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288 Cards in this Set
- Front
- Back
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Manifestation: plaques with scales: what is this?
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Psoriasis
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Manifestation: Ecchymosis (bruise) and purpura (bleeding into skin): what is this?
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S/S of a platelet d/o or fragile vessels
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Manifestation: Urticaria (wheals or hives): what is this?
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S/S of infection or allergic reaction
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Manifestation: Cutaneous lesions: blue-red OR dark brown plaques and nodules: what is this?
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Kaposi's Sarcoma
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Manifestation: Macular, tan "cafe'-au-lait" spots: what is this?
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Neurocutaneous d/o's: ie, neurofirbromatosis (von Recklinghausen's)
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What 6 vital functions does the Skin do?
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1.) Protection 2.) Sensation 3.) Fluid Balance 4.) Temp Regulation 5.) Vitamin Production (vit. D aka Cholecalciferol) 6.) Immune Response Function (Langerhan Cells facilitate reuptake of IgE-allergens)
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What are some common BENIGN skin changes r/t aging (in the elderly)
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1.) Cherry Angiomas (bright red "moles") 2.) Diminished hair- esp scalp/pubic 3.) Dyschromias (color variations- ie, solar lentigo, melasma and lentigines) 4.) Neurodermatitis (itchy spots) 5.) spider angiomas 6.) Telangiectasias (red marks on skin r/t stretching of blood vessles) 7.) wrinkles 8.) xerosis (dryness) 9.) xanthelasma (yello waxy deposits on upper and lower eyelids)
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What's Solar Lentigo?
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Liver spots- normal, BENIGN occurrence r/t aging
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What's Melasma?
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Dark discoloration of the skin- normal, BENIGN occurrence r/t aging
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What's Lentigines?
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Freckles- normal, BENIGN occurence r/t aging
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What's Neurodermatitis?
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itchy spots- normal, Benign and r/t aging
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What's Telangiectasias?
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Red marks on the skin r/t stretching of blood vessles- Normal, Benign and r/t aging
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What are Seborrheic Keratoses?
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Crusty brown "stuck on" patches- Normal, Benign and r/t aging
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What's Xerosis?
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skin dryness- normal, benign and r/t aging
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What's Xanthelasma?
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Yellowish, waxy deposits on upper and lower eyelids- normal, benign and r/t aging.
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What are 7 skin conditions that are r/t genetic factors?
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1.) Albinism 2.) Eczema 3.) Hypohidrotic Ectodermal Dysplasia 4.) Incontinentia Pigmenti 5.) Neurofibromatosis type 1 6.) Pseudoxanthoma elasticum 7.) Psoriasis
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How's an assessment performed when a pt c/o pruritus (itching)?
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1.) Pt's asked to show which part of the body's involved 2.) Gently, stretch the skin to decrease the reddish-tone/make the rash more visible 3.)Point a penlight LATERALLY across the skin to highlight/make it easier to observe
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How does Pallor manifest in dark skin?
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Brown Skin-looks yellow-brown/dull; Black skin looks ashen gray/dull
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How's erythema assessed in dark skin?
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Purplish-tinge that's hard to see (palpate for warmth w/inflammation, taught skin and deep tissue hardening)
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How does Carbon Monoxide poisoning manifest on dark skin?
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Cherry red nail beds, lips and oral mucosa
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How's tissue for a skin biopsy obtained?
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2 ways: scalpel excision or w/a skin punch instrument that removes a small core of tissue
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How does Immunofluorescence work?
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It identifies the site of an IMMUNE REACTION. Antibodies are made fluorascent w/dye. DIRECT immuneoflurescence detects AUTO-antibodies on the SKIN. INDERECT detects specific antibodies in the pt's SERUM.
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How does Patch testing work?
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It's done to ID what a pt's ALLERGIC to. Allergens are applied to normal skin under OCCLUSIVE patches.
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How are patch testing reactions determined?
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WEAK positive: redness, fine elevations or itching.; MODERATELY positive: fine blisters, papules and severe itching.; STRONG positive: blisters, pain and ulceration.
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How do SKIN SCRAPING tests work?
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Samples are scraped from suspected FUNGAL lesions w/a scapel moistened w/OIL, so it'll stick to the blade. It's put onto a slide, covered w/a coverslip and looked at under a microscope.
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What type of conditions can be detected using a SKIN SCRAPING test?
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Fungal infections-spores/hyphae and Scabies.
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How does a TZANCK SMEAR work?
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Secretions from a lesion are put on a glass slide, stained and examined. Used for BLISTERING skin conditions: herpes zoster, varicella, herpes, and all forms of PEMPHIGUS.
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How does WOOD'S LIGHT exam work?
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It's a lamp that produces long-wave ultraviolet rays-which are a drk purple fluorescence-best seen in a DARK room. The pt's reassured the light won't harm their eyes or skin.
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What's the3 key points of bathing pt's with skin problems?
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1.) mild, LIPID-FREE soap or soap substitue 2.) Rinse completely/BLOT dry w/a soft cloth 3.) NO DEODORANT SOAPS
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What are the key points w/removing an adherent dry dressing, loosen crust or remove exudates?
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Pledgets (ie, gauze/cotten) are saturated w/oil, sterile solution or prescribed solution.
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What's the GENERAL rule of the type of treatment used for skin lesions?
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acutely INFLAMED (hot,red and swollen) and OOZING: WET dressings w/soothing lotion .; CHRONIC DRY/SCALY: Water-soluble emulsions, creams,ointments and paste
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Which meds can cause Pruritus?
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Aspirin, Antibiotics, Hormones (including Birth Control Pills) and Opioids (ie-morphine and cocaine)
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What skin conditions are relieved using a bath solution that includes medicated tars? (ie, BalneTAR, Doak Oil, lavaTAR)
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Psoriasis and chronic eczema *tar's volitile-bath area needs to be well ventilated*
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What are the key points of taking a therapuetic bath? (aka BALNEOTHERAPHY)
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1.) fill tub 1/2 full 2.) don't let water cool excessively 3.) bathmat 4.) tar bath's require an area with good ventilation 5.) wear light, loose clothing after bath
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Which topical corticosteroid's OTC?
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0.5-1% hydrocortisone
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Which topical Corticosteroids are considered to be of LOWEST potency?
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DECADERM, ACLOVATE, HYTONE
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Which topical Corticosteroids are of VERY HIGH potency?
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TEMOVATE, DIPROLENE, ULTRAVATE
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Basic treatment guidelines for Pruritus
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Avoid situations that cause VASODILATION (ie, overly warm places, alcohol, hot foods/liquids); use a humidifier if air's dry; Avoid sweating; Cotton clothing-not synthetic material; keep nails trimmed.;
Shake off excess water after TEPID bath & BLOT-don't rub vigerously. Don't wash w/soap/HOT water; LUBATH or ALPHA-KERI may be sufficient for cleaning (w/exception of ELDERLY-no oils in their bath); warm bath w/mild soap followed immediately w/application of bland emollient to moist skin; COLD compress/ice cube/or agents w/menthol & camphor may help relieve it by CONSTRICTING blood vessels. |
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Meds for Pruritus:
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topical CORTICOSTEROIDS: to decrease itching; oral ANTIHISTAMINES: night: BENEDRYL or ATARAX. day: ALLEGRA.; TRICYCLIC antidepressents for neuropsychogenic pruritus: SINEQUAN
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Pt care for perineal/perianal pruritus:
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D/C home/OTC remedies; Rinse anus w/LUKEWARM water & BLOT dry w/COTTON BALLS; moist tissues after pooping; Cornstarch in skinfolds; don't bath in baking soda, bubble baths, hot water, etc; wear cotten underwear, avoid VASODILATING agents (ie, alcohol, caffeine) and rough/wool clothes; Fiber to keep stools soft
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Risk factors Acne Vulgaris:
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Stems from Genetic, Hormonal & Bacterial factors. 12-35 yrs old; equally affects men and women; onset's slightly earlier w/women because puberty's earlier; Women usually have flare ups a few days BEFORE menses; More pronounced @puberty-ENDOCRINE glands up secretions of the sebaceous glands.
