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Exam 16- Integ/MS


aloplecia loss of hair
angioma benign tumors made up of small blood vessels or lymph vessels, birthmark
crust dried serum, blood, purulent exudate, slightly elevated, size varies
furuncle boil, inflammation deep in the hair follicle, spreads to surrounding tissues
carbuncle cluster of furuncles
dermatitis inflammations of the skin-through direct contact with an agent
eczema 1.commonly associated with allergies 2.seen in infants 3.papular and vesicular lesions that rupture
keloid tough, irregularly shaped scar that becomes enlarged
macule discolored spot, not raised above surface
papule elevated, firm, circumscribed area
nodule elevated, firm, circumscribed lesion extending deeper into the dermis
vesicle elevated circumscribed skin lesion, not into the dermis, filled with serous fluid
pustule elevated, superficial lesion, filled with purulent fluid
tinea pedia athlete's foot
wheal elevated, irregularly shaped area of edema
1. stratum corneum 2. pigment layer 3. stratum germinativum epidermis
1. "true skin" 2. contains blood vessels, nerves, glands, hair follicles 3. cells composed of connective tissue and elastic fibers, bathed in interstitial fluid 4.papillae dermis
1. "fatty layer" 2. adipose tissue and loose connective tissue 3. stores water and fat, insulates, protects organs, pathway for nerves and blood vessels subcutaneous
sudoriferous glands sweat glands
ceruminous glands 1. secrete wax like substance called cerumen 2. located in external ear canal
sebaceous glands 1. "oil glands" 2. lubricate skin and hair 3. inhibits bacterial growth
bleb large blister filled with serous fluid
atheroma abnormal mass of fat or lipids
1. caused by herpes virus hominis 2. two types herpes simplex virus
1. area reddened and edematous 2. vesicles ulcerate and crust over 3. general malaise 4. no cure Herpes Simplex type 1
1. vesicles rupture and encrust causeing ulcerations 2. lesions may be present for 2-3 weeks 3. headache, fatigue, myalgia, and elevated temperature occur 3-4 days after vesicles erupt herpes simplex type 2
1. caused by varicella virus 2. lesions along the nerve fibers of spinal ganglia 3. pain, itching, and heightened sensitivity along nerve pathway 4. vesicle formation, crusting of skin 5. severe pain Herpes Zoster (Shingles)
1. caused by staphylococcus aureus, streptococci 2. lesions start as macules and develop into vesicles 3. rupture and crust 4. crust leaves skin smooth/red 5. highly contagious from contact Impetigo
medical management of impetigo 1. erythromycin 2. cephalosporin 3. rocephin 4. bactroban
what causes furuncle? staphylococcus infection of a hair follicle
tinea capitis ringworm of the scalp
tinea corporis ringworm of the body
tinea cruris "jock itch"
oral antifungal drugs 1. Fulvicin 2. Grifulvin
what is used to diagnose tinea capitis? Wood's light- ultraviolet light
Contact dermatitis 1. skin reaction from direct contact with agents in environment to which one is hypersensitive
dermatitis venenata poison ivy or poison oak
wheals from an allergic reaction (hives) urticaria
acne vulgaris 1. develops when oil glands become occluded 2. inflammatory skin eruption from sebaceous glands
1. noninfectious 2. sloughing and new generation of skin cells occurs more rapidly than 28 days 3. chronic, hereditary psoriasis
______ and ______ decrease the shedding of skin keratolytic agents (tar preparations), salicylic acid (Calicylic)
PUVU therapy photochemotherapy used in treatment of psoriasis
pediculosis (lice) parasitic disorder of skin associated w/poor living conditions or poor hygiene
Pediculicides used in lice 1. Lindane (Kwell) 2. pyrethrins (RID)
1. parasitic skin disorder 2. female itch mite penetrating skin, laying eggs 3. eggs mature and rise to skin surface 4. wavy, brown threadlike lines on body, sever pruritis scabies
treatment specific to scabies crotamiton (Eurax) 4-8% solution of sulfur in pretrolatum
