Chapter 19 Disorders Of The Integumentary Systemi

Question 0

The three most common inflammatory skin problems of older adults are?

Answer 0

Seborrheic dermatitis, intertrigo, Psoriasis.

Question 1

Name three common benign skin lesions of older adults.

Answer 1

Cherry angioma: 1 to 5 mm red or deep purple dome shaped lesions that usually occur on the trunk
Seborrheic Keratosis: Scaly brownish black lesions that have a stuck on appearance, Appear on sun exposed areas.
Acrochordon: Skin tags that usually occur on the neck eczema breasts and growing

Question 2

Some treatments for seborrheic Dermatitis?

Answer 2

Shampoo with ketoconazole, Hot oil treatments with peanut oil, Low to moderate potency hydrocortisone ointment, T-cell modulators such as pimecrolimus.

Question 3

Treatment for intertrigo (a dermatitis that results from friction of skin surfaces).

Answer 3

Weight loss, keeping the skin clean and dry, topical antifungal’s, in rare cases, topical hydrocortisone

Question 4

Treatment for psoriasis is?

Answer 4

Topical steroids or coal tar preparations
Topical vitamin D3 for moderate cases
Topical retinoids For more severe cases
Ultraviolet a light therapy plus oral or topical psoralen

Question 5

This is a chronic inflammatory dermatitis. affected individuals often will have a history of atopy. This is characterized by dry, pruritic skin. Dermatologist often refer to this disorder of the skin as the itch that rashes because of the intense itching.

Answer 5

Eczema

Question 6

What are the patients who classically present with eczema?

Answer 6

Men with a history of dry skin. Patients will have coin shaped lesions.

Question 7

Treatment for eczema includes?

Answer 7

Avoidance of irritants and use of emollients, and low to medium potency topical steroids.

Question 8

Nursing assessment and intervention for eczema.

Answer 8

Be alert for bacterial and fungal supra infection in these patients
Education about the chronic nature of this disease
The importance of preventing excessive dryness of skin

Question 9

This is an eruption caused by reactivation of latent varicella virus in the dorsal root ganglia. The virus remains in the dorsal root ganglia after an earlier episode of chickenpox.

Answer 9

Herpes zoster

Question 10

Varicella virus a.k.a. herpes zoster recurs because of depression of immune response. Causes of this immunosuppression that can lead to shingles includes?

Answer 10

Age, stress, fatigue, radiation, HIV/AIDS, any malignancy, chemotherapy, and steroids.

Question 11

Herpes zoster is not infectious except in individuals?

Answer 11

Individuals age 6 months or older who have not had chickenpox or the vaccine for chickenpox. Until age 6 months, infants have maternal antibodies to protect them.

Question 12

Shingles most commonly occurs on what part of the body?

Answer 12

The thorax, however, it can be seen in the cervical and lumbar areas or in the ophthalmologic areas. Herpes zoster in the ophthalmologic branch of the trigeminal nerve is a true medical emergency as these individuals can develop blindness

Question 13

What are symptoms of the prodrome prior to an eruption of herpes zoster?

Answer 13

Patients will have pain, burning, paresthesias, and itching along the affected dermatome. 3-5 Days later patients will have an eruption of the vesicles. These lesions will follow one to two dermatomes and they will not cross the midline.

Question 14

The average case of shingles last how many weeks?

Answer 14

Three weeks.

Question 15

Complications of shingles includes?

Answer 15

Bacterial superinfection and postherpetic neuralgia, which consists of chronic, lancinating pain and persists after the lesions of cleared.

Question 16

What should shingles be treated with?

Answer 16

The virus should be treated with antivirals within 72 hours of the rashes appearance in an attempt to decrease the incidence of PHN.

Question 17

One of the most effective topical agents for the pain of shingles is?

Answer 17

Domeboro soaks

Question 18

This vaccine reduces the occurrence of both the shingles and PHN, and should be administered to all older adults except those who have a weekend in immune system Even if they have had shingles in the past.

Answer 18

Zostavax

Question 19

This skin condition is caused by a might that burrows under the skin and causes inflammation and severe itching. In older adults the presentation often is muted; patients will experience a chronic mild itching of the hands, wrists, and genitalia.

Answer 19

Scabies

Question 20

The incubation period for scabies is?

Answer 20

4 to 6 weeks. Diagnosis is confirmed by skin scraping.

Question 21

Treatment for scabies is?

