Skin and Burns
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 3 Skin Layers | Subcutaneous fat: Innermost layer covers bone, Insulation, Source of energy
Dermis: Second layer, Connective tissue, Collagen, Elasticity, Flexibility, Strength, Blood supply
Epidermis: Outermost layer, Contains melanin and keratin
🗑
|
||||
| Additional Skin Anatomy | Hair: You can live without it, Warmth, Now cosmetic
Nails: Scratching, Grasping, You can live without them
Glands: Sebaceous and Sweat glands
🗑
|
||||
| What to included in a skin assessment | Shelter/soap/water/afford prev?
Drugs (scab eating, photosensitivity)
Allergies (detergent)
Nutrition (protein/water)
Family Hx (cancer, fair)
Current Dx (stretch marks, atrophy, pressure ulcers)
Onset/Characteristics/Severity/Relieving factors
🗑
|
||||
| Genetic Factors of Skin | Ask about disorders in immediate family and gender of family member
Examples: Albinism, Keloids, Vitiligo (White patches on skin), Baldness Hirsutism (Excessive hair), Skin Cancer
🗑
|
||||
| More Skin Assessment | Color
Lesions (primary and secondary)
Pruritus/lichenified
Edema
Assess each lesion for:
o A—asymmetry of shape
o B—border irregularity
o C—color variation within one lesion
o D—diameter >6 mm
🗑
|
||||
| Skin Lesions | Primary
o Macule, patch
o Papule, plaque
o Nodule, tumor
o Vesicle, bulla
o Wheal
o Pustule
o Cyst
Secondary
o Atrophy
o Erosion
o Lichenification
o Scales
o Cust
o Ulcer
o Fissure
o Scar
o Keloid
🗑
|
||||
| Identifying Skin Integrity | Skin tears
o Thin skin, less elasticity
o Pulling up in bed
o Tape for IVs
o Pets
Cleanliness
o Psychological
o social-economical
Tattoos and piercings
o Considered skin lesion
🗑
|
||||
| Skin Changes Associated with the Elderly | > atrophy
< wound healing, inflammatory response
> sensitivity to sun
Dry skin (Xerosis), Wrinkles, Cherry angiomas
< sensory perception
> risk for hypothermia, heat stroke (< sweat prod)
Hyperpigmentation (liver/age spots)
> risk for shearing, ski
🗑
|
||||
| Palpation | touch it!
Confirms size of the lesions
Determines flat or raised
o Macular—flat rash
o Papular—raised rash
Skin temperature
o Use back of hand
Turgor
o Pinch clavicle or sternum
🗑
|
||||
| Skin Diagnostics | Cultures
o Fungal infections (scrape w/ tongue blade)
o Bacterial inf. (throat swab)
o Viral inf.
Skin biopsies: (#1 for skin cancer)
o Punch biopsy (small chunk of skin)
o Shave biopsy (horizontal)
o Incisional biopsy
o Excisional biopsy (remove
🗑
|
||||
| Hair Basics | Distributed all over body except: palms, soles, nipples, inside genital area, lips
Root enclosed in follicle
Shaft exposed and consists mainly of dead cells
In nare, trap bacteria and foreign debris
Insulation
Protects eyes
Reduces laceration risks
🗑
|
||||
| Hair Assessment | Cleanliness
o Dandruff
Distribution
o Hirsutism
o Bald spots
Quantity and quality
🗑
|
||||
| Nail Assessment | Dystrophic nails (abnormal nail)
Color of nail plate
o < color = < oxygen/blood flow
Nail shape changes
Nail thickness, consistency, lesions
o Thicken with age, trauma, infection
Acute and chronic paronychia
o Inflammation of the area around the na
🗑
|
||||
| Pruritis | Primary Cause = Emotional stress
Secondary Cause = Disease, liver problems, Meds, Diabetes
Subjective
“Itch-scratch-itch” cycle
Comfort: Lotion, Fluids, Distraction, Cool temps < itch sensation, oatmeal, baking soda, oils, Trim nails, antihistamines
🗑
|
||||
| Xerosis | (Dryness)
Common among older patients
Fine flaking and pruritus = scratching = may result in open wounds
Relieve itching
Avoid hot baths
🗑
|
||||
