Integumentary System (Lewis Med-Surg CH.22 & 23)

Describe what is indicated by the ABCDEs of malignant melanoma. A B C D E

A: Asymmetry (one half unlike other half) B: Borders (irregular and poorly circumscribed) C: Color (changes and variations within lesion) D: Diameter (greater than 6 mm) E: Evolving (changing look and appearance)

A patient is a 78-year-old woman who has had chronic respiratory disease for 30 years. She weighs 212 lb (96.4 kg) and is 5 ft 1 in (152.5 cm) tall. She has recently completed corticosteroid and antibiotic treatment for an exacerbation of her respiratory disease. Identify 4 specific predisposing factors for bacterial skin infection in this patient. a. b. c. d.

a. chronic disease b. obesity c. recent antibiotic therapy d. recent corticosteroid therapy

When obtaining important health information from a patient during assessment of the skin, it is most important for the nurse to ask about a. a history of freckles as a child. b. patterns of weight gain and loss. c. communicable childhood illnesses. d. skin problems related to the use of medications.

d. skin problems related to the use of medications. A careful medication history is important because many medications cause dermatologic side effects and patients also use many OTC preparations to treat skin problems. Freckles are common in childhood and are not related to skin disease. Patterns of weight gain and loss are not significant, but the presence of obesity may cause skin problems in overlapping skin areas. Communicable childhood illnesses are not directly related to skin problems, although varicella viruses may affect the skin in adulthood.

A woman calls the health clinic and describes a rash that she has over the abdomen and chest. She tells the nurse it has raised, fluid-filled, small blisters that are distinct. a. Identify the type of primary skin lesion described by this patient. b. What is the distribution terminology for these lesions? c. What other information does the nurse have to document the critical components of these lesions?

a. vesicles b. discrete, localized to the chest and abdomen c. color, size, height, shape, configuration, and odor

What is the most common skin cancer and has pearly borders? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Squamous cell carcinoma

b. Basal cell carcinoma Basal cell carcinoma (BCC) is the most common skin cancer and has pearly borders. Actinic keratosis is an irregularly shaped, flat, slightly erythematous papule with indistinct borders and an overlying hard keratotic scale or horn. Malignant melanoma tumors are often dark brown or black. Malignant melanoma is the deadliest skin cancer and has an increased risk in people with dysplastic nevus syndrome. SCC is a malignant neoplasm of keratinizing epidermal cells.

A patient has a plaque lesion on the dorsal forearm. Which type of biopsy is most likely to be used for diagnosis of the lesion? a. Punch biopsy b. Shave biopsy c. Incisional biopsy d. Excisional biopsy

b. Shave biopsy A shave biopsy is done for superficial lesions that can be scraped with a razor blade, removing the full thickness of the stratum corneum. An excisional biopsy is done when the entire removal of a lesion is desired. Punch biopsies are done with larger nodules to examine for pathology, as are incisional biopsies.

20. What is an appropriate intervention to promote debridement and removal of scales and crusts of skin lesions? a. Warm oatmeal baths b. Warm saline compresses c. Cool sodium bicarbonate baths d. Cool magnesium sulfate compresses

b. Warm saline compresses Tepid or warm solutions should be used when the purpose is debridement, and saline is a common debridement solution. Warm baths of oatmeal and sodium bicarbonate are used for itching of large areas of the body. Magnesium sulfate is used in baths or compresses for inflammation.

What characteristic is commonly seen with dysplastic nevus syndrome? a. Associated with sun exposure b. Precursor of squamous cell carcinoma c. Slow-growing tumor with rare metastasis d. Lesion has irregular color and asymmetric shape

d. Lesion has irregular color and asymmetric shape Dysplastic nevus syndrome involves atypical moles with irregular borders and various shades of color. Dysplastic nevus syndrome may be a precursor of malignant melanoma, although not directly related to sun exposure. There are frequently multiple nevi to monitor.

