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Med-SurgII (ch. 27)
Problems of Protection
| Question | Answer |
|---|---|
| Dry skin | xerosis |
| What a person who cannot take a tub bath can do to reduce dry skin | Wrap trunk and extremities in warm, moist towels covered by plastic sheeting or clean garbage bag for 15-20 min |
| Water seeking | hydrophilic |
| Caused by stimulatoin of itch-specific nerve fibers at teh dermal-epidermal junction | Pruritis |
| A first degree or superficial burn and a very common skin injury | Sunburn |
| The layer of skin injured by excessive exposure to UV light | Dermis |
| May decrease inflammation of sunburn temporarily | Topical corticosteroids |
| Hives; white or red edematous papules or plaques of various size | Urticaria |
| Things to avoid with hives that contribute to blood vessel dilation and make the symptoms worse | Overexertion; alcohol consumption; warm environments |
| The 3 phases of wound healing | inflammatory/"lag" phase; Fibroblastic/connective tissue repair phase; maturation/remodeling phase |
| A wound without tissue loss that can be closed with sutures or staples | clean laceration or surgical incision |
| Wound edges are brought together with the skin layers lined up in correct anatomic position and held in place until healing is complete | Approximated |
| Healing in which the wound can be easily closed and dead space eliminated without granulation, which thus shortens phases of tissue repair; results in think scar | First Intention healing |
| Healing in which deeper tissue injuries/wounds with tissue loss result in a cavity-like defect that requires gradual filling in of the dead space with connective tissue; prolongs repair process | Second Intention Healing |
| healing in which wounds with a high risk for infection are intentionally left open for several days; after debris are debrided and inflammation has subsided, wound is closed by first intention, but involved delayed primary closure; results in scar | Third Intention Healing |
| Dead cells and tissues | Debris |
| Removal of exudate | Debrided |
| The 3 process in which skin integrity is restored following an injury | Re-epithelialization, granulation, and wound contraction |
| The production of new skin cells by undamaged epidermal cells in the basal layer of the dermis and the linings around hair follicles and sweat glands; occurs most rapidly in tissue that is hydrated & oxygenation & has few organisms present | Re-epithelialization |
| Regrowth across teh open area of a skin injury; only one cell layer thick initially | Resurfacing |
| The cell layer forms layers to resemble normal skin | Stratifies |
| How long does healing by re-epithelialization take? | 5-7 days |
| Scar tissue | granulatoin |
| New blood vessels form at the base of wound and fibroblastic cells begin moving into the wound space; fibroblasts deposit new collagen to replace damaged tissue | Proliferation phase |
| Fibroblasts begin to pull wound edges inward along path of least resistance | contraction |
| Necessary for healing to occur | Thorough wound debridement |
| Tissue damage cuased when skin and underlyng soft tissue are compressed between a bony prominence and an external surface for an extended period | Pressure ulcer |
| Restricts blood flow to the skin, resulting in reduced tissue perfusion and oxygenation, leading to cell death | Tissue compression from pressure |
| Complications associated with chronic pressure ulcers | sepsis, kidney failure, infectious arthritis, and osteomyelitis |
| Mechanical forces that impair skin integrity and set the stage for skin breakdaown | Friction and shear |
| Occurs as a result of gravity | Pressure |
| Result of prolonged or excessive pressure | compression of blood vessels at point of contact, leading to ischemia, inflammation, and tissue necrosis |
| Factors influencing pressure | amount of weight exerted at point of contact; distribution of weight at pont of contact; density of contacting surface |
| Generated when skin itself is stationary and the tissues below the skin shift or move | Shear/shearing forces |
| Result of reduced blood supply to skin created by movement of deeper tissue layers | skin hypoxia, anoxia, ischemia, inflammation, and necrosis |
| Predisoposes older people to skin tears from mechanical shearing forces | Progressive flattening of cells at the dermal-epidermal junction |
| Unrelieved pressure of skin | Tissue destruction progresses to ful-thickness injury |
| Use of computerized tool that measures pressure distribution for a person sitting in a chair or lying on a mattress | Pressure mapping |
| The most commonly used skin risk assessment tool | Braden Scale |
| Route of protein loss | draining wounds |
| Nutrition is inadequate when serum albumin level is less than ______; prealbumin level is less than ____; or lymphocyste count is less than ____ | 3.5mg/dL; 19.5 mg/dL; 1800/mm3 |
| Levels are affected by hydration, stress, and infection | serum albumin levels |
| A more sensitive indicator of changes in nutritional status and response to diet supplementation | Prealbumin |
