NR 283 Exam Review 2 SKIN CH8 Latest Version Rated A+

NR 283 Exam Review 2 SKIN CH8 Latest Version Rated A+   NR 283 Exam Review 2 SKIN CH8 Layers of skin: *varies in layer of thickness • Epidermis a. Avascular/no nerves b. Consists of 5 layers c. Hair follicles d. glands • Dermis a. Elastic fibers b. Collagen fibers c. Flexibility & strength of the skin d. Contains nerves & blood vessels • Subcutaneous tissue (hypodermis) a. Connective tissue b. Fat cells c. Blood vessels d. Nerves e. Macrophages f. fibroblasts Keratin: waterproofing of the skin Melanin: skin pigment- determines color of skin Albinisim: lack melatonin production • lacks pigmentation in iris • White hair • White skin – susceptible to skin cancer • Autosomal rec Vitiligo: small areas of hypopigmentation Melasma: overproduction of melanin • Patches of darker skin Dermis… Sensory receptors: • Pressure • Touch • Pain • Heat • Cold Appendages of the skin: • Hair follicles • Sebaccous glands • Sweat glands Functions of skin: • First line of defense • Prevents excessive fluid loss • Controls body temp • Active in sensory perception • Synthesizes vitamin D Skin lesions: Causes: • Systemic disorders- liver disease • Systemic infection- chicken pox • Allergies to ingest foods/drugs • Localized factors- exposure to toxins Types: • Location • Length of time lesion has been present • Changes to occurring over time • Physical appearance- color, elevation, texture, type of exudate • Presence of pain or pruritus (itching) Macules- freckles, sun spots; small, flat lesions Papule- firm, elevated warts Nodule- fatty tumor, benign Pustule- elevated lesion filled w/ pus (pimple) Vesicle- raised blister, filled w/serous fluid Plaque- buildup of dead skin tissue, psoriasis (silvery color) Crust- opened, dried vesicle, empitygo Lichenification- leather-like appearance Keloid- too much collagen Fissures- cracks in a line, athlete’s foot Ulcer- lack of blood supply (longer healing period), open sore Erosion- has a glistening appearance, a cut Pemphigus- watery blisters; mouth/genitals Comedone- bacteria under skin, blackhead/whitehead a. Contact dermatitis- systemic; poison ivy, allergic to gold, nickel, etc b. Irritant contact dermatitis; bleach (immersing hand in it for a long period of time) c. Uticaria; hives d. Atopic dermatitis (eczema) e. Psoriasis; silvery plaque f. emp=igus; type of vesicle g. Scleroderma- skin tightness Bacterial Infections: • Cellulitis a. Cause: S. aureus or Streptococcus spp b. s/s: reddened area, edematous (swollen), pain, red streaks • Furuncle a. Cause: S. aureus; infected hair follicle b. s/s: firm red lesion, abscess causes large amounts of purulent exudate • Carbuncle a. Cause: cluster of furuncles (boil) b. s/s: red painful bumps, pustule or crust Impetigo a. Cause: S. aureus or A group streptococcus; mainly caused in young kids appears around mouth b. s/s: vesicles, crust, pruritis, • Acute necrotizing fasciitis “flesh eating bacteria” a. Cause: mixture of aerobic & anaerobic bacteria b. s/s: inflamed, painful, dermal gangrene, systemic toxity: fever, tachycardia, hypotension • Leprosy (Hansen’s disease): causing nerve damage, fingers/nose will absorb back into body a. Cause: Mycobacterium leprae b. s/s: vary; affects skin, mucous membranes, peripheral nerves Viral Infections: • Herpes simplex I “cold sore”: can remain latent Herpes simplex II: sexually transmitted • Verrucae (warts) • Varicella (chicken pox): vesicles, itchy • Shingles: latent Fungal Infections: • Candidiasis (thrush) • Tinea capitis: ringworm of the scalp • Tinea corporis: ringworm of the body • Tinea pedis (athlete’s foot) • Tinea unguium (onychomycosis) Other Infections: • Scabies(mites) • Pediculosis (lice) Skin Cancers Warning Signs: 1. Sore that doesn’t heal 2. Change in shape, size, color, or texture of a lesion 3. New moles or odd shape of lesion 4. Lesion bleeds repeatedly • Seborrheic keratosis • Actinic keratosis: pre-cancerous • Squamous cell carcinoma • Nevus: mole • Malignant melanoma: cancerous ABCDE: Appearance Border Color Diameter Elevation • Kaposi’ sarcoma: present in HIV; present in immunosuppressed pts, skin appears purple OTHER types of skin disorders NOT associated w/skin cancers • Discoid lupus erythematosus • Rosacea Respiratory System Disorders CH13 Eu= normal Brady= slow Tachy= fast • Eupenia= normal breathing • 12-20 normal breathing rate/min • Bradypnea= slow breathing • Tachypnea= fast breathing • Hyperpnea= fast, deep breathing; working out • Apnea= no breathing • Dyspnea= difficulty breathing • Orthopnea= occurs when lying down; pt must sit up • Paroxysmal nocturnal dyspnea= wake up gasping Dyspnea: Uses accessory muscles • Substernal retraction • Suprasternal retraction • Intercostal retraction • Nasal flarings Tests: 1. Spirometer 2. Chest x-ray 3. O2 saturation monitor 4. Culture/sensitivity tests; sputum Sputum: • Yellow/green (bacterial infection) • Purulent • Bloody • Thick 5. Auscultation: listening for sounds, perhaps with a stethoscope, within the body Upper Tract Infections: 1. Common cold: • Causes: rhinovirus • S/S: scratchy throat, fever, watery eyes • Tx: fluids, rest 2. Sinusitis: • Casues: cold & allergies= infection • S/S: headache, pressure, hearing issues • Tx: antibiotic, antihistamine 3. Epilogttits: • Commonly seen in children age 2 & under • Causes: bacteria • S/S: drooling, unable to swallow • Tx: anibiotics 4. Croup (larynotracheobronchitis): • Commonly seen in children 2 & under • Causes: viral • S/S: barking cough (stridor), hard time breathing in/out • Tx: cool mist humidifier 5. Infuenza (flu): • Causes: viral • S/S: fever, body aches, headache • Tx: treat the symptoms 6. Scarlet fever: • Causes: strep-beta hemolytic • S/S: strawberry tongue, fine red rash, fever, can affect the heart • Tx: antibiotics 7. Infant Respiratory Distress Syndrome: • Causes: no surfactant in lungs • Tx: ventilator, give surfactant Respiratory sounds: • Normal • Crackle: fluid • Rhonchi: low pitch wheezing due to thick mucus • Wheezing: whistling sound • Stridor: hi-pitch crowing; airway obstruction • Biots • Cheyenne- Stokes • Kussmaul: deep rapid due to acidosis Aspiration: passage of food, fluid, emesis, other foreign material into lungs causing aspiration pneomonia Tests: • Bronchoscopy • Arterial blood gas (ABG): PaO2= 80-100 pH= 7.35-7.45 –aci- alk CO2= 35-45 -resp HCO3= 22-26 -metab CO2- • Lungs are responsible for ridding of co2-repiratory • Acidotic • 45-35 normal range HCO3- • Kidneys- metabolic • 22-26 Atelectasis: alveoli collapse Pneumothorax: • Lung collapse • Spontaneous • men, tall, thin, smokers 1. Tension pneumothorax: cause: lung puncture Tx: needle apsiration 2. Open pneumothorax: stabbing, bullet wound to lung 3. Hemothorax: blood in pleural cavity Diffusion: gas exchange Ventilation: air movement Perfusion: decrease in blood flow Pulmonary embolism: blood clot Lower Resp Tract Infections 1. Pneomonia • Causes: viral, bacterial, fungal, nossocmial, community acquired • S/S: fever, low O2 levels, difficulty breathing, diffusion problems 2. Acute respiratory distress syndrome (ARDS) • Patho: inflammation & alveolar injury • Causes: sepsis, pneumonia, MODS (multi organ dysfunction syndrome) • S/S: dyspnea, resp alkalosis, hypoxemia, crackles, stiff lungs • Tx: ABG, chest xray 3. Legionnaire’s disease • Causes: warm, moist air ex: spas 4. Severe acute respiratory syndrome: • Causes: • S/S: flu-like syndrome, fever, headache, myalgia, chills ,diarrhea, dry cough, dyspnea, nausea, sweats (drenched • Tx: antiviral ribavirin, glucocorticoid 5. Tuberculosis (TB) • Causes: Myobacterium tuberculosis (affects the lungs • s/s: anorexia, malaise (feeling of discomfort not easily identified), fatigue, weight loss, night sweats, prolog=nged cough, purulent suptum contains blood • Tx: TB test, chest xray 6. Anthrax • bacterial infection of the skin, respiratory tract, or gastrointestinal tract • S/S: itchy blisters/bumps, swelling around sore,fever/chills Obstructive lung diseases: 1. Cystic fibrosis • Causes: autosomal rec, thick, sticky mucous obstructing airway • S/S: salty skin, foul stool, distended abdomen 