1. NSAIDS 2. Corticosteroids 3. disease-modifying anti-rheumatics (DMARDS) types of antirheumatic agents
1. celebrex 2. advil 3. indocin NSAIDS
1. betamethasone 2. dexamethasone 3. methylprednisolone 4. prednisone corticosteriods
1. Enbrel 2. Arava 3. Remicade 4. Folex DMARDS
DMARDS side effects 1. pulmonary fibrosis 2. anemia 4. hepatotoxicity 5. nephropathy
be cautious of ________ in use of DMARDS immunosuppression
ankylosis fixation of a joint, usually in an abnormal postition resulting from destruction of cartilage or bone
arthrocentesis puncture of a joint with a needle to withdraw fluid used for diagnostic purposes
bipolar hip replacement prosthetic implant used to replace the femoral head and neck in hip fractures when the vascular supply to the femoral head is or may become compromised
Blanching test test of the rate of capillary refill
callus bony deposits formed between and around the broken ends of a fractured bones during healing
Colles' fracture a fracture of the distal portion of the radius within 1 inch of the wrist
crepitus sounds that represent the cracking noise heard when rubbing hair between fingers, assoiciated with broken bones
fibromyalgia a musculosskeletal chronic pain syndrome of unknown etiology that causes pain in muscles, bones, or joints
kyphosis abnormal condition of the vertebral column, characterized by increased convexity in the curvature of the thoracic spine
lordosis an increase in the curve at the lumbar space region that throws the shoulders back
paresthesia any subjective sensation, such as prickling "pins and needles" or feeling of numbness
scoliosis curvature of the spine usually consisting of two curves, the original abnormal curve and compensatory curve in the opposite direction
sequestrum a fragment of necrotic that is partially or entirelydetached from the adjacent healthy bone
subluxation partial dislocation
Volkmann's contracture a permanent contracture with clawhand
Functions of Musculoskeletal system (5) 1. support 2. protection 3. movement 4. mineral storage 5. hematopoiesis
found in extremitites long bones
found in the hand short bones
found in the vertebrae irregular bones
functions of joints (2) 1. hold bones together to form skeleton 2. allow movement and flexibility of skeleton
no movement joints synarthrosis
slight movement joints amphiarthrosis
free movement joints diarthrosis
epimysium connective tissue that surrounds each muscle fiber
7Ps of neurovascular assessment 1. pulselessness 2. paresthesia 3. paralysis 4. polar temperature 5. pallor 6. puffiness (edema) 7. pain
normal calcium levels 9-10.5 mg/dl
erythrocyte sedimentation rate 1. indicates presence of inflammation (rheumatoid arthritis) 2. (males) 15 mm/hr; (females) 20 mm/hr
muscle functions (3) 1. motion 2. maintenance of posture 3. production of heart
normal uric acid levels 1. (males) 2.1-8.5 mg/dl 2. (females) 2.0-6.6 mg/dl
common types of arthritis (4) 1. rheumatoid arthritis 2. osteoarthritis 3. gout 4. ankylosing spondylitis
1. systemic inflammatory disorder of connective tissue/joints 2. chronicity, remissions, and exacerbation 3. cause unknown, strongly believed to be autoimmune rheumatoid arthritis
4 classic symptoms of rheumatoid arthritis 1. morning stiffness 2. joint pain 3. muscle weakness and atrophy 4. fatigue
classic deformities of RA 1. swan neck deformity 2. boutonniere deformity 3. ulnar deviation
methotrexate (Rheumatrex is used in RA when there are _______ _____________ bony erosions
injections of viscosupplements (Hyalgan, Synvisc and Supartz) act as... lubricants to provide joint tissue viscosity
Degenerative joint disease 1. also known as osteoarthritis 2. most common type 3. typically affects "weight-bearing" joints 4. no remission, no systemic systems 5. non-inflammatory disorder that progressively causes bones and joints to degenerate
s/s of degenerative joint disease 1. joint stiffness and pain 2. joint enlargement 3. limitation of movement 4. Herberden's/Bouchard's nodes