Answer 21

Local application of 5% permethrin cream to the entire body at bedtime. The following morning, all bed linens and bedclothes must be washed in hot water to eradicate the mite.

Question 22

This premalignant lesion is commonly seen in fair complexion people and they occur because of exposure to the sun. They begin in vascular areas as a reddish macules or papules with a rough, yellowish-brown scale.

Answer 22

Actinic keratosis

Question 23

The concern for premalignant lesions such as AK is that they may progress to what?

Answer 23

Squama cell cancer.

Question 24

The most common cancerous lesion found in older adults is?

Answer 24

Basal cell cancer

Question 25

This lesion most commonly seen in fair skinned, blonde, or redheaded individuals who have had marked sun exposure. This cancer commonly occurs on the face and scalp and areas of scarring or chronic irritation.

Answer 25

Basal cell cancer

Question 26

Characteristics of basal cell cancer?

Answer 26

These lesions do not metastasize for the most part and are slow growing. They usually appear as pearly papules with depressed centers, But on occasion can have a different appearance.

Question 27

How are basal cell cancer lesions removed?

Answer 27

Cryotherapy if they are small or incision.

Question 28

This is the second most common skin cancer in older adults. This cancer arises from the epidermis. Lesions are commonly found on the scalp, helix and pinna of the ears, dorsum of the hands and lower lip. This cancer can develop in chronic leg ulcers. Approximately 20% of this type of cancer will metastasize

Answer 28

Squamous cell carcinoma

Question 29

What is the appearance of squamous cell carcinoma?

Answer 29

This lesion usually has an ulcerated or crusted Center. On occasion these lesions look like a common wart or skin tag, the base maybe inflamed, Reddened, or bleeding, or it may appear as a totally benign growth.

Question 30

This type of skin cancer originates from the pigment forming cells, the melanocyte. These lesions, which are capable of metastasizing at an early age, are becoming more common throughout United States because of the use of tanning booth and recreational sun exposure.

Answer 30

Malignant melanoma

Question 31

What is the typical demographic of a person who develops malignant melanoma?

Answer 31

It occurs in fair skinned individuals who have a tendency to sunburn. In addition people with red or blonde hair who have multiple moles, and those with a tendency to freckle are thought to be at high risk.

Question 32

What is the physical appearance of a malignant melanoma?

Answer 32

Appears as an irregularly shaped mole, papule, or plaque that has recently appeared or changed in color or size.

Question 33

What is the ABCD's of skin assessment created by the American Cancer Society?

Answer 33

Asymmetry Border irregularity Color variation: red, white, blue, gray. Diameter greater than 6 mm

Question 34

As a melanoma advances it may begin to what?

Answer 34

Itch or bleed

Question 35

Melanoma prognosis is determined by what?

Answer 35

By how much vertical growth has occurred.

Question 36

How are melanomas treated?

Answer 36

Melanomas are treated with wide and deep excisions in hope of getting skin margins that are free of tumor

Question 37

Will Medicare reimburse for hospital acquired pressure ulcers?

Answer 37

No, pressure ulcers present on admission will qualify for reimbursement but not hospital acquired pressure ulcers.

Question 38

What must be documented if a patient comes in with a pressure ulcer?

Answer 38

The presence of a pressure ulcer on admission must be identified, coded, and noted in the chart, with documentation by the admitting physician.

Question 39

This is the sliding of parallel surfaces that will cause stretching and occlusion of the arterial supply of fascia and muscle.

Answer 39

Shearing

Question 40

This is the rubbing of the skin against another surface and can cause a superficial abrasion of the epidermis and dermis.

Answer 40

Friction

Question 41

These are thought to be major contributors to pressure ulcer formation.

Answer 41

Friction and shearing

Question 42

Patients who have a serum albumin of less than what are at increased risk of ulcer development and poor wound healing?

Answer 42

<3.5g/dL

Question 43

What physiologic changes put an older adult at higher risk for ulcer development?

Answer 43

Thin dermis with less elasticity. Age causes vessel the degeneration and reduced blood flow to the skin appendages. Healing is slowed with normal aging, as is the immune response.

Question 44

What is the most important factor in wound healing and prevention?

Answer 44

Adequate oxygenation, whether in the form of pressure reduction or elevation of blood pressure. Also, make sure the patient is properly hydrated.

Question 45

Patients who are at risk for pressure ulcers include?

