a change in skin color, less than 1 cm- freckles, flat moles (nevi)
macule
a solid raised lesion, less than 1cm - wart, elevated mole
papule
elevated, irregular-shaped area of edema - insect bites, urticaria, allergic reaction
wheal
raised solid lesion, 1 to 2 cm, - lipoma
nodule
raised lesions filled with clear fluid, less than 1 cm - varicella (chickenpox), herpes zoster (shingles)
vesicle
fluid-flled lesion, greater than 1 cm- blister
bulla
elevated lesion that contain pus - pus - acne, impetigo
pustule
enlarged scar, caused by excessive collagen formation during healing
keloid
linear, hollowed out - abrasion or scratch
excoriation
linear crack or break which extends into dermis- athletes foot
fissure
loss of epidermis, concave, decubitus ulcer- pressure sore
ulcer
abnormal growth in basal layer, most common, least aggressive, pearl colored, depressed center, rolled border
basal cell carcinoma
atypical squamous cells, more aggressive, slow growing, firm.
squamous cell carcinoma
form melanocytes (cells that produce pigment)
can metastasize to any organ, common in young people, may arise from moles
malignant melanoma
what does ABCDE stand for?
asymmetry borders color diameter evolution
inflammatory disorder of sebaceous glands
acne
liver spots- “age spots” (senile lentigo & lentigo maligna)
lentigo
chronic, genetis, redness, dry patches, & heavy silver surface. lifelong with remissions and exacerbations
psoriasis
benign plaques 3-20 mm with variety of surfaces
seborrheic keratosis
arrhythmic vesicles, honey colored, highly contagious, face, arms, legs & butt
impetigo
diffuse inflammation with various lesions, preceding wounds, common in adults.
cellulitis
inflammed hair follicle, red lesion or pustules, in eye it is called a stye
folliculitis
absess or boil, deep folliculitis, pus filled, painful, firm
furuncles (abscess or boil)
herpes simplex type I is?
fever blister
herpes simplex type II is ?
genital herpes
herpes zoster is ?
shingles
macroles =
flat
pacroles =
raised
type of macrole that is a yeast-like fungus?
candidiasis
ringworm of scalp, patchy hairloss
tinea capitis
ringworm of the body, red circles
tinea corporis
athletes foot, itchy
tinea pedis
moist, dark areas, treated with powders or creams
candidiasis (oral thrush)
pediculosis is?
lice
pediculosis capitis is?
head lice
reaction with something you’ve touched
contact dermatitis
itchy rash with raised areas, check airway
urticaria (hives)
what is a burn?
injury to tissues caused by: heat chemicals electrical currents radiation
first degree burns affect what layers of skin?
outer layers of epidermis
PARTIAL THICKNESS
red, pink, painful, usually no blisters
second degree affects what layers of skin?
entire epidermis and dermis
FULL THICKNESS
paintful, moist, red, blistered, and edema
third degree affects what layers?
extend into subcutaneous tissue & may involve muscle and bone
waxy white or yellow to tan, brown, deep red, or black
hard, dry, leathery
no pain
what is used to estimate percentage of total body surface area of burn (TBSA)
rule of nines
skeleton is made of
bones and joints
what are the two systems in musculoskeletal?
skeletal muscles and skeleton
2 types of connective tissue
cartilage and bone
rigid tissue, contains crystals and blood vessels, calcium and salts
bone
gel-like and made of water
cartilage
two types of bone
cancellous(spongy) and compact
outer shell of bone, more rigid
compact
inferior bone, lattice-like pattern
cancellous (spongy)
end of bone
epiphysis
shaft of bone
diaphysis
what part contains bone marrow?
diaphysis
makes blood cells
red marrow
contains fat
yellow marrow
widening before end of bone
metaphysis
growth plate is called?
epiphyseal cartilage
when does the growth plate (epiphyseal cartilage) calcify?
after puberty
to keep bones healthy they need _____ ____.
