Skin

Front 1

functions of suq-Q fat?

Back 1

-energy reserve
-heat insulation
-extra padding to protect from injury
-blood vessels run through this layer

Front 2

corneum = ?

Back 2

dermis

Front 3

What layer of skin do sensory nerves live?

Back 3

dermis

Front 4

What makes skin waterproof?

Back 4

protein keratin

Front 5

Vit D is activated by?

Back 5

UV light

Front 6

Stages of hair growth?

Back 6

1. anagen: growth
2. telogen: resting/shedding

Front 7

Nail clubbing caused by___

Back 7

hypoxia

Front 8

Spoon nails caused by___

Back 8

Fe deficient anemia

Front 9

Beau's Grooves caused by _____

Back 9

acute illness, prolonged febrile state, periods of malnutrition

Front 10

Nail pitting caused by _____

Back 10

psoriasis, alopecia areata

Front 11

white nails caused by _____

Back 11

kidney or liver disease, shock, anemia, MI

Front 12

yellow nailed caused by__-

Back 12

jaudice, bacterial/fungal infection,psoriasis, diabetes, heart failure, smoking, ...cyclines

Front 13

red nails caused by___

Back 13

endocarditis, trichinosis, trauma to nail bed, cardiac insufficiency, also normal for some

Front 14

Blue nails caused by___

Back 14

resp failure, venous stasis

Front 15

normal function of skin???

Back 15

1. first line of defense
2. fluid management
3. temp regulation

Front 16

name that lesion:
Primary: freckles/flat moles, rubella; flat lesions that are <1 cm in diameter there color us usually different from surrounding skin

Back 16

macules

Front 17

Name the lesion
lipomas, elevated marble-like lesions > 1cm wide and deep

Back 17

nodules

Front 18

Name the lesion:
Primary: vitiligo, macules that are >1 cm in diameter. May or may not have some surface changes-either a slight scale or fine wrinkles

Back 18

patches

Front 19

Name the lesion:
Primary: sebaceous ____ are nodules filled with either liquid or semi-solid material that can be expressed

Back 19

cysts

Front 20

Name the lesion:
Primary: warts/elevated moles…small, firm, elevated lesions < 1cm in diameter

Back 20

papules

Front 21

name the lesion:
Primary: (acute dermatitis)/(2nd degree burns): blisters filled with clear fluid.

Back 21

vesicles/bullae

Vesicles = < 1cm
bullae = >1cm

Front 22

Name the lesion:
Primary: psoriasis, elevated plateau-like patches more than 1 cm in diameter that do not extend into the lower skin layers

Back 22

plaques

Front 23

Name the lesion:
primary: acne/ acute impetigo, vesicles filled with cloudy or purulent fluid

Back 23

pustules

Front 24

name the lesion:
primary: urticarial/insect bites, elevated irregular shaped, transient areas of dermal edema

Back 24

wheels

Front 25

Name the lesion:
Primary: varicella, wider than fissures but involve only the epidermis, they are often associated with vesicles, bullae, or pustules

Back 25

erosions

Front 26

Name the lesion:
Secondary:exfoliative dermatitis/psoriasis, are visible thickened stratum corneum. Appear dry and whitish. They are seen most often with papules and plaques.

Back 26

scales

Front 27

Name the lesion:
Secondary:such as stage 3 pressure ulcers, deep erosions that extend beneath the epidermis and involve the dermis and sometimes the sub-q fat

Back 27

ulcers

Front 28

Name the lesion:
Secondary: : eczema/impetigo, composed of dried serum or pus on the surface of the skin, beneath which liquid debris may accumulate. Frequently result from broken vesicles, bullae, or pustules

Back 28

crusts/oozing

Front 29

Name the lesion:
Secondary:chronic dermatitis, palpably thickened areas of epidermis with accentuated skin markings. They are caused by chronic rubbing and scratching.

Back 29

lichenifications

Front 30

Name the lesion:
Secondary: athletes foot, liner cracks in the epidermis, which often extend into the dermis.

Back 30

fissures

Front 31

Name the lesion:
Secondary: striae, characterized by thinning of the skin surface with loss of skin markings. The skin is translucent and paper-like. Atrophy involving the dermal layer results in skin depression

Back 31

atrophy

Front 32

Name is lesion:

red-purple in color may be caused by extravasation of blood into the skin tissue or by visible superficial vascular irregularities

Back 32

vascular lesion

Front 33

Pruritus = ?