2. Lung cancer • Causes: 90% from smoking, pleural fibrosis • S/S: dyspnea, cough 3. Obstructive sleep apnea (OSA) • Causes: collapse of pharyngeal tissue • S/S: loud snoring w/gasping for air, chronic hypoxia, fatigue, daytime sleepiness • Tx: (CPAP) continuous positive airway pressure 4. Chronic obstructive pulmonary disease (COPD) • Patho: chronic bronchitis, chronic bronchitis, emphysema, asthma • Causes: smoking, air pollution • S/S: cough, wheezing,barrel chest, cyanosis • Tx: chest xray, ABG 5. Pulmonary edema • Patho: Edema of the lungs • Causes: L side heart failure, increased pulm pressure • S/S: pink frothy sputum, dyspnea, decreased or absent breath • Tx: chest xray, thoracentesis Blood & Circulatory Disorders CH 10 • Arteries: oxygenated blood to body • Veins: deoxygenated blood back to heart; has valves • Capillaries: microcirculation within tissues • Systemic circulation: exchange of gases, nutrients, and wastes in tissues • Pulmonary circulation: gas exchange Perfusion: blood flow to tissues Composition of blood: • Plasma • Cellular components: a. Erythrocytes: contains no nucleus, life span 120 days, contains hemoglobin b. Leukocytes c. Thrombocytes: platelets; blood clotting Hematopoiesis • Process of blood cell production • Made bone marrow • 2 types: red & yellow • Erythropoietin- produces in the kidney (erythrocyte production) Hemostasis- Blood clotting • Calcium required • 3 steps: a. Vasoconstriction b. Platelet clot c. Coagulation mechanism Blood Typing • ABO system a. O neg= universal donor • Rh system: a. Rh+ = antigen D present in plasma membrane b. Rh- = absent antigen D Diagnostic Tests • CBC count a. Total RBCs, WBCs, and platelets b. Leukocytosis- increased WBCs c. Leukopenia- decreased WBCs d. Increased eosinophils- allergic reactions • Morphology- blood smears • Hematocrit- percentage • Hemoglobin- oxygen carrying capacity in blood • Reticulocyte count- assessment of bone marrow formation • Chemical analysis- serum levels9ex: iron, B12, floic acid, cholesterol, urea, glucose • Bleeding time- platelet function • Prothrombin time (warfarin) or Partial thromboplastin (heparin)- measures function of various factors in coagulation process Blood therapies • Whole blood, packed RBCs, packed platelets- for anemia or thormobocytopenia • Plasma- to expand blood volume • Artificial blood products- compatible w/ all blood types, no exp date, cannot perform functions of normal whole blood • Epoetin alfa- artificial form of erythropoietin; anemia related to cancer, chronic remal failure • Bone marrow/ stem cell transplant- treatment of cancers, sever immunodefiency Blood dyscrasias (disorders) Patho Causes/factors S/S Tests treatment Anemia Hemoglobinn deficient Reduction in O2 transport Fatigue, pallor (pale face) dyspnea, tachycardia, GI tract inflamed and ulcerated (stomatitis), dysphasia, changes w/skin & hair, CHF (congestive heart failure) Iron deficiency Mild-severe, occurs in all age group, more common in women of childbearing age (menstration) Insufficient iron levels: Dietary intake (low iron), chronic blood loss, impaired duodenal absorption (malabsorption syndrome, severe liver disease Pallor, fatigue, cold intolerance, glossitis, delayed healing, tachycardia, heart palpatations, dyspnea, syncope, strawberry tongue iron supplements Pernicious (B12) Genetic factors, chronic gastritis Lack of intrinsic factor leads to problems w/ absorbing B12 Enlarged red sore shiny tongue, nausea/diarrhea, paresthesia (pin needle feeling) Bone marrow exam, B12 serum level below normal B12 injection Sickle cell Genetic: autosomal 1parent carrier: 50% 2parent carrier: 25% 1parent w/disorder: 100% Abnormal hemoglobin O2 levels are low Severe pain from ischemia & infarction, pallor, weakness, tachycardia, dyspnea, jaundice, splenomegaly Blood tst, prenatal DNA analysis Hydroxyurea, folic acid, bone marrow transplant, immunization in kids aplastic No blood cells due to failure of bone marrow Myelotoxins: radiation, industrial chemicals, drugs Viruses: Hep C Genetic: myelodyplastic