| Urticaria | (Hives)
White or red edematous papules or plaques
Remove triggering substances
Client has been exposed to something, Antihistamines release, leaving wheals behind
May use steroids to treat
🗑
|
||||
| Psoriasis | Chronic immune disorder
Raised reddened round plaques
Silvery white scales
Pruruitis (severe itching)
Usually seen around age 30 Caucasian men and women
Psoriasis vulgaris (thick reddened plaques)
Psoriasis arthritis (affects joints)
🗑
|
||||
| Psoriasis Triggers | Stress
Irritation
Cold/dry weather
Steroid withdraw
🗑
|
||||
| Psoriasis Treatments | Corticosteriods
Tar preps (Suppress cell division)
UV light (even tanning beds)
Photochemotherapy
Propanolol
Medicated shampoo
Immunosuppressant meds
🗑
|
||||
| Bacterial Skin Infections | Folliculitis (shaved bump, staff infection, red, pustulous)
Furuncle (boil, much deeper, firm)
Carbuncle (group of infected hairs)
Cellulitis (deep tissue, large area, red, edematous, warm, chills, malaise)
Culture, treat with antibiotic
🗑
|
||||
| MRSA | Resistant to broad-spectum antibiotics
Resists penicillin, amoxicillin
Small raised, red nodule resembles pimple or spider bite
Rapidly increases in size, color, pain
Abscess
Potentially fatal
🗑
|
||||
| Hospital Acquired MRSA | Wound
IV
Foley catheter
🗑
|
||||
| Community Acquired MRSA | Unsanitary living conditions
Football – community sweat rag
🗑
|
||||
| Treat MRSA | Wound or Blood culture
Antibiotics: Bactrim, Vibramycin, Mupirocinointment (Bactroban)
Antiseptic body washes
🗑
|
||||
| MRSA Prevention | Wash hands
Don’t save antibiotic for later, TAKE THEM ALL!
Don’t share personal items (razor, towel, athletic equipment)
Shower after games with soap and water
Don’t pop zits
🗑
|
||||
| Fungal Infections (Dermatophyte) | Tineapedis (Athletes foot)
Tineamanus (Hands)
Tineacruris (Jock itch, thighs, buttocks)
Tineacapitis (Head)
Tineacorporis (body, ringworm, happens in large circular patterns like a ring)
Candida albicans (Yeast, Mouth, skin folds, under breasts, geni
🗑
|
||||
| Fungal Infections (Dermatophyte) Diagnostics | KOH
Cultures
Wood’s Lamp (ultraviolet inspection)
🗑
|
||||
| Fungal Infections (Dermatophyte) Treatments | Clotrimazole(Mycelex) topical
Miconazole(Monistat) topical
Nystatin(Mycostatin) topical or oral rinse
Fluconazole(Diflucan) pill
🗑
|
||||
| Pediculosis | Lice
Pediculosiscapitis (Head)
Pediculosiscorporis (Body)
Pediculosispubis (Genitals)
🗑
|
||||
| Pediculosis Manifestations | Itching
Knits in hair
Transmitted by physical contact (Combs, towels, hair bows, hats, clothes)
🗑
|
||||
| Pediculosis Treatments | Drugs= sprays, creams, shampoos, combs to pick knits
Laundering of clothing and bed linen in HOT water
🗑
|
||||
| Scabies | Contagious mite (burrows under skin and lays eggs)
Found in webs of fingers, wrist, elbow, axillae, nipple, penis, and belt line
Dx: lesion scrapings under microscope
Rx: similar to lice, launder in hot water, K-oil, Scabasin, Treat itch with topical
🗑
|
||||
| HPV-Warts | Non genital or genital
Common areas: fingers, forehead, genitals, feet
Rx: Acid therapy, Cryosurgery, Liquid nitrogen, Electrical, Immune system
🗑
|
||||
| Herpes Simplex Virus | Fever blister or cold sore
Type 1 (HSV-1)
a. Usually mouth
b. Can appear on genitalia
Type 2 (HSV-2)
a. Usually genitalia
b. Can appear on mouth
🗑
|
||||
| Herpes Simplex Virus Manifestations and Treatments | Tingly
Erupts, blister
Heal in 10-14 days
Triggers (Sunlight, Menstruation, Injury, Stress)
Spread by direct contact
Meds (Acyclovir, Abreva)
🗑
|
||||
| Herpese Zoster/Shingles | Reactivation of dormant varicella
