Test 4 NOA

What is the outermost layer of the skin?

epidermis: the outermost layer that covers the dermis, the base continually produces new cells to replace those at the surface

what are the innermost layer of at the skin?

Dermis: strong connective tissue that contains nerve endings, sweat glands, and hair roots, well supplied with blood vessels, causing the skin to redden when surface vessels are dilated, subcutaneous lies beneath the dermis

What are the appendages of the skin?

hair, nails, and sebaceous glands are appendages of the skin

What are the functions of the skin?

protection

temperature regulation

secretion

sensation

synthesis of vitamin D

blood reservoir

How does skin protect our body?

shields underlying tissues from trauma and pathogens

prevents excess loss of fluids from underlying tissues

langerhans cells initiate an immune response when foreign substances invade the epidermis

How does the skin regulate temperature?

alters the diameter of surface blood vessels to dissipate heat through dilation, and retain heat through constriction

sweating helps cool the body because the heat is lost as sweat evaporates from the skin

How does secretion relate to the skin?

sweat and sebum are both secretions

sebum coats the skin, creating an oily barrier that holds in water

sweat promotes loss of body heat through evaporation and plays a role in excretion of wastes

How does sensation relate to the skin?

touch, pressure, pain, temperature, when sensory receptors of the skin are stimulated the nerves convey messages to the brain for interpretation

How doe the skin synthesize of vitamin D

UV rays in sunlight activate a substance that undergoes a series of changes that eventually convert it into vitamin D

What is the blood reservoir of the skin?

blood vessels network that can store as much as 10% of the body’s total blood volume

constriction of these superficial blood vessels shunts blood to vital organs when needed

Why would a pt come to the hospital about their skin?

discomfort, pruritus (itching), color changes, lesions, hair loss, abnormal hair growth

What would the nurse want to know relating to skin past health?

previous diagnosed skin diseases or problems, current and recent medications (including nonprescription medications), and allergies

What would the nurse want to know about the family history relating to the skin?

family history of asthma, hay fever, eczema, food allergies, or skin cancer

What is the functional assessment for the nurse relating to the skin?

pts past and present occupations

exposure to chemicals or other irritants

skin care habits

extent of sun exposure

recent changes in work or living environment

current stresses and sources of anxiety

What would the nurse look for when inspecting the hair?

color, distribution, oiliness and palpate to determine the texture

inspect scalp for scaliness, infestations, and lesions

inspect skin with attention to the…..

color and variation in pigmentation, sun exposed areas are typically darker than protected areas

What should the nurse document in relation to the skin?

dilated blood and angiomas (benign tumors composed of blood vessels)

What changes should the nurse note in relation to the skin?

changes in mole, sores that have been slow to heal, itching unusual hair growth, and changes in nails

What would a physical exam reveal about a pts skin?

other disorders that cause changes in the skin, specific signs and symptoms may be associated with circulatory, respiratory, renal, hepatic, GI, and endocrine disorders

How should the nurse inspect a nevi (mole)?

irregularities in shape, pigmentation, and ulcerations or changes in surrounding skin, nevi are palpated for tenderness and measured in cm

If a nurse finds a rash how should she document it?

describe the location, distribution, and characteristics

What should the nurse note about drainage existing in a skin assessment

note color, amount, and odor

What should the nurse look for when inspecting the nails

shape and contour of fingernails and toenails and color of nail bed, check capillary refill

palpitating the skin is a way to……

collect data about the temperature, moisture, texture, thickness, edema, mobility, and turgor

What is macule?

distinct flat area with color different from surrounding tissue

ex) freckles, petechiae

what is a papule?

any raised solid lesion with clearly defined margins; <1 cm in diameter

ex) mole, wart

What is a vesicle?

raised, fluid filled cavity; <1 cm in diameter

ex) herpes simplex, herpes zoster

What is a pustule?

raised, well defined cavity; <1cm in diameter

ex) acne, impetigo

What is a patch?

macule >1cm

ex) vitiligo

What is plaque?

combined papule that form a raised area >1cm in diameter

ex) psoriasis

What is a nodule?

