UNIT FIFTEEN Understanding the Integumentary System

Chapter 53
Integumentary System Function, Data Collection, and
Therapeutic Measures
Name: __________________________________
Date: __________________________________
Course: __________________________________
Instructor: __________________________________
AUDIO CASE STUDY INTEGUMENTARY STRUCTURES
Listen to the audio case study available on Davis Advantage and Match each integumentary structure with its appropriate
then answer the following questions. description.
Hakem Assesses Skin Lesions 1. _______ Epidermis
1. What is the difference between a vesicle and a bulla? 2. _______ Dermis
_______________________________________________________ 3. _______ Subcutaneous tissue
_______________________________________________________ 4. _______ Collagen fibers
_______________________________________________________ 5. _______ Eccrine glands
6. _______ Receptors
_______________________________________________________ 7. _______ Melanin
_______________________________________________________ 8. _______ Stratum corneum
2. What disorder did Hakem see that had scales and plaques? 9. _______ Stratum germinativum
_______________________________________________________ 1. If unbroken, prevents entry of pathogens
_______________________________________________________ 2. Give strength to the dermis
_______________________________________________________ 3. Detects changes in the external environment
_______________________________________________________ 4. Contains the accessory structures of the skin, such as
glands
_______________________________________________________
5. Made of both living and nonliving cells
3. What term would you use to describe small, red raised 6. Mitosis takes place to produce new epidermis
areas? 7. Stores fat
_______________________________________________________ 8. Acts as a barrier to ultraviolet (UV) light
_______________________________________________________ 9. Stimulated by exercise or heat
_______________________________________________________ VOCABULARY
_______________________________________________________ Match the word at the right with its definition at the left.
_______________________________________________________ 1. _______ Absence or loss of hair
4. How should ointment be applied to a wound prior to 2. _______ Blue-black bruise, changing to greenish brown or
applying an occlusive dressing? yellow with time
_______________________________________________________ 3. _______ Diffuse redness over the skin
4. _______ Small, purplish, hemorrhagic spots on the skin
_______________________________________________________
5. _______ Measure of skin elasticity and hydration
_______________________________________________________ 1. Ecchymosis
_______________________________________________________ 2. Erythema
_______________________________________________________ 3. Petechiae
5. Use the SBAR format to communicate Hakem’s encounter 4. Turgor
with the patient with eczema to the registered nurse 5. Alopecia
supervisor. DIAGNOSTIC SKIN TESTS
S:__________________________________________________ Match the test with its definition.
____________________________________________________ 1. _______ Skin biopsy
B:__________________________________________________ 2. _______ Wood light examination
3. _______ Scratch test
____________________________________________________
4. _______ Patch test
A:__________________________________________________ 1. Superficial testing with allergen for immediate reaction
____________________________________________________ 2. Excision of a small piece of tissue for microscopic
R:__________________________________________________ assessment
____________________________________________________ 3. Superficial testing with allergen for delayed
hypersensitivity reaction
4. Use of UV rays to detect fluorescent materials in skin and
hair
PRIMARY SKIN LESIONS Exposed dermis on arm:
Match the lesion with its description. _______________________________________________________
1. _______ Macule _______________________________________________________
2. _______ Papule _______________________________________________________
3. _______ Vesicle
_______________________________________________________
4. _______ Bulla
5. _______ Pustule _______________________________________________________
6. _______ Wheal _______________________________________________________
7. _______ Plaque _______________________________________________________
8. _______ Cyst _______________________________________________________
1. Vesicle or blister larger than 1 cm
2. Flat, nonpalpable change in skin color 3. With whom can you collaborate to help your patient attain
3. Round, transient elevation of the skin caused by dermal a healthy weight?
edema and surrounding capillary dilation _______________________________________________________
4. Patch or solid, raised lesion on the skin or mucous _______________________________________________________
membrane that is greater than 1 cm
5. Palpable, solid raised lesion _______________________________________________________
6. Small elevation of skin or vesicle or bulla that contains pus _______________________________________________________
7. Closed sac or pouch tumor that consists of semisolid, solid, _______________________________________________________
or liquid material _______________________________________________________
8. Small, raised area that contains serous fluid, less than 1 cm _______________________________________________________
CLINICAL JUDGMENT _______________________________________________________
A 90-year-old female patient is admitted to the long-term care REVIEW QUESTIONS
facility where you work. Her husband, age 94, was caring for her, Choose the best answer unless directed otherwise.
but he is no longer able to do so. On admission, you note that she
1. The nurse is examining a patient with a macular
is very thin and confused and has multiple lesions on her
extremities, torso, and coccyx. rash due to a reaction to antibiotics. Mark the image
1. Identify the term to use when you document each of the that represents macules.
following problems.
a. Small, fluid-filled blisters on her torso, about 0.8 cm
each.