Lesions over dermatone with nerve involvement
Shows on nerve line
Manifestations: itching and pain generally unilateral, multiple vesicles
Neuralgia (nerve pain)
🗑
|
||||
| Herpese Zoster/Shingles Assessment and Labs | Diagnosed with clinical manifestations
History
Tzancksmear
Swab culture
🗑
|
||||
| Herpese Zoster/Shingles Medications | Acycliver
Lytoderm patches (relieve pain, put on shingle site, expensive, antihistamine for itching also)
Zostavax (Vaccine, weakened form of varicella)
🗑
|
||||
| Common Inflammations | Contact dermatitis
Atopic dermatitis (Eczema, Seasonal allergies)
SeborrheicDermatitis (Inflammation of skin around hair, brow, lashes, areas that secrete oil)
ExfoliativeDermatitis (Excessive shedding of the skin)
🗑
|
||||
| Interventions for Common Inflammations | Steroids
Avoidance of oil-based products
Antihistamines
Compresses and baths
Removing allergen
🗑
|
||||
| 2 Kinds of Acne | Noninflammatory comedones (white/black head)
Inflammatory papules, pustules, and cysts (pimple)
🗑
|
||||
| 3 Kinds of Inflammatory Acne | Acne Vulgaris (teen-adult, face/neck/back/chest/shoulders, may scar, < self-esteem)
Acne Rosacea (erythema on checks/nose, middle to older adult)
Acne Conglobata (middle adulthood, white/black head, pimple/cyst, scars, buttocks/chest, purulent/malodorou
🗑
|
||||
| Acne Treatments | Topical agents (face wash, remove makeup, wash 2x daily, don’t touch face, eat balanced diet, get sun exposure, exercise, don’t pop zits, follow treatment plan)
Systemic antibiotics
Isotretinoin(Accutane) (Not while pregnant, blood work every month)
🗑
|
||||
| Other Skin Disorders | Lichen Planus (itch/flat/purple papules, wrist/forearm, steroid/antihistamine)
Pemphigus Vulgaris (chronic blistes, rare, autoimmune, steroid/chemo)
Toxic Epidermal Necrolysis (drug reaction, peal)
Stevens-Johnson Syndrome (Penicillin/Sulfa-drug caused
🗑
|
||||
| Benign Tumors | Cysts
Seborrheic keratoses (thickening over growth of skin), dark patches, doesn’t hurt, removed for cosmetic)
Keloids
Nevi (moles)
Angiomas
Skin tags (excessive irritation under bra, breast, collar, eyes)
🗑
|
||||
| Skin Cancers | Actinic keratoses (Premalignant lesions, can turn to skin cancer, bleeds easily, shiny)
Non-melanoma (squamous cell carcinomas, basal cell carcinomas)
Melanomas (highly metastatic; survival depends on early diagnosis and treatment)
🗑
|
||||
| Risk Factors for Non-melanoma Skin Cancer | Fair skin, flecked, blue/green eyes
Blonde or red headed
Family hx
Unprotected and/or excessive UV exposure
Severe Sunburns as a child
Occupational
HPV
Organ transplant with immunosuppressive drugs
🗑
|
||||
| Non-melanoma Skin Cancer Basal Cell Basics | Most common, least aggressive
Tends to recur
Rarely Metasizes
🗑
|
||||
| 5 Types of Non-melanoma Skin Cancer Basal Cell | Nodular (face/neck/hands, itchy/white/angiomas)
Superficial (trunk/extremities/flat/ulcerate/heal)
Pigmented (blue/black/brown; head/neck/face; shinny)
Morpheaform (rare; head/neck; ivory/fleshy; scar-like)
Keratotic (metastisis; pre/postaricular; nod
🗑
|
||||
| Non-melanoma Skin Cancer (Squamous Cell) | Areas of exposure to UV and weather
More aggressive
Greater risk for metastasis
Small, firm red nodule
Increase size=ulcerate, bleed, painful
Develops into a nodule that is indurated (hard nodule)
🗑
|
||||
| Skin Cancer Surgery | Biopsy
Surgical excision
Curettage and electrodesiccation (0pen up, electrocute cancer)
Mohs’ surgery (thin shaving)
Radiation (better cure rate, less tissue removed)
Others
🗑
|
||||
| Melanoma Risk Factors | # of moles
