-
macule
- flat, nonpalpable change in skin color
- usually smaller than 1 cm
- e.g. freckles, scarlet fever, rubell
-
papule
- palpable raised lesion less than 1 cm in diameter
- caused by superficial thickening of epidermis
- e.g. ringworm, wart mole
-
vesicle
- small, blister-like raised area of the skin up to 1cm in diameter
- contains serous fluid
- e.g. shingles, poison ivy, chicken pox
-
bulla
- fluid filled vesicle or blister larger than 1 cm
- e.g. burns, contact dermatitis
-
pustule
- small elevation of skin or bulla or vesicle that contains pus or lymph
- e.g impetigo, acne, scabies
-
wheal
- round transient eleveation of the skin
- caused by dermal edema or capillary dilation
- white center, red periphery
- e.g. hives, insect bites
-
cyst
closed sac containing semisolid, solid or liquid material
-
a wood's light examination uses uv light to detect flourescent materials in the skin when would it be performed
when ringworm is suspected
-
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
-
is obesity a contributing factor to pressure ulcer formation?
yes, adipose tissue is poorly vascularized
-
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
-
who is at greatest risk for pressure ulcers
- advanced age
- low diastolic pressure
- elevated body temp
- inadequate intake of protein
-
which mechanical forces cause pressure ulcers
-
a pressure ulcer stays red and doesn't blanch after pressure is applied, is this true?
yes
-
most common pressure ulcer sites
- sacrum
- heels
- elbows
- lateral malleoli
- greater trochanter
- base of skull
- scapulae
- ears
- ischial tuberosities
-
when is surgical debridement used on a pressure ulcer
pt has sepsis, cellulitis or removal of excess eschar
-
mechanical debridement
- premedicate; painful procedure
- scissors and forceps
- wet-to-dry dressings
- whirpool bath
-
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
-
how long does a dressing take to reach the right healing temperature
12 hours
-
the best environment for a wound to heal fast
- moist environment
- minimal bacterial colonization
- healing temp
-
how would you clean a stage 1 or 2 pressure ulcer
- with mild soap and water
- no alcohol, creams, ointments or antiseptics
-
stage 1 pressure ulcer
- skin is intact
- area is red and doesn't blanch when touched
-
stage 2 pressure ulcer
- partial thickness loss
- appears as abrasion, shallow crater or blister
- no slough
-
stage 3 pressure ulcer
- full thicness loss, extends to subcutaneous fat
- bone, tendon and muscle not visible
-
stage 4 pressue ulcer
- full thickness skin loss
- bone, tendon, and muscle visible
- slough or eschar may be present
-
what makes a pressure ulcer unstageable
base is covered by eschar
-
acne medications
- benzoyl peroxide
- antibiotics (erythromycin, tetracycline)
- vitamin a acid (retin-a, tretinoin)
- acutane (isotretinoin)
- birth control pills
-
basal cell carcinoma
- most common type of skin cancer
- pearly or translucent papule
- usually benign
-
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
-
eczema
- allergic reaction
- part of the allergy triad
- rash that's thick and scaly usually found at crease of joints and face
-
what treatments are used for eczema
- topical corticosteroids
- antihistamines
- soaks, occlusive dresssings and emollients to keep skin moist
-
-
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
-
what happens to body fluids within the first 48 hrs after a burn
plasma shifts into the interstitial space causing edema and hypovolemia
-
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
-
what are curlings ulcers
ulcers caused by the stress of a burn injury
-
what are the signs on a burn pt that indicate an inhalation injury
- facial burns
- swelling of the pharynx
- restlessness
- cough
- dyspnea
- sooty sputum
-
rule of nines
- each leg is 18%
- each arm s 9%
- ventral torso is 18%
- dorsal torso is 18%
- head is 9%
-
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
-
what is a possible complication if a pt has a circumferential burn
the burn acts like a tourniquet impeding arterial and venous flow
-
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
-
do burn pts get a tetanus booster
yes
-
common topical medications for burn pts
- silver sulfadiazine (silvadene)
- sulfamylon
-