Back 33

Itching

Front 34

Meds for pruitus?

Back 34

antihistamines
tranquilizers (sleep, stress)
antibiotics (infection present)
topical corticosteroids

Front 35

fancy word for dry skin?

Back 35

Xerosis

Front 36

Types of moisturizers for xerosis?

Back 36

Emollients: “making soft or supple”
Humectants a substance that promotes retention of moisture
Occlusives: retain moisture, waterproof

Front 37

Seborrhea

Back 37

"greasy itchy scaling"

Front 38

Name the condition:
”: red pustular eruption that affects the sebaceous glands of the skin. Lesions result from increased sebum production. Caused by androgenic hormones or obstruction of the glands themselves. Debris can accumulate and cause bacteria to overgrow and infect the surrounding dermis causing inflammation. AAD definition “chronic dermatosis notable for open and/or closed comedomes (blackheads and whiteheads) and inflammatory lesions including papules, pustules, or nodules”

Back 38

ACNE vulgaris (common acne)

Front 39

How is acne graded?

Back 39

-Mild: 25% of the face: few or several papules or pustules, no nodules

-Moderate: 50% of face: several to many papules or pustules: nodules and few scars

-Severe: >75% of the face: many papules, pustules and nodules: scaring present

Front 40

topical tx for acne?

Back 40

-benzyl peroxide: antibacterial/comedolytic

-Retinols: derived from Vit-A, decreases coheasiveness of epidermal cells and increases epidermal cell turnover (inactivated by UV light, and benzyl peroxide so use at night by itself)

-Topical antibiotics: “…cyclines”, “…mycins” decreases future infections of P. acnes

Front 41

Common oral meds for acne?

Back 41

-Antibiotics: moderate- severe, “…cyclines”

-Isoretinoin (Accutane) severe acne, iPLEDGE, labs needed : LFT, lipids, hematologic disorders
Decreases sebum production, sebaceous gland size, and keratinization, P. Acnes no longer has as much oil for nutrients
Causes severe dry skin and mucous membranes, nosebleeds, depression
Pregnancy class X: 2 forms of birth control one month before starting and one month after stopping. Pharmacist cannot fill a rx if it is more than 7 days old. And can only give 30 day supply. Monthly pregnancy tests required for female client.

-Birth-control: estrogen may help, can take 6 months to show improvement

Front 42

Common teaching for client with acne?

Back 42

Hygiene: use gentle cleanser, wash hands frequently, avoid touching your face
Wash face and wait 20 minutes(allow skin to dry) before applying topical rx,
Oil-free NOT waterproof makeup
Do not pick/squeeze pimples
Avoid friction on skin (hats/hair)
Emphasize good nutrition for healing

Front 43

: Scaling disorder with an underlying dermal inflammation. Abnormality in the growth of epidermal cells in the outer skin layers

Back 43

Psoriasis

Front 44

Main characteristic of psoriasis?

Back 44

to build up of reddened circumscribed plaques usually with a red base (erythematous base) covered by silvery scales

Front 45

Psoriasis appears to be exacerbated by?

Back 45

Psoriasis appears to be an autoimmune reaction to overstimulation of the immune system.

Front 46

What is the basic mechanism of psoriasis?

Back 46

Langerhans’ cells respond to unknown antigen T-cell activationIL6 and targets keratinocytes increasing cell division and plaque formation.

Front 47

What % of psoriasis patients have a genetic predisposition?

Back 47

30%

Front 48

Psoriasis outbreaks can be influenced by?

Back 48

trauma, infections, stress, seasonal changes, hormone fluctuations, steroid withdrawal, and certain drugs (beta-blockers) ACE inhibitors, and chloroquine

Front 49

psoriasis is associated with what other disorders?

Back 49

psoriatic arthritis, inflammatory bowel disease, diabetes, cardiovascular disease, and lymphoma

Front 50

Common topical meds for psoriasis?

