1523 Evidence Based Practice: Skin & Tissue Integrity
What are the 3 categories of infectious skin diseases?
1)Bacterial infections: Impetigo, Folliculitis, furuncles, and carbuncles -AKA Boils 2)Viral infections: Herpes zoster, Herpes simplex 1 and 2: orolabial, genital 3)Fungal infections: tinea pedis, tinea coporis, tinea capitis, tinea cruris, tinea unguium
At what Braden scale score does treatment need implemented?
17
tine pedis
A ringworm fungus of the foot, athletes foot
When assessing a mole for cancer what do you look at?
A: asymmetry B: border irregularity C: color variation D: diameter larger then 6mm E: evolving, changing features
What antibiotics can be treat lyme disease?
Amoxicillin, Ceftriaxone, Metronidazole
Explain why adequate circulatory status is the most important factor in the healing process of an infected decubitus ulcer
Blood flow to the area must be present to bring nutrients and prescribed antibiotics to the tissues. Rest and a balanced diet are essential to health maintenance but are not the priority for healing an infected decubitus ulcer. A fluid intake of 2,000 to 3,000 mL/day, if not contraindicated, is recommended to provide hydration to the client's tissues.
Azole antifungals medication
Diflucan (fluconazole)
What is the cause of mottled skin?
Disease process related to the underlying vessels resulting in decrease circulation, O2, and nutrients to the area.
Explain a vesicle
Elevated cavity of serous fluid •Up to 1cm happen when small amounts of fluid become trapped in the skins surface.
Explain a bulla
Fluid filled cavity •Superficial in epidermis •Larger than 1cm
What are the oral or topical corticosteroids?
Hydrocortisone (Cortisone 10), Prednisone, methylprednisolone, dexamethosone
What diagnostic test scrapes the skin combined with potassium hyroxide?
KOH exam
Grouped configuration
Lesions that are clustered together
Confluent configuration
Lesions that have merged together so that individual lesions are not distinguishable
What is the cause of keloid scars?
Overgrowth of fibrous tissue or May be due to genetics
What are the 3 blistering diseases?
Pemphigus, bullous pemphigoid, dermatitis herpetiformis
What are the calcium inhibitors?
Pimecrolimus (Elidel), Tacrolimus (Protopic)
What are some common causes of contact dermatitis and what are some treatment for it?
Poison Ivy, Oak & Sumac, contact with a mild allergen (new soap, lotion, ect.) & if mild apply cortisone cream or take benadryl if severe take PO or IM prednisolone
Explain scales and give examples of it
Scales = Thickened •Flakes of skin •Silvery or white •Texture thick or fine •Examples: Psoriasis, Dandruff
What type of wound debridement is the removal of dead/dying tissue by surgical means
Surgical debridement
Explain telangiestasia
Telangiectasia are dilated superficial blood vessels, blue or red in color, does not blanch
What does the woven gauze dressing type do?
absorb exudate
What medications are used to treat herpes simplex type 2?
acyclovir and valtrex
Increased melanocytes in basal layer with pigmentation accumulation "liver spots"
age spots
What are the 4 labs looked at in a diagnostic test?
albumin, bilirubin, protein, O2
What is a furuncle (boil) and what is the cause?
an infected hair follicle, caused most often by staph
What is the cause of eczema?
an overactive immune system response
What is an antifungal treatment?
antimycotics
What is the classification of zovirax/acyclovir?
antiviral PO,IV
What are the 3 laser treatments of lesions?
argon laser, carbon dioxide laser, pulse-dye laser
Lyme disease usually don't spread until attached for how long?
at least 36 hours
What is the most common form of eczema?
atopic dermatitis
What are blistering disease caused by?
bacteria, fungi, virus, allergic reaction, metabolic disorder, immune reaction, burns
What are the 4 kinds of infections?
bacterial, viral, fungal, parasitic
What are the 3 types of skin cancer?
basal cell carcinoma, squamous cell carcinoma, malignant melanoma
Ecchymosis
bruising: •Within 24 hours: Red/blue or purple •1 - 5 days: blue to purple •5 - 7 days: green •7-10 days: yellow •10 - 14 days: brown
What Provides homeostasis, debridement, absorption, and protection, Can be used as packing for deep wounds, Great for irritated or macerated (over hydrated) wounds, and Requires a secondary dressing for securing?
