1. macule
    • flat, nonpalpable change in skin color
    • usually smaller than 1 cm
    • e.g. freckles, scarlet fever, rubell
  2. papule
    • palpable raised lesion less than 1 cm in diameter
    • caused by superficial thickening of epidermis
    • e.g. ringworm, wart mole
  3. vesicle
    • small, blister-like raised area of the skin up to 1cm in diameter
    • contains serous fluid
    • e.g. shingles, poison ivy, chicken pox
  4. bulla
    • fluid filled vesicle or blister larger than 1 cm
    • e.g. burns, contact dermatitis
  5. pustule
    • small elevation of skin or bulla or vesicle that contains pus or lymph
    • e.g impetigo, acne, scabies
  6. wheal
    • round transient eleveation of the skin 
    • caused by dermal edema or capillary dilation
    • white center, red periphery
    • e.g. hives, insect bites
  7. cyst
    closed sac containing semisolid, solid or liquid material
  8. a wood's light examination uses uv light to detect flourescent materials in the skin when would it be performed
    when ringworm is suspected
  9. pressure ulcers are the result of tissue anoxia. how long does it take for one to start developing?
    within 20 - 40 minutes of unrelieved pressure on the skin
  10. is obesity a contributing factor to pressure ulcer formation?
    yes, adipose tissue is poorly vascularized
  11. what can be done to prevent pressure ulcers
    • examine and document skin condition daily
    • avoid massaging bony prominences or reddened skin areas
    • teach pts to shift weight every 15 minutes when sitting or lying
    • perform frequent ROM exercises 
    • turn and reposition pts on bedrest every 2 hours
    • avoid elevating head of bed more than 30 degrees
    • don't place pts on their trochanter
    • avoid donut shaped cushions
  12. who is at greatest risk for pressure ulcers
    • advanced age
    • low diastolic pressure
    • elevated body temp
    • inadequate intake of protein
  13. which mechanical forces cause pressure ulcers
    • shear
    • pressure
    • friction
  14. a pressure ulcer stays red and doesn't blanch after pressure is applied, is this true?
  15. most common pressure ulcer sites
    • sacrum
    • heels
    • elbows
    • lateral malleoli
    • greater trochanter
    • base of skull
    • scapulae
    • ears
    • ischial tuberosities
  16. when is surgical debridement used on a pressure ulcer
    pt has sepsis, cellulitis or removal of excess eschar
  17. mechanical debridement
    • premedicate; painful procedure
    • scissors and forceps
    • wet-to-dry dressings
    • whirpool bath
  18. when cleansing a wound what types of instrument should be used
    • 30 - 60 mL syring with a 18 gauge needle
    • irrigating system with pressure of 4 -15 psi
  19. how long does a dressing take to reach the right healing temperature
    12 hours
  20. the best environment for a wound to heal fast
    • moist environment
    • minimal bacterial colonization
    • healing temp
  21. how would you clean a stage 1 or 2 pressure ulcer
    • with mild soap and water
    • no alcohol, creams, ointments or antiseptics
  22. stage 1 pressure ulcer
    •  skin is intact
    • area is red and doesn't blanch when touched
  23. stage 2 pressure ulcer
    • partial thickness loss
    • appears as abrasion, shallow crater or blister
    • no slough
  24. stage 3 pressure ulcer
    • full thicness loss, extends to subcutaneous fat
    • bone, tendon and muscle not visible
  25. stage 4 pressue ulcer
    • full thickness skin loss
    • bone, tendon, and muscle visible
    • slough or eschar may be present
  26. what makes a pressure ulcer unstageable
    base is covered by eschar
  27. acne medications
    • benzoyl peroxide
    • antibiotics (erythromycin, tetracycline)
    • vitamin a acid (retin-a, tretinoin)
    • acutane (isotretinoin)
    • birth control pills
  28. basal cell carcinoma
    • most common type of skin cancer
    • pearly or translucent papule
    • usually benign
  29. squamous cell carcinoma
    • lesion is fragile and prone to oozing and bleeding
    • can metastasize if untreated
    • mainly on lower lip, neck, tongue, head and dorsa of hands
  30. eczema
    • allergic reaction
    • part of the allergy triad
    • rash that's thick and scaly usually found at crease of joints and face
