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IM1 > Skin Integrity > Flashcards

Skin Integrity Flashcards

1
Q

Who has the responsibility to assess & monitor the skin?

A

The nurse

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2
Q

What is the purpose of skin?

A

protection
sensory
Vitamin D synthesis
Fluid balance
natural flora

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3
Q

How should we assess the skin?

A

inspect entire body
visual & tactile
assess any rases or lesions
note hair distribution
skin color
blanch test

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4
Q

What should we pay special attention to on the skin?

A

where there are bony prominences

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5
Q

During the skin assessment what should we identify?

A

the pt’s risk
signs/symptoms of impaired skin or wound healing

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6
Q

What should we examine skin for?

A

Actual impairment

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7
Q

What are the focuses we should have when looking at the skin?

A

level of sensation, movement, & continence

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8
Q

When should we assess the skin?

A

when pt is admitted
once per shift after admission

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9
Q

How often we should assess high-risk pt’s?

A

assess every 4 hrs or more often

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10
Q

Where should we palpate skin?

A

on areas of redness to determine if skin is blanchable

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11
Q

What areas should we pay special attention to?

A

bony prominences
medical devices
areas with adhesive tape

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12
Q

Braden scale sensory perception: What does 1. Completely limited mean?

A

unresponsive
limited ability to feel pain over most of the body

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13
Q

Braden Scale sensory perception: What does 2. Very limited mean?

A

painful stimuli
cannot communicate discomfort
sensory impairment over half the body

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14
Q

Braden Scale Sensory perception: What does 3. Slightly limited mean?

A

verbal commands
cannot always communicate discomfort
sensory impairment 1-2 extemities

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15
Q

Braden scale sensory perception: What does 4. no impairment mean?

A

verbal commands
no sensory deficit

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16
Q

Braden scale moisture: What does 1. Constantly moist mean?

A

perspiration, urine, etc
always

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17
Q

Braden scale moisture: what does 2. very moist mean?

A

often but not always
linen changed @ least once per shift

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18
Q

braden scale moisture: what does 3. occasionally moist mean?

A

extra linen changed qday

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19
Q

braden scale moisture: what does 4. rarely moist mean?

A

usually dry

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20
Q

Braden scale activity: what does 1. bedfast mean?

A

never oob

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21
Q

braden scale activity: what does 2. chairfast mean?

A

ambulation severely limited to non-existent
cannot bear own wt - assisted to chair

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22
Q

braden scale activity: what does 3. walks occasionally mean?

A

short distances daily w/ or w/o assistance
majority of time in bed or chair

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23
Q

braden scale activity: what does 4. walks frequently mean?

A

outside room 2 x per day
inside room q 2 hrs during waking hrs

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24
Q

braden scale mobility: what does 1. completely immobile mean?

A

makes no change in body or extremity position

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25
Q

braden scale mobility: what does 2. very limited mean?

A

occasional slight changes in position
unable to make frequent/significant changes independently

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26
Q

braden scale mobility: what does 3. slightly limited mean?

A

frequent slight changes independently

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27
Q

braden scale mobility: what does 4. no limitation mean?

A

major & frequent cahnges w/out assistance

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28
Q

Braden scale nutrition: what does 1. very poor mean?

A

never eats complete meal, very little protein
NPO, clear liquids, IV >5 days

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29
Q

Braden scale nutrition: what does 2. probably inadequate mean?

A

rarely eats complete meal, some protein
occasionally takes dietary supplements
receives less than optimum liquid diet

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30
Q

braden scale nutrition: what does 3. adequate mean?

A

eats over 1/2 of most meals, adequate protein
usually takes a supplement
tube feeding or TPN probably meets nutritional needs

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31
Q

braden scale nutrition: what does 4. excellent mean?

A

eats most of meal, never refuses, plenty of protein
occasionally eats b/w meals
does not require supplements

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32
Q

braden scale friction & shear: what does 1. problem mean?

A

moderate to maximum assistance in moving
frequently slides down in bed or chair
spasticity, contractures or agitation leads to almost constant friction

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33
Q

braden scale friction & sheer: what does 2. potential problem mean?

A

moves feebly, requires minimum assistance
skin probably slides against sheets
relatively good position in chair or bed w/ occasional sliding

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34
Q

braden scale friction & sheer: what does 2. potential problem mean?