What is the primary difference between an excoriation and an ulcer? a. Ulcers do not penetrate below the epidermal junction. b. Excoriations involve only thinning of the epidermis and dermis. c. Excoriations will form crusts or scabs, while ulcers remain open. d. An excoriation heals without scarring because the dermis is not involved.

d. An excoriation heals without scarring because the dermis is not involved. An excoriation is a focal loss of epidermis; it does not involve the dermis and, as such, does not scar with healing. Ulcers do penetrate into and through the dermis, and scarring does occur with these deeper lesions. Epidermal and dermal thinning is atrophy of the skin but does not involve a break in skin integrity. Both excoriations and ulcers have a break in skin integrity and may develop crusts or scabs over the lesions.

Priority Decision: When performing a physical assessment of the skin, what should the nurse do first? a. Palpate the temperature of the skin with the fingertips. b. Assess the degree of turgor by pinching the skin on the forearm. c. Inspect specific lesions before performing a general examination of the skin. d. Ask the patient to undress completely so that all areas of the skin can be inspected.

d. Ask the patient to undress completely so that all areas of the skin can be inspected. It is necessary for the patient to be completely undressed for an examination of the skin. Gowns should be provided, and exposure minimized as the skin is inspected generally first, followed by a lesion-specific examination. Skin temperature is best assessed with the back of the hand, and turgor is assessed by pinching the skin on the back of the hand.

CASE STUDY: Cellulitis Patient Profile: W.B., a 72-year-old man, cut his lower arm with a kitchen knife. At the time of the injury, he did not seek medical attention, even though it was fairly deep. On the third day following the injury, he began to be concerned about the condition of the wound and the way he was feeling. Subjective Data • States he has a fever and has had a general feeling of malaise • Has pain in the area of the cut and the entire lower arm Objective Data • 4-cm area around cut is hot, erythematous, and edematous with redness extending both up and down his arm • Temp: 100.8° F (38.2° C) Discussion Questions 1. What other assessment data are needed before treatment begins? 2. What care of the wound should W.B. have taken to prevent the occurrence of cellulitis? 3. What are the usual etiologies of this type of infection? 4. Patient-Centered Care: What discharge teaching does W.B. need to care for his wound and cellulitis? 5. What could result if treatment is not initiated and maintained? 6. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

1. The nurse would assess the size and depth of the injury, what the knife was being used for before the patient cut himself, and whether the patient had problems like this in the past. 2. W.B. should have cleansed the wound with soap and water and sought medical care for cleaning and suturing. A sterile dressing should have been applied, and the arm should have been elevated to reduce edema. 3. Staphylococcus aureus and streptococci are the usual etiologies of this type of infection, often following a break in the skin. 4. Teach W.B. that systemic antibiotics will be necessary and the full course to be taken. Warm, moist packs or dressings should be used to help localize the infection and elevation of the arm to decrease edema. Teach W.B. the signs of it not healing and when to notify the HCP. Hospitalization will be necessary for IV antibiotics if it becomes severe. A follow-up appointment should be made. Care of future similar injuries includes washing with soap and water and seeking medical help. 5. If treatment is not initiated and maintained, gangrene of the extremity and possible septicemia could occur. 6. Nursing diagnoses • Impaired tissue integrity; Etiology: trauma • Risk for infection; Etiology: trauma • Acute pain; Etiology: inflammatory process • Hyperthermia; Etiology: inflammatory process • Lack of knowledge; Etiology: self-care postinjury Collaborative problems Potential complications: gangrene, septicemia

A patient with a contact dermatitis is treated with calamine lotion. What is the reason for using this base for a topical preparation? a. A suspension of oil and water to lubricate and prevent drying b. An emulsion of oil and water used for lubrication and protection c. Insoluble powders suspended in water that leave a residual powder on the skin d. A mixture of a powder and ointment that causes drying when moisture is absorbed

Insoluble powders suspended in water that leave a residual powder on the skin A lotion is an emulsion of water, alcohol, and/or oil. Calamine has insoluble powder that has cooling and drying properties when the residual powder is left after water evaporation. It is useful when itching is present. Ointments and creams have an oil and water base that lubricate and ointments prevent drying. Creams protect skin and paste is a mixture of powder in an ointment base.

