TOPIC 14 - Integumentary : diseases of skin, eye, and ear Flashcards
skin cancer major causes
Overexposure to sunlight is the major cause of skin cancer, although other factors are associated.
most common skin cancer types
actinic or solar keratosis, squamous cell carcinoma, basal cell carcinoma, and melanoma. These are involved in cellular regulation of growth.
what is a nevus
a mole, is a benign growth of the pigment-forming cells classified according to their location within the layers of the skin.
what treatment is being tried to treat metastatic melanoma
experimental therapy
who is skin cancer likely to develop in
light-skinned races
individuals older than 60 years of age
outdoor workers
higher altitudes
ABCDE
asymmetry
border
color
diameter
evolving
how often should TSSE be performed
monthly
surgeries for skin cancer
Cryosurgery
Curettage and electrodesiccation
Excision
Mohs’ surgery
Wide excision
nonsurgical therapy for skin cancer
radiation
medications
malignant melanoma
a tumor arising in melanocytes, the cells producing melanin. Melanoma causes the majority of skin cancer deaths.
where can melanoma occur
in the eyes, ears, gastrointestinal tract, and oral and genital mucous membranes
what is it called when melanoma begins in the skin
cutaneous melanoma
characteristics of melanoma
can be Irregular color, surface, and border Variegated color, including red, white, blue, black, gray, brown, *Flat or elevated. Eroded or ulcerated, Often <1 cm in size
most common sites of melanoma in male vs female
Most common sites in males are trunk, head and neck. In females are legs, then back metastasize to any organ, including the brain and heart.
treatment of melanoma
Wide surgical excision and possible sentinel lymph node evaluation
Possible use of adjuvant therapy after surgery if lesion >1.5 mm in depth
Correlation between survival rate and depth of invasion
Poor prognosis unless diagnosed and treated early
Spreading by local extension, regional lymphatic vessels, and bloodstream
psoriasis
Sharply demarcated silvery scaling plaques on reddish colored skin commonly on the scalp, elbows, knees, palms, soles, and fingernails
Itching, burning, pain
Localized or general, intermittent or continuous
topical treatments for psoriasis
Corticosteroids, tar, salicylic acid,
Intralesional injection of corticosteroids for chronic plaques
systemic treatments for psoriasis
Natural or artificial UVB. PUVA (UVA with topical or systemic photosensitizer
Antimetabolite (methotrexate)
immunosuppressant (cyclosporine)
biologic therapy (adalimumab [Humira], etanercept [Enbrel], infliximab [Remicade]
shingles
activated varicella zoster virus
Potentially contagious to anyone who has not had varicella or who is immunosuppressed
clinical manifestations
Linear distribution along a dermatome of grouped vesicles and pustules on erythematous base resembling chickenpox
Usually unilateral on trunk, face, and lumbosacral areas
Burning, pain, and neuralgia preceding outbreak
Mild to severe pain during outbreak
topical treatment for herpes
Wet compresses, silver sulfadiazine (Silvadene) to ruptured vesicles
systemic treatment for herpes
Antiviral agents within 72 hr to prevent postherpetic neuralgia
Analgesia. Mild sedation at bedtime
Gabapentin (Neurontin) to treat postherpetic neuralgia
Usually heals without complications, but scarring and postherpetic neuralgia possible
Vaccine (Zostavax) to prevent shingles for adults ≥50 yr
cataract
Opacity within the lens in the eye of the patient
Cataract may be in one or both eyes
If in both eyes, one eye may affect the person’s vision more than the other
causes of cataracts
Age
Blunt or penetrating trauma
Congenital factors such as maternal rubella
Radiation exposure or ultraviolet (UV) light (sunlight) exposure
Certain drugs such as systemic corticosteroids or long-term topical corticosteroids
Ocular inflammation
signs and symptoms of cataracts
Decrease in vision
Abnormal color perception
Glare (may be significantly worse at night when the pupil dilates)
Visual decline is gradual, but the rate ofcataractdevelopment varies from patient to patient.
