Med /surg Chapters 23/24/25 Notes

Front 1

the outermost skin layer?

Back 1

epidermis

Front 2

Two major types of epidermal cells include?

Back 2

melanocytes (5%) and keratinocytes (90%).

Front 3

Melanocytes contain melanin, a pigment giving color to skin and hair and protecting the body from damaging ultraviolet (UV) sunlight. More melanin results in

Back 3

darker skin color

Front 4

Keratinocytes produce a fibrous protein called keratin, which is

Back 4

vital as a protective barrier of the skin.

Front 5

second skin layer or the connective tissue below the epidermis?

Back 5

dermis

Front 6

The dermis is divided into two layers:

Back 6

upper thin papillary layer and deeper, thicker reticular layer.

Front 7

Collagen forms the largest part of the dermis and is responsible for the?

Back 7

mechanical strength of the skin.

Front 8

The dermis is highly vascular and assists in the regulation of body temperature and blood pressure by supporting the

Back 8

nerve and vascular networks.

Front 9

The subcutaneous layer is composed of?

Back 9

fat and loose connective tissue.

Front 10

The fat in the subcutaneous layer does what?

Back 10

insulates the body and provides protection from trauma.

Front 11

Skin appendages include hair, nails, and?

Back 11

glands (sebaceous, apocrine, and eccrine).

Front 12

Hair and nails form from specialized keratin that becomes?

Back 12

hardened

Front 13

Pigmented longitudinal bands (melanonychea striata) may occur in the nail bed in most people with?

Back 13

dark skin

Front 14

Sebaceous glands secrete sebum, which is emptied into hair follicles. Sebum prevents ?

Back 14

skin and hair from becoming dry

Front 15

Apocrine sweat glands are located in the axillae, breast areolae, umbilical and anogenital areas, external auditory canals, and eyelids. They secrete a thick, milky substance that becomes odoriferous when altered by ?

Back 15

skin surface bacteria

Front 16

Eccrine sweat glands are widely distributed over the body, except in a few areas such as lips. These glands cool the body by? (and two more functions)

Back 16

evaporation, excrete waste products through skin pores, and moisturize surface cells.

Front 17

The primary function of skin is to protect underlying body tissues by serving as a?

Back 17

surface barrier to the external environment. Skin is also a barrier against bacteria, viruses, and excessive water loss.

Front 18

The esthetic functions of the skin include the expression of

Back 18

emotions and displaying individual identity.

Front 19

With aging, the following changes occur in the skin?

Back 19

fewer melanocytes (gray and white hair), less volume in the dermis, nail plate thinning, nails become brittle and prone to splitting and yellowing, nails may thicken with age (especially toenails), skin wrinkling, decreased subcutaneous fat, hypothermia, and skin shearing.

Front 20

A number of benign and premalignant neoplasms related to aging can occur, placing the elder at risk for?

Back 20

carcinomas

Front 21

Information related to sensitivities should be obtained. History of chronic or unprotected exposure to

Back 21

UV light, including tanning bed use and radiation treatments, should be noted.

Front 22

The skin should be inspected for ?

Back 22

general color and pigmentation, vascularity, bruising, tattoos and piercings, and presence of lesions or discolorations.

Front 23

Palpate skin for information about ?

Back 23

temperature, turgor and mobility, moisture, and texture.

Front 24

Primary skin lesions develop on previously unaltered skin. These include?

Back 24

macule, papule, vesicle, plaque, wheal, and pustule.

Front 25

Secondary skin lesions change with time or occur because of factors such as scratching or infection and include

Back 25

fissure, scale, scar, ulcer, and excoriation.

Front 26

Individuals with dark skin are predisposed to

Back 26

keloids, dermatosis papulosa nigra, Nevus of Ota, traction alopecia, and pseudofolliculitis

Front 27

dermatoscopy?

Back 27

using a lighted instrument and magnification

Front 28

Biopsy is one of the most common diagnostic tests in evaluation of skin lesions. Techniques include?

Back 28

punch, incisional, excisional, and shave biopsies.

Front 29

Other diagnostic procedures for skin include

Back 29

stains and cultures for fungal, bacterial, and viral infections as well as patch testing.

Front 30

Actinic keratoses, basal cell carcinoma, squamous cell carcinoma, and malignant melanoma are problems associated with?

Back 30

sun exposure

Front 31

Skin cancer is the most common malignant condition. Nonmelanoma skin cancers are

Back 31

neoplasms of the epidermis

Front 32

Patients should be taught to self-examine their skin monthly. The cornerstone of self-skin examination is the ABCDE rule. Examine skin lesions for

Back 32

Asymmetry, Border irregularity, Color change/variation, Diameter of 6 mm or more, and Evolving in appearance.

Front 33

a premalignant form of squamous cell carcinoma (SCC) affecting nearly all the older white population.
?

Back 33

Actinic keratosis

Front 34

A typical actinic lesion is ?

Back 34

an irregularly shaped, flat, slightly erythematous papule with indistinct borders and an overlying hard keratotic scale or horn.

