Module 4

Which of the following integumentary symptoms that need attention from a healthcare professional? Select all that apply.

-Inflammation -Pruritus -Cutaneous lesions or eruptions --erythema -pain

keratoses

Benign lesions that are usually associated with aging or skin damage

crust

Dry, rough surface or dried exudate or blood

stratum basale (base layer)

the innermost layer of the epidermis, located on the basement membrane

seborrheic keratosis

-A sudden increase in the number of these lesions may indicate the presence of an internal malignancy, most commonly the stomach -Benign growths originating in the epidermis -Usually painless but may itch -Appear as tan-brown, greasy papules or plaques -May have a rough, wartlike texture

actinic keratosis

-Benign growths originating in the epidermis -Initially appear as rough, vascular skin which later forms a yellowish brown crust -Common premalignant lesions seen on sun exposed areas of the body -Caused by long-term exposure to the UV portion of sunlight -Light-skinned individuals are at a higher risk of developing

Which of the following are true regarding decubitus ulcers? Select all that apply.

-Commonly called a pressure ulcer or bed sore, is a localized area of dead skin that can affect the epidermis, dermis, and subcutaneous layer. -Signs that eventually occur include blisters, erosions, necrosis, and ulceration. -Caused by impairment or lack of blood supply to the affected area of skin. This is the result of constant pressure against the surface of the skin, as seen in people who are debilitated, paralyzed, or unconscious. -It is vital to make arrangements for those who are immobile to be visited by a physician in their environment. -An early sign is shiny, reddened skin appearing over a bony prominence in individuals with prolonged immobilization.

urticaria

-Example: ingested substances such as shellfish or certain fruits or drugs -S/S include: eruption of hard, raised erythematous lesions on the skin, often scattered all over the body, highly pruritic lesions -results from a type I hypersensitivity reaction -Occasionally can develop in the pharyngeal mucosa and may obstruct the airway, causing difficulty with breathing -over-the-counter antihistamines often proves effective. In more serious cases where inflammation of the airways occurs, prescription corticosteroids taken orally can be effective but are usually only used in more severe cases

Malignant Melanoma

-Grow quickly, extending down into the tissues, then metastasize quickly to the regional lymph nodes and then to other organs, leading to a poor prognosis in many cases -Change in shape, especially the development of an irregular, notched border of an area with a previously regular border -Change in the surrounding skin: redness, swelling, or the development of colored areas adjacent to, but not part of, the pigmented area

Imetigo

-It is a highly contagious infection, it is a significant threat to neonates in nurseries due to their immature or compromised immune system and close contact with potentially infected caregivers or equipment -In older children, infection results primarily from S. aureus but, alternatively, may be caused by group A beta-hemolytic streptococci -S/S include: Small red vesicles are present, which rapidly enlarge, vesicles will rupture to form yellowish-brown crusty masses. Underneath this characteristic crust, the lesion is red and moist and exudes a honey-colored liquid, additional vesicles develop around the primary site by autoinoculation with hands, towels, or clothes, pruritus is common, leading to scratching and further spread of infection. -Is commonly spread among team members of full-contact sports in which mats or equipment (fomites) serve to spread the infection from one person to the next.

Kaposi sarcoma (KS)

-Lesions progress to form large, irregularly shaped plaques or nodules, which may be darker in color, purplish or brownish -Lesions progress to form large, irregularly shaped plaques or nodules, which may be darker in color, purplish or brownish -The malignant cells arise from the endothelium in small blood vessels

Which of the following is true regarding vitiligo? Select all that apply.

-Possibly an autoimmune condition, it produces pale irregular patches of skin, often evenly located on one side of the body -The patches may enlarge, shrink, or stay the same size. -any area of the body and affects all races -stressful incident -Patients should be encouraged to wear sunscreen -Possibly an autoimmune condition, it produces pale irregular patches of skin, often evenly located on one side of the body

contact dermatitis

-Sensitization occurs on the first exposure and on subsequent exposures, manifestations such as a pruritic rash develop at the site a few hours after exposure to that allergen -caused by exposure to an allergen or by direct chemical or mechanical irritation of the skin -S/S include: pruritic area, erythematous (reddened) area, edematous (swollen) area, area often covered with small vesicles -Example: poison ivy may cause lesions, often linear, on the ankles or hands, or a necklace may cause a rash around the neck -Removal of the irritant as soon as possible and reduction of the inflammation with topical glucocorticoids are usually an effective treatment

Which of the following is true regarding albinism? Select all that apply.

