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NURS2500 Patho/Pharma > Week 6: Tissue Integrity, Peripheral Perfusion, H2T Assessment > Flashcards

Week 6: Tissue Integrity, Peripheral Perfusion, H2T Assessment Flashcards

1
Q

How does the nurse perform an assessment of the integumentary system?

A

this is not completed as a separate step of the health assessment but integrated throughout the complete examination of the patient

focuses on inspection and palpation (from IPPA)

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2
Q

what are the physiological and embody (social) functions of skin?

A

Physiological Functions
Protection
Prevention of penetration
Temperature regulation
Wound repair
Absorption and excretion
Production of vitamin D

Embody (Social) Functions
Perception - sensory
Communication - blushes, startled
Identification - culturally

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3
Q

what is the subjective data - integumentary system?

A
  • Previous history of skin disease (allergies, hives, psoriasis, or eczema)
  • Change in pigmentation
  • Change in mole (size or colour)
  • Excessive dryness or moisture
  • Pruritus
  • Excessive bruising
  • Rash or lesion
  • Medications
  • Hair loss
  • Change in nails
  • Environmental or occupational hazards
  • Self-care behaviours
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4
Q

what is the objective data - integumentary system?

A

(A) Consider the colour of the patient’s skin:
Widespread colour change:
Pallor (white)
Erythema (red)
Cyanosis (blue)
Jaundice (yellow)
if darker - look at palms and feet (less pigment)
Areas of lighter pigmentation (vitiligo – absence of melanin pigment)

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5
Q

what follows under clinical context: widespread colour change?

A

pallor - clinical term for pale (under eyeballs

Jaundice - yellowish skin (enlarged belly) alcoholism - liver disease

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6
Q

what are objective assessments that can be done on the integumentary system?

A

consider the thickness of the patients skin - Are there any calloused areas? Is the skin thin or shiny?

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7
Q

What does general survey, head-to-toe assessment and system/focused assessment?

A

general survey is for safety and immediate concern

Head to Toe assessment - is or baseline, ( how is this individual doing, clinical manifestations)

system/focused assessment - in-depth focus on specific system ( focusing it and narrowing it)

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8
Q

Tissue integrity : When would a nurse prioritize an in-depth focused assessment of a patient’s skin?

A

burns, lesions, rash, and any obvious signs

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9
Q

who are the most prone for skin breakdown?

A

older client ( bed ridden)

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10
Q

From the following what are the integumentary system : subjective data ?

a. previous history of skin disease
b.change in pigmentation
c.change in mole
d.erythema
e.jaundice

A

a b c

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11
Q

true or false. Excessive dryness or moisture, excessive bruising and hairloss and pallor are a part of subjective data of integumentary.

A

false, although excessive dryness or moisture, excessive brusing, and hair loss is, pallor is not this is objective

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12
Q

integumentary System: objective data
what do you have to consider?

A

A) YOU HAVE TO CONSIDER the patient’s skin
areas of darker pigmentation ( freckles, moles, birthmarks)
areas of lighter pigmentation ( vitiligo- absence of melanin pigment)

B) Palpate the temperature of the patient’s skin
- Hypothermia or hyperthermia ?
- Use the back of your hand

C) Consider the moisture of the patient’s skin?
- diaphoresis or profuse perspiration
-dryness
-dehydration - oral mucous membranes

D) Consider the texture of the patient’s skin
- smooth, firm , with an even surface

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13
Q

Integumentary System : Objective data . true or false. widespread colour change can be a clinical manifestations to lead something is wrong with this patient?

A

true

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14
Q

What are the widespread colour change ?

A

1) pallor
2) erythema
3) cyanosis
4) jaundice

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15
Q

What color do these indicate?
Pallor
erythema
cyanosis
jaundice

A

white
red
blue
yellow

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16
Q

what are some indications of these terms :
pallor ( white )
erythema ( red )
cyanosis ( blue )
jaundice ( yellow )

A

anemia, not enough blood

fever, infection, C02 poisoning
not enough oxygen

not enough oxygen

something is wrong with the liver

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17
Q

If somebody has a darker skin tone ? what could be a big sign of a widespread colour change ( where in the body could we see this)?

