Med Surg Ch 53

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Med Surg Ch 53
2013-03-07 11:13:18
Integumentary System

Integumentary System
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  1. Which of the following is protein in epidermal cells that makes the skin relatively waterproof?
  2. Stratum Germinativum
    • Innermost epidermal layer 
    • where mitosis takes place to produce new epidermal cells
  3. Keratin
    • Relatively waterproof
    • prevents the loss of water and dehydration
    • prevents the entry of excess water through the body surface
  4. Stratum Corneum
    • Outermost epidermal layer 
    • Consists of many layers of dead cells; all that remains is keratin
    • barrier against pathogens and most chemicals
  5. Melanocytes
    • Cells in the lower epidermis
    • produce melanin
  6. Melanin
    • Protein that is a genetic characteristic
    • Gives color to the skin and hair
    • when exposed to UV rays, melanin increases

    pigment barrier to protect further exposure of living cells in the stratum germinativum to UV rays
  7. Langerhans' cells
    • Located in the epidermis
    • type of macrophage that presents foreign antigens to helper T cells
    • first step in destruction of pathogens that have penetrated the epidermis
  8. Fibroblasts
    • Produce the protein fibers collagen and elastin
    • located in the dermis
  9. Collagen fibers
    Form the strength of the dermis
  10. Elastin fibers
    Capable of recoil and make the dermis somewhat elastic
  11. Function of eyelashes and eyebrows and nostril hair
    • Eyelashes and eyebrows - keep dust and sweat out of eyes
    • nostril hair - filters air entering the nasal cavities
  12. Sensory receptors in the dermis
    For cutaneous senses

    • free nerve endings
    •   heat, cold, itching, pain
    • encapsulated nerve endings
    •   touch and pressure
  13. How is the sensitivity of an area of the skin determined?
    By the density of receptors present
  14. Sebum
    • Secreted by the sebaceous gland
    • A lipid substance that inhibits the growth of some bacteria
    • prevents drying of skin and hair
  15. Sudoriferous Glands
    AKA sweat glands

    • two types
    •   apocrine and eccrine
  16. Apocrine Glands (what, where, activated by?)
    • Modified scent glands
    • axillae and genital area
    • activated by stress and emotions
  17. Eccrine glands (where, activated by, function)
    • Faces, palms, soles
    • activated by high temperature and exercise
    • secrete sweat
    • cooling mechanism but can lead to dehydration
  18. What are the functions of subcutaneous tissue?
    • Cushions bony prominences
    • provides insulation
    • stores energy
  19. Older adults have fewer fibroblasts, and epidermal division slows. How do these changes affect nursing care?
    The nurse should take care to protect fragile skin
  20. Which term should be used to document a raised, fluid filled lesion smaller than 1 cm?
  21. What equipment is most important to have readily available when a patient is undergoing skin testing for allergies?
    Resuscitation equipment
  22. Why should wet dressing be applied only to one third of the body at one time?
    To prevent chilling the patient
  23. Erythema

    • may indicated:
    •  circulatory changes
    •  vasodilation
    •  increased blood flow
    •  fever
    • inflammation
  24. Pallor
    Paleness or decrease in color

    • can be caused by:
    •  vasoconstriction
    •  decreased blood flow
    •  decreased hemoglobin levels from amenia
  25. Subcutaneous tissue
    • Between the dermis and muscles (connects skin to muscle)
    • made of areolar and adipose connective tissue

    contains numerous wbcs that destroy pathogens that have entered by way of broken skin
  26. Discrete
  27. Grouped
  28. Confluent
  29. Linear
  30. Annular
  31. Polycyclic
  32. Arciform
  33. Reticular
  34. Jaundice
    • Yellow-orange discoloration
    • may result from liver disease
    • check in the sclera of the eye
  35. Lesion
    Any change or injury to tissue
  36. Documenting skin lesions
    • Exudate
    • amount
    • color
    • odor
  37. Moisture assessment
    Provides clues to the pts level of hydration
  38. vascular markings
    • normal / abnormal
    • petechiae and ecchymosis
  39. Petechiae
    • Reddish purple hemorrhagic spots
    • smaller than 0.5 mm in diameter
  40. Ecchymosis
    Bruise that changes color from blue black to greenish brown or yellow over time
  41. Papule 

