Integumentary (Skin) Notes
Integumentary (Skin) Notes NSG 335
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This 6 page Class Notes was uploaded by Brieanna Phipps on Sunday January 31, 2016. The Class Notes belongs to NSG 335 at University of North Carolina - Wilmington taught by Dr. Sauer in Spring 2016. Since its upload, it has received 13 views. For similar materials see Pathology and Pharmacology in Nursing and Health Sciences at University of North Carolina - Wilmington.
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Date Created: 01/31/16
Functions of the skin -PROTECTION -barrier -body temperature regulation -immunity -vitamin D activation Changes that occur with aging -the skin is thinner, more dry, and wrinkles appear -there is a loss of elastin and collagen -wound healing is decreased -decreased sensation, especially pressure and touch -temperature regulation is decreased Types of primary lesions -macule: flat, less than 1cm (mole) -papule: elevated, less than 1cm (wart) -patch: macule that is greater than 1cm (discolored skin, port-wine) -plaque: elevated, rough and firm (psoriasis) -wheal: elevated edema (insect bite) -nodule: elevated deep in dermis (lipomas) -tumor: elevated, solid, greater than 2cm (neoplasm, hemangioma) -vesicle: elevated, superficial, and filled with fluid (varicella, shingles) -bulla: vesicle, less than 1cm (blister) -pustule: elevated, superficial, filled with pus (acne) -cyst: elevated and encapsulated (acne, sebaceous cyst) -telangiectasia: fine, irregular red lines (rosacea) Types of secondary lesions (caused from a disease process) -scale: flakey skin (dermatitis, drug reaction) -keloid: irregular, elevated, growing (incision) -scar: fibrous tissue after injury of dermis -excoriation: loss of epidermis (scratch, abrasion) -fissure: linear crack in dermis (athlete’s foot) -erosion: loss of epidermis (varicella after the vesicle bursts) -ulcer: loss of epidermis (decub, stasis ulcers) -atrophy: thinning of skin (aging) Medications -Bacterial: cellulitis, impetigo, staph vs strep (MRSA) -Erythromycin: macrolide, cheap, staph and strep skin infections, GI SE -Bacteriostatic -macrolide (big molecule) -PO and IV -processed through liver -broad spectrum, used in place of PCN allergies -legionella, Bordetella, diphtheria, chlamydia, URI, otitis media, skin -SE: GI upset, prolonged QT interval -Zithromax (Azithromycin): macrolide, 5-day course (z-pack), better tolerated than Erythromycin -inhibits protein synthesis -absorption is increased with food -better tolerated than EES (diarrhea and abd pain) -cost effective and convenient (5 day dose) -Ancef (Cefazolin): given IV after surgery -similar to PCN -4 generations -IM, IV 6-8 hours -surgery prophylaxis and treating skin or soft tissue infection caused by staph or strep -ADR: anaphylaxis, serum sickness, GI upset, nephrotoxicity and hepatic enzyme abnormalities, bleeding disorders -Tetracycline -broad spectrum; PO, IV, IM -used to treat acne vulgaris -don’t take with calcium supplements, milk, iron, magnesium laxatives, or antacids -ADR: GI upset, can stain teeth, photosensitivity -caution in renal patients -Fungal: tinea capitis (scalp), pedis (athlete’s foot), unguium or onychomycosis (nails), and yeast infections **all –azoles metabolize in the LIVER** -Nystatin -used to treat Candida infections (skin, mouth, esophagus, vagina) -PO, topical -PO can cause N/V/D -Fluconazole (Diflucan) -used to treat candida, hstoplasmosis, vaginitis, esophagitis -PO, IV -use caution with other mediations, can cause increase in blood level (P450) -AE: N/V/D, HA, rash -Ketoconazole -PO and topical -inhibits hepatic cytochrome P450 -needs gastric acid for absorption (no antacids, PPI, H2blockers for 2 hours) -N/V -hepatic metabolism, caution is hepatic impairement -Metronidazole (Flagyl) -anaerobic organism and protozoal infections -C. diff, CNS infections, Abd organs, bones, joints, skin, soft tissues, and GU tract -IV, PO, topical -AE: dizziness, HA, abd pain, nausea, SJS, seizures -interaction with ETOH: flushing, vomiting, KILLER headache Inflammatory Diseases -Allergic contact dermatitis -Stasis dermatitis -Psoriasis -plaque -psoriatic arthritis (autoimmune) -Acne vulgaris -acne rosacea -lupus erythema (autoimmune) Glucocorticoid steroids **treat the SYMPTOM not the PROBLEM** -metabolic changes of carbs, proteins and fats -capillary permeability, suppresses vasoconstriction -retain Na and H20 -preterm babies- support development of lungs -anti-inflammatory -immunosuppressant Viral infections -herpes -varicella -warts Antivirals -Acyclovir (Zovirax) **Inhibits viral replications** -cream, PO, IV, drops -eliminated through kidneys -ADR rare, IV phlebitis Acne Medications **TERATOGENIC PREGNANCY, ABSOLUTE CONTRAINDICATION FOR PREGNANCY** -Tretinoin **retinoid derivative of vitamin A used to treat acne and fine wrinkles** -Increases sensitivity to sun, causes raw and red skin, extremely dry skin -need sunscreen greater than SPF 15 -Isotertinoin (Accutane) **severe acne** -decreases sebum, inflammation -ADR: nosebleed, inflammation of lips, dry itchy face, depression ***ADR WITH TETRACYCLINE AND VITAMIN A AGENTS*** Specific terms -Seborrheic keratosis: most common non-cancer in older adults, brown/black scaly, waxy appearance -Keratoacanthoma (KA): common low grade cancer, may be related to squamous cell carcinoma -Actinic keratosis (AK): pre cancer (10% will become SCC), raised rough sun spot -Nevi (moles): small dark brown/black spots, usually smaller than ¼ inch Skin Cancer -Basal cell carcinoma is the most common nd -Squamous cell carcinoma is the 2 most common -Malignant melanoma is the most dangerous ABCDE of Malignant Melanoma A: asymmetry B: border C: color D: diameter E: evolving
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