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Integumentary

Chapter 16 Part 1 Skin Disorders

QuestionAnswer
Nevi (moles) – Rounded, well-defined borders – Less than 5 mm; May be flat or raised; – May be singular or in groups
Seborrheic Keratoses – Benign overgrowth and thickening of cornified epithelium – Age-related-Adults > 50: on face and trunk - Cosmetic concern – Smooth or flaky-tan, yellow, darker brown
Psoriasis - Chronic auto-immune skin disorder - Raised, reddened, round circumscribed plaques covered by silvery white scales - Most common type is plaque psoriasis - AKA (psoriasis vulgaris) - Occurs most often in Caucasians; as child or middle 30’s.
Precipitating factors for Psoriasis – Certain drugs may act as trigger – Family history – Skin trauma from surgery – Sunburn – Excoriation – Sunlight – Stress – Seasonal changes – Hormone fluctuations – Steroid withdrawal
Hyperkeratosis – Abnormal keratin comes to outer layer of skin at greater rate - Produces abnormal cells with inflammatory response – Found over elbows, knees, scalp – Appear purple in darker-skinned patients
Manifestations of Hyperkeratosis - Characteristic lesions -silvery leathery plaques; May weep - Nails pitting, yellow/brown discoloration; separation from bed - Psoriatic arthritis
Psoriasis Diagnosis - Skin biopsy-If atypical - Ultrasound of skin
Psoriasis Treatments • Based on type, extent/location, pt age, degree of disfigurement • No cure • Topical medications • Oral immunosuppressants, if needed • Sunlight • Phototherapy • Photochemotherapy
Topical Psoriasis Medications Corticosteroids-anti-inflammatory-better with occlusive dressing
Topical Psoriasis Medications Tar preparations –decrease cell growth and inflammation: those from coal tar stain black with strong odor; Anthralin-made from coal tar without stain or have odor-used as shampoo
Topical Psoriasis Medications Vitamin D derivative
Phototherapy (Psoriasis Treatments) - Used sunlight in past, but can now use controlled UVB or UVA rays -gradually increasing dosage - UVB-decreases growth of epidermal cells - PUVA-w/lotion to make more sensitive/use of UVA rays - Eyes must be shielded; Must prevent severe sunburn
Photochemotherapy (Psoriasis Treatments) - Oral administration of chemo agent followed w/UVA exposure - High success rate with side effects of aging of exposed skin, risk of melanoma and altered immune function
Priorities of care for Psoriasis – Ensure adequate treatment of underlying process – Support physical and psychological responses – Provide emotional support – Teach patient and caregivers strategies for self-care
Pyoderma – Infection that occurs when a break in the skin allows invasion by pathogenic bacteria
Common infections of skin – Gram-positive Staphylococcus aureus (MRSA) – Beta-hemolytic streptococci
Folliculitis - Starts at hair follicles - Caused by S. aureus - Scalp and extremities; Pustules surrounded by area of erythema
Furuncles - Called boils-down hair shaft into dermis - Cysts may drain substantial amounts of purulent drainage
Carbuncle - Group of infected hair follicles - Common in hot, humid climates
Cellulitis - Reddened circle or streaks - Localized infection of dermis, subcutaneous tissue - Substance released (Spreading factor) breaks down barriers that usually localize infections
Methicillin-resistant Staphylococcus aureus (MRSA) infection - Skin, urine lungs and blood
Diagnosis of MRSA - Culture and sensitivity - Culture drainage from cleansed wound or blood culture - Test culture from external nares to identify carriers
Treatment of MRSA Antibiotic based upon sensitivity results, topical/oral or IV; Vancomycin IV-requiring trough drug levels for therapeutic doses prior to admin
Dermatophytes (Fungal Infection) - Tinea-like warm moist locations - Ringworm, athlete’s foot, jock itch-from direct contact
Candidiasis - Caused by fungus Candida albicans - AKA moniliasis - Found in moist skinfolds and mouth - Occurs from use of broad spectrum antibiotics that kill normal skin flora and allows candida to grow - Diabetes, immunodeficiencies, AIDS, chemotherapy
Vaginal infection (Yeast) - Odorless, thick cheesy discharge with itching and irritation
Diagnosis of Fungal Infection - Inspection and report - Cultures; Microscopic examination using KOH - Examination of skin with ultraviolet light (Wood's lamp)
Medications for Candidiasis Vaginal or skin treatment with topical cream (nystatin, miconazole) or oral fluconazole x 3 d – Oral candidiasis-Mycostatin swish and swallow
Herpes simplex 1 -(above the waist) - Skin and mucous membranes- forms vesicle (blister) – Lips, face and mouth – Initial infection often severe – Spread by contact, kissing, oral sex during outbreak - May have systemic sxs-fever, malaise
Herpes simplex 1 (HSV-1) - Virus lives in nerve ganglia: - Lesion heals in 10-14 days-if immune system healthy - Virus lies dormant and may have recurrent lesions - Triggers-sunlight, menstruation, injury, stress - Oral acyclovir used to treat current outbreak
Herpes simplex 2-Genital herpes - Caused by HSV-2 (below the waist)-first outbreak most severe - Spread by contact, sexual activity: (may have Herpes simplex 1 with oral sex) - Same treatment, progression and dormancy as type 1
Herpes zoster (Shingles) - Caused by reactivation of varicella zoster (herpes virus causing chickenpox) - Most common in adults over 60, patient's with leukemias, lymphomas, immunocompromised, HIV-may be first sign
Created by: pdimple