calcium alginates
What does melanoma translate to?
cancer of mole
Echinocandins medications
cancidas (caspofungin), mycamine (mycafungin)
What is a A cluster of boils connected under the skin. (tend to be deeper than furuncle)?
carbuncle, most often caused by staph
What type of debridement soften and separates eschar and necrosis from wound bed?
chemical
What type of wound debridement is the removal of dead/damaged tissue
chemical debridement
annular lesion
circular
What are the first lyme disease?
circular skin rash
Herpes simplex type 1
cold sores
What does valacyclovir (valtrex) treat?
cold sores, shingles, and genital herpes
Explain a macule
color change, flat and circular, less than 1 cm, flat nevi hypopigmentation
An inflammation of the skin caused by having contact with certain chemicals or substances; many of these substances are used in cosmetology.
contact dermatitis
Red (erythemic) raised rash often with small blisters (vesicles) with pruritis (itching) presenting where contact occurred may have mild to moderate edema present. Will seep serous drainage when damaged.
contact dermatitis
What are the 5 distributions of common skin disorders?
contact dermatitis, seborrheic dermatitis, acne, scabies, and herpes zoster
What diagnostic test commonly confirms a bacterial infection?
culture and sensitivity
•Grayish blue tone in nail beds, ear lobes, lips, mm, palms and soles of feet •Ashen gray color noted in conjunctiva, mm, nail beds
cyanosis
the removal of lacerated (heavily bleeding), devitalized (damaged or dying/dead), or contaminated (infected) tissue.
debridement
Explain tumors
deeper into the dermis, may be benign or malignant, can be firm or soft, greater than 2 cm
What is eczema still known as?
dermatitis
What diagnostic test eliminates erythema w glass slide?
diascopy
What is used to treat oral herpes?
docosanol abreva
What is the treatment for flee, chigger, and mosquito bites?
dont scratch, wash with sop and water, Benadryl PO
What are some normal changes related to skin change in the elderly?
dryness, scaly skin, wrinkling, sagging, skin folds, uneven pigmentation, loss of subq fat, slow skin replacement, decreased blood supply, thinning and graying hair, some skin lesions
What is the general term for many types of skin inflammtion
eczema
•Reddish tone •Deeper brown or purple skin tone •Cherry red nail beds, lips, mm
erythema
What are some examples of a nodule?
fibroma, squamous cell carcinoma
What dressing includes an absorbent layer under a foam layer?
foam
Where can skin testing be done?
forearm or back
What are some examples of a macule?
freckle, petechia, measles
punch skin biopsy
full thickness, cancer
What is the causes of fungal infections?
fungal molds nd yeast
Herpes simplex type 2
genital herpes
What is the most common viral infection?
herpes
What are some examples of a vesicle?
herpes simplex, shingles, chicken pox, poison ivy
Lesion on the finger or thumb caused by herpes simplex type 1 or 2
herpetic whitlow
Scratching releases ____ which increases ______
histamines, pruritus
What Dressings adhere and are non permeable to water, over time they soften and discolor?
hydrocolloids
What Help with autolytic debridement by maintain a moist environment in the wound, Are comfortable and soothing to painful wounds, Good with superficial wounds with high serous output, and are 90-95% water?
hydrogels
What the antihistamine drugs?
hydroxyzine (Atarax), Diphenhydramine (Benadryl),
Deliver high doses of O2 (100%) to the body via pressurized chamber: mask, hood
hyperbaric chamber
What scar overgrows but stays within the original area of damage?
hypertrophic
Discrete configuration
individual and distinct lesions
What is main concern of mosquitoes?
infection
What is folliculitis?
inflammation of a hair follicle
What does pruritus mean?
itching
•Yellowish color of skin, sclera, hard palate, nails, oral mucosa, palms & soles of feet - unless callused
jaundice
Malignancy of endothelial cells that line the blood vessels: dark reddish-purple lesions of the skin, oral cavity, GI tract, and lungs & organs
kaposi's sarcome
What Scar overgrows and extends beyond the initial boundary of the injury?
