STUDYGUIDE2045EXAM#1

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 1 sores are not open wounds. The skin may be

painful, appears reddened and does not blanch. In a dark-skinned
person, the area may appear to be a different color than the surrounding
skin, but it may not look red. Skin temperature is often warmer. Stage 1
sore can feel either firmer or softer than the area around it.

Stage 2, skin breaks open, wears away, or forms an ulcer,

which is usually tender and painful. The sore expands into deeper layers
of the skin. It can look like a scrape, blister, or a shallow crater. Sometimes
this stage looks like a blister filled with clear fluid.

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.

Stage 4, the pressure sore is very deep, reaching into

muscle and bone and causing extensive damage. Damage to deeper

tissues, tendons, and joints may occur.

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.