A

mouth ( oral( or lips
palm of the hands
looking for cellular differences

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18
Q

when doing an integumentary system: objective assessment, what do we have to consider?

A

a) consider the thickness of the patient’s skin
- are they any calloused areas?
-is the skin thin or shiny?

b) Palpate the patient’s skin for edema
- unilateral edema: local or peripheral cause

-bilateral edema or generalized edema ( anarsaca) : central problem

Nonpitting or brawny edema
Pitting Edema

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19
Q

What are the ranges for pitting edema ?

A

1+ = mild pitting, slight indentation, no perceptible swelling of the leg

2+ = moderate pitting, indentation subsides rapidly

3+ = deep pitting, indentation remains for a short time, swelling of leg

4+ = very deep pitting, indentation lasts a long time, gross swelling and distortion of leg

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20
Q

what else do we have to consider when it comes to integumentary system : objective assessments?

re-call :
- consider the thickness of the patient’s skin
-palpate the patient’s skin for edema

what else?

A

palpate the mobility and turgor of the patient’s skin

inspect vascularity and bruising

note the presence of any rashes or lessions

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21
Q

Go into further details about these objective assessments when it comes to integumentary system

palpating the mobility and turgor of the patient’s skin

inspect vascularity and bruising

note the presence of any rashes and lessions

A

-pinch up a large fold of skin on the anterior aspect of the chest under the patient’s clavicle
-mobility = skin’s ease of rising
-turgor = skin’s ability to promptly return to place

Cause of any bruises ?
signs of recreational IV drug use ( track marks)

Types of lessions, how to describe

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22
Q

focuses on :
1) different types of lessions what’s the first you wanna know
(feel them)

A

aute and chronic

notice what we can observe

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23
Q

Abnormal Finding : Lesions
what are the two things we should categorize?

A

1) Type
- Primary
-Secondary
2) Assessment
- health history
-inspection
-palpation

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24
Q

Abnormal Findings: Lesions
1. Type
Primary and Secondary
Go in depth with this ?

A

Primary : when a lesion develops an unaltered skin

Secondary : When a lesion changes over time ( scratching/itching)