Identify the reason/rationale for using the following interventions to control pruritus. Intervention a. Cool environment b. Topical menthol, camphor, or phenol c. Soaks and baths

Intervention Rationale a. Cool environment Vasoconstriction b. Topical menthol, Decreased inflammation camphor, or phenol and blood flow, numbing of itch receptor c. Soaks and baths Vasoconstriction and stopping itch sensation

Identify 1 nursing instruction the nurse should provide to a patient receiving the following medications for dermatologic problems. Medication a. Topical antibiotics: b. Topical corticosteroids: c. Systemic antihistamines: d. Topical fluorouracil: e. Topical immunomodulators:

Medication Nursing Instruction a. Topical Clean skin. Thin film, dry antibiotics: dressings. b. Topical Diagnosis of the lesion first. corticosteroids: Thin layers. Massage in at prescribed frequency. Occlusive dressing. c. Systemic Advise of side effects and antihistamines: potential risks associated with driving or operating heavy machinery. d. Topical Avoid sunlight. Causes fluorouracil: photosensitivity. Warn patient that it will cause painful, eroded dermatitis before healing. e. Topical Heat may be felt at immunomodulators: application site. Red, swelling, blistering, excoriation, itching, peeling, and burning may occur.

The patient has diabetes mellitus and chronic obstructive pulmonary disease that has been treated with high-dose corticosteroids for the past several years. Which dermatologic manifestations could be related to these systemic problems (select all that apply)? a. Acne b. Increased sweating c. Dry, coarse, brittle hair d. Impaired wound healing e. Erythematous plaques of the shins f. Decreased subcutaneous fat over extremities

a. Acne d. Impaired wound healing e. Erythematous plaques of the shins f. Decreased subcutaneous fat over extremities Corticosteroid excess can cause acne (a) and decreased subcutaneous fat over the extremities (f). Diabetes can cause erythematous plaques of the shins (e), and both corticosteroids and diabetes can impair or delay wound healing (d). Increased sweating is seen with hyperthyroidism (b) and coarse, brittle hair is seen with hypothyroidism (c).

What skin condition has hyperkeratotic scaly lesions, is a precursor of squamous cell carcinoma, and may be treated with topical fluorouracil (5-FU)? a. Actinic keratosis b. Basal cell carcinoma c. Malignant melanoma d. Squamous cell carcinoma

a. Actinic keratosis BCC is nodular and ulcerative with pearly borders. Actinic keratosis is the most common premalignant skin lesion. Malignant melanoma is the deadliest skin cancer and has an increased risk in people with dysplastic nevus syndrome. SCC is a malignant neoplasm of keratinizing epidermal cells.

What are the most appropriate compresses to use to promote comfort for a patient with an inflamed, pruritic dermatitis? a. Cool tap water compresses b. Cool acetic acid compresses c. Warm sterile saline compresses d. Warm potassium permanganate compresses

a. Cool tap water compresses Compresses used to treat pruritic lesions should be cool to cause vasoconstriction and have an antiinflammatory effect. Water is most commonly used, and it does not need to be sterile. Acetic acid solutions are bacteriocidal and are used to treat skin infections. Potassium permanganate compresses are questionable.

What is the most common diagnostic test used to determine a causative agent of skin infections? a. Culture b. Tzanck test c. Immunofluorescent studies d. Potassium hydroxide (KOH) slides

a. Culture A culture can be performed to distinguish among fungal, bacterial, and viral infections. A Tzanck test is specific for herpesvirus infections, potassium hydroxide slides are specific for fungal infections, and immunofluorescent studies are specific for infections that cause abnormal antibody proteins.