Fair skin, freckled blonde/red haired, blue eyes
Family hx
UV radiation from sunlight
Over age of 50
Xeroderma pigmentosus (genetic disorder, can look like bad acne)
Hx of melanoma
🗑
|
||||
| What dose Melanoma Look Like | >6 mm in diameter (an eraser)
Asymmetric (irregular shape)
🗑
|
||||
| 4 Types of Melanoma | Superficial spreading (flat/scaling from mole, back/neck/legs, red/white/blue)
Lentigomaligna (brown shades, sun exposure, modeled, cold/bluish)
Nodular (raised dome, blue/black, like blood blister)
Acral (palms/soles/mucous, > dark skin, brown/black)
🗑
|
||||
| Melanoma Diagnosed by | Biopsy
🗑
|
||||
| Melanoma Treatments | Wide excision (take mole, surrounding area, and may even take lymph nodes)
Immunotherapy
Radiation
Biological Therapy
🗑
|
||||
| Health Promotion to Prevent Melanoma | Sun screen
Decrease sun exposure
Slip on a shirt
Slop on sunscreen
Slap on a hat
🗑
|
||||
| Hints to Malignant Melanoma | ABCDE + ugly duckling sign
i. Asymmetry
ii. Borders
iii. Color
iv. Diameter
v. Evolving
🗑
|
||||
| Pressure Ulcer Definition | Skin breakdown
Impearled blood flow
Boney prominences
🗑
|
||||
| Mechanical Forces | Pressure
Friction (rubbing, pulling up in bed)
Shear (falling down in bed)
🗑
|
||||
| High Risk Clients for Pressure Ulcers | Elderly
Bed rest
Extensive surgeries
Handicap/wheelchair (position ever 15 min)
Poor nutrition
Decreased sensation
Incontinence (feces and urine accelerate skin breakdown)
🗑
|
||||
| Pressure Relieving Techniques | Key to prevention
Products and devices
Positioning/Transferring
Skin care (do not massage boney prominences that are red)
🗑
|
||||
| Staging a Pressure Ulcer | Stage I (red non-blanchable, skin intact)
Stage II (skin not intact, blister, shallow crater, partial thickness skin loss)
Stage III (full thickness skin loss, damage to fascia, tissue, or muscle)
Stage IV (bone, muscle, tendon exposed)
🗑
|
||||
| Wound Assesment | Staging
Location
Size (LxWxD)
Color (Granulation tissue, slough, use percentages)
Extent of tissue involvement
Wound base and margins (rolled, cupped, edges, maceration)
Exudate (COCA)
Condition of surrounding tissue
Presence of foreign bodies (ma
🗑
|
||||
| Wound Dressings | Mechanical debridement (detachment of dead tissue, scrub, wet to moist (or dry) dressing)
Natural chemical debridement (Santyl ointment)
Hydrophobic material (Wet to dry, little to no drainage)
Hydrophilic material (wet to moist, lots of drainage)
🗑
|
||||
| Nonsurgical Wound Therapies | PT (walk/position/trapeze/debris/whirlpool)
Rx (antibiotic, Dakins, GPC, Santyl, Silvadine)
Nutrition therapy
Others: Electrical stimulation; Anadime Machine; Vacuum-assisted; Hyperbaric O2 (> O2 under high pressure, Tx life/limb/spider bites/osteomeli
🗑
|
||||
| Surgical MGT of a Wound | Surgical debridement
Skin grafting (Can’t remove without physician’s order)
🗑
|
||||
| Plastic surgery (necessary or cosmetic) | Skin Grafts/flaps
Chemical peeling (Can predict, firmer, less wrinkled skin)
Liposuction
Dermabrasion (light chemical freezing then scraping with a sandpaper-like product)
Facial cosmetic
i. Rhinoplasty-nose
ii. Blepharoplasty-eye
iii. Rhytidectomy
🗑
|
||||
| Burn Definition | An injury caused by a heat source that causes physiologic changes and damage to the tissue
Skin can grow as long as dermis is present
🗑
|
||||
| Burn Pathophysiology | Skin changes resulting from burn injury (anatomic changes)
If entire dermis is burned, skin can no longer restore itself (functional changes)
Unable to maintain electrolyte balance and act as a barrier (temp)