mechanical stress
bone building
osteoblasts
bone chewing cells–function in bone resorption
osteoclasts
parathyroid hormone (PTH) is released when blood calcium levels ____
decrease
what are the 2 stages of osteoblasts….(bone building)
ossification and calcification
how does PTH increase blood calcium?
forms bones, kidneys, and intestines
released by thyroid gland when blood calcium is too highinhibits calcium release and reduce osteoclasts
calcitonin
calcitonin reduces the _____
osteoclasts–which break up bones to release calcium
fractures can be classified as:
complete or incomplete(green stick or partial)
open or closed
or direction of fracture line
pathologic, stress, or transchondral
parallel to axis
linear
sloping angle to shaft
oblique
encircles shaft
spiral
straight accross
transverse
what type of break happens in osteoporosis patients?
pathologic
what type of break happens in athletes?
stress
what type of break happens in adolescence?
transchondral
signs in symptoms of fractures?
pain swelling loss of function deformity no mobility decreased sensation
how can you diagnose fractures?
X-rays
manifestations
history
3 ways to treat fractures
reduction
immobilization
preservation and restoration of function
reduction means?
restore
how do you reduce a fracture?
closed manipulation (manual pressure) or surigical reduction (hardware by surgery)
how do you immobolize a fracture?
splints or external devices
how do you preserve and restore function of a fracture?
exercise to maintain strength and reduce joint stiffness
common way to pull bones back to correct spot. used to control spasms, & immobilize area before surgery
traction
what does ORIF stand for?
open reduction internal fixation
what are there 4 phases of fracture healing?
HEMATOMA- week 1
SOFT CALLUS- week 2-3
HARD CALLUS- week 4-16
REMODELING- week 17 and beyond
bone marrow or adipose tissue at fracture site releases fat droplets into circulation.
frequently occurs after fracture of long (femur) and pelvic bones
fat embolism syndrome
result of increased pressure within a limited space
causes decreased blood flow, tissue hypoxia, and necrosis
fascia unable to accommodate excessive edema
compartment syndrome
compartment syndrome is caused by:
bleeding and edema, related to fractures and bone surgery
or application of tight fitting dressing, splint, or cast
what are the 5 P’s of compartment syndrome:
pain parestriesia pail or cool paresis pulselessness
hallmark symptom of compartment syndrome?
severe pain out of proportion to initial injury
what are the 2 ways to reduce compartment pressures
fasciotomy and cast splitting or remove constrive dressings
tear or injury to a tendon(muscle to bone)
strain
tear or injury to ligament (bone to bone)
sprain
complete seperation of a tendon or ligament from bony attachment site
avulsion
loss of articulate of bone ends in joint- most common site: shoulder
dislocation
partial dislocation
subluxation
inflammation of a tendon
tendonitis
inflammation of a bursa, caused by repeated trauma
bursitis
type of bursitis caused by wound infection
septic bursitis
what is the acronym for strains & sprains
RICE
rest ice compression elevation
bone infection:
osteomyelitis
causes of osteomyelitis
open wound or from blood borne infection
bacteria, fungi, parasites, & viruses
open wound with direct contamination.
ex: open fractures, surgery, penetrating wounds
exogenous
blood borne
endogenous (hematogenous)
what happens in children with hematogenous osteomyelitis:
purulent exudate inside bone. affects long bones, damages arteries to bone. may penetrate skin or involve joints
what happens in adults with hematogenous osteomyelitis:
spine, pelvis, and small bones (affects joint space)
treatment for hematogenous osteomyelitis:
antibiotics, debrievement, surgery, hyperbaric
decreased bone mineral density.
caused by osteoporosis
osteopenia
porous bone, poorly mineralized bone, decreased bone density and strength.
reduced bone mass/density and an imbalance of bone resorption and formation
osteoporosis
1st line of defense to the body
ear wax tears saliva vomit defecation urination skin digestive acids normal bacterial flora
is inflammation good or bad? why or why not?
good because it’s a protective response
caused by activation of chemicals and cellular components found in blood and tissues
inflammation
redness
rubor
swelling
tumor
heat
calor
pain
dolor
loss of function
functio laesa
inflammation is the moves ___ & ____
fluid & leukocytes
itis follows what?
