TOPIC 14 - Integumentary : diseases of skin, eye, and ear

Question 1

skin cancer major causes

Answer 1

Overexposure to sunlight is the major cause of skin cancer, although other factors are associated.

Question 2

most common skin cancer types

Answer 2

actinic or solar keratosis, squamous cell carcinoma, basal cell carcinoma, and melanoma. These are involved in cellular regulation of growth.

Question 3

what is a nevus

Answer 3

a mole, is a benign growth of the pigment-forming cells classified according to their location within the layers of the skin.

Question 4

what treatment is being tried to treat metastatic melanoma

Answer 4

experimental therapy

Question 5

who is skin cancer likely to develop in

Answer 5

light-skinned races
individuals older than 60 years of age
outdoor workers
higher altitudes

Question 6

ABCDE

Answer 6

asymmetry
border
color
diameter
evolving

Question 7

how often should TSSE be performed

Answer 7

monthly

Question 8

surgeries for skin cancer

Answer 8

Cryosurgery
Curettage and electrodesiccation
Excision
Mohs’ surgery
Wide excision

Question 9

nonsurgical therapy for skin cancer

Answer 9

radiation
medications

Question 10

malignant melanoma

Answer 10

a tumor arising in melanocytes, the cells producing melanin. Melanoma causes the majority of skin cancer deaths.

Question 11

where can melanoma occur

Answer 11

in the eyes, ears, gastrointestinal tract, and oral and genital mucous membranes

Question 12

what is it called when melanoma begins in the skin

Answer 12

cutaneous melanoma

Question 13

characteristics of melanoma

Answer 13

can be Irregular color, surface, and border Variegated color, including red, white, blue, black, gray, brown, *Flat or elevated. Eroded or ulcerated, Often <1 cm in size

Question 14

most common sites of melanoma in male vs female

Answer 14

Most common sites in males are trunk, head and neck. In females are legs, then back metastasize to any organ, including the brain and heart.

Question 15

treatment of melanoma

Answer 15

Wide surgical excision and possible sentinel lymph node evaluation
Possible use of adjuvant therapy after surgery if lesion >1.5 mm in depth
Correlation between survival rate and depth of invasion
Poor prognosis unless diagnosed and treated early
Spreading by local extension, regional lymphatic vessels, and bloodstream

Question 16

psoriasis

Answer 16

Sharply demarcated silvery scaling plaques on reddish colored skin commonly on the scalp, elbows, knees, palms, soles, and fingernails

Itching, burning, pain

Localized or general, intermittent or continuous

Question 17

topical treatments for psoriasis

Answer 17

Corticosteroids, tar, salicylic acid,
Intralesional injection of corticosteroids for chronic plaques

Question 18

systemic treatments for psoriasis

Answer 18

Natural or artificial UVB. PUVA (UVA with topical or systemic photosensitizer

Antimetabolite (methotrexate)

immunosuppressant (cyclosporine)

biologic therapy (adalimumab [Humira], etanercept [Enbrel], infliximab [Remicade]

Question 19

shingles

Answer 19

activated varicella zoster virus
Potentially contagious to anyone who has not had varicella or who is immunosuppressed

Question 20

clinical manifestations

Answer 20

Linear distribution along a dermatome of grouped vesicles and pustules on erythematous base resembling chickenpox
Usually unilateral on trunk, face, and lumbosacral areas
Burning, pain, and neuralgia preceding outbreak
Mild to severe pain during outbreak

Question 21

topical treatment for herpes

Answer 21

Wet compresses, silver sulfadiazine (Silvadene) to ruptured vesicles

Question 22

systemic treatment for herpes

Answer 22

Antiviral agents within 72 hr to prevent postherpetic neuralgia
Analgesia. Mild sedation at bedtime
Gabapentin (Neurontin) to treat postherpetic neuralgia
Usually heals without complications, but scarring and postherpetic neuralgia possible
Vaccine (Zostavax) to prevent shingles for adults ≥50 yr

Question 23

cataract

Answer 23

Opacity within the lens in the eye of the patient
Cataract may be in one or both eyes
If in both eyes, one eye may affect the person’s vision more than the other

Question 24

causes of cataracts

Answer 24

Age
Blunt or penetrating trauma
Congenital factors such as maternal rubella
Radiation exposure or ultraviolet (UV) light (sunlight) exposure
Certain drugs such as systemic corticosteroids or long-term topical corticosteroids
Ocular inflammation

Question 25

signs and symptoms of cataracts

Answer 25

Decrease in vision Abnormal color perception Glare (may be significantly worse at night when the pupil dilates) Visual decline is gradual, but the rate of cataract development varies from patient to patient.

