Week 3 Flashcards
Integumentary System
- Epidermis
- Dermis
- Subcutaneous tissue (hypodermics)
Epidermis
- protective barrier
- 0.05-0.1mm thick
- regenerate every 28 days
- contains melanocytes and keratinocytes
Dermis
- connective tissue, highly vascular
- contains collagen (strength)
- upper (thin) layer, lower (thicker) reticular layer
Subcutaneous tissue (hypodermis)
- attaches skin to muscle and bone
- contains fat and loose connective tissues
- regulates temperature
Integumentary system function
- protects underlying tissues from the environment
- protection against bacteria, viruses, and excessive water loss
- fat within the subcutaneous layer insulates and protects from trauma
- interpret sensory information physiologic response
- temperature regulation
- secretion of sebum and sweat
- helps synthesize vitamin D
- melanin screens and absorbs ultraviolet light
Assessment data for integumentary assessment
hx of trauma, surgery, skin disease
health hx can explain alterations in skin colour:
- jaundice (liver disease)
- old wounds (diabetes mellitus)
- cyanosis (COPD)
- pallor (anemia)
Medications for acne, pruritus or rashes
Hx of skin biopsy and results
Exposure to sun
Allergy to pets? Are there pets in the home
Any new cleaning agents being used in the home
What does skin indicate about heath status
- heart disease
- colour
- temperature
- liver disease
- hydration
- potential signs of cancer (moles, growths)
- tell about hygiene practices
Hair, Skin and Nails Physical exam summary
- Inspect the skin
- Palpate the skin
- Note any lesions
- Inspect and palpate hair and nails
- Teach self examination
Mole assessment
- Asymmetry
- Border
- Colour
- Diameter
- Evolution
Age related considerations for integumentary system
- decreased skin turgor
- dryness
- benign neoplasms (barnacles as seborrhoea keratoses)
- vascular lesions
- increased skin fragility, skin shearing
- fewer melanocytes (grey and white hair)
- less volume in the dermis and subcutaneous layer, wrinkling
- nails become brittle and prone to splitting and yellowing
- hypothermia
Cultural and social considerations for integumentary
Recognition of unique clinical manifestations of disease
- related to variation in skin pigmentation and hair texture
- genetic advantage of dark pigmentation and lower incidence of skin cancer
- variation in sexual skin areas affected by hormones
- environmental adaptations affecting sweat glands
Biopsy
- specimen collection Typically used with suspended malignancy
- consent, pre-op, preparation, and post- op care
Microscopic tests
- used to identify causative substance
Ex. Culture and sensitivity
Woods lamp
- uses black light
- certain substances floresce (e.x head lice, scabies, fungal infections)
First line of defence
Epithelial cells
- skin, GI, GU, respiratory tract
Pathogens sloughed off with dead skin cells
Coughed, sneezed, expelled (vomit)
Flushed out by urine
Removed via stool (diarrhea)
Second line of defence
Inflammation (occurs rapidly)
A response to
- infection
- trauma
- immune response to allergens
Wound healing phases
- Inflammatory phase
- Proliferative phase
- Maturation/ remodeling
Inflammatory phase
-Hemostasis
- acute inflammation
Mast cells
- activate inflammatory response
- located in the skin and GI tract
Histamines
- vasodilation
- smooth muscle constriction
- antihistamines are important here to decrease inflammatory response
Phagocytic system
- eliminate pathogens and foreign debris
- living cells that recognize, attach, engulf and destroy
Local manifestations of inflammation
Redness
- hyperaemia from vasodilation
Heat
-increased metabolism at the inflammatory site
Pain
- nerve stimulation by chemicals, pressure from fluid exudate
Swelling
- fluid shift to interstitial space; fluid exudate accumulation
Patch testing
Evaluating response to different allergens
Exudate (fluid)
Typically serous (watery) in mild inflammation
- ex. Abrasions, rashes, blisters
Typically, thicker in severe inflammation
- ex. Pneumonia
- can contain pus (purulent)
-hemorrhagic exudate can be excreted from tissues with serious injury (burn)
Primary intention
Wound is closed, with surgical intervention. Edges are brought together. Best choice for clean, fresh wounds in sufficiently vascularized areas
Second intention
- Would is left open and allowed to heal spontaneously.