Back 50

Corticosteroids: anti-inflammatory, anti-proliferative, immunosuppression, vasoconstrictive effects, use low potency or not at all on genitals, face or on a baby

Vit-D: ointment

Tazatotene: topical retinoid

Anthralin and coal tar

Front 51

List tx for psoriasis

Back 51

- methotrexate

-cyclosporine

-biologic agents (Alefacept (IM), efalizamub (SC) target pathogenic T-cells
Adalimumab (SC), etanercept (SC), and infliximab (SC) Tumor Necrosis Factor inhibitors)

-UV light therapy

-Photochemotherapy

Front 52

describe the use of Methotrexate for psoriasis...

Back 52

-Causes bone marrow supression, CBC test may be done to identify likelihood. Client will take small doses and have another CBC drawn and few days later

-Hepatotoxicity-liver function tests monthly for 6 months then q 1-3 months. Client may need liver biopsy at some point. Not good from people who drink a lot of booze or if they have a jacked up liver to begin with.

-May also cause pulmonary fibrosis

-Fetal abnormalities and fetal death

-Don’t administer if client has active infection or live vaccine (MMR, Typhoid, or nasal flu mist)

-Men must stop >3 months before makin’ babies

Front 53

describe cyclosporine to tx psoriasis

Back 53

Administer same time daily with meals

Serious side effects nephrotoxicity & HTN; GFR/Creatinine tests should be done before and during tx

-Not good for systemic cancers, uncontrolled infections, live viral vaccinations, phototherapy with PUVA

Front 54

describe biologic agents for psoriasis

Back 54

Alefacept (IM), efalizamub (SC) target pathogenic T-cells
Adalimumab (SC), etanercept (SC), and infliximab (SC) Tumor Necrosis Factor inhibitors

Before administration: LFT, hepatitis screening, TB test, ongoing testing throughout tx

Monitor for infections/malignancies

Avoid live virus vaccines

Front 55

Describe UV light therapy for psoriasis

Back 55

UVB used for generalized psoriasis ( >30% of body)

Decrease epidermal cell growth rate

Admin. Gradually until client has mild erythema, usually 3 times a week

Front 56

describe Photochemotherapy PUVA-light activation of methoxsalen...tx for psoriasis

Back 56

a. Inhibits DNA synthesis and prevents cell mitosis
b. Phototherapy given about 2 hours after drug is taken
c. Avoid sun exposure for 12 hours
d. Can accelerate skin aging
e. Cause catarax
f. Can cause cancer
g. Can alter immune function

Front 57

Physical tx for psoriasis?

Back 57

gently removes scales

Front 58

How can psoriasis breakouts be limited?

Back 58

by identifying precipitating factors

Front 59

What is impetigo?

Back 59

Superficial infection of the skin usually due to staph, strep, or mixed bacteria

Front 60

What is foliculitis?

Back 60

furuncles and carbuncles- infection around hair follicles that can extend into the dermis and sub-q tissue (bacterial or fungal)

Front 61

What is cellulitis?

Back 61

deeper bacterial infection affecting the dermis and sub-q tissues-expanding red, swollen, tender plaque, s/s: fever, erythema, heat, pain

Front 62

Describe fungal infections?

Back 62

may affect skin and nails. Typical organisms include candida (yeast) and dermatophytes (tinea, ringworm)
a. Candida: affects outter layers of skin and mucus membranes, thrush vaginal candidiasis)
b. Tinea: affects head (tinea capitis), body (tinea corporis), feet (tinea pedis), groin (tinea cruris)
c. Need to keep skin dry and clean may be tx with topical antifungal or systemic antifungal
d. Teach not to share towels and personal items, if infection is at the genitals partners may need tx as well
e. Change clothing daily (socks/underwear)

Front 63

Describe viral infections affecting the skin?

Back 63

warts, molluscum, herpes simplex, varicella, herpes zoster (shingles)
a. Warts: due to HPV (60+ types) can cause genital infection (venereal warts) and non-genital infection (common warts, plantar warts) and mucous membranes
b. Herpes simplex: starts with burning tingling  erythema  vesicle formation  pain, progression to pustules  ulcers  crusting until healing (10-14 days)

Front 64

talk about a. Pediculosis capitis...

Back 64

a. Pediculosis capitis (lice/nits)
i. Louse lays eggs on hair shaft close to scalp  nits hatch in 10 days and reach maturity in 2 weeks
ii. Often found along the back hairline and behind the ears
iii. Itching due to excrement and feeding of louse on the scalp
iv. Spread through combs, hair gear, bed linins etc.
v. Tx: Kwell, Rid shampoo, nit comb, may need repeat tx
vi. Avoid sharing articles launder linens, vacuum, bag articles for 3 weeks.