the name of the infected organ
ex: appendicitis
quick/rapid disease
acute
long period of time
chronic
what type of cell “get to work” during acute inflammation?
leukocytes
chronic inflammation is what?
proliferation of blood vessels
tissue necrosis(death)
fibrosis(scarring)
endothelial cells are where?
lining of blood vessels
endothelial cells contain what>
antiplatelet and antithrobotic agents
vasodilators & vasoconstricters
contain histamines which cause leakiness
mast cells
potent effect on cells.
vasoactive–dilates capillaries
increase blood flow
increase vascular permability
histamines
circulate in the blood stream until vascular injury occurs.
work to stop bleeding
degranulate
platelets
WBCs
adhesion molecules
leukocytes
what are the 3 types of leukocytes
neutrophil
eosinophil
basophil
1st one on the scene.
mature cell
removes debris, dead cells, and bacteria
works then dies
neutrophil
cell ingests and gets rid of foreign matter
neutrophils and macrophages
leave blood stream and go to site of inflammation
phagocytosis
mildly phagocytic
2 jobs: defend against parasites & help limit inflammation by degrading histamine
eosinophils
important in allergic reactions
basophils and mast cells
basophils are a precursor for _____ cells.
mast cells
monocytes become _____. which kill and eat debris
macrophages
these replace the neutrophils and are important in chronic inflammation
macrophages
immune system is challenged by foreign substances which causes the body to create antigens. these two things are the immune systems response
lymphocytes and plasma
produced by bone marrow and injure antigens
B cells
made by thymus and attack antigen directly
T cells
both B & T cells reside in peripheral ____ ____ once mature
lymph tissue
recognize and eliminate cells infected with viruses and abnormal cells (Cancerous)
bind to infected or tumor cells & kill them
natural killer cells (NKs)
type of exudate that is clear liquid and makes blisters
serous
like pneumonia, blood clot-more serious.
“whited out” in chest xray
fibrinous
found on mucous membranes.
necrotic cells in fiber & pus
membranous
purulent (discharging pus)
bacterial
RBCs.
blood clot
bleeding, hemorrhagic
pus producing
pyogenic
pocket of pus
abcess
epithelial surface eroded, necrotic
ulceration
what are some symptoms of inflammation?
WBC count increase
“shift to the left”
lymph node changes
what does “shift to the left mean”?
immature leukocytes can’t keep up with infections
what are way to tell if a lymph node is cancerous?
not painful, not tender
normal core temperature must be?
97.0-99.5
fever is higher when?
in the evening/night
fever is lower in the?
morning
What controls core temp?
hypothalamus
difference between heat production and heat loss
body temp
what is the body main heat source?
metabolism
released when you need an increase in temp?
epinephrine and non epinephrine
what is shifted to produce heat, not energy?
body metabolism
what is a result of body metabolism being shifted?
weakness and fatigue
doing this 3-5 times increase in body temp?
shivering and chattering of teeth
what causes an increased body temp?
physical exertion
what is produced by muscle and viscera?
heat
heat is transferred in the blood to what?
body surfaces
what is an example of heat loss?
AV shunts
when do you have more blood volume?
hot weather
when do you have less blood volume?
cold weather
when is heat lost?
- radiation–60%
- conduction–cooling blankets
- convection
- evaporation
what is the scientific name for fever?
pyrexia
what is caused by pyrogens?
pyrexia (fever)
causes of fever?
- bacteria
- myocardial infarctions
- neurogenic fever
- brain bleeds
- increase in intracranial pressure
purposes of fever?
- cook the poison
- antiparetics
- immune function enhanced with small temp increases
fever is considered harmful when it reaches?
above 105
what are the patterns of fever?
- intermittent
- remittent
- sustained
- recurrent or relapsing
sepsis, abscesses, bacterial endocarditis
intermittent
viral upper respiratory infections
remittent
drug fever
sustained
TB, malaria
recurrent or relapsing
Your heart rate normally increases how many bpm with an increase of 1 degree fahrenheit?