nonsurgical therapy for cataracts
Change in glasses prescription
Strong reading glasses or magnifiers
Increased lighting
Lifestyle adjustment
preoperative care for cataracts surgery
Mydriatic, cycloplegic agents
Nonsteroidal anti-inflammatory drugs
Topical antibiotics
Antianxiety medications
surgery for cataracts involves
*Removal of lens
*Phacoemulsification
*Extracapsular extraction
*Correction of surgical aphakia
*Intraocular lens implantation (most frequent type of correction)
*Contact lenses
postoperative care for cataracts surgery
Topical antibiotic
Topical corticosteroid or other anti-inflammatory agent
Mild analgesia if necessary
Eye patch or shield and activity as prescribed by patient’s surgeon
Activity restriction: Activities that increase IOP: bending, stooping, coughing, or lifting
education for patients after eye surgery
Proper hygiene and eye care techniques to ensure that medications, dressings, and/or surgical wound is not contaminated during eye care
How to monitor pain, take pain medication, and report pain not relieved by medication
Importance of continued follow-up as recommended to maximize potential visual outcomes
Signs and symptoms of infection and when and how to report these to allow for early recognition and treatment of possible infection
Importance of complying with postoperative restrictions on head positioning, bending, coughing, and Valsalva maneuver to optimize visual outcomes and prevent increased intraocular pressure
How to instill eye medications using aseptic techniques and adherence with prescribed eye medication routine to prevent infection
two types of macular degeneration
age related or wet
risk factors for macular degeneration
genetics, family history, white ethnicity, chronic inflammatory conditions, smoking, hypertension
which type of macular degeneration is most common
age related
dry macular degeneration
90% of all cases
close vision tasks are becoming more difficult.
macular cells start to atrophy
slowly progressive and painless vision loss.
wet macular degeneration
more severe form
more rapid onset
development of abnormal blood vessels in or near the macula
etiology of macular degeneration
Related to retinal aging
Genetic factors
Family history
Gene responsible
Long-term exposure to UV light
Hyperopia
cigarette smoking
light-colored eyes
Nutritional factors: Vit C, E, and zine decreases progression
what vitamin supplements decrease the progression of advanced macular degeneration
vitamin C, vitamin E, beta-carotene, and zinc
manifestations of macular degeneration
Blurred and darkened vision,scotomas(blind spots in the visual field),
Distortion of vision.
treatment for macular degeneration
Limited treatment
Medications that are injected directly into the vitreous cavity.
“Cold” laser to excite the dye.
People at risk for developing advanced AMD should consider supplements of vitamins and minerals (in consultation with their health care provider).
retinal detachment
Aretinal detachmentis a separation of the sensory retina with fluid accumulation between the two layers.
causes of retinal detachment
Increasing age
Severe myopia
Eye trauma
Cataract surgery
Family or personal history of retinal detachment
signs symptoms of retinal detachment
Patients with a detaching retina describe symptoms that includephotopsia(light flashes); floaters; and a “cobweb,” “hairnet,” or ring in the field of vision. Once the retina has detached, the patient describes a painless loss of peripheral or central vision, “like a curtain” coming across the field of vision.
medical treatment for retinal detachment
Laser Photocoagulation & Cryopexy
Scleral Buckling
Pneumatic retinopexy
Vitrectomy
glaucoma
Increased intraocular pressure, optic nerve atrophy, resulting in peripheral visual field losses
eye drop medications
B-Adrenergic blockers, a-Andrergic Agonists
normal IOP vs acute angle closure glaucoma vs open angle glaucoma
normal is 10 to 21 mm Hg
In open-angle glaucoma, IOP is usually between 22 and 32 mm Hg.
In acute angle-closure glaucoma, IOP may be over 50 mm Hg.