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What are the Primary Lesions of Acne?
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Comedones
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What are Closed Comedones?
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Whiteheads- obstructive lesions r/t follicles being plugged w/Lipids or Oils and Keratin.
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What are Open Comedones?
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Blackheads- r/t accumulated Lipid, Bacterial & Epithelial Debris- NOT DIRT.
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How's MILD acne treated?
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Wash 2x's/day w/cleansing soap. Use Oil-free make up and creams.
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Teaching for pt's using Benzoyl Peroxide for Acne:
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Use once a day. Inform pt-symptoms may worsen & erythema/peeling may occure during early wks r/t inflammation. Improvement can take 8-12 wks. Avoid SUN EXPOSURE.
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Which Oral Antibiotics may be prescribed for MODERATE- SEVERE acne?
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Tetracycline, Doxycycline & Minocycline: in SMALL doses over a LONG time period. NOT for <12 yrs old or PREGNANT.
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What are side effects of Oral Antibiotics for Moderate-Severe acne? (Tetracycline, Doxycycline & Minocycline)
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Photosensitivity; N/D, vaginitis- warn women that they have an increased change of having a fungal/YEAST infection
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Which meds are for pt's with Nodular Cystic Acne OR active Inflammatory Papular Pustular acne w/a tendency to SCAR- that doesn't respond to conventional therapy?
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Synthetic Vitamin A compounds (ie Retinoids)- includes Isotretinoin- (ACCUTANE, SOTRET)
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What's the most common side effects of taking Retinoids (Isotretinoin- ACCUTANE, SOTRET)
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Most common: CHEILITIS (lip inflammation); also dry chaffed skin/mucus membranes; PHOTOSENSITIVITY; CONJUNCTIVITIS; nose bleeds, dry/irritated eyes.
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Warnings about taking Retinoids- isoretinoin (ACCUTANE, SOTRET)
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Don't take Vit. A supplements; TERATOGENIC- pt must use contraceptives during treatment and up to 4-8 wks AFTER treatment.
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Which surgical treatment may be used for NODULAR and CYSTIC forms of acne?
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Cryosurgery (freezing w/liquid nitrogen)
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Which surgical treatment may be used for pt's w/deep scars r/t acne?
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Deep Abrasive Therapy (Dermabrasion): Epidermis & some superficial Dermis are removed to scar level. NOTE: can increase scar formation.
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What's the proper way to remove Comedones?
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W/a comedo extractor. 1st clean site w/ALCOHOL, place opening of extractor over lesion & apply direct pressure. ERYTHEMA usually results from this and takes several wks to go away.
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What should pt's taking systemic antibiotics or isotretinoin be warned about, for once they d/c taking them?
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D/Cing these meds can make acne worse, cause more flare ups and increase the chance of deep scarring.
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Key teaching points for pt's w/Acne:
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Wash w/mild soap 2x's/daily; don't scrub; to get rid of "Oily feeling" may be prescribed mild abrasive soaps/ drying agents; Excessive abrasion can make acne worse; Don't prop hands/rub face; no tight collars/helmets; avoid cosmetics, shaking cream and lotions.
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Which skin condition's characterized by the formation of bullae (large, fluid filled blisters) from original vesicles. And when the Bullae rupture, raw, red areas are left?
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Impetigo- AKA "school sores"
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What causes impetigo?
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STREPTOCOCCI strains (inc. the ones that cause STREP throat) and STAPH infection.
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Who's most at risk for Impetigo?
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kids 2-6 yrs old, those who play close contact sports-(football/wrestling)
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What type of factors are usually involved in kids who have impetigo?
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It's especially common w/kids in poor hygienic conditions. Often follows head lice, scabies, herpes, insect bites, poison ivy or eczema.
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Impetigo's rare in adults, what type of conditions may predispose an adult to impetigo?
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Chronic health problems, poor hygiene and malnutrition.
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Describe the lesions of impetigo.
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small, red macules/pimple-like lesions surrounded by reddened skin. They fill w/pus then over 4-6 days break down and form a thick CRUST. Itching's common.
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How's impetigo on the scalp differentiated from Ringworm?
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Impetigo w/cause the hair to be MATTED.
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Pt's who suffer from ________ have a higher chance of contracting impetigo.
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Cold Sores
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What's the incubation period for Impetigo?
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1-3 days
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How's Impetigo spread?
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Scratching can spread the lesions to different body parts; also spread by DIRECT contact w/lesions or w/NASAL carriers.
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What type of meds are used for Impetigo?
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Systemic Antibiotics: -cillin drugs. Pt's who are allergic to penicillins w/be given ERYTHROMYCIN.
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If impetigo's limited to a small area, and a topical antibiotic prescribed- ( ie, BACTROBAN) what are the key points of taking this?
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Soak/Wash lesions w/a SOAP solution to remove the CRUST and reach the central site of bacterial growth. With GLOVES apply topical abx. Betadine may also be used to clean the skin, reduce bacteria & prevent spread.
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What information does a nurse give to the pt & family regarding Impetigo?
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Bath at least 1x/day w/BACTERCIDAL soap; Seperate towel/washcloth for everyone; Infected person needs to avoid contact w/others UNTIL LESIONS HEAL; Cleanliness/good hygiene prevents the spread of lesions from one skin area to another, and to other people.
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Tinea is the term used for ______.
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RINGWORM
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What's the s/s of tinea capitus?
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Ringworm on the head-a contagious fungal infection of the hair shaft- common in kids S/S: oval, scaling erythemoutous patches; small papules/pustules on the scalp; brittle hair that breaks easily and leaves bald patches w/BLACK DOTS.
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A child w/scaling of the scalp should be considered to have ____ until otherwise proven not to have it.
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Tinea Capitus (ringworm of the scalp)- a common cause of of TEMPORARY hair loss in kids.
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What's the medical treatment for TINEA CAPITUS?
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Tinea Capitus (ringworm-scalp) is treated w/ GRISEOFULVIN: PO x's6/wks; Shampoo hair 2-3x's w/NIZORAL or SELENIUM SULFIDE shampoo. Shampoo hair 2-3x's/wk.
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Nursing education about TINEA CAPITUS:
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ringworm on the scalp's CONTAGIOUS. Use separate combs, hairbrushes, hats, etc. Examine PETS for it.
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How's Tinea Capitus spread?
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Pt's CONTAGIOUS before s/s appear; Both skin-to-skin contact and Indirect contact (combs, hats, etc.); contact w/animals and contact sports (wrestling)
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S/S Tinea Corporis
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Tinea Corporis-BODY ringworm. Red pruritic, red macule that spreads in a RING on face, neck, trunk & extremities.
