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Fat cells act as _________ __________ for the body and ___________ shock and ___________ against mechanical injury by padding internal structures
Heat insulators
Above the subcutaneous fat lies the dermis, a layer of connective tissue that contains _____ cells
What is the main component of dermal tissue?
Collagen is a protein formed by dermal cells called _____________?
The elasticity of the skin depends on both the quantity and quality of the elastic fibers, which are scattered among the collagen fibers
The major component of the elastic fiber is ?
__________ cells continuously divide to form new cells
The outermost layer of skinÂ…
Stratum corneum
What is a keratinocyte?
A basal cell capable of cell division and located closest to the basement membrane
A keratinocyte takes about 28 to 45 days to move from the basement membrane to the skin surface
Hair follicles are located in the ___ layer of the skin but are actually extensions of the epidermal layer
Sebaceous glands continuously produce sebumÂ…
A mildly bacteriostatic, fat-containing substance
Eccrine sweat glands
Originate from the epithelial cells
Apocrine sweat glands
Are in direct contact with the hair follicle
Poor nutrition, especially protein deficiencies, vitamin deficiencies, and obesity, can predispose a client to skin lesions and delay wound healing
Skin disease is clinically described in terms of _________ and __________ lesions
Primary, secondary
Secondary lesions are changes in the appearance of the ?
Primary lesion
What does lichenified mean?
What is ABCD r/t skin cancer?
A = Asymmetry of shape
B = Border irregularity
C = Color variation within one lesion
D = diameter greater than 5 mm
In describing the location of lesions note whether they are ___________ or ____________
Generalized, localized
Ringlike with raised borders around flat, clear centers of normal skin
Well defined with sharp borders
Several lesions grouped together
Lesions that merge with one another and appear confluent
Widespread, involving most of the body with intervening areas of normal skin; generalized
Occurring in a straight line
With wavy borders, resembling a snake
All areas of the body involved, with no areas of normal-appearing skin
Vascular changes are classifies as normal or abnormal depending on the cause
Small vascular lesions (<.5mm in diameter)
Turgor indicates
The amount of skin elasticity
Common alterations in nail color – White
Chronic hepatic or renal diseases (hypoalbuminemia)
Early arteriosclerotic changes (toenails)
Myocardial infarction
Common alterations in nail color – Yellow-brown
Peripheral lymphedema
Bacterial or fungal infections of the nail
Cardiac failure
Staining from tobacco, nail polish, or dyes
Longterm tetracycline therapy
Normal aging
Normal finding in black people
Nevus or melanoma of nail matrix in white people
Common alterations in nail color – Red
Bacterial endocarditis
Trauma to the nail bed
Normal finding in some patients
Cardiac insufficiency
Polycythemia vera
Common alterations in nail color – Blue
Respiratory failure
Venous stasis disease (toenails)
Common variations in nail shape –
Early clubbing
Lung cancer
Common variations in nail shape – Late clubbing
Prolonged hypoxia
Advanced lung cancer
Common variations in nail shape – Spoon nails
Iron deficiency
Poorly controlled diabetes > 15 years in duration
Local injury
Common variations in nail shape – Beau’s grooves
Acute severe illness
Prolonged febrile state
Isolated periods of severe malnutrition
Common variations in nail shape – Pitting
Alopecia areata
Dark-Skinned Clients
If impaired gas exchange is suspected, examineÂ…
The lips, tongue, nail beds, conjunctivae, and palms and soles at regular intervals for subtle color changes
Use the back of the hand to palpate for increased warmth
Dark-Skinned Clients
Areas of the body where inflammation has recently resolved appearÂ…
Dark-Skinned Clients
Jaundice assessed where...
Oral mucosa, especially the hard palate for yellow discoloration
The most basic skin biopsy techniques is known as Â…
The Punch Biopsy
Dry skin is a flaking of which skin layer?
Stratum corneum
Dehydration of the stratum corneum is also known asÂ…
What is the cause of pruritus?
