Adult Health Test 1 Integumentary part 4

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Questions and Answers

What type of skin lesion is characterized by rough, papillomatous growths and can be contagious?

Angiomas

Nevi

Warts (correct)

Keloids

Which treatment is not commonly used for keloids?

Corticosteroid injections

Electrolysis (correct)

Laser surgery

Cryotherapy

What are spider angiomas associated with?

Liver disease (correct)

Viruses

Sun exposure

Genetic factors

Which characteristic is used to evaluate nevi for potential malignancy?

Symmetry Signup and view all the answers

What is a common appearance of basal cell carcinoma?

Waxy pearly border with a central crater Signup and view all the answers

Which type of skin tumors arise from a group of dilated blood vessels?

Angiomas Signup and view all the answers

What is the recommended procedure for the removal of basal cell carcinoma?

Mohs procedure Signup and view all the answers

Which statement about keloids is true?

They can cause tissue destruction. Signup and view all the answers

Which type of melanoma is characterized by irregular shape and multiple colors?

Superficial spreading melanoma Signup and view all the answers

What is the primary cause of hirsutism?

Genetics Signup and view all the answers

Which of the following is not a characteristic of partial thickness burns?

Dry appearance Signup and view all the answers

What best describes the most severe type of burn?

Dry, leathery appearance Signup and view all the answers

Which condition is commonly associated with onychomycosis?

Brittle and soft nails Signup and view all the answers

What is the emergent phase after a burn primarily focused on?

Preventing hypovolemic shock Signup and view all the answers

Which factor is NOT associated with increasing the risk of malignant melanoma?

Having a small number of moles Signup and view all the answers

What characterizes chemical burns compared to thermal burns?

Need extensive rinsing with water Signup and view all the answers

What are the signs of burn shock?

Hypotension and tachycardia Signup and view all the answers

Which type of melanoma is typically found on the heads and necks of older adults?

Lentigo malignant melanoma Signup and view all the answers

What treatment is effective for excessive hair growth (hirsutism)?

Shaving and waxing Signup and view all the answers

What is a primary complication associated with electrical burns?

Cardiac arrest Signup and view all the answers

What is the recommended protein intake for burn patients based on their weight?

1.5-2 grams per kilogram of body weight Signup and view all the answers

Which recommendation is NOT appropriate for post-graft care?

Expose the graft to direct sunlight after the first month Signup and view all the answers

Why is it important to monitor psychosocial needs during the rehabilitation phase?

To address changes in body image for increased independence Signup and view all the answers

What should be done to minimize the risk of infection in home care for burn patients?

Clean the tub thoroughly before each bath Signup and view all the answers

What is a correct action to take if a burn patient experiences severe itching?

Use a lukewarm bath with alpha-Keri lotion Signup and view all the answers

What is the proper response to discoloration and scarring during the healing process?

Normal skin color will return in several months Signup and view all the answers

How long should sunscreen be used on a graft after surgery?

For at least 6 months post-surgery Signup and view all the answers

What is one of the primary goals of the rehabilitation phase for burn patients?

To enhance independence in daily activities Signup and view all the answers

What is a key nutrition focus for burn patients?

High protein and calorie intake to meet energy requirements Signup and view all the answers

What signifies that a potential complication may be occurring in a burn patient?

Fever greater than 101°F and inability to cope Signup and view all the answers

Which of the following signs is NOT typically associated with carbon monoxide poisoning?

Flaring nostrils Signup and view all the answers

What is a common complication following severe burns after 72 hours?

Infection Signup and view all the answers

What treatment is used specifically for carbon monoxide poisoning?

100% oxygen Signup and view all the answers

Which laboratory shift can be expected in the acute phase following a burn?

Increased glucose Signup and view all the answers

What physiological change indicates a fluid shift back into the vascular space during the acute phase of burn treatment?

Increased urine output Signup and view all the answers

What is a key goal of treatment in the acute phase following burns?