1. metabolic disease resulting from accumulation of uric acid in blood 2. affects men 8-9 times more than women 3. three types (primary, secondary, idiopathic) Gout
primary gout linked to hereditary factors, severe dieting or starvations, excessive ingestion of purines
secondary gout resulting from use of certain medications or complications of another disease
s/s of gout 1. sudden onset of pain and tenderness in one joint 2. swelling and redness of joint 3. fever 4. joint deformities
medical management of gout: 1.uricosuric drugs 2. decrease ingestion of purine 3. use of NSAIDS
ankylosing spondylitis 1. aka Marie- Strumpell Disease 2. chronic connective tissue disorder of the spine and surrounding cartilaginous joints 3. ususally begins in early childhood 4. more common in men than women
Legg-Calve-perthes disease when ball of thighbone in the hip doesn't get enough blood causing the bone to die
pathophysiological changes associate with ankylosing spondylitis 1. immobility and fixation of the joints in the hip and ascends the vertebrae 2. respiratory functions may be compromised 3. inflammation of aorta 4. iridocylitis 5. pulmonary fibrosis
s/s of ankylosing spondylitis 1. difficulty in expanding ribcage 2. vision loss from glaucoma and pupil damage 3. low back pain and stiffness 4. sciatica pain 5. weight loss 6. edema
1. disorder that results in a reduction in bone mass which interferes with mechanical support function of the bone 2. women between ages of 55-65 at higher risk due to loss of estrogen osteoporosis
risk factors for osteoporosis 1. use of steroids 2. high caffeine intake 3. diet low in cacium 4. smoking 5. excessive protein
clinical manifestations of osteoporosis 1. disorder develops slowly 2. first symptoms is backache 3.bone becomes porous and brittle
osteomyelitis 1. local or generalized infection of the bone and bone marrow 2. infection introduced through trauma or surgery
fibromyalgia 1. chronic pain syndrome of unknown etiology that causes pain in muscles, bones, or joints 2. affects more women than men 3. no permanent damage, not life-threatening
clinical manifestations of fibromyalgia 1. generalized achiness (neck/lower back) 2. stiffness (worse in the morning) 3. aggravated by sever factors (cold, humidity, fatigue, stress)
additional problems that accompany fibromyalgia 1. irritable bowel syndrome 2. tension headaches 3. paresthesia of upper extremities 4. sensation of edematous hands with no visible edema 5. sleep dysfunction
why are tricyclic antidepressants used in fibromyalgia? 1. antidepressant effects 2. anti-inflammatory effects 3. central skeletal muscle relaxant effects 4. pain inhibition
corticosteroid side effects 1. personality changes 2. adrenal suppression 3. muscle wasting, osteoporosis
Important nursing implications for patients taking corticosteroids 1. assess potassium, blood glucose, urine glucose 2. monitor daily weight 3. monitor I
DMARDS important nursing implication: assess for pain and ROM
bone resorption inhibitors primarily used to treat and prevent osteoporosis in postmenopausal women
biphosphonates 1. type of bone resorption inhibitor 2. inhibit hydroxyapatite crystal dissolution and osteoclast activity 3. alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel)
raloxifene 1. type of bone resorption inhibitor 2. binds to estrogen receptor, producing estrogen-like effects on bone
do not use biphosphonates on patients with... hypocalcemia
bone resorption inhibitor side effects 1. acid regurgitation 2. esophageal ulcer 3. musculoskeletal pain
_______ __________ decrease absorption of biphosphonates calcium supplements
when should alendronate be administered? 1st thing in the morning with 8 oz of water 30 minutes before meals
1. cortisone 2. hydrocortisone systemic short-acting corticosteroids
1. methylprednisolone 2.prednisolone 3.prednisone systemic intermediate-acting corticosteroids
1. betamethasone 2. dexamethasone systemic long-acting corticosteroids
