Lecture test 4

• Protection
• sensation
• fluid balance
• temperature regulation
• vitamin D production
• immune response

• Thinning of skin
• uneven pigmentation
• wrinkling, skin folds, and decreased elasticity
• dry skin
• diminished hair
• increased fragility and increased potential for injury
• reduced healing ability

Initial lesion, characteristic of disease itself

• I Erythema, does not blanch with pressure, skin temp elevated
• II Skin breaks, abrasion, blister or shallow crater, edema persists, ulcer drains, partial-thickness wound
• III Ulcer extends into sc tissue, necrosis/drainage, full thickness
• IV Ulcer extends into underlying muscle and bone, deep pockets of infection develop, necrosis/drainage, full-thickness
• V DTI (deep tissue injury localized area discolored, purple, intact skin, or bloodfilled blister. d/t underlying soft tissue damage from pressure ulcer or shear. May evolve rapidly, & immediate

Mobility- changes in bone remodeling lead to decreased bone density, loss of muscle mass, deterioration of muscle fibers and cell membranes, leads to degeneration in the function and efficiency of joints

sun injury

Skin biopsy

HIV

• systemic illness
• multiple medications
• occult malignancies

• Exposure to overly warm environment
• Ingestion of alcohol or hot foods and liquids
• Avoid activities that result in perspiration
• Maintain the room cool and humidified
• Avoid vigorous scratching
• Trim nails to prevent skin damage and infection

Impetigo

Herpes zoster- shingles

• Cysts
• Keratoses
• Warts
• Angiomas
• Moles
• Keloids
• Dermatofibroma
• Neurofibromatosis : Von Recklinghausen's Disease

• Impaired tissue integrity
• Deficient fluid volume and electrolyte losses
• risk for imbalanced body temp
• Acute pain
• Anxiety
• deficient knowledge

TEN Toxic Epidermal Necrolysis

• Impaired tissue integrity (oral, eye and skin) r/t epidermal shedding
• Deficient fluid volume and electrolye losses r/t loss of fluids from denuded skin
• Risk for imbalanced body temp (hypothermia) r/t heat loss
• Acute pain r/t denuded skin, oral lesions and possible infection
• Anxiety r/t physical appearance of the skin and prognosis

• ABCD's
• A-asymmetry
• B-Irregular border
• C- Variegated color
• D-Diameter

• Skin grafts
• Classification:
• Autografts
• Allografts
• Xenografts

• Impaired vision imparied from shortened or elongated eyeball that prevents light rays from focusing sharply on the retina
• Blurred vision occurs- corrected with glasses or contact lenses

Blindness

• Physical
• Emotional
• Social

• Family history of glaucoma
• Thin Cornea
• Afraican American Race
• Older age
• DM
• CV disease
• Migrane syndromes
• Nearsightness (myopia)
• Eye trauma
• Prolonged use of topical or systempic corticosteroids

Bacterial conjuctivitis

• Speech
• Fatigue
• Indifference
• social Withdrawl
• Insecurity
• Indecision and procrastination
• Suspiciousness
• False pride
• Lonliness and unhappiness
• Tendency to dominate the conversation

• Age- Younger than 12 months
• Chronic URI
• medical conditions predisposing to ear infections (down syndrome, cystic fibrosis, cleft palate)
• Chroni exposure to secondhand smoke

Menire's disease

• Tympanoplasty 
• Purpose- to reestablish middle ear function, close perforation, prevent recurrent infection and improve hearing

• Inflammation of the inner ear
• Can be bacterial or viral in origin
• Bacterial-rare d/t antibiotic therapy
• Viral ism ost common dx, little known about this (affects hearing and balance)

hypothalamus and pituitary gland

graafian follice

fatigue, low back pain, painful breases, and feeling of abd fullness. irritability, fear of losing control, binge eating and crying spells

Painful menstruation, occurs at time of menarche or shortly after. crampy pain begins before or shortly after onset of flow. Pelvic exam normal. Result from excessive production of prostaglandins, causing painful contraction of uterus and arteriolar vasospasm. secondary dysmennorrhea, pelvic path endometriosis, tumor, or PID

Absence of menstrual flow

young women older than 16y have not begun to mestruate with evidence of sexual maturation, or young women who have not begun to show development by 14y

Abscence for 3 cycles or 6 months after normal menarche. Caused  by pregnancy, emotional upset, eating disorder or excessive exercise.  (obesity, anorexia and bulimia can all affect this)

prolonged or excessive bleeding at time of reg. flow. Young women- endocrine disturbance- later in live inflammatory disturbances, tumors of uterus or hormonal imbalance.

