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Internal Medicine > Week 12- Integumentary System > Flashcards

Week 12- Integumentary System Flashcards

1
Q

True or false: The skin is not the largest organ in the body

A

False

(it is lol)

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2
Q

The skin constitutes _____% of the body weight

A

15-20

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3
Q

The skin consists of ____ layers

A

3

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4
Q

Primary function of the skin

A

To protect underlying structures from external injury and harmful substances

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5
Q

Other functions of the skin

A

-Holding the organs together
-Sensory perception
-Contributing to fluid balance
-Controlling temperature
-Absorbing UV radiation
-Metabolizing vitamin D
-Synthesizing epidermal lipids

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6
Q

Two types of lesions

A

Primary and secondary

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7
Q

First lesion to appear on the skin and has a visually recognizable structure

A

Primary lesion

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8
Q

Macule, papule, plaque, nodule, tumor, wheal, vesicle, pustule

A

Primary lesion

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9
Q

When changes occur in a primary lesion

A

Secondary lesion

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10
Q

Scale, crust, thickening, erosion, ulcer, scar, excoriation, fissure, atrophy

A

Secondary lesion

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11
Q

True or false: Many factors affect the progression of a skin lesion to an open wound and the individual’s subsequent ability to heal

A

True

(ex: tobacco use, psychosocial status, and nutritional status)

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12
Q

Lab values to understand for skin lesions

A

-Prealbumin (indicate nutritional status)
-Glucose
-Hemoglobin
-Hematocrit (monitor wound healing)

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13
Q

True or false: The skin does not undergo numerous changes throughout the life span

A

False

(it does)

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14
Q

Changes the skin undergoes throughout the life span

A

-Gray hair, balding, loss of secondary sexual hair, increased facial hair
-Lax skin, vascular changes (e.g., decreased elasticity of blood vessel walls, angiomas), dermal or epidermal degenerative changes, and wrinkling

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15
Q

The most obvious changes occur first during __________ and again during older ___________

A

-Puberty
-Adulthood

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16
Q

True or false: Women may experience balding after menopause

A

True

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17
Q

During adolescence and adulthood, the use of birth control pills or pregnancy may result in temporary changes in __________ patterns or ____________ of the cheeks and forehead known as melasma or pregnancy mask

A

-Hair growth
-Hyperpigmentation

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18
Q

Structural and functional changes that occur in the skin

A

-Diminished pain perception
-Increased vulnerability to injury
-Decreased vascularity
-Weakened inflammatory response

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19
Q

__________ within the reticular dermis are reduced in number, and the walls are thinned

A

Blood vessels

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20
Q

The reduction and thinning of blood vessels result in the compromise of __________. The individual appears to have ___________ and impaired capacity to ____________, a possible contributing factor to the increased susceptibility of older individuals to ____________ and ___________.

A

-Blood flow
-Pale skin
-Thermoregulate
-Hypothermia
-Hyperthermia

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21
Q

A primary factor in the loss of protective functions of the skin is the diminished barrier function of the ____________.

A

Stratum corneum

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22
Q

As the stratum corneum becomes thinner, the skin becomes _____________ and ____________, reacting more readily to minor changes in humidity, temperature, and other irritants

A

-Translucent
-Paper thin

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23
Q

Fewer melanocytes results in decreased protection against ______________

A

UV radiation

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24
Q

A reduction in Langerhans cells represents a loss of ___________ and an increased risk of ___________

A

-Immune surveillance
-Skin cancer

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25
Q

The epidermis is one of the body’s principal suppliers of ___________

A

Vitamin D

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26
Q

Aging contributes to ____________ deficiency, which plays a role in bone mass and thus is linked to ____________

A

-Vitamin D
-Osteoporosis

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27
Q

The skin is rich in _________, __________, and __________, all of which are extremely sensitive to the oxidation damage or process

A

-Lipids
-Proteins
-DNA

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28
Q

Common skin disorders

A

-Atopic Dermatitis
-Contact Dermatitis
-Eczema and Dermatitis
-Stasis Dermatitis
-Environmental Dermatoses
-Rosacea
-Incontinence-Associated Dermatitis

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29
Q

Bacterial infections

A

-Impetigo
-Cellulitis

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30
Q

Viral infections

A

-Herpes Zoster
-Warts (Verrucae)

