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Integ Skin Disorders

common skin disorders of the integumentary system

What is Dermatitis (eczema) assoc. with? inflammation of the skin, redness, itching and skin lesions
List 2 causes of Dermatitis Allergic (contact dermatitis) and Actinic (photosensitivity)
What does the acute stage of dermatitis include red, oozing, crusting rash, extensive erosions, and exudate
What does the sub-acute stage of dermatitis include scaling, scattered plaques and erythamatous skin
What does the chronic stage of Dermatitis include thick skin, marks due to scratching and postinflammatory pigmentation
When treating a pt with dermatitis what substance should you avoid using when utilizing some modalities alcohol
Daily care for dermatitis includes what 2 things lubrication and hydration
How does bacteria typically enter the body by entering an abrasion or puncture wound
What 2 bacteria typically cause impetigo staphylococci and streptococci
Give 4 features of impetigo itching, inflammation, contagious, and assoc. with small pus filled vesicles
Cellulitis is suppurative inflamm of ________ or _________ tissue in or close to the skin cellular, connective
What 2 bacteria usually cause cellulitis to form staphylococci and strptococci
Describe the appearence of an area with cellulitis (5) poorly defined, widespread, hot skin, red skin, edematous (swelled) skin
Is cellulitis contagious yes, it can be
A person with cellulitis shouls do what 3 things to manage their condition cool, wet dressings and antibiotics, and elevate the extremity
What conditions can result from untreated cellulitis (4) lymphangitis, gangrene, sepsis, and abcess
What is an abcess cavity, pus-filled, inflammed tissue
An abcess is the result of a ______ infection local
What type of bacteria usually causes an abcess staphylococcal
What 2 places is Herpes I usually found mouth and face
What 2 symptoms are assoc. with herpes I itching and soreness
Where is Herpes II found usually genital
How is Herpes II spread by sexual contact
Shingles is also known as Herpes Zoster
Why does shingles happen It is a reactiviation of the chicken pox virus lying dormant in the cerebral ganglia, or ganglia of posterior nerve roots
in Herpes zoster the pt. gets pain and tingling along spinal or cranial nerve ________ pattern dermatome, it follows the infected nerve
What symptoms are assoc. with herpes zoster (6) itching, soreness, fever, chills, malaise, and GI disturbances
The neuralgic pain from herpes zoster may last _________, ________ or ________ weeks, months, years
Herpes Zoster is only contagious in people that have not had what childhood virus chicken pox
What 2 modalities are contraindicated for patients with active Herpes Zoster ultrasound and heat
Is there a cure for Herpes zoster no, conservative management using steroids, and anti-viral tx's
What virus causes warts HPV (human papilloma viruses)
How are warts contracted through direct contact
What type of precautions should be used with someone who has warts standard precautions
What is the management for warts cryotherapy, acids, over-the-counter meds, electrodesication
Ringworm and athletes foot are 2 types of _______ infection fungal
How is ringworm and athletes foot transmitted direct contact
what type of precautions are used if tx'ing a pt with ring worm or athletes foot standard precautions
Parasitic infections are cuased by insect or animal contact
scabies is becuase of mites that borrow into the skin
you treat scabies with scabicide
lice is a type of _____________ infection parasitic
lice are treated with special soap or shampoo
how are parasitic infections transmitted direct contact
what type of precautions should be used when a patient has a parasitic infection standard
Name some immune disorders of the skin (4) psoriasis, lupus, scleroderma and polumyositis
is psoriasis acute or chronic chronic
what type of course does psoriasis run exaccerbations and remissions
3 possible causes of psoriasis (3) hereditary, drugs, assoc. immune disorder
what is psoriasis treated with corticosteroids, coal tar, methotrexate, UV light (be careful make sure patient is sensitive or allergic to UV light)
Lupus is a ________, and ____________ inflammatory disorder of ____________ tissue chronic, progressive, connective
Name the 2 types of lupus discoid (DLE)and systemic (SLE)
Describe discoid lupus (4) only skin involvement, flares up with sun exposure, hypo/hyper pigmentation, scars b/c of lesions
Descibe SLE (systemic) chronic, multiple organ systems involved, can be fatal b/c of involvemnt in the major organ systems
what gender does SLE occur in more men or women women
Symptoms of SLE butterfly rash, fever, malaise, chronic fatigue, skin lessions, arthralgia, arthritis, anemia, hair loss, photosensitivity, and raynaud's phenomenon (sensitivity to cold)
is there a cure for lupus no
how do they treat lupus corticosteroid, anti-malarials, cytotoxic agents (immunosuppressive agents), pain medicine