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How's Tinea Corporis contracted?
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Pet's OR objects that have been in contact w/an animal that has it.
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Medications for Tinea Corporis
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(Body ringworm); TOPICAL antifungal creams for MILD/small areas that are affected. For SEVERE/extensive cases: ORAL antifungals- (-AZOLE drugs) *NOTE* oral antifungals can cause: photosensitivity, skin rashes, headache and nausea. -(Esp. GRIFULVIN V)
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A pt taking an Oral Antifungal drug for tinea corporis should be informed of what potential side effects.
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Photosensitivity, skin rashes, headache and nausea. GRIFULVIN V especially causes these side effects. The newer drugs cause fewer systemic side effects: SPORANOX, DIFLUCAN & LAMISIL.
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Nursing teaching for pt's w/TINEA CORPORIS.
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DAILY-use a clean towel/washcloth; dry skin/folds thoroughly; wear clean, COTTON clothes, next to the skin.
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What's the most common FUNGAL infection?
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TINEA PEDIS (athletes foot)
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What are the clinical manifestations of TINEA PEDIS?
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tinea pedis/athlete's foot's most prevalent on those using communal showers/swimming pools. It can be an ACUTE or CHRONIC infection on the soles of the feet or between the toes. Toenail may be involved.
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What 2 conditions can occur in a pt w/tinea pedis if a BACTERIAL SUPER INFECTION occurs.
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Lymphangitis or Cellulitis. *also- a mixed infection of-FUNGI, BACTERIA & YEAST can occur as well*
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What medical treatment is used for Tinea Pedis during the ACUTE, VESICULAR phase?
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Soaks of BURROW'S solution or POTASSIUM PERMANGANANT solution to remove crust, scales & debris and reduce inflammation.
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What meds are given for TINEA PEDIS and how long are they used for?
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Topical Antifungals: LOTRIMIN AF, DESENEX. Applied to infected areas- continue using for SEVERAL WEEKS after healing, because of the high rate of recurrence.
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Nursing Education r/t TINEA PEDIS:
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keep feet dry as possible-esp between toes; Small pieces of cotton between toes at night; Cotton socks/hosiery w/cotton feet; if feet prespire excessively-perforated shoes for aeration; Avoid plastic or rubber soles; Talcum powder or Antifungal powder 2x's/day; alternate shoes so they can dry completely before being worn.
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What's the different between Tinea and Pediculosis?
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Tinea's a fungus-ringworm and athlete's foot fall under the classification of Tinea. Pediculosis is parasitic skin infestation-head/pubic lice, crabs and scabies fall under the classification of Pediculosis.
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Define Ectoparasite
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Lice are called EXCTOPARASITES because they live on the OUTSIDE of the host's body.
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What's the general cycle of pediculosis capitis
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The scalp's infested by the head louse. Eggs (NITS) are laid close to the scalp and FIRMLY attach to the hair shaft. In 10 days the lice hatch. Maturity is reached in 2 wks.
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Silvery, oval bodies that are hard to remove from the hair are noticed, what is this?
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PEDICULOSIS CAPITIS- head lice. An itchy condition that's more common w/kids and those w/LONG HAIR.
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Medicines for Pediculosis Capitis:
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Shampoos that have Lindane (KWELL) or Pyrethrin w/piperonyl butoxide (RID or R&C); Pt follows shampoo directions, rinses hair thoroughly-then comb w/a fine-toothed comb dipped in VINEGAR. Nits may need to be picked out 1 at a time. *NOTE* Lindane (KWELL) can be toxic to the CNS & isn't to be used more than time specified on package.
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What temperature of water is needed to wash clothing, towels, bedding, etc that may have LICE or NITS?
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at least 130 degrees (54C); if unable to wash things at this temp. then items need to be DRY CLEANED.
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Nursing information for pt's w/Pediculosis Capitis:
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Assure pt that head lice can infest anyone and aren't a sign of being DIRTY; School epidemics-all kids shampoo hair on the same night; Every family member needs to inspect for lice DAILY-for at least 2 WEEKS.; Inform that Lindane (KWELL) can be toxic to CNS-don't use over time specified on the package.
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What's Pediculosis Corporis and Pubis?
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BODY LOUSE: CORPORIS:a disease of unwashed people or those who live in close quarters and don't change their clothes. PUBIS: mainly genital's are infested-spread through sex.
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Notes about the Body Louse:
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Usually affects areas that contact underclothes (neck, trunk and thighs); body louse primarily lives in the seams of underwear/clothes-clinging to it when it bites-leaving little hemorrhagic points.
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S/S of Pediculosis Corporis and Pubis:
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most common s/s: Extreme itching-esp at night; reddish-brown dust in underwear.
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How's a pt w/suspected Pediculosis Pubis examined?
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Pubic area's examined w/a magnifying glass for lice/nits.
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A pt w/Pediculosis Corporis or Pubis presents w/Gray-Blue Macules- what is it r/t?
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Gray-Blue macules may appear on the trunk, thighs or armpits-it's r/t either 1) a reaction of the louse's saliva w/bilirubin (turning into biliverdin) or 2.) an excretion made by the louse's salivary glands.
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What medical measures are taken for a pt being treated for Pediculosis Corporis or Pubis?
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1) Bathe w/soap & water 2.)Apply a prescription SCABICIDE- (ie-KWELL or ELIMITE)- to affected areas of SKIN (or can use the OTC- 1% NIX).; 3.) if eyelashes are involved- petrolatum's thickly applied 2x's/day for 8 days, followed w/mechanical removal of remaining nits.
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What's the treatment for Pediculosis Corporis in the eyelashes?
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Petrolatum's thickly applied 2x's/day for 8 days, followed w/mechanical removal of remaining nits.
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Which epidemic disease can be transmitted by body lice?
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Pediculosis (Lice) can transmit Rickettsial disease- (ie.Typhus, Relapsing Fever and Trench Fever.)
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Nursing management of pt's w/Pediculosis Corporis and Pubis:
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All family member/sexual contacts must be treated /instructed about personal hygiene & methods to control/prevent infestation. Pt & partner must be scheduled for STD testing; all clothing/bedding washed in hot-130F-water, or dry cleaned.
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What additional test can you expect to schedule for a pt who is dxed w/Pediculosis Pubis?
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STD testing for them and sexual partners. Pubic Lice usually coexsists w/STD's.
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Which conditon's characterized by superficial burrows and intense pruritus (itching)?
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Scabies
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General points about Scabies
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Caused by the itch mite- sarcoptes scabiei; Can occur in anyone-but usually found in people living in substandard hygienic conditions.; Consider any pt w/a rash to have a possible infestation of scabies.
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How's Scabies transmitted and how long for s/s?
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Usually involves fingers- can be infected via hand contact. Kids can get it from overnight stays or exchanging clothes. Takes 4 wks for S/S to appear.
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How's a pt w/suspected Scabies checked during examination?
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1.) Ask where pruritus is most severe 2.) w/magnifying glass & penlight held at an OBLIQUE angle-look for small, raised burrows-which may be multiple, straight/wavy, brown/black or threadlike lesions. Esp. check between fingers/wrist.
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Classic S/S of scabies:
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Itching that's worse at NIGHT.
