T1 - Care of Patient with Skin Probs (Josh) Flashcards Preview

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Flashcards in T1 - Care of Patient with Skin Probs (Josh) Deck (66):
1

Which type of past medical history can lead to Xerosis (dry skin)?

Liver Disease

Renal Disease

Autoimmune Disease

2

What are some suggestions to prevent Xerosis?

Adequate hydration

Fewer hot showers

Moisturizer cream

Milder soaps

Humidifier in winter time

3

--- is dry skin.

--- is itching skin.

Xerosis

Pruritis

4

What are the different phases of wound healing?

Inflammatory Phase (3-5 days)

Proliferative Phase (day 4 - 2-4 wks)

Maturation Phase (3 wks - year or more)

5

Which phase of wound healing?

Begins at time of injury or cell death and lasts 3-5 days?

Inflammatory Phase

6

Phases of Wound Healing:

What happens in inflammatory phase?

Immediate response is VASOCONSTRICTION and clot formation

After 10 mins, VASODILATION ooccurs with increased capillary permeability and leakage of plasma (and plasma proteins) into surrounding tissue

WBCs (esp. microphages) migrate to wound

7

Phases of Wound Healing:

What are the clinical manifestations of the Inflammatory Phase?

local edema

pain

erythema

warmth

8

Phases of Wound Healing:

What happens in the Proliferative Phase?

Fibrin strands form a scaffold or framework

Fibroblast cells migrate into wound, attach to framework, divide, and stimulate the secretion of collagen

Collagen builds tough and inflexible scar tissue

Capillaries in areas surrounding the wound form buds that grow into new vessels

Capillary buds and Collagen deposits form the granulation tissue in the wound that contracts

Epithelial cells grow over the granulation tissue bed

9

Phases of Wound Healing:

What happens in the Maturation Phase?

Collagen is reorganized to provide greater tensile strength

Scar tissue gradually becomes THINNER and PALER in color

Mature scar is firm and inelastic when palpated

10

Wound Intention:

Which type of wound is well-approximated (ex: like an incision that is sewn up)?

First Intention

11

Wound Intention:

Which type of wound has a cavity-like defect (ie: loss of tissue)?

Second Intention

12

Wound Intention:

Which type of intention requires that healing come from the bottom up (ie: inside out)?

Second Intention

13

Wound Intention:

Which type of intention is intentionally left open for a time to irrigate and prevent infection from occurring?

Third Intention

14

Wound Intention:

Which type has loss of tissue?

Which type has no loss of tissue?

Second Intention = tissue loss (ie: cavity)

First and Third Intention = no tissue loss

15

Mechanisms of Wound Healing:

When would re-epithelialization occur?

2nd Phase of Wound Healing (Proliferative Phase)

16

Mechanisms of Wound Healing?

In --- ---, re-epithelialization occurs.

In --- ---, granulation occurs.

Partial-Thickness Wounds

Full Thickness Wounds

17

Explain the Mechanism of Wound Healing in a Full Thickness Wound?

Granulation occurs

Contraction (edging of wounds lean in towards each other) occurs

18

T or F: A Full Thickness Wound will most likely NOT close on its own.

True

likely will require a skin graft

19

Pressure Ulcer Staging:

How many stages?

4

Stage 1 -- skin NOT broken
Stage 2 -- skin broken
Stage 3 -- tissue exposed
Stage 4 -- bone exposed

***Unstageable -- eschar that covers bottom so that we can't judge depth

20

Which tool is used to assess for Pressure Ulcers?

Braden Score

15-16 = mild risk
12-14 = moderate risk
less than 11 = severe risk

21

--- is a scaling disorder with underlying dermal inflammation.

Psoriasis

22

What is the clinical presentation of Psoriasis?

Plaque with silver color

23

What are risk factors for Psoriasis?

