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Patient Care Theory > week 2: integumentary > Flashcards

week 2: integumentary Flashcards

1
Q

vit d production

A
  • UV rays absorbed as vit D3/from diet–> Vit D3 circulates the blood—> liver(converts vit d3 into another form—> kidney—> either : ca2+ reabsorption, differentiation, immunity or: proliferation, inflammation, angiogenesis
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2
Q

layers of skin:

A

epidermis: most superficial ( chemo control, protection)
dermis: houses sensory receptors, follicles glands, papillary/reticular dermis)
subcutaneous layer: adipose tissue, muscle, & bone

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3
Q

ezcema:

A
  • common in kids
  • looks red/patchy/itchy skin ( can have flare ups)
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4
Q

Psoriasis:

A

raised lesions that look like white patches, chronic autoimmune disorder

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5
Q

Contact dermatitis:

A

irritation from contact w an irritant, red itchy, raised bumps

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6
Q

Scabies:

A

caused by mites under the skin, red and contagious.

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7
Q

heat rash:

A

caused by blocked sweat ducts, red raised bumps/rash

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8
Q

what systemic diseases have skin signs:

A

liver, diabetes, internal cancers, Obstructive cardiomyopathy, cardiac dysrhythmias

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9
Q

Sarcoidosis

A

inflammation of the skin tissues of the body.

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10
Q

life-threatening skin conditions:

A
  • pemphigus Vulgaris (PV), Toxic Epidermal Nercrolysis (TEN), AKA Stevens Johnsons syndrome
    -DRESS- drug rash w eosinophillia systemic symptoms syndrome
  • Toxic Shock Syndrome
    -meningoccocemia
  • rocky mountain spotted fever
  • Necrotizing Fasciitis: bacteria enters through breaks in the skin.S/s: fever, redness, swelling, hypotension, severe pain (POOP/POEM)-spreads fast
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11
Q

osteomies:

A

surgery of opening the abdo wall from the bowels or urinary tract, ex: cancer

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12
Q

what is the leading cause in death with burns?

A

smoke inhalation(50-80% of fire related deaths)

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13
Q

CO poisoning

A

Co= greater affinity than O2 for hemoglobin–> severe hypoxia
-s/s: throbbing headache starting in the temples, alt mental status, N/V, tachycardia/pnea, coma/seizures,
tx: Hyper oxygenate for >30mins, vent access prn, hyperbaric chamber prn ( if exposure>30mins)
Hx: how long exposed, what was burning, was the space enclosed, any LOC?

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14
Q

hyperbaric chamber:

A

uses pressure to displace CO off hemaglobin so O2 can bind
- daltons law: +pressure=+amount of dissolved O2
- machine uses + atmospheric pressure to 2.5x that of normal

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15
Q

functions of skin:

A

retaining moisture, temp control, protection, pain/sensory receptors

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16
Q

Epidermis:

A
  • outermost layer, no blood supply, strata granuolum= basal layer
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17
Q

dermis

A

-middle layer, vascularized and has collagen, ct, sweat glands, hair follicles, pain receptors, etc.

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18
Q

Subcutaneous layer

A

adipose tissuem loose CT between underlying organs & muscles

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19
Q

burns patho:

A

rupture cell membranes, blood cagulates, proteins denature, histamine= relasedsed–> cappillary D–> leaks blood plasma–> interstitialspace –> hypovolemia, edema, ,mass fluid shift.

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20
Q

Jackson’s theory of Thermal burns:

A

outer zone= red, zone of hyperremia
Middle zone= less red/orange= zone of stasis
inner most= yellow/white, Zone of coagulation

21
Q

3 stages of burns:

A

1.emergent:
- immediate pain response, catecholamine release, tachy/cardia/pnea, mild anxiety
2. fluid shift
- 18-24hrs after, inflmmatory response initiated(+bf to the site, intravascular fluid—> extravascular space, leaky capillaries, massive edema)
3.resolution
- days to weeks after, general rehab/progression back to normal function

22
Q
A
23
Q

Eschar?

A

dead tissue that is leather like & black. can lead to compartment syndrome! results from full thickness burns. Skin denatures/dies over the wound, edema limits BF to area–>die
(code 4/CTAS1/LOAD & GO)

24
Q

what are the first steps of Tx for burn pt….