  31. what treatments are used for eczema
    • topical corticosteroids
    • antihistamines
    • soaks, occlusive dresssings and emollients to keep skin moist
  32. allergy triad
    • eczema
    • hay fever
    • asthma
  33. kaposis' sarcoma
    • cancer of connective tissue associated with AIDS
    • caused by human herpesvirus-8 (HHV-8)
    • tumors most often appear as bluish-red or purple bumps on the skin
    • People who have kidney or other organ transplants are also at risk for Kaposi's sarcoma
  34. what happens to body fluids within the first 48 hrs after a burn
    plasma shifts into the interstitial space causing edema and hypovolemia
  35. physiological changes after a burn occurs
    • metabolism increases along with oxygen consumption
    • gastric dilation, peptic ulcers and parlytic ulcers
    • elevated epinephrine adn glucagon levels
    • decreased renal blood flow and low gfr
    • decreased cardiac output
  36. what are curlings ulcers
    ulcers caused by the stress of a burn injury
  37. what are the signs on a burn pt that indicate an inhalation injury
    • facial burns
    • swelling of the pharynx
    • restlessness
    • cough
    • dyspnea
    • sooty sputum
  38. rule of nines
    • each leg is 18%
    • each arm s 9%
    • ventral torso is 18%
    • dorsal torso is 18%
    • head is 9%
  39. what must be done at the time of a burn injury
    • remove pt from source
    • check ABCs
    • stop the burning process
    • stabilize related injuries
    • IV fluids 
    • pain control
  40. what is a possible complication if a pt has a circumferential burn
    the burn acts like a tourniquet impeding arterial and venous flow
  41. what is the purpose of an escharotomy for a pt with a circumferential burn
    linear incision through eschar to allow expansion of the skin and the return of blood flow
  42. do burn pts get a tetanus booster
  43. common topical medications for burn pts
    • silver sulfadiazine (silvadene)
    • sulfamylon
  44. to prevent contractions in a burn pt, what must be done
    • begin an exercise program with 24 - 48 hrs
    • do not place pt in a position of flexion (contracture)
  45. what is the purpose of a pressure suit for burn pts
    minimize scarring
  46. inflammation of the brain caused by bacterial or viral infection
  47. kernig's sign
    • examiner flexes pt hip to 90 degrees and tries to extend the pt knee
    • positive if pain is felt in hamstring
  48. brudzinski's sign
    flexion of the pts neck causes hips and knees to flex
  49. signs and symptoms of meningitis
    • headache
    • high fever
    • nuchal rigidity
    • photophobia
    • petechia of skin and mucous membranes
    • nausea and vomiting
  50. what signs are expected in the lab work of n a pt with bacterial meningitis
    • cloudy CSF
    • lowered glucose level 
  51. encephalitis
    • inflammation of brain tissue usually caused by a virus
    • mostly caused by bug bites
    • symptoms develop over several days
  52. cushings triad
    • late indication of increasing ICP
    • increased systolic pressure and widening pulse pressure
    • bradycardia
    • irregular respirations
  53. signs and symptoms of increased intracranial pressure
    • vomiting
    • headache
    • dilated pupil on affected side
    • hemiparesis or  hemiplegia
    • decorticate then decerebrate  posturing
    • decreased level on consciousness
    • increasing systolic blood pressue
    • increasing then decreasing pulse rate
    • rising temperature
  54. measures to prevent increased icp
    • keep head of bed elevated 30 degrees unless contraindicated
    • avoid flexing the neck
    • give antiemetics and antitussives
    • give stool softeners
    • minimize suctioning
    • avoid hip flexion
    • prevent unnecessary noise
    • space care activities to provide rest in between
  55. what causes migraine headaches
    cerebral vasoconstriction followed by vasodilation
  56. does an aura precede migraine headaches
    • maybe, maybe not
    • the aura can be a visual phenomena like a flashing light
  57. what triggers migraines
    • specific foods
    • noise 
    • bright light
    • alcohol
    • stress
  58. migraine meds
    • NSAIDS
    • triptans
    • amitryptyline
    • propanolol
    • nifedipine