10 BPM
when you have fever what also increases?
respiratory rate
when you have fever you are also seen to have?
- dehydration
- chills (draw blood cultures)
4 stages of fever?
- prodrome (warning)
- chills
- flush
- defervescence (sweating)
what are some signs that you may have fever?
- anorexia
- myalgia
- arthralgia
- fatigue
- respirations increase
if a patient has chills you should do what?
draw blood cultures
there are changes in fever because of?
increased oxygen need and metabolic rate
use of protein instead of glucose
what are some changes in the elderly and children?
elderly see confusion and agitation
febrile seizures
fever blisters
FUO
fever unknown origin
treatment for fever
spongebaths, or alcohol solutions
cooling blankets
fluids, carbs
antipyretic drugs
have a high risk for bacterial infections
neonates
limited signs of infection
lethargy, poor feeding, cyanosis
neonates, young infants
the elderly’s lower basal temp is?
97.6
in the elderly… fever is how many degrees above the baseline?
2
if the elderly don’t show signs of fever, we should check for
change in mental status
weight loss
weakness
fatigue
in elderly use what kind of thermometers?
rectal or tympanic
not oral
tissue repair for same type cells. sometimes there is no trace of injury
regeneration
repairs connective tissues which are scars or fibrosis
replacement
if regression is impossible—–
replacement with connective tissue and scar forms
growth of new blood vessels
angiogenesis
when is granulation good?
when its red and moist
3 ways to repair connective tissue
granulation
angiogenesis
scar forming by replacing CT
primary healing will…..
heal fine cause the cut was intended
secondary healing will heal….
from bottom up and will have trouble
“collagen on overdrive”
keloids
what affects wound healing?
nutritional status
blood flow & oxygen delivery
(Diagnosis of Diabetes mellitus, corticosteroids, infections, and foreign bodies in wound)
in the elderly does their skin change?
yes
elderly are in increased risk of…..
chronic wounds
do elderly have problem healing?
yes
normal ranges for pH?
7.35-7.45
normal range for PaCO2?
partial pressure of carbon dioxide
35-45
normal range for HCO3?
22-26
who is most sensitive to fluid deficits?
infants
happens to cell in isotonic?
stays same
what happens to cell in hypertonic?
shrinks
what happens to cell in hypotonic?
swells
Water follows…
salt
normal levels of salt?
135-145 mEq/L
Hyponatremia is….
decreased salt; under 135
do hyponatremia patients have floppy of twitchy symptoms?
floppy
hypernatremia is….
increased salt; over 145
do hypernatriema patients have floppy or twitchy?
twitchy
normal potassium levels?
3.5-5.0 mEq/L
hypokalemia is….
decrease in potassium; less than 3.5
hypokalemia; floppy or twitchy?
floppy
hyperkalema is….
increase in potassium; over 5.0
arrhythmias
hyperkalemia; floppy or twitchy?
floppy THAN twitchy
normal calcium levels
8.5-10.5 mg/dL
hypocalcemia is…
decrease in calcium; less than 8.5
hypocalcemia; floppy or twitchy?
twitchy
hypercalcemia is….
increase in calcium; over 10.5
hypercalcemia; floppy or twitchy?
floppy
sperm and egg
gametes
somatic cells are..
body cells
in somatic cells how many chromosomes are there?
46
XX
girl
XY
boy
23/23 pairs identical are called
autosomes
everyone inherits one copy of each ____ from each parent
gene
presence of only one copy of a chromosome….LETHAL
monosomy
presence of 3 copies of chromosome…may survive
trisomy
birth defects are called..
congenital defects
congenital defects are caused by:
environmental factors
genetic factors
Disorders are almost always associated with what chromosome?