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31
Q

Fungal infections (dermatophytosis)

A

-Ringworm (tinea corporis)
-Athlete’s Foot (tinea pedis)
-Yeast (candidiasis)

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32
Q

Parasitic infections

A

-Scabies
-Pediculosis (Lousiness)

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33
Q

Types of skin cancer

A

-Benign lesions
-Premalignant lesions
-Malignant nonmelanoma carcinoma
-Malignant melanoma
-Kaposi sarcoma

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34
Q

Benign lesions

A

-Seborrheic keratosis
-Nevi (moles)

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35
Q

Premalignant lesions

A

-Actinic keratosis
-Bowen disease

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36
Q

Malignant nonmelanoma carcinomas

A

-Basal cell carcinoma
-Squamous cell carcinoma

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37
Q

Skin disorders associated with immune dysfunction

A

-Psoriasis
-Lupus erythematosus
-System sclerosis
-Polymyositis and dermatomyositis

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38
Q

Injuries that result from direct contact with or exposure to any thermal, chemical, electrical, or radiation source

A

Burns

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39
Q

Burn severity is determined by…

A

-depth of injury
-total body surface area (TBSA)

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40
Q

The resulting depth of injury is a function of…

A

-Temperature
-Source of energy (ex: radiation)
-Duration of exposure

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41
Q

Other factors of burn severity include…

A

-Burn location
-Age of patient
-General health status
-Risk of infection
-Presence of inhalation injury

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42
Q

SLIDES 20-21

A
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43
Q

Of patients admitted to burn centers, ___% are male; ____% occurred at home

A

-68
-73

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44
Q

True or false: Older adults are most vulnerable to burns

A

False

(Children)

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45
Q

Thermal burns account for approximately ___% (___% flame or fire; ___% scalding) of all burn center admissions

A

-75
-43
-34

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46
Q

This is also called road rash

A

Friction burns

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47
Q

Involves household cleaning agents and various chemical used in industry, agriculture, and the military

A

Chemical burns

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48
Q

Burn that happens when electricity comes into contact with your body

A

Electrical burns

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49
Q

Sunburn from prolonged exposure to UV rays

A

Radiation burns

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50
Q

Burn risk factors

A

-Age
-Lack of smoke detectors, psychomotor disorders (e.g., impaired judgment, impaired mobility, drug or alcohol use)
-Smoking
-Rural location
-Low socioeconomic status
-Occupation
-Fireworks

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51
Q

_________ have a higher risk, owing to inadequate supervision and abuse with scald injuries

A

Children

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52
Q

Risk of burns is highest for individuals at the extremes of age (the very ________ and the very ________), __________ regarding prevention of burn accidents is especially important in these populations

A

-Young
-Old
-Education

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53
Q

Inflammatory response can be ____________ or _____________ burns

A

-Local
-Systemic

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54
Q

Local burns are…

A

Small burns

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55
Q

Systemic burns are…

A

Extensive burns

56
Q

Major systems affected

A

-Cardiovascular
-Renal and GI
-Immune

57
Q

_____________ (i.e., catecholamines, histamine, serotonin, leukotrienes, and prostaglandins) are released from injured tissue immediately, causing an increase in capillary ___________.

A

-Vasoactive substances
-Permeability

58
Q

Extensive burns result in generalized body ______ in both burned and nonburned tissues and a decrease in ______________

A

-Edema
-Circulating intravascular blood volume

59
Q

__________ increases in response to catecholamine release and hypovolemia

A

Heart rate

60
Q

______________ and death may result when heart rate increases in response to catecholamine release

A

Hypovolemic (burn) shock

61
Q

This decreases in the beginning, returns to normal and then increases about 24 hours after the injury (with intensive care) to meet the increased metabolic needs of the body

A

Cardiac output

62
Q

When a person gets burned, the body responds initially by ______________ from the kidneys and intestines

A

Shunting blood

63
Q

This happens in the renal and GI systems when a person gets a burn

A

-Oliguria (decreased urine output)
-Intestinal dysfunction (paralytic ileus)

64
Q

True or false: A patient becomes immunosuppressed after they get a burn

A

True

65
Q

True or false: Immunosuppression increases the risk of infection and life-threating sepsis

