skin consists of which two layer ?

Epidermis & Dermis

Epidermis is the outer layer of the skin and has how many layers?

5 thin layers

Dermis is the inner layer of the skin and has how many layers?

2 layers

Melanocytes

Skin cells constantly regenerating melanocytes gives the skin its hair and color

the dermis contains what?

blood vessels and nerves

Secrete Sebum

oily/wax that protects skin

Skin helps to stimulate vitamin D production when exposed to ultraviolet (UV) light

T/F

True

(vitamin and calcium need to work together)

Keratin

makes skin waterproof

Sebaceous Glands

produce sebum

in some spot melanocytes increase in production and produce brown spots called what?

Senile Lentigines (age spots)

what is the most common complaints of skin disorders

Pruitis(itching) and pain

overexposure to Uv light can cause what?

malignant changes (cancerous skin changes)

skin biopsy

removal of a sample from a skin lesion to differentiate between a benign and malignant lesion

shave biopsy

shave top layer off a lesion

punch biopsy

remove core from the center of a lesion

incisional biopsy

remove/excise the entire lesion

wood light

detects fungal infection

Keloid

a thick ridge of scar that stands up from surrounding skin

Maclue

flat area with a change in skin color

papule

elevated, solid lesion

• wart, elevated moles, limpoma, basal cell carcinoma

Vesicle

larger, raised fluid filled lesion

Bulla

a fluid filled vesicle or blister, larger than 1 cm

pustule

elevated, superficial lesions filled with purulent fluid

plaque

elevated,superfical, solid lesion

wheal

firm, edematous, irregularly shaped area

ABCDE'S

• A-asymmetric
• B-irregular border
• c-color change
• d- diameter change
• e-evolving

mupirocin medication

used topically for staph and strep infections

contact dermatitis

delayed allergic response- allergen has contact with the skin and immune system

Atopic dermatitis

-eczema

-genetic component

-red and itchy skin

Stasis dermatitis

due to venous stasis

-occurs mostly on lower extremities

-begins with erythema and pruitis

Seborrheic dermatitis

inflammation of the scalp, eyebrows, eyelids, ear caneles, nasal libia folds and axillary

acne vulgaris

usually begins during puberty; not contagious

acne rosacea

• usually begins between ages 30-50
• S/S- erythema, papules/Telangiectases (dilation of capillaries causing small red/pruple clusters or "spider veins"

Cellulitus

infection of the dermis and subcutaneous tissues

Furuncle

inflammation of the hair follicles

Carbuncles

collection of boils that have multiple pus "heads"

Onychomycosis

fungal infection of fingernails and toenails

scables

acquired by contact with infested person or their clothing, bed linens, bedding

-contagious

basal cell carcinoma

typically appears as a small, scaly area and tends to become larger as the disease progresses

-most commonly found on face or trunk

squamous cell carcinoma

• caused by sunlight
• starts as small nodule and rapidly becomes ulcerated
• most often appears on head and neck

actinic keratoses

• common among older adults
• pre-cancerous lesions
• appear on fair-skinned people as small, scaly, red or grayish papules
• can evolve into a squamous cell carcinoma that can grow rapidly and metastasize

malignant melanoma

least common form of skin cancer, but causes the most skin cancer deaths

epidermal burn (1st degree burn)

involves only the superficial epidermal layer and usually does not need treatment

-pink/red tender appearance

superficial partial thickness (2nd degree burn)

epidermis and parts of the dermis are affected

-red to white with blisters

-mild to moderate edema

deep-partial thickness (3rd degree burn)

includes tissue damage to the epidermis extending deep into the dermis

-red to white with moderate edema

-no blisters

-occurs from flames, grease, tar, chemical burns

full thickness (3rd degree burns)

tissue damage to the epidermis, deep into dermis and can extend into subcutaneous tissue- nerve damage

-red to tan, black,brown, white

serve edema and hard eschar

deep full thicknesss (4th degree burn)

involves all layers including underlying tissues such as fat, muscle, tendons, bone

-nerve endings get destroyed

emergent phase

first 24-48 hours but can last up to 72 hours

it begins with fluid loss and edema formation

respiratory support (phases of burns)

assess for respiratory distress and monitor signs of respiratory distress

• upper airway- swelling can occur and obstruct the airwya
• lower airway-damage from inhaling smoke and soot

Fluid resuscitation (emergent phase )

parkland formla for fluid restrictions

-4ml lactated ringers (LR) x % burn weight in kg

Auto graft

(preferred) the patients own skin

hemograft

the skin of another person- allograft

heterograft

pig

biosynthetic/synthetic

artificial graft

portal hypertension

ascites, varices, ercephalopathy, often irreversible-transplant may be needed.