-The patient is pale skinned, with white hair and generally pink or pale blue eyes -A rare disorder occurring in all races, albinism often is accompanied by eye problems. Eye problems may include myopia, hyperopia, astigmatism, nystagmus, strabismus, and photophobia -This genetic disorder has no cure, but many of the eye problems can be treated

herpes zoster (shingles)

-Treatment is directed toward making the patient comfortable. Analgesics, mild tranquilizers or sedatives, antipruritics, steroids and a drying agent to be applied directly to the vesicles may be prescribed -Although it can affect any age group, those older than 55 are more frequently affected -Is diagnosed by its characteristic pattern and painful vesicles. One can confirm the diagnosis by culturing the virus from vesicle scrapings.

seborrheic

-Treatment of cradle cap involves gentle massage of the scalp to loosen scales and improve circulation. When scales are present, shampooing daily with a mild soap is recommended. -One of the more effective methods of treatment is the use of a low-strength cortisone or hydrocortisone cream applied topically to the affected area -the frequent use of nonprescription shampoos containing tar, zinc pyrithione, selenium sulfide, sulfur, and salicylic acid is recommended

herpes simplex

-Viral particles may be present in the saliva for some weeks following healing of the lesion and therefore can spread the infection to others or to the fingers—for example, if there is a break in the skin -is the most common cause of cold sores or fever blisters, which occur on or near the lips -Recurrence may be triggered by infection such as a common cold, sun exposure, or stress. The virus is spread by direct contact with fluid from the lesion -The primary infection may be asymptomatic, but the virus remains in a latent stage in the sensory nerve ganglion of the trigeminal nerve, from which it may be reactivated, causing the skin lesion -A potential complication is spread of the virus to the eyes, causing keratitis (infection and ulceration of the cornea) -S/S include: A preliminary burning or tingling sensation along the nerve and at the site on the lips & development of painful vesicles, which then rupture and form a crust; spontaneous healing occurs in 2 to 3 weeks

Which of the following are ways to protect skin against excessive sun exposure? Select all that apply.

-Wear protective clothing, especially a hat. -Avoid sunlight between 10 AM and 3 PM, when ultraviolet (UV) rays are the strongest. -Use a sunscreen with a sun protection factor (SPF) of at least 15, applied 15 to 30 minutes before exposure and again after getting wet, especially after swimming.

partial thickness burn

-also known as partial-thickness burns -Grafts may be necessary to cover larger areas. These burns easily become infected, causing additional tissue destruction and scar tissue formation. -The area is red, edematous, blistered, and often hypersensitive and painful during the inflammatory stage. In severe cases, the skin appears waxy with a reddened margin. The dead skin gradually sloughs off, and healing occurs by regeneration from the edges of the blistered areas and from epithelium lining the hair follicles and glands. -The area is red, edematous, blistered, and often hypersensitive and painful during the inflammatory stage. In severe cases, the skin appears waxy with a reddened margin. The dead skin gradually sloughs off, and healing occurs by regeneration from the edges of the blistered areas and from epithelium lining the hair follicles and glands. -involve the destruction of the epidermis and part of the dermis

superfical burn

-also known as superficial burns -damage the epidermis and may involve the upper dermis -Examples include sunburn or a mild scald

superficial burn

-also known as superficial burns -damage the epidermis and may involve the upper dermis -Examples include sunburn or a mild scald

atopic dermatitis

-common problem in infancy and may persist into adulthood in some persons -Areas affected include the flexor surfaces of the arms and legs (eg, antecubital areas) and the hands and feet. -Eosinophilia and increased serum IgE levels indicate the allergenic basis -S/S in children include: Pruritic lesions may appear, lesions are moist, red, vesicular, and covered with crusts, involved areas are usually located symmetrically on the face, neck, extensor surfaces of the arms and legs, and buttocks

full thickness burn

-result in destruction of all skin layers and in cases of fourth-degree burns, often underlying tissues as well -The burn wound area is coagulated or charred and therefore is hard and dry on the surface. This damaged tissue (eschar) shrinks, causing pressure on the edematous tissue beneath it -Initially the burn area may be painless because of the destruction of the nerves, but it becomes very painful as adjacent tissue becomes inflamed due to chemical mediators released by the damaged tissues

