Ch 24 Integumentary (Test 4)

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Ch 24 Integumentary (Test 4)
2011-11-09 20:59:31
Test Massey

Massey Test 4
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  1. UVB Rays
    major factor in development of sunburn and non -melanoma skin cancers
  2. UVA Rays
    contribute to carcinogenic effects of UVB
  3. Tanning beds use which type of ray?
  4. Drugs increasing Photosensitivity
    • Anticancer – Methotrexate
    • Antidepressants – Elavil, Sinequen
    • Antidysrhythmics – Quinidine, Amiodarone
    • Antihistamines – Benadryl
    • Antimicrobials – Tetracycline, Azithromycin, Cipro
    • Antifungals
    • Antipsychotics – Thorazine
    • Diuretics - Lasix, Hydrdiuril
    • NSAIDS
  5. Role of Vitamin A in Integumentary System
    Maintenance of skin cell structure and normal wound healing
  6. Deficiencies in Vitamin B result in...
    Erythema and seborrhea-like lesions
  7. Role of Vitamin C
    Connective tissue formation and normal wound healing
  8. Deficiencies in Vitamin C result in...
    Symptoms of scurvy (petechiae, bleeding gums, purpura)
  9. Role of Vitamin K
    Helps blood clotting
  10. Deficiencies in Vitamin K result in...
  11. Role of Protein
    Cell growth and wound healing
  12. Skin Changes in Diabetes II
    • Velvety dark skin of neck and body folds
    • Rash
    • Impaired blood flow
  13. Risk Fx for Malignant Skin Neoplasms
    • Fair skin
    • red or blond hair
    • blue or green eyes
    • chronic sun exposure
    • family history
    • Living near equator
    • outdoor occupations or recreation
    • Smoking
  14. Actinic Keratosis
    • Premalignant form of squamous cell carcinoma
    • Typical lesion is irregular shaped, flat, slightly erythematous papule with indistinct borders and an overlying hard keratotic scale
  15. Treatments for Actinic Keratosis
    • cryosurgery
    • fluorouracil
    • surgical removal
    • Retin-A
    • chemical peeling agents
    • dermabrasion
    • laser resurfacing
  16. Basal Cell Carcinoma
    • Locally invasive malignancy arising from epidermal basal cells
    • Most common type of skin cancer and the least deadly
    • Small, slowly enlarging papule; borders semitranslucent or pearly with overlying erosion, ulceration and depression of center
  17. Treatments for Basal Cell Carcinoma
    • Excisional surgery, Chemosurgery, electrosurgery, cryosurgery
    • 90% cure rate
    • Slow growing tumor that invades local tissue
    • Metastasis rare
    • Fluoracil and Imiquimod for superficial lesions
  18. Squamous Cell Carcinoma
    • Less common that BCC but can be very aggressive, has the potential to metastasize and may lead to death
    • Manifestations include thin, scaly, erythematous plaque without invasion into the dermis; firm nodules with indistinct borders, scaling and ulcerations early; covering of lesion with scales late
  19. Melanoma
    • Tumor arising in melanocytes
    • Can metastasize to any organ including brain and heart
    • Most deadly skin cancer
    • About 1/3 occur in existing moles and frequently occur on lower legs and backs of women and trunk, head and neck in men
    • Continued production of melanin causes the lesions to appear dark brown or black.
    • Change in the size, shaper or appearance of mole is major risk factor
  20. Risk Fx for Melanoma
    • UV exposure or overexposure to artificial light such as tanning beds
    • genetic factors such as a prior diagnosis of melanoma and having a first degree relative with melanoma
    • immunosuppresion and exposure to environmental hazards such as herbicides
  21. Dysplastic Nevus
    • Abnormal nevus pattern increases risk of melanoma
    • Atypical moles that are larger than usual (>5mm across) with irregular borders and various shades of color
    • May have same ABCD characteristics as melanoma but are less pronounced.
    • Need to be assessed, evaluated and monitored as risk for melanoma increases greatly.