A

moves feebly, requires minimum assistance
skin probably slides against sheets
relatively good position in chair or bed w/ occasional sliding

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35
Q

braden scale friction & sheer: what does 3. no apparent problem mean?

A

moves on bed & chair independently
sufficient muscle strength to lift up completely during move
good position in bed or chair

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36
Q

Braden scale scores: low risk 15-18 are what components?

A

regular turning schedule
enable as much activity as possible
protect heels
mange moisture, fiction & sheer

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37
Q

braden scale scores: moderate risk 13-14 are what components?

A

regular turning schedule
enable as much activity as possible
protect heels
manage moisture, frictio & sheer
position pt @ 30 degree lateral incline w/ wedges or pillowa

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38
Q

braden scale scores: high risk 12 or less are what components?

A

regular turning schedule
enable as much activity as possible
protect heels
manage moisture, friction & sheer
position pt @ 30 degree lateral incline
make small shifts in position frequently
pressure redistribution surface

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39
Q

How often should we reposition pt’s?

A

frequently

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40
Q

How long should pt’s sit in the chair?

A

no more than 2 hours if not contraindicated

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41
Q

What other interventions can help prevent pressure injures?

A

keeping HOB @ 30 degrees & keeping a schedule of repositioning

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42
Q

What is a stage 1 wound characteristics?

A

nonblanchable redness

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43
Q

What is a stage 2 wound characteristics?

A

partial thickness

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44
Q

What is a stage 3 wound characteristics?

A

full-thickness skin loss

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45
Q

What is a stage 4 wound characteristics?

A

full-thickness tissue loss

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46
Q

What are unstageable/unclassified wound charateristics?

A

full-thickness skin or tissue
loss-depth
unknown

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47
Q

What is the depth of a suspected deep pressure wound?

A

unknown

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48
Q

What is our early intervention protocol acronym?

A

CHANT

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49
Q

What does C in CHANT stand for?

A

Cleanse

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50
Q

What does H in CHANT stand for?

A

hydrate (& protect) skin

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51
Q

What does A stand for in CHANT?

A

alleviate pressure

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52
Q

What does the N stand for in CHANT

A

nourish

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53
Q

What does the T stand for in CHANT?

A

treat

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54
Q

What should we do for a red/excoriated peri/rectal area to intervene for wounds?

A

cleanse
dry throughly
moisture barrier daily & prn

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55
Q

How can we intervene in wound prevention when we see redness/excoriation b/w skin folds?

A

cleanse
dry throughly
place inner dry or dry AG textile in skin folds

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56
Q

How can we intervene in wounds for red heels?

A

position pressure off heels
elevate on pillows
sage boot
reduce friction

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57
Q

How can we intervene in wounds for a red sacral/coccyx area?

A

change positions q 1-2 hrs
HOB <30 degrees unless contraindicated
avoid excess moisture
frequent peri care
wrinkle free linen

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58
Q

What are nursing priorites for skin?

A

assessing & monitoring skin integrity
identifying risks for skin problems
identifying present skin problems
planning, implementing, & evaluating interventions to maintain skin integrity

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59
Q

Inflammatory response: what is sequential response to cell injury?

A

neutralizes & dilutes inflammatory agent
removes necrotic materials
establishes an environment suitable for healing repair

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60
Q

Does inflammation equal infection? Why or why not?

A

No, inflammation is always present w/ infection, but infection is not always present w/ inflammation

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61
Q

Which conditions can an inflammatory response occur?

A

surgical wounds, other skin injuries
allergies
autoimmune diseases
skin infection

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62
Q

What does wound mean?

A

any disruption of the integrity & function of tissues in the body

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63
Q

What is important for wound healing?

A

wound assessment & classification

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64
Q

What can cause an inflammatory response in the first 24 hrs?

A

tissue trauma

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65
Q

Is the mechanism the same for inflammatory response regardless of the injury?

A

yes

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66
Q

What does the intensity of the inflammatory response depend on?

A

extent & severity of the injury
reactive capacity of the injured person

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67
Q

What is the vascular response to inflammation?

A

increased capillary permeability, fluid moves into tissue spaces
Results in redness, heat, & swelling @ site of injury & surrounding areas

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68
Q

What are local responses to inflammation?