Dermatophyosis

-the affected skin must be kept as clean and dry as possible, clothing should be loose-fitting and clean, and exercise should be limited to prevent excessive perspiration. -based on the appearance and location of the lesions. To isolate the causative fungus, a culture of the lesions is necessary. -Antifungal medications are prescribed either for topical application (ointment) or for oral use, depending on the severity of the infection. Selsun shampoo (2.5% selenium sulfide) is usually prescribed for treatment

stratum spinosum (spiny layer)

-the layer located above or outward of the stratum basale. -This layer is composed of irregularly shaped cells with intercellular connections called desmosomes

verrucae (warts)

-they frequently develop in children and young adults and are annoying but relatively harmless -S/S include: A papule, which is a solid, raised lesion with distinct margins & papules will develop a rough surface, white or tan in color, and often are multiple, may be painful if pressure is applied, especially on feet -Warts tend to persist even with treatment. Sometimes they resolve spontaneously within several years. -caused by human papillomaviruses (HPVs) -Common plantar warts are caused by HPV types 1 through 4

Stratum lucidum (clear layer)

A layer composed of the degenerating keratinocytes that are flattened, closely packed with indistinct cell margins.

seborrheic dermatitis

Affected skin is reddened and covered by yellowish, greasy-appearing scales. Itching may occur but is usually mild. can occur at any age, but is most common during infancy, when it is called cradle cap is marked by a gradual increase in the amount of, and a change in the quality of, the sebum produced by the sebaceous glands. The inflammation occurs in areas with the greatest number of sebaceous glands

benign tumor

Are usually a cosmetic problem only

basal cell carcinoma

Arises in the deepest layer of the epidermis, most common sites are sun-exposed areas. About 70% of theses lesions occur on the face

The diagnosis of actinic keratosis is made by visual examination; what may be necessary to confirm the findings?

Biopsy

scabies

Common sites include the areas between the fingers, the wrists, the inner surfaces of the elbow, and the waistline. Inflammation and pruritus caused by the damage done to the skin by the burrowing and the presence of mite fecal material in the burrow result of an invasion by a mite, Sarcoptes scabiei

subcutaneous tissue (hypodermis)

Consists of connective tissue, fat cells, macrophages, fibroblasts, blood vessels, nerves, and the base of many of the appendages

pustule

Elevated, erythematous lesion, usually containing purulent exudate

vesicle

Elevated, thin-walled lesion containing clear fluid (blister)

hair follicle

Has smooth muscle attached to it, the arrector pili, which is controlled by sympathetic nerves and may be stimulated by emotion or exposure to cold.

What is an immediate concern of a burn patient?

Inhalation of toxic or irritating fumes

plaque

Large, slightly elevated lesion with flat surface, often topped by scale

premalignant tumors

Must be identified and treated as early as possible to prevent them from developing into malignancies

Which of the following are warning signs of skin cancer? Select all that apply.

New moles or odd-shaped lesions that develop A change in shape, size, color, or texture of a lesion. A skin lesion that bleeds repeatedly, oozes fluid, or itches A sore that does not heal

squamous cell carcinoma

Painless, malignant tumor of the epidermis; sun exposure is a major contributing factor. The lesions are found most frequently on exposed areas of the skin, such as the face and neck. Smokers also have a higher incidence in the lower lip region and mucous membranes of the mouth.

nodule

Palpable, elevated lesion; varies in size

sebaceous glands

Produce oily sebum which keeps the hair and skin soft and hinders fluid loss from the skin

A large part of a nurse's role is to encourage preventive measures, and if any signs of impending skin breakdown are seen, they must _______________.