Stimulation of itch-specific nerve fibers at the dermal-epidermal junction
The anti-inflammatory properties of topical steroid preparations may be maximized if the ointment or cream is applied to –
a) dry skin
b) damp skin
c) open skin
d) cool skin
b) damp skin
What are the thee phases of wound healing?
- inflammatory or lag
- fibroblastic or connective tissue repair phase
- maturation or remodeling phase
For a full-thickness wound to heal the nonviable tissue must be removed to allow gradual filling in of the defect with granulation tissue
A pressure ulcer is any lesion caused byÂ…
Unrelieved pressure
Describe the pathophysiology of a pressure ulcer
- Mechanical forces exerted to or on the skin lead to the formation of pressure ulcers
- These forces – pressure, friction, and shear – lead to direct and ischemic tissue damage
- Injury occurs more often to skin over bony prominences
- May occur anywhere
- Excessive skin moisture increases the susceptibility of the skin to damage when mechanical forces are exerted
Excessive or prolonged pressure can compress blood vessels at the point of contact, leading to ischemia, inflammation, and tissue necrosis
Pressure occurs when the pt. is positioned on a hard, unyielding surface that does not diffuse the weight
Friction occurs when –
Surfaces rub the skin and irritate or directly pull off epithelial tissue
Hydrophobic material
Is beneficial when the wound is relatively free of drainage and the objective is to protect the ulcer from external contamination, such as urine or feces
Hydrophilic (absorbent) material
Draws excessive drainage away from ulcer surface
Superficial infection involving only the upper portion of the follicle
Caused by Staph
Furuncles (boils)
Caused by Staph
Generalized nonfollicular infection with either Staph or Strep involving deeper connective tissue
Herpes zoster (shingles) is caused by
Reactivation of the latent chickenpox virus
Herpes zoster is essentially a disease of ?
Antibacterial drugs for skin disorders (ointments)
- Neomycin sulfate
- Gentamicin
- Chloramphenicaol
- Povidone iodine
- Bactroban
Creams for skin disorders
Antifungal drugs (ointments and creams) for skin disorders
- Clotrimazole
- Nystatin
- Ciclopirox olamine
- Miconazole nitrate
- Econazole
- Tolnaftate
- Haloprogin
- Undecylenic acid
- Ketoconazole
Antifungal powders for skin disorders
- Nystatin
- Tolnaftate
Antifungal oral drugs for skin disorders
- Nystatin
- Clotrimazole
Scabies is a contagious skin disease caused by
Mite infestation
Psoriasis is characterized by what colored scales
Silvery white scales
Common sites of psoriasis
- scalp
- elbows
- trunk
- knees
- sacrum
- extensor surfaces of the limbs
What is a keloid?
An overgrowth of a scar resulting from an excessive accumulation of collagen and ground substance after skin trauma
What is a nevi?
A mole; benign neoplasm of the pigment forming cells
What is a wart?
Small tumor, or verrucae, caused by papillomavirus infection of the skin
What is a hemangioma?
A blood vessel tumor – one of the most common types of benign tumors
What is actinic keratoses?
Premalignant lesions involving the cells of the epidermis
What are factors that increase risk of frostbite?
- age
- immobility
- alcohol use
- vascular disease
- psychiatric disorders
Define accommodation
The process of maintaining a clear visual image when the gaze is sifted from a distant to a near object
What does 20/50 mean?
A person is able to see at 20 feet what a “healthy eye” sees at 50 feet
What is the confrontation test used to evaluate?
Used to examine a patientÂ’s visual fields, or peripheral vision
What is keratoconjunctivitis sicca also called and what is its cause?
- Dry eye syndrome
- Results from changes in the composition of tears, lacrimal gland malfunction, or altered tear distribution
What is bacterial conjunctivitis?
- Pink eye
What are recognized causes of bacterial conjunctivitis?
- Staph aureus
- Haemophilus influenzae
- Pseudomonas aeruginosa
What is trachoma?
