Week 6 180

Three; epidermis, dermis, and hypodermis

-Protection against infection and UV rays, chemicals, and physical injury
-Plays a role in temperature regulation and sensation and controls insensible fluid loss
-Key in the production of vitamin D, and can excrete water, ammonia, and urea

-Outermost layer of skin
-Provides the waterproof nature of the skin and influences skin color
-Contains the normal flora

-Layer of the skin below the epidermis that consists of two layers
-Contains sweat glands, hair, hair follicles, muscle, sensory neurons, and blood and lymphatic vessels

-The deepest layer of the skin (also called subcutaneous)
-Contains adipose lobules and connective tissue, hair follicles, sensory neurons, and blood vessels

A disruption in the epidermal layer that can go deeper into the dermis or subcutaneous tissue. Can be acute or chronic and heal in stages from hemostadis through tissue remodeling

-Hemostasis and inflammation
-Clotting cascade is initiated and vasoconstriction occurs. Fibrin mesh is established.
-Vasodilation then occurs, causing hyperemia and edema
-Chemotactic and growth factors complete hemostasis
-Neutrophils are recruited to kill bacteria and debride necrotic tissue

-Proliferation
-Starts 3-10 days and takes weeks to complete
-Characterized by granulation tissue and repair of vascular structures
-Epithelialization begins
-Fibroblasts proliferate to the wound and granulation tissue develops

Provide structure to the body

Skull, sternum, ribs, spine

Connect bone to bone

Connect muscle to bone

Provide oxygen rich blood to the tissues and remove waste

Innervates muscles to communicate signals from the brain and environment that allow for movement and responses to sensory input

Inflammation of the joint leading to joint pain, stiffness, swelling, and decreased mobility

-Immobilization
-Anti-inflammatory medication

Inhibits prostaglandin synthesis to treat mild to moderate pain

N-acetylcysteine

-Monitor liver function throughout treatment
-Avoid alcohol

Inflammation of the synovial membrane from contusion or sprain, repetitive motion, or rheumatologic disease

-Heat or ice
-Anti-inflammatory agents

Softening of the bones leading to increased risk for fractures and pain

-DXA scan
-Lab abnormalities in calcium, magnesium, vitamin D, and parathyroid hormone levels
-Rule out other causes (cancer or kidney disease)

-Biphosphonates
-Bone-builders
-Lifestyle changes

Decreases bone resorption by inhibiting osteoclast activity

-Not recommended for use during lactation
-May cause hypersensitivity reactions
-Monitor serum calcium

-Estrogen replacement to regulate bone metabolism

-May cause fetal harm in pregnancy
-Increases patient risk for thromboembolism and MI
-Increases risk for breast, endometrial, and ovarian cancer malignancy
-Patients should not smoke
-Advise patient to report fluid retention, thromboembolism, or hepatic dysfunction

Decreases number and actions of osteoclasts, inhibiting bone resorption

-Administer PO tablets whole with a full glass of water one hour before other medications or food
-Patients must remain upright at least 30 minutes after PO administration
-Dental exams and preventative work should be done prior to beginning treatment

Decreases osteoclast activity, decreasing bone resorption and increasing bone mineral density

-Increases risk for deep vein thrombosis
-Monitor liver function during treatment
-Discontinue 72 hours before prolonged bed rest
-Patients should take calcium and vitamin D supplements

Controls mild to moderate pain by inhibiting prostaglandin synthesis

-Increases bleeding time
-May cause GI upset, administer with food
-Complete baseline CBC, kidney and liver function tests before treatment
-May cause hypersensitivity reactions in patients with asthma and allergies

Ex: Tramadol
-Binds to opioid receptors, inhibits reuptake of serotonin and norepinephrine

Ex. Tramadol
-Crosses the placenta and enters breastmilk
-Use immediate-release with caution in the geriatric population
-Contraindicated in patients using MAOIs
-Central nervous system and respiratory depression

Suppresses inflammation

-Prolonged use may result in adrenal suppression (hypotension, weight loss, nausea, weakness, confusion)
-Do not discontinue abruptly
-May inhibit growth in children
-May mask signs of infection

Ex: baclofen, cyclobenzaprine
-Centrally and directly acting on skeletal muscle, depending on the specific medication, to decrease muscle spasm

Ex: baclofen, cyclobenzaprine
-Safety in pregnancy is not established
-Contributes to central nervous system depression
-Use cautiously in patients with liver disease

-Pressure ulcers
-UTI
-Contractures
-Ataxia
-Weakness
-Loss of cognitive function
-Falls
-DVT
-Pneumonia

-Characterized by scaly patches of skin
-Caused by an overproduction of keratin
-Thought to be an autoimmune disorder
-Common on elbows, knees, trunk, scalp, and sacrum