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25
True or false. Health history links to pain, healing, cause, when/where did it start spreading, contagious, environmental, itching fever, stress
true
26
true or false. Inspection links to colour, elevation, pattern or shape, size, location, and distribution on the body, any excaudate
true
27
True or false. Palpitation links to depth, pain, temperature, easily removed 'brushed off' - cause of bleeding> blanch with pressure?
true
28
Types ( Structure ) of Lesions Primary Skin Lesions are what kind?
macule & patch papule & plaque nodule & tumour wheal & urticaria ( hives ) vesicle & bulla cyst pustule
29
Types ( Structure ) of Lesions Secondary skin lesions
crust scale fissure (tear) erosion ulcer ( pressure sore) excoriation ( scratch or abrasion) scar atrophic scar keloid lichentication
30
Skin terminology : lesions and wounds Common shapes and configurations annular confluent discrete grouped gyrate target linear polycyclic zosteriform
circular merged, multi shaped distinct, separate cluster snakelike, coiled iris, bullseye scratch, streak annular grow together along nerve route
31
what is configurations?
pattern of the body ( the shapes)
32
true or false. closely monitor mole (can become malignant cancer --> skin cancer)
true
33
How do you assess moles ? ABCDE characteristics
Asymmetry Border irregularity Colour variation Diameter > 6mm Evolution Rapidly changing The ugly duckling sign
34
Integumentary System : objective assessment when assessing the nail beds for any abnormalities and hygiene ( name the examples )
clubbing, discoloration
35
When is a good time to check the patient's oral cavity ?
by checking their temperature ( orally)
36
As nurses we are obligated to inspect the patient's cavity, when we are doing our integumentary system subjective assessment?
false. Yes as nurse we are obligated to inspect their cavity, however it is not subjective but rather OBJECTIVE
37
name the examples of inspection we are looking for when inspecting a patient's oral cavity.
moist mucous membranes any lessions halitosis furrowed tongue condition of the teeth ( broken, clean, bleeding gums)
38
what is clubbing associated with ?
could be associated with lung disease
39
true or false. when doing an integumentary system, objective assessments. We palpate and inspect the scalp.
true
40
What do we look for when palpating and inspecting the patient's scalp?
tenderness sores/lessions infestations ( head lice )
41
Tissue Integrity - Laboratory Assessment what are the assessment?
wound cultures albumin biopsy
42
True or false. Protein in the blood is important for the healing?
True, it is important.
43
True or false. If someone has a really bad wound, it is recommended to eat high protein and high calories.
true
43
name the biopsy methods
curettage shave punch biopsy excisional incisional
43
If you have low albumin and you have a big wound, what happens?
if the albumin is low, there's not enough to heal for the wound--> takes longer
44
What are the 4 types of tissue
muscle neural connective epithelial
45
What is the scope of tissue integrity ?
intact skin tissue damaged skin tissue ( partial thickness injury and fullness thickness injury)
46
what are ways how a cell can die ? ( causes of lethal cell injury )
cellular ischemia ( doesn't have enough oxygen) physical damage - heat, cold, radiation, electrothermal, mechanical microbial injury -bacteria can come ( like a pimple etc.) immunological injury - damage caused by body's own immune system normal substances with unintended contact - gastric acid leads into abdominal cavity neoplastic growth ( benign or cancer)
47
True or false. Normal substances with unintended contact ( e.g gastric acid leads into abdominal cavity) . This can cause a leakage and cause cellular injury or death.
true
48
Cell Death: Necrosis : What does this mean?
uncontrollable passive pathological process of cell death ; occurs when cells are exposed to extreme conditions causes swell and rupture, leading to inflammation and damage of surrounding tissue
49
True or false. When having a heart attack, the heart cells looks normal but it's actually dead.
True
50
What are the terms we need to know that undergoes cell death : necrosis
coagulative liquefactive caseous gangrene - dry gangrene -wet gangrene
51
when describing the term coagulative , what does it mean?
caused by ischemia, free radical, still looks like a cell for a while
52
what is liquefactive, identify the term
caused by the body releasing enzymes to kill bacteria, causes damage ( liquefy) of neighbouring cells ( abscess)
53
what does caseous mean ?
a distinctive from coagulative necrosis, where tissue no longer recognizable, cheese-like appearance. caused by mycobacterial infections ( tuberculosis) or tumor necrosis.
54
what does gangrene mean ?