Promptly report to provider

scleroderma

S/S include: Hard, shiny, tight, immovable areas of skin are present, fingertips are narrowed and shortened, and the Raynaud phenomenon may be present, further predisposing the individual to ulceration and atrophy in the fingers, the facial expression is lost as the skin tightens, and movement of the mouth and eyes may be impaired The cutaneous form may also affect the microcirculation of various organs, eventually causing renal failure, intestinal obstruction, or respiratory failure due to pulmonary hypertension Collagen deposition in the arterioles and capillaries reduces blood flow to the skin or internal organs. Collagen deposits, inflammation, and fibrosis with decreased capillary networks develop in the skin

papule

Small, firm, elevated lesion

macule

Small, flat, circumscribed lesion of a different color than the normal skin

Stratum corneum (horny layer)

The outermost layer of the epidermis composed of flat, dead cells that are constantly being shred and replaced from the underlying layers

impetigo

Topical antibiotics may be used in the early stages, but systemic administration of these drugs is necessary if the lesions are extensive. Unfortunately, the number of antibiotic-resistant strains of S. aureus is increasing, resulting in local outbreaks of infection.

Deeper infections can cause the formation of a mass of pus in the tissue, which is referred to as an _________.

abscess

What is a formation of a mass of pus in the tissue?

abscess

pediculosis

are small, brownish parasites that feed off human blood and cannot survive for long without the human host. Macule is highly pruritic owing to mite saliva. The excoriations that result from scratching and the visible nits provide evidence of infestation; the adult lice usually are not visible. Pediculus humanus corporis is the body louse, Pediculus pubis is the pubic louse, and Pediculus humanus capitis is the head louse

psoriasis

chronic inflammatory skin disorder that affects 1% to 3% of the population and is considered to be genetic Onset usually occurs in the teen years, and the course is marked by remissions and exacerbations Results from the abnormal activation of T cells and an associated increase in cytokines in affected tissues. These immunologic changes then lead to excessive proliferation of keratinocytes and the symptoms of the disease

epidermis

consists of 5 layers, which vary in thickness at different areas of the body

A large part of a nurse's role is to discourage preventive measures and never report of any signs of impending skin breakdown to the provider.

false

A large part of a nurse's role is to encourage preventive measures and promptly report of any signs of impending skin breakdown to the provider.

false

A mild concern in the case of a burn patient is the inhalation of toxic or irritating fumes.

false

An immediate covering of a clean wound is needed to protect the burned area and prevent scaring.

false

If not treated vigorously, the ulcer progresses from a simple erosion of the skin to complete involvement of all layers of skin. Eventually, the ulcer will heal on its own.

false

stratum granulosum (granular layer)

the layer where the process of surface keratin formation begins

dermis

thick layer of connective tissue varying in thickness over the body that lies below the epidermis and includes elastic and collagen fibers.

An immediate covering of a clean wound is needed to protect the burned area and prevent infection.

true

Basal cell carcinoma and squamous cell carcinoma can develop in anyone, especially those with a history of sun exposure, but people at highest risk have both have fair skin and light-colored hair and eyes.

true

Biopsy is an important procedure in the detection of malignant changes in tissue and provides a safeguard prior to or following removal of any skin lesion.

true

If not treated vigorously, the ulcer progresses from a simple erosion of the skin to complete involvement of all layers of skin. Eventually, the ulcer extends to the underlying muscle and bone tissue, and osteomyelitis and/or gangrene may result.

true

In order to prevent dermatophytosis, the patient needs to be instructed to wear loose-fitting cotton clothing that helps prevent the condition. The patient must dry the skin after bathing or swimming, with special attention to drying the skin between the toes and in folds of the skin.

true

Patients with SCC should have a lymph node examination to assess for nodal metastases.

true

Which of the following are in the ABCDEs of Malignant Melanoma? Select all that apply.

• A = Asymmetry (lack of equality in the diameter) • B = Border (notched, scalloped, or indistinct) • C = Color (uneven, variegated—ranging from tan, brown, or black to red and white) • D = Diameter (usually larger than 6 mm) • E = Evolving (Any change in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting points to danger.)