Med-Surg Exam 5

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Med-Surg Exam 5
2012-05-29 22:58:41
Med surge exam skin hair nails burns plastic surgery integumentary system

The Integumentary System (skin, hair, nails): Lesson 1: skin disorders, Lesson 2: burns, Lesson 3: plastic surgery
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  1. Inflamatory skin disorder characterized by comedones, pustules, and cysts
  2. Skin condition characterized by scaly lesions and caused by rapid proliferation of epidermal cells
  3. Outer layer of skin:
  4. Epidermis is made up of ________ cells.
  5. Are there blood vessels in the epidermis?
  6. Helps waterproof the skin:
  7. Gives skin color:
  8. Sublayers:
  9. Vitamin D is synthesized in the base of the _______ layer.
  10. Layer that is made up of connective tissue/collegen
  11. Keratine is a vitamin __ source.
    Vitamin A
  12. Layer that includes nervous system connections:
  13. Sweat glands are found in the ______ layer and opens into the ________ layer.
    Dermis, Epidermis
  14. Sebaceous glands are found in the ________ layer.
  15. Sebum:
  16. Base of hair follicle
  17. What happens to skin as we get older?
    Skin gets dryer because of less production of sebum
  18. Subcutaneous is mainly _________ tissue.
  19. Blood vessels are found in which layer of the skin?
  20. "Living layers" include:
    Dermis and subcutaneous
  21. In the nail, the connection between living and dead cells:
  22. Inflammaroty condition caused by contact with a substance that triggers an allergic response (Characterized by redness/rash, severe itching, possible wheals [localized]):
    Contact dermatitis
  23. Has no cure, but can be treated topically or systemically:
  24. Dandruff that usually occurs with oily skin:
  25. Skin condition that affects the hair follicles and sebaceous glands:
  26. Can acne can be caused by fatty foods, chocolate, or poor hygiene?
  27. Causes an infection that begins with itching and buring and progresses to the development of vesicles that reupture and form crusts:
    Herpes simplex virus (HSV)
  28. HSV lesions are commonly called:
    Cold sores or fever blisters
  29. HSV infections on the face and upper body are usually caused by:
  30. HSV genital infections are usually caused by:
  31. Can both types of HSV cause oral or genital infections?
  32. Herpes simplex infections are treated with:
    acyclovir (Zovirax)
  33. Infection commonly called shingles:
    Herpes Zoster
  34. Herpes infection that is caused by the varicella-zoster virus:
    Herpes Zoster
  35. Herpes zoster is treated with:
    Antiviral agents; acyclovir
  36. Distinct flat area with color different from surrounding tissue like a freckle:
  37. Solid lesions that push outward; don't usually hurt:
  38. Fluid filled lesion:
  39. Superficial, irregular swelling caused by fluid acumulation:
  40. Eggs, or feces excreted by mites:
  41. Thin red lines on skin that may cause itching could be a s/s of:
  42. Itching of hairy areas of the body and eggs seen as tiny white particles attached to hair shafts can be a s/s of:
  43. Two minerals good for tissue healing:
    • Zinc
    • Selenium
  44. Vitamins that are good for the skin:
    • A
    • C
    • E
    • B
  45. Macronutrient that is good for the skin:
  46. Skin cancers are classified as:
    Nonmelanoma or melanoma
  47. Nonmelanoma skin cancers include:
    • Basal cell carcinoma
    • Squamous cell carcinoma
  48. Carcinoma that usually begins as painless, nodular lesions that have a pearly appearance:
    Basal cell carcinoma
  49. Carcinoma that may appear as scaly ulcers or raised lesions and grow rapidly and matastasize:
    Squamous cell carcinoma
  50. Types of burn injuries:
    • thermal
    • electrical
    • chemical
    • friction
  51. Thermal burns:
    • flam
    • flash
    • scald
    • contact
    • UVR
    • cold thermal injury/frostbite
  52. Most common thermal burn:
  53. Localized areas of tissue necrosis that develop when soft tissue is compressed between a bon prominence and an external surface or when pressure occures in combination with shearing force or friction or both:
    Pressure ulcer
  54. Pulsed lavage with suction:
    Wound debridement system used to clean wounds
  55. Sources of chemical burns:
    Acidic or alkaline source
  56. Burning process may continue up to ___ hours after chemical is removed.
    72 hours
  57. Brush away vs flush away:
    • Brush: dry chemicals
    • Flush: with large amounts of water
  58. If you get a chemical in your eye:
    Eye wash station
  59. You should be concerned about _____________ and ___________ with electrical burns.
    Cardiac arrest and neuro damage
  60. First aid for burns:
    • remove from source
    • stop/drop/roll
    • ABCs
    • stabilize spine
    • remove jewelry, clothing, shoes
    • cover with light blanket
    • elevate extremities affected
    • water to cool burn
    • avoid excess water on large burn bc of shock
    • NO topicals on wound
    • NPO
    • transport to ER/burn center
  61. Cause: an entrance and exit wound with severe damage in between:
    Electrical burn
  62. Burn that can cause deep burns, fractures from tetany like convulsion, spinal injury:
    Electrical burn
  63. Degree of burn that is AKA superficial partial thickness: affects the epidermis; red and dry, may peel/slough
    1st degree burn
  64. Degree of burn that is AKA deep partial thickness: affects the epidermis and dermis, red and blistered (weepy), peels
    2nd degree burn
  65. Degree of burn AKA full thickness: affects the epidermis, dermis, AND SQ, dark with eschar (dark leathery crust)
    3rd degree burn
  66. Degree of burn that is AKA deep full thickness: affects the epidermis, dermis, SQ, AND muscle (possibly bone), dark with eschar:
    4th degree burns
  67. A formula for estimating the percentage of adult body surface covered by burns by assigning 9% to the head and each arm, twice 9% (18%) to each leg and the anterior and posterior trunk, and 1% to the perineum. This is modified in infants and children because of the proportionately larger head size.
    Rule of nines
  68. Burn phases:
    • Emergent
    • Acute
    • Rehab
  69. Burn phase: Onset of injury to completion of fluid resucitation 24-48 hours
    Emergent phase
  70. Burn phase: beginning of diuresis to coverage of wounds or completion of wound closure/healing
    Acute phase
  71. Burn phase: major wound closure/healing to return to optimal level of functioning
    Rehabilitation phase
  72. Infection control precautions for burns:
    • protective isolation
    • steril technique
    • topical antimicrobials
  73. Skin graft types:
    • autograft
    • homograft (allograft)
    • heterograft (xenograft)
  74. Skin graft: self/identical twin; permanent
  75. Skin graft: other human/cadaver; eventually will be rejected
    Homograft (allograft)
  76. Skin graft: cow or pig; eventually will be rejected
    Heterograft (xenograft)
  77. 3 conditions for the graft to work:
    • Have sufficient blood supply
    • Stick closely to tissue/be fixed firmly
    • Be free from infection
  78. During post op care, when does the surgeon change the 1st dressing?
    in about 48 hours; leave alone until then
  79. During post op nursing care, you should:
    • report excess drainage/bleeding
    • check CMS
    • avoid excess pressure on graft site
    • monitor for infection
    • Benadryl for itching
    • teach pt about protecting site after healed; lotion, sunscreen, Teds for leg sites
  80. How do you treat contact dermatitis?
    w/wet compresses/soaks, antihistamines, steroids
  81. Lesion that is discolored and flat:
  82. Lesion that is discolored, raised and solid:
  83. Lesion that is fluid-filled, raised (blister):
  84. An allergic/hypersensitivity skin reaction caused by systemic reaction to foods/drugs/venoms that can cause angioedema/anaphylaxis (characterized by wheals, severe itching):