- Good for contaminated/ infected wounds.
- Increased scarring
Tertiary intention
- delayed primary closure
- good for wounds which are contaminated/ infected initially
Complications during wound healing
- adhesions
- contractures
- dehiscence
- evisceration
- fistula formation
- infection
- hemorrhage
- excess granulation
Nursing management of inflammation and healing
- Prevention
- Nutrition
- Early recognition
- Acute intervention
- fever management
- consider hot and cold application
- compression and immobilization
- wound management
Causes of pressure injuries
- pressure
- friction
- shearing force
- moisture
Risk Factors for Pressure injuries
- advanced age
- nutrition
- comorbidities
- duration
- incontinence
Nursing management of pressure injuries
- impaired skin integrity
- repositioning
-devices - identify stage, type, extent
- document and assessment
- wound care
Nursing assessment and documentation
- on admission
- every shift
- ongoing basis
- Braden scale
Wound management
Purpose
A) cleaning and debriding the wound to remove debris and dead tissue from the wound bed
B) controlling inflammation and treating infection to prepare the wound for healing
C) providing moisture balance for healable wounds and moisture reduction for non-healable and maintenance wounds
- negative pressure wound therapy
- hyperbaric oxygen therapy
- electrical stimulation
Vitamin A (retinol)
Derived from animal products and green and yellow/orange fruits/veggies
B- complex vitamins
Deficient in malabsorption, poor nutrition, ETOH abuse and prolonged fever/dehydration
Vitamin C (ascorbic acid)
Deficiency resulting from poor nutrition (scurvy)
Vitamin D
Regulates the absorption and utilization of calcium and phosphorus
Right drug for the right bug
Selection of anti microbial is based upon assessment, pharmacological and clinical judgement, and microbiological identification
Antibiotic classifications
- classified into broad categories based upon chemical structure and MOA
- common categories are sulfanomides, penicillins, cephalosporins, carbapenems, macrolides, quinolones, aminoglycosides and tetracyclines
Empiric therapy
Treatment of an infection before specific culture information has been reported or obtained
Targeted or definitive therapy
Antibiotic therapy tailored to treat organisms identified with cultures
Prophylactic therapy
Treatment with antibiotics to prevent an infection, as in intro abdominal surgery or after trauma
Antibiotics
- are medications used to treat bacterial infections
- ideally before beginning antibiotic therapy of suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities. However, risk vs benefit is always considered
Classes of antibiotics
- sulfonamides
- penicillins
- cephalosporins
-Macrolides - quinolones
- aminoglycosides
- tetracyclines
Penicillins G is..
Injectable
Penicillins V is
Oral pen
Penicillins G and Penicillin V
- inhibits cell was synthesis
- binds to the active site of penicillin-binding proteins (PBP) that halts peptidoglycan synthesis
- as a result, bacterial cells die from cell lysis
- bactericidal
Pen G and Pen V prevention and treatment of infections caused by susceptible bacteria such as
- many gram positive bacteria, included streptococcus spp, enterococcus ssp., and staphylococcus spp
- litttle gram negative coverage (greater coverage with extended spectrum penicillins)
B- lactation antibiotics
- penicillins
- cephalosporins
- carbapenems
- monobactams
Impetigo
- linked to seasons, hygiene
- contagious
- commonly perioral lesions, honey “crust”, prurtis, tenderness
- strep or staph
- local or systemic antibiotics (depending on the severity)
Folliculitis
- related to shaving, heat, oils, friction, moisture, DM
- commonly staph
- small pustules, tenderness
- local or systemic antibiotics (depending on the severity)
- warm compress, hygiene
Cellulitis
- subcutaneous tissue involvement
- commonly Steph or strep
- erythema, tenderness, Edelman, fever, malaise (commonly in lower legs)
- rest elevation, mosit heat
- systemic antibiotics
Scabies
Caused by sarcopetes scabies
Transmitted by direct contact
Clinical features
- severe itching, especially at night
- presence of burrowing tracks
- crusting