Corticosteroids, vitamin D, vitamin A, systemic cytotoxic agents, immune-suppressive agents

-Inflammation of the skin from exposure to allergens
-Lesions do not have boarders
-Patients are at increased risk for infection due to breaks in the skin from itching

Steroids, antihistamines, immunosuppressants

-Viral infection
-HSV1: above the waist
-HSV2: below the waist
-Primary infection: direct contact, respiratory droplet, fluid exposure

-Podromal phase: burning, tingling
-Vesicles and pustules
-Contagious until scars form

-Antiviral agents (oral and topical; acyclovir)
-Antibiotics for secondary infection
-Patient care: avoid triggers, safe sexual practices, avoid spread through straws, cups, or other shared utensils

-Acute inflammation/infection
-Painful vesicles
-Follows nerve distribution, usually one-sided

-Antivirals: acyclovir, valacyclovir, famciclovir

-Psoriasis (topical)
MOA: slows cellular division and reduces inflammation and causes sloughing of skin cells

-Contraindicated in pregnancy
-Monitor for localized reactions, burning sensation, and inflammation of the skin
-Avoid exposure to sun or UV lights

-Psoriasis (topical)
-Prevents cellular proliferation and regulates skin cell division

Ex: calcipotriene, calcitrol
-Monitor for itching, irritation, erythema
-Increased risk for skin cancer with use
-Do not use on face
-Monitor for hypercalcemia (weakness, fatigue, anorexia)

Ex: methotrexate, acitretin
-Psoriasis
-Reduces turnover of epidermal cells; used for severe, intractable cases

Ex: methotrexate, acitretin
-Avoid during pregnancy-can cause fetal death
-Monitor liver and renal function; avoid alcohol
-Decreases effectiveness of contraceptives

Ex: Adalimumab, ethercept
-Moderate to severe plaque psoriasis treatment, suppress the immune system and the stimulation of keratinocytes

Ex: Adalumimab, etanercept
-Evaluate patient for latent TB and Hep B
-Monitor for infection
-Do not use if pregnant or breastfeeding
-Treatment is lifelong with increased risk of cancer
-Avoid live vaccines

Ex: prednisone, hydrocortisone, triamcinolone
-Dermatitis treatment, reduces inflammation of lesions

Ex: Diphenhydramine, cetirizine, fexofenadine
-Dermatitis treatment, relief of redness, itching, and edema

Ex: Diphenhydramine, cetirizine, fexofenadine
-Monitor for urinary retention (anticholinergic effect)
-Can cause photosensitivity
-Can cause drowsiness

Temperature regulation, gland function, sensory function, and entire body systems depending on the severity of the burn

**First intervention is always to stop the burning process
-Remove clothing and jewelry
-Cold water soaks or rinses NO ICE
-Provide warmth
-Complete ABCDE assessment

-Medication for burn treatment
-Reduces fluid loss
-Bacteriostatic
-Inexpensive!

-Stains clothing
-Depletes sodium and potassium
-Does not penetrate exchar

-Medication for burn treatment
-Effective against gram-positive and gram-negative bacteria, and yeast

-Contraindicated in patients with sulfa allergy
-Can cause blue-grey discoloration
-Minimal penetration of eschar

-Medication for burn treatment
-Penetrates eschar
-Bacteriostatic against gram-negative and gram-positive bacteria

-Painful to apply and remove
-Can cause metabolic acidosis

-Medication for burn treatment
-Keeps burn moist
-Bacteriostatic against gram-positive organisms
*Hypersensitivity can develop

Interior body forces upon the skin when moving in opposite directions and may result in deep tissue injury

The mechanical force caused by dragging the skin across a surface, such as changing position in bed

-Perfusion
-Nutrients
-Protein, carbohydrates, fats
-Vitamins A, B, C, D, E
-Medications: pain management, supplementation, infection management

Input from the environment is received from our sensory receptors

Brain receives information from sensory receptors and puts it into context

-Carry sensory information from receptors in skin/other organs->central nervous system (sensory neurons)
-Cell bodies are located outside of the spinal cord

-Carry motor information from brain
->peripheral nervous system (motor neurons)
-Cell bodies are located in the ventral horn of the spinal cord

Involuntary body responses

Voluntary movement by skeletal muscles

Examples: atropine, cyclopentalate
-Temporarily paralyzes the ciliary body, prohibits the eye from focusing on near or intermediate objects, manages ciliary body spasms
-Mild dilation effect
-Allows for better measurement of visual problems
-Medication acts within 20 minutes, lasts for 24-72 hours
-Side effects: blurry vision, light sensitivity, tearing, redness
*Patients with narrow angle glaucoma may experience a dangerous increase in eye pressure