A
  1. stop the burning process: w sterile water/NS
    2 reasses damage–> remove clothing/jewerly
  2. cover w a sterile burn sheet
  3. Irrigate the area (10-30 mins dependent on thickness and SA)
  4. dress area w dry dressings if : greater than 15% of BSA, 2nd degree or full thickness ( full thickness always gets dry!)
  5. give fluids ( extreacellular space will fill uo w K+–> affects heart/hypovolemia)fluids ++ osmotic pressure
25
Q

what are some systemic affects of burns?

A

Infection, organ fialure ex: kidneys, could be due to abuse, or special factors

26
Q

burning wood/nylon releases….

A

cyanide in the air

27
Q

burning appliances releases

A

Freon in the air

28
Q

management of chemical burns?

A

scene safety: HAZMAT, fire etc
proper ppe, remove clothing/brush off dry chemicals
-irrigate chemicals w NS and sterile water
–acid-10 mins, Base=20mins
-tx: hydrofluoric acid with Ca2+ gluconate gel/injection

29
Q

how long should you irrigate the eyes if they have sustained a burn?

A

20 mins

30
Q

superficial thickness burns…(1st degree)

A

only involves the epidermis, site will be red w mild pain, heals in 5-7 days.

31
Q

superficial -Partial thickness burns (2nd degree)

A

through the dermis, pink/wet/blisters, 2-4 wks to heal

32
Q

Full thickness:(3rd degree)

A

through the subcutaneous layer, nerve receptors= burnt= no pain at the actual site, cherry red/pale/pearly white, slow/no cap refill, can produce keloid scarring/eschar ++ major risks for compartment syndrome.

33
Q

4th degree burns….

A

muscle + bone ( not used currently)

34
Q

deep partial thickness burns:

A

-less wet/red, +/- blisters, slow/no cap refill, +/- pain, 3-8 wks healing, severe scarring, requires skin grafts

35
Q

what are some indications for a/w burns?

A

soot in a/w, a/w edema, singed hair/facial hoarse, black tongue, carbonaceous sputum, hoarse voice, stridor, resp distress

35
Q

indications for early intubation?

A

resp distress, stridor, acessory muscle use, blisteres/edema of orpharynx, deep burns on face+ neck

35
Q

rule of 9’s (adult)

A

head (f+b)= 9%
Trunk=18%
Back=18%
genitalia=1%
each leg (f)=18%
each leg (b)=18%
arm= 9% each

36
Q

rule of 9”s for children:

A

head+neck(f+b)=18%
arms=9% each (4.5%=1 front/Back)
Torso= 18%
Back =18%
each leg(f/back only)=7%

37
Q

major burn %’s in adults…

A

> 25=BSA 2nd degree
10% BSA 3rd degree
any a/w burns

38
Q

major burns in children…

A

> 20% BSA 2nd degree, any 3rd degree, any a/w

39
Q

what are some risks of abuse …

A

premature baby, chronic illness, misbehaving child, toung parents, parents with mental health/drug/alc abuse, parent changing stories/lies, abnorm behaviour

40
Q

signs of abuse with burns

A
  • consistent burn patterns, depth, instruments around
41
Q

what is dangerous about cement burns?

A

cement= 64% Ca oxide ( lime), 21% silicon oxide, had a very alkaline ph of 12.5 ( very basic)

42
Q

do burn pt get O2 right away?

A

yes, it is best to get them on hi flow NRB at 15L/min immediately, humidified O2=better

43
Q

when to use sterile dressings..

A

partial thickess>15% BSA, full thickness >5%BSA, burn surfaces coming in contact w eachother ex: fingers

44
Q

how to prevent hypothermia in a burn pt?

A

blankets, foil blanket, ambient warming, fluid resus( IV, RL/NS)

45
Q

parkland formula?

A
  • recommended for >15% BSA in kids and >20% bsa in adults
    = vol of RL= 4mLx%BSAxweight(kg)/ 2
    1/2= 1st 8 hrs
    1/2= next 16 hrs
46
Q

why is it important to manage pain asap?

A

to reduce psycho trauma for the pt, +immune function/wound healing
(multi modal analgesics= recommended)

47
Q

When to transfer to a burn facility?

A
  • full thicknes in any age
  • partial thickness >10% BSA
  • any burn involving critical areas ex: hans/feet./face/genitals etc
  • significant chemicl injury, electric, lightning, coexisting majortrauma/preexsisting medical conditions
  • inhalation burns

Patient Care Theory (8 decks)

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