NUR 112 - Med Surg I ch 27.txt

epidermal thickening characterized by visible and palpable thickening of the skin with accentuated skin markings

too little as well as too much blood flow, especially to thye hands and feet

or hives) is a kind of skin rash notable for pale red, raised, itchy bumps. Hives are frequently caused by allergic reactions; however, there are many non-allergic causes.

Because the skin reaction is caused by the release of histamines, antihistamines such as Benadryle are helpful.

Most cases of hives lasting less than six weeks (acute urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer than six weeks) is rarely due to an allergy.

The majority of patients with chronic hives have an unknown (idiopathic) cause. Perhaps as many as 30�40% of patients with chronic idiopathic urticaria will, in fact, have an autoimmune cause. Acute viral infection is another common cause of acute urticaria (viral exanthem). Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight.

The classic model of wound healing is divided into three or four sequential, yet overlapping, phases: (1) hemostasis (not considered a phase by some authors), (2) inflammatory, (3) proliferative and (4) remodeling.

• INFLAMMATORY PHASE
  • Begins at the time of injury or cell death and lasts 3 to 5 days.
  • Immediate responses are vasoconstriction and clot formation.
  • After 10 minutes, vasodilation with increased capillary permeability and leakage of plasma (and plasma proteins) into the surrounding tissue.
  • Migration of white blood cells (especially macrophages) into the wound.
  • Clinical manifestations of local edema, pain, erythema, and warmth.

• FIBROBLASTIC PHASE (or proliferative)
  • Begins about the fourth day after injury and lasts 2 to 4 weeks.
  • Fibrin strands form a scaffold or framework.
  • Mitotic fibroblast cells migrate into the wound, attach to the frame-work, divide, and stimulate the secretion of collagen.
  • Collagen, together with ground substance, builds tough and inflexible scar tissue.
  • Capillaries in areas surrounding the wound form "buds" that grow into new blood vessels.
  • Capillary buds and collagen deposits form the "granulation" tissue in the wound, and the wound contracts.
  • Epithelial cells grow over the granulation tissue bed.

• MATURATION PHASE
  • Begins as early as 3 weeks after injury and may continue for a year.
  • Collagen is reorganized to provide greater tensile strength.
  • Scar tissue gradually becomes thinner and paler in color.
  • The mature scar is firm and inelastic when palpated.

• sepsis
• kidney failure
• infectious artritis
• osteomyelitis

a potentially deadly medical condition that is characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) and the presence of a known or suspected infection.[1][2] The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. A lay term for sepsis is blood poisoning, also used to describe septicaemia. Severe sepsis is the systemic inflammatory response, plus infection, plus the presence of organ dysfunction.

simply means an infection of the bone or bone marrow.

3-14% of all Pts!

• • Sensory perception - Ability to respond meaningfully to pressure-related discomfort
  • Moisture - Degree to which skin is exposed to moisture
  • Activity - Degree of physical activity
  • Mobility - Ability to change or control body position
  • Nutrition - Usual food intake pattern
  • Friction & Shear

• 15-16: Mild Risk
• 12-14: Moderate Risk
• <=11: Severe Risk

Neutrophil

Eosinophil

Monocyte

Lymphocyte

superficial infection involving only the upper portion of the follicle and usually caused by Staphylococcus

boils that are also cause by Staphylococcus but the infection is much deeper in the follicle

A generalized infection involving Staphylococcus or Streptococcus that involves the deeper connective tissue

the most common viral infection of adult skin. After infection the virus remain in the body in the nerve ganglia and the Pt has no symptoms.

Herpes type 1 is a recurring cold sore of the mouth

type 2 herpes is genital herpes, also recurrent

Herpes simplex infection of the fingertips

Commonly known as shingles, It affects Pts who have prevously had chickenpox (Varicella-zoster) virus

severe pain persisting after lesions have resolved is a common complaint of older Pts.

A fungal infection (Dermatophyte) of the foot

Same Dermatophyte (fungal) infection as athlete's foot, that involves the rest of the body and is commonly called ringworm.

As with all Dermatiphyte infections, it can be spread via inanimate objects - sharing contaminated combs, hats, pillowcases.

yeast infection. Risk factors include immunosuppresion, long-term antibiotic use, diabetes mellitus and obesity. In the mouth it is called thrush.

swab culture of puruent material

Tzanck smear and viral culture - multinucleatid giant cells confirms viral but not specific virus

potassium hydroxide (KOH) test - fungl hyphae present under microscope

Think VIRUS

oral antibiotics for 60 days.

lice

a "mite" infection - white skin ridges are formed by burrowing mites

When the cause is not known, it is referred to as non-specific exzematous dermatitis or exzema

low-dose steroids

topical steroids, topical tar and anthalin preparations, and UV light. Corticosteroids have anti-inflammatory actions and when applied to psoriasis lesions, they surpress cell division

or moles are benign growths of pigment forming cells with regular, well-defined borders and uniform color. Because 50% of malignant melanomas arise from moles, nevi with irregular spreading borders and those with multiple colors should be highly suspect.