Beruflich Dokumente
Kultur Dokumente
October13,2014
DefineEcchymosis=abruise,traumacausesbleedingundertheskin&
turnsitbluecolored
Methodforcheckingskinturgor:Pinchafoldofskinthenreleaseit,
watchinghowlongittakestheskintoreturntoitsnaturalshape.Skinturgorshouldbe
nearlyimmediateforayoungerpersonbutitdeclineswithAging.Ifittakesmorethan3
secondstoreturn,thePTmaybedehydrated.
FunctionsofSubcutaneousTissueorfattylayerare:
Connectdermis&epidermistotheunderlyingorgans
Helpscushioninternalorgans
Helpsinsulatethebody
Formsandstoresfatcells(lipocytes)
SkinLesions:
Type
Size
Fluid
Description
Examples
Macule
Patch
<1cm
None
Flat,nonpalpableskincolorchange;roundborder
Freckles,flatmoles,petechial
>1cm
None
Flatskincolorchange;IRREGULARBorder
Portwinestain,ecchymosis(bruise)
Vesicle
Bulla
<1cm
Serous
Small,Elevated,palpablemassw/fluid
Herpessimplex,chickenpox,burns
>1cm
Serous
Larger,Elevated,palpablemassw/fluid
Pemphigus,contactdermititus,poisonivy,largeblister
Papule
<1cm
Serous
Small,Elevated,palpablesolidmassw/roundborder
Elevatednevi(mole);warts,crustedpapuleswithflattop
Plaque
>1cm
Serous
Larger,Elevated,palpablesolidmass
Psoriasis
Pustule
small
Pus
Pusfilledvesicleorbullaontoplayerofskinorbeneathindermis(ofteninsweatglandsorhair
follicles)
Acne,Impetigo,Furuncles&Carbuncles
Petechiae
<3mm
Purpura
Smallredorpurplespotsonskin(hematoma)causedbybleedingunderskin
minorhemorrhage,usuallyfromphysicaltrauma
<1cm
Redorpurplediscolorationsonskinthatdonotblanchcausedbybleedingunderskin
Typhus,meningitis,plateletdisorder
Ecchymosis
>1cm
BruiseLargeredspot(hematoma)causedbybleedingunderskin
Bruise,blackeye,hemophilia
HeatLossfromhumanbody:
Type
Characteristics
Examples
Convection
Disseminationofheatbymotiontransfersheatfromskintothesurroundingair
Fancanmovewarmairawayfromtheskinssurface
Evaporation
Conversionoffluidtovapor
Perspirationisvaporizedfromtheskin,whichcausesacoolingeffect,loweringbody
temperature
Radiation
Diffusionofheatinelectromagneticwaves
Thebodygivesoffwavesofheatfromuncoveredsurfaces
Conduction
Transferofheattoanotherobjectduringdirectcontact
Anicepacktransferscoldtothebody,loweringthetemp.oftheskin.
Explainthefunctionofthearteriolesinthedermis:
Arteriolescirculatebloodtotheskin,bringingoxygenandnutrientstothedermislayer.The
epidermisdoesnthaveanybloodvessels,sooxygenandnutrientsarepassedupwardfrom
thedermisbydiffusion(spreadingoftheblood,oxygenandnutrients).
EffectsofAgingontheIntegumentarySystem:
Melaninislostorclusters
Liverspotsappear
Whitespots(vitiligo)appear
EpidermisandDermisflatten
Capillarybedindermisbecomesmorefragilebloodoozesintodermis
Purpura(darkredpatches)andPetechiae(smallreddots)appearonskin
Lossofsensationandlossofabilities
Elderlymaynotdetectpressureulcers
Maybemoresusceptibletofalls
LossofElasticity
Wrinklesdevelopandtheskinbecomeslessresilient.
