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A non-infectious, hereditary, chronic, proliferative disease involving the epidermis and can be mild or severe.
Psoriasis
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Whats the treatment for psoriasis?
- Steroids-tar preparation to decrease inflammation
- Duvonex and Tazoric-cause upper cells to slough off faster so you dont get the build up
- Light therapy-helps slow down psoriasis
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What are the 4 stages of pressure ulcers?
- 1) Redness, nonblanchable intact skin
- 2) Shallow crater, pink or red base
- 3) into subq tissue, has lip or an edge, drainage
- 4) deep into the muscle or bone
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How do you prevent pressure ulcers?
- reposition every 2 hrs
- use aids that minimize pressure w/o restricting circulation or creating pressure on surrounding areas
- gentle handling is required
- use mechanical lifts as assistant devices
- remove urine/feces immediately-washing and patting the skin dry
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What is the treatment of pressure ulcers?
- well balanced diet with attention to protein, vitamins and minerals
- practice surgical asepsis when caring for a client to prevent secondary infection
- monitor I/O, keep pt hydrated
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What are the functions of the skin?
- synthesize vit D
- protect organs against pathogens
- excretion of fluids and waste
- regulate body temp
- detect sensation of touch, heat, and pain
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The outer layer of teh skin, contains melanin and sloughs off.
epidermis
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Inner layer of the skin thats made up of elastic fibers and has hair follicles
dermis
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Layer of the skin stores triglycerides, provides heat and cushioning
subq layer (fat)
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Modifiable dead tissue and accessory organ
hair
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Made of keratin and an accessory organ
nail
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Secretes sweat everywhere except hands/feet-odorless and is an accessory organ
sweat glands
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Secreted through hair follicles that keep skin from drying out and is an accessory organ
sebum oil
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Nutrients that the skin requires
Vit D, E, A, K and protien
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Redness of the skin caused by dialtion of the cappillaries and often a sign of inflammation or infection
erythema
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Break in the skin surface usually covered in blood or serous fluid. Also known as a "scratch mark"
excoriation
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Drainage of fluid rich in protein and cellular elements that oozes out of blood vessels
exudate
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Type of skin cancer that is vicious and spreads fast, most deadly and has ability to metastasize to any organ.
melanoma
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How do you prevent melanoma
- limite exposure to sun-stay inside certain times of day
- use sunblock-SPF 30 or greater
- wear hat, long sleeves
- avoid deoderant soap, antibacterial soap and cosmetics (all 3 bad for skin)
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Localized collection of pus anywhere on the body caused by any type of an infection
abscess
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closed pocket of tissue with all sorts of stuff like air, fluid tissue filled, fat filled caused from a clogging of the sebacous glands
cysts
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small, flat, distinctly colored area of skin (freckle) less than 10mm around
macule
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skin lesion that is generally small, solid and raised (ex:wart)
papule
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long narrow opening of cracked dry skin (ex: athletes foot)
fissure
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elevated, firm, and rough lesion with a flat top surface greater than 1cm in diameter (ex: psoriases, cradle cap)
plaque
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elevated superficial lesion, similar to a vesicle but filled with purulent fluid (ex: impetgo, acne)
pustules
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elevated, circumscribed, superficial, not into the dermis, filled with serous fluid, less than 1 cm in diameter (ex: varicella, herpes zoster)
vesicle
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vesicle greater than 1cm in diamter (ex: blister)
bulla
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loss of epidermis and dermis, concave, varies in size (ex: pressure sores)
ulcer
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hardening of tissue thats raised above skin level and known as TB
induration
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what are the 4 types of biopsies
- punch biopsy-punch piece of skin out of body
- excisional biopsy-cutting a piece of skin off the body
- incisional biopsy-go inside the body and take a piece out
- shave biopsy-shave a piece of skin off body
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what are some nursing interventions for biospies?