Front 35

actinic lesion Treatments include?

Back 35

cryosurgery, fluorouracil (5-FU), surgical removal, tretinoin (Retin-A), chemical peeling agents, laser resurfacing, photodynamic therapy, and dermabrasion.

Front 36

a locally invasive malignancy from epidermal basal cells.
o Treatment includes surgical excision, electrodesiccation and curettage, cryosurgery, topical and systemic chemotherapy, photodynamic therapy, and radiation therapy.
o The cure rate is greater than 90% with treatment??????

Back 36

basal cell carcinoma

Front 37

a malignant neoplasm of keratinizing epidermal cells.
?

Back 37

Squamous cell carcinoma (SCC)

Front 38

Squamous cell carcinoma (SCC) Treatment includes ??

Back 38

surgical excision, electrodesiccation and curettage, excision, radiation therapy, photodynamic therapy, and intralesional injection of 5-FU or methotrexate.

Front 39

Malignant melanoma tumors arise in?

Back 39

melanocytes

It is the deadliest skin cancer, and its incidence is increasing faster than that of any other cancer.

Front 40

Important prognostic factor of melanoma is tumor thickness at the time of diagnosis. Stage 0 is % curable?
Stage 4 % curable?

Back 40

100 and 0 basically

Front 41

Melanoma can metastasize to any organ. If it has spread to lymph nodes or nearby sites what is needed?

Back 41

chemotherapy, biologic therapy, and/or radiation therapy is often required.

Front 42

People with dysplastic nevus syndrome are at an?

Back 42

increased risk for melanoma

Front 43

Staphylococcus aureus and group A β-hemolytic streptococci are?

Back 43

major types of bacteria responsible for primary and secondary skin infections.

Front 44

the most common viral infections affecting the skin?

Back 44

Herpes simplex, herpes zoster, and warts

Front 45

Allergies and hypersensitivity reactions may present as contact dermatitis and ?

Back 45

other lesions

Front 46

A careful history involving exposure to possible offending agents and patch testing are useful in determining the causative agent. The best treatment then becomes?

Back 46

to avoid the agent

Front 47

The most common benign dermatologic problems are ?

Back 47

acne, psoriasis, and seborrheic keratoses.

Front 48

Psoriasis is a chronic, autoimmune dermatitis characterized by?

Back 48

silvery, scaling plaques on the elbows, knees, palms, and soles.

Front 49

Ultraviolet light (UVL) of different wavelengths may be used to treat many dermatologic conditions including?

Back 49

psoriasis, cutaneous T-cell lymphoma, atopic dermatitis, vitiligo, and pruritis.

Front 50

Antibiotics are used topically and systemically to treat dermatologic problems. Common over-the-counter topical antibiotics include ?

Back 50

bacitracin, monocycline, and polymyxin B.

Front 51

Corticosteroids are particularly effective in treating a wide variety of dermatologic conditions and are used topically, intralesionally, or systemically. High-potency corticosteroids may produce side effects when use is prolonged, including?

Back 51

skin atrophy, rosacea eruptions, severe exacerbations of acne vulgaris, and dermatophyte infections.

Front 52

Oral antihistamines are used to treat conditions that exhibit ?

Back 52

urticaria, angioedema, and pruritus

Front 53

Diagnostic and surgical therapy techniques include skin ?

Back 53

scraping, electrodesiccation and electrocoagulation, curettage, punch biopsy, cryosurgery, and excision.

Front 54

Tissue biopsy is the definitive test for diagnosing a number of ?

Back 54

skin lesions, particularly cancers of the skin.

Front 55

commonly used when skin is oozing from infection and/or inflammation, to relieve itching, to suppress inflammation, and to debride a wound.?

Back 55

wet dressings

Front 56

Factors affecting the outcome of long-term dermatologic problems include ?

Back 56

skin type, history of previous exacerbations, family history, complications, intolerance to therapy, environmental factors, and lack of adherence to the prescribed regimen.

Front 57

Skin grafts may be necessary to provide protection to underlying structures or to reconstruct areas for cosmetic or functional purposes. Ideally, wounds heal by?

Back 57

primary intention

Front 58

Two types of grafts are free grafts and skin flaps. Soft tissue expansion is a technique for ?

Back 58

resurfacing a defect, such as a burn scar; removing a disfiguring mark, such as a tattoo; or as a preliminary step in breast reconstruction.

Front 59

body tissue injuries caused by heat, cold, chemicals, electrical current, or radiation?

Back 59

Burns

Front 60

The resulting effect of burns is influenced by the?

Back 60

temperature of the burning agent, the duration of contact time, and the tissue type injured.

Front 61

tissue injury and destruction from acids, alkalis, and organic compounds. ?

Back 61

Chemical burns

Front 62

inhalation of hot air or noxious chemicals. There are three types: metabolic asphyxiation, upper airway injuries, and lower airway injuries?

Back 62

Smoke and inhalation injuries

Front 63

result of intense heat generated from an electric current. The severity depends on the amount of voltage, tissue resistance, current pathways, surface area in contact with the current, and length of time that the current flow was sustained?

