Endocrine Study guide(1).
Skin cancer-define, risk factors, signs and symptoms, medical management, nursing management
Skin assessment
• Asymmetrical
• Border Irregularity
• Color Changes
• Diameter < 6mm
• Evolvi
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Endocrine Study guide(1).
Skin cancer-define, risk factors, signs and symptoms, medical management, nursing management
Skin assessment
• Asymmetrical
• Border Irregularity
• Color Changes
• Diameter < 6mm
• Evolving Appearance
Prevention strategies
• Avoid environmental hazards (prolonged sun exposure, radiation, irritants or allergens, proper hygiene and nutrition, and self examination.
Basal cell: most common type of skin cancer and least deadly.
Squamous cell: potential for metastasize. Pipe, cigar, and cigarette smoking.
Malignant melanoma – define, risk factors, signs and symptoms, medical management, nursing management
• Cause unknown: environmental factors, genetic factors.
• S/S: ABCDE Rule
o asymmetry
o border irregularity
o color change
o diameter >6mm
o evolving in appearance
• Risk factors:
o red or blond hair
o light colored eyes
o fair skin that freckles
o chronic sun exposure
o family history
• Tumor staging:
o O-IV
o Tumor size
o Nodal involvement
o Metastasis
o T-N-M
• Diagnosis/Collaborative Therapy
o topical therapy
o phototherapy
o radiation therapy
o laser therapy
o drug therapy
• Diagnostic/Surgical Therapy
o skin scraping
o electrodesiccation
o electrocoagulation
o curettage: scraping
o punch biopsy: extraction of tissue for pathologist to view to diagnose pt
o cryosurgery: liquid nitrogen used to destroy unwanted tissue
o excision - Mohs procedure: most effective for BCC and SCC, taken off little by little till normal cells found
• Nursing Management
o ambulatory and home care
o wet dressings
o baths
o topical medications
o control of pruritus
o lichenification (skin becomes thick and leathery due to constant itching)
o prevention of spread
o prevention of secondary infections
o specific skin care
Mohs procedure: during Mohs surgery, thin layers of cancer containing skin are progressively removed and examined until only cancer free tissue remains. Also known as micrographic surgery.
Burns-
Types- define, describe damage to tissue, assessment, emergent care and management, nursing management
• Thermal: exposure to flame, hot object/surface, or scalding (stove top, grease, bathtub, hot water)
• Chemical: exposure to acid, alkali, or organic substance (gasoline, household cleaners, garden products.)
• Electrical: electrical energy converted into heat (power cords, power tools, lightening)
Burn classification- describe and define
1
degree: (superficial thickness) sunburn, low intensity flash, superficial scald. Least damage; epidermis is only part of the skin damaged. Erythematous, but epidermis is intact; may blister. Peeling of dead skin may occur in 2 to 3 days after burn.
2
degree: (partial thickness) scalds, flash flame, contact. Involves entire epidermis and dermis in varying depths. Painful and typically associated with blister formations; hair follicles and skin appendages remain intact. Healing time depends on depth of injury and usually ranges from 2-3 weeks.
3
degree: (full thickness) flame, prolonged exposure to hot liquids, electric current, chemical, contact. Destruction of entire epidermis and dermis and sometimes destruction of underlying tissues. Edema; wound color ranges from pale white to red, brown, or charred; burned area lacks sensation because nerve fibers damaged; leathery appearance; hair follicles and sweat glands destroyed. Skin does not regrow.
4
degree: (deep full-thickness) deep burn necrosis. Extends into the fat, fascia, muscle, and/or bone. Prolonged exposure or high voltage electrical injury. Would appears charred; burn shock; myoglobinuria (presence of myoglobin in the urine, usually associated with rhabdo or muscle destruction). Amputations likely; grafting as no benefit.
Rule of nines- the rule of 9s assesses the % of burn and is used to help guide treatment decisions including fluid resuscitation and becomes part of the guidelines to determine transfer to a burn unit. You can estimate body surface area on an adult that has been burned by using multiples of 9.
Smoke and inhalation injury- signs and symptom, assessments, treatments, complications
• Caused by components of smoke, heat particules, systemic toxins.
• Mechanisms of injury is thermal damage, asphyxiation, and irritation of the pulmonary tissue.
• S/S:injury occurring in an enclosed space; burns of the face or neck, singed nasal hair; hoarseness, high-pitched voice change, stridor; soot in sputum; dyspnea or tachypnea and other signs of reduced oxygen levels; erythema and blistering of the oral or pharyngeal mucosa.
• Upper and lower airway injuries result in edema.
• Pulmonary deterioration by be delayed as long as 24-36 hours
Emergent phase- define, time frame, assessments, medical management, nursing management
• Severity of Injury:
o Determination of depth: how the injury occurred, causative agent, temperature, duration of contact with causative agent, and thickness of the skin.
o Temperatures ≥ 54°C (130°F) for 30 seconds will results in burn injury
o Temperatures ≥ 60°C (140°F) tissues destruction occurs in 5 seconds
o Temperatures ≥ 71°C (160°F) a full thickness burn occurs instantaneously
o Burns that exceed ⅓ of the TBSA are considered major burn injuries
o Consider age of the patient
o Secondary injuries
• Burn injuries that should be referred to a burn center include:
o partial thickness burns greater than 10% TBSA
o burns that involve the face, hands, feet, genitalia, perineum or major joints
o electrical burns including lightning injury
o third degree burns of any age group
o chemical burns
o inhalation injury
• Medical management:
o STABILIZATION
o airway, breathing, circulation
o fluid resuscitation
o assessment of secondary injuries
o removed all clothing and jewelry
o contact lenses? removal
o monitor temp
o validate history of injury
o indwelling catheter
o Burns > 20% TBSA need NGT to LIS
o Tetanus prophylaxis if not given within last 5 years
• Nursing management:
o stabilization of airway, breathing, and circulation
o cardiac monitoring pulse assessment; BP
o large-bore IVs (14 to 18 gauge)
o hourly assessment of intake and output
o infusion pumps for IVF
o elevation of burned extremities above the heart
o indwelling catheter
o pain management
o documentation
Fluid therapy- using the Parkland formula – (4 ml formula)
• Adults with electrical burns
o 4mL LR x patients weight in Kg x %TBSA burned = amount of fluid resuscitation used within first 24 hours
Potential complications
• Fluid and electrolyte shifts
• Cardiovascular problems
• Respiratory problems
• Immune
Drugs used- (pain meds) opioids, NSAIDS, anxiolytics and anesthetic agents. Drug of choice: Morphine
Nutrition therapy
Endocrine Study guide
2 types of glands- exocrine and endocrine (each does what?)
• Endocrine glands - include the hypothalamus, thyroid, parathyroid, adrenals, pancreas, ovaries, testes, and pineal gland. The glands secrete hormones which play a role in
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