X; MOMs
Risk factors for genetic problems:
miscarriage maternal/paternal influences familial type 2 DM VSD Hematology Age Nutrition Environment Multifactorial
chromosome disorder on the 21st chromosome
down syndrome— trisomy 21
down syndrome is a predisposition for:
Congenital heart disease
leukemia
hypothyroidism
hirschsprung’s Dx—-colon
S&S of down syndrome?
physical
intellectual—moderate to severe
sensory—eyes are different
one crease across palm(simian crease)
Downs syndrome problems?
- respiratory infections (since tongue protrudes)
- vital signs, congestion, can’t feed
- prevent infection
- cardiac
- monitor—urine, edema, feeding, skin color
deletion or abnormal x on chromosome 45
turner’s syndrome
what does turners affect?
women; they will only have 1 X chromosome
turner’s is a predisposition for:
hypothyroidism
aortic coarctication (aorta narrows)
renal structure
behavioral and learning disturbances
what do the females look like with turners?
short webbed neck underdeveloped breasts imperfect ovaries normal intellect frequent UTIs must give estrogen prior to 12 to develop normally watch for cardiac, renal, thyroid dysfunction
how many turner’s babies are spontaneously aborted?
99%
syndrome in which you have X-linked one or more extra x chromsome
klinefelter’s syndrome
how many male births are affected by this?
1:850
how to klinfelter’s look?
tall lean body long legs normal intellect testicular dyngenesis (testes don't develop) gynecomastia sterility voice doesn't change after puberty sparse facial hair
abnormalities in klinfelter’s?
scoliosis
dental
cardiac
pulmonary
metabolic disorder — lack enzyme which converts phyenylalanine to tyrosine
phenylketonuria (PKU)
if untreated PKU can cause
severe retardation
seizures
death
how many are affected by PKU?
1:15,000
when are people screened for PKU?
at birth
S&S of PKU
musky odor to urine
failure to thrive
mental retardation
seizures, vomiting, rashes
PKU management…..
breastfeeding blood tests special dairy products avoid high protein foods some veggies monitor nutrition
Problems with PKU
if phenylalanine is not converted it can increase to toxic levels
irreversable CNS probs. and mental retardation
Seizures
degeneration of cerebral cortex.
25-55 yrs of age
neutrotransmitters loss—GABA
huntington’s disease
connective tissue disorder
chromosome 15
1:20,000
marfan’s syndrome
marfan’s often causes what?
aortic aneurysm–common cause of early death
in marfan’s syndrome you should monitor what?
growth, development, vision
CARDIAC
give beta blockers for heart probs.
absence of tyrosinase—needed for melanin production
albinism
there are two types (I & II).
which is worse?
type I is worse
it is worse because they have NO melanin in their eyes. type II has some pigment
S&S of albinsim
bleeding problems
lung and bowel disease
low vision or legally blind
interventions for albinism
screen vision avoid sun check for melanomas wear glasses genetic/cultural counseling
- interruption of development in utero
- feeding difficulties
- risk for aspiration, malnutrition
cleft lip/palate
interventions for cleft palate
surgery
speech therapy
social worker
nutrition
audiologist
orthodontist
monitor for ear infections/hearing loss
autosomal recessive chromosome disorder
cystic fibrosis
cystic fibrosis involves blockages where?
pancreas
cystic fibrosis also affects the respiratory system how?
thickened secretions decrease ciliary function
cystic fibrosis affects mostly
Caucasians
CF patients ____ is not transported. so people perform the ____ test to see if it is secreted through the sweat
NaCl & Kiss test
CF leads to ___ side heart failure (for pulmonale)
right
Treatment for CF
administer oxygen, but not too much cause it could kill
increase fluids
S&S of CF
large protruding abdomen
failure to thrive
steatorrhea ( foul smelling stool)
Biliary obstruction
minor-major problems mental retardation behavioral problems intellectual problems skull, brain malformation small eye opening, thin upper lip, flat midface
fetal alcohol syndrome (FAS)
anacephaly
spinabifida
all women of child bearing age should take this
all enriched grain cereals in US have this
folic acid deficiency
TORCH microorganisms
toxoplasmosis
rubella
cytomegalovirus
herpes