| Requires intake of 30-35 cal/kg of body weight daily with a protein intake of 1.25-1.5 g/kg/day | Positive Nitrogen Balance |
| Up to ____g/kg/day of protein may be needed when nutritional deficits are severe or protein loss is ongoing | 2 g/kg/day |
| Skin should be washed with a ______ to maintain normal acid level when in contact with excessive moisture | pH-balanced soap |
| Why are reddened areas of skin never massaged directly? | Action could damage capillary beds and increase tissue necrosis |
| the amount of pressure needed to occlude skin capillary blood flow in an area at risk | Capillary closing pressure |
| Normal capillary closing pressure | 12-32 mm Hg |
| Characteristics of effective pressure-relieving device | Keeps tissue pressure below capillary closing pressure to ensure adequate tissue perfusion and oxygenation |
| Alteration inflation and deflation of pressure-relieving device through use of electricity | Dynamic systems |
| Made of gel, water, foam, or air and are in a constant state of inflation that distributes pressure load over a larger area and reduces pressure any one area experiences | Static Devices |
| Bony prominences sink tnto mattress or cushion, causing pressure even with special product in place | "bottoming out" |
| Inflammation of skin cells | cellulitis |
| A layer of balck, gray, or brown nonviable, denatured collagen | Wound Eschar |
| Separation of skin layers at wound margins from underlying granulation tissue | undermining |
| "hidden" wound that initially has small opening in the skin with purulent drainage | Tunnels |
| A wound that is exposed is always _______ but is not always ______ | contaminated; infected |
| A contamination with pathogenic organisms to the degree that growth and spread cannot be controlled by the body's immune defenses | Wound infection |
| Helpful only in identifying the types of bacteria present on teh ulcer surface and may be misleading when trying to identify or quantify bacteria in deeper tissues | Swab cultures |
| Allow the numbers of bacteria to be analyzed, but are time consuming, costly, and unavailable in many labs | Wound biopsies |
| Mechanical entrapment and detachment of dead tissue | Mechanical Debridement |
| Creating an environment that promotes self-digestion of dead tissue by the bacterial enzymes | Natural Debridement |
| Self-digestion of dead tissues by bacterial enzymes | Autolysis |
| Ideal environment for pressure ulcer healing | Clean, slightly moist ulcer surface with minimal bacterial colonization |
| Mushiness of healthy tissue | maceration |
| Nonabsorbent, waterproof | hydrophobic |
| The application of a low-voltage current to a wound area to increase blood vessel growth and promote granulation; performed by wound culture specialist; avoid in pt's with pacemaker or wound over heart | Electrical Stimulation |
| Removes fluids or infectious materials from wound and enhances formation of granulation tissue to reduce or even close chronic ulcers; should not be used in areas with skin cancer | Vacuum-assited wound closure |
| The administration of oxygen under high pressure, raising tissue oxygen concentration; reserved for life or limb threatening wounds | hyperbaric oxygen (HBO) |
| Biologically active substances that stimulate cell movement and growth; more successful in clean, surgically debrided chronic wounds | Topical growth factors |
| Engineered products that aid in teh temporary or permanent closure of different types of wounds; used mainly for surgically debrided wounds | Skin substitutes |
| Removal of necrotic tissue and skin grafting or use of muscle flaps to close wounds that cannot heal by epithelialization and contraction | Surgical management of pressure ulcer |
| The removal of thick, adherent wound crust using a scalpel or scissors | Surgical debridement |
| Used for wound closure when full-thickness ulcers cannot close and when natural healing would result in loss of joint function, an unacceptable cosmetic appearance, or a high potential for wound recurrence | Grafting |
| Used to cover deep, massive ulcers or ulcers in which vital structures (bone, tendon) are exposed | Full-thickness free grafts and myocutaneous flaps |
| A full-thickness flap of skin that is raised and rotated to cover the defet, with one edge of the flap still attached to the site of origin to provide a blood supply | Pedicle falp |
| The number of days graft sites are immobilized with bulky cotton pressure dressings to allow vascularization, or "take", of the newly grafted skin | 3-5 days |
| Sign that flap may have inadequate arterial perfusion | A pale flap with delayed capillary filling when blanched |
| Suggests inadequate venous or lymphatic drainage in a pedicle flap | A dusky color or sharp line of colore change |
| Can be substituted for whirlpool therapy for home care | Handheld shower device or forceful irrigation of wound with 35mL syringe and 19 gauge angiocatheter |
| Usually start at the hair follicle, where it is easily collected and grown in the warm, moist environment | Bacterial skin lesions |
