Pathophysiological Concepts Chapter 41: Structure, Function, and Disorders of the Integument

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Questions and Answers

Which of the following is a primary internal factor contributing to pressure ulcers?

Friction and shearing forces

Impaired perfusion; ischemia (correct)

Sedation

Prolonged pressure

What is the characteristic of Stage 1 pressure ulcers?

Exposure of muscle or bone

Crater-like appearance with full-thickness skin loss

Open sore with partial-thickness skin loss

Nonblanchable erythema of intact skin (correct)

Which treatment is appropriate for a Stage 1 pressure ulcer?

Frequent repositioning and moisture elimination (correct)

Surgical intervention

Using flat, moisture-retaining dressing

Cleansing with saline

Which risk factor is related to external factors contributing to pressure ulcers?

Infrequent position changes Signup and view all the answers

How is Stage 2 pressure ulcer distinguished from Stage 1?

Partial-thickness skin loss with an open sore Signup and view all the answers

What does a Deep Tissue Pressure Injury indicate?

Localized deep red discoloration with possible blood-filled blisters Signup and view all the answers

What is NOT a recommended treatment for Stage 2 pressure ulcers?

Immediate surgical intervention Signup and view all the answers

Which condition may increase the risk of developing pressure ulcers?

Excess moisture from incontinence Signup and view all the answers

Which type of burn is characterized by a dry leathery appearance and involves full thickness damage to the epidermis, dermis, and underlying subcutaneous tissue?

Third Degree Burn Signup and view all the answers

What is the total body surface area (TBSA) percentage assigned to each leg using the Rule of 9’s?

18% Signup and view all the answers

Which of the following best describes the hallmark of burn shock?

Decreased cardiac contractility and output Signup and view all the answers

What response is characterized by a hypermetabolic state beginning 24 hours post-burn and can persist up to 2 years?

Flow Phase Metabolic Response Signup and view all the answers

Which type of cold injury is characterized by reversible cold exposure without tissue freezing, resulting in skin pallor and numbness?

Frostnip Signup and view all the answers

Which characteristic distinguishes keloids from hypertrophic scars?

Keloids extend beyond the original site of injury. Signup and view all the answers

What is a common feature of eczema or dermatitis?

Chronic thickening and hyperpigmentation of the skin. Signup and view all the answers

What primary lesion is characterized by a small, solid elevated lesion?

Papule Signup and view all the answers

Which type of dermatitis is associated with a history of hay fever or asthma?

Atopic dermatitis Signup and view all the answers

What is a key feature of psoriasis?

Rapid turnover of epidermal shedding. Signup and view all the answers

Which lesion is a secondary lesion that involves loss of epidermis, often resulting in an open sore?

Erosion Signup and view all the answers

Which of the following infections is characterized by an acute superficial infection affecting the upper dermis?

Erysipelas Signup and view all the answers

What condition is associated with chronic inappropriate vasodilation and typically develops in adulthood?

Acne rosacea Signup and view all the answers

Which skin condition typically manifests as a butterfly pattern over the nose and cheeks?

Discoid lupus erythematosus Signup and view all the answers

Which of the following describes a bulla?

Large, fluid-filled blister. Signup and view all the answers

What is a common characteristic of Stage 3 pressure ulcers?

Visible fat and granulation tissue Signup and view all the answers

Which treatment is recommended for Stage 4 pressure ulcers?

Wound dressings and NPWT Signup and view all the answers

What is the role of slough in a wound?

It is non-viable tissue that needs removal. Signup and view all the answers

What strategy is essential for the successful healing of pressure ulcers?

Regular dressing changes and pressure relief Signup and view all the answers

What is the primary goal of wound debridement in unstageable pressure ulcers?

To expose healthy tissue for assessment Signup and view all the answers

Why are offloading boots recommended in pressure ulcer prevention?

They redistribute weight away from pressure points. Signup and view all the answers

What is a defining feature of an unstageable pressure ulcer?

Base covered in slough or eschar Signup and view all the answers

What approach should be taken to eliminate moisture in pressure ulcer prevention?

Frequent skin cleansing and drying Signup and view all the answers

Which of the following is NOT a method for pressure ulcer prevention?

Limiting patient movement Signup and view all the answers

In which situation might a patient be at higher risk for Stage 4 pressure ulcers?

Conditions leading to paralysis Signup and view all the answers

What characteristic is associated with Scleroderma?

Skin is thickened and shiny Signup and view all the answers

Which type of skin cancer is most serious and commonly causes death?

Malignant Melanoma Signup and view all the answers

What is a characteristic feature of Actinic Keratosis?

Composed of aberrant proliferations of keratinocytes Signup and view all the answers

Which factor does NOT contribute to the risk of developing melanoma?

High melanin levels in the skin Signup and view all the answers

What is the most common cause of lip cancer?

Squamous Cell Carcinoma Signup and view all the answers

Which statement regarding burn types is accurate?

Third-degree burns result in complete skin loss Signup and view all the answers

Which benign tumor is characterized by a proliferation of cutaneous basal cells?