skeletal muscle relaxants 1. spasticity associates with spinal cord diseases or leasions 2. adjunctive therapy in the sumptomatic relief of acute painful musculoskeletal conditions
central-acting spinal muscle relaxants 1. inhibits reflexes at the spinal level 2. i.e. baclofen, carisoprodol, cyclobenzaprine
direct-acting spinal muscle relaxants 1. acts directly on skeletal muscle, causing relaxation by decreasing calcium release 2. i.e. dantolene
skeletal muscle relaxant side effects 1. seizures 2. drowsiness 3. hypotension 4. nausea
avoid ____ and _____ _________ while taking skeletal muscle relaxants alcohol, CNS depressants
tophi calculi containing sodium urate deposits that develop in periarticular fibrous tissue, resulting in inflammation of the joint
allopurinol 1. antigout agent 2. prevention of attack of gouty arthritis and nephropathy 3. treatment of secondary hyperuricemia 4. inhibits production of uric acid
colchicine 1. antigout agent 2. acute attacks of gouty arthritis 3. prevention of gout reocurrences 4. interferes with the functions of WBCs in initiating and perpetuating the inflammatory response to monosodium urate crystals
allopurinol side effects 1. drowsiness 2. rash 3. bone marrow depression
cochicine side effects 1. anuria 2. agranulocytosis 3. aplastic anemia 4. peripheral neuritis
colchicine may cause malabsorption of vitamin B12
taking oral hypoglycemics or warfarin with allopurinol will ______ the effects increases
minimum fluid intake for a patient on allopurinol 2500-3000mL/day
signs of colchicine toxicity 1. weakness 2. abd pain 3. nausea 4. vomiting 5. diarrhea
important labs to monitor for patient on colchicine CBC, AST, and alkaline phosphatase
__________ does not relieve acute attacks of gout allopurinol
to coincide with the body's normal secretion of cortisol, administer __________ in the morning corticosteroids
clinical improvement from allopurinol will show within... 2-6 weeks
colchicine will show improvement in pain and swelling within 12 hours
open (compound) bone breaks through the skin
closed (simple) a fracture that does not break the skin
displaced the bone ends are separated at the fracture line
incomplete bone breaks through only one cortex
greenstick one side of a bone is broken and the other side is bent
complete the fracture line extends entirely through the bone
comminuted the bone is splintered into many small fragments at the fracture site with the bone ends separated and usually misaligned
impacted (telescope fracture) one bone fragment is forcibly wedged into another
transverse break runs directly across the bone, a right angle
oblique break slants the length of the bone, at a 45 degree angle
spiral breaks coils around the bone
Colles' fracture fractures of the distal portion of the radius within 1 inch of the joint of the wrist, commonly occurs from the attempt to break a fall
Pott's fracture distal end of the fibula, chiping off a piece of the medial malleolus with a displacement of the foot outward
false motion 1. unnatural motion 2. sign of fracture
closed reduction manual manipulations, moving bony fragments into position by applying traction and pressure
gas gangrene 1. severe infection of the skeletal muscle caused by gram positive Clostridium bacteria- C. perfringens 2. occurs in the presence of compound fractures/lacerated wound 3.s/s- crepitation, gas bubbles, foul odor
assess for Homan's sign to determine if there is a _________ thromboembolus
thermal burns 1. flames, scalding and thermal energy (heat) 2. most common type
nonthermal burns 1. electricity 2. chemicals 3. radiation
superficial (1st degree) 1. epidermis is damaged, dermis unharmed, heals in less than 5 days 2. i.e. sunburn
partial thickness (2nd degree) 1. affects both epidermis and dermis 2. up to three weeks to heal, may scar 3. scalds, chemicals
full thickness (3rd degree) 1. all layers of skin are detroyed- no pain 2. can lead to sepsis, scarring and contractures