A chronic, bilateral scarring form of conjunctivitis caused by Chlamydia trachomatis
For a sharp image to be focused on the retina, the cornea must be _______ and __________
- Transparent
- Intact
With aging, the lens gradually loses water and increases in density
Define intraocular pressure
The fluid (aqueous humor) pressure within the eye
Primary open-angle glaucoma is the most common form of primary glaucoma and is usually bilateral and asymptomatic in the early stages
Angle-closure glaucoma (also called closed-angle glaucoma, narrow-angle glaucoma, or acute glaucoma) has a sudden _____ and is treated as an _____
- Sudden
- Emergency
How does HTN possibly lead to retinal damage and decreased vision?
May cause blood vessel changes in the eyes
What is the vascular complication of diabetes in the retina?
Diabetic retinopathy
In background diabetic retinopathy, the supporting cells of the retinal vessels die, and the capillary walls of the retina allow fluid to leak. As this fluid is absorbed, thick yellow-white deposits, or hard exudates, are formed. The retinal capillaries
The ability of the eye to focus images on the retina depends on the _____ of the eye from front to back and the _____ power of the lens system
- length
- refractive
Myopia is also known as ?
In myopia, the refractive ability of the is too _____ for the eye length
Astigmatism occurs when the _____ of the cornea is uneven
Waxlike secretion of the external ear canal
Conductive hearing loss
Hearing loss resulting from a physical disruption in the transmission of sound waves
MeniereÂ’s diseases
An intermittent but progressive deterioration of hearing and balance
Otitis media
Inflammation/infection of the middle ear
Formation of spongy bone around structures of the middle and inner ear, leading to low-town hearing impairment
Damaging to the structures important for hearing
External otitis
Painful condition caused when irritating or infective agents come into contact with the skin of the external ear
External otitis is also known as
SwimmerÂ’s ear
What happens during otitis media?
An infecting agent introduced into the middle ear causes an inflammation within the mucosa, leading to selling and irritation of the ossicles within the middle ear
The _____ tube and _____, connected to the middle ear by a continuation of cells, are also affected by otitis media
- Eustachian
- Mastoid
What is a myringotomy?
A surgical opening of the pars tensa of the tympanic membrane
What is mastoiditis?
A secondary disorder resulting from untreated or inadequately treated otitis media
Tympanic membrane perforations usually heal within?
24 hours
Define tinnitus
Continuous ringing or noise perception in the ear
Define dizziness
A disturbed sense of a personÂ’s proper relationship to space
Define vertigo
A sense of whiling or turning in space
What is a cholesteatoma?
Benign overgrowth of squamous cell epithelium
What are three distinct characteristics of meniereÂ’s disease?
- tinnitus
- unilateral sensorineural hearing loss
- vertigo
When is a hearing loss termed sensorineural?
If the inner-ear nerve, or sensory, fibers that lead to the cerebral cortex are damaged
What might lead to conductive hearing loss?
Any inflammatory process or obstruction of the external or mille dear by cerumen or foreign objects
Spinal cord neurons do not regenerate
Cervical involvement usually results from a herniation
of the nucleus pulposus in an intervertebral disk
A herniation results in spinal nerve root compression withÂ…
Subsequent motor and sensory manifestations, typically in the neck and down the affected arm
Herniated disks occur most often between the _____ and _____ lumbar vertebrae
- Fourth
- Fifth
Smoking has been linked to _____ degeneration
Clients with low back pain reportÂ…
- sharp, burning posterior thigh or calf pain that may radiate to the ankle or toes
Define paresthesia
Tingling sensation or numbness in the involved limb
If the sciatic nerve is compressed, the client reports Â…
Severe pain when raising a straight leg
Describe the Williams position
Client lies in the semi-FowlerÂ’s position and flexes the knees to relax the muscles of the lower back and relieve pressure on the spinal nerve root
Opioid analgesics are no more effective than nonsteroidal analgesics regarding back pain
What is a diskectomy?
