EAQs Integumentary
Which interventions would the nurse include in the plan of care for a client admitted with herpes zoster?
-antiviral medications: acyclovir -silvadene can be applied to open vesicles -gabapentin can be used to treat nerve pain -wet compresses can be applied to the vesicles to relieve discomfort -contact isolation precautions
What is patient education for patient receiving radiation therapy?
-avoid lotions and powders over area -do not use gauze and tape on area -do not use warm compresses -assume position of comfort
When does the maturation phase occur?
21 days to 2 years after proliferative phase
What angle should a coma patient's head of bed be at to prevent shearing force?
30 degrees
When does the proliferative phase occur?
4-24 days after inflammatory phase
How is the rule of nines calculated?
9% for each body area -1% for groin -4.5 for head, each arm -9 for each limb, stomach, chest, lower back, upper back -18% for each lower limb
How is a punch biopsy performed?
A small circular cutting instrument with a diameter of 2 to 6 mm is used to remove a small amount of skin
What is the removal of bulging fat in the periorbital area that is used to treat bags under the eyes?
Blepharoplasty
What is essential for open method of wound treatment?
PPE, no dressings, room temp of 85
What results in increased susceptibility to dry skin?
a decrease in dermal blood flow
What is benign neoplasm?
a harmless mass that is encapsulated and does not spread to other tissues
Which GI change may be found with burn injuries?
abdominal distention due to loss of peristalsis; GI motility may be inhibited, blood flow may be reduced and mucosal damage might have occurred
What does electrical stimulation of wounds do?
application of low-voltage current to increase blood vessel growth and promote granulation
What factors put a client at risk for bacterial infections?
atopic dermatitis, diabetes mellitus, systemic antibiotics
What are adverse reactions of radiation therapy?
atrophy, mucositis, and ocular damage
What type of infection is impetigo?
bacterial skin infection
What is an example of third spacing with a burn injury?
blister formation; NOT examples: fluid accumulation, fluid mobilization, edema formation
What is methemoglobinemia?
blood disorder in which oxygen can not be released by hemoglobin to tissue that needs it
What skin color alteration may be observed in a client diagnosed with methemoglibinemia?
blue, caused by an increase in deoxygenated blood
What is medication eruption characterized by?
bright-red erythematous macules and papules
Which life-threatening wounds are treated with hyperbaric oxygen therapy?
burns, osteomyelitis, diabetic ulcers; raises tissue oxygen concentration
What skin infection is lymphadenopathy common in?
cellulitis
Anthralin can cause what adverse reaction?
chemical burns; strong irritant; used to treat psoriasis
Contact with grease and alkali in oven cleaners may cause what kind of injury?
chemical injury
How does verruca vulgaris clinically manifest?
circumscribed, hypertrophic, flesh-colored papule limited to the epidermis
Full-thickness burns involve what?
complete damage of epidermis and dermis, may damage subcutaneous; skin grafting is necessary
Scalding injuries usually result from what?
contact with hot liquids or steam
The dilution of viscous exudate is promoted through what kind of dressing?
continuous wet-gauze technique
What causes dry, coarse hair?
decrease in oils
What physical changes may cause longitudinal nail ridges?
decreased blood flow
What causes white skin or pallor?
decreased level of hemoglobin, risk of anemia and shock
What causes facial hirsutism?
decreased levels of estrogen
Which change in the epidermis causes increased risk of sunburn?
decreased melanocyte activity
Which changes with hair would be responsible for developing white hair at the age of 23?
decreased melanocytes
What causes decreased tone and elasticity of skin?
degeneration of elastic fibers in the dermis
Decreased cell division causes what?
delayed wound healing
What kind of soap should patient's avoid when experiencing dry skin?
deodorant
What is the process of removing the facial epidermis or a portion of the dermis to treat acne scars?
dermabrasion
What layer of skin gives the skin its flexibility and strength and provides cells for wound healing?
dermis
Which changes to the skin are caused by atrophy of eccrine sweat glands?
dry skin and decreased body odor
Increased capillary fragility and permeability will result in what?
ecchymosis
Rough, thick skin is an assessment finding with which skin condition?
eczema
How does tinea corporis clinically manifest?
erythematous, annular, ring-like scaly appearance with well-defined margines
What is nonspecific eczematous dermatitis characterized by?
evolution of lesions from vesicles to weeping papules and plaques
Which type of biopsy is required for removal of entire lesions on the skin?
excisional biopsy
Where does a fibroma form?
fibrous tissue
What secondary skin lesion may include athlete's foot as an example?