- need informed consent
- pre-cleanse the site as prescribed
- assist during the procedure
- label all specimens
- dress the site per order
- watch for drainage, bleeding and infection
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When starting a pt on antibiotics, when should you get a skin culture?
before starting antibiotic
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scraping of the sore and put under a slide to determine if its chicken pox or herpes
Tzanck test
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used to identify certain things under the skin using an ultraviolet light in the dark that will make the lesion glow and help identify what it is
woods light
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used for fungal infections by scraping the infection off of the nail and then dropping potassium hydroxide on it to show if its fungal
Kott test
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puncturing the skin
allergy testing
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what the ABCDE of moles?
- A=Assymmetry of the lession
- B=Border irregularity
- C=Color variation
- D=Diameter, if greater than 6mm needs dr to look at
- E=elevated and enlarged
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Treatment for herpes simplex 1 and 2
- no cure
- can use anti-viral med "acyclovir"
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education on herpes simplex 1 and 2
- no cure-painful
- type 1: fever, blister-above the waist
- type 2: blister below the waist (most common in women), seen on vulva and cervix, reoccurs more than type 1
- both types are contagious and spread by direct contact with open lesion
- dont have unprotected sex/oral sex if have cold sore above/below waist
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treatment of impetigo
- antibiotics-erythromycin, cephalosporins, topical antibiotic, steroids
- wash rash with antiseptic soap
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education on impetigo
- contagious until 48 hrs after med is applied
- highly contagious
- most important:WASH HANDS
- use seperate towels, washclothes, etc.
- wash clothes, & linens in HOT water
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treatment for tinea
antifungal meds-creams, powders, lotion, oral meds, topical "tinactin" (OTC), "griseofulvin"
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education on tinea
- apply topicals 2x per day, washing and drying area thoroughly before applying
- hand washing is important
- clothing washed/dryed well
- wash feet thoroughly-apply clean cotton socks
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treatment for contact dermatitis
- antihistamines and steroids
- possible allergy testing
- use burrows solution-drys out rash
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education on contact dermatitis
- cause could be detergents, plants, flowers
- terapeutic baths
- wash clothes
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treatment for lice
antiparasitic (Rid or Nix)
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education on lice
- after treating, must retreat entire family 2 weeks later
- hot soapy water for all linens/clothing, and hot dry
- stuffed animals should be put in garbage bag and sealed for 1 month
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what is the causitive agent of herpes zoster (shingles)
chickenpox
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what are the symptoms of herpes zoster (shingles)
- painfulo burning sensation
- itchy
- usually occurs on 1 side of the body
- causes flu-like symptoms
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treatment for herpes zoster
- analgesics for pain (narcotic strength)
- antihistamines (topical or oral)
- keep clear
- contact isolation
- zostrex cream or IV/oral acyclovir
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What type of isolation requires mask, private room, usually for pts with dipthoria, meningitis, or flu
droplet isolation
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What type of isolation requires mask, gown, gloves, shoe covers and dont want to carry anything into them ex: aids, leukemia
immune compromised/reversed isolation
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Signs and Symptoms of scabies
- greyish lines on the hands
- itching, vesicles, lesions and crust
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education on scabies
- caused by a mite
- contagious-spread by direct contact
- usually affects the whole family
- female mite burrows into skin laying eggs
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treatment for scabies
- topical medication: elimite/scaben cream (stays on 12-24 hrs)
- treat whole family-may need more than 1 treatment
- must wash everything
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signs and symptoms of eczema
- causes red crusty layers
- may be result of an allergic reaction
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treatment of eczema
- antihistamines
- steroids
- topical corticosteroids
- tar compound (acts as a inflammatory)
- Elidel cream
- Treat symptoms:
- dry skin makes it worse
- dont wash with soap everyday
- use moisturizer
- avoid extreme temp change
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signs and symptoms of latex allergies
- redness
- itching
- allergies
- bronchospasms
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treatment of latex allergies
- administer prophylactic treatment with steroids and antihistamines preoperatively
- use latex-free pharmaceutical measures to prepare the patients medication