inhalation burns Categorized as one of the most lethal types of burns especially when there is a cutaneous injury associated with the respiratory tract burn
three causes of inhalation burns 1. heat inhalation 2. inhalation of toxic chemicals or smoke 3. inhalation of carbon monoxide gas
effects of inhalation burns on the body 1. mucosa in lungs swell and break, leaking fluid into nearby alveolar spaces and damaging cilia 2. mucus builds up and plugs passages 3. oxygen is reduced and can lead to death
very late signs of carbon monoxide poisoning 1. cherry-red coloring to unburned skin 2. changes in color of mucous membrane 3. neurological damage
s/s of inhalation burns 1. edema of face and neck 2. burned mucosa in mouth and throat 3. hoarseness 4. stridor 5. AMS
4cc lactated ringers X %burn X weight(kg)= initial 24 hour fluid replacement modified brooke formula for fluid replacement
dosing for fluid replacement 1. first 8 hours- give 1/2 of total calculated fluid 2. during second 8 hours, give 1/4 of total fluids 3. during 3rd 8 hours, give 1/4 total fluids
emergent phase (stage 1) 1. initital 24-48 hours 2. capillaries dilate and become hyperpremeable causing a shift of intravascular fluid into interstitial space
burn shock 1. hypostension 2. decreased urine output 3. increased pulse 4. rapid and shallow respirations 5. most burn deaths
intermediate or acute phase (stage 2) 1. aka diuretic phase 2. 48-72 hours after burn 3. potential for circulatory overload as a result of fluid shift from interstitial into the capillaries 4. kidneys excrete large volumes
long term rehabillitation phase (stage 3) begins when treatment begins
autograft uses the patients own skin
allograft or homograft from a cadaver
heterograft 1.obtained from animals, usually pigs 2. temporary
alternative materials used to cover wounds and promote healing 1. TransCyte 2. Biobrane
purpose of skin graft 1. lessen chance of infection 2. minimize fluid loss 3. reduce scarring and function loss
Silver sulfadiazine (Silvadine) 1. most affective if applied immediately 2. pain free 3. diadvantage- may delay epithelialization, bone marrow suppression
mafenide acetate (Sulfamylon) 1. best when treating highly contaminated wounds 2. disadvantages- exaggerates post-burn hyperventilation, painful application
Silver nitrate 1. causes loss of sodium, potassium, chloride and calcium 2. best if applied immediately 3. does NOT eschar 4. ineffective if infection already established
spider angiomas 1. a group of venous capillaries that dilate like a branch of spiders 2. associated with liver disease
verruca (wart) 1. viral lesion 2. contagious
plantar's wart occur on soles of feet and are very painful
nevus (mole) 1. a congentital, non-vascular skin blemish 2. usually benign but may become cancerous 3. raised, and black is considered pre-cancerous and removal is recommended
basal cell carcinoma 1. malignant tumor 2. occurs in epidermis 3. usually scaly, pearly papule w/central crater 4. favorable outcome if treated early
squamous cell carcinoma 1. occurs in the epidermis layer on areas exposed to sun 2. firm, nodular lesion topped with a crust or ulceration
malignant melanoma 1. occur in dermis and epidermis 2. originates in melanocytes of epidermis
ABCD's of melanoma 1. A= assymmetry 2. B= border is irregular 3. C= color is varied from one area to another 4. D= diameter is generally larger than 6mm
phantom pain occurs because the nerve tracks that register pain in the amputated area continue to send messages to the brain
how often should you assess for neurovascular impairment in a postoperative amputation patient hourly
place the patient in a prone postitiona minimum of twice a day, in order to stretch the ______ ________ flexor muscles
tx for sevre and persistent phantom pain 1. stump revision with reamputation at a higher level 2. local infiltration of the stump with procaine 3. mechanical percussion (shrink neuromas) 4.sympathetic nerve block
Created by: hegaub