NR283 Worksheet 3 Skin and Respiratory

NR283 Worksheet 3 Skin and Respiratory NR283 Worksheet 3 Skin and Respiratory. SKIN 1. Define the following:and give an example of each a. Macule Less than 1 cm, flat, well defined border. Includes freckles and measles. b. Papule Small firm and usually elevated, 1 cm, solid mass, circumscribed border. Includes moles and warts c. Nodule Elevated, solid, palpable mass, 1-2 cm. Includes small lipoma, squamous cell carcinoma and fibroma. d. Pustule Elevated, lesion, usually contains purulent. Includes acne and impetigo e. Vesicle Circumscribed, elevated, palpable mass filled with fluid. Includes poison ivy, chicken pox, and shingles f. Plaque Greater than 1 cm, slightly elevated with a flat surface. Includes psoriasis g. Crust Dry rough surface, dry exudate, or dry blood. Includes a scab. h. Lichenification Thick, dry, rough surface that is almost like leather. Includes eczema i. Keloid Raised, irregular, and increasing mass. Includes scar formation after surgery. j. Fissure Small, deep cracks in the skin that may be painful. Includes athletes foot. k. Ulcer Cavity with loss of tissue, weeping, bleeding, 4 stages. Includes venous stasis ulcer l. Pediculosis An infestation of lice, includes head lice. m. Erosion Shallow, moist cavity located in the dermis. Includes a secondary lesions of herpes zoster n. Comedone Mass of sebum, keratin, and debris blocking the opening of a hair follicle. Includes a blackhead. o. Urticaria Hard, raised lesions on the skin due to a type 1 hypersensitivity reaction. Includes a reaction to shellfish. p. Furuncles Also known as a boil, an infection that begins in a hair follicle. Includes a carbuncle which is a cluster of furuncles. q. Psoriasis Chronic inflammation of the skin, T cells are produced at a faster rate than normal creating patches of thick skin. Includes plaque psoriasis. 2. Match the types of skin disorders with their causative organisms. 1. __D___ Tinea A. Bacterial infection 2. __A___ Impetigo B. Varicella virus 3. __B___ Chicken pox C. Human Herpes Virus 8 4. ___C__ Kaposi sarcoma D. Fungal infection 5. ___E_Plantar Warts E. Human Papillomavirus 3. Discuss an important component in teaching skin cancer prevention. An important component of teaching skin cancer prevention is making sure patients use sunscreen every time they go out in the sun. 4. What is the most invasive skin cancer that nurses must teach patients to identify and treat early? Squamous cell carcinoma is the most common form of skin cancer and is the most aggressive. 5. Why is this skin cancer important to identify and treat early? It is important to treat this cancer early because it can grow rapidly and spread to other parts of the body causing more complications. RESPIRATORY 1. Define the following: a. Apnea The stoppage of breathing usually occurring at night b. Cyanosis This is due to poor circulation, fingers and lips may turn blue c. Clubbing This occurs when the nail beds are greater that 180 degrees. d. Dyspnea Difficulty breathing e. Hemoptysis Throwing up blood f. Hypoxemia Low levels of oxygen in the blood g. Hypercapnia High levels of carbon dioxide in the blood h. Orthopnea Shortness of breath i. Rales Crackling sound when coughing j. Stridor A high pitched crowing sound when breathing usually due to an obstruction of the upper airways k. Wheezing A whistling sound when breathing usually due to an obstruction of the airways 2. Discuss the color and significance of abnormal sputum (see page 281) a. Yellow-green A sign of a bacterial infection b. Rusty or dark A sign of pneumococcal pneumonia c. Large amounts of purulent A sign of bronchiectasis d. Thick tenacious - May be blood tinged A sign of tuberculosis e. Blood tinged Hemoptysis 3. Discuss laryngotracheobronchitis (croup). Include the pathophysiology and clinical manifestations. Croup is a common viral infection usually found in children 1-2 years of age. It begins as an upper respiratory condition with a cough and nasal congestion. The larynx and subglottic become inflamed due to swelling and exudate. This causes obstruction and a barking cough, hoarse voice, and inspiratory stridor. It is usually more severe at night. 4. Discuss epiglottis. Include the pathophysiology and clinical manifestations. An acute infection caused by H. Influenzae type B most common in children 3-7 years of age but can be found in adults. The larynx, supraglottic area, and epiglottis start to swell obstructing the airway. The manifestations include a fever and a sore throat causing the child to refuse to swallow. Child becomes anxious and pale, sits in the tripod position, with a rapid pulse and respirations. 5. Discuss lobar pneumonia. Include the pathophysiology and clinical manifestations. Lobar pneumonia occurs in one or both lobes and is caused by Strep. Pneumoniae. The alveolar wall becomes inflamed. Cells, fibrin, and fluid begin to leak into alveoli which causes a consolidation. Manifestations include a high fever, chills, productive cough with rusty sputum, and rales. 6. Discuss aspiration pneumonia. Include the pathophysiology, risk factors, and clinical manifestations. Aspiration pneumonia occurs when some sort of liquid leak into the bronchi. They cause inflammation causing the airway to narrow and increased secretions. This makes it difficult for the lungs to expand. Risk factors are drinking fluids too fast, inhaling toxic substances, and age. Manifestations include coughing, chest pain, shortness of breath, and cyanosis 7. Discuss cystic fibrosis. Include the pathophysiology and clinical manifestations. a common inherited disorder found in children. It is caused by the gene mutation to the CFTR gene and relates to a protein involved in chloride ion transport in the cell membrane. There is a defect in the exocrine glands that leads to thick secretions. The main effects are found in the lungs and the pancreas where the secretions can obstruct the airways. Within the lungs, the secretions obstruct airflow in the bronchioles and small bronchi causing air to get trapped that causes damage to the bronchial walls. In the digestive tract, the small intestine is blocked preventing the excretion of meconium shortly after the child is born. In the pancreas, the exocrine gland ducts are blocked causing a deficit of the pancreatic digestive enzymes. The bile ducts in the liver can also be blocked preventing bile from reaching the duodenum, interfering with digestion and absorption of fats. Manifestations include salty skin, signs of malabsorption, chronic cough, frequent respiratory infections, hypoxia, fatigue, and failure to meet normal growth milestones. 