syndrome, fanconi’s anemia Infections, excessive bleeding CBC indicates panycytopenia (anemia, leukopenia, thrombocytopenia) Bone marrow biopsy Continuous blood transfusions Polycythemia Increased erythrocytes Distended blood vessels, increased Bp, hepatomegaly, headaches, visual problems, thromboses & infarction, dyspnea Increased cell counts, hemoglobin, hematocrit Radiation, phlebotomy Blood clotting disorders • Hematemesis a. Blood in feces b. Anemia c. Low Bp d. Rapid pulse e. Red, purple, blue spots/freckles • Hemophilia A a. X linked recessive b. Lacks clotting factor VIII c. Prolonged bleeding d. Blood in feces • Von Willebrand’s disease a. Hereditary b. S/S: skin rashes, nosebleeds, easy bruising, bleeding gums, an=bnormal menstrual • Disseminated intravascular coagulation a. Uncontrollable hemorrhage and clotting b. Abruptio placentae, infections, carcinomas, major trauma • Thrombophilia a. Abnormal clots in veins or arteries • Myelodysplastic syndromes a. Low production of cells in bone marrow • Leukemias a. Neoplastic disorder b. Uncontrolled WBC production in bone & lymph node c. Infiltrates lymph nodes, spleen, liver, brain, etc Cardiovascular Flow of blood Blood return to heart= Vena cava- R atrium- tricuspid valve- R ventricle- pulmonic valve- pulm artery- lungs- pulm vein- L atrium- bicuspid valve (mitral valve)- L ventricle- aortic valve- aorta= out to body Murmur a. “swishing” sound when heart valves aren’t closing properly b. Tests: echocardiogram Nodes: a. SA node- 60-100 norm b. AV node- 40-60 norm c. Purkinje- 20-40 Lethal Rhythms Asystole a. Flat line b. Do not shock this pt; render CPR Ventricular fibrillation a. Pt can be shocked or CPR b. Bottom of heart is “quivering” c. no heart beat Ventricular tachycardia a. No heart beat b. Shock or CPR Cardiac Output • Heart rate X stroke volume • Stroke volume • Preload • Afterload Blood pressure • Systolic Bp: 120 • Diastolic Bp: 80 Orthostatic hypotension • Low Bp • Risk of falling Primary Hypertension a. Cause: overweight, smokers, African amer, age, sedentary life b. s/s: non; “silent killer” c. risks: heart attack, stroke, blindness, kidney failure Secondary Hypertension a. cause: renal failure, diabetes mellitus b. s/s: non c. risks: heart attack, stroke, blindness, kidney failure Malignant hypertension-extremely high Bp ex: 220/140 Aortic aneurysm • arterial wall becomes dilated and weak a. saccular: bulging on one side of the wall b. fusiform: dilation of an entire section of the artery c. aortic dissection: tear in the wall & continues to tear as blood flows Venous disorders • varicose veins a. genetic, older age, overweight, prolonged standing, pregnancy b. dilated veins • Deep vein thrombosis a. Blood clots, poor blood circulation, inactivity b. Can break off and risk pulm embolism Peripheral Vascular Disease • Cause: smoking, old age, diabetes, hypertension • Check for: hairy feet (blood supply), warm, shiny, pain in legs, paresthesia (tingling/numbness), gangrene Coronary Artery Disease • Arteriosclerosis: hardening & loss of elasticity in arteries • Atherosclerosis a. Risks non modifiable- genetics, age, gender (male=45-55, female 55-65) modifiable- smoking, high fat diet, alcohol, sedentary life, hypertension, diabetes, oral contraceptives w/smoking b. Angina chest pain: chest pain/discomfort when the heart doesn’t get enough O2 1. Stable- overworking yourself Tx: stop; rest 2. Unstable- chest pain when resting; pre heart attack 3. Variant angina metal- arteries aren’t blocked, arteries begin to spasm • Myocardial infarction a. Coronary artery is completely blocked b. Commonly known as heart attack c. s/s: pressure, heaviness, burning in chest, shortness of breath, weakness, pain in jaw, L arm pain, back pain, anxiety/confusion, sweaty (diaphoretic), gas indigestion (women) • Cardiac arrest a. All circulation stops, heart stops beating • Congestive heart failure a. Heart cant pump hard enough b. Forward effects= perfusion: weak, tired, poor healing c. Backward effects= R side heart failure- backflow into body leads to edema, jugular