SkinTurgordeclines
Tentingonsomeareascangivefalsepositiveresult(slownessdoesntindicatedehydration,just
lossofskinelasticity)
Fatlayerdecreases
Insulationoffatisreducedwhyolderpersonareoftenchilly
Dermallayerthins
Skinbecomestransparent
Lossofbodyhair
Scalpandpubichairthins
Hairmaythickeninnose,earsandeyebrows
Femalehormonesarelost
Womendevelopfacialhair(hirsutism)
Nailsgrowmoreslowlyandbecomethicker
Nails,especiallytoenails,becomethickandbrittle
Glandsinskindecreasesecretions
Lessperspiration,lessoilyskincauseskintobecomedry&scaly
Fatlayerdecreasesthermoregulation
Moresusceptibletoheatstrokeandchilling
Circulationreduces
Woundhealingtakeslongeroldordamagedcellsarenotreadilyreplaced
LiverSpotsandtheircause:Liverspotsaremaculeswheretheskin
changescolortobrownorblackduetothepersonagingtypicallytheystartappearing
afterage40.Usuallyareonbacksofhands,face,forearms,foreheadandshouldersfrom
exposuretosunorotherultravioletrays.
LayersoftheSkin:
Epidermis
Toplayerthin,waterproof,protectiveouterlayer.Nonervecellsnorbloodsupply
Onlylivingcellsareinlowestlayer(basalorgerminativum)
Livingcellspushupwardandreplaceouter,deadcells2to4weekcycle(desquamation)
ComposedofSqumousepitheliumin5layers/Stratum:
Corneum(toplayer)
Lucidum
Granulosum
Spinosum
Germinativum(basal/bottomlayer)
Melanocytescreatepigmentmelanin
Langerhanscellsdefendagainstinfectionandskinallergies
Dermis(akaCorium)
Thickerskinlayer,alllivecells.
Nourishes,cushions&protectsepidermis.
Twolayers:
Papillary(toplayer):containsblood&lymphvessels,nerveendingsand
glands.Madeupofelastictissue,collagen&fibrin
Reticular:thickerlayerattachedtosubcutaneous(akahypodermis/fat
layer)
Subcutaneous(notactuallypartoftheskin)
Layerbelowdermisattachedtoorgans
Formslipocytes;cushion,protects&insulatesorgans.
PTs
Someactions,whilecaringforaclient,thatcouldharmtheclientsskin:
Inadequatehydration
Inadequatenutrition
Insufficientmobilitydontturn,reposition,exerciseandambulate
Excessivefrictionandshearinge.g.notusingdrawsheetto
repositionPTs
Excessivepressurenotusingpillows&supportstructuresto
buffervulnerablebodyparts,bonyprominencessuchassacrum,hips,heelsand
elbows
Excessivemoistureinsufficientbriefchanges
Harshcleansingagents/toohotwater/excessivefriction
Nosocomialinfections:
swelling
Inadequatehandhygience
improperbriefchanges,
impropercareoflinens
impropercareofmedicalwaste
Notperformingregularassessmentofskinintegrity,skincolor&
WoodsLightExam:Useofspecial,highpressuremercurylampthat
produceslongwaveultraviolentraystodiagnoseabnormalpigmentanddetectfungal&
bacterialskininfections.
Tocollectaskin/woundspecimenforacultureandsensitivitytest.
MakesurePTisnottakingantibiotics
MaygivePTalocalanesthesiatonumbtheskinarea
Insertsterileswaborsterileneedleintowoundorsore
Turnswabgentlytocollectasmuchtissueand/orfluidaspossible
Placeswabinaerobicoranaerobicculturetube,dependingontype
oforganismsuspected
Waystocareforapatientwithacne:
TopicalAgents
OTCSalicylicacid&BenzoylPeroxide(antibacterial)
PrescriptionRetinA;Tetracyclinecream&Erythromycin
cream
Monitordryingofskin
Avoidapplicationtomucousmembranes,eyes,inflamed/
sunburnskin
Maycausebleachingofhairorclothing
SystemicAgentsTetracyclineorminocycline
Take1hourbeforemealsor2hoursafteranyfood,
especiallydairy&meat
Drinkplentyofwater
Mayinteractnegativelywithiron,lithiumandoral
contraceptives
Donottakewhenpregnantorlactatingmaypermanently
stainbabysteeth
Donotusewithkidneyorliverdysfunctions
Accutanehighlyrestricteduseduetodangeroussideeffects
Dermabasionorlaserresurfacingtosmoothskinaftersevere
scarring
Whatwouldyouteachtheclient?
Followskincareinstructionscarefully&patiently.Acne
takeslongtimetoclear.