___________________________________________
___________________________________________
b. Large open area on her coccyx, 4 × 6 cm,
approximately 1 cm deep, from lying on her back. It is
draining yellowish-green purulent material.
___________________________________________
___________________________________________
c. Thin flap of skin on her arm that exposes the
underlying dermis.
___________________________________________
___________________________________________
d. Multiple large bruised areas on her arms and legs.
___________________________________________
___________________________________________
e. Bluish cast to her lips and toes.
___________________________________________
___________________________________________
2. List dressings you can choose to help the following skin
problems she is experiencing and explain why they might
help.
Wound on coccyx:
_______________________________________________________ 2. The nurse is reviewing a patient chart and notes
_______________________________________________________ the following: “Poor elasticity and dry, thin skin
_______________________________________________________ noted.” The nurse recognizes this is a normal finding
_______________________________________________________ for which of these patient groups?
_______________________________________________________ 1. Adolescents
_______________________________________________________ 2. Young adults
_______________________________________________________ 3. Middle-aged adults
_______________________________________________________ 4. Older adults
3. When assessing a patient in hospice who is near 8. Which nursing intervention is essential to
death, the nurse notes a bluish discoloration and protecting the patient’s skin integrity when applying
mottled appearance on the patient’s feet and lower occlusive dressings?
legs. Which of the following terms would the nurse 1. Make sure all skin surfaces are covered.
use to best document this finding? 2. Remove the dressings for 12 of every 24 hours.
1. Cyanosis 3. Apply a thick layer of prescribed ointment before
2. Erythema applying the dressings.
3. Jaundice 4. Apply a gauze dressing next to the skin,
4. Pallor underneath the plastic film.
4. A nurse is providing care for an older adult patient
who reports being sensitive to cold temperatures. The
nurse would base teaching on which of the following
principles?
1. There is slower cell division in the epidermis with
aging.
2. Older adults experience deterioration of collagen
and elastin fibers.
3. There is less fat in the subcutaneous layer with
age.
4. Death of melanocytes in the skin occurs with age.
5. Which of the following dressing types is most
appropriate for the nurse to apply to a skin tear in an
older adult patient?
1. Moist, sterile gauze
2. Transparent dressing
3. Paste
4. Nonadherent dressing
6. Which of the following actions should the nurse
take when new petechiae are observed on a patient’s
skin?
1. Cleanse the skin.
2. Apply cool compresses.
3. Inform the registered nurse or provider.
4. Apply heat to the area.
7. A nurse is preparing to collect a wound culture.
Which of the following would be included in the
collection process? Select all that apply.
1. Swab wound and wound edges in a rotating
motion.
2. Swab over areas of eschar.
3. Use sterile saline to remove excess debris before
culture.
4. Use clean cotton-tipped swab to collect purulent
drainage.
5. Swab wound 10 times in a diagonal pattern.
6. Obtain sterile calcium alginate swab for culture
collection.
