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Exam4Lecture6SkinDisorders

Terms in this set (50)

All skin diseases produce characteristic...
primary skin lesion
Nursing skin assessment hx
- systemic disorder
- exposures (home, work, chemical, physical)
- medication
Nursing skin assessment PE
- nails, scalp, palms, soles, mucosa, entire skin surface
- important to use natural light
- rash: purpuric, erythematous
nonblanchable
purpuric
blanchable
erthematous
Common primary lesions
- freckles (nonpalpable)
- elevated nevus, lipoma (palpable/solid)
- herpes simplex, acne vulgaris (palpable/fluid-filled)
Lesion description
A, B, C, D
changes in aging
INCREASE capillary fragility and collagen stiffness
DECREASE melanocytes, or increase in focal
- change in sweat and subcutaneous glands
- change in sensory nerves
- degenerate elastic fibers
pigment disappears from an are of skin; sudden onset; pernicious anemia, hyperthyroidism; usually before age 21
vitiligo (leukoderma)
recessive trait, impaired/absent synthesis of melanin
albinism
a breach in the skin =
susceptible to invasion of organisms
type of infection depends on:
- depth of infiltration
- type and virulence
- host defenses
MOST COMMON ARE STAPH AND STREP
inflammation of hair follicle, painful, yellow pustules surrounded by erythema with presence of central hair
folliculitis
- staph most common
- DM is risk factor
- hot tub ~ pseudomonas ~ up to 4 days after poor chlorinated hot tub
group of pus filled bumps creating infected underlying area
carbuncle
a boil
furuncle
folliculitis treatment
- cleanse with chlorhexidine and saline compress
- mupirocin for bacterial
- ciprofloxacin for pseudomonas
- dicloxacillin for staph
HSV1
- above the waist
HSV2
- genetal
treat HSV1&2
- no known cure
- palliative: lidocaine and benedryl
- for flare up: Acyclovir, Famciclovir, Valacyclovir
Varicella-zoster (herpes zoster)
- shingles from chicken pox
- inflammatory
- follows dermatome
- unilateral, severe pain, parasthesisas
- neuralgia: systemic corticosteroids
Treat shingles
- Zostavax, live vaccine
- recommended age over 50
- antiviral
- analgesia
Tinea
- Dermatophytic infection
- pedis, corporis, capitis, barbae, cruris, manus, faciei
Candida albicans
- thrush, intertrigo, mucocutaneous candidiasis
- treat with azoles ~ intraconazole, fluconazole, ketoconazole, topical, systemic
- treat with polyene (nystatin)
superficial inflammation of the skin; erythema, warmth, tenderness around involved area; infection penetrates to subcutaneous tissue
cellulitis
- risk for immunocompromised, poor venous circ., puncture wound, small cut or area of irritation
- face and lower extremities most common
- STAPH and STREP most common
- other causes: vibrio vulnificus, erysipelothrix rhusiopathiae, aeromonas hydrophilia
liver disease and immunocompromised host, salt water exposure
vibrio vulnificus
handling fish, poultry, meat
erysipelothrix rhusiopathiae
contaminated open wound in fresh water
aeromonas hydrophilia
cellulitis requiring surgical attention
male genital region
cellulitis of the hand
damage to underlying structures
cellulitis potentially life-threatening, may develop from ethmoid sinusitis, pain in EOMs, mental status changes, severe systemic symptoms
periorbital cellulitis
hx rt cellulitis
- underlying disease state, saphenous venectomy or axially node dissection, exposure to salt/fresh water, insect, spider (brown recluse), animal bites
MRSA
- can be deadly
- can result from spider bite with red ring
- can result from cellulitis
- acts like a burn, lose a lot of fluid very fast
Cellulitis treatment
*** immobilize
ERYSIPELAS
- PCN, erythromycin; cephalosporin or vancomycin if pcn allergiC
STAPH
- dicloxacillin, naficillin, vancomycin if pcn allergy
PSEUDOMONAS
- stepped on nail ~broad spectrum antipseudomonal
ANIMAL/HUMAN BITE
- amoxicillin/clavulanate, ampicillin/sulbactam
FRESH WATER
- aminoglycosides, fluoroquinolones
SALT WATER
- tetracycline, cefotaxime
FISH TANK
- rifampin, ethambutol, TMP/SMX
skin is tense, yellow-bronze, hemorrhagic bullae
gas gangrene
skin is blanched, hemorrhagic bullae
necrotizing fasciitis
skin - erythema, necrosis
streptococcal
examples of parasitic infestations
lime disease, rocky mountain spotted fever, bed bug bites, cat scratch disease, phthirus pubis, pediculus humanus ~ capitis
inflammatory processes include
- pruritus, rosacea, dermatitis, psoriasis, eczema
- acne vulgaris ~ treated by retinoids
a drug related rash
fixed drug eruption
UVA rays
- cause aging changes
- penetrate deep into skin
- break down elastin and collagen
- tanning beds
UVB rays
- cause burning
- non-melanoma cancer of skin
- play role in malignant melanoma
skin cancer risk factors
- Caucasian, light-eyed, blonde or red-head, more than a few moles, lots of freckles, cumulative sun exposure
6 types of basal cell carcinoma
- nodular - MOST COMMON
- superficial
- pigmented
- cystic
- sclerosing or morpheaform - LEAST COMMON
- nevoid
preferred treatment for basal cell carcinoma
surgical incision
squamous cell carcinoma
- malignant tumor arising from epithelium
- 2nd MOST COMMON
- higher incidence in lower altitudes
- twice as much in FEMALE
- incidence increase with age and sun exposure
- CM: scaly, erythematous macule or plaque; may have central ulceration; present as lesions that grow over period of months
common sites of squamous cell carcinoma
- scalp, neck, back of hands, pinna, lip
squamous cell carcinoma treatment
- surgical removal; if penetrate through entire dermis, may need radiation and chemo
Malignant Melanoma
- only 5% of skin cancers but 75% of deaths
- arises from melanocytes
- upper back, women's lower legs
4 types of MM
- superficial spreading (most common)
- nodular
- lentigo meligna
- acral lentiginous
MM diagnosis and treatment
- biopsy to diagnose and determine thickness, depth, mitotic rate, radial/vertical growth, lymphocyte involved
- surgical incision, lymph node dissection, adjuvant therapy
- treat with chemo, immunotherapy, radiation
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