Answer 45

Immobile, protein calorie malnourished, incontinent, frail, disabled, nutritionally compromised, mentally compromised.

Question 46

This scale is used to assess the risk of skin integrity issues.

Answer 46

Braden scale

Question 47

What score on the Braden scale indicates the patient is at risk for skin breakdown?

Answer 47

15 to 18

Question 48

What score on the Braden scale indicates a patient is at moderate risk for skin integrity problems?

Answer 48

13 to 14

Question 49

This score on the Braden scale indicates the patient is at high risk

Answer 49

10 to 12 indicate high risk and less than 9 indicate very high risk

Question 50

Should a nurse massage over bony areas that are reddened on their patients?

Answer 50

No, as the action may worsen the damage. Turning patients every two hours or more frequently is mandatory. Patient should be turned at a 30° oblique angle, and a pillow should be put under the calves to keep the heels and feed off the bed.

Question 51

A group one device is used for what level of risk for pressure ulcer development

Answer 51

It is used for patients were at low risk for pressure ulcer development. They are static devices and include air, foam, Gel, and water overlays or mattresses.

Question 52

What are group 2 devices and what level of risk for pressure ulcers are they used on?

Answer 52

Group 2 devices are for patients were moderate high risk for pressure ulcers or have full thickness pressure ulcers. These devices are powered by electricity or a pump.

Question 53

Group 3 devices are used for what risk for pressure ulcer and what type of devices are they?

Answer 53

Group 3 devices also dynamic, our air fluidized beds. These beds are electric and contain silicone coated beads. When Air is pumped through the bed the beads become liquid. These beds are used for patients at very high risk for pressure ulcers

Question 54

Other interventions to prevent ulcer formation include?

Answer 54

Avoid sharing friction, monitor nutritional status, ensure adequate hydration.

Question 55

Patients should be weighed how often and at what percentage loss of their ideal body weight should interventions be taken?

Answer 55

Patients should be weighed monthly, as weight changes slowly in most individuals. Intervention should be taken for patients who lose 5 to 10% of their ideal body weight. If the patient loses one third of their ideal body weight the healthcare team should view this as an ominous sign.

Question 56

What are the three major stages of wound healing?

Answer 56

Inflammation, proliferation, and maturation

Question 57

In this stage of wound healing the wound is red, warm, and painful. This inflammation stabilizes the wound through platelet activity that stops bleeding. The immune systems heavily involved, sending neutrophils, macrophages and monocytes to the site to control bacteria and cleanup debris's. The stage Lasts 4 to 5 days

Answer 57

The inflammatory stage

Question 58

This stage of wound healing begins within 24 hours of injury and can last up to three weeks. During this time three important processes occur: epithelialization, neovascularization or granulation, and collagen synthesis.

Answer 58

The proliferative stage or granulation stage

Question 59

Can a wound that is covered in eschar be staged?

Answer 59

No, Wounds cannot be staged when they are covered with eschar

Question 60

Basic principles of pressure ulcer management include?

Answer 60

Eliminate or minimize pressure, friction, and sharing. Monitor and optimize nutrition. Create and maintain a clean, moist woundbed. Ensure adequate circulation and oxygenation.

Question 61

A non-blanchable area on the skin is an example of what stage of pressure ulcer?

Answer 61

Stage one

Question 62

This stage of a pressure ulcer includes an abrasion, blister, or shallow crater. It is an extension through the epidermis.

Answer 62

Stage two

Question 63

This stage of a pressure ulcer is a full thickness one involving subcutaneous tissue. An example would be a deep crater with or without undermining

Answer 63

Stage III

Question 64

This stage of pressure ulcer is a full thickness wound with extension into muscle, bone, or supporting structures. It is a deep wound and usually involves undermining and sinus tracts.

Answer 64

Stage 4

Question 65

In this stage of the wound the bases are covered with slough and or eschar.

Answer 65

Unstageable

Question 66

This wound can be purple or maroon discolored intact skin or a blood-filled blister. Surrounding skin is painful, firm, mushy, boggy, warmer, or cooler compared to adjacent tissue.

Answer 66

Suspected deep tissue injury or unstageable

Question 67

Wounds that are not infected should be cleansed with what?

Answer 67

Normal saline. Other topical therapies should only be used when wound beds are infected, because they kill healthy granulation tissue's.

Question 68

Antiseptic solutions To clean infected wounds such as Betadine, acetic acid, hydrogen peroxide, or sodium hypochlorite (dakins) should be discontinued when?