fissure
Occasional papules are present with what skin infection?
folliculitis
Isolated erythematous pustule occur in what skin infection?
folliculitis bacterial infections
What type of infection is candidiasis?
fungal infection
Where does an adenoma form?
glandular epithelium
What is the visible swelling due to extravasation of blood of sufficient size?
hematoma
What skin infection involves the evolution of vesicles into pustules?
herpes simplex viral infections
What skin infection could cause facial paralysis?
herpes zoster; Bell palsy, which causes facial paralysis, is a complication of the herpes zoster infection that occurs when the trigeminal nerve is infected by the virus
How do you clean burns?
hydrotherapy in a large tank tub
The nurse would assess for which electrolyte imbalances during the first 48 hours after a client has sustained a thermal injury?
hyperkalemia and hyponatremia
Seizures are the clinical manifestation of what electrolyte imbalance in burns?
hypernatremia
Which bacterial skin infections are caused by group A b-hemolytic streptococci?
impetigo, erysipelas
Thinning of the subcutaneous layer also causes what?
increased risk for hypothermia
What phase of normal wound healing is when white blood cells migrate into the wound and there is an increase in capillary permeability?
inflammatory phase
How does tinea pedis clinically manifest?
interdigital scaling, maceration, and a scaly plantar surface, sometimes with erythema and blistering
What is a serpiginous skin lesion?
lesion with wavy borders that resemble a snake
What is contact dermatitis characterized by?
localized eczematous eruption when the skin comes into direct contact with irritants or allergens
What are some established chemotherapy medications used for the treatment of metastatic melanoma?
lomustine, carmustine, temozolomide
What phase of normal wound healing is when a scar is firm and inelastic on palpation, collagen is strengthening, and there is thinning of scar tissue?
maturation phase
How do corticosteroids affect patients with acne?
may cause flare-ups
Which organism infestation is diagnosed with the help of the mineral oil test?
mites
What type of dressing promotes the spontaneous separation of necrotic tissue through autolysis
moisture-retentive dressing
Which intervention would the nurse use for a client with full-thickness burns to the chest and anterior right arm?
monitoring vital signs, cutting off clothing, inserting a urinary catheter, removing jewelry, establishing an IV
Which technology would the nurse use to reduce chronic ulcers by removing fluids from the wound?
negative pressure wound therapy
What benign condition of the skin is associated with the grouping of normal cells derived from melanocyte-like precursor cells?
nevi
Which term would the nurse use to document a 1 cm elevated solid lesion?
nodule
What is the medication Isotretinoin used for?
nodulocystic acne; may provide lasting remission
Decreased vitamin D production leads to increased risk for what?
osteomalacia (softening of bones)
Partial-thickness burns involve what?
painful, reddened, and blistering; damage to the epidermis and part of the dermis; recovery with no infection occurs in 2-6 weeks; grafting is not needed
Which benign tumor forms on the surface of the epithelium?
papilloma
What skin damage occurs from chronic exposure to ultraviolet rays?
photoaging and skin wrinkling
What type of specimen does an incisional biopsy provide?
portion of the skin
What goal is the nurse trying to achieve when placing a client with severe burns on a circulating air bed?
preventing pressure on peripheral blood vessels
What phase of normal wound healing is when epithelial cells grow over the granulation tissue bed?
proliferative phase
What phase of normal wound healing is when the fibrin forms a scaffold or framework?
proliferative phase
What dermatological problem is treated by using intralesional corticosteroids?
psoriasis
What is an acute viral infection, characterized by convulsions and difficulty swallowing?
rabies
What does hyperbaric oxygen therapy do?
raises the tissue oxygen concentration
Which nail color would indicate trauma to the nail bed?
red
Which color would the nurse anticipate when assessing a client's skin tears?
red; gray/black indicates a wound caused by a full-thickness or third-degree burn yellow indicates a wound that has nonviable necrotic tissue that create an ideal situation for bacterial growth
What in the dermis leads to decreased sensory perception?
reduced number and function of nerve endings
What surgery is used to remove excessive tissue or cartilage from the nose?
rhinoplasty
Which surgery is used to treat excessive wrinkling or sagging of facial skin?
rhytidectomy
How does tinea unguium (onychomycosis) clinically manifest?
scales under the distal nail plate
What is atopic dermatitis characterized by?
scaling and excoriation; occurs due to food allergies, chemicals, or stress
Decreased subcutaneous fat will result in what injury?
shearing of the skin
What types of clients may have a false-positive result while assessing capillary refill?