Match the invasive interventions with conditions that they are used to treat (interventions may be used for more than 1 condition). Interventions Conditions a. Electrodessication (or 1. Malignant melanoma electrocoagulation) 2. Common and genital warts b. Excision 3. Basal and squamous cell carcinomas c. Mohs surgery 4. Telangiectasia d. Curettage 5. Lesions involving the dermis e. Cryosurgery 6. Seborrheic keratoses

a. Electrodessication: 4 (Telangiectasia) (or electrocoagulation) b. Excision: 1 (Malignant melanoma); 2 (Common and genital warts); 3 (Basal/squamous cell carcinomas); 5 (Lesions involving the dermis) c. Mohs surgery: 1 (Malignant melanoma); 3 (Basal/squamous cell carcinomas) d. Curettage: 2 (Common and genital warts); 3 (Basal/squamous cell carcinomas); 6 (Seborrheic keratoses) e. Cryosurgery: 2 (Common and genital warts); 3 (Basal/squamous cell carcinomas); 6 (Seborrheic keratoses)

The patient is visiting the free clinic to refill her medications. During the generalized assessment, the nurse documents alopecia; an increased heart rate; warm, moist, flushed skin; and thin nails. The patient also says she is anxious and has lost weight lately. Which systemic problem will the nurse suspect and relate to the health care provider? a. Hyperthyroidism b. Systemic lupus erythematosus c. Vitamin B1 (thiamine) deficiency d. Human immunodeficiency virus (HIV) infection

a. Hyperthyroidism These manifestations are all present with hyperthyroidism related to accelerated body processes. Alopecia, fatigue, and photosensitivity are seen with systemic lupus erythematosus. Tachycardia, redness of the soles of the feet, and edema are seen with vitamin B1 (thiamine) deficiency. Human immunodeficiency (HIV) infection would more likely manifest as Kaposi sarcoma or eosinophilic folliculitis.

What is the most common reason patients request elective cosmetic surgery? a. Improve self-image b. Remove deep acne scars c. Lighten the skin in pigmentation problems d. Prevent skin changes associated with aging

a. Improve self-image Improvement of self-image is the most common reason for undergoing cosmetic surgery; appearance is an important part of confidence and self-assurance. Acne scars, pigmentation problems, and wrinkling can be treated with cosmetic surgery but the surgery does not prevent the skin changes associated with aging.

A nurse caring for a disheveled patient with poor hygiene observes that the patient has small red lesions flush with the skin on the head and body. The patient complains of severe itching at the sites. For what should the nurse further assess the patient? a. Nits on the shafts of his head hair b. The presence of ticks attached to the scalp c. history of sexually transmitted infections d. The presence of burrows in the interdigital webs

a. Nits on the shafts of his head hair Pediculosis (head lice and body lice) causes very small, red, noninflammatory lesions that progress to papular wheal-like lesions and cause severe itching. Lice live on the scalp and body and nits (tiny white eggs) are firmly attached to hair shafts. Sexually transmitted infections and ticks do not produce these manifestations. Burrows, especially in interdigital webs, are found with scabies.

Which statements are true about skin and skin care (select all that apply)? a. One of the detrimental effects of obesity on the skin is increased sweating. b. Ultraviolet (UV) exposure from tanning beds is safer and causes less damage than UV from the sun. c. The nutrient that is critical in maintaining and repairing the structure of epithelial cells is vitamin C. d. Exposure to UV rays is believed to be the most important factor in the development of skin cancer. e. The photosensitivity caused by various drugs can be blocked using topical hydrocortisone. f. Photosensitivity results when certain chemicals in body cells and tissues absorb light from the sun and release energy that harms the tissues and cells.

a. One of the detrimental effects of obesity on the skin is increased sweating. d. Exposure to UV rays is believed to be the most important factor in the development of skin cancer. f. Photosensitivity results when certain chemicals in body cells and tissues absorb light from the sun and release energy that harms the tissues and cells. Obesity affects skin with increased sweating that causes inflammation and dry skin, poor wound healing, and problems in skin folds. Photosensitivity occurs when certain chemicals absorb light from the sun and harm the skin. Benzophenones block both UVA and UVB rays. Vitamin A, not vitamin C, is critical in maintaining and repairing the structure of epithelial cells. Exposure to UV is important in the development of skin cancer. Chronic UV exposure from tanning beds causes the same damage as UV from the sun.