Treat the burn wound Signup and view all the answers

Which of the following interventions is important to prevent contractures in burn patients?

Range of motion exercises Signup and view all the answers

What is the effect of an eschar on the burned area?

Hinders breathing and circulatory flow Signup and view all the answers

Which treatment is indicated for a patient with signs of infection after a burn?

Topical antimicrobials Signup and view all the answers

What is the primary purpose of an escharotomy?

To relieve pressure and promote lung expansion Signup and view all the answers

What type of skin graft uses skin from a different species, such as a pig?

Heterograft Signup and view all the answers

What is an indicator of Curling's ulcer in burn patients?

Bright red blood in vomit Signup and view all the answers

What nutritional components are critical for skin repair in burn patients?

Healing minerals like zinc and iron Signup and view all the answers

Which of the following is a recommended room condition for burn patients?

85 degrees Fahrenheit and 30-50% humidity Signup and view all the answers

Study Notes

Tumors of the Skin

Keloids are an overgrowth of collagenous scar tissue at the site of a wound on the skin.
- More prevalent in African Americans than Caucasians.
- Skin becomes raised, hard, and shiny.
- Can be pink, red, or flesh-colored.
- Treatment options include corticosteroid injections, radiation, cryotherapy, laser surgery, and surgical excision.
- May recur and be larger after treatment.
Angiomas are a group of blood vessels that dilate and form a tumor-like mass.
- Port Wine birthmarks are a common type of angioma.
- Discoloration is not elevated and may be found on any part of the body.
- Treatment options include electrolysis and radiation.
Spider angiomas resemble little spider veins.
- Also known as telangiectasia.
- Can be associated with liver disease.
- Often resolve when liver disease improves.
Warts, also known as Veruca, are benign viral warty skin lesions.
- Have a rough papillomatous (nipple-like) growth.
- Can be singular or in groups.
- Thought to be contagious.
- Commonly found on hands, arms, and fingers, but can occur anywhere.
- Plantar warts are found on the soles of the feet and can be painful.
- Treatment options include cauterization, solid carbon dioxide (dry ice), liquid nitrogen, and salicylic acid.
- May take multiple treatments to eliminate.
Nevi (moles) are non-vascular tumors, also known as birthmarks.
- Some may be malignant.
- Raised black nevi are the most threatening and should be removed to prevent malignancy. Clients should self-examine their skin, including their backs, for changes in color, size, texture, bleeding, or purpura.
- ABCDE: Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, and Elevation or Enlargement should be investigated.

Skin Cancer

Basal Cell Carcinoma is a type of skin cancer that originates in the basal cell layer of the epidermis.
- Often found on the face and upper trunk.
- May be subtle and unnoticed.
- Can appear as a red, scaling area that comes and goes.
- Can cause underlying tissue destruction and progress to vital structures.
- Causes include chemicals, sun exposure, and radiation treatments.
- Usually presents as a scaling appearance with a pearly papule with a central crater and a waxy pearly border.
- Early detection and complete removal using the Mohs procedure is recommended for the best outcome. The Mohs procedure involves taking layers of tissue and examining them under a microscope until no further cancer is found.
- Can reoccur in 40-50% of patients.
Squamous Cell Carcinoma arises from the epidermis, forming a firm nodular lesion topped with a crust or an ulceration.
- Found most commonly in sun-exposed areas, such as the head, neck, and lower lip.
- May also occur in areas of chronic irritation or injury, such as scars, irradiated skin, or leg ulcers.
- Metastasis occurs in 10% of patients.
Malignant Melanoma is a cancerous neoplasm that occurs when pigment cells (melanocytes) invade the epidermis, dermis, and sometimes subcutaneous tissue.
- Can arise in pre-existing moles.
- Heredity is a factor.
- Individuals with a large number of moles of varying sizes and colors should have regular dermatologic exams.
- Sun exposure, chronic skin irritation, family history of unusual moles and melanoma, and personal history of melanoma increase the risk.
- The four types of melanoma are superficial spreading melanoma, lentigo malignant melanoma, nodular melanoma, and acral lentiginous melanoma.
- Superficial spreading melanoma is the most common and is characterized by irregular shape and multiple colors.
- Lentigo malignant melanoma is typically found on the heads and necks of older adults and presents as tan flat lesions with changing shape and size.
- Nodular melanoma appears as a blueberry-type growth and varies from blue to black or pink. It grows and metastasizes quickly.
- Acral lentiginous melanoma occurs in areas not exposed to the sun and without hair follicles, commonly on the hands, soles of the feet, and mucous membranes of dark-skinned people.
- Diagnosis is made through biopsy.
- Treatment options include wide surgical excision of the lesion, sometimes requiring a skin graft, immunotherapy, chemotherapy, chemo-immunotherapy, and radiation.