Vaginal bleeding between reg menstrual periods- may be a sign of cancer, benign tumors of uterus, or other gynecologic problems

Bleeding 1 year after menses cease at menopause must be investigated. r/o malignant condition (assumed until proven otherwise)

• Atrophy of breast tissue and genital organs
• Loss in bone density
• Vascular changes

5-10

AMD (macular degeneration) no cure.

20/200

Loss of peripheral vision

• age
• Presbyopia
• Cataracts
• Glaucoma
• Diabetic retinopathy
• Macular degeneration
• Eye infection, inflammation, or injury
• Brain tumor

Double vision

an ophthalmoscope is used to examine the back part of the eye (fundus), including the retina, optic disc, macula, and blood vessels

used to measure the intraocular pressure (normal is 10-21 mmHg) elevated with glaucoma, especially angle-closure glaucoma

• Age
• DM
• Heredity
• Smoking
• Trauma
• Excessive sun exposure
• Chronic corticosteroid use

Seeing dark spots

some possible causes of the client's reduced vision including cataracts, glaucoma, and terinopathy. presbyopia causes decreased vision during the 5th decade of life

• Wear sunglasses outside
• Do not engage in sexual intercourse until your provider has verified that your eye has healed
• Manage eye pain with acetaminophen
• Take a stool softener to prevent constipation

eating

Occurs when there is an alteration in the middle ear and sound waves are blocked before reaching the inner ear

occurs when there is an alteration in the inner ear that involves cranial nerve VIII and/or cochlear damage

• Hearing loss
• Tinnitus
• Dizziness or vertigo

• Vomiting
• Nystagmus
• Poor balance

Observe the client for dizziness when ambulating

at age 21 or within 3 years of becoming sexually active, until age 30, if all negative, every 2-3 years

Atypical squamous cells of undetermined significance (considered mildly abnormal)

Atypical squamous cells of which high-grade squamous intrapithelial lesions cannot be excluded (indicates high risk of being precancerous)

low-grade squamous intrepithelial lesion (indicates mild abnormality that demonstrates early changes in shape and size of squamous cells)

high-grade squamous intraepithelial lesion (indicates a more sever abnormality in size and shape of cells that can progress to invasive cancer)

indicates the presence of precancerous cells in the glandular tissue

Syphilis

a protrusion of the posterior bladder through the posterior vaginal wall. it is caused by weakened pelvic muscles and/or structures

a protrusion of the anterior rectal wall through the posterior vaginal wall. It is called by a defect of the pelvic structures, a difficult delivery, or a forceps delivery

• Urinary frequency and/or urgency
• Stress incontinence
• Report of frequent UTI's
• Sense of vaginal fullness

• Constipation
• Sensation of a mass in the vagina
• Pelvic pressure or pain
• Pain with intercourse
• Pain the back or pelvis

• Early sexual activity (before 18)
• Client and/or male partner has had multiple sexual partners
• Male partner who had a female partner with cervical cancer
• Low economic status
• Family history of cervical cancer
• African American
• Chronic cervical inflammation/infections
• Infection with HPV, which is associated with 90% of cases
• history of STD's
• Infection with HIV or other immunosuppressive disorders
• Cigarette smoking
• Intrauterine exposure to diethylstilbestrol during pregnancy

• Painless vaginal bleeding between periods
• Water, blood-tinged vaginal discharge
• Unexplained weight loss
• Pelvic pain
• Pain during and after intercourse

• Over 55 years
• Obesity
• Unopposed estrogen hormone replacement therapy
• Nulliparity
• Use of tamoxifen to prevent breast cancer
• Late menopause

• over 40 years of age
• nulliparity or first pregnancy after 30 years
• Family history of ovarian, breast, or colon cancer
• History of dysmenorrhea or heavy bleeding
• Endometriosis
• High-fat diet (possible risk)
• Hormone replacement therapy
• Use of infertility medications
• Older adult clients following surgery for cancer

• Abdominal pain or swelling
• Abdominal discomfort (dyspepsia, ingigestion, gas, distention)
• Abdominal mass
• urinary frequency

• Perform exercises at least 4 times a day
• Hold the contraction for 6-10 seconds
• Perform exercises in, lying, sitting and standing positions
• Tighten pelvic muscles for a count of 10

Do not engage in intercourse for at least 6 weeks

oscillating mov't of the eyeball

blind areas in the visual field

Anaphylactic reaction characterized by vasodilation, increased capillary permeability, smooth muscle contraction, and eosinophilia. may include laryngeal stridor, angieoedema, hypotension, and bronchial, GI or uterine spasms, or hives. extrinsic asthma, allergic rhinitis, systemic anaphylaxis.

cytotoxic reaction, involves binding either IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. Examples- myasthenia gravis, goodpasture's syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction and thrombocytopenia.