Reviewsideeffects&instructionsforprescribedMeds,
especiallyAccutane
Inspectskinforanyadversereactions
Avoidpinchingorpickingatpimplescancause
inflammation,scarring&infection
Usegentlecleansingtoavoidfurtherskindamage
Usecleantowelwitheachwashing.
Shampoofrequently
Maintaingoodhealthpracticesbalancednutritionand
regularexercise
Maintaincarefulskincare,evenafteracnelesionshave
cleared
Cellulitisandhowitistreated:
Acute,spreadinginfectionofdermisorsubcutaneouslayers
TypicallybacterialinfectioninPTswithdiabetesordecreased
immunefunction
Mayfollowskindamage,suchasbiteorwound
Causesfever,erythemaandlymphangitis(infectionoflymph
vessels)
Maydevelopintothrombophlebitis
TREATMENT:
OralorIVantibiotic
Warmsoakstositetorelievepain&decreaseedema
PainMedasneeded
Elevateinfectedextremity
Surgicaldrainageordebridementifabscessforms
FourStagesofPressureUlcers
Stage 3, the sore gets worse and extends into the tissue
beneath the skin, forming a small crater. Fat may show in the sore, but not
muscle, tendon, or bone.
FungalDisorders:Fungusaffectsnonlivingkeratinskin
TineaCorporis:Skinfungalinfectiononbody
TineaCapitis:Skinfungalinfectiononhairandscalp
NursingDiagnosisforPTwithbeginningstageofapressureulcer:
PositionPToffaffectedreddenedarea
Initiateturningscheduleevery2hoursinbed;1hourinchair
Keepskinclean&dry;moisturize2xperday
Placeprotectivebarriercreamorhydrocolloidoverreddenedarea
Encourageadequatenutritionandhydration
Increasetissueperfusionbymassagingaroundaffectedarea
Limitchairsitting
Encourageambulation,ifpossible
TeachPThowtoandimportanceofshiftingweight
TypeofdietshouldbeencouragedforPTwithpressureulcer:
Highprotein
Highcalorie
Highfluids
VitaminAandCforimmunesystemandhealing
Zincsupplementforcollagenandimmunefunction
Whatyoushouldteachaclienttomaintainhealthyskin
Frequentandcarefulhandwashing
Protectskinfromsunexposureusesunscreen,avoiddirectsun
between10:00&4:00
Dontsmoke
Treatskingentlyavoidhotshowers/baths;avoidstrongsoaps;
shavecarefully;patdry;andmoisturizewithmoisturizerthatfitsyourskintype
Eathealthydietplentyoffruits,vegetable,wholegrains&lean
protein
Managestress
Exercisetoimprovecirculation
TzanckSmearDiagnosticusedforViralinfections
Gentlyrupturevesiclewithscapel
Gentlyscrapemushydebrisfrombaseofvesiclewithcurvedbelly
ofblade(dontusecottonswab)
Smeardebrisontosterilemicroscopeslide
Sample34vesicles,ifpossible
Undermicroscope,cellsarediagnosedforherpesvirusorvaricella
(chickenpox)
Care/TeachingofPatientfollowingskinbiopsy
AdministerNSAIDforpainandswelling
Carefullywashwoundwithsoap&water
Dryareaandputonnew,cleanbandages
Changebandagewhenitgetswetordirty
Monitorforfever
Monitorwoundsiteforabnormalities:
Yelloworgreendrainage
Redlinesextendingfromwound
Bloodsoaksthrubandage
Paindoesnotgoaway,evenwithanalgesics
Care/TeachingofPatientprescribedclotrimazole(Lotrimin)usedfor
fungalinfections,suchasathletesfoot(tineapedis),ringworm(tineacorporis)andjock
itch(tineacruris).
Holdlozengesinmouthandallowthemtodissolveslowly&
completely(1530mins)
Swallowsalivaduringthistime;donotcheworswallowthem
whole.
KeepusingClotrimazoleforfullprescribedtimeoftreatmenteven
ifsymptomsbegintoclearupafterafewdays.Ifyoustop,thesymptomsmay
return.
Avoidmissinganydoses.Ifyoudo,takeitassoonaspossible.
Donotdoubledose.
StoreClotrimazoleinclosedcontaineratroomtemp.Avoid
moisture,directsun&heat.
