Integumentary

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The complete review for Integumentary system for nursing board exam.

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Integumentary

  1. 1. Integumentary Bienes, lyco nino
  2. 2. Diagnostic Test A. Skin biopsy  1. methods: punch, exisional, incisional  and shave 2. Obtain informed consent  3. cleanse site as prescribed  4. use surgically aseptic technique for  biopsy site dressing 5. assess the biopsy site for bleeding  and infection 6. keep dressing in place at least 8 hrs 
  3. 3. B. Wood’s light examination   1. skin is viewed under UV through a special glass (Wood’s glass) to identify superficial infections  2. darken the room before the examination  3. assist the client during the adjustment form the darkened room
  4. 4. C. Skin Testing  1. administration of an allergen  2. by patch, scratch or intradermal techniques  3. D/C systemic corticosteroids and  antihistamine therapy for 5 days 4. obtain informed consent  5. site should be dry  6. if patch is applied, avoid activities that may  produce sweat 7. record the date and time for follow-up site  reading 8. provide least of potential allergens 
  5. 5. D. Tzanck’s Smear   1. fluids and cells from vesicles and bullae  2. viral infections such as herpes E. Scabies Scraping   1. unscratched lesion looking fro the mite, eggs or feces
  6. 6. Skin disorders A. Dermatitis   1. inflammatory response of the skin that produces skin changes after contact with a specific antigen  2 types  A. Allergic contact dermatitis  -eruptions from allergy to poison ivy, oak, drugs, fiber clothing, plants and dyes
  7. 7. B. Primary irritant dermatitis   -occurs when the skin is in contact with strong chemicals such as solvent or detergent 2. Assessment a. Pruritus with burning sensation b. Edema c. Erythema d. Signs of infection e. Vesicles with drainage
  8. 8. 3. Medical Management  1. removal of the substance causing the reaction  2. topical lotions, such as calamine or systemic drugs  3. moisturizing creams for lubrications  4. wet dressings with astringent solution, such as Burow’s solution for severe cases
  9. 9. 4. Nursing management   a. Elevate the ext. to reduce edema  b. Apply cool dressings and tepid baths  C. Cool environment  d. Protect area from trauma  e. Prevent scratching and rubbing  f. Avoid contact with allergens  g. Advise to wear rubber gloves when in contact
  10. 10. Measures to reduce itching or preserve integrity of the 1. keep nails short and clean   2. use light cotton bedding and clothing that allow normal evaporation of moisture  3. wear white cotton gloves if prone to scratching  4. use hypoallergenic soaps  5. pat rather then rub the skin during TSB
  11. 11. Acne Vulgaris 1. self limiting   2. unknown. Androgenic influence on sebaceous gland, inc sebum produced and proliferation of Propionibacterium acnes  3. exacerbation coincides with menstrual cycle  4. heat, humidity and excessive perspiration have a role in increased acne  5. aggravated by cosmetics, picking
  12. 12. A. Assessment   1. appears in chest, face and back  2. closed comedones – whiteheads  3. open comedones – blackheads B. Medical and surgical management   1. topical application of tretinoin (Retin-A) derivative of Vit. A  2. Oral administration of isotretinoin (Accutane) – CI with preg (teratogenic)
  13. 13. C. Nsg Management   1. skin cleansing method  2. not to squeeze, prick or pick at lesions  3. keep hair short, clean and away from the face and forehead  4. wash the hair frequently  5. avoid makeups, lotions, hair sprays and skin care products
  14. 14. Furuncles and Carbuncles 1. furuncle is a boil (dermis), caused  by staph  2. carbuncle is a furuncle from which pus drains. (subcutaneous)  3. boils occur on the face, neck arms, legs and groin (irritation, pressure, frictiona and excessive perspiration)
  15. 15. B. Assessment   1. redness on the skin  2. swollen, tender and painful  3. a yellow or white center at the furuncle  4. fever C. Medical Management   1. hot wet soaks to localize the infection  2. surgical incision or drainage may be
  16. 16. C. Nursing Management   1. not to be squeezed  2. good handwashing technique  3. apply hot moist compresses wunitl drainage occurs  4. use of separate bath linens  5. clothing should be washed separately from family laundry  6. if at perineum, bed rest is necessary  7. fatal pyemia