Reaction is marked by acute inflammation resulting from formation and deposition of the immune complexes. The joints and kidneys are susceptible to this king of reaction which is assoc. with lupus, erythemotosus, serum sickness, nephritis, and RA. S/S urticartia, joint pain, fever, rash and adenopathy (swollen glands)

A delayed, or cellular reaction occurs 1-3 days after exposure to an antigen, results in tissue damage, involves activity by lymphokines, macrophages and lysozymes. Erythema and itching are common. Contact dermatitis, graft-versus-host disease, hashimoto's thyroiditis, and sarcoidosis

• Epicutaneous- scratch or prick test
• intradermal

the direct admin of the suspected allergen to the sensitive tissue, such as the conjuctiva, nasal or bronchial mucosa, or gastrointestanal tract (by ingestion) with observation

RAST is a radioimmunoassay that measures allergen specific IfE. A sample of the pt's serum is exposed to a variety of suspected allergen particle complexes. Values 2+ are considered significant.

infectious agents (bacteria, fungi, mycoplasma, or other conditions, urethral stricture, benign prostatic hyperplasia. E. Coli is the most commonly isolate organism.

• actue bacterial prosatitis- type I
• chronic bacterial prostatitis- type II
• Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)- type III
• asymptomatic inflammatory prostatitis -type IV
• Type III occurs in more than 90% of cases

sudden onset of fever, dysuria, perineal prostatic pain and severe lower urinary tract symptoms: dysuria, frequency, urgency, hesitancy and nocturia

ultrasound- transillumination, hydrocele transmits light, hernias do not

phimosis

blood tests for AFP and beta-hCG. Inguinal orchiectomy is the standard way to establish the diagnosis of testicular cancer. Other staging tests to determine the extent of the disease in the retroperitoneum, pelvis, and chest include CT scans.

monitor pts response to poss. effects, of surgery, chemo, and radiation.

patients may be required to endure a long course of therapy and will need encouragement. educate about the importance of adhering to follow up appointments. Quit smoking, limit alcohol, healthy diet, most couples should use birth control for 18-24 months after chemo

Erectile dysfunction-psychogenic causes- anxiety, fatigue, depression, pressure to perform, negative body image, absence of desire, privacy and trust and relationship issues, organic causes- CVD, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism and hypothyroidism), cirrhosis, chronic renal failure, ....

benign prostatic hyperplasia (enlarged prostate) may lead to lower urinary tract symptoms, s/s frequency, urgency, nocturia, hesitancy in starting urination, decreased and intermittent force of stream and sensation of implete bladder emptying, abdominal straining with urination a decrease in volume of urine, recurrent UTI's

fatigue, anorexia, nausea, vomiting, and pelvic discomfort

occurs anywhere on the body and is the most common form of melanoma. usually on the trunk and lower extremities. Lesions tend to be circular, with irregular outer portions. may be flat or elevated and palaple

slowly evolving, pigmented lesion that occurs on exposed skin areas, especially the dorsum of the hand, the head and the neck

accounts for 1% of diagnosed breast cancer. Symptoms usually include scaly, erythematous, pruritic lesion of the nipple. Often represents ductal carcinoma in situ of the nipple but may have an invasive component. Prognosis favorable

5-7 days after menses begin for premenopausal women and once monthly for postmenopausal women

Common fungal infection- ringworm

the lesion is cleand and a scapel or glass slide is used to remove scales from the margin of the lesion

Contagious fungal infection of the hair shaft- common in children, oval, scaling, erythematous patches, brittle hair that breaks easily

body- begins with a red macule, which spreads to a ring of papules or vesicles with central clearing, found in clusters. Very pruritic- pets may be the source.

(groin, jock itch) begins w/ small, red scaling patches, which spread to form circular elevated plaques. Very pruritic, clusters of pustules may be seen around borders

athlete's foot- soles of one or both feet have scaling and mild rewdness with maceration in toe webs. More acute infections may have clusters of clear vesicles on dusky base

(toenails, affects about 50% of adults) nails thicken, crumble easily, lack of luster. Whole nail may be destroyed.

• Erosion
• Ulcer
• Fissure
• Scales
• Crust
• scar
• keloid
• atrophy
• lichenification

Loss of superficial epidermis that does not extend to dermis; depressed, moist area, ruptured vesicles, scratch marks

Skin loss extending past epidermis; necrotic tissue loss, bleeding and scarring possible- stasis ulcer of venous insufficency, pressure ulcer

Linear crack in the skin that may extend to dermis- chapped lips or hands, athletes foot

scales

Crust

hypertrophied scar tissue secondary to excessive collagen formation during healing

atrophy

lichenification

scabies

swimmers ear- trauma to the skin and ear canal allowing infection, bacterial and fungal.

fever, cellulitis, lumphadenopathy- discharge of a yellow or green and foul smelling. in fungal infections, hairlike black spores may be visible

associated with sensory- hearing and equilibrium

vertigo

Nystagmus