Infections

Skin Trauma, Recent Surgery

Genetics

Stress

Seasons (warm weather IMPROVES symptoms)

Hormones (puberty or menopause)

Meds
- lithium
- beta blockers
- antimalarials
- indocin

24

What are the three types of Psoriasis?

Psoriasis Vulgaris (most common)

Exfoliative Psoriasis

Palmoplantar Pustulosis (PPP)

25

Psoriasis:

Which type will NOT be silver in appearance?

Exfoliative Psorasis

Palmoplantar Pustulosis (PPP)

26

Psoriasis:

Which type is most common and is silver in appearance?

Which type is not very common and is eruptive and inflammatory?

Which type is not very common and has pustules on palms of hands or soles of feet?

Psoriasis Vulgaris

Exfoliative Psoriasis

Palmoplantar Pustulosis (PPP)

27

Meds for Psoriasis:

What are the corticosteroids and what should we know?

triamcinolone acetonide

- observe for thinning skin, striae, or hypopigmentation
- avoid on face or in skin folds
- take periodic med vacations

28

Meds for Psoriasis:

What are the Tar Preparations and what should we know?

coal tar and anthralin

- used for moderate psoriasis
- short wave ultraviolet B light is often used in conjuction (remove creams first)
- may stain skin and harir
- may stimulate growth of skin cancers
- Antralin can not stay on longer than 2 hrs or will cause chemical burns
- SMELLS BAD

29

Meds for Psoriasis:

Because tar prep meds stink, what should we advise?

apply at night and cover areas of body with old pajamas, gloves, and socks

30

Meds for Psoriasis:

Why are most of these meds a problem if your pregnant?

most work by suppressing cell division

31

Meds for Psoriasis:

What is calcipotriene and what should we know?

synthetic form of Vit D

- not for older adults and breastfeeding moms because it reduces accelerated development of epidermal cells
- monitor for HYPERCALCEMIA (symptoms are muscle weakness, fatigue, and anorexia)

32

Meds for Psoriasis:

What is tazarotene and what should we know?

derivative of Vit A

- TERATOGENIC

33

Meds for Psoriasis:

What should we teach client about Calcipotiene and Tazarotene?

- burns when you put it on
- report muscle weakness, fatigue, or anorexia (hypercalcemia is a side effect of tazarotene)
- use sunscreen and avoid sun exposure
- obtain a pregnancy test before taking

34

Meds for Psoriasis:

Which treatments can be used in conjunction with Ultraviolet B Light Therapy?

Tar Therapy and Anthralin

35

Meds for Psoriasis:

What is PUVA Therapy?

Photochemotherapy and UV Light

- a psoralen photosensitizing med (methoxsalen) is administered followed by a long-wave UV A ligh tto decrease proliferation of epidermal cellls
- psoralen is given beforehand
- given 2-3 times a week (but NOT on consecutive days)
- eye protection during and 24 hrs afterwards

36

Meds for Psoriasis:

What are the different types of Systemic Therapy?

Cyclosporine
Adalimumab
Alefacept
Etanercept
Methotrexate

37

--- --- is a chronic inflammation and scaling of scalp , face, underarms and chest.

Seborrheic Dermatitis

38

Seborrheic Dermatitis:

What should we teach client?

Keen skin dry

Avoid overheating and sweating

Do NOT scratch lesions

39

Seborrheic Dermatitis:

What are the Clinical Manifestations?

Chronic inflammation and scaling of scalp, face, underarms, chest, and sacral region

Secondary candida infection may devleop in body folds and creases and requires treatment with KETOCONAZOLE

Waxy, flaky-appearing plaques and scales

Skin lesions primarily on the oily areas of the body (scalp, forehead, nose, axilla, groin)

40

Seborrheic Dermatitis:

Treatment

Topical Corticosteroids
- avoid getting in eyes or you could get glaucoma or cataracts
- avoid in skin folds

Antiseborrheic Shampoos
- use at least 3 x's a week
- leave on for 2-3 mins

41

Types of Skin Cancer:

Name the 4 types we talked about.