Chapter 54
Nursing Care of Patients With Skin Disorders
Name: __________________________________
Date: __________________________________
Course: __________________________________
Instructor: __________________________________
AUDIO CASE STUDY 5. Pruritus
Listen to the audio case study available on Davis Advantage 6. Pediculosis
and then answer the following questions. 7. Onychomycosis
Mr. Fletcher’s Pressure Injuries 8. Lichenified
1. What risk factors for pressure injuries did Mr. Fletcher 9. Dermatitis
have? 10. Comedo
_______________________________________________________ 11. Cellulitis
_______________________________________________________ 12. Blanch
_______________________________________________________ BENIGN SKIN LESIONS
_______________________________________________________ Match the lesion with its definition.
_______________________________________________________ 1. ______ Cyst
2. What are characteristics of stages 1, 2, 3, and 4 2. ______ Seborrheic keratosis
pressure injuries? 3. ______ Keloid
_______________________________________________________ 4. ______ Pigmented nevi
_______________________________________________________ 5. ______ Warts
_______________________________________________________ 6. ______ Hemangiomas
_______________________________________________________ 1. Small, common growths caused by a virus
_______________________________________________________ 2. Vascular tumors of dilated blood vessels
3. How was Patrick vigilant in helping Mr. Fletcher heal 3. Saclike growth with a definite wall
and preventing new pressure injuries? 4. Excessive scar formation at site of trauma or surgical
_______________________________________________________ incision
_______________________________________________________ 5. Light brown to dark brown patches, plaques, or
_______________________________________________________ papules that occur mainly in older patients
_______________________________________________________ 6. Flesh-colored to dark brown macule or papule
_______________________________________________________ PLASTIC SURGERY PROCEDURES
VOCABULARY Fill in the blanks.
Match the word with its definition. 1. A ________________________ is done to correct nasal
1. ______ To lose color shape or septal defects.
2. ______ Inflammation of cellular or connective tissue 2. A ________________________ is referred to as a
3. ______ Skin lesion that occurs in acne vulgaris rhytidoplasty.
4. ______ Inflammation of the skin 3. Removal of bags under the eyes is known as
5. ______ Thickened or hardened from continued ___________________.
irritation CLINICAL JUDGMENT
6. ______ Disease of the nails due to fungus Read the following case study and answer the questions.
7. ______ Infestation with lice Mr. Carr is a 96-year-old home-care patient you assist with
8. ______ Severe itching bathing and dressing changes. He has chronic dermatitis
9. ______ Chronic inflammatory skin disorder in which and open wounds on his legs, which you help monitor and
epidermal cells proliferate abnormally quickly dress with occlusive dressings twice a week. Today when
10. ______ Describes fluid that contains pus you see Mr. Carr, you note that he has already removed his
11. ______ Any acute, inflammatory, purulent bacterial dressings, and his legs are bleeding from being scratched.
dermatitis Mr. Carr says they were so itchy; he couldn’t stand it!
12. ______ Disease of the sebaceous glands marked by 1. What are your concerns for Mr. Carr?
increase in the amount, and often alteration of the _______________________________________________________
quality, of sebaceous secretion _______________________________________________________
1. Seborrhea _______________________________________________________
2. Pyoderma _______________________________________________________
3. Purulent _______________________________________________________
4. Psoriasis
2. What are priority nursing interventions for Mr. Carr?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. What complications can arise if Mr. Carr’s itching is
not controlled?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4. Develop an SBAR report to provide to the supervising
nurse.
S:__________________________________________________
____________________________________________________
B:__________________________________________________
____________________________________________________
A:__________________________________________________
____________________________________________________
R:__________________________________________________
____________________________________________________
CLINICAL JUDGMENT
Read the following case study and answer the questions.
Mrs. Miller, age 59, is admitted for a femoral-popliteal
bypass graft. She has type 2 diabetes mellitus. After surgery,
she is in the intensive care unit and is hypotensive for 24
hours. Her operative leg is painful, and she barely moves.
During her bath, the nurse notes a shallow, open, reddened
area 2 inches in diameter on her sacral area and a large
tender purple area with intact skin on the heel of her right
foot.
1. Why did these areas develop?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. To plan Mrs. Miller’s care, how would you stage these
lesions?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. The surgeon is notified of these areas and orders
turning every 2 hours, elevation of the right foot, and
a special pressure-reducing bed. What is the benefit
and effectiveness of each of these ordered
interventions?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4. With whom can you collaborate to manage Mrs.
Miller’s skin injuries?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
REVIEW QUESTIONS
Choose the best answer unless directed otherwise.
1. Which of the following activities creates a mechanical
force that can lead to the formation of a pressure
injury?
1. Massaging nonreddened areas
2. Whirlpool baths
3. Pulling a patient up in bed
4. Range-of-motion exercises
2. Which of the following dressings should a nurse
choose for a deep pressure injury that has purulent
drainage?
1. Sterile gauze
2. Transparent film (OPSITE)
3. Hydrocolloid (DuoDERM)
4. Occlusive
3. A nurse is caring for a nursing home resident with a
red, pruritic skin rash. The patient is confused and
scratches the rash, which results in broken skin. Which
interventions will help the rash heal? Select all that
apply.
1. Pat the skin dry after bathing.
2. Leave topical agent as ordered at bedside so
patient can apply when itching is severe.
3. Place a transparent dressing on the rash to
prevent scratching.