22.DiscusstheteachingfortheclientprescribedClotrimazole(Lotrimin)?
Clotrimazole(Lotrimin):AntifungalmedicationtotreatfungalinfectionssuchasTinea
Corpis/TineaCrurisandTineaPedis.
Teaching:(Topical)Cleananddryarebeforeapplying.Donotuseanydressings.Avoidcontact
witheyes,maystainclothing.ForAthletesFoot:changeshoesfrequentlyandusecottonsocks
daily.
23.Compareandcontrastpunchbiopsyandexcisionalbiopsy.
Bothareusedtoremoveasampleoftissue.Excisionbiopsyisdonewithascalpandpunch
biopsyisdonewithacircularbladeandgoesdowntothesubcutaneousfat.
24.Whatmedicationsareusedforpsoriasis?
Topicalcorticosteroidslikekenalog.
Tarpreparations(suppresscelldivisionsmaystainhairandskin)
Topicalepidermopoiesissuppressivemed.calcipotrien(dovonex),Tazarotene(tazorac).
Tazoracmaycausebirthdefects.Womenshouldusebirthcontrol.MonitorforHypercalemia.
Cytotoxicmedication(sever,intractablecases)Methotrexate(Trexall)contraindicatedin
pregnantwomen.
25.DiscussteachingfortheclientprescribedCalcipotrien(Dovonex).
Usedtotreatpsoriasis.(Topical)Reducesaccelerateddevelopmentofepidermalcells.Monitor
fors/sofHypercalemia(elevatedSerumCalcium,Muscleweakness,fatigue,andanorexia)
PatientTeaching:Avoidusingproductonfaceorskinfolds.Burningandstingingmayoccur
uponapplication.Donotuseproductwithcorticosteroids.
26.DiscusstheteachingfortheclientprescribedMethotrexate(Trexall).
Methotrexate(Trexall)isacytotoxicmedicationusedinsevereintractablecases.Reduces
proliferationofepidermalcells,itiscontraindicatedinpregnantwomen.Itcanbetoxic:causes
GIeffectssuchasdiarrheaandulcerativestomatitisandbonemarrowdepression.Canbe
hepatotoxicandhepaticfunctionshouldmonitoredduringtherapy.Instructclienttoavoid
alcoholwhiletakingthismedication.Adviseclienttomonitorforfever,sorethroat,increased
bleedingorbursingandfatigue.
27.Whatisseborrheickeratosis?Whatarethesignsandsymptoms?
28.Whattypeofequipmentshouldbereadilyavailablewhentheclientisundergoing
allergytesting?
HaveEpipenandcrashcartavailable
29.DiscusstheteachinginvolvedfortheclienttakingDiphenhydramineHCI(Benadryl)
forpruritus.
Warnitmakespatienttired.Shouldntdriveorworkwiththesemedications(urgetoavoid).Dry
mouthiscommon.Encouragefluidsandwater,snackonhardcandy.Othersideeffectsmay
includeupsetstomachandfrequenturinatingorretention.Discontinue4daysbeforeallergy
testing.
30.Whatisatopicdermatitis?Howisittreated?
Longtermchronicskindisorderthatinvolvesscalyanditchyrashes.Anotherformofeczema.
(Mostlycommonininfants.)Associatedwithasthmaandallergies.
Treatment:Hydrationofskin/usetropicalsteroids.Warmsoaksfor1520minfollowedby
occlusiveointment/wetdressings.Antihistaminesmaybeusedfortreatingitching.Causessmall
vesiclestoappear/reddenedcommonlyfoundinelbows,knees,neckandfeet.
31.Whatisangioedemaandwhatcausesit?Whatothersymptomsmightyouseewiththe
disorder?
Angioedemaisaformofurticarialinthesubcutaneoustissues.Itisusuallyseeninthelips,
eyelids,skin,GItract,hands,feet,genitalia,tongue,andlarynx.Ifitaffectsthelarynxtheclient
isatriskofdevelopinganaphylaxis.
32.Discussthefunctionofsebaceousglands
Sebaceousglandssecreteoils.Theoiliscalledsebum.Sebumhelpsmaketheskinsoftandhair
glossy.Sebumalsopreventsdryingoftheskin.
33.Whatisthebodyspurposeforperspiration?
