.

47
Q

What type of skin lesions are ulcers? Are they primary or secondary?

A

Ulcers, secondary skin lesions are deep, irregularly shaped area of skin loss extending into the dermis or subcutaneous tissue. Ulcers may bleed or leave a scar.

Examples: Decubitus ulcers (pressure sores), stasis ulcers, and chancres.

48
Q

What are chancres?

A

The secondary skin lesion called ulcers.

49
Q

What type of skin lesions are fissures? Are they primary or secondary?

A

The secondary lesions called scars are linear crack with sharp edges, extending into the dermis.

Examples: Cracks at the corners of the mouth or on the hands and athlete’s foot.

50
Q

What type of lesions are scars? Are they primary or secondary?

A

The secondary lesions called scars are flat, irregular area of connective tissue left after a lesion or wound has healed. New scars may be red or purple; older scars may be silvery or white.

Examples: Healed surgical wound or injury and healed acne.

51
Q

What type of lesions are keloids? Are they primary or secondary?

A

The secondary lesions called KELOIDS are elevated, irregular, darkened area of excess scar tissue caused by excessive collagen formation during healing. Keloids extend beyond the site of the original injury. There is a higher incidence in individuals of African descent.

Examples: Keloid from ear piercing or surgery.

52
Q

What skin integrity issues should nurses be aware are related to immunity?

A

Immunity Impaired tissue integrity triggers immune responses; immune responses can also lead to impaired tissue integrity.
Assess for rash and inflammation.

Be alert to topical and latex allergies that could worsen symptoms.

Be alert to abscess formation.

Anticipate: Use of aspirin, antipyretics, and cold packs

53
Q

A patient has an autoimmune condition. What skin integrity issues should the nurse be alert for?

A

Be alert to topical and latex allergies that could worsen symptoms.

Be alert to abscess formation.

54
Q

When a patient as a latex allergy or other immune associated tissue integrity issue, what interventions should a nurse anticipate?

A

Anticipate: Use of aspirin, antipyretics, and cold pack

55
Q

What skin integrity issues are associated with infection?

A

Infection Microorganisms grow on the skin, and breaks in the skin serve as portals for these microorganisms to enter the body.
Assess for complications of infectious disease.

Exercise infection control measures, and use personal protective equipment.

Anticipate: Blood cultures, antibiotics, and isolation practices

56
Q

When infection is involved with integrity of skin issues, what should the nurse assess for?

A

Assess for complications of infectious disease.

Exercise infection control measures, and use personal protective equipment.

57
Q

What interventions should a nurse anticipate when there are skin infections?

A

Anticipate: Blood cultures, antibiotics, and isolation practices

58
Q

How might mobility impact skin integrity?

A

impaired mobility may lead to skin breakdown and the development of pressure ulcers.
Assess for skin breakdown at least once per shift; pay special attention to bony prominences.

Anticipate: Repositioning, wound care, comfort measures, hygiene care, and infection control measures

Educate patient about how to care for impaired skin.

59
Q

What skin integrity issues should a nurse assess for when there is a lack of mobility?

A

Assess for skin breakdown at least once per shift; pay special attention to bony prominences.

60
Q

What interventions should a nurse anticipate when there are skin integrity issues related to mobility? How should he/she educate the patient?

A

Anticipate: Repositioning, wound care, comfort measures, hygiene care, and infection control measures. Educate patient about how to care for impaired skin.

61
Q

What skin integrity issues are associated with nutrition?

A

Adequate nutritional intake is essential for the maintenance of tissue integrity, healing, and recovery.
Assess nutritional intake.

Identify signs of poor nutritional status (e.g., pale, dry skin; subcutaneous tissue loss).

Anticipate: Laboratory testing (CBC, transferrin, serum albumin and serum electrolyte values; protein supplements)

62
Q

What nursing interventions regarding skin are associated with inadequate nutrition? What testing and interventions should a nurse antipipate?

A

Identify signs of poor nutritional status (e.g., pale, dry skin; subcutaneous tissue loss).

