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Ameritech COTAC I Fall 2020: Integumentary system

Terms in this set (100)

Gerontologic considerations
Thinning skin, uneven pigmentation, wrinkling, skin folds and decreased elasticity
Dry skin, diminished hair, increased fragility and increased potential for injury reduced healing ability
Erythema
Redness of the skin
Rash
Raised red skin and spread out
Cyanosis
Bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
Jaundice
Yellowing of the skin and the whites of the eyes caused by an accumulation of bile pigment (bilirubin) in the blood
Pruritis
Itchiness
Ecchymosis
Red bruising
Primary lesion
Initial lesion; macule, vesicle, plaque, wheal, nodule, cyst, purstule
Macule
Freckles, a group of referred patches
Vesicle
Fluid filled sac on the skin, associated w/ virus;
Bunch is called abulla
Plaque
Scale like skin lesion; seen with psoriasis
Wheal
Raised, itchy hive; bug bites
Nodule
Harmless, small bump; piece of overgrowth
Cyst
Fluid filled sac; mobile, either sebaceous or epidermal
Pustule
Fluid filled sac with bacteria; acne
Secondary lesions
Changes in primary lesion; erosion, scar, keloid, fissure, atrophy, scales, crust, lichenification
Erosion
Nonscarring loss of the superficial epidermis; surface is moist but does not bleed; Scratch marks
Scar
Fibrous tissue replaces tissue in the dermis or subcutaneous layer; Healed wound of incision
Ulcer
Open sore or lesion in the skin or mucous membrane; Can happen due to disease process (stasis or pressure)
Keloid
Thick scar resulting from excessive growth of fibrous tissue; hypertrophied scars, 3D scar tissue
Fissure
Opening, groove, or split in the skin; chapped lip openings
Atrophy
Thinning of the skin, loss of skin furrows, shiny; occurs in aging skin
Scales
The outer layer of skin and scalp is constantly being shed; Dandruff, psoriasis; growth on top of the plaque
Crust
Dried residue of serum, pus, or blood; residue left after vesicle rupture (impetigo)
Lichenification
Prolonged, intense scratching eventually thickens the skin and produces tightly packed sets of papules; eczema
Nail assessment
Configuration, color, consistency
Spooning in nails
Iron deficiency anemia
Beau lines
White lines across the fingernails; usually a sign of systemic disease or injury; severe illness or local truama
Clubbing in nails
Chronic hypoxia
Pitted surface of nails
Psoriasis
Hair assessment
Color, texture, distribution, hair loss, inditification
Color of hair
Ranges from white to black, Graying due to loss of melanin (hereditary)
Albinism
Absence of pigment in the skin, hair, and eyes
Texture of hair
Coarse, silky, brittle, oily, dry, shiny, dull
Straight, wavy, curly, kinky
Distribution of hair
Axillae, pubic, head, face
Hair loss
Male and female pattern baldness
Alopecia
Hair loss; in spots due to not being bale to grow hiar
Hair helps identify
Malnutrition, hygiene, drug use, decreased cardiovascular functions
Integument Dx
Sample collection, patch testing- detects allergens
Diascopy
Examination of skin lesions by pressing a glass plate against the skin;
Check for blanching with glass slide (stage 1 pressure sore)
Integument culture and sensitivity
Skin scraping- identify fungi and scabies
Integument culture and sensitivity
Potassium hydroxide (KOH) confirms fungal lesions
Tzanck smear
Identifies blistering viruses like herpes
Wood light examination
Identifies skin infections
Skin biopsy
R/o malignancy check for bacteria or fungal elements
Types of skin biopsys
Punch, shave, excisional
Punch biopsy
Removal of a small core of tissue using a hollow punch;
Removal of a small plug, may need possible sutures
Shave biopsy
Technique using a surgical blade to "shave" tissue from the epidermis and upper dermis;
Removal of raise portion of lesion, does not require sutures
Excisional biopsy
Removal of larger, deeper skin sample;
Needs sutures
Skin biopsy considerations
Remember sterile field, watch for and mx bleeding
Medications for integumentary disorders
Bacterial- topical, systemtic ABX, viral- topical, PO, IV, fungal- topical
Topical bacterial ointment
Neosporin;
Need skin to be clean and dry.
