Exam 4 Integument and Cancer Flashcards
What are the functions of the skin?
-Protection from excess water loss
-Barrier to bacteria and viruses, mechanical injury or trauma/exposure to the environment
-Regulation : primarily an insulator - temperature control
-Sensory perception (pain, touch, vibration, and pressure)
-Excretion and Lubrication : sweat glands and sebaceous
- Emotional expression
-Attraction to others : aroma
What are sweat glands composed of?
Water, salts, ammonia, urea, and other wastes
How many mL of fluid loss through the skin?
600-900 mL/day
Does skin help with nonverbal communication?
Yes, is provides facial expressions that is a result from muscles pulling on the skin of the face.
What are some large skin alterations sequelae?
-Increased infection potential
-Alteration in comfort
-Temperature regulation problems
-Need for increased body fluids, especially if lots of weeping
-Needs for increased protein in the diet to promote skin repair
-Growth and development alterations r/t loneliness, sensory deprivation, restraints, semi-isolation
-Disturbed body image
-Pain
-Isolation/mobility
Types of isolation
Contact - gown and gloves (MRS.WEE)
Airborne - gown, gloves, mask-N95, in negative pressure room (My Chicken has TB)
Droplet - gown, gloves, mask, goggles (spread through coughing, sneezing, talking)
Reverse isolation
Used to protect patient from other germs from other people as opposed to protecting ourselves from the patient
Normal skin changes in children
-Heal quickly
-Bleed
-Susceptible to sun
-Greater exposure environmental
-Epidermis not well bonded to dermis
-Larger surface area/wt
Normal skin changes in elderly
-Skin thinner
-Less Vascular
-More brittle nails
-Inadequate nutrition
-Wrinkling
-Alopecia
-Decreased melanin
-Declined ability to repair damage
-Decrease in SQ fat
-Atrophy apocrine and eccrine sweat glands
How to keep normal skin healthy?
-Rest and sleep
-Exercise
-Hygiene
-Nutrition
-OTC (over the counter medication)
What are key nutritional elements elderly tend to not get?
Protein, calories, and vitamins
Eccrine sweat glands
Located - found on most of body, except the lips, ear canals, nail beds, labia minora, glans penis, and prepuce.
Function - cools body by evaporation, excrete waste products, and moisturize surface cells
Type -simple sweat gland
Apocrine sweat glands
Location - mainly found in the axillary, genital, and breast areas
Function - secrete a thick milky substance that is naturally odorless, odor occurs when skin surface bacteria alter the secretions
Fact - they are always connected to a hair follicle, these glands enlarge and active at puberty because of reproductive hormones
Incubation
No signs or symptoms
Prodromal
Vague general symptoms
Illness
Most severe signs and symptoms
Decline
Declining signs and symptoms
Convalescence
No signs or symptoms
Most reportable diseases
Measles(rubella), plague
Varicella Zoster - Chicken pox
-AKA - herpes virus
-Highly contagious
-Lifelong immunity once exposed
-Incubation 2-3 wks
-Prodromal - low grade fever, malaise, anorexia about 24 hrs before rash
-Contact, airborne, droplet objects
-Infectious from 1-2 days before lesion to all lesions crusted over (5-6 days)
-SE: secondary skin infections, CNS encephalitis, scaring, meningitis, Reye syndrome(avoid aspirin)
-Goal: Don’t remove crust (increases scaring), cut nails, mittens for itching, apply pressure to itch area, cool sponge bath, calamine lotion, fluids, baking soda, diphenhydramine or antihistamine if needed
-Most common in late winter, early spring
-Acute phase : lesions begin a red maculopapular rash, turns almost immediately to vesicles with erythemic base, vesicles ooze and crust, new crops continue 3-5 days, pruritis outstanding sx, pain
Fifth’s Disease - ParavoVirus B-19
-AKA Erythema infectiosum
-Caused by airborne virus paravovirus B-19
-Droplet or blood
-Mild illness, starts with facial rash “slapped cheeks”, mild fever, HA, sore throat, joint pain
-Adults less rash, joint pain & swelling, flu like sx
-Incubation : 4-14 days, can be up to 21 days
-Rash appears in 3 stages
-1. Cheeks. erythema on face 1-4 d
-2. Maculopapular red spots appear 1 day after rash, symmetry, proximal to distal, last week or more
-3. Rash subsides but skin looks irritated and traumatized (sun, heat, cold, friction) can appear with cold or stress