  17. 17. Psoriasis 1. chronic noninfectious, involving a  faster keratinocytes proliferation resulting to psoriatic patches  2. genetic predisposition  3. triggering mechanism – systemic infection, injury to the skin, stress, injection and climate changes  4. Koebner’s phenemenon- devt of psoriatic lesions at the site of injury
  18. 18. A. Assessment   1. pruritus or may not be present  2. shedding, silvery, white scales on a raise, Reddened plaque at the scalp, knees, elbows and sacral regions  3. a yellow discoloration and thickening of the nails, if affected  4. psoriatic arthritis
  19. 19. B. Medical Management   1. salicylic acid, corticosteroids, vit D prep and retinoid compound – suppress epidermopoieses and cause sloughing  2. occlusive dressings  3. systemic therapy – antimetabolites  4. Photochemotherapy – UV A and psoralen drug
  20. 20. C. Nsg Management –gentle removal   1. wet compresses, coal tar and soft brush  2. emollient creams or salicylic may be applied to soften the thick scales  3. not to scratch and to keep lubricated  4. to wear light clothing over the area  5. patting rather than rubbing
  21. 21. Scabies 1. coexist with pediculosis   2. infestation of Sarcoptes scabiei (itch mite)  3. risk factors: close personal contact and sexually active A. Assessment   1. threadlike, brownish, linear burrows up to 1 cm caused by female itch mite
  22. 22. 2. intense pruritus that worsens at night  B. Medical Management  1. lotions – lindane (Kwell, Scabene) or  permethrin 5% - applied thinly from neck down  and to leave for 8 to 12 hrs. To repeat the ttt after 1 week Lindane – CI to children younger than  age 2 Permethrin 5% (Nix, Elimite) – from  head to sole
  23. 23. Erysipelas – an acute, superficial  rapidly spreading inflam of the dermis caused by GABHS  Cellulitis – deeper into the dermis and SQ fats caused by Strep pyogenes  Vitiligo - hypopigmentation
  24. 24. Alopecia aka Baldness Causes   - neoplastic drugs, inadequate diet, tinea infection, improper application of hair care products or styling  Two types  A. Alopecia areata – i - autoimmune disorder  characterized by patchy area of hair loss
  25. 25. B. Androgenic alopecia - e  -genetically acquired Management 1. Minoxidil (rogaine) – promote hair growth
  26. 26. Head lice / Pediculosis capitis Assessment A. Intense pruritus 1. Presence of tiny silver or gray 2. specks that are visible and firmly attached to the hair shaft near the scalp, behind the ears, nape of the neck B. Medical Management - pediculicide shampoo - permithrin rinse (Nix)
  27. 27. C. Nsg Management   1. clothing and bedding should be changed daily and should be washed separately from family laundry  2. furnitures, maps and carpets should be vacuumed frequently  3. all contacts of the infested patient should be examined ( every 2 weeks)
  28. 28. Nail Disorder Onychocryptosis aka Ingrown Toenail Assessment A. redness, swelling and pain 1. Compensatory gait and postural 2. change 3. Local pressure from abnormal growth B. Causes 1. trauma, external pressure (tight shoes), internal pressure ( deformed toes), infection
  29. 29. B. Nsg management   1. tripping straight across  2. filing the corners  3. prevent pressure from the surrounding  4. warm wet soaks  5. visit a podiatrist C. Surgical management 
  30. 30. Fungal Infections/ mycotic/ Tineas A. Tinea Pedis ( Athlete’s Foot)   -most common  -soaks of Burow’s sol saling and K permanganate to remove crust T. Corporis – body B. C. T. Capitis – scalp D. T. Cruris (jock itch)- inner groin, buttocks E. T. Unguium ( onychomycosis) - nails
  31. 31. Management   1. keeping the area dry and clean  2. avoid sharing of personal clothings  3. administration of antifungal
  32. 32. Decubitus Ulcer - skin lesions resulting from prolonged  pressure which then deprives the skins of oxygen  -common locations: skin over bony promninces Measures that reduce conditions  under which pressure sores are likely to form  1. TTS every 2 hrs  2. keeping client’s skin clean and dry
  33. 33. 3. massaging bony prominence if the  client’s skin blanches with pressure relief  4. using moisturizing skin cleanse rather than soap  5. applying pressure – relieving devices to the bed and chairs  6. padding body areas that are subject to pressure and friction  7. avoid shearing

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