A

True

66
Q

True or false: Injury may occur secondary to inhalation of carbon monoxide, poisoning resulting from inhalation of toxins contained in smoke, and/or thermal burns to the pulmonary airways

A

True

67
Q

Electricity travels through the body, resulting in internal tissue damage and potential multisystem injury

A

Electrical burns

68
Q

In electrical burns, entrance wounds tend to be __________ compared with _________, more explosive exit wounds

A

-Smaller
-Larger

69
Q

True or false: In electrical burns, cutaneous wounds may be negligible, whereas soft tissue and muscle damage can be extensive, particularly in high-voltage electrical injuries

A

True

70
Q

___________ is more dangerous than ___________ and is more often associated with cardiopulmonary arrest, ventricular fibrillation, and tetanic muscle contractions

A

-Alternating current
-Direct current

71
Q

These burns may be deep, as they often continue to burn until neutralized

A

Chemical burns

72
Q

__________ usually result in comparatively less extensive burns compared with alkalis

A

Acids

73
Q

___________ chemicals tend to result in deeper burn injuries

A

Alkaline

74
Q

True or false: Burn location does not influence injury severity

A

False

(it does)

75
Q

Burns of the ________ and _________ can result in permanent physical and vocational disability

A

-Hands
-Joints

76
Q

_____________ burns may produce a tourniquet-like effect and lead to compartment syndrome or total occlusion of circulation

A

Circumferential

77
Q

In full-thickness burns, _____________ are destroyed, rendering these specific burned areas of skin painless

A

Nerve endings

78
Q

Most full-thickness burns occur in conjunction with surrounding _______________ in which nerve endings are intact and expose

A

Superficial and partial-thickness injuries

79
Q

True or false: As peripheral nerves regenerate, painful sensation returns, creating increased pain with healing for some patients

A

True

80
Q

The most common and life-threatening complication of burn injuries

A

Infection

81
Q

Individuals with ___________ and in whom _________ is difficult to achieve are at the greatest risk for infection and other complications

A

-Extensive burns
-Wound closure

82
Q

Other complications associated with burns

A

-Respiratory failure
-Pneumonia
-Sepsis
-Hypertrophic scarring

83
Q

Associated with considerable morbidity and potential lifelong disfigurement

A

Hypertrophic scarring

84
Q

The clinical course for a patient with a major burn admitted to a burn unit can be divided into ___ overlapping phases

A

3

85
Q

Phases of a patient admitted to a burn unit

A

-Emergent phase
-Acute phase
-Rehabilitative phase

86
Q

Phase that focuses on:
-Fluid resuscitation
-Ventilatory management
-Assessment of the extent of the burn
-Early wound management

A

Emergent phase

87
Q

Phase that focuses on:
-Burn wounds management and infection prevention
-Debridement and skin grafting
-Physical therapy

A

Acute phase

88
Q

Phase that focuses on return to maximal independence and function

A

Rehabilitative phase

89
Q

Types of skin transplantations

A

-Autograft (person’s own skin)
-Allografts (homografts)
-Xenografts (heterografts)
-Biosynthetic grafts

90
Q

Skin transplantation used to treat a full-thickness burn and permanently close the burn injury

A

Autograft

91
Q

Skin transplantation that uses cadaver skin

A

Allografts

92
Q

Skin transplantation that uses pigskin

A

Xenografts

93
Q

Skin transplantation that is a combination of collagen and synthetics

A

Biosynthetic grafts

94
Q

3 classic determinants of burn mortality

A

-TBSA
-Age
-Inhalation injury

95
Q

Factors that further complicate burn recovery and increase mortality rates in adults

A

-Obesity
-Alcoholism
-Cardiac disorders that impair peripheral circulation

96
Q

PTs are involved throughout the ___________ and ___________ phases of burn care

A

-Acute
-Rehabilitation

97
Q

As a PT, you do not have to arrange a session with pain medications

A

False

(you do lol)

98
Q

Caused by a variety of underlying disorders, including neuropathy, vascular insufficiency, radiation, systemic sclerosis (SSc), vasculitis, and prolonged pressure

A

Integumentary ulcers

99
Q

Neuropathic ulcer in people with diabetes

A

Diabetic ulcer

100
Q

True or false: Neuropathic ulcers can occur in anyone with loss of sensation (e.g., alcoholic neuropathy, peripheral neuropathy)