  59. absence seizures
    • aka petit mal
    • occurs most often in children
    • period of staring that last several seconds
  60. is a concussion considered a mild brain injury
  61. concussion is characterized by which symptoms
    • headache
    • dizziness
    • nausea and vomiting
  62. what kind of bleeding is involved with a subdural hematoma
    • venous in nature
    • blood accumulates between dura and arachnoid mater
  63. which ppl are most at risk for sudural hematoma
    • alcoholics
    • older ppl
  64. acute subdural hematoma is characterized by appearance of symptoms within what time frame
    24 hours
  65. what happens to the pt when they suffer an epidural hematoma
    • pt loses consciousness directly after injury
    • pt regains consciousness and is briefly coherent
    • pt develops dilate pupil and paralyzed extraocular muscles on the side of the hematoma and become less responsive
  66. epidural hematomas are often associated with which head injury
    skull fracture
  67. pt should be warned of which physical changes post op
    • swollen face especially around the eyes
    • periorbital bruising
  68. symptoms of spinal shock
    • vasodilation
    • hypotension
    • bradycardia
    • pt in danger of hypothermia
  69. autonomic dysreflexia
    • at risk with injuries above t6
    • noxious stimuli cause stimulation of sympathetic system below spinal injury
  70. which stimuli cause autonomic dysreflexia
    • uti
    • ingrown toenails
    • pressure ulcers
    • pain
    • labor in pregnant women
    • bowel impaction
    • wrinkled sheets
  71. signs and symptoms of autonomic dysreflexia
    • cool pale skin and vasodilation below injury
    • systolic blood pressure may rise to 300
    • vasodilation and flushing above the injury
    • bradycardia as low as 30 bpm
    • pounding headache
    • nasal congestion
  72. what should be done if you suspect autonomic dysreflexia
    check blood pressure and continue to monitor every 5 minutes
  73. which brain chemical is deficient in a parkinson's pt
    • dopamine
    • an acetylcholine imbalance causes the temors, muscle rigidity and akinesia (loss of muscle movement)
  74. pill rolling tremors are associated with which CNS disorder
  75. what happens in huntington's disease
    • progressive loss of normal movement and intellect
    • pts display personality changes and inappropriate behavior
    • involuntary jerky movements occur
  76. which meds treat huntingtons
    • antipsychotic
    • antidepressant
    • antichoreic
  77. which lifestyle factors increase the risk of alzheimers
    • hypertension
    • hypercholesterolemia
    • poorly controlled diabetes
  78. alzheimers meds
    • acetylcholinesterase inhibitors (aricept and exelon)
    • increasing levels of acetylcholine in brain allow better functioning
  79. warning signs of an impending stroke
    • sudden numbness or weakness of face, arm or leg
    • sudden confusion or trouble speaking or understanding
    • sudden trouble seeing in one or both eyes
    • sudden trouble walking, dizziness, loss of balance or coordination
    • sudden severe headache with no known cause
  80. the acronym FAST is used for recognizing strokes what does it stand forf
    • Facial droop
    • Arm drift
    • Speech
    • Time
  81. define aphasia
    absence of language
  82. thrombotic stroke
    • type of ischemic stroke
    • occlusion builds up in artery and blocks blood flow
  83. embolic stroke
    • type of ischemic stroke
    • thrombus travels from another part of the body and occludes an artery
  84. risk factors for stroke
    • high blood pressure
    • smoking
    • DM
    • cardiovascualr disease
    • afib
    • asymptomatic carotid stenosis
    • tia
    • sickle cell 
    • dyslipidemia
    • obesity
    • excessive alcohol intake
    • poor diet (high fat, low potassium, high sodium)
    • postmenopausal hormone therapy
  85. what is the timing for the medication tpa
    given within 3 hrs of symptom onset
  86. meds given after a stroke
    • antiplatelets
    • plavix  and aspirin
    • afib pts may get coumadin
  87. what causes MS
    • progressive breakdown of the myelin sheath
    • loss of myelin sheath inflames nerves and may block transmission
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