Med Surg Ch 54 & 55

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Author:
kaitierowe
ID:
207229
Filename:
Med Surg Ch 54 & 55
Updated:
2013-04-02 11:11:28
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Med Surg 54 55
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Description:
Skin disorders and burns
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  1. Dermatitis
    • Inflammation of the skin
    • characterized by itching, redness, and skin lesions with various borders and distribution patterns
  2. Preventing dry skin
    Lubricate with creams, oils, or ointments as appropriate
  3. How is skin protected?
    • Lightly patting dry
    • avoid friction
    • avoid hot water
    • use sunscreen when outdoors
  4. Its is important to teach pts that when applying a topical medication..
    More is not better!
  5. Why is topical administration preferred over systemic steroids?
    Systemic steroids can cause serious side effects including adrenal suppression
  6. What can be used to suppress dermatitis and how are they administered?
    • Steroids such as hydrocortisone and methylprednisolone
    • administered topical, intralesional, or systemic agent
  7. Define psoriasis
    Chronic inflammatory skin disorder in which the epidermal cells proliferate abnormally fast
  8. What is the average age of onset psoriasis?
    • Average is 27
    • can begin at any age
    • condition can be severe if onset is in childhood
  9. Characteristics of psoriasis
    Characterized by exacerbations and remisions
  10. aggravating factors of psoriasis
    • Streptococcal pharyngitis
    • emotional upset
    • stress
    • hormonal changes
    • cold weather
    • skin trauma
    • smoking
    • alcohol
    • certain drugs
  11. Prevention of psoriasis
    Avoidance of upper respiratory infections, especially streptococcal infections
  12. Complications of psoriasis
    • Psoriatic arthritis may develop
    • severe- fever, chills, increased cardiac output, and benign lymphadenopathy
  13. Psoriasis is an inflammatory skin disorder that is characterized by which underlying pathology?
    Epidermal proliferation
  14. What information is most important for the nurse to teach patients about avoiding malignant skin lesions?
    Avoid overexposure to ultraviolet rays
  15. What action by the nurse is appropriate when caring for a pt with dermatitis?
    Apply gloves to the hands at night
  16. What factors may contribute to a pts skin breakdown other than not being turn and positioned?
    • Pt commonly slides down the chair
    • pt sits in the chair most of the day
    • pt is often diaphoretic
    • pt is incontinent of urine and stool
  17. What instruction should the nurse provide to a Pt who is being treated for scabies?
    Wash linens, towels, and clothes
  18. A pt diagnosed with impetigo contagiosa wants to know when the disease will no longer be contagious. What will the best response be?
    When all lesions are healed
  19. When does shearing occur?
    When pt slides down in bed when the head of the bed is raised, or when being pulled or repositioned without being lifted with the sheets
  20. How do you prevent pressure ulcers?
    • examine and document condition of the skin daily
    • pat the skin dry rather than rubbing it try
    • moisturize
    • avoid massage bony promises or reddened skin areas
    • teach pt to shift their weight every 15 minutes
    • turn and reposition q 2 hr
    • avoid elevating the head more than 30 degrees
    • elevate heels off the bed with pillows places lengthwise under the calf
    • prevent malnutrition and dehydrating by ensuring an adequate intake of protein, calories, and fluidĀ  (2500 mL of fluid each day)
  21. What is the first sign and symptom of a pressure ulcer?
    begins with a reddened area, usually over a bony prominence, that does not blanch with pressure
  22. If a pt comes into a health care facility, what precautions should you take to "cyoa"
    take photographs and document all pressure ulcers present
  23. Describe the three-color pressure ulcer system
    • Black wounds - necrosis
    • yellow wounds - have exudate and may be infected
    • red wound - pink or red, healing stage
  24. When treating a pressure ulcer, which color should you treat first?
    black
  25. The removal of dead or nonviable tissue from a wound to help clean up the wound and facilitate formation of granulation tissue
    debridement
  26. Types of debridement
    • Mechanical
    • Enzymatic
    • Autolytic
    • Surgical
  27. Removal of devitalized tissue, slough, or thick, adherent eschar with a scalpel, scissors, or other sharp instrument
    Surgical debridement

    • may be in operating room or pt room
    • grafting may be required
  28. How is the stage of a pressure ulcer decided?
    It is based on the depth of tissue destroyed
  29. Describe stage I of a pressure ulcer
    • skin is intact
    • area is red but does not blanch
    • difficult to detect in a dark skinned person
  30. Describe Stage 2 of a pressure ulcer
    • break within the skin
    • partial thickness skin loss of epidermis, dermis, or both
    • may appear as an abrasion or blister
  31. Describe stage 3 of a pressure ulcer
    • full thickness skin loss, extends to subcutaneous fat but not dascia
    • deep crater
    • bone,tendon, and muscle are not visible
  32. Describe stage 4 of a pressure ulcer
    • full-thickness skin loss with exposed muscle, bone, or support structures such as tendons
    • slough or eschar may be present
    • undermining and tunneling
  33. Serosanguineous exudate
    fluid consisting of serum or blood
  34. Purulent fluid
    • contains mus
    • varies in color and odors
  35. Creamy yellow pus may indicate
    staphylococcus
  36. Beige pus that has a fishy odor may indicate
    proteus
  37. green blue pus with a fruity odor may indicate
    pseudomonas
  38. Brown pus with a decal odor may suggest
    bacteroides
  39. Granulation has what kind of appearance and texture if healthy?
    • budding appearance from the development of tiny new capillaries
    • spongy texture
  40. PUVA therapy
    • treats psoriasis
    • when oral psoralen tablets are followed by exposure to UVA
    • temporarily inhibits DNA synthesis

    pt must wear dark glasses during treatment and for the entire day after treatment

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