Front 65

Talk about Pediculosis corporis & pubis ...

Back 65

i. Body lice related to hygiene and close quarters

ii. Pubic lice spread by sexual contact, may coexist with other STDs

iii. Tx with Kwell or other products over affected areas and skin and hairy regions.

Front 66

name the infestation:
: infestation of the skin by itch mites, pregnant female burrows into the skin and lays 2-3 eggs each day for about a month. The eggs hatch in 3-5 days, and the larvae migrate to the surface but burrow into the skin for nutrients and protections

Back 66

SCABIES

Front 67

Characteristics of scabies

Back 67

Characterized by short red-brown burrows (2-3mm) sometimes covered with vesicles, appears as a rash.

Front 68

what are common areas you can find scabies living on a client?

Back 68

Infestations often found in webs between fingers, inner surface of wrist, axilla, female nipples, penis, beltline and butt crack

Front 69

name that skin cancer:
premalignant skin changes related to sun exposure and chronic skin changes....Progression to squamous cell carcinoma may occur if untreated

Back 69

Actinic Keratosis

Front 70

name that skin cancer:
Most common, least aggressive form of skin cancer, appears on sun-exposed areas of the body and incidence increases with age...Frequently reoccurring

Back 70

basal cell carcinoma

Front 71

Tx for basal cell carcinoma?

Back 71

surgical removal

Front 72

name that skin cancer:
Malignant proliferation of the epidermis, may occur on sun damaged skin or normal skin
Can metastasize via blood or lymphatic system, evaluation of lymph nodes is important
Typically appears as a rough thickened scaly tumor, common sites are head and face, and upper extremities
These make up 10-20% of skin cancers
Men are more susceptible, as are people who work outdoors

Back 72

squamous cell carcinoma

Front 73

Tx for squamous cell carcinoma?

Back 73

excision

Front 74

Name that skin cancer:
cancerous neoplasm arising from melanocytes, 10 times more likely in fair skinned individuals, can originate anywhere where there is pigment, 1/3 originate in existing nevi.
Usually >6mm in diameter, asymmetrical, develop within the epidermis over a long period of time (in-situ)
When they penetrate the dermis the can metastasize
High morbidity and mortality

Back 74

Malignant melanoma

Front 75

Malignant melanoma, having this on what areas of the body have a poor prognosis?

Back 75

hands, feet, scalp

Front 76

Explain the ABCDE lesion assessment

Back 76

A. Asymmetrical (one half of the nevi doesn’t match the other)

B. Border irregularity (edges are ragged, blurred, or notched)

C. Color variation or dark black color

D. Diameter greater than pencil eraser (6mm)

E. Evolving (change in size, shape, color, etc.

Front 77

risk factors for malignant melanoma?

Back 77

Family hx- inherited genetic mutation has been found in some familial melanoma, in this case a suppressor gene is affected and cell growth goes uncontrolled

3+ blistering sunburns <20 year of age

Immunosuppression

Located on upper back

Moles

PUVA therapy

Front 78

How is malignant melanoma confirmed?

Back 78

biopsy with micro-staging, diagnostic tests to identify any metastases

Front 79

Tx for malignant melanoma?

Back 79

Surgery: excision, regional lymph nodes, palliative management of isolated metastases (brain, liver, lung, GI Tract)

Immunotherapy: interferons, interleukins, monoclonal antibodies

Radiation therapy: for tumor and soma metastases

Front 80

What is most important to teach regarding malignant melanoma

Back 80

We need to teach clients about sun safety

Use of SPF 15< (skin and lips)

Protective clothing (hats, long sleeves etc)

AVOID TANNING BOOTHS & high intensity sun when possible

Front 81

describe nursing implications for C&S (Culture and sensitivity)

Back 81

Must be done before antibiotic therapy is begun.

Sterile container, follow facility policy

Lab should receive within 30 minutes or refrigerate

Results in about 48 hours

Front 82

What is Potassium Hydroxide examination and fugal culture?

Back 82

skin is scraped and K hydroxide kills all non-fungal cells

Front 83

What is Tzanck’s Smear?