raised, solid lesion >1cm in diameter: may be hard or soft and may extend deeper into dermis than papule

ex) fibroma, xanthoma

What is a wheal?

superficial, irregular swelling caused by fluid accumulation

ex) allergic response, insect bite

What is a tumor?

firm or soft lesion that extends deep into dermis

ex) lipoma, hemangioma

What is bulla?

thin-walled, fluid filled chamber >1cm in diameter

ex) blister

What is crust?

thick, dried, exudate remaining after vesicles rupture

ex) impetigo, weeping eczematous dermatitis

What is scale?

dry or greasy skin flakes

ex) psoriasis, eczema

What is a fissure?

distinct linear crack extending into dermis

ex) tinea pedis

What is erosion?

shallow, superficial depression

ex) impetigo, herpes zoster, herpes simplex

What is an ulcer?

depression deeper than erosion; may bleed

ex) pressure injury

What is excoriation?

abrasion caused by scratching

ex) scratching with insect bites, scabies, dermatitis

What is a nevus (mole)?

flat or raised; color darker than surrounding skin

What is a cyst?

fluid filled cavity in dermis or subcutaneous tissue

ex) sebaceous cyst

What are some age related changes with the skin?

wrinkling a result of thinning skin layers and degeneration of elastin fibers

sweat glands decrease, although production changes little until advanced age

production of sebum decreases, becoming apparent earlier in women than men

dryness and pruritic are common

skin pales because the number of cells that produce melanin decreases

skin lesions are more common

nails flatten; become dry, brittle, and discolored

What is potassium hydroxide test used to diagnose?

fungal infections of the skin, hair, or nails

What is a Tzanck used to diagnose?

viral skin infections

scabies scrapings are used to detect….

scabies (mites), eggs, or feces excreted by mites

Culture of a skin infection is used to….

identify fungal, bacterial, and viral infections

a black light is used to assess….

for pigmentation changes and superficial skin infections

may also be used to examine the vulva after a sexual assault because it may reveal traces of saliva or semen

What is a shave removal of tissue for a microscopic exam?

specimen no deeper than the dermis is obtained with a scalpel, minimal bleeding

what is a punch removal of tissue for microscopic exam?

circular tool cuts around lesion, lifted up and served

what is an incisional removal of tissue for microscopic exam?

wedge of tissue is removed from the lesion

what is an excisional removal of tissue for microscopic exam?

deep specimens, surgical excision, entire lesion is removed

What are dressings for when treating the skin?

protect healing wounds and to retain surface moisture to promote healing, types include wet, dry, absorptive, and occlusive dressings

wet dressings

used to decrease inflammation, soften crusts, and promote tissue granulation

dry dressing

protect wounds and absorb drainage

absorptive dressing

promote removal of excess exudate and are especially useful in wounds with necrotic tissue

occlusive dressings

protect wounds and maintain moisture to promote healing

negative pressure wound therapy

appears to greatly reduce the time required for healing traumatic wounds, dehisced surgical wounds, skin grafts, pressure injuries, and chronic ulcers

soaks and wet wraps

used to soothe, soften, and remove crusts, debris, and necrotic tissue

warm water is used, various agents may be added for specific skin conditions

what is phototherapy

use of light in combination with photosensitive drugs to promote shedding of the epidermis

may be used to treat psoriasis, vitiligo, and chronic eczema

when would phototherapy be contraindicated?

history of herpes simplex infections, skin cancer, cataracts, and lupus because it aggravates these conditions

what may happen after phototherapy?

pt may have pruritus and dry skin

what should the pt do for 8 hours before and after a phototherapy treatment

wear sunscreen, protective clothing, and dark glasses to decrease exposure to other sources of uv light

What is purities

itching; symptom rather than a disease

what are some causes and risk factors for pruritus?