build up decomposing dead tissue, usually refers to appendage/limb /with ischemic necrosis
55
what are the two types of gangrene ?
dry and wet gangrene
56
what is a dry gangrene
chronic/slow caused by degenerative diseases ( atherosclerosis. diabetes) may auto-amputate
57
what is wet gangrene
acute/quick, caused by sudden elimination of blood flow ( severe burn or traumatic crush injury) possible bacteria
58
Pressure Ulcers Etiology :
Pressure- Skin and soft tissue compressed shearing force- skin stationary, tissue below moves Friction - Surfaces rub the skin Excessive moisture
59
Pressure Ulcers Risk Factors :
loss of mobility confusion poor nutritional status dehydration
60
True or false. Sitting all day in that bony premises ( cutting circulation in that issue) initially getting a cellular injury cutting off that perfusion= leading to cellular death.
true
61
Who is more prominent for pressure ulcers ?
underweight, ( but both under and over weight could be )
62
True or false. Shearing forces pulling skin layers away from the deeper tissue.
true
63
The skin is " bunched up " against the back of the mattress while the rest of the bone and muscle in the area presses download on the lower part of the mattress. This is called =
shearing
64
define if this is true. Shearing forces pulling skin layers away from the deeper tissue. The skin " bunched up " against the back of the mattress while the rest of the bone and muscle in the area presses downward on the lower part of the mattress. Blood vessels become kinked, obstructing circulation and leading to tissue death.
true
65
ISTAP skin tear classficiation
1) no skin loss 2) partial flap floss 3) total flap loss
66
what category is this in? Linear or Flap tear which can be repositioned
no skin loss
67
what category is this in ? Total flap loss exposing entire wound bed
total flap loss
68
what category is this in? cannot be repositioned to cover the wound bed
partial flap loss
69
true or false.When doing a skin assessment, notice it's red ( see if it's latching lighting) telling me you're still perfusion there ( red spot and it doesn't launch) not getting perfusion = stage 1 ulcer
true
70
what is stage II of ulcers?
artial thickness loss of dermis presenting as a shallow open ulcer with a red pink moist wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.
71
What stage of ulcers is this? Full thickness tissue loss with exposed bone, tendon or muscle.
stage IV
72
what stage of ulcers is this? Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed.
Stage III
73
what is the unstageable stage of ulcers?
Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
74
what is a Suspected Deep Tissue Injury? (ulcer)
A purple or maroon localized area of discolored intact skin or blood- filled blister due to damage of underlying soft tissue from pressure and/ or shear
75
what are the four types of wound drainage or exudate?
Serous Serosanguineous Sanguineous Purulent
76
what is a serous wound drainage?
Clear, watery plasma WNL – expected with wound healing
77
What is a Serosanguineous wound drainage?
Pale, red, watery: mixture of clear and red fluid WNL – expected with wound healing
78
what is Sanguineous wound drainage?
Bright red Active bleeding
79
What is a purulent wound drainage?
Thick, yellow, green, tan, or brown Possible infection
80
what is wound healing - primary intention?
incision with blood clot - edges approx. with suture - fine scar
81
what is wound healing - secondary intention?
irregular large wound with blood clot - granulation - large scar
82
what is wound healing - tertiary intention?
contaminated wound - granulation tissue - delayed closure with suture
83
what does wound healing involve?
Inflammatory response - involved in the healing of wounds Partial thickness wound (damage to epidermis and upper dermal layers) - Re-ephithelization – production of new skin cells by undamaged dermal layer - Occurs in 5-7 days (hydrated, well-oxygenated, few microorganisms) Full thickness wounds (lower layers of dermis and subcut tissue) - Granulation – gap in tissue filled by scar tissue - Contraction – gap in tissue fibroblasts pull wound edges inward
84
what is granulation? what is contraction (full thickness wounds) ?
Granulation – gap in tissue filled by scar tissue Contraction – gap in tissue fibroblasts pull wound edges inward
85
What stage do we want to have early intervention?
stage 1 these are early signs, and prevent from getting worse.
86
When someone sitting on a wheelchair all the time. Causing friction and shearing What stage is this occurring?
Stage 1 pressure ulcers
87
What is this : we now have broken skin ( still in the dermis) , seeing that skin opening up
stage II
88
With through the epidermis and through the dermis, and all the way through that tissue ( see that underline subcutaneous tissue)
stage III
89