Back 83

cells from the base of the lesion are examined under a microscope confirming viral infection

Front 84

What is scabies scraping?

Back 84

Skin scrapings are examined under a microscope looking for eggs/mites

Front 85

What is the wood's light examination?

Back 85

black lights used in a dark room to look for areas of pigment change and infection. Good for light skinned clients

Front 86

What is patch testing?

Back 86

test chemicals containing the allergen are applied for 48 hours, then client is assessed for allergic rxn (localized redness, blisters, swelling)

Front 87

What is a biopsy?

Back 87

surgical removal of a nevi/lesion to be examined under a microscope. Local anesthetic/conscious sedation used for the procedure

Front 88

How does sun screen work?

Back 88

impede UV radiation from reaching viable cells

Front 89

What malignancies can sunscreens protect against?

Back 89

Can protect against: actinic keritinosis and squamous cell carcinomas

Unclear if sunscreen protects against basal cell carcinoma and melanoma

Front 90

What are the types of sunscreens?

Back 90

Organic (chemical): absorb radiation and dissipate heat (aveeno con’t protection, coppertone sport)

Inorganic (physical): act as barriers to sun’s rays.( Zinc oxide)

Front 91

possible sunscreen side effects?

Back 91

Contact dermatitis and photosensitivity can occur with sunscreens

Front 92

Basics of sun safety?

Back 92

a) Use UVA.UVB sunscreen

b) At least SPF 15, higher if you burn easily, including lips

c) Apply 30 min BEFORE sun exposure (PABA sunscreens 2 hrs prior)

d) Reapply after swimming/sweating

e) Reapply every couple hours

f) Wear hat, sunglasses, long sleeves

g) Avoid summer sun between 1000-1600

h) Avoid tanning beds

Front 93

Physical assessment of the skin includes___

Back 93

inspection, palpitation

Front 94

What should a nurse note upon inspection?

Back 94

Obvious changes in color and vascularity
Presence or absence of moisture
Edema
Skin lesions
Skin integrity

Front 95

easiest places to see skin color changes?

Back 95

Color changes are most easily seen in areas of least pigmentation, such as oral mucosa, sclera, nail beds, and palms/soles.

Front 96

What is a primary lesion?

Back 96

are an initial reaction to a problem that alters one of the structural components of the skin

Front 97

What is a secondary lesion?

Back 97

are changes in the appearance of a primary lesion. It is very important to identify whether lesions are

Front 98

What should the nurse note regarding edema?

Back 98

Note distribution, color and location of areas of edema

Front 99

What does edemenuos skin look like?

Back 99

shiny, taut, pale

Front 100

How is skin moisture assessed?

Back 100

is assessed by noting the thickness and consistency of secretions. Excess moisture can cause skin breakdown in bedridden and debilitated patients. Dryness may be due to a dry environment, poor skin lubrication, inadequate fluid intake and normal process of aging.

Front 101

Vascular changes or markings are classified how?

Back 101

normal or abnormal depending on the cause. Normal vascular markings include birthmarks, cherry angiomas, spider angiomas, and venous stars. Abnormal findings include purpuric lesions, petachiae, and ecchymoses

Front 102

Integrity of the skin is assessed by __________

Back 102

first thoroughly examining areas with actual breaks or open areas.

Describe breaks in skin integrity by location, size, color and distribution as well as by the presence of drainage or signs of infection.

Common areas for skin tears associated with fragile, aging skin include: where constricting clothing rubs against the skin, on the upper extremities, or where adhesive tapes or dressings have been applied or removed.

Front 103

How is cleanliness of skin evaluated?

Back 103

Cleanliness of the skin is evaluated to gain information about self-care needs. Inspect hair, nails, and skin closely for excessive soiling or offensive odors. Assess cognitive function of patients whose hygiene appears inadequate.

Front 104

palpitation used for?

Back 104

gather additional information about skin lesions, moisture, temperature, texture and turgor

Palpation may confirm the size of lesions and whether they are raised (papular) or flat (macular), soft or firm. Ask patient if palpation causes tenderness.

Run a finger over areas of dryness to determine level of flaking or scaling.

Make sure hands are warm when testing temperature and use the back of the hand.

Assess skin for turgor. In older patients, test turgor on forehead or chest.