Liver biopsy

identifies extent of liver damage, inflammation, fibrosis, or cirrhosis when diagnosis is unclear

Diverticulum

a singular smalll outpouching of the colon wall

Diverticulosis

when multiple diverticula are present without evidence of inflammation with increased pressure within the colon or stool trapped in a diverticulum, a tear can occur.

diverticulitis

• inflammation and infection can develop from diverticulum
• with aging, the incidence of diverticular disease increases as a result of chronic constipation

Crohns Disease

an autoimmune inflammatory bowel disease that can involve any part of the GI tract

Crohns disease S/S

Crampy abdominal pain, chronic intermittent diarrhea (with or without blood), weight loss, and fatigue

-inflammatory symptoms can affect the outside GI tract (eyes, liver, bile ducts, skin, and joints)

crohns disease diet

foods that increase symptoms, such as dairy products, fatty foods, and fresh fruits and vegetables should be limited

Ulcerative colitis

similar to crohns disease however, only occurs in the large intestine and rectum

Ulcerative colitis diet

high fiber foods, caffeine, spicy foods, and milk products are avoided. diarrhea may increase the need for fluids TO prevent dehydration

irritable bowel syndromeq

not a disease but rather a functional problem

HEP A

Fecal-oral route: fecal contact; fecal contaminated flood, water or raw shellfish

HEP B

blood or bodily fluids such as saliva, semen, menstrual or vaginal fluid; equipment contaminate by infected blood

HEP C

blood or bodily fluids that contain blood; IV drug use is the most common birth from HCV-infected mother

pancreatitis

inflammation of the pancreas, may be either acute or chronic.

Acute pancreatitis

inflammation of the pancreas appears to be caused by a process called auto digestion

-commonly associated with heavy alcohol consumption or cholelithiasis (gallstones)

chronic pancreatitis

a progressive fibre-inflammatory disease in which functioning pancreatic tissue is replaced with fibrotic tissue because of inflammation

-appears in LUQ pain that worsens after eating, nausea, and vomiting, weight loss, strerrohaa and intolerance to fatty foods.

Appendicitis

inflammation of the appendix, the small, fingerlike appendage attached to the cecum of the large intestine

S/S of appendicitis

abdominal pain, anorexia, nausea, vomiting, diarrhea, fever, and increased WBC'S. within hours of onset, the pain usually becomes localized to the right lower quadrant at the mcburneys point , mid-way between the umbilicus and the right iliac crest

Peritonitis

an inflammation of the perioneum that occurs from a variety of causes.

common causes of peritonitis

a ruptured appendix, peptic ulcer, gangrenous gallbladder, perforated colon, pancreatitis, peritoneal dialysis, diverticulitis, incarcerated hernia, or gangrenous small bowel

peritonitis S/S

decreased peristalsis results in bloating, full feeling, anorexia, nausea, and vomiting, and no bowel movement or flatus

S/S of diverticulitis

most people have no symptoms. steady or crampy pain in the left lower quadrant of the abdomen is the most common symptom. nausea, vomiting, and bowel habit changes with constipation can occur; other symptoms may include bleeding, fever, and fatigue

cholecystitis

an inflammation of the gallbladder

cholelithiasis aka cholecystolithiasis

the formation of gallstones in the gallbladder

choledocholithiasis

refers to gallstones within the common bile duct.

the nephron is the basic unit of the kidney

T/F

true

creatine normal

0.5-1.2

specific grvaity

1.005-1.03

-the lower, excessive fluid intake

-the higher, dehydration- heart failure or shock

ribrofavin

bright yellow urine

IV contrast or dye, which labs should you get done

BUN and creatine so you dont hurt the kidney

oliguria

decreased urine output

anuria

absence of urine

polyuria

increased urine output

nacturia

excess urination at night

pyuria

puss in urine

always collect cultures before antibiotics T/F

True

which lab is going to tell you how the kidneys are functionign

creatine

BUN.

10-30

ALT NORMAL

7-56

AST NORMAL

10-40

creatine

90-120

Pylogram

imaging of renal pelvis, calyces, ureter.

-labs needed bun and creatine

Renal Angiography

visualizes renal blood vessels

-checking the distal pulses in the legs every 30-60 minutes with vital signs

-do not bend the leg or raise head of bed (more than 45 degrees)

Cystoscopy

scope that goes up through the bladder

-local or sedation for the patient

Is contrast that's instilled dangerous or safe?

dangerous can shut the kidneys down

stress incontience

involuntary urine loss from increasing abdominal pressure

urge inconteience

involuntary urine loss with abrupt/ strong desire to void

disability- associated incontience

inability to get to toilet due to health/ environment barrier

overflow incontience

involuntary loss of urine , associated with bladder over distention

total incocnitence

loss of urine

azotemia

to much nitrogen and creatine / waste products in the blood

cysitis

-aka honeymoon cystitis

inflammation of the bladder wall

Pylelonephritis

kidney infection

-hgiher risk for sepsis

lithotripsy