-Tx= antipyretics, analgesics, anti-inflammatory, blood tx if transient aplastic anemia
-Complications : arthritis, arthralgia, myocarditis(rare)
-At risk children: sickle cell, aplastic anemia crisis
-Isolation not necessary as not infections by time rash on cheeks appears
-Pg women can work around but not care for children with this disease
Roseola Infantum
-AKA Human Herpes Virus Type 6
-Contact, saliva of healthy adult
-Children under 3, peak 6-15 months
-Incubation : 5-15 days, passed through saliva of adults, usually unknown contact
-High fever 3-7 days in a child who appears well, then rash occurs
-Discrete rose pink macules or maculopapules first on trunck, then neck, face, and extremeities
-Rash is non-prurtic, fades on pressure 1-2 days
-Cervical, post auricular lymphadenophathy
-Can have inflammed throat, pharynx and cough as well
-Tx fever with antipyretic, fluids
-Complications : febrile seizures, encephalitis, lymphadenopathy
Mumps
-AKA ParamyxoVirus
-Transferred saliva : direct or droplet
-Incubation 14-21 days and communicable immediately before and after
-Duration 10 days
-Prodromal low grade fever, malaise, HA, anorexia 24 hr then “earache”
-By day 3, painful enlargement of parotid unilateral/bilateral, so pain behind ear
-Tx analgesic, antipyretics, hot or cold packs, rest, fluid, bland or no chew foods
-Complications r/t infection or ear : meningitis, encephalitis, deafness, or orchitis, warmth, support, poss sterility from orchitis
-MMR vaccine
Rubeola
-AKA measles virus
-Source : respiratory tract secretions, blood, urine of infected person
-Direct contact, dropelt, airborne, usu direct contact with droplets in winter
-Incubation 10-20 days, communicable 4 days before and 5 days after rash
-Prodromal (Catarrhal sx) most contagious, isolate from prodrome til 5 days after eruptive stage begins
-Earliest sx fever and malaise, then upper resp with fever, sore throat, URI-3Cs –coryza, conjunctivitis, and cough and koplik spots
-Fever high as 104 w/n 24 h rash
-Progression of rash : shows 3-4 d from promd start, rash is confluent maculopapules of rash trunk and face and discrete on extremities. Goes down face and down body. After 3-4 d of full rash then despquamation occurs
-Tx fever : bedrest, fluids, sleep, tepid baths, vaporizer, meds(children:ibuprophen, tylenol)
-Complications: OM, pneumonia, bronchiolitis, encephalitis, laryngitis
-Live vaccine
Rubella
-AKA German Measles virus
-Direct and indirect contact : direct through nasopharyngeal secretions, droplet
-Person makes antibodies, so if exposed or vaccinated, resistance
-Vaccine 12-18 mos, 2nd @ 36 mo
-Incubation 14-21 days, communicable 7 days before and 5 days after rash
-Prodromal absent in children, sx come with rash, adolescent and adults will have prodromal before rash
-Sx in addition to rash: low grade fever for 1-5 days, w malaise, mild c’s cough, conjunctivitis, congestion, sore throat, HA, anorexia, lymphadenopathy
-Rash starts on face and spreads rapidly down and across body to trunk, arms, legs. Will fade out as it spreads so first day rash gone by day 3 when arms and leg opposite side
-Requires no specific RX - antipyretics and analgesics
-Isolate from pregnant women
-Complications rare : congenital rubella syndrome
-MMR vaccine
Scarlet Fever
-AKA Beta Hemolytic Strepto A
-Sx caused by toxins
-Lasting immunity once episode occurs
-Direct contact and large droplet
-Incubation 2-5 days, communicable during acute phase about 10d – respiratory
-Most common 6-12 year old group, late winter & early spring
-1st day = sore throat, abrupt fever(high 103-104), and pharyngitis, tachycardia due to fever, tonsils inflamed, uvula and throat beefy red, may vomit, HA, chills, malaise, abd pain & halitosis
- 1st & 2nd days, tongue becomes white and furry
- 3rd day papillae enlarge and tongue looks like white strawberry
- 4th & 5th day, white coat goes away and “strawberry tongue”
- Rash 12h after pharyngeal sx start, rash is enanthematous and exanthematous red pinpoint lesions blanche, rapid spread, face flushed, circumoral pallor. rash 1 wk, then desquamation
-Tx : usu appear quite ill=need rest, comfort, soft or liquid diet, analgesic for pain and fever, penicillin or cephalosporin oral 10 days
-Complications : otitis media, sinusitis, abscesses, acute rheumatic fever, and acute glomerulonephritis 2-3%