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If a pt has scabies, how long can you expect it to take for other family members/friends to start c/o pruritus?
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About a month- it takes 4 wks for S/S to appear.
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What procedure's done to diagnose Scabies?
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Diagnosis is confirmed by recovering S. scabiei or by-products of the mite from the skin. A sample of epidermis is scraped from the top of burrows or papules w/a small scapel, put on a slide and looked at w/a microscrope at LOW power.
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What's the treatment for scabies?
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1.) remove scaling debris from crust, by taking a warm, SOAPY bath/shower 2.) dry thoroughly & let skin COOL 3.)apply KWELL, EURAX or ELIMITE in a THIN layer on q.thing from the neck down (NOT ON FACE/SCALP) 4.) leave on 12-24 hrs 5.)Wash off 6.) Repeat treatment in 1 wk. 7.) Apply ointment-corticosteroid-to lesions. 8.) itching may continue for several wks- doesn't mean treatment didn't work-pt's not to use more scabicide or take hot showers; can take BENEDRYL or ATARAX to control the itch.
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Nursing education for Scabies:
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Wash all bedding/clothes in HOT- 130F water-or DryClean. After treatment w/scabicide- apply topical corticosteroid to lesions. Pruritus can continue for several wks- it does NOT mean that the treatment failed. Pt's NOT to apply more scabicide or take hot showers. Pt can take BENADRYL or ATARAX to control pruritus. All family/friends need treatment at the same time. There's scabicides available that are safe for infants/pregnant women.
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Which condition involves lesions that are red, raised patches of skin covered w/silvery scales?
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Psoriasis- *if the scales are scraped off, a drk red base is exposed-producing multiple bleeding points.
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What are the risk factors for Psoriasis?
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European ancestry; can occur @any age, but most common 15-35 yrs old; r/t a hereditary defect.
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General points about Psoriasis:
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A Chronic, NON-infectious, inflammatory disease r/t hereditary defect that causes overproduction of KERATIN. A condition that improves/recurs. Has an IMMUNOLOGIC basis.
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What can trigger Psoriasis?
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Stress/Anxiety; Trauma; Infections; Seasonal and Hormonal changes.
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What is Guttate?
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A variation of Psoriasis. Guttate are drop shaped, about 1 cm wide, scattered like raindrops over the body. Believed to be r/t STREP THROAT
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Which sites are most affected by Psoriasis?
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Scalp, Elbows, Knees, Lower Back & Genitilia- usually bilateral.
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What type of symmetry is a feature of psoriasis?
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Bilateral Symmetry
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Describe Erythrodermic Psoriasis
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An exfoliative psoriatic state which involves the total body surface, pt's acutely ill w/fever, chills and ELECTROLYTE imbalance.
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How's Psoriasis diagnosed?
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By the presence of plaque-type lesions. Skin biopsy has no dx value & there's no specific blood test for it.
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If a pt presents with plaque-type lesions and the HCP's in doubt on whether or not they have psoriasis, what would be assessed to confirm a dx of psoriasis?
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S/S of Nail/Scalp involvement and family hx. (Nails would be pitting, discolored, crumbling on free edges w/nail plate separation)
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What's the most important principle of psoriasis treatment?
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Removing the scales. This is done w/BATHS w/Oils (olive oil, mineral oil or Aveeno Oilated Oatmeal) or coal tar (balneTAR) added to water and using a SOFT brush to GENTLY scrub the plaques. After bathing-an EMOLLIENT cream w/either alpha-hydroxy (Lac-Hydrin, Penederm) OR salicylic acid's applied.; Maintain this routine even when the psoriasis isn't in an acute stage.
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A pt w/Psoriasis has been prescribed a high-potency topical corticosteroid. (ie-Temovate, Diprolene or Ultravate)- what instructions should be given to them regarding the use of this?
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Use over a 2x's/day for 4 wks course, followed w/a 2wk break before repeating. Don't use it on the face or intertriginous areas (where 2 skin areas touch/rub-armpit, skin folds, between fingers, etc)
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Which type of corticosteroids are appropriate for LONG term therapy?
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Those w/Moderate potency- ie, DesOwen, Tridesilon, Synalar, Westcort, Valisone or Cutivate.
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Which corticosteroids are safe to use on the face and intertriginous areas (where 2 skin areas touch/rub: armpit, skin folds, between fingers, etc.)
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only LOW potency/OTC: .5-1% Hydrocortisone, Decaderm, Aclovate or Hytone.
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A pt w/PSORIASIS is advised to use Occlusive dressings to increase the effectiveness of corticcosteroids, how should you instruct them to do this and what's the longest they can keep them on?
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*Occlusive dressing's can't stay on over 8 hrs* 2 Large Plastic bags w/openings for head/arms/legs.; Large rolls of tubular plastic can be used on arms/legs; Vinyl Jogging Suit.
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HYPERcalcemia should be monitored for in a psoriasis pt who's taking which 2 drugs?
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DOVENEX and TAZORAC- both of which are topical non-steroid treatments.
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What's DOVONEX used for and who should NOT use it?
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it's avail. as a body cream and scalp solution for PSORIASIS. It's NOT for elderly pts, or Pregnant/Lactating women. Pt's taking this must be monitored for HYPERcalcemia.
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What's TAZORAC used for, side effects to watch out for w/it and who shouldn't use it?
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Tazorac's a RETINOID that causes sun sensitivity- pt's must use sunscreen. Pt's taking this need to be monitored for HYPERcalcemia. NOT for pregnant women-before giving this MUST HAVE A NEG. PREGNANCY TEST and contraception used during treatment.
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What's Photochemotherapy using PUVA and what's it used for?
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For SEVERELY deblitating psoriasis.; A photosensitizing med (8-METHOXYPSORALEN) is taken and when the med's plasma level peaks, they're exposed to long-wave ultraviolet light
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What hazards are r/t PUVA/photochemotherapy
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(for Psoriasis) hazards include: skin cancer, cataracts and premature skin aging.
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A pt w/psoriasis is starting photochemotheraphy using PUVA, what should you tell them, regarding how often they'll have treatment/and what the PUVA chamber w/look like?
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PUVA chamber has high output black-light lamps. Exposure time's calibrated based on the type of unit used and anticipated tolerance of the pt's skin. Pt has treatments 2-3x's/wk until the psoriasis clears- with a 48 hr break BETWEEN treatments-because it takes that long for burns to become evident. AFTER psoriasis clears- a maint program's started until little/no disease occurs-then less potent therapies are used to control minor flare ups.
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In Photochemotherapy- what's the difference between PUVA, UVB and narrow-band UVB light therapy?
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PUVA- light ranges from 180-400 nm and the pt takes a photosensitizing med (8-methoxypsoralen); UVB: light ranges from 270-350. Used alone or w/topical coal tar. ; narrow-band UVB: ranges from 311-312, which lowers exposure to harmful ultraviolet energy & gives a more INTENSE/SPECIFIC therapy.
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If a psoriasis pt doesn't have access to photochemotherapy units, what can they do as an alternative?
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Get Sun exposure
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Pt's who use topical corticosteroids repeatedly on the face/around eyes should be warned that there's a risk for developing ______.
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Cataracts
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What can occur if corticosteroids are overused?
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Skin atrophy, striae (white stripes) and med. resistance.
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Key points about pt's taking Methoxsalen for PUVA treatments.