Alopecias

Alopecia is hair loss, often not permanent unless due to aging.
Hirsutism or Hypertrichosis is excessive hair growth in a masculine distribution pattern.
- Can be hereditary or acquired due to hormone dysfunction or medications.
- Treatment methods include dermabrasion, electrolysis, chemical depilation, shaving, tweezing, and rubbing with a pumice stone.
Hypotrichosis is the absence or decrease in hair growth.
- Can be caused by various factors, including skin diseases, endocrine problems, and malnutrition.
- Treatment focuses on addressing the underlying cause.

Nail Disorders

Onychomycosis is a disorder of the nails.
- The nails become soft, brittle, and their shape can change as they grow into soft tissue.
- Includes conditions like ingrown toenails and infections around the nail.
- Infected nails become painful and may loosen and separate from the tissue.
- Treatment includes wet dressings, topical antibiotics, and sometimes incision and drainage for infections.

Burns

Thermal burns are the most common, caused by flames or scalds (boiling water).
Non-thermal burns are caused by electricity, chemicals, or radiation.
The extent of tissue destruction depends on the burning agent, temperature, condition of the skin, and duration of exposure.
Factors affecting burn severity include:
- Extent of the burn: Documented as the percentage of body surface area burned.
- Depth of the burn:
  - Superficial (first-degree): Dry appearance, minimal/no edema, blanches with pressure and refills rapidly. Primarily affects the epidermis.
  - Partial thickness (second-degree): Large moist vesicles that increase in size, blanches with pressure and refills rapidly. Affects the epidermis and dermis.
  - Full thickness (third-degree): Dry, leathery appearance, charred vessels visible, no blanching with pressure. Affects the epidermis, dermis, and subcutaneous tissue.
Burns exceeding 20% of the total body surface area result in significant evaporative water loss and fluid shifting into the interstitial spaces.
Chemical Burns: Requires extensive rinsing with cool water for many minutes to remove the chemicals.
Electrical Burns: Have an entry and exit site, often leading to cardiac arrest. CPR is necessary if a pulse is absent.

Burn Stages and Emergent Phase

Emergent Phase: Occurs from the time of the burn up to 48 hours.
- Greatest risk is burn shock (hypovolemic shock) due to fluid evaporation and shifting from the vascular compartment to the interstitial spaces.
- Treatment includes:
  - Oxygen
  - Intubation if needed
  - Control bleeding
  - Remove non-adherent clothing and jewelry
  - Cover with a sheet or cloth
  - Transport to the hospital
- Fluid loss is greatest within the first 12 hours.
- Damaged capillaries dilate, leading to capillary hyperpermeability for about 24 hours, causing edema and blistering.
- Fluid shift results in:
  - Third spacing: Fluid moves from the vascular space (blood vessels) into the interstitial space (tissues).
  - Burn Shock: Dehydration of cells, leading to hypovolemic shock.
- Burn shock causes:
  - Hypotension
  - Decreased urinary output
  - Tachycardia to compensate
  - Increased respirations to deliver oxygen
  - Restlessness
- Laboratory abnormalities:
  - Increased hemoglobin and hematocrit due to fluid loss
  - Decreased sodium
  - Increased potassium due to cell damage.
  - Decreased plasma proteins and electrolytes
- Smoke Inhalation: Can cause damage to the cilia and mucosa of the respiratory tract and potentially lead to carbon monoxide poisoning.
  - Signs and symptoms include:
    - Singed nasal hairs
    - Soot in the throat
    - Hoarseness
    - Stridor (noisy breathing)
    - Productive cough
    - Agitation
    - Tachypnea (rapid breathing)
    - Flaring nostrils
    - Intercostal retractions (pulling inward between ribs)
    - Brassy cough
    - Grunting or guttural sounds
    - Erythema or edema of the oropharynx or nasopharynx
  - Carbon monoxide poisoning can mimic hypoxia, so ABG's are recommended over pulse oximetry.
  - Signs and symptoms of carbon monoxide poisoning include:
    - Headache
    - Nausea
    - Vomiting
    - Unsteady gait
  - Treatment for carbon monoxide poisoning includes 100% oxygen.