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)
-
what is the purpose of a pressure suit for burn pts
minimize scarring
-
inflammation of the brain caused by bacterial or viral infection
meningitis
-
kernig's sign
- examiner flexes pt hip to 90 degrees and tries to extend the pt knee
- positive if pain is felt in hamstring
-
brudzinski's sign
flexion of the pts neck causes hips and knees to flex
-
signs and symptoms of meningitis
- headache
- high fever
- nuchal rigidity
- photophobia
- petechia of skin and mucous membranes
- nausea and vomiting
-
what signs are expected in the lab work of n a pt with bacterial meningitis
- cloudy CSF
- lowered glucose level
-
encephalitis
- inflammation of brain tissue usually caused by a virus
- mostly caused by bug bites
- symptoms develop over several days
-
cushings triad
- late indication of increasing ICP
- increased systolic pressure and widening pulse pressure
- bradycardia
- irregular respirations
-
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
-
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
-
what causes migraine headaches
cerebral vasoconstriction followed by vasodilation
-
does an aura precede migraine headaches
- maybe, maybe not
- the aura can be a visual phenomena like a flashing light
-
what triggers migraines
- specific foods
- noise
- bright light
- alcohol
- stress
-
migraine meds
- NSAIDS
- triptans
- amitryptyline
- propanolol
- nifedipine
-
absence seizures
- aka petit mal
- occurs most often in children
- period of staring that last several seconds
-
is a concussion considered a mild brain injury
yes
-
concussion is characterized by which symptoms
- headache
- dizziness
- nausea and vomiting
-
what kind of bleeding is involved with a subdural hematoma
- venous in nature
- blood accumulates between dura and arachnoid mater
-
which ppl are most at risk for sudural hematoma
-
acute subdural hematoma is characterized by appearance of symptoms within what time frame
24 hours
-
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
-
epidural hematomas are often associated with which head injury
skull fracture
-
pt should be warned of which physical changes post op
- swollen face especially around the eyes
- periorbital bruising
-
symptoms of spinal shock
- vasodilation
- hypotension
- bradycardia
- pt in danger of hypothermia
-
autonomic dysreflexia
- at risk with injuries above t6
- noxious stimuli cause stimulation of sympathetic system below spinal injury
-
which stimuli cause autonomic dysreflexia
- uti
- ingrown toenails
- pressure ulcers
- pain
- labor in pregnant women
- bowel impaction
- wrinkled sheets
-
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
-
what should be done if you suspect autonomic dysreflexia
check blood pressure and continue to monitor every 5 minutes
-
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)
-
pill rolling tremors are associated with which CNS disorder
parkinson's
-
what happens in huntington's disease
- progressive loss of normal movement and intellect
- pts display personality changes and inappropriate behavior
- involuntary jerky movements occur
-
which meds treat huntingtons
- antipsychotic
- antidepressant
- antichoreic
-
which lifestyle factors increase the risk of alzheimers
- hypertension
- hypercholesterolemia
- poorly controlled diabetes
-
alzheimers meds
- acetylcholinesterase inhibitors (aricept and exelon)
- increasing levels of acetylcholine in brain allow better functioning
-
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
-
the acronym FAST is used for recognizing strokes what does it stand forf
- Facial droop
- Arm drift
- Speech
- Time
-
define aphasia
absence of language
-
thrombotic stroke
- type of ischemic stroke
- occlusion builds up in artery and blocks blood flow
-
embolic stroke
- type of ischemic stroke
- thrombus travels from another part of the body and occludes an artery
-
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
-
what is the timing for the medication tpa
given within 3 hrs of symptom onset
-
meds given after a stroke
- antiplatelets
- plavix and aspirin
- afib pts may get coumadin
-
what causes MS
- progressive breakdown of the myelin sheath
- loss of myelin sheath inflames nerves and may block transmission
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