11. Which skin condition occurs as an allergic reaction to mite eggs? a. Scabies b. Impetigo c. Folliculitis d. Pediculosis

a. Scabies In scabies, mites penetrate the skin and deposits eggs. An allergic reaction can result from the presence of eggs, feces, and mite parts. Streptococci or staphylococci cause impetigo with vesiculopustular lesions that develop a thick, honey-colored crust surrounded by erythema. Folliculitis is a small pustule at the hair follicle opening with minimal erythema caused by staphylococci. Pediculosis is lice.

What is a skin graft that is used to transfer skin and subcutaneous tissue to large areas of deep tissue destruction called? a. Skin flap b. Free graft c. Soft tissue extension d. Free graft with vascular anastomoses

a. Skin flap Skin flaps as grafts include moving skin and subcutaneous tissue to another part of the body and are used to cover wounds with poor vascular beds, add padding, and cover wounds over cartilage and bone. Free grafts transfer the epidermis and part or all of the dermis or include establishment of circulation as well. Soft tissue extension involves placement of an expander under the skin, which stretches the skin over time to provide extra skin to cover the desired area

To prevent lichenification related to chronic skin problems, what does the nurse encourage the patient to do? a. Use measures to control itching. b. Wear sterile gloves when touching the lesions. c. Use careful handwashing and safe disposal of soiled dressings. d. Use topical antibiotics with wet-to-dry dressings over the lesions.

a. Use measures to control itching. Lichenification is thickening of the skin caused by chronic scratching or rubbing and can be prevented by controlling itching. It is not an infection, nor is it contagious, as the other options indicate.

What should the nurse include in the instructions for a patient with urticaria? a. Apply topical benzene hexachloride. b. Avoid contact with the causative agent. c. Gradually expose the area to increasing amounts of sunlight. d. Use over-the-counter antihistamines routinely to prevent the condition.

b. Avoid contact with the causative agent. Urticaria (hives) is inflammation and edema in the upper dermis, most commonly caused by histamine released during an allergic reaction. The best treatment for all types of allergic dermatitis is avoidance of the allergen. Topical benzene hexachloride is used to treat pediculosis. Sunlight and warmth would increase the edema and inflammation. Antihistamines may be used for an acute outbreak but not to prevent the dermatitis.

A female patient with chronic skin lesions of the face and arms tells the nurse that she cannot stand to look at herself in the mirror anymore because of her appearance. Based on this information, the nurse identifies which priority nursing diagnosis? a. Anxiety; Etiology: as a result of personal appearance b. Disturbed body image; Etiology: perception of unsightly lesions c. Lack of knowledge; Etiology: lack of knowledge of cover-up techniques d. Social isolation; Etiology: decreased activities as a result of poor self-image

b. Disturbed body image; Etiology: perception of unsightly lesions Defining characteristics for reduced self-concept problems include verbalization of self-disgust and reluctance to look at lesions, as evidenced in this patient. Social isolation is indicated only if there is evidence of decreased social activities and of anxiety by verbalization of anxiety or frustration. Although impaired health maintenance may be a problem, it is not indicated in this situation.

An active athletic person calls the clinic and describes her feet as having linear breaks through the skin. What is the best documentation of this problem? a. Scales b. Fissure c. Pustule d. Comedo

b. Fissure Fissures are linear cracks, such as athlete's foot. Scales are excess dead epidermal cells. A pustule is a circumscribed collection of leukocytes and free fluid. Comedo is associated with acne vulgaris.

The nurse plans care for a patient with a newly diagnosed malignant melanoma based on the knowledge that initial treatment may involve (select all that apply) a. shave biopsy. b. Mohs surgery. c. surgical excision. d. localized radiation. e. 5-FU. f. topical nitrogen mustard.

b. Mohs surgery c. surgical excision In the early stages, surgical excision with a margin of normal skin is the initial treatment for malignant melanoma (c). Mohs surgery can also be used to treat malignant melanoma (b). A shave biopsy is used for diagnosis, not treatment (a). Radiation may be used for malignant melanoma after excision, depending on staging of the disease (d). Fluorouracil is used to treat actinic keratosis (e). Topical nitrogen mustard may be used for treatment of cutaneous T-cell lymphoma (f).