What are some side effects of corticosteroids to look for in your patients increased risk of infection, osteoporosis, wt. gain, HTN, bruising, myopathy, tendon ruptures, diabetes, gastric irritation, and low paotassium
Scleroderma is a _______, _______ disease of connective tissue chronic, diffuse (widespread)
What does it cause int eh skin, joints, blood vessels and internal organs fibrosis
define fibrosis taut, firm, hardening
In scleroderma with skin involvement is it symmetrical or assymetrical symmetrical
What treatments are there for scleroderma corticosteroids, vasodilators, analgesics, immunosuppressive agents
How can physical therapy affect scleroderma slow the development of contracture and deformity
Scleroderma skin is ________ sensitive skin pressure
Polymyositis is a disease of ________ tissue characterized by inflamm, edema, and degeneration of __________ connective, muscles
What types of muscles are affected by polymyositis proximal muscles
is the damage done by polymyositis symmetrical or assymetrical symmetrrical
If there is cardiac muscle involvement with the patients polymyositis it can be _______ fatal
too much exercise in a patient with polymyositis can cause ___________ muscle fiber ________ additonal , muscle
In polymyositis ____________ and ________ ulcers can result from prolonged bedrest contractures and pressure
is a basal cell carcinoma benign or malignant malignant
does a basal cell carcinoma metastisize not usually
A basal cell carcinoma is assoc with pronlonged _____ ___________- sun exposure
is a basal cell carcinoma fast or slow growing slow growing
Describe the features of a basal cell carcinoma (4) raised patch, ivory in color, rolled border, indented center
Does a squamous cell carcinoma usually metastasize yes
is a squamous cell carcinoma fast or slow growing fast
A squamous cell carcinoma is common on _____ exposed areas sun
Describe a squamous cell carcinoma (3) flat, red, poorly defined margins
What is a malignant melanoma tumor arsing from melanocytes
What are the clincial manifestations of a malignant melanoma? Hint ABCD's A - assymetry, uneven edgesB - borders, irregular, poorly definedC - color, black , brown, red or whiteD - diameter, larger than 6mm
What are the risk factors for a malignant melanoma intense sun exposure (repeated sun burns), family hx, people with fair skin and/or freckles
what is the tx for malignant melanoma surgical resection
define contusion bruise with pain, swelling, and discoloration, skin is unbroken, APPLY cold immed
define ecchymosis trauma to underlying blood vessels, turns blue cuase blood enters subcutaneous tissue
define Petechiae tiny hemorrhage w/in dermal/submucosal layers, pinpoint in size red or purple in color
define abrasion scraping away of skin
define laceration irregular tear of skin (jagged wound)
define Pruritus itching
define urticaria smooth, red, elevated patches of skin (hives)
define rash local redness and itching
define xeroderma excessive dryness
How many integumenatary preferred practice patterns are there 5
What is pattern A for Integ primary prevention for integ disorders
What is pattern B for Integ Superficial skin involved - impaired integrity
What is pattern C for Integ Partial thickness skin and scar formation - impaired integrity
What is pattern D for integ Full-thickness skin and scar formaiton - impaired integrity
What is pattern E for integ skin involvement extending to fascia, muscle or bone and scar formation - impaired ingteg integrirty
What types of modalities can you use with a broad spectrum of integumentary disorders (11) manual lyphatic drainage, therapeutic massage, dressing and topical agents, TENS, HVPC, EMS (electrical muscle stimulation), ultrasound, phonophoresis, hydrotherapy, UV light, compression therapies
Name 4 types of Burns thermal, chemical, electrical and radioactive agents
Name the 3 zones of a burn wound zone of coagulation, zone of statis, zone of hyperemia
Name the zone assoc with cell death and irreversible cell injury zone of coagulation
Name the zone assoc with cell injury, patient needs to get treatment within 24-48 hours zone of stasis
Name the zone assoc with minimal cell injury and cell recovery zone of hyperemia
Define a critical burn 10% of body or more with 3rd degree burns, 30% or more with 2nd degree burns
Define a moderate burn less than 10% with 3rd degree burns, 15-30% of body with 2nd degree burns
Define a minor burn less than 2% with 3rd degree burns and less than 15% with 2nd degree burns
Rule of nines (adult) Head and neck - 9%Ant trunk - 18%Post trunk - 18%Each arm - 9%Each Leg - 18%Perineum - 1%
Head, Right ant arm and front of trunk are burned what percentage of the body is burned 31.5%
Left leg (ant/post), perineum, and right ant leg is burned what percentage of the body is burned 28%
post trunk, perinueum and post of both legs is burned what percentage of the body is burned 37%
1st degree burn is also known as a superficial burn
What is damaged in a 1st degree burn epidermis only