A

redness
heat
pain
swelling
loss of function

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69
Q

What are systemic response to inflammation?

A

increased WBC count
Malaise
Nausea & anorexia
Increased pulse & RR
Fever

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70
Q

What can cause systemic response to systemic response to inflammation?

A

complement activation & release of cytokines

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71
Q

Types of inflammation: Acute

A

healing in 2-3 wks, no residual damage
neutrophils predominant cell type @ site

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72
Q

Types of inflammation: subacute

A

same feature as acute but lasts longer

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73
Q

Types of inflammation: chronic

A

may last for years
injurious agent persists or repeats injury t site
predominate cell types are lymphocytes & macrophages
may result from changes in immune system

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74
Q

How do we promote good health with wounds?

A

prevention
adequate nutrition
early recognition of injury/inflammation
immediate treatment

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75
Q

What is the final phase of inflammatory process?

A

wound healing

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76
Q

What two major components are part of healing?

A

regeneration & repair

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77
Q

What does regeneration mean?

A

replacement of lost cells & tissues w/ cels of the same type

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78
Q

What does repair mean?

A

healing as a result of lost cells being replaced by connective tissue, results in scar formation
- more common
- more complex
- occurs by primary, secondary, or tertiary intention

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79
Q

What 3 phases are apart of healing by primary intention?

A

initial phase
granulation phase
maturation phase

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80
Q

What does the initial phase mean?

A

3-5 days, acute inflammation response

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81
Q

What does the granulation phase mean?

A

fibroblasts secrete collagen, wound pink & vascular, risk for dehiscence, resistant to infection

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82
Q

What does the maturation phase mean?

A

this is where scar formation occurs
begins 7 days after injury, continues for months/yrs, fibroblasts disappear, wound becomes stronger, mature scar forms

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83
Q

What does healing by secondary intention mean?

A

wounds from trauma, ulceration, & infection have large amounts of exudate & wide, irregular wound margins w/ extensive tissue loss
edges cannot be approximated

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84
Q

How do can wounds with secondary intention heal?

A

healing process is same as primary, but inflammatory reaction may be greater, wound may need to be debrided before healing can take place

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85
Q

How does tertiary wound intention occur?

A

delayed primary intention due to delayed suturing of wound
occurs when a contaminated wound is left open & sutured closed after infection is controlled

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86
Q

Partial thickness wounds: What are the 3 components of healing?

A

inflammatory response
epithelial proliferation & migration
reestablishment of epidermal layers

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87
Q

Full-thickness wounds: What are the 4 components of healing?

A

hemostasis
inflammatory phase
proliferative phase
maturation

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88
Q

How do full-thickness wounds that extend into the dermis heal?

A

heal by scar formation

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89
Q

What factors influence wound healing?

A

nutrition
tissue perfusion
infection
age

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90
Q

How does nutrition impact wound healing?

A

Protein, Vitamins (ESP. A & C), & trace minerals of zinc & copper
Adequate calories

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91
Q

How does tissue prefusion impact wound healing?

A

oxygen fuels cellular functions

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92
Q

How does infection impact wound healing?

A

prolong the inflammatory stage, delays collagen synthesis,. prevents epithelialization, increases cytokine production

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93
Q

How does age impact wound healing?

A

decreased function of macrophage leads to delayed inflammatory response in older adults

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94
Q

What are complications of wound healing?

A

hemorrhage
hematoma
infection
dehiscence
evisceration

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95
Q

What does hemorrhage mean?

A

abnormal internal or external blood loss may be caused by suture failure, clotting abnormalities, dislodged clot, infection or erosion of a blood vessel (tubing, drains) or infection process

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96
Q

What does hematoma mean?

A

extravasation of enough size to cause visible swelling

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97
Q

What does infection mean?

A

occurs when a pathogen invades the body multiplies, & produces disease, usually causing harm to the host

98
Q

What dose dehiscence mean?

A

separation & disruption of previously joined wound edges
usually occurs when a primary healing site bursts open

99
Q

What does evisceration mean?

A

occurs when wound edges separate to the extent that intestines protrude through wound
usually needs immediate surgical treatment

100
Q

How are wounds classified?

A

by cause & depth
surgical or non-surgical; acute or chronic
superficial, partial thickness, full thickness

101
Q

What is a skin tear?