Cells are destroyed by increasing temperatu
🗑
|
||||
| Factors Associated with Burns | Age (sunburn exposure, < sensation, dementia, elderly and children are more prone)
Smoking carelessly
Alcohol and drug intoxication
Physical or mental disabilities
Certain occupations
Look for abuse (Cigarette burns)
🗑
|
||||
| 4 Kinds of Burns | Thermal
Chemical injury
Electrical injury
Radiation injury
🗑
|
||||
| Burn Priority | Neutralize
Flush
CPR
Corticosteroids
Increase fluids
Cool water
🗑
|
||||
| Depth of Burn Injury | Superficial-Thickness (pink-red, blanchable/chills/headache, N/V, skin peals)
Partial thickness (red/blister, pale/waxy, large blisters)
Full Thickness (no cells to repopulate, pale/waxy/yellow/brown/mottled/charred/non-blachable/hard/dry/leathery/edema
🗑
|
||||
| Measure % of Body with | Rule of 9's:
Anterior and Posterior
Head/Neck = 9
Upper Limbs = 18
Trunk = 36
Perineum = 1
Lower Limbs = 36
🗑
|
||||
| Complications of Major Burns | Integumentary
Cardiovascular
Respiratory
GI
Urinary
Immune
Metabolism
🗑
|
||||
| Emergent Phase of Burns | First 48 hr: Fluid loss,Maintain body temperature
Goals of management include:
o Secure airway
o Support circulation—fluid replacement
o Prevent infection
o Maintain body temperature
o Provide emotional support
🗑
|
||||
| Injuries to Respiratory from Burns | Direct airway injury (Fire burn)
Carbon monoxide poisoning (more binding than O2, Takes over cells, Visual impairment, coma, death, odorless, colorless)
Thermal injury (Smoke poisoning, Toxic gas)
Cyanide poisoning (Headache, seizure)
🗑
|
||||
| Cardiovascular Issues from Burns | Hypovolemic shock
Monitor vital signs, cardiac status, heart monitor
Restore fluid
🗑
|
||||
| Renal/Urinary Trauma from Burns | Changes are related to cellular debris and decreased renal blood flow
Myoglobin is released from damaged muscle and circulates to the kidney
Assess (BUN, Creatinine, Serum sodium levels)
Examine urine color, odor, and presence of particles or foam
🗑
|
||||
| Gastrointestinal Issues from Burns | Changes in GI function are expected
Assess for GI bleeding, Paralytic ileus
🗑
|
||||
| Emergent/Resuscitative Phase of Burn | Onset of injury to Fluid restoration
Estimate extent of injury
First Aid
Respiratory Management
Fluids
Monitor urine output
Hemodynamic monitoring
🗑
|
||||
| Acute Phase of Burn Injury | Diuresis to wound closure
Wound management
Nutritional therapies (Enteral or TPN)
Control infection
Pain management
🗑
|
||||
| Escharotomy | Longitudinal incision to release taut skin and allow for expansion from edema
🗑
|
||||
| Surgical Debridement for Burn | Fasciectomy (Full-thickness burns only, fat and lymphatic tissue loss)
Mechanical
Enzymatic
🗑
|
||||
| Auto-grafting | I give to me
🗑
|
||||
| Biologic and biosynthetic dressings | Homograft (Another human)
Heterograft (Pig skin)
DuoDerm dressing
🗑
|
||||
| Dressing the Burn Wound | Open or closed
Positioning, Splints and Exercise (Prevent contractures, Ambulate ASAP)
Support Garments (reduce scaring, Jobst garment 6 mo – 1 yr)
🗑
|
||||
| Topical Antibiotics | Sulfamylon (it burns)
Silver Nitrate (blackens everything it comes in contact with, use only in first 72 hrs)
Silvadene (silver sulfadiazine)(marked leukopenia, but corrects itself)
🗑
|
||||
| Other Meds | Systemic antibiotics
Tetanus
H2 blockers or PPI
🗑
|
||||
| Rehabilitative Stage | Wound closure till return of highest level of health
Biopsychosocial
Prevention of contractures
Vocational, occupational, physical rehabilitation
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
nimeggs
Popular Nursing sets