shock, anemia, peripheral vascular disease, diabetes
Cellulitis is usually caused by what bacteria?
staph. aureus and streptococci
Furuncle is a deep infection caused by what bacteria?
staphylococci
What side effects are related to oral psoralen in phototherapy?
sunburn and persistent pruritus
How are cellulitis, erysipelas, and carbuncles treated?
systemic antibiotics such as synthetic sulfur
Which finding could be described as visibly dilated, superficial, and cutaneous small blood vessels found on the face and thighs?
telangiectasia
Where does a chondroma form?
the cartilage
What is tenting?
the failure of the skin to immediately return to the normal position after a gentle pinch
During the acute phase of treatment for a full-thickness burn, the nurse should consider what potential complications?
the risk of septicemia and its potential complications from treatment
Shift of plasma proteins into a burned area increases what?
the shift of fluid from the intravascular to the interstitial compartment--leads to decreased blood volume and hypovolemic shock
What type of injury is caused by the open flame in a house fire?
thermal injury
What warning should be given about tazarotene and calcipotriene?
they are teratogenic
Which fungal infection is commonly referred to as ringworm?
tinea corporis
Which fungal infection is commonly referred to as jock itch?
tinea cruris
Which fungal infection is commonly referred to as athlete's foot?
tinea pedis
Prednisone is used to treat what skin condition?
topically to treat psoriasis, rash, dermatitis, itching, and eczema
What is carbon dioxide laser used for?
treatment of skin disorders, vaporizing/cutting tool for most tissues
Ipilimumab is a medication for what?
treats metastatic melanoma; newer treatment option; monoclonal antibody
How does impetigo clinically manifest?
vesiculopustular lesions that develop as thick, honey-colored crust surrounded by erythema
Which nail color would indicate anemia, chronic liver disease, or kidney disease?
white
Which nail color would indicate jaundice or cardiac failure?
yellow-brown
Which skin color indicates an increased urochrome level?
yellow-orange; urochrome is yellow pigment from urine
What is a coalesced skin lesion?
one that merges with another or others and appears confluent
What type of biopsy is usually recommended for superficial or raised lesions?
shave biopsies; they remove the skin portion that rises above surrounding tissues
What layer of the skin retains body heat, acts as a mechanical shock absorber, acts as an energy reservoir, and provides insulation?
subcutaneous
Which fungal infection is commonly referred to as onychomycosis?
tinea unguium, fungal infection of the nails
What causes a breakdown of the denatured protein of the eschar?
topic enzyme preparations
What is the medication clindamycin used for?
topical antibiotic used to treat acne vulgaris to suppress new lesions and minimize scarring
What is the medication Imiquimod used for?
topical immunomodulator that treats plantar warts
Localized edema is caused by what?
trauma or inflammation
What are gold vapors and neodymium lasers used for?
treatment of skin disorders
How does herpes zoster (shingles) clinically manifest?
unilaterally on the trunk, face, and lumbosacral areas along nerve pathways
What type of infection is plantar warts?
viral infection caused by HPV
What type of infection is verruca vulgaris (common warts)?
viral infection caused by HPV
How does tinea cruris clinically manifest?
well-defined scaly plaque in the groin area
When does the hemostasis phase occur?
when wound occurs
Decreased subcutaneous fat, degeneration of elastic fibers, and stiffening of the collagen fibers will result in what?
wrinkles
Desquamation is a serious side effect of what diagnostic procedure?
x-rays
What is psoriasis?
an autoimmune chronic dermatitis that involves excessively rapid turnover of epidermal cells
Which type of laser is used in the treatment of vascular and other pigmented lesions?
argon
How should a client undergoing chemotherapy perform oral care?
clean the mouth with a soft toothbrush or a gentle spray
How does folliculitis clinically manifest?
commonly seen on the scalp, beard, and extremities in men
What are some symptoms of a fungal infection in the toenail?
crumbly, discolored, thickened toenail
What does gray-colored tongue and lips indicate in a dark-skinned client?
cyanosis
What layer of the skin inhibits the proliferation of microorganisms and allows the photoconversion of 7-dehydrocholesterol to vitamin D?
epidermis
Is a shave biopsy, a punch biopsy, or an excisional biopsy more uncomfortable?
excisional biopsy
Fatigue, paresthesia, and cardiac dysrhythmias are clinical manifestations of what electrolyte imbalance?
hyperkalemia
When does the inflammatory phase occur?
immediately after injury; lasts 3-5 days
Wet-to-damp saline-moistened gauze does what?
mechanically removes the necrotic tissue