A

wound caused by shear, friction, &/or blunt force
can be partial thickness or full thickness
common in older adults & those critically/chronically ill

102
Q

When should we assess skin?

A

on admission & every shift

103
Q

What should we include when documenting a wound?

A

location, size, condition of surrounding tissue, & wound base
any drainage - consistency, color, odor

104
Q

What else should nurses consider when examining a wound?

A

if there are any factors that may delay healing

105
Q

What determines the care we do for a wound?

A

extent, character, & phase of healing

106
Q

What do we need for cleaning wounds?

A

may need cleansing & some type of wound closure (adhesive strips, sutures, staples)
various dressings can be used to keep wound clean & moist

107
Q

What are surgical wounds allowed to be covered with and when can this be removed?

A

covered with sterile dressing & remove in 2-3 days

108
Q

What is an enemy of wound healing?

A

dryness

109
Q

What can damage new epithelium & delay healing?

A

antimicrobial & antibacterial solutions should not be used in a clean granulating wound

110
Q

What can surgical wounds have that may help get rid of fluid?

A

Drains
Ex. Jackson-Pratt drain (JP)

111
Q

What must be converted to a clean wound before healing can occur

A

a contaminated wound

112
Q

What is debridement and what is it for?

A

debridement is removal of dead tissue & debris
it is for cleaning contaminated wounds

113
Q

what is available that can absorb exudate & clean the wound?

A

dressings

114
Q

what is the purpose of dressings?

A

protects from microorganisms
aids in hemostasis
promotes healing by absorbing drainage or debriding a wound
supports wound site
promotes thermal insulation
provides a moist environment

115
Q

what type of dressings do we have?

A

gauze
transparent film ‘
hydorcolloid
hydrogel
foam
composite

116
Q

when changing dressings what should we know?

A

what type of dressing is needed, if there are any drains/placement of said drains, & equipment needed

117
Q

How do we prep for a pt dressing change?

A

review previous wound assessment
evaluate pain &, if indicated, admin analgesics
describe procedure
gather supp
recognize normal signs of healing
answer q’s about the procedure or wound

118
Q

what are comfort measures we can utilize when doing the dressing change?

A

admin analgesic meds 30 to 60 mins before
carefully remove tape
gently clean wound edges
carefully manipulate dressings & drains to minimize stress on sensitive tissues
turn & position pt carefully
date & time dressings
document

119
Q

how do we clean the wound?

A

clean least contaminated top to the surrounding skin
use gentle friction
when irrigating, allow the solution to flow from the least to most contaminated area

120
Q

what else can nurses do for wounds?

A

clean & drain sites
suture care
staple removal

121
Q

how do we remove sutures?

A

review policy & orders prior to removing sutures
document how many u removed
clip near skin, opposite of knot

122
Q

how do we remove steri strips?

A

we dont!
dont pull or create tension with steri strips
teach pt to leave them be & allow them to fall off naturally (about 10 days), pt may shower

123
Q

what can prophylactic doses decrease?

A

decrease the incidence of infection in certain kinds of surgery

124
Q

When do we observe prophylactic use of antibiotics?

A

cardiac surgery
peripheral vascular surgery
GI surgery
& OB/GYN surgeries

125
Q

What surgeries use antibiotics as treatments not prophylaxis?

A

compound fractures
perforated abdominal organs
animal bites

126
Q

when should prophylactic antibiotics be given

A

prior to surgery
can be redosed if surgery is unusally long
can be given after surgery if needed but is unsusal

127
Q

what are cephalosporins most affective against?

A

cells undergoing active growth & division

128
Q

are cephalosporins one of the most widely used antibacterial drugs?

A

yes

129
Q

What are first gen cephalosporins called?

A

cefezolin, cephalexin

130
Q

What are second gen cephalosporins called?

A

cefotentan

131
Q

what are thrid gen cephalosporins called?

A

ceftrixaone (also used for active infections, penetrates CSF)

132
Q

what are pressure ulcers also called?

A

pressure injuries

133
Q

What are pressure ulcers?

A

localized injury to skin &/or underlying tissue

134
Q

Where are pressure ulcers usually located?

A

usually over bony prominences
most common on scrum & heels

135
Q

How are pressure ulcers developed?

A

results from prolonged pressure or pressure in combination w/ shearing forces

136
Q

what else can we get pressure ulcers from?