| A superficial infection involving only the upper portion of the follicle; rash is raised and red and usualy shows small pustules; caused by staph | Folliculitis |
| Boils; caused by staph; infectioin is much deeper in follicle; large, sore-looking, raised bump that may or may not have a pustular "head" at its point | Furuncles |
| A generalized infection with either staph or strep and invovles the deeper connective tissue | Cellulitis |
| Easily spread to others by direct contact with infected skin and by contact with articles of clothing, bed linens, athletic equipment, towels, and other objects used by those infected | MRSA methicillin-resistant staphylococcus aureaus |
| The most common viral infection of adult skin | Herpes simplex virus (HSV) |
| Infections that cause the classic recurring cold sore | Type 1 (HSV-1) infection |
| Genital herpes | Type 2 (HSV-2) infection |
| Where the herpes virus remains dormant in the body after the first infection | Nerve ganglia |
| Transfer of HSV type 1 and type 2 from one part of the body to another | autoinoculation |
| The number of days outbreaks of oral herpes simplex usually last | 3-10 days |
| Mode of transmition of HSV type 1 | respiratory droplets or by direct contact with an active lesion or virus-containing fluid |
| A form of herpes simplex infection occurring on the fingertips of medical personnel who have come in contact with viral secretions | Herpetic Whitlow |
| Caused by reactivation of the dormant varicella-zoster virus in those who have previously had chickenpox | Herpes zoster (shingles) |
| Where the dormant shingles virus resides | Dorsal root ganglia of the sensory cranial and spinal nerves |
| Severe pain persisting after shingle lesions have resolved | Postherpetic neuralgia |
| When herpes zoster is most likely to be contagious | when leions are present as fluid-filled blisters |
| Complications of herpes zoster | full-thickness skin necrosis, bell's palsy, or eye infection, and scarring |
| Term used to describe dermatophytoses | tinea |
| athlete's foot | tinea pedis |
| dermatophytoses of the hands | tinea manus |
| jock itch | tinea cruris |
| dermatophytoses of the head | tinea capitis |
| ringworm | tinea corporis |
| Where dermatophytes mainly live | soil, animals, and on humans |
| yeast infection | candida albicans |
| Herpes zoster vaccine; when is it recommended? | Zostavax; adults older than 60 years |
| Confirmation of viral infections | Tzanck smear/viral culture (presence of multinucleated giant cells) |
| Confirmation of fungal infections | potassium hydroxide (KOH) test (presence of fungal hyphae) |
| Astringent compresses applied to viral lesions for 20 min 3xd to promote crust formation and healing | Burow's solution |
| Most common systemic drugs used for bacterial skin infections | PCN and cephalosporins |
| Most common systemic drugs used for bacterial skin infections in those who are infected with MRSA | IV vancomycin, oral linezolid, clindamycin |
| Used for the treatment of viral infections | Acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) |
| Used for treatment of dermatophyte and yeast infections | Topical antifugal agents such as imidazole cream |
| Used for widespread or resistant fungal infections | Systemic antifungal agents such as ketoconazole (Nizoral) |
| An infection caused by the spores of the bacterium Bacillus anthracis | Cutaneous Anthrax |
| Most common risk factor for cutaneous anthrax infection in the U.S. | contact with an infected animal |
| Group of people most at risk for cutaneous anthrax infection | farm workers, veterinarians, tannery and wool workers |
| The two features that distinguish anthrax lesions from insect bites or other skin lesions | painless and eschar forms regardless of treatment |
| Treatment indicated for those who have no edema or systemic symptoms and who cutaneous anthrax lesions are not located on head or neck | oral antibiotics for 60 days (Cipro, Doryx, Vibramycin) |
| Treatment indicated for those who have a fever, cutaneous anthrax lesions on teh head or neck, are pregnant, or have extensive edema | Antibiotics given IV and then followed by an oral course for 60 days (Cipro, Doryx, Vibramycin) |
| An infestation by human lice | Pediculosis |
| Head lice | Pediculosis capitis |
| Body lice | Pediculosis corporis |
| Pubic, or crab lice | Pediculosis pubis |
| Treatment of pediculosis | chemical killing of parasites with topical sprays, creams, & shampoos (methrin, lindane, topical malathion) |
| A contagious skin disease caused by mite infestations | scabies |
| Where scabies are carried | on pets (found amoung schoolchildren, homeless people, and institutionalized older patients) |
| Manifestation of scabies | curved or linear white ridges in skin |
| Hypersensitivity reaction of scabies | excoriated erythmatorous papules, pustules, and crusted lesions on elbows, nipples, lower abdomen, buttocks, and thighs and in axillary folds |
| Treatment of scabies infection | Scabicides: permethrin, lindane, malathion, benzyl benzoate |