The spinal nerve is lifted to remove the offending portion of the disk
What is a laminectomy?
The removal of one or more vertebral laminae plus osteophytes, if present, and the herniated nucleus pulposus
Spinal shock occurs immediately after injury as a result of
Disruption in the communication pathways between upper motor neurons and lower motor neurons
Spinal (or neurogenic) shock is characterized byÂ…
- Flaccid paralysis
- Loss of reflex activity below the level of the lesion
- Bradycardia
- Paralytic ileus (occasionally)
- Hypotension
Autonomic dysreflexia (aka hyperreflexia) is usually seen in injuries _____ the level of the _____ thoracic vertebra
- above
- sixth
Autonomic dysreflexia results from uninhibited _____ discharge
Sympathetic; the SNS is no longer controlled by higher centers in the cerebral cortex because of the disruption in impulse transmission
Occurs when the head is suddenly and forcefully accelerated forward, causing extreme flexion of the neck
Example – motor vehicle stopping and head continues forward
Occur most often in automobile accidents in which the pts. Vehicle is struck from behind or during falls when the clientÂ’s chin is struck.
Example – whiplash
Axial loading (vertical compression)
Falls on the buttocks or a jump in which a person lands on the feet
Example – falling on bottom from a ladder
Excessive rotation –
Example – motor vehicle ejection
Penetrating injuries –
Classified by the velocity of the vehicle (knife or bullet) causing the injury
Brown-Sequard syndrome generally results from _____ injuries that cause _____ of the spinal cord or injuries that affect half of the spinal cord
- penetrating
- hemisection
Define quadriplegia
Paralysis from the neck down involving all four extremities
Define paraplegia
Paralysis involving only the lower extremities
The number cause of death in SCI patients (replacing renal failure) is/are –
- Pneumonia
- Pulmonary emboli
During the period of spinal shock, peristalsis _____, leading to a loss of bowel sounds and gastric distension
Autonomic dysfunction initially causes an areflexic bladder, which lead to
Urinary retention and neurogenic bladder
The first course of drug treatment for SCI is oftenÂ…
Methylprednisolone (Solu-Medrol)
What is a cause of orthostatic hypotension in SCI individuals?
Interrupted autonomic innervation results in the blood vessels being unable to constrict quickly enough to push blood up into the brain, causing dizziness or lightheadedness
The most important part of promoting self-care in SCI is
Setting realistic goals on the basis of the ptÂ’s. potential functional level
What are ways to potentially stimulate voiding?
- Stroking the inner thigh
- Pulling on pubic hair and hair of the upper thigh
- Pouring warm water over the perineum
- Tapping the bladder area to stimulate the detrusor muscle
List essentials of a bowel retraining program
- Consistent time for bowel elimination
- High fluid intake
- High fiber diet
- Rectal stimulation with or without suppositories
- Stool softeners
Intramedullary tumors account for _____% of spinal cord tumors and are usually _____
- 10
- malignant
Extramedullary tumors account for _____% of spinal cord tumors
Name two risks of the immobilized SCI pt
- Pressure sores
How often ought the SCI pt. be turned in bed or adjusted in chair?
- at least every 2 hours
- every 30-60 minutes
Six types of MS
- Benign
- Relapsing-remitting
- Progressive-relapsing
- Primary progressive
- Secondary progressive
- Malignant
Motor assessment of individual with MS may indicate what findings?
- Increased or hyperactive deep tendon reflexes
- Clonus
- Positive BabinskiÂ’s reflex
- Intention tremor
- Dysmetria (inability to direct or limit movement)
- Dysdiadochokinesia (inability to stop one motor impulse and substitute another)
Sensory assessment of individual with MS may indicate what findings?
- Hypalgesia (diminished sensitivity to pain)
- Paresthesia
- Facial pain
- Decreased temperature perception
What are the ABCÂ’s of drug therapy of MS?
- Avonex
- Betaseron
- Copaxone
What is BRM?
Biologic response modifiers

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