Healing of a 1st degree burn occurs in 3-7 days
A superficial burn (1st) is characterized by (3) erythema, slight edema, tenderness (NO BLISTERS)
A 2nd degree burn is also known as a superficial partial-thickness burn or Deep partial thickness burn
what is damaged in a sup partial thickness burn epidermis and upper layers of dermis
what is a sup partial thickness burn characterized by (3) inflammation, pain, blisters
how long does a sup partial thickness burn take to heal 7-21 days
A deep partial thickness burn damages what structures epidermis, dermis, and injury to nerve endings, hair follicles and sweat glands
what are the characteristics of a deep partial thickness burn red/white, edema, blistering and severe pain
how long does a deep partial thickness burn take to heal 21-28 days
full thickness burn is also known as 3rd degree burn
A 3rd degree burn is what color white, gray or black (charred)
is a 3rd degree burn wet or dry dry
do people have pain with 3rd degree burns no
What is eschar scab or dry crust must be debrided
3rd degree burns are assoc. with an increased risk of ___________ infection
what is the difference b/t a hypertrophic scar and a keloid scar BOTH are raised red and firmhypertrophic- stays w/in the borders of original burnkeloid scar - extends beyond the boundaries of the original burn
What is a 4th Degree burn also known as subdermal burn
what is destroyed in a 4th degree burn epidermis, dermis, subcutaneous tissues with muscle and/or bone involvement
What causes 4th degree burns electrical burn, prolonged exposure to flame
A 4th degree burn often requires _________ or _________ surgery or amputation
what is the first thing you should do in emergency burn management immersion in cold water or cold compresses, then cover with sterile bandage (no ointments or creams)
What are some of the complications that can occur with a burn injury? infection, shock, pulm complications (smoke inhalation, pneumonia, restrictive lung disease if trunk is burned), metabolic complications (wt. loss, neg nitrogen balance, decreased energy, Cardiac complications (increased fluid loss = decreased CO)
The Epidermis heals by epithelization
the dermis heals by scar formation (injured tissue replaced by CT)
Describe the inflammatory phase of healing 3-5 days, red, edema, warmth, pain, decreased ROM
Describe the proliferative phase of healing fibroblasts form scar, Wound contraction, Re-epithelization may still occur
Describe the maturation phase of healing up to 2 years long, b/c scar formation can last that long, hypertrophic or keloid scar forms
What is sepsis local or generalized invasion of the body by pathogenic microorganisms or their toxins
Asepsis and wound care - should clothing be removed yes
Asepsis and wound care - should the wound be cleansed yes
Asepsis and wound care - what 2 techniques are used in wound care management open - topical anti-bacterial agents on skin with no bandageclosed - dressing on top of a topcial agent
Name 3 anti-bacterial topical agents typically used with burns silver nitrate (used w/wet dressings)surface organisms only, Silver sulfadiazine, andSulfamylon penetrates through eschar
If you were working in the hospital with a burn victim what should be monitored vital signs, urinary output, electrolyte levels, arterial blood gases, gastrointestinal function
Primary excision removes what surgical removal of the eschar
A Z-plasty is a resection of a ______ contracture scar, used to lenthen it
Grafts are used to _______ the wound close
Autograft use pt's own skin
Allograft (homograft) another human's skin
Xenograft (heterograft) skin from another species
biosynthetic grafts collagen and synthetics
cultured skin lab grown from pt's own skin
split-thickness graft epidermis and upper layers of dermis from donor site
full-thickness graft epidermis and dermis from donor site
ant neck splinting for burns hyperext w/plastic cervical orthosis
shoulder splinting for burns flexion, ER, ABD
elbow splinting for burns extension and sup
hand splinting for burns 15 deg wrist extension70 deg MCP extensionPIP and DIP extensionthumb ABD
Hip splinting for burns extension, ABD, neutral rot
knee splinting for burns extension w/post knee splint
ankle splinting for burns df with foot in ankle neutral
what is the etiology of arterial ulcers arteriosclerosis obliterans, non-healing trauma, chronic arterial insufficiency, artheroembolism
what is the etiology of venous ulcers chronic venous infufficicency, venous HTN, hx of DVT, valvular incompetance
An arterial ulcer appears irregular, smooth edges, DEEP wound
an venous ulcer appears dark pigmented, sometimes fibrotic, shallow
Where does an arterial ulcer form distal lower leg usually on toes and feet, lat malleolus, ant tibial area
where does on venous ulcer form med malleolus, and distal lower leg
Are pedal pulses absent or present in an arterial ulcer diminished or absent
Are pedal pulses absent or present in an venous ulcer present