POAG progression
primary open angle glaucoma develops slowly and without symptoms of pain or pressure. The patient usually does not notice the gradual visual field loss until peripheral vision has been severely compromised.Eventually the patient with untreated glaucoma has “tunnel vision” in which only a small center field can be seen, and all peripheral vision is absent.
acute angle closure glaucoma symptoms
causes definite symptoms, including sudden, excruciating pain in or around the eye. This is often accompanied by nausea and vomiting. Visual symptoms include seeing colored halos around lights, blurred vision, and ocular redness.
chronic open angle glaucoma drug therapy
*β-Adrenergic blockers
*α-Adrenergic agonists
*Cholinergic agents (miotics)
*Carbonic anhydrase inhibitors
acute angle closure glaucoma therapy
*Topical cholinergic agent
*Hyperosmotic agent
*Laser peripheral iridotomy
*Surgical iridectomy
external otitis
Inflammation or infection of the epithelium of the auricle and ear canal
causes of external otitis
Swimmer’s ear: due to chemical and contaminated water
Using a sharp object in ear
Bacteria: Pseudomonas aeruginosa
Fungi: Candida Albicans and Aspergillus
symptoms of external otitis
Pain is the first sign
Discomfort may be during chewing, moving the auricle, pressing on the tragus
May have serosanguineous or purulent drainage
Fever
treatment of external otitis
Exam
C & S may be done
Moist heat, mild analgesics, and topical anesthetic drops to control pain
Antibiotics and corticosteroids
when will patients see improvement with antibiotics
within 48 hours
still need to complete course (7-10 days)
acute otitis media
infection of the tympanum, ossicles, and space of the middle ear
causes of acute otitis media
Swelling of the auditory tube from colds or allergies can trap bacteria
Pressure from the inflammation pushes on the TM, causing it to become red, bulging, and painful.
Infection can be due to viruses or bacteria.
otitis media with effusion
an inflammation of the middle ear with a collection of fluid in the middle ear space.
chronic otitis media and mastoiditis
Repeated attacks of otitis media may lead to chronic otitis media
symptoms of chronic otitis media and mastoiditis
purulent exudate and inflammation that can involve the ossicles, auditory tube, and mastoid bone
Painless, hearing loss, nausea, and episodes of dizziness can occur.
Hearing loss is a complication from inflammatory destruction of the ossicles, a TM perforation, or accumulation of fluid in the middle ear space
treatment for chronic otitis media and mastoiditis
IV or oral antibiotics
Tympanoplasty (myringoplasty)involves reconstruction of the TM and/or the ossicles
post op care for Tympanoplasty
Impaired hearing is expected
A cotton ball dressing is used for the incision
Instruct the patient to change the cotton packing as needed.
Ménière’s diseasesymptoms
episodic vertigo
Tinnitus
fluctuating sensorineural hearing loss
aural fullness.
when do symptoms usually begin for Ménière’s disease
age 30-60
possible causes of Ménière’s disease
excessive accumulation of endolymph in the membranous labyrinth
symptoms during attacks of Ménière’s disease
Attacks may be preceded by a sense of fullness in the ear, increasing tinnitus, and muffled hearing.
The patient may experience the feeling of being pulled to the ground (“drop attacks”).
Some patients report that they feel like they are whirling in space.
Attacks may last hours or days and may occur several times a year. The clinical course of the disease is highly variable.
diagnostic tests for Ménière’s disease
Hearing (Audiometric) Tests
Vestibular Tests for balance
Inner ear assessment: electronystagmography, glycerol test
acute nursing interventions for Ménière’s disease
Bed rest
Quiet dark room
Avoid sudden head movements and position changes
Avoid fluorescent lights & flashing lights
Sedation
Ambulate with assistance only, not independent
Call light within reach
Side rails up
Fall precautions
Monitor Input & Output
Antiemetics – Prochlorperazine
Antivertigo – Meclizine
Verbal & tactile reassurance and support