Question 26

nonsurgical therapy for cataracts

Answer 26

Change in glasses prescription Strong reading glasses or magnifiers Increased lighting Lifestyle adjustment

Question 27

preoperative care for cataracts surgery

Answer 27

Mydriatic, cycloplegic agents Nonsteroidal anti-inflammatory drugs Topical antibiotics Antianxiety medications

Question 28

surgery for cataracts involves

Answer 28

* Removal of lens * Phacoemulsification * Extracapsular extraction * Correction of surgical aphakia * Intraocular lens implantation (most frequent type of correction) * Contact lenses

Question 29

postoperative care for cataracts surgery

Answer 29

Topical antibiotic Topical corticosteroid or other anti-inflammatory agent Mild analgesia if necessary Eye patch or shield and acti­vity as prescribed by patient's surgeon Activity restriction: Activities that increase IOP: bending, stooping, coughing, or lifting

Question 30

education for patients after eye surgery

Answer 30

Proper hygiene and eye care techniques to ensure that medications, dressings, and/or surgical wound is not contaminated during eye care How to monitor pain, take pain medication, and report pain not relieved by medication Importance of continued follow-up as recommended to maximize potential visual outcomes Signs and symptoms of infection and when and how to report these to allow for early recognition and treatment of possible infection Importance of complying with postoperative restrictions on head positioning, bending, coughing, and Valsalva maneuver to optimize visual outcomes and prevent increased intraocular pressure How to instill eye medications using aseptic techniques and adher­ence with prescribed eye medication routine to prevent infection

Question 31

two types of macular degeneration

Answer 31

age related or wet

Question 32

risk factors for macular degeneration

Answer 32

genetics, family history, white ethnicity, chronic inflammatory conditions, smoking, hypertension

Question 33

which type of macular degeneration is most common

Answer 33

age related

Question 34

dry macular degeneration

Answer 34

90% of all cases close vision tasks are becoming more difficult. macular cells start to atrophy slowly progressive and painless vision loss.

Question 35

wet macular degeneration

Answer 35

more severe form more rapid onset development of abnormal blood vessels in or near the macula

Question 36

etiology of macular degeneration

Answer 36

Related to retinal aging Genetic factors Family history Gene responsible Long-term exposure to UV light Hyperopia cigarette smoking light-colored eyes Nutritional factors: Vit C, E, and zine decreases progression

Question 37

what vitamin supplements decrease the progression of advanced macular degeneration

Answer 37

vitamin C, vitamin E, beta-carotene, and zinc

Question 38

manifestations of macular degeneration

Answer 38

Blurred and darkened vision, scotomas (blind spots in the visual field), Distortion of vision.

Question 39

treatment for macular degeneration

Answer 39

 Limited treatment Medications that are injected directly into the vitreous cavity.  “Cold” laser to excite the dye.  People at risk for developing advanced AMD should consider supplements of vitamins and minerals (in consultation with their health care provider).  

Question 40

retinal detachment

Answer 40

A retinal detachment is a separation of the sensory retina with fluid accumulation between the two layers.

Question 41

causes of retinal detachment

Answer 41

Increasing age Severe myopia Eye trauma Cataract surgery Family or personal history of retinal detachment

Question 42

signs symptoms of retinal detachment

Answer 42

Patients with a detaching retina describe symptoms that include photopsia (light flashes); floaters; and a “cobweb,” “hairnet,” or ring in the field of vision. Once the retina has detached, the patient describes a painless loss of peripheral or central vision, “like a curtain” coming across the field of vision.

Question 43

medical treatment for retinal detachment

Answer 43

Laser Photocoagulation & Cryopexy Scleral Buckling Pneumatic retinopexy Vitrectomy

Question 44

glaucoma

Answer 44

Increased intraocular pressure, optic nerve atrophy, resulting in peripheral visual field losses

Question 45

eye drop medications

Answer 45

B-Adrenergic blockers, a-Andrergic Agonists

Question 46

normal IOP vs acute angle closure glaucoma vs open angle glaucoma

Answer 46

normal is 10 to 21 mm Hg In open-angle glaucoma, IOP is usually between 22 and 32 mm Hg. In acute angle-closure glaucoma, IOP may be over 50 mm Hg.