When the legs are elevated an arterial ulcer feels _______ painful and a venous ulcer feels _______ painful more, less
does a venous ulcer have exudate yes
Gangrene may be _________ in an arterial ulcer and _________ in a venous ulcer present, absent
what are the assoc signs of a arterial ulcer trophic changes, pallor in foot upon elevation, Rubor upon dependency
What are the assoc signs of venous ulcer edema, cyanosis upon dependency (not always)
what is the etiology of a diabetic ulcer DIABETES - assoc with arterial and neuropathy
where do diabetic ulcers usually occur plantar aspect of foot sometimes lat malleolus
are diabetic ulcers painful not usually
what fatal condition is assoc with diabetic foot ulcers sepsis
Will the pt with a diabetic neuropathy have an ankle reflex no, b/c of neuropathy
A pressure ulcer (Decub, bed sore) is caused by unrelieved pressure resulting in ishcemic hypoxia and damage to underlying tissues
shearing is caused by an external force
friction is caused by an rolling or sliding over something
what color is a pressure ulcer red, brown/black or yellow
how many stages of pressure ulcers are there 4
A stage I pressure ulcer nonblanchable erythema, pain/itching, skin may be cool or warm, tissue consitency may be firm or boggy
A stage II pressure ulcer superficial ulcer involves epidermis and/or dermis, abrasion, blister
a stage III pressure ulcer full-thickness skin loss may extend down to but not through underlying fascia, deep crater
a stage IV pressure ulcer full thickness skin loss, extensive destruction of tissue, damage to muscle or bone or suppporting structures
To assess the size of a wound what 4 things should be looked at length, width, depth, and wound area
what 2 tools should you use to assess area and depth film grid, q-tip (depth)
What is tunneling underlying tissue destruction beneath intact skin
what is serous fluid watery-like serum
what is purulent fluid contains pus
what is sanguinous fluid contains blood
what is a red wound indicative of healthy granulated tissue
what is a yellow wound indicative of contains slough(dead tissue) is fibrous tissue
what is a black wound indicative dried necrotic tissue(eschar)
what is an indolent ulcer an ulcer slow to heal, not painful
what is a halo of erythema around a wound indicative of cellulitis
What is maceration indicative of may lead to wound deterioration or enlargement
what are trophic changes wound is poorly arterially supported
Name some topical anti-mircrobials silver nitrate, silver sulfadiazine, erythromycin, gentamycin, neomycin, triple antibiotic
Name some anti-inflammatory agents corticosteroids, hydrocortisone, ibuprofen, indomethacin
Name one topic anesthetic lidocaine
Describe a vacuum assisted closure open cell foam dressing put in a wound, the subatmospheric pressure is controlled, 125mmHG, controls edema, increases blood flow, and removes infectious material
what is hyperbaric oxygen therapy pt reaches 100% oxygen in a chamber with a raised atmospheric pressure, this reverses hypoxia by oversaturating oxygen in blood
what is Pulsatile lavage squeezable bottle with suction to remove wound debris
when is a whirlpool indicated in wound care ulcers with a lot of exudate, slough and necrotic tissue
what is wound debridement removal of necrotic or infected tissue which decreases bacteria and improves wound healing
what is an unna boot a pliable nonstretchable dressing impregnated with ointment
what types of e-stim can you use on a wound direct current with continuous waveform, HVPC, MENS, alternating biphasic current
lift don't ______ drag
is it best to use a transfer board in w/c transfers yes minimize shear and friction forces
what is a hydrocolloid adhesive waters that interact with wound fluid to form a gel over it
is a hydrocolloid semiocculsive or occlusive both
what types of wounds would a hydrocolloid be good for partial-thickness, mild-exudate, supports autolytic debridement of necrotic tissue
what is a hydrogel water or glycerine based gel, insoluble in water
what types of wounds would a hyrdrogel be good for partial to full-thickness, wound with necrosis, radiation burns
what is a foam semipermeable membrane
what are the 2 types of foam hydrophilic or hydrophobic
what types of wounds would a foam be good for partial to full-thickness w/ min-mod exudate, as a 2nd layer,
what is an alginate soft, absorbent which is derived from seaweed, form a viscous hydrophilic gel
what types of wounds would an alginate be good for mod-large amts of exudate, exudate and necrotic wounds, wounds that need packing, infected/noninfected exudating wounds
gauze can be used for what 3 techniques wet to dry, continuous dry, continous moist
what types of wounds would a gauze be good for exudative wounds, wounds with dead space or tunneling, wounds with both necrotic and exudate
when should surgical debridement be used cellulitis, immunocompromised pts, where an infection threatens the pts life
Created by: dcohen
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