Acute Phase

Acute phase: Occurs from 48 to 72 hours after the burn.
- Fluid shifts back from the interstitial space to the vascular space, leading to circulatory overload and increased risk of heart failure.
- Increased cardiac output and renal perfusion.
- Signs of fluid shift:
  - Increased urine output
  - Decreased edema
  - Diuresis (increased urine production)
- Goals of treatment in the acute phase:
  - Treat the burn wound
  - Prevent and manage complications
- Increased metabolism, urinary output.
- Vital signs stabilize:
  - Increased blood pressure
  - Decreased heart rate and respiratory rate
  - Improved level of consciousness
- Common complications:
  - Heart Failure
  - Renal Failure
  - Paralytic Ileus (cessation of bowel sounds)
  - Contractures: Shortening and tension in the muscles, causing limited movement.
  - Curling's Ulcer: Duodenal ulcers that develop 8-14 days after severe burns, indicated by bright red blood in vomit.
- Laboratory shifts:
  - Decreased hemoglobin and hematocrit
  - Decreased sodium
  - Decreased potassium
  - Increased white blood cells (initially), then decrease with shift
  - Possibly elevated glucose due to stress
  - Slight hypoxia (low oxygen levels) from metabolic acidosis
  - Decreased total protein and albumin due to fluid loss
- Treatment:
  - Oxygen
  - Fluid resuscitation with lactated ringers
  - Inotropic agents (to increase cardiac output)
  - Osmotic diuretics (to reduce fluid overload)
  - Central line insertion for IV fluids
  - Urinary catheter with hourly urine output measurement
  - G-tube for aspiration prevention
  - Frequent small doses of morphine for pain (monitor respiratory rate)
  - Tetanus booster if not given within the last 5 years
  - Elevate extremities to reduce edema
  - Turn, cough, and deep breathe
  - Topical antimicrobials
  - Nutrition: High caloric, high protein diet, oral supplements as needed
  - Range of motion to prevent contractures
  - Monitor for acute renal failure (BUN, creatinine), heart failure (edema, fluid in the lungs), and infection.
- Infection is the most common complication after 72 hours, requiring reverse isolation.
- Signs of infection:
  - Erythema (redness)
  - Odor
  - Green or yellow exudate (drainage)
  - Wound cultures should be obtained
- Treatment for infection includes antibiotics.
- Nutrition needs increased protein, calories, vitamins, minerals, and calcium, zinc, magnesium, and iron for skin repair and general nutrition.
- Encourage small, frequent meals as tolerated.
- 85 degrees Fahrenheit and 30-50% humidity in the room are recommended.
- Important to address psychological needs.

