2024CE_INTEGUMENTARY.pdf

2024CE_IntegumentarySystem into the dermis INTEGUMENTARY SYSTEM e.g. A...

2024CE_IntegumentarySystem into the dermis INTEGUMENTARY SYSTEM e.g. Athlete’s Foot Jeffry T. Sangalang, RN Anatomy 1. Epidermis Superficial 2. Dermis Partial 3. Subcutaneous Tissue Full ○ anything below the dermis Types of Lesion Macule Discolored spot on the skin e.g. Freckle Wheal Localized, elevation of the skin that is often accompanied by itching e.g. Urticaria Papule Solid, circumscribed, elevated area on the skin e.g. pimple Nodule Larger papule e.g. Acne Vulgaris Vesicle Small fluid-filled sac e.g. blister Bulla = Large Vesicle ○ e.g. Varicella Pustule Small, elevated, circumscribed Filled with pus e.g. white head *Erosion a.k.a. “ulcer” eating or gnawing away of tissue Diagnostic Tests e.g. Decubitus Ulcer 1. Patch Test *Crust Dry, serous or seropurulent, Diagnostic Test for allergies brown, yellow, red, or green Best Site = Back exudation seen in secondary Other sites: lesions ○ inner arm e.g. eczema ○ abdomen ○ inner thigh *Scale Thin, dry flake of cornified not done in the PH epithelial cells Goal : create an allergic reaction e.g. Psoriasis Time frame : ○ 3-5 days Fissure Crack-like sore or slit that Readings: extends through the epidermis ○ Initial = 1st 48 hours ○ Final = 2nd 48 hours eia  2024CE_IntegumentarySystem Avoid prior to testing: Types of Skin Cancer: ○ Anything that will suppress ○ Basal Cell Carcinoma on white skin immunity most common Corticosteroids ○ Squamous Cell Carcinoma Immunosuppressive second most common Agents ○ Melanoma ○ Cream and Moisturizers worst type ○ Bathing ○ Merkel Cell Carcinoma Acute Period: ○ no bathing Changes in weather trigger allergens to appear, not an allergen itself. 2. Biopsy Reviewing a sample for testing Types: ○ Shave Biopsy top layer ○ Punch biopsy deeper layer **onychectomy = removal of nails ○ Excisional biopsy most invasive Contact Dermatitis scalpel use with healthy tissue Specific Allergen sample Characteristics: Nursing care ○ erythematous ○ WOF bleeding ○ edematous Gold Standard = CA and Psoriasis ○ itchy / pruritus 3. Skin Scraping Nursing Care: evaluation of: ○ Cold compress ○ SarcopticMange ○ Phototherapy ○ Parasitic Infection UV A / B 4. Woods Lamp ○ Topical Steroids a.k.a. “Woods Light” , “Black Light Test” cover part to improve done on the scalp, hairy parts absorption brightest UV Light = Pathologic common material = Nickel Indication: ○ Fungal Infection ○ Bacterial Infection ○ Parasitic Infection Nursing Care: ○ Done in a dark room ○ Patient and Tester will wear safety goggles / glasses ○ 5. Tzanck Smears Deroofing of lesion Indication : ○ Herpes Virus ○ Pemphigus Group Poisonous plants 6. Diascopy Test for erythema in a lesion Characteristics: ○ to check if lesion is blood ○ papulovesicular rash petechiae, purpura ○ Itchy ○ Extravasation MGT: ○ Calamine Lotion Skin Cancer ○ Topical Corticosteroids Self-assessment (Mirror Assessment) Intertrigo ○ body mirror and portrait mirror Risk Factors: Superficial inflammatory skin condition ○ Fair skin Due to friction ○ Family History Characteristics: S/SX ○ Flexural Surfaces ○ Asymmetry Predisposing Factors: ○ Border ○ Obesity Irregular borders ○ DM ○ Color May occur from NC Different Colors / Shades = Diagnostic: Suspicion for Cancer ○ Scraping ○ Diameter At risk for Candida Albicans size of a pencil eraser Treatment ¼ inch or 6 mm ○ Identify / Remove the cause ○ Evolution ○ Antibiotics eia  2024CE_IntegumentarySystem ○ Antifungals ○ CONTACT PRECAUTION BUT NOT ○ Petroleum Jelly ISOLATION ○ Zinc May interact with other kids just cover the mouth Complication : ○ Ischemic Heart Disease ○ Kidney Failure Cellulitis / Erysipelas Erysipelas: ○ inflammation of the superficial layer of the skin Cellulitis ○ deeper layer Pathogen: ○ Staphylococcus ○ Streptococcus S/Sx: ○ Red ○ Swollen ○ Painful ○ Tender Predisposing Factors [HOE]: ○ Hx of CABG Necrotizing Fasciitis ○ Obesity ○ Edema a.k.a. “Flesh-eating Disease” Management S/Sx: ○ Oral / IV Antibiotics ○ Severe Continuous Pain; pulsating Complications [BOSE]: spreading quickly ○ Bacteremia ○ Fever ○ Osteomyelitis Pathogen : GAHBS ○ Suppurative Arthritis Diagnostics: ○ Endocarditis ○ CT Scan ○ Biopsy Forms: ○ Fournier Gangrene Genitalia Treatment: ○ IV Antibiotics ○ Surgery Most common / simple : Debridement Worst case scenario : Amputation Complication : ○ Loss of Limb ○ Sepsis ○ Shock ○ Organ Failure Gold Standard = Biopsy Acne Vulgaris Impetigo Formation of comedones a.k.a. “Infantigo” ○ skin-coloured, small bumps (papules) Most common in young children frequently found on the forehead and Pathogen: chin of those with acne ○ Group A Beta Hemolytic Streptococcus As a result of obstruction and inflammation of (GABHS) pilosebaceous units Heart / Kidney S/sx: S/Sx: ○ Cyst ○ Honey-colored Crust ○ Papules Treatment: ○ Pustules ○ Antibiotics eia  2024CE_IntegumentarySystem ○ Nodules potentiates medicine Causes (By rank of best answer): Koebner’s Phenomenon ○ Unknown ○ appearance of new skin lesions on ○ Hormonal Imbalance previously unaffected skin secondary to ○ Genetics trauma Triggers: ○ Heat Frostbite ○ Humidity ○ Perspiration damaged tissue due to prolonged exposure to MGT: cold ○ Wash face at the end of the day Temperature: Best board answer ○ 40% = Lethal Emergency 6. Radiation General Exposure to Sun 7. Thermal Morphine IV Liquid/ Steam / Fire ○ antidote = Narcan Most common To avoid sudden pain from allodynia ○ Bed Cradle Burn Depth Prevention of Infection = Reverse / Protective Isolation Medications: 1st Degree 2nd Degree ○ Nitrofurazone (Furacin) Superficial Partial Thickness banned in several countries since carcinogenic to animals Positive Epidermis and Discard if discolored Blanching Dermis ○ Sulfamylon (Mafenide Acetate) Pink and Painful Blister A/E: Intact Red Skin ○ most Anemia painful Metabolic Acidosis Healing time ○ **Ace=Aci ○ 2-6 ○ Silver Sulfadiazine (Silvadene) weeks A/E : Leukopenia 3rd Degree 4th Degree ○ Silver Nitrate Full Thickness Full Thickness Fourth can cause discoloration Discard if discolored Leathery Subcutaneous, Hydrotherapy Epidermis and Muscles, and ○ painful procedure Dermis Bones Involved Prevention of Ulcer Subcutaneous Charred ○ Curling’s Ulcer exposed ○ black acute gastric erosion resulting Painless usually requiring as a complication from severe Tingling grafting and burns when reduced plasma Sensation amputation volume leads to ischemia and May need Surgery Painless cell necrosis (sloughing) of the gastric mucosa Phase ○ NGT ○ Antacids 1. Stage 1 : Emergent Phase Shock Phase or Fluid Accumulation Airway Phase eia  2024CE_IntegumentarySystem PRIORITY : ○ ACTIVELY BURNING PATIENT WET blanket Stop, drop, roll ○ Electric Burn look for the power source > switch off Can’t find the source: Paddle/Kick the Patient ○ ED Patient Smoke Inhalation Injury (SII) singed nasal facial hair soot Hoarseness Burns in the face, neck, and chest Burn > 15% TBSA 3rd - 4th degree Fluid Vital Signs Urine Output Loss of Consciousness Percentage of Burn ○ Lund Browder Chart most accurate age-specific ○ Rule of 9’s quickest most convenient ○ Palm Method patient’s palm 1 palm = 1 percent Goal : ○ Hyper Hydrate the patient Parkland Formula ○ 4mL x BSA (%) x weight (kg) 1st half = first 8 hours 2nd half = next 16 hours A. 4mL x 22.5% x 60 kg = 5400 mL Fluid of choice a. Face : 4.5% ○ LRS b. Chest : 9% 1st degree burn never counted c. Left Thigh : 9% ○ Lund Browner d. Sum = 22.5% ○ Rule of 9’s B. 4 mL x 27% x 81.818 kg = 8,836 mL Board exam trick : higher than your answer from a. Left Arm : 9% choices b. Back : 18% goal : promoting diuresis c. Sum : 27% d. 180 lbs = 81.818 kg C. 4mL x 46% x 50 kg = 1, 800 mL a. 1st degree on hand : 0 b. 3rd degree on abdomen : 9% c. 1st degree on bilateral legs : 0 Debridement eia  2024CE_IntegumentarySystem 1. Autolytic Debridement chest because of the burn > Tight skin most conservative treatment Difficulty breathing occlusive moist dressing 2. Enzymatic Debridement Collagenase (Santyl) occlusive moist dressing 3. Biological Debridement Larvae used 4. Surgical Debridement Scalpel 5. Mechanical Debridement sponge / scrub used different stages of wound Skin Grafting 1. Isograft / Syngeneic Identical Twin 2. Autograft Self Donor Site ○ Inner thigh ○ Inner Upper Arm ○ Soft Palate breast genitalia 3. Allograft /Homograft Same species 4. Heterograft /Xenograft Different Species Graft Care Immobilize Keep off pressure Elevate Avoid weight-bearing Photosensitive ○ both donor and receiver site Nutrition High calorie, High protein, high carbohydrate ○ **IF WITH RF IN SITUATION = moderate protein be cautious with RF, common in burns Rehabilitation Hands should be in neutral position ○ other answers grasping position slightly open rolled towel inside hand Feet: ○ Boots ○ Foot board Compartment Syndrome increase in pressure inside a muscle, restricts blood flow and cause pain edema develops ○ followed by increased interstitial pressure Surgical Escharotomy / Fasciotomy ○ priority if the burn is on the neck or eia