    • Solid
    • raised less than 1 cm in diameter due to superifical thickening in the epidermis
  42. Normal nail characteristics
    • Pink
    • smooth
    • hard
    • slightly convex
    • firm base
  43. What should you assess when examining a patients nails?
    • Color
    • Shape
    • texture
    • thickness
    • any abnormalities
  44. Beau's lines
    • Transverse depressions in the nails
    • could indicate systemic illnesses or nail injury
  45. Paronychia
    • Inflammation of the skin at e base of the nail
    • could indicate local infection or trauma
  46. Three common types of skin biopsies
    • Punch
    • shave
    • incisional
  47. Punch biopsy
    Uses a small round cutting instrument to cut a cylinder shaped plug of tissue for a  full thickness specimen
  48. Shave biopsy
    Removes just the area that has risen above the rest of the skin
  49. Incisional biopsy
    Performed with a scalpel to make a deep incision and almost always requires sutures for closure
  50. What is the most uncomfortable part of a biopsy procedure?
    the injection of local anesthesia
  51. Wood's light examination
    Involves the use of ultraviolet rays to detect fluorescent materials in the skin and hair present in certain diseases

    example tinea capitis (ringworm)
  52. What test should be performed when allergic contact dermatitis is suspected?
    Patch and scratch tests

    performed by dermatologist on uninvolved skin
  53. What is the purpose of wet dressings?
    • Decrease inflammation
    • cleanse and dry a wound
    • continue drainage
  54. How long should wet dressings be perscribed and why?
    No longer than 72 hours because the skin may be too dry or macerated
  55. When would you avoid using a topical powder?
    Powders would be avoided for pts with respiratory disease or tracheostomies
  56. What can an overuse of topical steroids cause?
    Thinning of the skin
  57. How long should plastic wrap dressings be applied?
    For no longer than 12 hours a day
  58. How should skin tears be covered?
    With a non-adherent dressing such as xeroform and wrapped with gauze
  59. When collecting a wound culture, what should you not swab?
    Do not swab over the eschar (scabby black part)
  60. What are the two layers of the skin?
    • Outer dermis
    • inner dermis
  61. T or F: the skin is an organ
  62. what is the innermost layer of the skin?
    Stratum germinativum
  63. What happens in the stratum germinativum?
    • Production of new epidermal cells
    • production of the protein keratin
  64. function of keratin
    • Prevents dehydration
    • prevents the entry of pathogens
  65. What is the outermost layer of the epidermis?
    stratum corneum
  66. what is the function of melanin?
    • Genetic characteristic that gives color to skin and eyes
    • production increases when skin is exposed to UV rays
  67. What is langerhan's cells?
    Macrophages that destroy pathogens that enter the epidermis
  68. why do we need some uv rays?
    enables the formation of vitamin d from cholesterol
  69. What do fibroblast cells produce?
    the Protein fibers: collagen and elastin
  70. Where are ceruminous glands found and what do they secrete?
    • Dermis of the ear canal
    • secretes cerumen or earwax to prevent drying of outer surface of the ear drum
  71. What is the function of the blood vessels in the dermis?
    • Provide tissue nourishment
    • maintain body temp
    • dilation of the blood vessels in the dermis in warm environment increase blood flow and heat loss to air
    • constriction of the blood vessels in cold environment decreases blood flow to skin to conserve body heat
  72. What happens to blood vessels during stressful situations?
    cause vasoconstriction in the dermis, allowing blood to flow to more vital organs, heart, liver, brain, muscles
  73. Subcutaneous tissue
    • Between the dermis and muscle
    • made of areolar and adipose connective tissue - cushions, insulates, stores energy 
    • consists of numerous WBCs to destroy pathogens that enter the cracks in the skin
  74. Jaundice
    • May result from liver disease
    • check the sclera of the eye
  75. Cyanosis
    Blush discoloration may indicate a cardiac pulmonary or perfusion problem

    assess lips, nailbeds, conjunctivae, and palms
  76. Erythema in dark skin pts
    Shows as purpleish gray color
  77. Lichenification
    thickening and hardening of skin due to fibrotic changes following healing of a wound or surgical incision
  78. Alopecia
    Hair loss
  79. Abnormal nail features
    • Clubbing - hypoxia
    • spoon /concave - anemia
    • thick - fungal
  80. Crust
    A scab formed by dry serum, pus, or blood