Back 63

electrical burns

Front 64

Burn treatment is related to injury severity. Severity is determined by the extent of the burn, as calculated by?

Back 64

the percent of the total body surface area (TBSA) burned; the depth of the burn (determined by the degree of tissue destruction); location of the burn (e.g., face, hands, perineum); and patient risk factors (e.g., age, past medical history).

Front 65

Burns are defined by degrees:

Back 65

first degree (same as sunburn), second degree, third degree, and fourth degree.

Front 66

A more precise definition of second-, third-, and fourth-degree burns includes the depth of skin destruction:

Back 66

partial thickness and full thickness.

Front 67

Partial- and full-thickness burn extent can be determined using TBSA based on two guides:

Back 67

Lund-Browder chart and Rule of Nines. Burn extent is often revised after edema subsides and demarcation of injury zones occurs.

Front 68

Face, neck, and circumferential burns to the chest/back area may inhibit?

Back 68

respiratory function with mechanical obstruction resulting from edema or leathery, devitalized tissue (eschar) formation. These injuries may cause inhalation injury and respiratory mucosal damage.

Front 69

Circumferential burns to extremities can cause circulatory compromise distal to the burn and may need an

Back 69

escharotomy or fasciotomy.

Front 70

Burn management is organized chronologically into three phases:

Back 70

emergent (resuscitative), acute (wound healing), and rehabilitative (restorative). Overlaps in care exist from one phase to another.

Front 71

Emergent Phase
• This is the period of time required to resolve immediate, life-threatening problems. It usually lasts

Back 71

48 to 72 hours

Front 72

The greatest threat in the emergent phase is?

Back 72

hypovolemic shock and edema formation.

Front 73

Toward the end of the phase, if fluid replacement is adequate, the capillary membrane permeability is

Back 73

restored

Front 74

Areas of full-thickness and deep partial-thickness burns are initially anesthetic because the nerve endings are destroyed. Superficial to moderate partial-thickness burns are

Back 74

extremely painful

Front 75

Most burn patients are alert. Unconsciousness or altered mental status is usually a result of ?

Back 75

hypoxia associated with smoke inhalation, head trauma, or excessive sedation or pain medication.

Front 76

If inhalation injury has occurred, the upper airway is vulnerable to ?

Back 76

edema formation and obstruction of the airway.

Front 77

If the patient is hypovolemic, kidney blood flow may decrease, causing renal ischemia. If it continues, acute kidney injury may develop. With full-thickness and electrical burns, myoglobin and hemoglobin are released into the bloodstream and can occlude the

Back 77

renal tubules

Front 78

The primary goals of wound care are ?

Back 78

coverage and prevention of infection.

Front 79

Early and aggressive nutritional support decreases mortality and complications, optimizes healing of the burn, and minimizes negative effects of?

Back 79

hypermetabolism and catabolism.

Front 80

Venous thromboembolism prophylaxis should be initiated if not

Back 80

contraindicated

Front 81

The acute phase begins with the mobilization of extracellular fluid and subsequent diuresis and concludes when burned area is

Back 81

completely covered by skin grafts or when wounds are healed. This may take weeks or many months

Front 82

Partial-thickness wounds form eschar, which begins separating fairly soon after injury. Once the eschar is removed, re-epithelialization appears as

Back 82

red or pink scar tissue.

Front 83

Margins of full-thickness eschar take longer to separate. As a result, they require

Back 83

surgical debridement and skin grafting for healing.

Front 84

Because the body is trying to reestablish fluid and electrolyte homeostasis, it is important for you to follow the patient’s serum electrolyte levels closely, particularly for changes in ?

Back 84

sodium and potassium levels.

Front 85

acute phase Complications include wound infection progressing to

Back 85

sepsis

Front 86

Other problems that may develop during the acute phase include:

Back 86

Paralytic ileus may result if the patient becomes septic.
o Patients can become extremely agitated, withdrawn, or combative during this phase of recovery.
o As scar tissue forms, there may be the development of limited range of motion with contractures.

Front 87

The predominant therapeutic interventions in the acute phase are?

Back 87

wound care, excision and grafting, pain management, physical and occupational therapy, nutritional therapy, and psychosocial care.

Front 88

Current management of full-thickness burn wounds involves early removal of the ?

Back 88

necrotic tissue followed by application of split-thickness autograft skin. Interventions afterward are aimed at promoting rapid, moist wound healing; decreasing pain at the site; and preventing infection.

Front 89

Individualized and ongoing pain assessment and intervention are essential. Note two kinds of pain:

Back 89

(1) continuous, background pain existing throughout the day and night and (2) treatment pain associated with dressing changes, ambulation, and rehabilitation activities.

Front 90

Burns Range of motion can be performed during wound care to reduce ?

Back 90

contractures

Front 91

Rehabilitation begins when wounds have healed and the patient is able to participate in self-care activity. This may occur as early as 2 weeks or as long as

Back 91

7 -8 months