A

True

101
Q

____________ may be classified using the Wagner system or the site, ischemia, neuropathy, bacterial infection, area, depth (SINBAD) score

A

Neuropathic ulcers

102
Q

SLIDE 40

A
103
Q

The lesions caused by unrelieved pressure, resulting in damage to underlying tissue

A

Pressure injuries

104
Q

Pressure injuries are also called…

A

-Pressure ulcer
-Decubitus ulcer
-Bed sore

105
Q

Pressure injuries usually occur over ______________

A

Bony prominences

106
Q

Examples of bony prominences

A

-Heels
-Sacrum
-Ischial tuberosities
-Greater trochanters
-Elbow
-Scapula
-Under medical devices

107
Q

Stages of pressure injuries are used to…

A

Classify the degree (extent) or soft tissue damage observed

108
Q

The current staging system is reflective of the range of ____________

A

Skin pigmentation

109
Q

Stage for Nonblanchable Erythema of Intact Skin

A

Stage 1

110
Q

Stage for Partial-Thickness Skin Loss With Exposed Dermis

A

Stage 2

111
Q

Stage for Full-Thickness Skin Loss

A

Stage 3

112
Q

Stage for Full-Thickness Skin and Tissue Loss

A

Stage 4

113
Q

Obscured Full-Thickness Skin and Tissue Loss

A

Unstageable pressure injury

114
Q

Persistent Nonblanchable Deep Red, Maroon, or Purple Discoloration

A

Deep tissue pressure injury

115
Q

True or false: Wounds can be back-staged

A

False

(nope lol)

116
Q

True or false: Once a pressure injury is designated as stage 2, 3, or 4, it will retain this original classification until it has resolved

A

True

117
Q

As the lesion fills with granulation tissue and closes via epithelialization, graft, or flap, it should be documented as a healing stage ____

A

2, 3, or 4

118
Q

The two primary causative factors for the development of pressure injuries are ________ pressure (externally) and pressure with __________

A

-Interface
-Shearing forces

119
Q

Decreased sensation, impaired mobility or activity levels, incontinence, diaphoresis, impaired nutritional status (prealbumin and albumin), and altered levels of consciousness or cognition

A

Intrinsic factors

120
Q

Pressure, shear, friction, and moisture

A

Extrinsic factors

121
Q

True or false: Bedbound and chairbound patients and patients with impaired ability to reposition themselves should be assessed for additional factors (e.g., above-noted pressure injury risk factors) that increase the risk of developing pressure injuries

A

True

122
Q

Anyone with a history of previous pressure injury is considered a __________ patient requiring a prevention protocol

A

High-risk

123
Q

SLIDE 47

A
124
Q

Continuous pressure on soft tissues between bony prominences and hard or unyielding surfaces compresses capillaries and occludes ___________ causing ischemia and tissue necrosis

A

Blood flow

125
Q

___________ predisposes bacterial invasion and subsequent infection, preventing healthy granulation

A

Necrotic tissue

126
Q

SLIDE 49

A
127
Q

True or false: Infection can’t be localized and self-limiting or can’t progress to sepsis

A

False

(it can)

128
Q

Patients who are _________ or who have _________ are often unable to mount a sufficient inflammatory response to start the healing cascade and thus are at greater risk for infection

A

-Immunosuppressed
-Diabetes

129
Q

Evidence of infection includes…

A

-Erythema
-Heat
-Swelling
-Pain
-Purulence
-Delayed healing
-Foul odor

130
Q

Proteolytic enzymes from bacteria and macrophages dissolve necrotic tissues

A

Foul-smelling discharge

131
Q

Necrotic tissue is ________, but surrounding tissue can be _________ in individuals with normal sensation

A

-Insensate
-Painful

132
Q

The high-risk patient will need ____________ changes

A

Frequent position

133
Q

For repositioning, use all turning surfaces, positioning the patient at a 30-degree oblique angle when ____________

A

Sidelying

134
Q

Elevate the head of the bed to no greater than ____ degrees when the patient is supine

A

30

135
Q

If the head of the bed is elevated beyond 30 degrees (e.g., for eating, watching television, nursing care, therapy intervention), the duration of this position needs to be limited to minimize both __________ and __________

A

-Pressure
-Shear forces

Internal Medicine (25 decks)

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