What cells give a person their skin or hair color?
Melanocytes
How should the nurse prepare the patient to perform a skin assessment?
While respecting privacy and dignity as much as possible, ensure that the entirety of the skin is assessed including genitals and breast area
Topical medication: powders
How should they be applied?
Avoid in what patients?
Pour in hand and patting area
Avoid in Respiratory patients
A patient comes to the ED complaining of painful, red vesicles on one side of the body following the nerve root. What disease does the nurse suspect the patient has?
A patient presents to the ED with a burn injury. What are some first steps as part of the assessment?
Assess and treat ABGs
Remove clothes
Get a Hx
Cool the wound with tepid water
This layer of the skin contains elastin and collagen fibers
Dermis
Vital cultures have to be placed on _____.
Ice
Why should open wet dressings be used for only 72 hours or less?
Prevents the skin from becoming too dry or macerated
The nurse is caring for a patient who has a pressure injury on the coccyx of the 3rd stage. The nurse enters the room and the patient is sitting in bed at 45 degrees. What should the nurse do?
Can turn the patient q2h; tell patient to readjust if able every 15 minutes; put bed at 30 degrees of lower
What is the goal for the rehabilitation stage of burn treatment?
Wound closure with optimal level of function
The top layer of skin is called ________ and acts as a ________________.
Epidermis; barrier
What does WHATS UP stand for?
Where is it
How does it feel
Aggravating and Alleviating Factors
Timing
Severity
Useful other data
Patient's Perception
Patient has painful lesions. What non-pharmacological measure could be offered?
Warm Compresses
Describe the three types of dermatitis:
Contact: exposure to an allergen or irritant (soap, laundry detergent, perfume, or poison ivy)
Atopic (eczema): hereditary and associated with allergies, asthma, hay fever
Seborrheic: often on the scalp, usually with others with oily skin
A burn patient is at risk of hypovolemic shock. What signs or symptoms should the nurse watch out for?
Decreased urine output
Increased heart rate
Decreased BP
Peripheral edema
Describe the two types of receptors that describe feeling
Free nerve ending: heat, cold, and pain
Encapsulated Nerve ending: touch or pressure
What are the three types of skin biopsies?
What is the nurses job?
Skin tears and other minor open wounds should be treated with what kind of dressing?
Nonadherent dressings, xeroform, wrapped gauze
What are the signs and symptoms of psoriasis?
Red papules that form plaques with distinct borders; thickened silvery, white scales often on elbows, knees, scalp, umbilicus, and genitals; itching; dry/brittle hair
A burn patient complains of 10/10 pain in his right leg. His right lower extremity is swollen and has absent pulses. What does the nurse suspect is going on?
Compartment Syndrome
Tell me how the skin changes with aging:
Skin becomes more dry; Wrinkles develop; Epidermal cell division slows; Skin becomes more fragile; Hair becomes thinner and loses color as hair follicles become inactive; fibroblasts in the dermis die; Nails become more brittle; age spots
A patient is coming in for a scratch test. How is it performed? What does a positive reaction result in? What should the nurse have prepared?
Scratched/ pricked allergen for an immediate reaction
Wheal appears if positive
Have resuscitation material nearby
Plastic wrap occlusive dressings should be used less than 12 hours to help decrease the risk of:
Skin atrophy
Folliculitis
Maceration
Erythema
Systemic absorption of the medication
What are the different types of fungal infections:
Tinea Pedis: affects the feet/ athletes feet
Tinea Capitis: Ringworm of the scalp
Tinea Corporis: Ringworm of the body
Tinea Cruris: Ringworm of the groin/ Jock Itch
Tinea Unguium: Ringworm of the Nails/ Onychomycosis
Candidiasis: Thrush
What are some systemic changes due to burns?
Cardiac Function: 48 hours fluid shifts lead to hypovolemia; decreased intravascular fluid, increased hct, decreased platelets
Metabolic Changes: weight loss and decreased wound healing, can stimulate hyperglycemia
GI Problems: Peptic ulcers, Paralytic Ileus
Renal Function: AKI
Pulmonary: oxygen consumption increases