  85. How do you treat urticaria/hives?
    • Depends on severity
    • immediately d/c allergen
    • antihistamines
    • allergy testing
    • call code/911
    • maintain ABCs
    • wear medic alert/Epi-pen
  86. Herpes virus that is oral herpes, AKA "cold sore" or "fever blister" that is characterized by small vesicles that rupture/crust around the mouth/upper lip:
    Herpes simplex 1
  87. What are some treatments for HSV-1?
    • Abreva
    • script: Danovir
    • teach infection control
  88. Herpes virus that involves inflammation along a nerve pathway caused by the same virus as the chickenpox:
  89. Common site of herpes zoster:
    side of back
  90. For best results, treatment of herpes zoster should be started within ___ hours.
    72 hours
  91. Treatment for herpes zoster:
    • Zovirax (PO/topical)
    • cool compresses
    • pain meds
    • topical antibiotics
    • Neurontin for neuralgia
    • vaccine if over 65 years
  92. ________ are more prone to ________________ in skin folds.
    Diabetics, fungal infections
  93. ___________ thrive in warm, moise, dark environments.
  94. A contagious fungal skin infection appearing as a bright red ring:
  95. The most common fungal infection of the skin that is contagious and appears as red, scaling, itchy areas between toes:
    Athlete's foot
  96. ABCDE's of skin cancer assessment:
    • Asymmetry
    • Border
    • Color
    • Diameter; larger than a pencil eraser (6 mm)
    • Elevation
  97. _____________ can be caused by life-threatening shifts in fluids/electrolytes and is especially severe in the 1st ___ to ___ hours.
    Burn shock, 12 to 24 hours
  98. What fluid/electrolyte imbalance disorders can burns cause?
    • hypoatremia
    • hyperkalemia
    • hypovolemia
  99. Name the disorder associated with burn shock that involves fluid from blood vessels moving to the interstitial space and the burn wound.
  100. Name the disorder associated with burn shock that involves potassium moving from injured cells to the bloodstream.
  101. Name the disorder associated with burn shock that involves sodium moving from outside the cells to the interstitial space and the burn wound.
  102. ______________ is a med that interferes with viral DNA to reduce severity of viral infection; best applied early and may burn/sting:
    acycolvir (Zovirax)
  103. __________ is a med used topically to treat cancer lesions; apply only to area being treated because it will eat away healthy skin; wear double gloves; ____________ is a side effect.
    fluorouracil (Efudex, topical 5-FU), photosensitivity
  104. ____________ is a med that is a vitamin A based med that reduces sebaceous gland size in severe, resistant acne; teratogenic effects; iPLEDGE program?
    isotretinoin (Claravis)
  105. _____________ is a med used to treat fungal infections; available as cream or shampoo; use shampoo _____ times a week for ____ weeks, then intermittently.
    ketoconazole (Nizoral), 2 times a week for 4 weeks
  106. _____________ is a chemo drug/immunosuppressant found to treat severe, resistant __________; given ______ time a week and must be taken with ___________ because it interferes with the folic acid metabolism; It is contraindicated in pregnancy/lactation because it has a _____________ effect; Has many a/e including pulmonary fibrosis, liver toxicity, anemia, gout, and photosensitivity; monitor for _____________ suppression.
    methotrexate (Rheumatrex), psoriasis, one time a week, daily folate, teratogenic, bone marrow
  107. _____________ is a med used to treat Strep or Staph infections like impetigo; applied ___ times a day after cleansing crusted areas on lower lip/chin with mild soap and water; teach _________________.
    mupirocin (Bactroban), 3 times a day, infection control
  108. _____________ is a med used to treat fungal infections; swish and swallow/spit for thrush or applied topically to skin/vaginally; may burn/irritate/stain.
    nystatin topical (Mycostatin, 1/2 Mycolog II)
  109. _________________ is a med used to prevent bacterial colonization in burn wounds; can also control ___________; may burn/irritate; comes in a wide mouth jar.
    silver sulfadiazine (Silvadine), mild yeast
  110. _______________ is a steroid applied thin/sparingly to decrease inflammation/itching; no occlusive dressings; may have systemic effects.
    Triamcinolone (Aristocort, 1/2 Mycolog II)