Seborrheic Keratosis Signup and view all the answers

What treatment is recommended for Kaposi Sarcoma?

Surgical removal of lesions Signup and view all the answers

Which of the following options identifies a feature of basal cell carcinoma?

Often presents as a firm, ulcerated lesion Signup and view all the answers

What is indicated for the evaluation of suspicious nevi?

ABCDE assessment Signup and view all the answers

Study Notes

Pressure Ulcers

Moisture from incontinence or sweating increases skin fragility.
Risk factors for pressure ulcers include:
- Prolonged pressure and immobilization.
- Infrequent position changes and exposure to moisture.
- Malnutrition and dehydration.
- History of pressure ulcers and aging-related thin skin.

Staging of Pressure Ulcers

Stage 1: Nonblanchable erythema on intact skin.
Stage 2: Partial-thickness skin loss; open sore.
Stage 3: Full-thickness skin loss; crater-like appearance with visible fat.
Stage 4: Extensive tissue loss; exposes muscle or bone.
Unstageable: Full-thickness loss obscured by slough or eschar.
Deep Tissue Pressure Injury: Nonblanchable deep red discoloration; may have blood-filled blisters.

Treatment Strategies by Stage

Stage 1: Frequent repositioning; moisture management; ensure nutrition and oxygenation.
Stage 2: Clean wound with saline; cover with moisture-retaining dressing.
Stage 3: Cleansing and potentially involving a wound care nurse.
Stage 4: Dressings, debridement, and negative pressure wound therapy (NPWT).

Prevention of Pressure Ulcers

Regular skin assessments and repositioning.
Use specialty beds and offloading boots.
Maintain moisture balance and ensure proper nutrition.

Skin Lesions

Features for describing skin lesions include size, type, shape, color, surface area, and distribution.
Primary lesions: Macule, papule, vesicle, etc.
Secondary lesions: Scale, scar, ulcer, etc.

Scarring

Keloids: Rounded, elevated scars extending beyond the injury site.
Hypertrophic scars: Elevated but do not exceed the original border.

Dermatitis (Eczema)

Characterized by itchiness and lesions with indistinct borders.
Types include:
- Allergic contact: hypersensitivity response.
- Irritant contact: similar to allergic but involves irritants.
- Atopic: often with hay fever or asthma history.
- Stasis: related to venous stasis in legs.
- Seborrheic: chronic inflammation affecting scalp and other areas.

Papulosquamous Disorders

Psoriasis: Chronic inflammatory disorder, thickening dermis and epidermis, fast turnover of skin.
Acne rosacea: Inflammation leading to flushing and sensitivity.
Lupus erythematosus: Autoimmune disease with skin and systemic effects.

Bacterial Infections

Types include folliculitis, furuncles, carbuncles, cellulitis, erysipelas, and impetigo.

Cellulitis

Infection of dermis and subcutaneous tissue, marked by warmth, redness, swelling, and pain.
Treatment: antibiotics and pain management, differentiate from necrotizing fasciitis.

Vascular Disorder - Scleroderma

Causes thickening and hardening of the skin; can be localized or systemic.

Benign Tumors

Seborrheic keratosis, keratoacanthoma, actinic keratosis, and nevi (moles) are types of benign skin growths.

Skin Cancer

BCC: Most common skin cancer, grows slowly, rarely metastasizes.
SCC: Second most common, can be linked to sun exposure.
Melanoma: Most serious, often linked to UV exposure and family history; evaluated using the ABCDE criteria.

Kaposi Sarcoma

Vascular malignancy associated with immunodeficiency, characterized by purplish-brown lesions.

Burns

Caused by thermal or non-thermal sources, affecting cutaneous and respiratory systems.
Burn classification: first-degree (epidermis), second-degree (partial thickness), third-degree (full thickness), fourth-degree (deeper tissues).
Total Body Surface Area (TBSA) can be estimated using the rule of nines.

Fluid & Water Losses in Burns

Major burns (>20% TBSA) cause significant fluid loss leading to hypovolemic shock.
Intravenous fluid resuscitation is vital for recovery.

Responses to Major Burn Injury

Cardiovascular: Decreased cardiac contractility, risk of shock if untreated.
Cellular: Disrupted sodium-potassium pump, leading to cellular edema.
Metabolic: Hypermetabolic response can last up to 2 years post-injury.
Immunological: Prolonged immunosuppression, increased infection risk.

Treatment of Burns

Goals: wound debridement, closure, nutrition support, pain management, and infection monitoring.

Cold Injury

Types include:
- Frostnip: Mild skin pallor, reversible.
- Chilblain: Painful, violaceous skin changes.
- Frostbite: Freezing injury leading to ice crystal formation; classified by depth.

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Description

This quiz focuses on the various risk factors associated with pressure ulcers, emphasizing both external factors such as prolonged pressure and immobilization, and disease-related factors like impaired perfusion. Understanding these risks is crucial for effective patient care and prevention strategies.