A

can come from medical or other devices

137
Q

When will pressure ulcers heal?

A

generally by secondary intention

138
Q

Where are the 22 pressure ulcer sites?

A

occipital bone
scapula
spinous process
elbow
iliac crest
sacrum
ischium
achilles tendon
heel
sole
ear
shoulder
anterior iliac spine
trochanter
thigh
medial knee
lateral knee
lateral edge of foot
posterior knee

139
Q

what is interface pressure?

A

pressure of body pressing the skin down onto a firm surface

140
Q

How do pressure ulcers form

A

being in one position for a prolonged period of time
stops capillary flow to the tissues
which deprives tissues of oxygen & nutrients
this cause cell death & necrosis

141
Q

What is pressure intensity

A

amount of pressure

142
Q

what is pressure duration

A

length of time pressure is exerted on the skin

143
Q

what is the definition of tissue tolerance

A

ability of tissue to tolerate the pressure

144
Q

what are the tissue tolerance factors

A

nutrition
perfusion
co-morbidities
condition of soft tissue

145
Q

what are shearing forces

A

when skin adheres to a surface & skin layers slide in direction of body movement

146
Q

how does moisture influence skin breakdown

A

sitting in moisture for a long period of time will eventually cause skin breakdown especially if pt is incontinent or unable to clean themselves

147
Q

who/what factors make people at risk for developing pressure ulcers

A

advanced age
anemia
diabetes
elevated body temp
friction
immobility
impaired circulation
incontinence
low diastolic bp (<60 mmHg)
mental deterioration
neurologic disorders
obesity
pain
prolonged surgery
vascular disease

148
Q

how are pressure ulcers staged

A

based on visible/palpable tissue in ulcer bed

149
Q

who makes the guidelines for pressure ulcer staging

A

national pressure ulcer advisory panel (NPUAP)

150
Q

how many stages are there for classifying pressure ulcers and what is the most minor to most major stage

A

4 stages
stage 1 minor
stage 4 major

151
Q

what may prevent identification of wounds?

A

presence of slough or eschar

152
Q

what does a suspected deep tissue injury look like

A

purple or maroon localized if discolored intact skin or blood-filled blister

153
Q

What does the purple or maroon color indicate?

A

indicates damage if underlying soft tissue from pressure &/or shear

154
Q

What can precede a deep tissue pressure injury

A

tissue that is painful, firm, mushy, & boggy

155
Q

what should we know about deep pressure injuries in dark skinned tone people

A

it may be difficult to detect

156
Q

what should we look for during a skin assessment?

A

darker areas of skin
skin temp
skin/tissue consistence
pt sensation

157
Q

how do we look for darker areas on the skin

A

look for areas of skin that are darker than surrounding skin

158
Q

how may darker areas present on the skin

A

purple
brown
blue

159
Q

how do you assess skin temp?

A

use your hand to assess skin

160
Q

how does and ulcer feel temp wise

A

it may feel warm initially then become cooler with time

161
Q

how do we check skin/tissue consistence

A

apply gentle pressure to common sites of injury

162
Q

what does boggy or edematous tissue indicate?

A

a stage 1 pressure ulcer

163
Q

how do we assess pt sensation

A

pt’s may report pain or itchy sensation

164
Q

how do stage 1 pressure ulcers look

A

intact skin*
non-blanchable redness of a localized area

165
Q

where are stage 1 ulcers commonly found

A

common over bony prominences

166
Q

how might the ulcers feel when we asses them

A

firm, soft, warmer, or cooler compared to adjacent tissue

167
Q

what would a pressure ulcer look like on a darker skin tone

A

it may not have visible blanching but color may differ from the surrounding area

168
Q

what do stage 2 pressure ulcers look like

A

partial-thickness loss of dermis
shallow open ulcer with red/pink wound
may be intact or ruptured serum filled blister
can be shiny or dry shallow ulcer without slough or bruising

169
Q

What is not visible in the stage 2 pressure ulcers

A

adipose (fat) & deeper tissues are not visible

170
Q

What is not present during a stage 2 pressure ulcer

A

granulation tissue, slough, & eschar are not present

171
Q

what qualities does a stage 3 pressure ulcer have

A

full-thickness skin loss
subcutaneous tissue may be visible
presents as a deep crater w/ possible undermining or adjacent tissue