Answer 68

When the exudates or signs of infection have abated

Question 69

Some nursing considerations when using Providone iodine on wounds.

Answer 69

It can be used short-term if diluted, limit to 3 to 5 days. Never use on healthy granulating tissues.

Question 70

Some nursing considerations for the use of acetic acid with wounds.

Answer 70

Can be used on wounds infected with Pseudomonas. Suitable for use for wounds with a malodorous, green drainage.

Question 71

Some considerations for the use of hydrogen peroxide as a wound antiseptic

Answer 71

Provides debridement. Do not use in a sinus tract or deep crater.

Question 72

Nursing considerations for the use of Dakin solution or sodium hypochlorite.

Answer 72

Can be used for fungal type pathogens. Ideally, solution should be diluted, as it is essentially bleach. Can affect clotting abilities and burn intact skin.

Question 73

This Wound bed description indicates healthy granulation.

Answer 73

Beefy red color

Question 74

Exudates and necrotic tissue can interfere with the process of wound healing. This is done to remove necrotic material. In addition dry hard eschar should be removed.

Answer 74

Debridement

Question 75

Both necrotic material and eschar delay the healing process and slows the migration of epithelial cells. Debridement is recommended for both with the exception of?

Answer 75

Eschar on the heels. Eschar in this location should be left in place as long as it is dry, because it provides a protective shield for the heel. If it becomes soft or mushy it should be removed, because that suggests the fluid has accumulated beneath the eschar.

Question 76

What are the 4 modes of debridement for wounds?

Answer 76

Mechanical, autolytic, chemical, and surgical.

Question 77

Mechanical wound debridement is usually carried out in what fashion?

Answer 77

Wet to dry dressings or whirlpool.

Question 78

What is autolytic debridement?

Answer 78

Hydrocolloid or hydrogel dressings are used to soften it help remove exudate. Uses the bodies own enzymes to provide debridement and cleansing. Cannot be used with infected wounds.

Question 79

What is chemical debridement of wounds?

Answer 79

The use of chemicals to remove necrotic areas or tender yellow slough that is difficult to remove surgically. It is used on small wounds.

Question 80

Some general guidelines to remember with evaluating and treating pressure ulcers include?

Answer 80

Gently irrigate all wounds with a 1 to 2 ounces of normal saline at each dressing change. Evaluate the one border for candidiasis with each dressing change.

Question 81

This type of dressing product is useful for debriding and cleaning the wound bed. If one has tumbling or undermining the cavity can be loosely packed with this moistened.

Answer 81

Gauze dressing

Question 82

This type of dressing protects the wound bed by leaving the epithelial cells undisturbed. It is used for skin tears skin grafts, or other wounds that require minimum intervention. Topical antibiotics can be used beneath these dressings, which are changed once or twice a day.

Answer 82

Nonadherent dressings.

Question 83

This type of absorbent dressing protects ulcers and minimizes maceration. It is useful for wounds with excess drainage or exudates. It can be used under films or other primary dressings. Topicals can be applied beneath it.

Answer 83

Foam dressings

Question 84

This type of wound care product facilitates auto lysis. Dressings are semipermeable to allow air exchange. It is used on superficial wounds. Can be used to secure other dressings and protect the vulnerable areas from friction. Usually left on for 3 to 7 days. Can cause fluid buildup beneath dressing.

Answer 84

Transparent films such as opsite or Tegaderm

Question 85

This type of wound care product and be used on stage two and stage III wounds. Their sticky non-permeable wafers that contain Hydrocolloid material that melts and combines with natural body fluids to keep the wound bed moist. Usually left on for 3 to 7 days.

Answer 85

Hydrocolloids

Question 86

This type of dressing can be used on superficial or deep wounds, as the product can be obtained in sheet or gel that can be spread into deep cavities. Consist primarily of water, help maintain a moist one bed and facilitates healing. Can be left in place for 1 to 7 days. Should not be used on infected wounds. Requires a cover dressing.

Answer 86

Hydrogel's

Question 87

This wound care product is used to manage wounds with exudate. It is made of seaweed, products soak up drainage. It can be used on infected wounds. It is helpful around drainage tubes and wounds that are macerating healthy surrounding tissues.

Answer 87

Alginates

Question 88

What should be considered for large or nonhealing wounds?

Answer 88

Electrical stimulation, vacuum drains, surgical debridement, and possible skin grafting.