Systemic ABX
Cephalosporins unless allergic - tetracycline....mycin
If MRSA use vanco, linezolid, clindamycin
Viral meds
Acyclovir, valacyclovir, famciclovir
Funal meds
Topical cream, power PO liduid
Nystatin, clotrimazole
Skin needs to be clean and dry
Pruritis
Itching; most common compliant; first indication of internal thing going on
Causes of pruritis
Meds, radiation therapy, heat, psychological factors, kidney disease
Pt education for pruritis
Reinforce Prescribed Therapeutic Regimen
Educate on Self-Care
Use Tepid Water for Showering
Avoid Rubbing Vigorously with Towel
Pt education for pruritis
Lubricate Skin within 3 Minutes After Showering
Avoid Situations that Cause Vasodilation
Overly Warm Environment
Ingestion of Alcohol or Hot Foods and Liquids
Colloidal Oatmeal Bath
Psoriasis
Chronic skin condition producing red lesions covered with silvery scales
Psoriasis
A Chronic, Autoimmune, Inflammatory Disease of the Skin in Which Epidermal Cells are Produced at an Abnormally Rapid Rate
Risk factors for psoriasis
Infection, stress, trauma, seasonal changes, hormonal changes
S/S of psoriasis
Exacerbation and remission of pruritic lesions; bleeding with removal of scales
lesions on scalp, elbows, knees, sacrum, lateral extremities
Corticosteroids for psoriasis
Reduce inflammation and suppresses cellular proliferations
Triamcinolone, betamethasone
Avoid facial application, pt must wash hands after application
Vitamind D analogs for psoriasis
Prevent cellular proliferations
Calciprotriene, calcitriol
Vitamin A for psoriasis
Reduce inflammation and suppresses cellular proliferation
Taxarotene
Cytotoxic meds for psoriasis
Reduce turnover epidermal cells
Methotrexate, acitretin;
teratogenic, avoid ETOC
Biological agents for psoriasis
Suppresses immune function
adalimmumab
Tetratogenic;
^ risk for cancer, no live vaccines
Immunosuppressants for psoriasis
Cyclosporine, azathioprine
Nephrotoxicity
Light therapy
Tanning;
Premature skin aging, cataracts, skin cancer
Dermatitis
Inflammation of the skin that does not spread
Risk factors for dermatitis
External skin exposure to allergens, internal exposure to allergens and irritants
Stress, genetic predisposition, idiopathic
S/S if dermatitis
Thickened areas of skin, pruritus, possible symmetrical involvement;
Dry and most w/crust, possible recent exposure to allergens, well defined rash, chronic rash
Topical steroids meds for dermatitis
Triamcinolon
*proper application
*warm, most, non occlusive dressing over topical application to ^ absorption
Systemic steroids meds for dermatitis
Prednisone
*Taper off
Topical antihistamines meds for dermatitis
Diphenhydramine
*Will cause drowsiness
Systemic antihistamine meds for dermatitis
Diphenhydramine, cetiriine, fexofenadine
*Will cause drowsiness
Topical immunosuppressants for dermatitis
Tacrolimus
*Stop when rash clears, avoid direct sunlight
Monoclonal antibody meds for dermatitis
Dupilumab
*Biweekly SQ injections
Impetigo
Bacterial skin infection characterized by isolated pustules that become crusted and rupture; contagious
Impetigo considerations
May Spread to Other Parts of Patient's Body or to Others; Shower Daily with Antibacterial Soap
Folliculitis
Inflammation of the hair follicles; Furuncles (Boils) or Pimples, spreads
Folliculitis pt education
Shower, quarantine yourself
Take ABX and take care of skin and lesions
Herpes zoster
Chicken pox and shingles
Take antiviral meds, do lesion care and wash your hands!
Herpes simplex
HSV1- cold sores, HSV2- genital warts
Herpes simplex considerations
Take antiviral meds including prophylactic meds; limit the spread and know how its spread (kissing and sex, can go both ways)
Tinea caporis (fungal)
Ring worm
Pediculosis (parasitic
Lice infestionation of the hair; tx with shampoo and bad everything up for 2 week and wash in very hot water; mayo works for hair
Scabies
Contagious skin disease transmitted by the itch mite; itching is worse at night
Scabies considerations
Shower with soap and warm water, allow skin to cool
Tx for scabies
Treat all contacts at the same time, apply RX scabicide and leave on for up to 24 hrs
Tx for scabies
Repeat tx in 1 week to prevent reinfestionation
Pruritus may continue for several weeks and doesnt mean retreatment is necessary
Tx for scabies
ALL articles of clothing and bedding must be disinfection
wash in Hot water or dry clean (tightly seal back of unwashable items for 2 weeks)
Furniture and floors should be frequently vaccumed
Steven Johnson Syndrome (SJS)
Severe blistering of the skin, with mucous membrane involvement and fever; Can be fatal, usually caused by ABX, autoimmune
Toxic Epidermal Necrolysis (TEN)
Toxic skin reaction with sloughing of skin and mucous membranes;
Caused by medications/drugs
Steven johnsons syndrome (SJS) & toxic epidermal necrolysis (TEN)
Epidermal detachment or sloughing and erosion caused by medication reaction
Steven johnsons syndrome (SJS) & toxic epidermal necrolysis (TEN)
Potentially fatal acute skin disorders - can occur on outside or inside body
Steven johnsons syndrome (SJS) & toxic epidermal necrolysis (TEN)
Mx for s/s of infection, daily weight; VS- decreased RR, fever, tachycardia
Collaborative problems for Steven johnsons syndrome (SJS) & toxic epidermal necrolysis (TEN)
Sepsis, conjunctival retraction, scars, corneal leasions
Nursing interventions for Steven johnsons syndrome (SJS) & toxic epidermal necrolysis (TEN)
Maintaining skin and mucous membrane integrity
Attaining and maintaining fluid balance
Preventing hypothermia
Relieving pain
Prevent infection
Monitoring and managing potential complications
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