Which statements describe malignant melanomas (select all that apply)? a. Related to chemical exposure b. Neoplastic growth of melanocytes c. Skin cancer with highest mortality rate d. Irregular color and asymmetric shape e. Frequently occurs on previously damaged skin

b. Neoplastic growth of melanocytes c. Skin cancer with highest mortality rate d. Irregular color and asymmetric shape Malignant melanomas are neoplastic growths of melanocytes, have the highest mortality rate of skin cancers, and are irregular color and asymmetric shape. Cutaneous T-cell lymphoma is related to chemical exposure. Squamous cell carcinoma (SCC) frequently occurs in previously damaged skin.

The patient asks the nurse what telangiectasia looks like. Which is the best description for the nurse to give the patient? a. A circumscribed, flat discoloration b. Small, superficial, dilated blood vessels c. Benign tumor of blood or lymph vessels d. Tiny purple spots resulting from tiny hemorrhages

b. Small, superficial, dilated blood vessels Telangiectasia looks like small, superficial, dilated blood vessels. A small circumscribed, flat discoloration describes a macule. A benign tumor of blood or lymph vessels describes an angioma. Tiny purple spots resulting from tiny hemorrhages describes petechiae.

Which description characterizes seborrheic keratosis? a. White, patchy yeast infection b. Warty, irregular papules or plaques c. Excessive turnover of epithelial cells d. Deep inflammation of subcutaneous tissue

b. Warty, irregular papules or plaques Seborrheic keratoses are irregularly round or oval and are often verrucous (warty) papules or plaques. Candidiasis is a white, patchy yeast infection. Psoriasis is an excessive turnover of epithelial cells. Cellulitis is a deep inflammation of subcutaneous tissue.

Priority Decision: A patient is receiving chemotherapy. She calls the HCP's office and says she is experiencing itching in her groin and under her breasts. What is the first nursing assessment that would be done before the nurse makes an appointment for the patient with the HCP to determine the treatment? a. Her height and weight b. What the areas look like c. If chemotherapy was completed d. Culture and sensitivity of the areas

b. What the areas look like The appearance of candidiasis on the skin shows diffuse papular erythematous rash with pinpoint satellites around the affected area. Height and weight could show if the patient is obese, but it would be better to ask if the areas affected are moist. The chemotherapy could contribute to candidiasis, but it does not matter if the chemotherapy treatments are finished. Culture and sensitivity of the area may be ordered by the HCP at the patient's appointment.

A home health nurse is visiting an older obese woman who has recently had hip surgery. She tells the patient's caregiver that the patient has intertrigo. When the caregiver asks what that is, the nurse should tell the caregiver that it is a. thickening of the skin. b. dermatitis in the folds of her skin. c. loss of color in diffuse areas of her skin. d. a firm plaque caused by fluid in the dermis.

b. dermatitis in the folds of her skin. Intertrigo is dermatitis in the folds of her skin. Thickening of the skin is lichenification. Loss of color in diffuse areas of skin is vitiligo. A firm, edematous area caused by fluid in the dermis is a wheal.

The nurse sees that redness remains after palpation of a discolored lesion on the patient's leg. This finding is characteristic of a. varicosities. b. intradermal bleeding. c. dilated blood vessels. d. erythematous lesions.

b. intradermal bleeding. Discolored lesions that are caused by intradermal or subcutaneous bleeding do not blanch with pressure. Those caused by inflammation and dilated blood vessels will blanch and refill after palpation. Varicosities are engorged, dilated veins that may empty with pressure applied along the vein.

When assessing a black patient, the nurse notes ashen color of the nail beds. What should the nurse do next? a. Palpate for rashes on the legs. b. Assess for jaundice in the sclera of the eye. c. Assess the mucous membranes for cyanosis. d. Assess for pallor of the skin on the buttocks

c. Assess the mucous membranes for cyanosis. In dark-skinned persons, cyanosis is seen as ashen nail beds, conjunctiva, or mucous membranes. Vital signs, lung sounds, and cardiorespiratory history would be assessed after verifying cyanosis of mucous membranes. Palpating for rashes and assessing for jaundice and pallor would not be related to this patient's potential cyanosis.

