EAQs Integumentary

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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


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