Question 47

POAG progression

Answer 47

primary open angle glaucoma develops slowly and without symptoms of pain or pressure. The patient usually does not notice the gradual visual field loss until peripheral vision has been severely compromised. Eventually the patient with untreated glaucoma has “tunnel vision” in which only a small center field can be seen, and all peripheral vision is absent.

Question 48

acute angle closure glaucoma symptoms

Answer 48

causes definite symptoms, including sudden, excruciating pain in or around the eye. This is often accompanied by nausea and vomiting. Visual symptoms include seeing colored halos around lights, blurred vision, and ocular redness.

Question 49

chronic open angle glaucoma drug therapy

Answer 49

*β-Adrenergic blockers *α-Adrenergic agonists *Cholinergic agents (miotics) *Carbonic anhydrase inhibitors

Question 50

acute angle closure glaucoma therapy

Answer 50

* Topical cholinergic agent * Hyperosmotic agent * Laser peripheral iridotomy * Surgical iridectomy

Question 51

external otitis

Answer 51

Inflammation or infection of the epithelium of the auricle and ear canal

Question 52

causes of external otitis

Answer 52

Swimmer’s ear: due to chemical and contaminated water Using a sharp object in ear Bacteria: Pseudomonas aeruginosa Fungi: Candida Albicans and Aspergillus

Question 53

symptoms of external otitis

Answer 53

Pain is the first sign Discomfort may be during chewing, moving the auricle, pressing on the tragus May have serosanguineous or purulent drainage Fever

Question 54

treatment of external otitis

Answer 54

Exam C & S may be done Moist heat, mild analgesics, and topical anesthetic drops to control pain Antibiotics and corticosteroids

Question 55

when will patients see improvement with antibiotics

Answer 55

within 48 hours still need to complete course (7-10 days)

Question 56

acute otitis media

Answer 56

infection of the tympanum, ossicles, and space of the middle ear

Question 57

causes of acute otitis media

Answer 57

Swelling of the auditory tube from colds or allergies can trap bacteria Pressure from the inflammation pushes on the TM, causing it to become red, bulging, and painful. Infection can be due to viruses or bacteria.

Question 58

otitis media with effusion

Answer 58

an inflammation of the middle ear with a collection of fluid in the middle ear space.

Question 59

chronic otitis media and mastoiditis

Answer 59

Repeated attacks of otitis media may lead to chronic otitis media

Question 60

symptoms of chronic otitis media and mastoiditis

Answer 60

purulent exudate and inflammation that can involve the ossicles, auditory tube, and mastoid bone Painless, hearing loss, nausea, and episodes of dizziness can occur. Hearing loss is a complication from inflammatory destruction of the ossicles, a TM perforation, or accumulation of fluid in the middle ear space

Question 61

treatment for chronic otitis media and mastoiditis

Answer 61

IV or oral antibiotics Tympanoplasty (myringoplasty) involves reconstruction of the TM and/or the ossicles

Question 62

post op care for Tympanoplasty

Answer 62

Impaired hearing is expected A cotton ball dressing is used for the incision Instruct the patient to change the cotton packing as needed.

Question 63

Ménière's disease symptoms

Answer 63

episodic vertigo Tinnitus fluctuating sensorineural hearing loss aural fullness.

Question 64

when do symptoms usually begin for Ménière's disease 

Answer 64

age 30-60

Question 65

possible causes of Ménière's disease 

Answer 65

excessive accumulation of endolymph in the membranous labyrinth

Question 66

symptoms during attacks of Ménière's disease 

Answer 66

Attacks may be preceded by a sense of fullness in the ear, increasing tinnitus, and muffled hearing. The patient may experience the feeling of being pulled to the ground (“drop attacks”). Some patients report that they feel like they are whirling in space. Attacks may last hours or days and may occur several times a year. The clinical course of the disease is highly variable.

Question 67

diagnostic tests for Ménière's disease 

Answer 67

Hearing (Audiometric) Tests Vestibular Tests for balance Inner ear assessment: electronystagmography, glycerol test

Question 68

acute nursing interventions for Ménière's disease 

Answer 68

Bed rest Quiet dark room Avoid sudden head movements and position changes Avoid fluorescent lights & flashing lights Sedation Ambulate with assistance only, not independent Call light within reach Side rails up Fall precautions Monitor Input & Output Antiemetics – Prochlorperazine Antivertigo – Meclizine Verbal & tactile reassurance and support