    • Education on other risk factors and sun safety is imperative
  22. Risk Fx for Bacterial Skin Infections
    • moisture
    • obesity
    • breaks in skin
    • systemic corticosteroids
    • antibiotics
    • chronic diseases such as diabetes
  23. Most Common Microorganisms causing Bacterial Infections
    • Staph
    • group A B hemolytic strep
  24. Impetigo
    • Vesicular lesions that develop crust surrounded by erythema, pruritis
    • Can be caused by staph, group A b-hemolytic strep, or combination
    • Associated with poor hygiene
    • Contagious
  25. Treatment of Impetigo
    Systemic Antibiotics such as Penicillin
  26. Cellulitis
    • Inflammation of subcutaneous tissue possibly often following break in skin
    • Strep and staph usual causative agents
    • Deep inflammation of subcutaneous tissue from enzymes produced by bacteria
    • Hot, tender, erythematous and edematous area with diffuse borders
    • chills, malaise and fever indicate worsening
  27. Treatment of Cellulitis
    • Moist heat
    • immobilization and elevation
    • systemic ABT
    • (Could progress to gangrene if left untreated)
  28. Herpes Simplex Virus (1 and 2)
    • Oral or genital HSV are recurrent lifelong viral infections that return to skin and mucous membranes to indicate recurrence when exacerbated by sunlight, trauma, menses, stress and systemic infection
    • Both contagious, transmitted by respiratory droplets, or virus containing fluid such as saliva, cervical secretions
    • Symptoms occur 3-7 days or more after contact
    • Painful, local reaction of single or grouped vesicles on erythematous base; may be accompaned with fever, malaise
  29. Herpes Simplex Virus Treatment
    • symptomatic medication, soothing moist compresses
    • Antiviral agents such as acyclovir, famciclovir and Valtrex
  30. Herpes Zoster (Shingles)
    • Activation of varicella-zoster virus
    • Must be put on Contact Isolation
  31. Characteristics of Herpes Zoster
    • linear distribution along a dermatome of grouped vesicles or erythematous base; usually unilateral on trunk, face, lumbosacral areas
    • Burning, pain and neuralgia preceding outbreak with mild to severe pain during outbreak
  32. Treatment of Herpes Zoster
    • Antiviral agents, analgesics, Neurontin may be given for severe neuralgia
    • New vaccine available for adults >60 who previously had chicken pox
  33. Candidiasis
    • Caused by Candida albicans
    • Occurs in warm, moist areas such as groin, oral mucosa, sub mammary folds
    • Common post chemotherapy, HIV infection, radiation. Organ transplantation related to depression of immune response
    • Diabetes and obesity are common risk factors
  34. Characteristics of Candidiasis
    • Mouth – White plaques that often coat the tongue
    • Vagina – red, edematous, painful, white patches, vaginal discharge, pain on urination and intercourse
    • Skin – papular erythematous rash
  35. Treatment of Candidiasis
    • Nystatin in form of powder, suppository, oral lozenge
    • hygiene (keep area clean and dry)
  36. Allergic Dermatitis
    • Manifestation of a delayed hypersensitivity, absorbed agent acting as antigen
    • Sensitization after several exposures
    • Lesions appear 2-7 days after contact
    • Red papules, usually pruritic
  37. Treatment of Allergic Dermatitis
    • corticosteroids
    • antihistamines
    • skin lubrication
    • elimination of allergen
  38. Urticaria
    • Usually allergic phenomena that results from histamine response
    • Erythema and edema in upper dermis
    • Single lesions usually resolves in 24 hours
  39. Treatment of Urticaria
    • removal of source
    • antihistamine therapy
    • cool compresses
    • possibly systemic corticosteroids in severe cases
  40. Drug Reactions
    • Hypersensitivity reaction to drug.
    • Rash of any morphology, often red, macular and papular
    • Abrupt onset
    • May appear up to 14 days after cessation of drug
    • Possibly pruritic
  41. Treatment of Drug Reactions
    • With draw drug
    • Antihistamines, corticosteroids
  42. Acne
    • Inflammatory disorder of sebacious glands
    • May persist into adulthood
    • Associated with menses, use of corticosteroids, and androgen dominant birth control pills
    • Non inflammatory lesions, including blackheads and whiteheads; papules and pustules most common on face, neck and upper back
  43. Treatment of Acne
    • Treatment aimed at suppressing new lesions and minimizing scarring
    • topical benzoyl peroxide or other antimicrobial topical retinoids, systemic antibitocis
    • Acutane – contraindicated in women who are pregnant or at risk for pregnancy – has been known to produce birth defects in fetus
  44. Psoriasis
    • Autoimmune Chronic dermatitis that involves excessively rapid turnover of epidermal cells
    • Usually develops before age 40
    • Family predisposition
    • Silvery scaling plaques commonly on scalp, elbows, knees, palms soles and fingernails (intermittent or continuous)
  45. Treatment of Psoriasis
    • Goal of treatment is to reduce inflammation and suppress rapid turnover of epidermal cells
    • topical corticosteroids, tar, sunlight (UV rays alone or with other medications
    • Systemic treatments include antimetabolites (methotrexate) or immunosuppressants ( cyclosporine, retinoid, remicade)
  46. Rhytidectomy
    lifting and repositioning of the lower two thirds of the face and neck to improve appearance
  47. Blepharoplasty
    eyelid lift
  48. Important Nursing Implications for Face Lifts
    • Prevent hematoma formation – apply ice packs 24-48 hours to reduce swelling and decrease hematoma formation
    • Avoid smoking and vigorous exercise
    • Minimal pain is expected and infection is not a common complication
  49. Preoperative Management of Cosmetic Surgery
    • Informed consent
    • Realistic expectations of what surgery can accomplish (ex. face lift has no effect on deep wrinkling of forehead and temples, deep nasolabial grooves, or vertical lip wrinkles)
    • Third phase of healing most surgeries not complete for one year
  50. Postoperative Management of Cosmetic Surgery
    • Usually not extremely painful
    • Infection not common but assess for signs and educate patient about signs upon discharge
    • Monitor carefully for adequate circulation
    • Supportive, compressive dressings and ice packs may be necessary during early postoperative period