Med Surg Ch 53
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Which of the following is protein in epidermal cells that makes the skin relatively waterproof?
- Innermost epidermal layer
- where mitosis takes place to produce new epidermal cells
- Relatively waterproof
- prevents the loss of water and dehydration
- prevents the entry of excess water through the body surface
- Outermost epidermal layer
- Consists of many layers of dead cells; all that remains is keratin
- barrier against pathogens and most chemicals
- Cells in the lower epidermis
- produce 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
- Located in the epidermistype of macrophage that presents foreign antigens to helper T cells
- first step in destruction of pathogens that have penetrated the epidermis
- Produce the protein fibers collagen and elastin
- located in the dermis
Form the strength of the dermis
Capable of recoil and make the dermis somewhat elastic
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
Sensory receptors in the dermis
For cutaneous senses
- free nerve endings
- heat, cold, itching, pain
- encapsulated nerve endings
- touch and pressure
How is the sensitivity of an area of the skin determined?
By the density of receptors present
- Secreted by the sebaceous gland
- A lipid substance that inhibits the growth of some bacteria
- prevents drying of skin and hair
AKA sweat glands
- two types
- apocrine and eccrine
Apocrine Glands (what, where, activated by?)
- Modified scent glands
- axillae and genital area
- activated by stress and emotions
Eccrine glands (where, activated by, function)
- Faces, palms, soles
- activated by high temperature and exercise
- secrete sweat
- cooling mechanism but can lead to dehydration
What are the functions of subcutaneous tissue?
- Cushions bony prominences
- provides insulation
- stores energy
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
Which term should be used to document a raised, fluid filled lesion smaller than 1 cm?
What equipment is most important to have readily available when a patient is undergoing skin testing for allergies?
Why should wet dressing be applied only to one third of the body at one time?
To prevent chilling the patient
- may indicated:
- circulatory changes
- increased blood flow
Paleness or decrease in color
- can be caused by:
- decreased blood flow
- decreased hemoglobin levels from amenia
- 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
- Yellow-orange discoloration
- may result from liver disease
- check in the sclera of the eye
Any change or injury to tissue
Provides clues to the pts level of hydration
- normal / abnormal
- petechiae and ecchymosis
- Reddish purple hemorrhagic spots
- smaller than 0.5 mm in diameter
Bruise that changes color from blue black to greenish brown or yellow over time
- raised less than 1 cm in diameter due to superifical thickening in the epidermis
Normal nail characteristics
- slightly convex
- firm base
What should you assess when examining a patients nails?
- any abnormalities
- Transverse depressions in the nails
- could indicate systemic illnesses or nail injury
- Inflammation of the skin at e base of the nail
- could indicate local infection or trauma
Three common types of skin biopsies
Uses a small round cutting instrument to cut a cylinder shaped plug of tissue for a full thickness specimen
Removes just the area that has risen above the rest of the skin
Performed with a scalpel to make a deep incision and almost always requires sutures for closure
What is the most uncomfortable part of a biopsy procedure?
the injection of local anesthesia
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)
What test should be performed when allergic contact dermatitis is suspected?
Patch and scratch tests
performed by dermatologist on uninvolved skin
What is the purpose of wet dressings?
- Decrease inflammation
- cleanse and dry a wound
- continue drainage
How long should wet dressings be perscribed and why?
No longer than 72 hours because the skin may be too dry or macerated
When would you avoid using a topical powder?
Powders would be avoided for pts with respiratory disease or tracheostomies
What can an overuse of topical steroids cause?
Thinning of the skin
How long should plastic wrap dressings be applied?
For no longer than 12 hours a day
How should skin tears be covered?
With a non-adherent dressing such as xeroform and wrapped with gauze
When collecting a wound culture, what should you not swab?
Do not swab over the eschar (scabby black part)
What are the two layers of the skin?
T or F: the skin is an organ
what is the innermost layer of the skin?
What happens in the stratum germinativum?
- Production of new epidermal cells
- production of the protein keratin
function of keratin
- Prevents dehydration
- prevents the entry of pathogens
What is the outermost layer of the epidermis?
what is the function of melanin?
- Genetic characteristic that gives color to skin and eyes
- production increases when skin is exposed to UV rays
What is langerhan's cells?
Macrophages that destroy pathogens that enter the epidermis
why do we need some uv rays?
enables the formation of vitamin d from cholesterol
What do fibroblast cells produce?
the Protein fibers: collagen and elastin
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
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
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
- 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
- May result from liver disease
- check the sclera of the eye
Blush discoloration may indicate a cardiac pulmonary or perfusion problem
assess lips, nailbeds, conjunctivae, and palms
Erythema in dark skin pts
Shows as purpleish gray color
thickening and hardening of skin due to fibrotic changes following healing of a wound or surgical incision
Abnormal nail features
- Clubbing - hypoxia
- spoon /concave - anemia
- thick - fungal
A scab formed by dry serum, pus, or blood
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