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failure to distinguish "self" protein from "foreign" protein
autoimmune disorders
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removal of plasma that contains components causing, or thought to cause disease
plasmapheresis
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examples of autoimmune illnesses
- diabetes
- addisons
- rheumatoid arthritis
- glomerulonephritis
- thromocytopenic
- guillan barre syndrome
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allograft
from one species to another of the SAME species
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isograft
between identical twins (monozygotic)
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exograft/heterograft
animal to human
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what does RACE stand for
- R=Rescue
- A=Alert
- C=Contain
- E=Evacuate
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type of acquired immunity and an example of one
Adaptive, ex: vaccinations
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when the immune system is not doing its job
immune compromised
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being insusceptible or uneffected by a particular disease
immunity
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to hurry up and protect against acute, rapidly developing infection mediated by B-cells and produced antidbodies and an example
- humural immunity
- ex: 2nd exposure to a disease you have already had (chicken pox)
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body forms antibodies against the disease and an example
- active immunity
- ex: chicken pox
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newborns recieve this immunity from their mother and only lasts a certain amount of time
passive immunity
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what types of cells produce antibodies
B lymphocytes (B cells)
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whats the purpose of hydrotherapy
to soften the eschar with water to make removal less painful
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what is black leathery crust that the body forms over burned tissue, and what is often done to relieve the circulatory constriction
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what procedure goes deeper than escharotomy to prevent internal compartment syndrome
faciotomy
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priority interventions in the emergent phase of burns
- watch airway
- edema, external and internal
- assess decreased B/P
- fluids to shift to burns
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priority interventions in the intermediate/acute phase of burns
watch for fluid overload
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priority interventions in the long term rehabilitation phase for burns
- pain control
- watch for secondary infections
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whats the nutrition for HIV and AIDS
high calorie and high protein
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what should you watch for with a transfusion reaction
- change of greater than 2 degrees in temp
- flank pain, fever, blood in urine
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how do you prevent transfusion reactions
- 6 checks on blood (2x at bank, 2x at nurse station, 2x by patient)
- monitor for 1st 15 min after administration
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why are electrical burns so dangerous
they have a current that burns internally and externally, following the whole path, and interferes wtih the electrical current of the heart
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what is caused by normally non-pathogenic organisms and give examples
- oppurtunistic
- ex: PCP, thrush, herpes
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signs and symptoms of analphylactic reaction
- drop in B/P
- laryngal edema
- bronchospasm
- cardiovascular collapse
- MI
- respiratory failure
- swelling of face
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treatment of analphylactic reaction
- ABC
- give epinephrine-15 min intervals of bendryl
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interventions for analphylactic reactions
- educate
- medical alert bracelet
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Rule of 9s (burns)
- front leg=9%
- back leg=9%
- head and neck=9%
- anterior trunk=18%
- posterior trunk=18%
- front of arm=4.5%
- back of arm=4.5%
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3 types of skin cancer
- melanoma
- basal cell carcinoma
- squamos cell carcinoma
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type of cancer that can metastaize quickly via lymphatic system, early detection important. It is a firm, nodular lesion topped with a crust or cental area of ulceration and indurated margins
squamous cell carcinoma
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type of skin cancer that rarely metastasizes, may appear as a pearly papule with a central crater and waxy pearly border. Related to frequent contact with certain chemicals, overexposure to sun, and radiation treatment
basal cell carcinoma
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side effects of antihistamines
- drowsiness
- dizziness
- confusion
- dry mouth
- urinary retention
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side effects of steroids
- increase in appetite
- difficulty sleeping (insomnia)
- changes in mood and behavior
- flushing (redness) of the face
- short-term weight gain due to increased water retention
- increase in their blood sugar readings
- elevated B/P
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