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PUVA's for moderate-severe psoriases.; causes photosensitization (skin's sensitive to sun) until methoxsalen's been excreted (in 6-8 hrs); avoid sun exposure- use sunscreen/tight net clothes, etc; GRAY or GREEN tinted wrap-around sunglasses worn DURING/AFTER treatment & ophthalmologic exams should be done on a regular basis.
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A pt taking Methoxsalen for PUVA c/o Nausea- what should you advise them?
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Take it w/food
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Key points-PUVA therapy:
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Lubricant/bath oils can be used to remove scales- BUT no other creams/oils on areas exposed to ultraviolet light. Women-use contraceptives.
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Which 2 skin cancers are the most common, which one's the 3rd most common?
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Most common's-Basal Cell; 2nd is Squamous Cell; The 3rd's Melanoma.
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What's the leading cause of skin cancer? And some key points about being exposed to it.
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Sun exposure: skin cancer's r/t the TOTAL amount of exposure; proportional to age (avg. 60 yrs) and proportional to amount of MELANIN in the skin.
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What are the risk factors for Skin Cancer
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Fair skinned/haired w/blue eyes- esp. of CELTIC origin- due to insufficient skin pigmentation; those who burn & don't tan; Chronic Sun exposure; exposure to chemical pollutants; sun-damaged skin; hx of x-ray therapy for Acne or benign lesions; scars from severe burns; chronic skin irritations; immunosuppression and Genetic factors.
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Workers around which type of chemical pollutants are at higher risk for skin cancer?
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Arsenic, Nitrates, Coal, Tar/Pitch, Oils and Paraffin.
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Which cancer starts off as a small, waxy nodule w/rolled, translucent, pearly borders. And what's the prognosis for it?
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Basal Cell Cancer- it rarely mestastasizes and is the MOST COMMON skin cancer. However, neglected lesion can result in loss of a nose, ear or lip.
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Which 2 ways does Basal Cell Cancer present itself?
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As a shiny, flat, gray or yellowish plaque OR as a small, waxy nodule w/rolled, translucent, pearly borders.
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Key points about Basal Cell Cancer:
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Most Common skin cancer; rarely mestastasizes; neglected lesions can result in losing nose, ear or lip; Most frequently appears on the face
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Which skin cancer is characterized by invasion and erosion of contiguous (adjoining) tissues?
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Basal Cell Carcinoma
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Why is Squamous Cell Carcinoma a bigger concern than Basal Cell Carcinoma?
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It's an invasive carcinoma that metastasizes by blood or lymphatic system.
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Which skin cancer appears as a rough, thickened, scaly tumor that may be asymptomatic or may involve bleeding?
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Squamous Cell Carcinoma
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Squamous Cell Carinoma can be Primary (arising on the skin/mucous membranes) or they can be from a PRECANCEROUS condition such as: which 3 things?
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1.) Actinic Keratosis (lesions in sun-exposed areas) 2.) Leukoplakia (premalignant lesion of the mucous membrane) or 3.) Scarred or Ulcerated Lesions
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Key points between Basal Cell & Squamous Cell Carcinomas and pt's w/HIV
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Incidence of BCC & SCC is HIGHER in ALL immunocompromised people. Though the tumors look the same, in pt's w/ HIV the tumors may grow faster/recur more often. Treatment's the same for pt's w/HIV & w/OUT HIV.
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How often should people w/HIV or immunosuppression have f/u exams for reccurance of Basal Cell or Squamous Cell?
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q. 4-6 months
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What's the prognosis for Basal Cell carcinoma?
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Good, because tumors stay localized. Some may require wide excision-causing disfigurement- the risk for death is LOW.
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What's the prognosis for Squamous Cell Cancer?
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Depends on whether there's mestastases. If Mestastases has occured- it depends on the histologic type (tissue type) and level/depth of invasion.
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In general- w/Squamous Cell Carcinoma- which is considered a riskier place for it to arise- on a sun-damaged area or on an area w/out sun exposure?
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SCC on sun-damaged area's are LESS invasive and rarely cause death. SCC on area's w/out much Sun or ARSENIC exposure or SCAR formation has a greater chance to spread. Regional lymph nodes should be checked for metastases.
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What treatments are available for Basal Cell and Squamous Cell Carcinoma?
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Surgical Excision; Mohs Micrographic Surgery; Electrosurgery; Cryosurgery & radiation therapy.
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What's the size of the incision for removing a Basal Cell or Squamous Cell Carcinoma?
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Usually has a legnth-to-width ratio of 3:1
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Key points about Surgically managing Basal Cell or Squamous Cell Carcinoma
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Incision's length-width ratio's 3:1; if tumor's large- reconstructive surgery w/skin flap or graft may be needed; incision's closed in layers for cosmetic reason's; a PRESSURE dressing's put over the wound.
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Which treatment's considered the most accurate and best for conserving normal tissue, when removing Basal Cell or Squamous Cell Carcinoma?
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Mohs Micrographic Surgery
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Describe Mohs Micrographic Surgery
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Removes the tumor layer-by-layer; removes a small margin of normal looking tissue; specimen's frozen & analyzed by section to see if all the tumor's gone. If not-additional layers are shaved/examined until all of it's gone. High cure rate for BOTH BCC and SCC.
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Which procedure's the treatment of choice for removing BCC and SCC tumors from around the eyes, nose, upper lip and auri-/peri-auricular areas?
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Moh's Micrographic Surgery
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Key points about Electrosurgery
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Used for Basal Cell and Squamous Cell carcinoma; destroys/removes tissue using ELECTRICAL energy. Current's turned to heat, which passes to the tissue from a COLD electrode.; Electro-DISICCATION's then done.; this process is repeated TWICE. Healing occurs w/in a month.
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What size lesions would electrodesiccation be useful for?
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lesions smaller than 2 cm
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Key points: Cryosurgery
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Destroys Basal Cell and Squamous Cell carcinomas by deep-freezing the tissue. A needle's put into the skin and liquid nitrogen's directed at the the tumor's base until it's -40C to -60C; the tumor's frozen, allowed to thaw, then refrozen. The site thaws naturally, becomes gelatinous & heals spontaneously.; SWELLING & EDEMA follow freezing; Healing takes 4-6 wks.
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Key Points: Radiation Therapy for Basal Cell/Squamous Cell Carcinomas
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For OLDER pts (because x-ray changes may be seen after 5-10 yrs and MALIGNANT scar changes may be induced by irradiation 15-30 yrs later) & Cancer on the eyelid, tip of the nose and near vital structures (facial nerves)
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Things a pt should told before having radiation therapy for Basal Cell/Squamous Cell Carcinomas:
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Skin may become RED/BLISTERED. A bland skin ointment w/be prescribed to relieve discomfort; AVOID SUN exposure
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Things to advise pt's about, who've had Basal/Squamous Cell treatment in the perioral area:
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drink through a straw; limit talking/facial movements; No Dental work until area's completely healed
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Following treatment for Basal/Squamous Cell Carcinoma, how often should f/u exams be done?
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q. 3 months x's 1 yr- which should include PALPATING adjacent LYMPH NODES. Also advise pt to seek treatment that are subjected to friction/irritation.