| The term used when the specific cause of inflammatory rashes is not known | non-specific eczematous dermatitis, or eczema |
| An acute or chronic rash caused either by direct contact with an irritant substance, resulting in toxic injury to the skin, or by contact with an allergen, resulting in cell-mediated immune reaction | Contact dermatitis |
| A chronic rash that occurs with respiratory allergies and atopic skin disease; made worse by factors that include dry or irritated skin, food allergies, chemicals, or stress | Atopic dermatitis |
| Reason long-term oral corticosteroids must be tapered rather than stopped abruptly | adrenal suppression |
| Corticosteroids never cure ___________ | inflammation |
| Method to increase absorption of topical steroids | moisten dressings with warm tap water and place over topical steroid |
| Reason applying oil-based ointments and pastes to the sweaty skin-fold areas should be avoided | maceration and blocking of pores may result in folliculitis |
| Provide some relief of itching but may not keep person totally symptom free | Antihistamines |
| Therapeutic comfort measures for various skin issues | cool, moist compresses and luke-warm baths with bath additives have a soothing effect, decrease inflammation, ad help debride crusts and scales ; colloidal oatmeal preparations, tar extracts, cornstarch, or oils added to baths relieve itching |
| A scaling disorder with underlying dermal inflammation involving an abnormality in the growth of epidermal cells in the outer skin layers | Psoriasis |
| Normal time cells at basement membrane of epidermis take to reach outermost layer, where they are shed | 28 days |
| Number of days cells at basement membrane of epidermis take to reach outermost layer, where they are shed in a person with psoriasis | 4-5 days |
| The proposed cause of psoriasis | an autoimmune reaction resulting from overstimulation of the immune system in which Langerhans' cells in skin respond to unknown antigen, leading to T-cell activation. T-cells target keratinocytes, causing increased cell division an plaque formation |
| Previously injured area is more susceptible to development of cancer or chronic skin problems | Koebner's phenomenon |
| May be mild or can lead to severe joint changes similar to those seen in R.A. | Psoriatic Arthritis |
| Most common type of psoriatis and presents as thick, reddened paules or plaques covered by silvery white scales; borders are sharply defined | Psoriasis vulgaris |
| An explosively eruptive and inflammatory form with generalized erythema and scaling; does not form obvious lesions | Exfoliative psoriasis (erythrodermic psoriasis) |
| Cause of dehydration and hypo/hyperthermia related to exfoliative psoriasis | increased blood vessel dialation and blood flow to skin can reduce fluid volume through evaporative water loss from skin surface |
| When applied to psoriatic lesions, they suppress cell division | Corticosteroids |
| Applied to skin to suppress cell division and reduce inflammation in inpatient care and spcialized outpationg treatment clinics | Tar preparations |
| A topical skin therapy; hydrocarbon similar in action to tar that is a strong irritant and can cause chemical burns; | anthralin (Drithocreme, Lasan) |
| A synthetic form of vitamin D that regulates skin cell division | calcipotriene (Dovonex) |
| A teratogenic topical therapy that can bve effective for many with mild to moderate psoriasis | tazarotene (Tazorac) |
| A physical agent commonly used as a topical treatment in many skin conditions | Ultraviolet (UV) radiation |
| responsible for the obvious biologic effects of the sun, such as burning; producaves more energy | Ultraviolet B (UVB) light |
| Emits a lower level of energy, requiring longer exposure time before cellular destruction occurs | Ultraviolet A (UVA) light |
| Involve the ingestion of a photosensitizing agent 2 hours before exposure to UVA light | Psoralen and UVA (PUVA) treatments |
| Because UVA light produces less enery that UVB light, the onsetof erythema and skin darkening may be delayed as long as ____hrs after exposure | 96 hours |
| Alter the acquired immune response, thus preventing overstimulation of keratinocytes | Systemic Biologic agents |
| Firm, flesh-colored nodules that contain liquid or semisolid material; moves and indents on palpation; material can be expressed if lesion is squeezed | Cysts |
| Most common cyst; asymptomatic; can occur anywhere on the body | Epidermal inclusion cyst |
| Most common cyst on scalp | Sebaceous or pilar cyst |
| A lesion of the sacral area that often has a sinus track extending into deeper tissue structures | Pilonidal cyst |
| Removal of cyst | surgical excision with primary closure |
| Removal of pilonidal cyst | surgical excision healed by second intention |
| Benign epidermal neoplams; appear as multiple "pasted on" papules or plaques ranging in color from flesh tones to brown or black; rough, greasy, wart-like texture | Seborrheic keratoses |
| Treatment of seborrheic keratoses | Cryosurgery or curettage |
| Overgrowth of a scar with an excessive |
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