Actinic Keratoses

Squamous Cell Carcinomas

Basal Cell Carcinomas

Melanomas

42

Types of Skin Cancer:

Which type is scaly and commonly called pre-cancerous?

Actinic Keratoses

43

Types of Skin Cancer:

Which type is rough, scaly lesion with central ulerceration and crusting?

Squamous Cell Carcinomas

44

Types of Skin Cancer:

Which type is small, waxy nodule with superficial blood vessels and well-defined borders?

Basal Cell Carcinomas

45

Types of Skin Cancer:

Which type is a new mole or an existing mole?

Melanomas

46

Types of Skin Cancer:

What can look like skin cancer but is NOT? Has the rough look of a lesion.

Seborrheic Keratosis

47

Skin Cancer:

How do we assess?

ABCDE

Assymetric
Borders not well-defined
Colors (multi-colored)
Diameter is greater than 6 mm
Evolving

48

Skin Cancer:

What are some risk factors?

Sun Damage

Lighter Skin

Age

High Altitudes

Lower Latitudes

Arsenic Exposure

Family History

49

Skin Cancer:

What is TSSE?

Thorough Self Skin Examination

***teach clients to do this regularly

50

Skin Cancer:

What are ways we can treat with surgery?

Cryosurgery

Curettage

Excision, biopsy

Moh's Surgery (layer after layer removal)

Wide Excision

51

Skin Infections fall under three categories. What are they?

Bacterial

Viral

Fungal

52

Skin Infections:

What is Folliculitis?

What is presentation?

Which type is it?

infection of hair follicles

looks like small bumps on skin

Bacterial Skin Infection

53

Skin Infections:

What is Furuncles?

What is presentation?

Which type is it?

like, folliculitis, it is an infection of hair follicles

A painful, pus-filled bump under the skin caused by infected, inflamed hair follicles. (MORE CENTRALLY LOCATED)

Bacterial Skin Infection

54

Skin Infections:

What are the 4 types of Bacterial Infections we talked about?

Folliculitis

Furuncles

Cellulitis

MRSA

55

Skin Infections:

What are the Viral Skin Infections we mentioned?

Herpes Simplex, Type 1, Type 2 (genital)

Herpes Zoster (chicken pox, shingles)

56

Skin Infections:

Which type of Herpes Simplex is genital?

Type 2

57

Skin Infections:

With Herpes Zoster, --- is more common in kids while --- would be seen in adults.

Chickenpox

Shingles

58

Skin Infections:

What are the Fungal Infections we talked about?

Tinea Pedis

Tinea Cruris

Tinea Capitis

Tinea Cororis

Candida Albacans (yeast infection)

59

Skin Infections:

What should we monitor with Candida Albacans (yeast infection)?

skin folds (yeast like dark, moist places)

60

Acute Skin Disorders:

Which two did we mention?

Toxic Epidermal Necrolysis (TEN)

Stevens-Johnson Syndrome

61

Acute Skin Disorders:

What is TEN?

Toxic Epidermal Necrolysis

- rare drug reaction
- diffuse, large blister formation

62

Acute Skin Disorders:

What is Stevens Johnson Syndrome?

drug reaction, similar to TEN

mix of vesicles, erosions, and crusts

can be mild or severe

***PHENYTOIN (dilantin) can cause

63

What is the major risk factor with Cutaneous Anthrax?

contact with an infected animal

64

What is the clinical presentation of Cutaneous Antrax?

Raised vesicle on arms or legs

Center of vesicle sinks and becomes hemorrhagic

Necrosis and ulceration forms

65

How would Cutaneous Anthrax be diagnosed?

Appearance

Culture of site

Anthrax antibodies in blood

66

What is typical treatment for Cutaneous Anthrax?

Oral Antibiotics for 60 DAYS!!!

- Ciprofloxacin
- Doxycycline