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Key points about SPF- Solar Protection Factor
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Rated in stregnth: 4 (weakest) to 50 (strongest); SPF indicates how much longer a person can stay in the sun before skin begins to redden. Ex- if a pt can stay in the sun for 10 min before reddening starts- an SPF of 4 w/protect them from reddening for 40 min.
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Key Points about Sun Protection:
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50% of ultraviolet rays penetrate LOOSELY woven clothes; sun's most intense 10-3; Use sunscreen 15 SPF or higher that blocks UVA and UVB light; no oils before/during sun exposure
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How often should WATER-RESISTANT sunscreens be reapplied after swimming, sweating OR prolonged sun exposure?
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q. 2-3 hrs
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A sun screen w/SPF 15 can reduce RECURRENCE of skin cancer by as much as ____
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40%
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When should sunscreen be applied and how often should it be reapplied?
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every morning at least 30 min before leaving the house; then q. 4 hours if sweating. Intermittent application only when exposure's anticipated is proven to be less effective than daily use.
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How can the incidence of solar keratoses be reduced?
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daily use of sunscreen on the HANDS and FACE. (Solar Keratoses are precursors of Squamous Cell Carcinomas)
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Which skin cancer has atypical melanocytes in the epidermis and dermis. (sometimes the subQ)
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Malignant Melanoma
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What are the different forms of Malignant Melanoma?
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-Superficial Spreading; Lentigo-Maligna; Nodular and Acral-Lentiginous
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Most melanomas arise from where?
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Cutaneous Epidermal Malanocytes; some can appear in pre-exisiting nevi (mosles) or in the uveal tract of the eye
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The peak incidence of melanoma occurs between what ages?
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20-45 yrs; Worldwide: the incidence of melanoma DOUBLES q. 10 yrs.
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Risk factors for melanoma:
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Celtic/Scandinavian decent; hx of severe sunburns; living in SouthWest/or near equator; those <30 yrs who's used a tanning bed >10 x's/yr; Whites; genetics- member of a "melanoma-prone family w/multiple changing moles" (dysplastic nevi)
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Which Melanoma is circular, w/irregular boarders; margins that are flat or elevated; and can be any color from tan, brown, black w/gray, blue-black or white. & may have a pink color in a small area w/in the lesion?
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SUPERFICIAL SPREADING MELANOMA- the most common
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Which Melanoma 1st appears as a tan, flat lesion that changes size and color?
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LENTIGO-MALIGNA MELANOMA- a slowly evolving lesion that occurs on sun exposed areas.
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Which Melanoma's "blueberry-like" nodule w/a smooth surface or dome shape, which may be described as a "blood blister" that doesn't heal?
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NODULAR MELANOMA- has a poorer prognosis because it grows VERTICALLY into adjacent dermis.
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Which Melanoma occurs in area's that aren't excessively exposed to sun and are absent of hair follicles- ie palms, soles, nail beds or mucous membranes.
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ACRAL-LENTIGINOUS- become invasive early
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How's Melanoma diagnosed?
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Biopsy- either Excisional or Incisional; Excisional removes a 1-cm margin w/some SubQ; Incisional's done when lesion's too large to remove w/out scaring. *samples taken any other way are NOT considered proof- ie, shaving, curettage or needle aspiration*
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Once a pt's been dxed w/Melanoma, what tests are done?
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1.) Chest X-ray 2.) CBC 3.) Liver Function Test and 4.) Radionuclide OR a CT scan; these are all done to STAGE the extent
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The prognosis for long-term (5 yr) survival for a melanoma lesion that >1.5 mm thick OR there's regional lymph node involvement is
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POOR
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What's the prognosis for long-term (5 yr) survival for a pt w/a thin melanoma lesion and no lymph node involvement?
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3% chance of metastases/ 95% chance of surviving 5 yrs.
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If there's lymph node involvement w/melanoma, what's the chance for surviving 5 yrs?
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20%-50%
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Key points of melanoma prognosis:
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Melanoma on the hand, foot or scalp= better prognosis; Melanoma on Torso= INCREASED chance of mestastases to Bone, Liver, Lungs, Spleen and CNS; Men & Elderly have a poorer prognosis.
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Which Melanoma is circular, w/irregular boarders; margins that are flat or elevated; and can be any color from tan, brown, black w/gray, blue-black or white. & may have a pink color in a small area w/in the lesion?
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SUPERFICIAL SPREADING MELANOMA- the most common
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Which Melanoma 1st appears as a tan, flat lesion that changes size and color?
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LENTIGO-MALIGNA MELANOMA- a slowly evolving lesion that occurs on sun exposed areas.
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Which Melanoma's "blueberry-like" nodule w/a smooth surface or dome shape, which may be described as a "blood blister" that doesn't heal?
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NODULAR MELANOMA- has a poorer prognosis because it grows VERTICALLY into adjacent dermis.
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Which Melanoma occurs in area's that aren't excessively exposed to sun and are absent of hair follicles- ie palms, soles, nail beds or mucous membranes.
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ACRAL-LENTIGINOUS- become invasive early
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How's Melanoma diagnosed?
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Biopsy- either Excisional or Incisional; Excisional removes a 1-cm margin w/some SubQ; Incisional's done when lesion's too large to remove w/out scaring. *samples taken any other way are NOT considered proof- ie, shaving, curettage or needle aspiration*
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Once a pt's been dxed w/Melanoma, what tests are done?
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1.) Chest X-ray 2.) CBC 3.) Liver Function Test and 4.) Radionuclide OR a CT scan; these are all done to STAGE the extent
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The prognosis for long-term (5 yr) survival for a melanoma lesion that >1.5 mm thick OR there's regional lymph node involvement is
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POOR
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What's the prognosis for long-term (5 yr) survival for a pt w/a thin melanoma lesion and no lymph node involvement?
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3% chance of metastases/ 95% chance of surviving 5 yrs.
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If there's lymph node involvement w/melanoma, what's the chance for surviving 5 yrs?
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20%-50%
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Key points of melanoma prognosis:
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Melanoma on the hand, foot or scalp= better prognosis; Melanoma on Torso= INCREASED chance of mestastases to Bone, Liver, Lungs, Spleen and CNS; Men & Elderly have a poorer prognosis.
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What's looked for when checking A: Asymmetry of moles?
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If lesion's balanced on both sides & the SURFACE- is it irregular or smooth? *NOTE* Some Nodular melanomas have a smooth surface
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What's looked for when checking B: Border of moles?
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Notches, does it look fuzzy/indistinct- like it was rubbed w/an eraser?
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What's looked for when checking C: Color?
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Varigated Color: NORMAL moles are uniform light-med brown. Darker color indicates melanocytes have penetrated to a deeper dermis layer; Suspicious colors- if found together- red, white & blue-blue's considered ominous.; White in pigmented lesion's are suspicious. *NOTE* Some malignant melanoma's aren't variegated, but instead are uniformly colored.
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What's looked for when checking D: Diameter?
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>6mm's considered suspicious IF there's other signs. If there's no other signs, it's not considered significant.
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Melanoma's are almost always curable if caught early- periodic self-exam's help find new/developing lesions. How should a pt be taught to do a self exam for melanomas?
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MONTHLY-skin and scalp should be checked- Use: full length & hand mirror & have good lighting. 1.) In full length: check front & back, then both sides W/ARMS RAISED 2.) Bend elbow-check forearms, back of upper arms & palms 3.) Check back of legs/Feet, between toes & Soles 4.) W/hand mirror-check back of neck & scalp w/hair parted/lifted 5.) W/hand mirror-check butt and back LAST
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How often should "at risk" pt's do a self exam of their scalp and body for melanomas?