Ex: epinephrine, phenylephrine
-Dilates the pupil with mild relaxation of the ciliary body
-Allows the provider to assess the anatomy of the back of the eye more easily
-Acts within 20 minutes, lasts 24-72 hours
-Side effects: blurry vision, light sensitivity, dry eyes
*Patients with narrow angle glaucoma may experience a dangerous increase in eye pressure

-Aqueous humor usually drains from the ciliary body in the posterior chamber of the eye
-Glaucoma is the blockage or resistance to this drainage leading to a buildup of pressure

-Sudden onset severe eye pain
-Drainage of agueous humor is completely blocked
**THIS IS A MEDICAL EMERGENCY

-Progressive increased ocular pressure against optic nerve
-Eye pain, loss of peripheral vision and visual acuity in the dark, presence of halos around lights
-Corrective lenses do not improve visual sensory perception

Measures IOP (ERR: 10-20). IOP is elevated with glaucoma, especially closed-angle

-Opthalmic solution
-Prostaglandin analog that reduces intraocular pressure by increasing the drainage rate of aqueous humor in the eye
-Instill one drip in effected eyes every 12 hours as prescribed
-Check for corneal abrasions and do not administer if cornea is not intact

-Opthalmic solution
-Beta blocker that reduces intraocular pressure by reducing aqueous humor production
-First-line treatment for glaucoma
-Instill one drop in effected eye every 12 hours as prescribed
-Can cause hypotension, bradycardia, bronchoconstriction, and hypoglycemia

-Always wash hands before and after use
-Avoid touching the tip of the application bottle to the eye
-Once a drop is instilled, apply gentle pressure by placing fingers on the inner corner of the eye
-Wait 5-10 minutes between eye drops if more than one is prescribed to prevent one medication from diluting another

Hearing and balance

-Tympanic membrane
-Ossicles (malleus, incus, and stapes)
-Connects to the nasopharynx via eustacian tube

-Located within the temporal bone
-Cochlea (hearing organ)
-Semicircular canals (balance)

-Signals from these systems send signals to the brain where they are combined with sensory information to coordinate physical movement
-Organs for input are in the inner ear
-Detects the position and movement of our head in space
-Allows for the coordination of eye movements, posture, and balance

-Signals from these systems send signals to the brain where they are combined with sensory information to coordinate physical movement
-Located in muscles, tendons, and joints
-Allows perception of the location, movement, and action of parts of the body relative to each other

-Caused by factors such as otitis media, otosclerosis, and presence of foreign body (such as impacted cerumen)

Causes by damage to cranial nerve VIII

-Protect hearing (ear protection in loud environments)
-Avoid ototoxic medications (Aspirin, ibuprofen, furosemide, aminoglycoside antibiotics (‘micins’)

-Routine hearing examinations
-Assess safety and balance
-Fall precautions
-Monitor blood levels of ototoxic medications
-Hearing aids, cochlear implants

-Antivert
-Has antihistamine and anticholinergic effects
-Used to treat vertigo, decreases excitability of the middle ear labrinth
-Fall precautions
-Do not take with other medications or substances that can cause CNS depression

(Zofran)
-Antiemetic that blocks the effects of serotonin at the 5-HT3 receptor site
-Can cause prolonged QT interval and cardiac dysrhythmias
-Can cause serotonin syndrome: agitation, restlessness, anxiety, depression

Common skin problem caused by gray-brown patches on the face. More common in women than men and pregnancy is a common cause

-Topical combination of hydroquinone cream and avoidance of sun or estrogen exposure
-Discontinuing the use of high-SPF sunscreens (>50)

-Louse infestation
-Pediculus humanus capitus (head louse)
-Pthirus pubis (crab louse)
-Pediculus humanus (body louse)

-Patients frequently present with pruritis
-Itching induces scratching which can lead to secondary bacterial infection
-Can lead to impetigo and pyoderma
-Body lice can transmit trench fever, relapsing fever, and epidemic typhus to humans

Hearing thresholds
-Normal: 0-20 decibels (dB) which equates to being able to perceive a sound quieter than a whisper
-Mild hearing loss: 20-39 decibels
-Moderate: 40-69
-Severe: 70-89
-Profound: >90

Otitis media with effusion (glue ear)

Sensorineural hearing loss as a result of a disruption in the auditory pathway at any point from the cochlea of the inner ear through to the brainstem

-Neonates: otoacoustic emissions, automated auditory brainstem response
-6-8 months: distraction techniques
-9-36 months: visual reinforcement audiometry
-24-36 months: conditioned play audiometry
-Over 60 months: pure tone audiometry

-Hearing aids
-Lifestyle modifications (family support)
-Cochlear implant
-Ventilation tubes