keloid
Miscellaneous antifungals medication
lamasine (terbinafine)
What is the cause of stasis dermatitis?
large blood vessel damage - circulation to lower legs and arms decreases - lack of nutrients
What are some examples of a tumor?
leaoma, carcinoma
Shampoo for lice
lindane (kwell)
Zosteriform configuration
linear shape of skin lesion along a nerve route
Side effects of azole antifungals
liver and kidney failure, birth control
Side effects of echinocndins
liver failure
Side effects of miscellaneous antifunglas
liver failure
What kind of anesthetic is given for a skin biopsy?
local
Skin breaking down resulting from prolonged moisture exposure.
maceration
What 3 problems can come from mosquitoes?
malaria, west nile, and zirka
What type of wound debridement is the removal of dead/damaged tissue using some kind of force?
mechanical debridement
What type of dressing type will spontaneous separation of necrotic tissue is promoted by autolysis occur?
moisture-retentive dressing
What are some examples of a papule?
moles, warts
Skin with patchy discoloration
mottled
What 4 items are looked at in a skin assessment, inspection of color?
mucous membranes, conjunctive, sclera, and skin
What type of wound debridement does the body naturally loosens and sheds the dead/damaged tissue?
natural (autolytic) debridement
Polyenes medications
nilstat (nistatin), fungizone (amphoteracin B)
What dressing category is used to cover topical medications, is a sterile or non-sterile gauze, and is kept airtight with plastic film?
occlusive dressings
What is a Self-adhesive, transparent film used to cover a wound, line, or medication?
occlusive dressings
What is the appearance of mottled skin?
often purplish or darker appearance, commonly found on the lower legs and shins
What are the treatments for of eczema?
oral or topical corticosteroids, antihistamines, calcineurin inhibitors
What is the cause of hypertrophic scars?
overgrowth of erythema's tissue and tension on the scar
•Pale, ashen •No underlying red tone; yellowish brown, ashen, gray
pallor
What are the 6 parasitic skin infections?
pediculosis (lice), scabies, bed bugs, fleas/chiggers, mosquitos, ticks
What type of healing the wound edge are brought together surgically by sutures, stapes, or glue. Heals quickly with less risk for infection?
primary
What is the most common symptom of skin/tissue disorder?
pruritus
What is a Chronic, noninfectious inflammatory disease of the skin?
psoriasis
What type of wound drainage/exudate will be cloudy and or thick due to the presence of dead WBCs, it indicates the presence of infection, this is never a normal finding in a wound?
purulent
What med is the first choice for lice and can be used for scabies, less toxic then lindane?
pyrethrin (RID)
When do SJS/TEN occur and what are the initial signs/symptoms?
reaction to medication and Conjunctival burning/itching, HA, fever, cough, sore throat, aching, pain, malaise
incisional biopsy
removal of a selected portion of a lesion
tinea barbae
ringworm of the beard
tinea corporis
ringworm of the body
tinea cruris
ringworm of the groin, jock itch
tinea capitis
ringworm of the scalp
What are the 4 types of fungal infentions?
ringworm, jock itch, athletes foot, nd fungal nail infection
What type of wound drainage/exudate will be a bright or dull red due to the presence of red blood cells, it indicates the presence of a vascular injury or leak?
sanguineous
What type of healing is the would healed by granultion?
secondary
What complications can arise from SJS/TEN?
sepsis and visual impairment
What type of wound drainage/exudate is a middle stage between serous and sanguineous?
serosanguineous?
What wound drainage/exudate is clear may be slightly yellow and will form crust if it is allowed to dry?
serous
Jaundice indicated elevated levels of?
serum bilirubin
acne vulgaris
severe acne
What can permethrin (NIX) be used for?
shampoo for lice or lotion for scabies
herpes zoster
shingles
What are the types of herpes?
simplex 1, simplex 2, herpes zoster, shingles, and herpetic whitlow
What diagnostic test looks the signs and symptoms of aallergic reactions and appropriate medications to give?
skin testing
What is the cause of ringworm?