Treatment
- topical 5% permethrin
- cohabitants and sexual partners
- bleach for clothing and hard surfaces
- consider secondary infection
- treatment of puritus
Bed Bugs
Treatment considerations:
Lesions: No treatment needed
Pruritis: antihistamines, corticosteroids
Melanocytes
Contain melanin, giving pigment colour to skin and hair and protects the body from damaging ultraviolet light
More melanin = darker skin colour
Keratinocytes
Produce keratinocytes fibrous protein, vital to the protective barrier function of skin
Wheal
Skin leasion
- firm
- edematous (insect bite, urticaria)
Plaque
Skin lesion
- elevated, superficial, solid
- ex. Psoriasis
Macule
Skin lesion
- flat, change in skin colour
- ex. Freckle, flat mole
Pustule
Skin lesion
- elevated, superficial, furulent fluid
- ex. Acne
Papule
Skin lesion
- elevated, solid
- ex. Wart, elevated moles
Vesicle
Skin lesion
- superficial collection of fluid
- ex. Varicella (chicken pox), herpes zoster (shingles) and second degree burns
Sublethal injury
Alters function without causing cell death
Lethal injury
An irreversible process that causes cell death
Causes of cell injury
- heat
- cold
- radiation
- electro thermal
- mechanical trauma
- chemical trauma
- virus
- bacteria
- fungus
- neoplastic growth
Common topical antibacterial
- polysporin, neosporin, bacitracin (most commonly treats skin infections from staph and strep)
- mupirocin (bactroban) *impetigo
- silver sulfadiazine (flamazine) *burns
Common topical antifungals
- candidiasis, tinea ringworm: clotrimazole
- clotrimazole
- nystatin
- terbinafine hydroclordide
Less common antiviral ointments
Acyclovir: herpes, HPV
Common topical anesthetic *pain
- lidocaine (with or without prilocaine)
Common topical anti-inflammatories or antipruritic
Corticosteroids: used for inflammation or pruritus, the “sones”
Variable % of concentration, variable potency
Ex. Hydrocortisone, betamethasone, ect
Common oral antihistamines
May treat urticaria, angiogram, pruritus, contact dermatitis and allergic cutaneous reactions
- different generations of antihistamines, first generation often causes drowsiness as a side effect
Diphenhydramine (Benadryl)
Fexofenadine (Allegra)
Cetrizine (reactine)
Lortadine (Claritin)
Structures of the eye
External structures
- eyebrows, eyelids, eyelashes, lacrimal system, conjunctiva, cornea, sclera, extraocular muscles
Internal structure
- iris, lens, ciliary body, choroid, retina
The eyeball or globe is composed of three layers
1. Outer layer is sclera and transparent cornea
2. Uveal tract (iris, choroid and collard body)
3. Innermost layer is the retina
Refractive media
For the light to reach the retina, it must pass through several structures
Cornea-> aqueous humour-> lens-> vitreous humour
All these structures must remain clear for light to reach the retina and stimiulate the photoreceptors cells. The cornea, which is normally transparent, is the first structure through which light passes, it is responsible for most of the light refraction nexessary for clear vision
Myopia
Nearsigntedness
Hyperopia
Farsightedness
Astigmatism
Caused by corneal unevenness resulting in vision distortion
Presbyopia
Type of hyperopia due to aging, usually beginning around age 40
Diagnostics: Snellen chart
- determines visual acuity (distance vision)
- normal vision is 20/20
Diagnostics: ophthalmoscopy
- using light and magnification to examine the back of your eye (including the retina and optic nerve)
Diagnostics: Tonometry
- used to measure the pressure inside your eyes (IOP)
- screens for glaucoma and monitors treatment for glaucoma
- non-contact tonometry= eye puff test
Nursing interventions (non-pharm) *eyes
- knowing the pts vision needs (reading glasses, etc)
- mellow lighting
- warm/ cool eye compress
- gentle cleaning eye lubricant
- sunglasses
- reduce exposure to irritants
Eye health promotion
- regular visual exams (every 3-5 years until the age of 40) (2-4 years until 65) (2 yearly after 65)
(Yearly eye exams if family hx glaucoma or if from African American descent) - a balanced diet and fluid intakes
- reduce risky lighting (blue screen exposure)
- sunglasses
- reduce exposure to irritants with protective eyewear