vein distension, ascites (edema in abdomen) L side heart failure- lungs, pulm edema leads to dyspnea, pink frothy sputum, hypoxemia • Shock a. Hypovolemic shock: loss of blood b. Anaphylactic shock: severe allergic reaction c. Cardiogenic shock d. Vasogenic e. Septic: bacteria in blood Gastrointestinal Dysfunction • Anorexia: lack of desire to eat despite physiologic stimuli that produces sensation of hunger • Nausea: subjective feeling; s/s: vomiting are hypersalivation and tachycardia • Retching: nonproductive vomiting • Vomiting (emesis): forceful emptying of the stomach & intestinal contents thru the mouth • Constipation: Infrequent or difficult defecation Normal is no less than 3/wk  2 types: 1. Primary: Problems w/ colon Weal muscles 2. Secondary: Neurogenic disorders Low residue diet Sedentary lifestyle Medications Hiatal hernia, diverticuli, IBS, pregnancy, aging • Diarrhea Increased frequency of BM Increased volume, fluid content, weight of feces Large volume of diarrhea a. Osmotic diarrhea b. Secretory diarrhea Small volume diarrhea a. Inflammatory BM Steatorrhea “fatty diarrhea a. Causes cystic fibrosis, celiac disease b. Problems w/ digestion c. Problems w/absorption • Abdominal pain: symptom of a number of GI disorders 3 categories: a. Parietal pain: abdominal wall/peritoneum b. Visceral pain: organs c. Referred pain: radiated visceral pain • GI bleeding a. Upper GI bleeding: esophagus, stomach, duodenum b. Lower GI bleeding: jejenum, ileum, colon, rectum Hematemesis: bloody vomit (from esophagus) Hematochezia: bright-red blood (colon, rectum “hemmoraoid”) Melena: burgundy color (old blood; jejunum) Occult bleeding: hidden bleeding (blood cells present in feces) Problems w Oral Cavity • Cleft palate • Caries “cavity” • Periodontal disease Salivary Gland Disorders • Mumps Dysphagia: difficulty swallowing • Mechinal obstructions: inside/outside sophagus (strictures, fistula, tumor) • Functional obstructions: disorders that interfere w/ swallowing, congenital atresia, neurological damage to cranial nerves -alchasia: rare condition failure to the LES to relax because of nerve damage • CM: painful, swallowing, aspiration GERD Reflux of chime within 1-2 hours after eating • Patho: Normally pressures in the esophagus are high w/GERD, pressure is lower affecting the LES delayed gastric emptying • Causes: weakened LES, increased abdominal pressure, weak esophageal peristalsis, hernia or ulcer Hiatal Hernia  Sliding hiatal hernia: Most common Stomach slides thru thoracic cavity thru esophageal hiatus  Paraesophegeal hiatal hernia Stomach herniates the secondary……  Causes: Pyloric obstruction • Blocking/narrowing of the opening between the stomach & duodenum • Acquired or congenital • Manifestations: epigastric pain & fullness, succession splash Gastritis Inflammatory disorder of gastric mucosa • Acute gastritis Cause: injury to mucosal lining by microorganisms (e coli), allergies, alcohol, aspirin, corrosive substances, radiation or chemo • Chronic gastritis- H. Pylori, NSAIDS, alcohol, tobacco • Increased risk of cancer • Diagnosis: endoscopy Peptic Ulcer Disease A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum • Cause: H. pylori, NSAIDS, zollinger Ellison syndrome • 2 types: Duodenal- most common; due to increased acid or inflammation from bacteria Gastric- mucosal barrier damage Manifestations: pain, Intestinal obstruction Any condition that prevents the flow of chime thru the colon • Simple- most common • Functional- paralytic ileus • Patho: obstruction leads to gas & fluid build up, distention, bile & secretions don’t get absorbed • Manifestations: crampy pain followed by vomiting & distension, dehydration/hypovolemia, ischemia/necrosis Postgastrectomy syndromes Caused by anatomic & functional changes in the abdomen & small intestine • Dumping syndrome: rapid emptying of chime; immediately going to restroom after eating • Alkaline reflux gastritis: inflammation of gastric mucosa • Diarrhea • Weight loss: inadequate calorie intake • Anemia/bone/mineral disorders: due to malabsorption