skin to skin contact with an infected human or animal
Explain a papule
solid, elevated, palpable, circular, less than 0.5cm, may have different color then the surrounding skin
Explain a nodule
solid, round or oval elevated lump 1-2cm in diameter
Shallow open ulcer with a red-pink wound bed, without slough.•*Slough is white or yellow tissue that clings to the wound bed in strings or clumps. This category of pressure ulcer can also present as an intact or open/ruptured serum-filled or serosanguineous filled blister.
stage 2
This wound is full-thickness and includes skin loss. •Subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed. •Slough may be present but it does not obscure the depth of tissue loss. •The wound may include undermining and tunneling.
stage 3
Exhibit full-thickness tissue loss with exposed bone, tendon, or muscle.• Slough or eschar may be present, as may undermining and tunneling.
stage 4
Pressure ulcer does not blanch, skin it intact, and red tone to area is stage what?
stage one
skin dry & fragile & thick/leathery/yellow in color often mottled- wounds heal more slowly
stasis dermatitis
What is SJS/TEN?
steven-johnson syndrome/ toxic epidermal necrolysis
linear lesion
straight line
scrape skin biopsy
superficial fungal infection culture
Appears as sudo bruising deep red or purple areas. •Although it looks like a deep bruise, deep tissue injury is sometimes mistaken for a category I pressure ulcer.
suspected deep tissue injury
Side effects of polyenes
tachycardia, respiratory depression
shave skin biopsy
takes several thin layers
What does the self-adhesive, transparent film dressing type do?
temp. "second skin" small superficial wound
What type of healing is the wound cleaned and or debrided then closed by primary or secondary intention, it is required for infections, edges that fail to adhere?
tertiary
What happens to the epidermal cells in psoriasis?
the epidermal cells are produced at an abnormally rapid rate
What diagnostic test confirms a viral skin lesion?
tzanck smear
What is herpes zoster/shingles causes by?
varicella virus-chickenpox
What is the cause for venous stasis?
vein function (vein walls or valves) is compromised & blood pools in legs. •Most frequently occurs in legs due to dependence. Decreased unoxygenated blood return to the heart.
What dressing category is used for acute, inflammatory lesions and is not commonly used due to success of newer products?
wet dressings
What type of dressing mechanically removes necrotic debris?
wet-to-damp saline-moistened gauze
What diagnostic test is performed in a dark room/black light?
woods light examination
What medications is given for herpetic whitlow?
zovirax
What are some examples of a bulla?
•Blisters •Contact dermatitis
Explain an ulceration and give examples
•Deep depression extending into the dermis •Irregular shape •Example: pressure wound
Explain crusts and give examples
•Dried out exudate (residue after vesicle ruptures) •Examples: Impetigo, Weeping dermatitis, Herpes, Eczema
Explain the inflammation phase of scar formation
•Lasts up to a week •White blood cells and collagen formation is at its maximum
Explain the maturation phase of scar formation
•May last up to a year •The scar is restructured •The scar flattens out and turns a paler color
What are the 5 moisture-retentive dressings?
•Occlusive dressings •Foam •Calcium Alginates •Hydrogels •Hydrocolloids
What are the 4 purposes of the integumentary system?
•Protect •Insulate •Temperature regulation •Flesh bag
Explain a pustules and give some examples?
•Pus filled vesicle or bulla •Circumscribed •Elevated •Examples: Impetigo, Acne, Furuncles
What are the 4 confusing facts of scaly skin?
•Scaly skin is a term for unusually dry skin •Scaly skin is common finding in the elderly. •Scaly skin is different than scales •Scaly skin is common in sun burns during the healing phase.
Explain the proliferation phases of scar formation
•Scars edges are pulled inwards •New capillaries are produced •Collagen production slows •Takes on a reddened appearance may look wet or shiny
Explain an Excoriation (scratches) and give examples
•Superficial abrasion •Sometimes crusted •Example: scratches from insect bites, scabies, dermatitis
Explain a cyst and give some examples
•distinct walled off (encapsulated) fluid or semi solid filled material in dermis or subcutaneous layer •Examples - sebaceous cyst
Explain a cheery angioma
•round, papular, red or purple, may blanch, normal age-related change •These lesions are made up of clusters of dilated capillaries which explain the reason for the purple or cherry-red color •are possibly the most common vascular lesions