this is all the way to the skin, and subcutaneous tissue ( underlying tissue, bones, tissues, muscles) this is starting to get that slough ( wet greene)
Stage IV
90
True or false. Nutrition is a big thing ( component) in a long term care home ( dealing with a skin tissue ) --> can be seen in all stages
true
91
This is when we still don't see the top layer breaking down ( but is swollen and darkening in colour ) what stage is this ?
Staging of Pressure Ulcers: Suspected Deep Tissue Injury
92
What type of wound healing is this? heals by generating new cells, new baby skin cells to fill in that wound left with a large scar
secondary intention
93
what type of wound healing is this? this is a cut to bone to heal take a structure and sew it back together ( closed the wood and it's healed) -> fine scar
primary intention
94
what type of wound healing is this? this is when someone goes for surgery ( and there is infection in there, not going to close it immediately.Leave it open and clean the tissue is infected, we do that by giving them antibiotics)
tertiary intention
95
In terms of wound healing: what type of response is this ? Help form clot ( and form a clot and clot has been formed, the wound heals itself, has chemical mediators so it can start healing itself)
inflammatory response
96
In terms of creating skin cells and starting to generate skin cells what type of wound healing is this ?
partial thickness wounds
97
How does the nurse perform an assessment of the PVS ? ( peripheral vascular system)
assessing the peripheral vascular system involves inspecting and palpating the patient's arms and legs informs the nurse about the patient's peripheral perfusion, or the body's ability to circulate blood to and from extremities
98
arteries and veins in the leg
located on the top of our foot ( and behind our ankle) fetal pulses
99
Peripheral Vascular Assessment : subjective data
leg pain or cramps skin changes on arm or legs r/t PVD (peripheral vascular disease) swelling in arms or legs r/t PVD (peripheral vascular disease) lymph node enlargement medications
100
Peripheral Vascular Assessment : objective data , name the three things we should look at
A) palpate/compare the color, warmth, sensation, movement Colour Warmth Sensation Movement Palpate the oulses
101
True or false. Peripheral Vascular Assessment : objective data should we assess the capillary refill of the fingers and toes . - depress the nail edge to cause blanching, and then release -note the return of colour brisk vs. sluggish
true
102
what is brisk ? and what is sluggish ?
brisk >3-5 sluggish < 3-5 sec
103
what are the different pulses that we can find in our body ?
carotoid temporal brachial radial femoral popliteal posterior tibial dorsalis pedis
104
Peripheral Vascular Assessment : objective data. True or False. Colour changes : suspected arterial deficit we lift the patient's leg under the table, and ask the patient to make their leg still and hold it for one minute to drain venous blood have patient stand out - assess how long for colour to return
false. lift the patient's legs above the table, ask the patient to move their feet, hold for 30 seconds to drain venous blood have patient sit up legs over bed- assess how long for colour to return ( normal is < 10 seconds)
105
what is the scope of perfusion?
Optimal perfusion Impaired perfusion no perfusion
106
what are the four stages of peripheral arterial disease?
stage 1: Asymptomatic stage 2: Claudication stage 3: Rest Pain Stage 4: Necrosis/Gangrene
107
In the following option, which one goes away from out heart to our arteries, and which goes back into our arteries into the heart ?
oxygenated dexygenated
108
what is stage 1: asymptomatic?
No claudication (pain in thigh, calf or buttocks) Bruit or aneurysm may be present Pedal pulses are decreased or absent
109
Blood that flows through arteries and capillaries to target tissues
tissue perfusion
110
what is tissue perfusion?
blood that flows through arteries and capillaries to target tissues
111
what are the three categories under tissue perfusion
-blood that flows through arteries and capillaries to target issues -arterial blood pressure -venous blood pressure
112
what is stage 2: Claudication?
Muscle pain, cramping, burning occurs with exercise * Relieved with rest Symptoms are reproducible with exercise
113
what is Step 3: Rest Pain?
Pain while resting commonly awakens the patient at night Pain described as numbing, burning, toothache-type pain Pain usually in distal part of extremity Pain is relieved by placing the extremity in a dependent position
114
go more in depth for arterial blood pressure under tissue perfusion
determined by CO and SVR ventricular contraction creates pressure pushes blood through arteries, capillaries into intersial spaces Delivers oxygen, fluid and nutrients to the cells Blood pressure is maintained by constricting or dilating arteries and arterioles in response to stimuli
