Skin Grafts & Flaps
What is the primary purpose of a skin graft?
To provide coverage and promote healing over an area where normal skin has been lost.
Which skin cancer is characterized by a pearly or translucent lesion and usually grows slowly?
Basal cell carcinoma.
Which layer of skin is affected by a superficial, or first-degree, burn?
The epidermis.
When caring for a patient with a major burn, what is the first priority?
Assess and maintain the airway.
What is the nurse's first priority when responding to a disaster scene?
Personal and scene safety.
What is the major difference between a skin graft and a skin flap?
A graft initially has no direct blood supply and must establish vascularization from the recipient bed, while a flap retains or establishes its own blood supply.
Which type of skin cancer has a greater metastatic potential than basal cell carcinoma?
Squamous cell carcinoma.
A burn is moist, red, blistered, and very painful. What type of burn is this most consistent with?
A partial-thickness, or second-degree, burn
What important assessment helps the nurse determine whether fluid resuscitation is adequately supporting renal perfusion in a major burn patient?
Urine output.
What system provides a standardized organizational structure for coordinating disaster response?
The Incident Command System (ICS).
A patient with a newly placed skin graft asks why the nurse is avoiding unnecessary movement of the area. What is the reason?
Movement can cause friction or shearing and interfere with graft adherence and vascularization.
What does the "E" in the ABCDE assessment of melanoma stand for?
Evolution—change in size, shape, color, or symptoms.
What is the major physiologic problem that places a patient with a major burn at risk for hypovolemic shock?
Increased capillary permeability causes fluid to shift from the intravascular space into the tissues, resulting in decreased circulating volume.
What should the nurse do first for a patient who has sustained a chemical burn?
Remove the chemical exposure, including contaminated clothing, and begin appropriate copious irrigation.
During mass-casualty triage, which color identifies a patient requiring immediate treatment for a life-threatening but potentially survivable condition?
Red.
The nurse notices that a skin flap has suddenly become pale, cool, and swollen. What complication should the nurse suspect?
Vascular compromise of the flap.
A mole has an irregular border, multiple colors, and an asymmetrical shape. What type of skin cancer should the nurse suspect?
Melanoma.
A patient has facial burns, soot around the mouth, hoarseness, and singed nasal hair. What is the nurse's priority concern?
Inhalation injury and impending airway edema.
Why should ice not be applied directly to a major burn?
Ice can cause additional tissue injury and contribute to hypothermia.
What triage category generally describes patients with minor injuries who can walk and have treatment that can safely be delayed?
Green/minimal.
A patient has a flap with increasing pain, dusky coloration, and delayed capillary refill. What is the nurse's priority action?
Notify the surgeon/provider promptly because these findings suggest impaired perfusion and possible flap failure.
Which skin cancer originates from melanocytes and has significant potential for invasion and metastasis?
Melanoma.
Why is a circumferential burn of the chest particularly dangerous?
It can restrict chest expansion and impair ventilation.
A patient rescued from an enclosed-space fire has headache and confusion, but the pulse oximeter shows an acceptable oxygen saturation. Why should the nurse still suspect carbon monoxide poisoning?
Carbon monoxide can interfere with accurate pulse-oximeter readings; oxygen saturation may appear normal despite impaired oxygen delivery.
In a mass-casualty event, why might a nurse provide less intensive care to one critically injured patient while treating another patient first?
Disaster triage focuses on achieving the greatest good for the greatest number by allocating limited resources according to urgency and likelihood of benefit.