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Monthly
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In addition to the treatment of surgical removal of melanoma, what are the other adjuvant treatments that may be done?
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Chemo AND Immunotherapy or Radiation
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Key points about Immunotherapy for melanoma treatment
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Varied success; Immune function/other biological responses to cancer are altered. The monoclonal antibody- PROLEUKIN-shows promise in preventing recurrence. Still experimental.
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Key points about Regional Perfusion
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May be used when melanoma's in an extremity. Chemo's perfused directly into the area w/melanoma.; High concentration of cytotoxics are delivered; NO SYSTEMIC/TOXIC side effects occur; limb's perfused for 1 hr w/medication given at temps of 102-104F via perfusion pump; Hyperthermia enhances therapy; Goal: control mestasis
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Which skin condition is characterized by red,scaly skin that becomes an open sore?
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Squamous Cell Cancer
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What's the difference between Rubeola and Rubella
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Rubeola=Measles; Rubella=German Measles
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Measles, Mumps and Chickenpox are all ____________.
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Viruses
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When's measles (Rubeola/Rubella) most likely to occur?
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Late winter and Spring
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How does measles manifest?
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Starts w/fever that lasts a few days, followed w/cough, runny nose & PINK EYE. Rash starts on face/upper neck & spreads down the back/trunk, then extends to arms/hands/legs/feet. After 5 days- rash fades in the SAME ORDER IT APPEARED.
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When's measles most contagious?
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4 days BEFORE rash starts to 4 days AFTERWARDS.
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How's measles spread?
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Droplets- the virus is in the mucus of the nose/throat- sprays into the air when pt sneezes/coughs. Droplets are active/contagious on surfaces for up to 2 hrs.
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How long can measles remain on a surface after a pt sneezes/coughs and be contagious?
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up to 2 hrs
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What type of precautions need to be taken w/a pt who has measles?
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Droplet & Contact precautions: pt's highly contagious and needs to be isolated-esp from PREGNANT women. Put them in either another waiting room or in a NEGATIVE PRESSURE isolation room.
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Which virus causes mumps?
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Parmyxovirus
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How does Mumps manifest?
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Fever, headache, muscle aches, tiredness, loss of appetite; Followed by swelling of the salivary glands. The parotid salivary glands-are most affected. (located in cheek, near jaw line-below ears.)
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Which salivary glands are most frequently affected by Mumps?
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Parotid Salivary Glands- located in cheek, near jaw line, below the ears.
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What severe complications can occur from Mumps?
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INFLAMMATION-brain and/or tissue over brain/spinal cord (ENCEPHALITIS/MENGINITIS), testicles (ORCHITIS), ovaries and/or breast (OOPHORITIS/MASTITIS); SPONTANEOUS ABORTION; permanent DEAFNESS
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What care is given for a pt w/Mumps?
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1.)Isolation 2.) TYLENOL for fever (don't use aspirin) 3.) bed rest 4.) liquid diet-for swollen/painful glands 5.) if testes are swollen- supportive undergarments
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What's Varicella commonly known as?
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ChickenPox
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How's Varicella transmitted?
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(chickenPox): highly infectious- spreads from direct contact, in droplets from coughing/sneezing, and touching the fluid from a blister can spread the disease.
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When's a person w/Varicella considered to be contagious?
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1-2 days BEFORE the rash appears until ALL the blisters have formed scabs (in about 5-10 days)
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True or False: once a pt w/Varicella has formed scabs on all of their blisters, they're no longer contagious
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TRUE- takes about 5-10 days for the blisters to form scabs (chickenpox)
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How long does it take to develop varicella, after coming into contact w/an infected person?
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10-21 days
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How does the rash from varicella present on a person who's infected?
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Pt's w/chickenpox w/have a rash that's more profuse on the TRUNK- that becomes sparse distally.
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Though recurrence of Varicella is rare- what type of people are more likely to have it occur?
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Those w/a compromised immune system's more likely to have a recurrence of chicken pox
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What's the treatment for Varicella?
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ChickenPox is treated stymptomatically: Calmine Lotion: itching; Tylenol: fever; Antihistamines (benedryl); cool baths; strict ISOLATION; change linens DAILY; keep kids cool/occupied; no scratching-instruct them to apply direct pressure on the lesions-to relieve itch-but NO SCRATCHING-can cause scars.
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Though Varicella's rarely fatal, what type of people are at risk?
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With Chickenpox- Pregnant women and those w/depressed immune systems.
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Who's at the greatest risk for being affected by Burns?
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Kids <4; Elderly >65; the very poor, and those in manufactured homes and rural areas.
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What increases the risk of death, in a pt who has a cutaneous burn injury?
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Smoke inhalation
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Where do most burn injury's occur-and how?
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At home: Cooking's the primary cause of 1/3 of fires- burn injury's also occur from using electric appliances in the bathroom or LIVING ROOM.
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Which age groups have a high risk for thermal injury and why?
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Young kids and Elderly- because their skin's thin/fragile-so even a short contact w/heat can cause a full thickness burn.
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What's the most frequent type of thermal injury in young kids and the elderly?
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Scalds
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Promoting _____ has the greatest impact on decreasing fire deaths, in the U.S.
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Smoke Alarms
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What are the 4 major goals r/t burns?
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1.) prevention 2.) Institution of lifesaving measures for the severely burned person 3.) preventing disability/disfigurement through early, specialized treatment 4.) Rehabilitation through reconstructive surgery/rehabilitation programs
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To prevent burns- the water heater should be set no higher than ____
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120 F
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What factors place old people at higher risk for burn injuries? What are the leading causes of burn injuries in the elderly?
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Factors: lowered mobility, vision changes and decreased sensation in the feet/hands. The leading causes: scalds and flames
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What are the 4 common causes of Thermal Burns?
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1.) Flame 2.) Flash 3.) Scald 4.) Contact w/a hot object
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What 2 things Chemical Burns?
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Acids (most common) and Alkaline (ie, Bleach- Alkaline's harder to treat)
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What 2 factors make Alkaline burns harder to treat than Acid burns?
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1.) They're not neutralized by tissue fluids as easily as Acids 2.) It adheres to the tissue and continues to damage-even after it's neutralized.
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3 problems that can occur from Chemical burns:
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1.) Respiratory-from inhalalation 2.) Skin 3.) Eye Injuries- Morgan lens can be used to flush the chemical out of the eye
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A low-intensity flash burn would cause what type of burn?
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Superficial Partial-Thickness (a sunburn would also cause this type of burn)
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Scalds and flash flame would cause what type of burn?
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Deep Partial-Thickness
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Flame, prolonged exposure to hot liquids, electric current and chemical would cause what type of burn?
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Full thickness
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What type of burn involves the Epidermis and possibly some of the dermis?
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Superficial Partial-Thickness
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What type of burn involves the Epidermis, Upper dermis and a portion of the deeper dermis?
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Deep Partial-Thickness
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What type of burn involves the Epidermis, the entire dermis, and possibly SubQ, connective tissue, muscle and bone?
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Full-Thickness
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A pt presents with a burn that's reddened, blanches w/pressure and appears dry with very little edema and possibly some blisters- what type of burn is this?