Anticipate: Laboratory testing (CBC, transferrin, serum albumin and serum electrolyte values; protein supplements)

63
Q

How does perfusion impact tissue integrity?

A

Perfusion: ↓ Blood flow to tissues →↓ oxygen and nutrient delivery. If prolonged, damage or death may occur.
Assess for signs of decreased tissue perfusion (i.e., changes in skin temperature, color, characteristics or sensation; or weak or absent pulses at least once per shift).

Identify conditions or contributing factors, such as position, mobility level, or constrictive devices that place the patient at risk for impaired tissue perfusion.

Anticipate: Repositioning, wound care

64
Q

What tissue integrity issues should a nurse assess/identify for when there are issues of perfusion?

A

Assess for signs of decreased tissue perfusion (i.e., changes in skin temperature, color, characteristics or sensation; or weak or absent pulses at least once per shift).

Identify conditions or contributing factors, such as position, mobility level, or constrictive devices that place the patient at risk for impaired tissue perfusion.

65
Q

What interventions should a nurse anticipate are associated with lack of perfusion in regards to tissue integrity?

A

Assess for signs of decreased tissue perfusion (i.e., changes in skin temperature, color, characteristics or sensation; or weak or absent pulses at least once per shift).

Identify conditions or contributing factors, such as position, mobility level, or constrictive devices that place the patient at risk for impaired tissue perfusion.

66
Q

How would issues of safety impact tissue integrity? What should a nurse assess? What interventions should he/she expect?

A

Impaired safety may lead to alterations in tissue integrity.
Assess for barriers to safety.

Identify patients at increased risk for alterations in safety.

Anticipate: Use of mechanical devices for patient transfer, bed alarms

Educate the patient on ways to promote safety in the environment.

67
Q

What issues pertaining to self are associated with skin integrity? What should a nurse assess for? What interventions should be anticipated?

A

Alterations in tissue integrity can affect perceptions of self in relation to body image and functional ability.
Perform a psychosocial assessment.

Anticipate: Cognitive–behavioral therapy; antidepressants, anxiolytics

68
Q

What layer covers and protects the fetus/newborn?

A

vernix caseosa

69
Q

What is the vernix caseoa?

A

A substance of sebum, shed cells and fluid that covers and protects the newborn.

70
Q

What is milia?

A

tiny, filmy white bumps that may be present on newborn skin

71
Q

Impetigo

A

Impetigo: a superficial skin infection common in children; caused by Streptococci Staphylococci. Ruptured vesicles develop a honey-colored crust.

Risk factors: poor hygiene, moist environment, chronic nasopharyngeal infection

72
Q

Folliculitis

A

Infection of hair follicles. Characterized by pruritis or irritation.

73
Q

Furuncles and carbuncles

A

Furuncles or boils are caused by staphylococcal bacteria and involve a hair follicle and surrounding tissue. MRSA is a common cause.

Carbuncles are clusters of furuncles connected beneath the skin that cause deeper pus formation and scaring.

74
Q

Paronchyia

A

Paronchyia is a soft tissue infection around the fingernail; it can be acute or chronic. Acute are caused by staphylococci; chronic infections are usually caused by fungus.

This is the most common hand infection in the US. It begins as cellulitis and can progress to painful, purulent abscesses. In more advanced cases, pus can colllect under the skin near the nailbed.

75
Q

Candidiasis

A

thrush; most common in skin-folds; papules and pustules may be present around teh primary patches of infection

76
Q

Tinea capitis

A

fungus caused infection; tinea capitis also known as scalp ringworm; causes gradual appearance of round patches/scales/alopecia

77
Q

Tinea corporus

A

Body ringworm is a fungal infection of the face, trunk, and extremities. Causes pink to red ring-shaped patches and patches with raised scaly borders and a clear center.

78
Q

Tinea cruris

A

jock itch/tinea cruris

79
Q

tinea onychomycosis or tinea ungulum can happen in 10

A

A nail fungus causing thickened, brittle, crumbly, or ragged nails. Usually, the problems caused by this condition are cosmetic. The main symptoms are changes in the appearance of nails. Rarely, the condition causes pain or a slightly foul odor.
Treatments include oral antifungal drugs, medicated nail polish or cream, or nail removal.