Eschar Management and Skin Grafting

Eschar is black, leathery tissue that forms over burned areas.
- Harbor microorganisms that can cause infection.
- Can cause circulatory constriction and hinder breathing.
- Treatment:
  - Escharotomy: A surgical procedure that uses a scalpel to make an incision through the eschar to relieve pressure and allow for chest expansion.
Temporary Skin Substitutes:
- Integra: A synthetic skin substitute that stimulates the regeneration of the dermis and skin layer.
  - Used in surgical debridement to promote healing.
  - Removed after it has stimulated tissue growth and replaced with a client's own skin graft.
Traditional Treatment:
- Daily debridement (removal of eschar) to cleanse the wound and promote regeneration.
- Pain medications 30 minutes before debridement
- Topical antibiotics applied after debridement
- Dressing changes twice daily
- Hydrotherapy to soften eschar
Dressing Options:
- Open Dressing: Wounds are left open after debridement and cleansing
- Closed Dressing: Wounds are closed with a dressing after treatment
Fluidized Beds: Used to decrease pressure on burns and promote healing.
Bed Cradles: Used to keep linens off of the burned skin.

Skin Grafting

Autografting: Skin is taken from another part of the client's body and placed on the burned area.
Homograft: Skin is taken from another person or a cadaver.
Heterograft: Skin is taken from another species, such as a pig or cow.
Synthetic Skin Substitutes: Man-made graft substitutes are also available.
Post-Graft Care:
- Minimize movement to allow the graft to adhere
- Moistened with lotion daily for 6-12 months
- Protected from direct sunlight with sunscreen for at least 6 months
- Report any changes in the graft, hematoma, or fluid collection
- Elastic stockings worn for 4-6 months for grafts on lower extremities

Nutrition and Rehabilitation Phase

Nutrition for Burn Patients:
- Increase protein and calorie intake due to high energy requirements (1.5-2grams per kilogram of protein, 2000-6000 calories per day)
- Offer high-calorie foods frequently
- Supplements like Ensure may be given
- Small, frequent meals due to decreased appetite
- Vitamin C and Zinc are essential for wound healing
Rehabilitation Phase:
- Goal is to increase independence
- Mobility is a major concern, requiring physical therapy (PT) assistance
- Address psychosocial needs due to changes in body image
- Focus on achieving independence in daily activities
- Monitor for complications.

Additional Definitions

Blanching: When skin becomes pale after pressure is applied
Erythema: Redness of the skin.
Exudate: Drainage from a wound.
Hyperpermeability: Increase in the permeability (leakage) of the capillaries.
Hypovolemia: Decreased blood volume.
Hypoxia: Low oxygen levels in the blood.
NPO: Nothing by mouth.
Intratracheal Tube: A breathing tube inserted into the trachea to assist breathing.
Osmotic Diuretics: Medications that help excrete fluid from the body.
Paralytic ileus: A condition in which bowel sounds are absent.
Stridor: A noisy breathing sound.
Tetanus Shot: A vaccine to prevent tetanus.
Topical Antimicrobials: Medications applied to the skin to prevent infection.
ABG: Arterial blood gas (a blood test that measures oxygen and carbon dioxide levels)
BUN: Blood urea nitrogen (a measure of kidney function)
Creatinine: A measure of kidney function
H&H: Hemoglobin and hematocrit, which measure the concentration of red blood cells in the blood.
Albumin: A protein found in the blood that helps to maintain fluid balance.

Home Care Considerations

Bathe twice a day with mild soap.
Test water temperature before bathing as skin is sensitive.
Clean the tub thoroughly before each bath.
For severe itching, use a lukewarm bath with alpha-Keri lotion.
Do not use lotions containing lanolin or alcohol as they can cause blisters.
Avoid direct sunlight.
Wear light clothing to cover burned areas.
Discoloration and scarring are normal during healing.
Scars may remain red for 6-12 months before softening and changing color.
Normal skin color may take several months to return.
Report any signs of infection to the healthcare provider (e.g., fever greater than 101°F, inability to cope).
Schedule follow-up appointments with the provider for burn and wound progress checks.
Multiple return visits are needed to monitor healing.

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Description

This quiz covers various types of skin tumors, including keloids, angiomas, spider angiomas, and warts. You'll explore their characteristics, prevalence, and available treatment options. Test your knowledge on these common skin conditions and their implications.