115
what is stage 4: Necrosis/Gangrene
Ulcers and blackened tissue occur on the toes, forefoot, heel Distinctive gangrenous odor
116
what are the clinical manifestations of peripheral arterial disease?
loss of hair on lower calf/ankle/foot Dry, scaly/dusky pale or mottled skin thickened toenails decreased or absent pulses pain at rest, leads to or worsening at night Cold and cyanotic or darkened skin (pallor with elevation, dependent rubber when lowered) Muscle atrophy with chronic cases ulcers to toes, metatarsal heads, and lateral ankle (ulcers = ale ischemic base, well defined edges, no bleeding)
117
go more in depth by venous blood pressure under tissue perfusion
blood is returned through veins and venules ( less sturdy than arteries and arterioles) more stretchy lower pressure than arteries veins contain valves to keep blood flowing forward to the heart
118
complications of peripheral arterial disease?
infection, gangrene delayed-/non-healing, amputations
119
what is the impaired perfusion risk factors ( who are at risk). Who are at populations at risk ? Who are individuals at risk ?
populations at risk - older adults, and social determinants of health Individual risk factors- genetics, lifestyle, immobility
120
how to calculate ankle brachial index?
ABI = Ankle Pressure/Branchial Pressure Normal = 1.00 - 1.40
121
what is peripheral venous disease?
Prolonged venous hypertension that stretches veins and damages valves includes: Backup of blood leads to edema and decreased tissue perfusion Standing/sitting for prolonged periods Obesity Hypercoagulable states/Vein trauma/Thrombus formation Incompetent valves (varicose veins)
122
true or false. Peripheral vascular Disease are perfusion risk factors which includes peripheral arterial disease and chronic venous insufficiency.
true
123
what are the stages of peripheral arterial disease
1) asymptomatic 2) claudication 3) rest pain 4) necrosis/gangrene
124
what does Peripheral Venous Disease (CVI) lead to?
Venous stasis ulcers Swelling Cellulitis
125
what are the clinical manifestations of PVD/CVI
Edema Stasis dermatitis: reddish-brown discolouration - extending up calf stasis ulcers - from edema/minor injury - often above medial malleolus - Irregular borders - Difficult to heal
126
Stages of peripheral arterial disease is a problem with
arteries
127
what are designed to get nutrients to our extremities ?
arteries
128
if we lose nutrients and are not getting enough perfusion, what do we get?
peripheral arterial disease
129
true or false. Peripheral arterial disease must be catch and carry on ( they get weaker by clotting formation)
true
130
what would the location be for arterial and venous?
Deep muscle pain, usually in calf Calf, lower leg
131
what would the character be for arterial and venous?
intermittent claudication (cramping, numbness) Aching, tiredness, feeling of fullness
132
what would the onset and duration be for arterial and venous?
chronic, onset gradual after exertion chronic, increases at end of day
133
GO in depth with the information of stages of peripheral arterial disease.
1) asymptomatic - no claudition - bruit or aneurysm may be present - pedal pulses are decreased or absent 2) claudication - muscle pain, cramping, burning occurs with exercise =relieved with rest - symptoms are reproducible with exercise 3) Rest Pain - Pain while resting commonly awakens the patient at night -Pain described as numbing, burning, tootache-type pain -Pain usually in distal part of extremity -Pain is relieved by placing the extremity in a dependant position 4) Necrosis/Gangrene - ulcers and blackened tissue occur on the toes, forefoot, heel -distinctive gangerenous odor
134
what would the Aggravating Factors be for arterial and venous?
Activity (walking, stairs), Elevation (rest pain indicates severe involvement) Prolonged standing, sitting
135
what would the relieveing factors be for arterial and venous?
Rest (usually within 2 min [e.g., standing]) Dangling (severe involvement) Elevation, lying, walking
136
what would the associated symptoms be for arterial and venous?
Cool, pale skin Edema, varicosities, weeping ulcers at ankles
137
what would the population at risk be for arterial and venous?
Older adults; history of hypertension, smoking, diabetes, hypercholesterolemia, obesity, vascular disease Prolonged standing or sitting; obesity; prolonged bed rest; varicosities, or thrombophlebitis; veins crushed by trauma or surgery
138
what major arteries can be found in the arm?
radial, ulnar and brachial
139
what major arteries can be found in the leg?
femoral, popliteal and posterior tibial
140
what major veins are found in the leg?
great saphenous, small saphenous, femoral, anterior tibial

NURS2500 Patho/Pharma (16 decks)

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