80
Q

tinea pedis

A

athletes foot

81
Q

tinea versicolor

A

tinea versicolor caused by yeast Malassezia fufur; more common in young adults

82
Q

urticaria

A

urticaria consists of erythematous, raised, pruritic, slightly elevated areas; generally caused by allergies.

83
Q

lentigo

A

Lentigo: A type of freckle that is a small tan, brown, or black spot which tends to be darker than the usual (ephelis-type) freckle and which do not fade in the winter. This kind of spot is referred to as lentigo simplex.

84
Q

Acanthosis nigricans

A

Acanthosis nigricans is a skin condition that causes a dark discoloration in body folds and creases. It typically affects the armpits, groin and neck. Acanthosis nigricans is a skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened.

85
Q

What does this cause in aging?

Epidermis: ↓ thickness and miotic activity

A

Skin more fragile and at greater risk for tears or injury
Delayed wound healing
Hyperkeratosis and skin cancer more evident in sun-exposed areas

86
Q

What does this cause in aging?

Epidermis: ↑ permeability, ↓ Langerhans cells

A

Increased risk of reactions to irritants

Decreased inflammatory response

87
Q

What does this cause in aging?

Epidermis: ↓ number of active melanocytes

A

Increased susceptibility to skin damage from sun exposure

88
Q

What does this cause in aging?

Epidermis: hyperplasia of melanocytes, especially in sun-exposed areas

A

Small areas of hyperpigmentation (liver spots) and hypopigmentation (age spots), especially on the hands

89
Q

What does this cause in aging?

Epidermis: ↓ vitamin D production

A

Increased risk of osteomalacia and osteoporosis

90
Q

What does this cause in aging?

Epidermis: flattened dermal–epidermal junction

A

Increased risk of skin tears, purpura, and pressure ulcers

91
Q

What does this cause in aging?

Dermis: ↓ perfusion

A

Greater susceptibility to dry skin

Decreased sensation (pain, touch, temperature, and peripheral vibration)

Increased risk of injury

92
Q

What does this cause in aging?

Dermis: ↓ vasomotor response

A

Greater risk of hyperthermia and hypothermia

93
Q

What does this cause in aging?

Dermis: elastic fiber degeneration

A

Decreased tone and elasticity, with wrinkle formation

94
Q

What does this cause in aging?

Dermis: proliferation of capillaries

A

Cherry hemangiomas common

95
Q

What does this cause in aging?

Subcutaneous skin layer: thinning

A

Greater risk of hypothermia

Increased risk of pressure ulcers

96
Q

What does this cause in aging?

Subcutaneous skin layer: redistribution of adipose tissue

A 
Cellulite formation
Bags over and under the eyes
Double chin formation
Increase in abdominal fat
Sagging of breasts
Skin slower to return to normal when pinched (tenting)
97
Q

What does this cause in aging?

Glands: T eccrine and apocrine activity

A

Dry skin common

Absent perspiration

98
Q

What is exudate?

A

Material such as fluid and dead phagocytic cells that has escaped from blood vessels during the inflammatory process.

99
Q

What is serous exudate

A

Serous exudate generally accompanies mild inflammation and presents as clear or straw colored.

Thin and watery, with few cells: blister burn are examples.

100
Q

What is purulent exudate?

A

Purulent exudate is milky; it is pus and the process of creating the suppuration

101
Q

What is supparation?

A

The process of the creation of pus or purulent exudate.

102
Q

What are pyogenic bacteria?

A

Pyogenic bacteria are bacteria that create purulent exudate?

103
Q

What is sanguineous exudate?

A

Sanguineous exudate is also called hemorrhagic eudate. It has RBC’s. Bright red indicates fresh bleeding; darker is older.

104
Q

What is serosanguieous exudate?

A

Clear and blood tinged drainage commonly seen in surgical incisions.

105
Q

A nurse sees drainage that has pus and blood. What is it called?

A

Purosanguineous discharge can be seen in a new wound that is infected.

Nursing 110 (8 decks)

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