1523 Evidence Based Practice: Skin & Tissue Integrity

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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


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