8. Discuss lung carcinoma. Include the pathophysiology, risk factors, early and late clinical manifestations. The lungs experiences metaplasia, a change in the epithelial tissue usually due to smoking or chronic irritation. The lung tissue becomes more likely to be affected by irritants and inflammation. Smoking, occupational or industrial exposure to carcinogen, and COPD. Early signs include persistent productive cough, dyspnea, wheezing, hemoptysis, chest pain, and hoarseness. Late signs and symptoms include weight loss, anemia, and fatigue. 9. Discuss asthma. Include the pathophysiology and clinical manifestations. Asthma is the obstruction of the bronchioles in a person that has a hypersensitivity. Asthma can be acute or chronic and its two pain types are extrinsic or intrinsic asthma. Extrinsic asthma is associated with acute, short episodes and is caused by a type 1 hypersensitivity. Intrinsic asthma beings later in life and is due to hyperresponsive tissues within the airway tract. Manifestations include coughing, wheezing, tachycardia, hypoxia, respiratory failure, and respiratory distress. 10. Discuss chronic obstructive pulmonary disease (COPD). Include the pathophysiology, risk factors, and clinical manifestations. COPD are chronic respiratory disorders with tissue degeneration and obstruction within the lungs. The pathophysiology starts with damage to the airways and air sacs in the lungs. The damage is unchangeable and progressive and may result in respiratory failure. Manifestations include 11. Discuss pulmonary edema. Include the pathophysiology, risk factors, and clinical manifestations. the fluid collecting in the alveoli and interstitial area reducing the amount of oxygen entering the blood and interfering with lung expansion which also reduces the oxygenation of the blood. Risk factors: high pressure in the pulmonary circulation, left-sided congestive heart failure, inflammation in the lungs, hypoproteinemia. Manifestations: cough, orthopnea, rales, hemoptysis, frothy sputum, labored breathing, drowning feeling, cyanosis, hypoxemia, and paroxysmal nocturnal dyspnea. 12. Discuss pulmonary embolus. Include the pathophysiology, risk factors, and clinical manifestations. A blood clot or mass material that obstructs the pulmonary artery or a branch of it that blocks the floe of blood through the lung tissue. Emboli are usually thrombi or blood clots that originate from the veins deep in the leg. Small emboli are usually asymptomatic, medium sized emboli cause respiratory impairment causing vasoconstriction, large emboli cause right-sided heart failure. Risk factors: traveling for long periods of time, sedentary lifestyle, trauma or surgery, childbirth, congestive heart failure, dehydration, cancer, and increased coagulability of the blood. Signs and symptoms: small emboli cause chest pain, cough, or dyspnea. Large emboli cause chest pain, cough, deep breathing, tachypnea, hemoptysis, and fever. Massive emboli cause crushing chest pain, low blood pressure, rapid weak pulse, and loss of consciousness. 13. Discuss pneumothorax. Include the pathophysiology and clinical manifestations. A pneumothorax is air in the pleural cavity. Closed pneumothorax- spontaneous, idiopathic, ruptured emphysematous bleb. Air enters from inside the lung through a tear in the visceral pleura. Signs include absent breath sounds and hypoxia. Open pneumothorax- caused by a puncture wound through the chest wall. Air enters from outside the body through an opening in the thorax and parietal pleura. Signs include a sucking noise, tracheal swing, decreased blood pressure, and moderate hypoxemia. Tension- open: caused by a puncture through the thorax. Closed caused by a tear in the lung surface. Both contain a flap or one way valve. Signs includes absent breath sounds on the affected side, tracheal deviation to the unaffected side, increasing respiratory distress, shock, distended neck veins, cyanosis, and severe hypoxia. All pneumothorax have increased, labored respirations with dyspnea, tachycardia, pleural pain, and asymmetrical chest movements. 14. Discuss tuberculosis. Include the pathophysiology, incidence, risk factors, and clinical manifestations. Tuberculosis is a disease found in areas of homelessness, poverty, overpopulation, and high HIV rates. It is caused by Mycobacterium tuberculosis. It was thought to be under control but is now starting to occur more often. Tuberculosis most commonly affects the lungs, but it can also affect other organs. In the primary infection, the person has first come into contact with the virus and the microbe is attacked by macrophages causing and inflammatory response. A granuloma containing bacilli is formed at the inflammation site. A healthy person can usually avoid the invasion and not have an immune response to it but the tubercle will remain in the person for years. An unhealthy person will not be able to avoid the invasion and the primary infection may become active. Extrapulmonary tuberculosis is fast acting destroying the lungs and tissues. In secondary tuberculosis, the bacilli have become activated in the person usually due to a suppressed immune system. This causes tissue destruction, large open areas in the lungs, necrosis. Risk factors include, populations of overcrowding, increase in homelessness, traveling often to new areas, increase in HIV/AIDs, and the resistance to several drugs. Manifestations- usually asymptomatic but systemic signs usually occur first. They include anorexia, malaise, fatigue, and weight loss. A low-grade fever and night sweats develop as the disease gets worse. Cough becomes more severe and more productive.