172
Q

what is not visible in a stage 3 pressure ulcer

A

bone, tendon, or muscle are not

173
Q

what makes the ulcer depth vary

A

varies on location, this depends on the depth tissue in that area

174
Q

what are the characteristics of a stage 4 pressure ulcers

A

full-thickness loss
extends to muscle, bone, or supporting structures

175
Q

What may be visible with stage 4 ulcers

A

bone, tendon, or muscle

176
Q

can slough or eschar be present with these wounds

A

yes

177
Q

are undermining & tunneling able to be present/occur

A

yes

178
Q

what are the characteristics of an unstageable ulcer

A

full-thickness tissue loss
the ulcer is completely covered with slough or eschar in wound bed

179
Q

what does slough look like

A

yellow, tan, green, grey, brown

180
Q

what does eschar look like

A

tan brown or black

181
Q

what needs to happen to classify the wound if it’s unstageable

A

slough & eschar need to be removed

182
Q

what type of eschar should not be removed & what location is it

A

stable, dry eschar on heels should not be removed

183
Q

what complications can arise from pressure ulcers

A

infection: leukocytosis, fever, increased ulcer size, odor, or drainage, necrotic tissue, indurated, warm, painful

184
Q

what can untreated ulcers lead to?

A

cellulitis w/ spread of inflammation/infection to subcutaneous tissue, connective tissue, bone (osteomylitis), can lead to sepsis & death

185
Q

what is the most common complication of pressure ulcers

A

recurrence of tissue breakdown/repeat pressure ulcers

186
Q

what are the signs that a wound may have an infection

A

swelling, redness, & foul odor

187
Q

how important is the nurses role in preventing skin breakdown & treatment

A

it’s a critical role

188
Q

When should we assess pt’s skin?

A

assess skin of every pt on admission & every shift

189
Q

how often should we assess a pt that has been admitted

A

every 12 hours

190
Q

do we want stage 3 & 4 pressure injuries after admission

A

no
hospital will be liable for pt’s stay

191
Q

how can we prevent pressure ulcers

A

constantly shift wt
keep skin dry
clean incontinent pt’s often
reposition pt w/ drawsheet, transfer board, position them @ 3o degrees lateral position, HOB @ 30 degrees or less, trapeze bar
turning schedule
nutrition & fluid intake

192
Q

how can we reposition the pt

A

w/ drawsheet
transfer board
position them @ 3o degrees lateral position
HOB @ 30 degrees or less
trapeze bar
turning

193
Q

what is the care plan for prevention of a pressure ulcer

A

prevent deterioration
reduce factors that contribute to pressure & skin breakdown
prevent infection
promote healing
prevent recurrence

194
Q

what do we do if a pt has a pressure injury

A

document*
take pics if needed for EMR
wound care specialist
surgical treatment

195
Q

what do we document for a wound

A

stage
size
location
exudate
infection
pain
tissue appearance

196
Q

what do wound care specialists do for the pt’s

A

determine the cleansing protocol
what type of dressings are appropriate

197
Q

what are the general principles for cleaning a wound/how do we clean it before wound care

A

clean w/ normal saline to avoid damaging cells
keep slightly moist to encourage re-epithelialization

198
Q

what surgical treatments may pt’s undergo for wounds

A

skin grafts
skin flaps
musculocutaneous flaps

199
Q

what should we teach to pt’s & caregivers about pressure wounds

A

teach prevention techniques & early warning signs of skin breakdown & tissue injury
nutrition
pressure ulcer care techniques
wound care at home
turning schedule

200
Q

what are other skin damage things we can identify

A

moisture-associated skin damage (MASD) or incontinence associated dermatitis (IAD)
medical adhesive related skin injury (MARSI)
skin tear

201
Q

how do lower extremities develop

A

related to changes in blood flow to lower extremities to chronic disease processes

202
Q

how are arterial pressure ulcers caused

A

by Peripheral Artery Disease (PAD) ischemia & nutrition deprivation as a result of decreased circulation

203
Q

how will the skin look for arterial ulcers

A

thin
shiny
dry
w/ loss of hair on ankles & feet

204
Q

what diseases will people have that can increase their risk for arterial ulcers

A

atherosclerosis
PVD
diabetes
smoking
hypertension
advanced age
obesity
cardiovascular disease