Perspirationispartofthermoregulation,andperspiringhelpscoolthebodydown.
34.Whatisscabies?
Scabiesisaparasiticinfestation.Scabiesburrowundertheskinandlayeggs,theresiteofchoice
forburrowingisinbetweenthefingers.
35.Discussherpessimplexvirus.Howwouldyoudescribethelesionsassociatedwithit?
Herpessimplexvirusiscausedbydirectcontactwithherpesvirushominis.Residesindormant
forminthenervesofthebody.Type1ColdsoresType2genitalvesiclesarethetypeoflesion
seenwithherpes.Avesicleisanelevatedpalpablemasscontainingserousfluidlessthan1cm.
36.DiscussthemedicationTazorac:
TazoracisatopicalepidermopoiesissuppressivemedicationandisavitaminAderivative.It
reducesaccelerateddevelopmentofepidermalcells.Itisnotrecommendedforolderadults.It
mayalsocausebirthdefects.Womenshouldbeadvisedtousebirthcontrolwhiletakingthis
medication.Instructclienttoavoidusingtheproductonthefaceorskinfolds.Instructclientthat
burning/stingingcanoccur,andclientshouldbeinstructedtousesunscreenandwearprotective
clothingwhenindirectsunlight.
37.DiscussImpetigoandhowlongitiscontagious
Impetigoismostcommonlycausedbyastreptococcalorstaphylococcalbacteriathatis
contagiousamonginfants,childrenandyoungadultsalthougholderadultsaresusceptibleas
well.Thevesiclesoozeaclearexudate,whichdevelopsagoldenyellowcrustthatcauseslocal
discomfortandpruritus.Impetigoistreatedwithsystemicantibiotics.Dailybathingwith
antibacterialsoaphelpsremovethecrusts.Becausethebacteriatransfersfromtheinfectedclient
toanotherpersonthroughtouch,teachclientstoavoidtouchingtheexudatesandcruststo
preventthespreadofinfection.Soimpetigoiscontagiousuntilallexudatehasdrainedandcrusts
havefallenoffleavingasmooth,redmoistsurface.
38.5factorsthatnegativelyimpactwoundhealing:
LossofskinturgorSlowertissueregeneration
SkinfragilityDecreasedcollagen
decreasedperipheralcirculationandoxygenation
Decreasedabsorptionofnutrients
39.Compareandcontrast:serous,sanguineous,serosanguineous,andpurulentsecretions.
Serous:madeupofserum;clear,thinandwatery
Serosanguineous:composedofserumandsomeblood
Sanguineous:Bloody,containingagreatdealofbloodandsomeserum.
Purulent:containingpus.Colorgreen,tan,yellow,red.Odormalodorous,noodor,sweet
smelling
40.DiscussthefunctionofMelanin
Melaninisabrownblackpigmentproducedbythemelanocytes.Ithelpsprotectthebodyfrom
damagingeffectsofUVlightandcausestheskintodarken.
41.DiscussShingles;includecause,typeoflesion,symptoms,andtreatment
Shinglesorherpeszoster,isanacuteviralinflammationofanervecausedbythevaricellazoster
virus.Itisaunilateralvesicularrashalongnervefibersprecededbypain,andpruritus.Itis
treatedwithAcyclovir,analgesics,steroids,andantipruriticlotions.
42.DiscusstheuseofAccutanefortheclientwithacne
Accutaneisalastresortforacne.Patientmustsigndocumentsstatingthattheyunderstandthe
dangersofthemedicationandagreetotakebirthcontrolandalsotakepregnancytestsbefore,
during,andafteruse.Itcausesseverelifethreateningbirthdefects.
43.WhatisVitiligo?
Vitiligooccurswhenareasoftheskinarecompletelylackinginpigmentationresultinginareas
orpatchesofpale,whitelookingskin.Thecauseisunknown
44.WhatisJaundice?
Jaundiceistheyellowingoftheskinandwhitesoftheeyesthatoccurswhenthebloodcontains
toomuchbilirubin.Bilirubincomesfromthenormalbreakdownofredbloodcellsinthebody
andisexcretedintothebiliaryandcysticductsaspartofbile.Liverdiseasecausesthebuildup
ofbilirubinleadingtojaundice.