Which skin conditions are more common in immunosuppressed patients (select all that apply)? a. Acne b. Lentigo c. Candidiasis d. Herpes zoster e. Herpes simplex 1 f. Kaposi sarcoma

c. Candidiasis e. Herpes simplex 1 f. Kaposi sarcoma Patients who are immunocompromised are at an increased risk for candidiasis (a fungal infection), herpes simplex 1 (caused by a virus), and Kaposi sarcoma (vascular lesions on the skin, mucous membranes, and viscera with wide range of presentation). The other options are not at increased risk with immunosuppression. Acne is caused by inflammation of sebaceous glands. Lentigo (also called liver spots or age spots) is caused by an increased number of normal melanocytes in the basal layer of epidermis. Herpes zoster, which is caused by an activation of the varicella-zoster virus, is a group of vesicles and pustules resembling chickenpox located in a linear distribution along a dermatome.

When the nurse is assessing the skin of an older adult, which factor is likely to contribute to dry skin? a. Increased bruising b. Excess perspiration c. Decreased extracellular fluid d. Chronic ultraviolet light exposure

c. Decreased extracellular fluid In older adults, there are decreased surface lipids, apocrine and eccrine sweat gland and sebaceous gland activity, and fewer blood vessels that all cause dry skin. Some older people do not drink enough fluids, and this can also contribute to dry skin. Increased bruising from capillary fragility does not contribute to dry skin. Chronic ultraviolet (UV) light exposure leads to wrinkles.

Which skin condition would be treated with laser surgery? a. Preauricular lesion b. Redundant soft tissue conditions c. Obesity with subcutaneous fat accumulation d. Fine wrinkle reduction or facial lesion removal

d. Fine wrinkle reduction or facial lesion removal Laser surgery reduces fine wrinkles and removes facial lesions. A facelift is used for preauricular lesions and redundant soft tissue reduction. Liposuction is used for obesity with subcutaneous fat accumulation.

A patient with psoriasis is being treated with psoralen plus ultraviolet A light (PUVA) phototherapy. During the course of therapy, for what duration should the nurse teach the patient to wear protective eyewear that blocks all UV rays? a. Continuously for 6 hours after taking the medication b. Until the pupils are able to constrict on exposure to light c. For 12 hours following treatment to prevent retinal damage d. For 24 hours following treatment when outdoors or when indoors near a bright window

d. For 24 hours following treatment when outdoors or when indoors near a bright window Psoralen is absorbed by the lens of the eye, and eyewear that blocks 100% of ultraviolet (UV) light must be used for 24 hours after taking the medication. Because UVA penetrates glass, the eyewear must also be worn indoors when near a bright window. Psoralen does not affect the accommodative ability of the eye.

What is the name for papillomavirus infection seen on the skin? a. Furuncle b. Carbuncle c. Erysipelas d. Plantar wart

d. Plantar wart A plantar wart is caused by human papillomavirus (HPV). A furuncle is a deep skin infection with staphylococci around the hair follicle. A carbuncle is multiple, interconnecting furuncles. Erysipelas is superficial cellulitis primarily involving the dermis.

Priority Decision: A 66-year-old black patient is scheduled to have a basal cell carcinoma on his cheek excised in his health care provider (HCP)'s office. What discharge teaching is most important for the nurse to include for this patient? a. You will probably need radiation as well after the excision. b. It is good you are having it removed to avoid massive tissue destruction. c. It is too bad you can't have this done by laser because it leaves less scarring. d. Using the prescribed ointment and an adhesive bandage will promote the healing with less scarring.

d. Using the prescribed ointment and an adhesive bandage will promote the healing with less scarring. Using the prescribed ointment to keep the wound moist and the bandage for protection will promote healing and less scarring. Radiation is not used after excision of BCC. Without treatment, BCC causes massive tissue destruction, but he has it treated. Laser surgery is not used for BCC, so this is not appropriate. The potential of keloid scarring may be included for this black patient.