205
Q

where can arterial ulcers be found

A

b/w toes
tips of toes
phalangeal head
lateral malleolus
areas w/ rubbing footwear

206
Q

how do arterial ulcers look

A

even wound margins
punch-out appearance
pale
deep wpund bed

207
Q

do arterial ulcers drain

A

no/very minimal they are painful

208
Q

how can we help heal an arterial ulcer

A

revascularize w/ stents to treat ischemia, then topical treatments will help ulcer

209
Q

how does venous insuffiency occur

A

when blood cannot flow upward from veins in the legs

210
Q

when does chronic venous insufficiency occur

A

happens when valves are damaged allowing blood to leak backward resulting in venous stasi

211
Q

who are at risk for venous ulcers

A

those with:
obesity
deep vein thrombosis (DVT), pregnancy
incompetent valves
CHF
muscle weakness
decreased activity
advance age
family history

212
Q

where are venous ulcers found & what do they look like

A

found in lower legs
have irregular wound margins & superficial ruddy granular tissue

213
Q

howe painful are venous ulcers

A

PAINLES TO MODERATE

214
Q

how may the surrounding skin look with venous ulcers

A

rred
scaly
weepy
thin

215
Q

what can prevent blood from pooling

A

compresion therapy

216
Q

how are diabetic ulcers formed

A

by peripheral neuropathy in skin & decreased ability to fight infection

217
Q

where are diabetic ulcers found

A

plantar aspect of foot
over metatarsal heads
under heels
& on toes

218
Q

are diabetic ulcers painful

A

no

219
Q

how do the wound margins look

A

even margins
rounded or oblong shape with surrounding callous

220
Q

what can diabetic ulcers easily turn into

A

cellulitis or osteomyelitis

221
Q

how can we treat these diabetic ulcers

A

removinf stress/pressure from injured site
debriding wound
antibiotics if infection occurs

222
Q

what is cellulitis

A

inflammation of subcutaneous tissue

223
Q

how does cellulitis form

A

from a staph & strep infection & often following a break in skin
deep inflammation caused by enzymes produced by bacteria

224
Q

how does cellulitis look

A

hot
tender
‘erythematous
edematous area w/ diffuse borders

225
Q

what symps can pt with cellulitis look

A

chills
malaise
fever

226
Q

how do we treat cellulitis

A

moist heat
immobilization
elevation
systemic antibiotic therapy
hospitilzation if IV therapy warranted (sever infections)
progresses to gangrene if left untreated

227
Q

what is the most important treatment for wounds

A

prevention

228
Q

what can we treat skin & soft tissue infections with (meds)

A

cephalosporins
some penicillins (narrow-spectrum pcn)
carbapenems
vancomycin
clindamycin
linezolid
daptomycin
levofloxacin

229
Q

what are the narrow spectrum penicillins called

A

penicillin g
penicillin v
nafcillin
oxacillin
dicloxacillin

230
Q

how may penicillins be given

A

PO
IM
IV

231
Q

are penicillins effective against MRSA

A

no

232
Q

what should penicillins never be mixed w/ in IV solution

A

aminoglycosides

233
Q

what are the least toxic of all antibiotics

A

pernicilins

234
Q

how are penicillins metabolized & excreted

A

kidneys

235
Q

what are the adverse effects of penicillins

A

allergies
pain & IM injection site
neurotoxicity

236
Q

what should we avoid when doing intra-arterial injections of penicillins

A

gangrene
necrosis
sloughing of tissue can result

237
Q

what is psoriasis

A

common, chronic autoimmune inflammatory disorder characterized by plaque formation

238
Q

what does mild psoriasis look like

A

red patches covered w/ silvery scales on:
scalp
elbows
knees
palms
& soles

239
Q

what does sever psoriasis look like

A

involve entire skin surface & mucous membranes
superficial pustules
high fever
lekocytosis
painful fissuring of skin

240
Q

what are the two process of psoriasis

A

accelerated maturation of epidermal cells
excessive activity of inflammatory cells

241
Q

how can we treat psoriasis

A

topical treatments
systemic treatments
phototherapy

242
Q

what should we avoid w/ psoriasis

A

scrubbing
long exposure to water
trying to remove scales

IM1 (18 decks)

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