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Superficial-Partial Thickness- w/have a complete recovery within a week with no scars.
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What Symptoms would you expect from a pt w/a superficial partial-thickness burn/
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Tingling, Hyperesthesia (super-sensitivity) w/pain that's soothed by cooling
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Key points about Superficial partial-thickness burns
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Involves: Epidermis/possibly some of the dermis; S/S: Tingling, Hyperesthesia (supersensitivity), pain's soothed w/cooling; Appearance: Reddened, blanches w/pressure, dry. Minimal to no edema. Possible blisters.; Healing time: w/in a week w/no scarring.
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A pt presents with a burn that's blistered, has a mottled red base, weeping surface and edema. What type of burn is this?
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Deep Partial-Thickness burn (heals in 2-4 wks w/some scarring/depigmentation) *Infection can turn it into a full thickness burn*
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What symptoms would you expect a pt w/a Deep Partial-Thickness burn to have?
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Pain, Hyperesthesia, SENSITIVE TO COLD AIR
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Deep-Partial Thickness burns are most likely to cause ______ scars.
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hypertrophic scars
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Key points about Deep-Partial Thickness burns:
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Involves: Epidermis, upper dermis & portion of deeper dermis; S/S: Pain, Hyperesthesia & sensitivity to cold air; Appearance: Blistered, mottled red base, broken epidermis, weeping surface exuding fluid; Recovery time: 2-4 wks w/some scarring & depigmentation contractures
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A pt presents w/a burn that's Dry, pale white, leather or charred. The skin's broken and fat's exposed and there's edema- what type of burn is this?
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Full-thickness burn
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What symptoms would you expect a pt w/Full Thickness burns to have?
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No pain, SHOCK, Hematuria & possible hemolysis (blood cell destruction) and possible entrance/exit wound-if r/t electrical burn.
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Key points- Full Thickness Burns:
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Involves: Epidermis, entire dermis & sometimes SubQ, connective tissue, muscle & bone; S/S: no pain, Shock, hematuria & possible hemolysis (blood cell destruction) & possible entrance/exit wound- if r/t electrical burn; Appearance: Dry, pale white, leather or charred, broken skin w/fat exposed, edema
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What can be expected in the recuperative course of a Full thickness burn?
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Eschar Sloughs, Grafting, Scarring/loss of contour/function, contractures, possible loss of extremity/digits
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What color's can full thickness burns range?
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White to red, brown or black.
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Burn depth determines whether _____ will occur.
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Epithelialization (the growth of skin over the wound)
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What 5 factors need to be considered, in order to determine the depth of a burn?
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1.) HOW the injury occurred 2.) CAUSTIVE AGENT- ie, flame or scalding liquid 3.) TEMPerature of the burning agent 4.) DURATION of CONTACT w/the agent 5.) THICKNESS of the skin
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What 3 methods are used to estimate the total body surface area that's affected by burns?
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1.) Rule of 9's 2.) Lund and Brower method 3.) Palm Method
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Key points about the Rule of 9's
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A Quick way to estimate the TBSA affected: Percentages are assigned to major body surfaces, in multiples of 9's.;
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Key points about the Lund and Browder method
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More precise than the rule of 9's- it recognizes that the percentage of surface area on various anatomical parts- esp head/legs- changes w/growth; the calculated TBSA changes w/AGE as well; An initial evaluation's made when pt arrives at the hospital and is revised on the 2nd & 3rd post-burn day because the demarcation's usually not clear until then.
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Key points about the Palmar method to estimate TBSA that's been burned:
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Good for pt's w/SCATTERED, irregular or odd shaped burns; the size of the pt's palm is approx 1% of the TBSA.
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In burn victims, what's the TBSA used for?
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To calculate the pt's fluid replacement needs.
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How do you use the PARKLAND/BAXTER formula to determine a burn pt's fluid replacement needs?
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(4mL of L.R.)(weight in kg)(%TBSA)= total fluid requirements for 24 hrs. Take the amount for 24 hrs and divide in 1/2= that amount's going to be given in the 1st 8 hrs. Take the remaining 1/2 and give 1/4 in the 2nd 8 hrs and the other 1/4 in the 3rd 8 hrs.
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Key Points about Fluid therapy for burn pt's: what gauge angiocath?
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start 2 large bore IV's (14-18 g.) Consider EJ, Subclavian or Femoral Line
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In a burn pt: adequate fluid resuscitation would result in ___ blood volume levels in the 1st 24 post burn hrs and plasma levels to normal by ____.
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slightly decreased blood volume levels in the 1st 24 hrs and return of plasma levels to normal by the end of 48 hrs. (this serves as a guide, but it isn't the PRIMARY determinant of actual fluid therapy)
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Which initial labs should be drawn for a burn pt?
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CBC, CMP, Type and cross match for blood products (just in case)
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The vital signs you want to aim for in a burn pt: Urine output _____cc/hr for adult (_____cc/hr for ELECTRICAL BURN); BP >___systolic; Pulse <____ BPM; Resp. ____/min; AAOx's 3
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For burn pt's- shoot for a Urine output of 30-50 cc's/hr (adult)/ or 75-100 cc/hr in an ELECTRICAL burn pt; BP >90 systolic; Pulse <120 BPM; Resp. 16-20/min; and AAOx's 3
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What's the PRIMARY determinant of actually fluid therapy? How often is it assessed?
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Pt's response as evidenced by Heart Rate (<120); B.P. (>90 systolic) and urine output (30-50 mL/hr for adult, electrical burn pt: 75-100 mL/hr): these things must be assessed at least HOURLY
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Which eye structures bend, refract and focus light rays for vision?
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Cornea, lens and vitreous
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Key Points about the MACULA:
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an area of Retina-the MOST USED part of the Retina- takes care of critical focusing and is used for reading and staring intently at an object.
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Which group of diseases causes damage to the eye's optic nerve and can result in vision loss/blindness?
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Glaucoma
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Which vision problems a result of normal fluid pressure inside the eyes slowly rising?
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Glaucoma
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Who's most at risk for Glaucoma?
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Blacks >40; EVERYONE >60 esp. Mexicans; pt's w/a family hx. 5x's more likely to occur in blacks than whites. 4x's more likely to cause blindness in blacks than whites; 15x's more likely to cause blindness in blacks between 45-64 than in whites of the same age group.
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Which eye problem results in pt's losing their peripheral vision, ie "tunnel vision" develops.
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Glaucoma (can occur in 1 or both eyes)
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Key Points Glaucoma:
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No symptoms at 1st, vision stays normal/no pain. Side vision graduallyl fails, while objects in front may still be seen clearly. Without treatment, pt w/start having tunnel vision, then eventually straight ahead vision w/decrease until blind.; Can occur in 1 or both eyes.
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What risk factors r/t Glaucoma can a DILATED eye exam revel?
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1.) High Eye Pressure 2.) Thinness of the Cornea 3.) Abnormal Optic Nerve Anatomy
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Which eye conditon's a clouding of the lens of the eye?
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Cataract
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Key points about cataracts:
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Most are r/t AGING-very common in the elderly; can occur in either or both eyes-can't spread from 1 eye to another;
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When visually inspecting a pt's eye- the lense appears gray or milky- what condition should be suspected?
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Cataracts
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What s/s would a pt w/cataracts c/o?
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painless, blurry vision
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