triggered by touch, temp changes, emotional stress and chemical, mechanical, and electrical stimuli

what are some disorders that would have pruritus as a sx

psoriasis, dermatitis, eczema, insect bites, urticaria, some cancers, renal failure, DM, thyroid disorders, liver disease, and anemia

opiates and phenothiazines can cause

pruitus

What is the treatment for pruritus

apply cold, wet clothes for 5-10 minutes

take oatmeal bath

use moisturizer free of additives, fragrances and perfumes

topical anesthetic (bacitracin, Neosporin)

apply cooling agents like calamine

lukewarm bath

wear loose-fitting clothing

avoid extreme temperature changes

corticosteroids, antihistamines, and local anesthetics may be used

What is atopic dermatitis

eczema

stage one eczema

acute, red oozing crusty rat and intense pruritus

stage two eczema

redness, excoriations, and scaling plaques or pustules

stage three eczema

skin dry, thickened, scaly, and browning gray-ish color

What are some causes and risk factors for eczema

personal or family hx of asthma, hay fever, eczema, or food allergies

immune dysfunction

How is acute dermatitis diagnosed

H and P, skin biopsy, serum immuonoglobin E levels, culture

if am allergy is inspected os the cause of dermatitis

the provider may perform allergy tests to identify allergens

what is the medical treatment for eczema?

emoolient’s, lukewarm socks, and occlusive dressings help to

emollients, lukewarm soaks, and occlusive dressings to keep the skin moist, topical cortical and antihistamine

what is contact dermatitis?

inflammatory condition cause by contact with a substance that ttriggers an allergic response

What is suborrheic dermatitis

chronically relapsing inflammatory death

what does seborrheic dermatitis

affects scalp, forehead below the hairline,, eyebrowns, eyelids, ears sternal area, axillae, umbilicus growing, gluteal crease, and under breasts, mustache and beard can be affect

how does seborrheic dermatitis start as

dandruff

how is seborrheic dermatitis characterized

powdery scales, thick crusts, oily, patches, scales, may be white, yellowish, reddish; pruritus is

what are some causes and risk factors for seborrheic dermatitis

may be inflammatory reaction for the fungal malazzezia

people with IDV infections and parkisons disease are more usectabe

aggravated during clod,d ry during cold, dry winter, months and stress

how is sebbarious dermatitis diagnosed

based on healthcare team and HP exam

what is acne

affects hair follicles and sebaceous glands

what are some characteristic of acne

affects ahir follicles and sebaceous, comedones, pustules, and cyst many often FaceTime neck and upper trunk

adolesece begins and may end in adulthood

What are the causes and risk factors of acne

androgenic hormones cause increased sebum production and bacteria proliferates, sebaceous follicles become blocked and inflamed

what causes acne to get worse (exacerbate)

high levels of progestin in birth control pills, oil based cosmetics, high doses of systemic corticosteroid, hormonal changes associated with periods, endocrine disorders

How is acne diagnosed

health history and physical exam

what is the tx for acne

varies with severity, topical antimicrobials, estrogen, spironolactone

what is the nursing care for acne

explore concerns and knowledge of acne

document tx being used

note medical conditions and medications

what are some nursing interventions for acne

altered self concept, inability to manage treatment program

What is a fungal infection

superficial infections of the skin and mucous membranes caused by fungi (tinea) or yeast

what are the causes and risk factors of fungal infections

warm, moist tissue, sharing contaminated objects, scratching that breaks skin leads to a secondary bacterial infection

what is the term ringworm

used to describe circular lesions of tinea

what is a yeast infection

also called candidiasis caused by C albicans

how is a fungal infection diagnosed

history and physical exam

confirmed with microscope exam of scrapings using KOH wet mount

what is the medical tx of fungal infections

wet compresses and keralytics may be ordered to soften scales with some tinea infections

for AIDS pts, clotrimazole is superior to nystatin

what is the nursing care for a fungal infection

focused assessment, identify conditions that might make a person more susceptible to fungal infections

note antibiotic therapy

aspect skin and mucous membrane for lesions for creamy white lesions (oral candidiasis)

What conditions would make a person more susceptible fungal infections

diabetes, malnutrition, immunosuppression

what are some nursing interventions for fungal infections

disrupted oral tissue integrity, disrupted skin tissue integrity, altered self concept