Integument

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Which individual is least likely to be at risk for the development of Kaposi's sarcoma?

An individual working in an environment in which exposure to asbestos is possible

A client with acquired immunodeficiency syndrome (AIDS) is diagnosed with the early stage of cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse would expect which assessment finding?

Appearance of reddish-blue lesions on the lower extremities

The nurse prepares to care for a client with acute cellulitis of the lower leg. Which treatment would the nurse anticipate being prescribed for the client?

warm compresses to AA

A client is being admitted to the hospital for the treatment of acute cellulitis of the lower left leg. The client asks the nurse to explain what cellulitis means. Which response would the nurse give to the client's question?

"It is a skin infection that involves the deeper skin layers and subcutaneous fat."

Open dressings

-used when MD wants air circulating to lesions open compresses changed repeatedly, NEVER DRY -rewet 20-30 min -solution room temp or warmer

What time of day should a person avoid sun exposure?

10-2 standard or 11-3 daylight savings

Stevens-Johnson Syndrome

A severe, possibly fatal reaction that mimics a burn; may be due to a medication, infection, mallignancy

Melanoma assessment

A-asymetery B- boarder C-color consistency D-diameter >1/4

When is the best time to apply lotion

After bathing when skin still damp

atopic dermatitis

Excess inflammation; dry skin, redness, and itching from allergies and irritants. (eczema)

stage 3 pressure ulcer

Full-thickness pressure ulcer extending into the subcutaneous tissue and resembling a crater. May see subcutaneous fat but not muscle, bone, or tendon.

stage 4 pressure ulcer

Full-thickness tissue loss with deep ulceration and necrosis -dry, black

Isotretin

Gastrointestinal concerns, birth defects, suicide -organ damage & mental problems

A client arrives at the health care clinic and tells the nurse that he was just bitten by a tick and would like to be tested for Lyme disease. Which nursing action is appropriate?

Inform the client that he will need to return in 4 to 6 weeks to be tested because testing before this time is not reliable.

The client, diagnosed with Lyme disease stage 2, asks the nurse "what is indicative of stage 2?" The nurse explains to the client that which sign or symptom is assessed in stage 2?

Neurological deficts

inhalation burn symptoms

SOB & productive cough

Differentiate between macule and papule

Shine a flashlight at a right angle to the lesion. A papule will cast a shadow. If there is no shadow the lesion is a macule.

Category II skin tear

Skin tear with partial tissue loss, edges not realligned

Category 1 skin tear

Skin tear without tissue loss, edges realligned

exudate w creamy yellow drainage

Staphylococcus

What is a shave biopsy

shaving a top layer off lesion that rises above skin line

contact dermatitis

a delayed allergic reaction from skin contact with a specific allergen, cell mediated

Closed dressings

thoroughly soaked with the prescribed solution and wrapped with an airtight, waterproof material

Cold light

transmitted thru quartz or plastic to dissipate heat -Applied to skin to illuminate layers showing malignant changes

seborrheic

an inflammation that causes scaling and itching of the upper layers of the skin or scalp

Malignant Melanoma

arises from pigment producing cells factors- genetic, solar radiation , steroid hormone influence

Psoriasis

chronic skin condition -inflammed, edematous skin lesions -silvery white scales

Macule

circumscribed flat area, change in skin color <0.5 ex- freckles, petechiae, measles, flat mole

Category III skin tear

complete tissue loss, epidermal flap missing

wood light

ultraviolet light used for diagnosing skin conditions -fungal infections of scalp (erythrasma) chronic bacterial infection of skin folds

Papule

elevated solid lesion <0.5 ex: wart, elevated mole, lipoma, basal cell carcinoma

squamous cell carcinoma

firm nodular lesion, crust

The skin is first line of de

infection

cellu

infection of dermis & subcutaneous tissue causes by staphylococcus -occurs as wound, ulcer or form furuncles or carbuncles

Stage 1 pressure ulcer

intact skin with nonblanchable redness

melanoma

irregular papule w red, white, blue

basal cell carcinoma

irregular waxy border

Elevated solid lesion >0.5

nodule

Stage 2 pressure

partial thickness skin loss involving epidermis, dermis, or both blistered or abraded, surrounding area red

Circumscribed flat area w change in color, >0.5

patch

Parasitic infections

pediculosis & scabies

escharotomie

performed to alleviate compartment syndrome outcome- return of distal pulses

DX for herpes zooster

positive culture results

Salicylic Acid

psoriasis Adverse- tinnitus, dizzy, hyperpnea, psychological disturbances

excisional

removal of an entire lesion

What is a punch biopsy

removing the core from center of lesion

Shock in burn PT

replacement of lost fluids & electrolytes (fluid resuscitation) tissue perfusion


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