4. Place gloves or mitts on the patient.
5. Keep the patient’s fingernails short.
6. Place wrist restraints on the patient during the
night.
4. A patient has a wound that is draining moderate
blood-tinged clear fluid. Which of the following
would be an appropriate description of this drainage
for the nurse to document?
1. Purulent drainage
2. Serosanguineous drainage
3. Copious drainage
4. Serous drainage
5. The nurse is providing care for a patient with a
noninfected stage 3 pressure injury. Which of the
following actions is most appropriate for cleaning the
wound?
1. Flushing the wound with pressure of 45 pounds
per square inch
2. Gentle flushing with a needleless 30-milliliter
syringe
3. Gentle scrubbing with gauze and normal saline
4. Flushing with a 30-milliliter syringe with an 18-
gauge needle
6. A 62-year-old patient is admitted to the hospital with
a lesion on the face that is a small, pearly papule. It
has a rolled, waxy edge with crusting and ulceration.
Which action by the nurse is best?
1. Notify the RN or physician.
2. Clean the lesion.
3. Place a gauze dressing on the lesion.
4. Place an occlusive dressing on the lesion.
7. Place the wounds in correct order from stage 1 to
stage 4.
1. Skin appears abraded.
2. Skin is red, intact, and nonblanchable.
3. Full-thickness skin is lost; muscle and bone are
showing.
4. Full-thickness skin is lost; no muscle or bone
involvement.
8. A 92-year-old patient is admitted from a nursing
home to the hospital for a colon resection. Four days
postoperatively, the patient reports that the perineum
is sore. It is reddened and has whitish discharge. The
patient has been on three intravenous antibiotics.
Which of the following as-need orders should the
nurse implement?
1. Apply antifungal powder.
2. Apply cortisone ointment.
3. Apply topical antiviral agent.
4. Administer an antihistamine.
9. The nurse recognizes that which of the following
individuals should be evaluated for a specialty bed
that provides a pressure-relieving surface?
1. A 46-year-old with scoliosis who has a urinary
tract infection
2. A 94-year-old with a Braden score of 15 and left
arm weakness from a cerebrovascular accident
3. An 88-year-old with foot drop who has a Foley
catheter
4. A 15-year-old with a Braden score of 9 who
experiences pain with turning
10. The nurse notes a pressure injury on a newly admitted
patient’s ischial tuberosity, with a thick, tough black
center. Which intervention is most appropriate first?
1. Coat the wound with antibiotic ointment.
2. Snip away the black tissue with sterile scissors.
3. Flush the wound with sterile saline.
4. Consult with the health-care provider about
debridement.
11. A patient develops pressure injuries on the sacrum
and buttocks despite being turned and repositioned
regularly. Which factors may have contributed to the
patient’s skin breakdown? Select all that apply.
1. The patient is 20 pounds overweight.
2. The patient commonly slides down in the chair.
3. Staff use a lift sheet to move the patient in bed.
4. The patient sits in a chair most of the day.
5. The patient is often diaphoretic.
6. The patient is incontinent of urine and stool.
12. Which instruction should the nurse provide to the
patient being treated for scabies?
1. “Dry clean all linens, towels, and clothes.”
2. “Wash linens, towels, and clothes.”
3. “Discard infested mattresses.”
4. “Remove infested pets from the home.”
Chapter 55
Nursing Care of Patients With Burns
Name: __________________________________
Date: __________________________________
Course: __________________________________
Instructor: __________________________________
AUDIO CASE STUDY
Listen to the audio case study available on Davis Advantage
and then answer the following questions.
Peyton and Burns
1. What do partial-thickness burns, superficial and deep,
look like? Full-thickness?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. Which types of burns are most painful?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. Why was Peyton at risk for fluid loss? How did Chris
monitor Peyton’s fluid status?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4. Why did Peyton need extra caloric intake?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
VOCABULARY
Match each phrase with the type of burn or burn term.
1. ______ Leathery skin, usually painless
2. ______ Pink to red moist skin; blisters may be present
3. ______ The growth of skin over a wound
4. ______ Removal of a slough or scab formed on skin
and underlying tissue of severely burned skin
5. ______ Epidermis and dermis involved, pain from
exposed nerve endings
6. ______ Hard scab or dry crust from necrotic tissue
1. Debridement
2. Eschar
3. Epithelialization
4. Superficial partial-thickness burn
5. Partial-thickness deep burn
6. Full-thickness burn
CRITICAL THINKING AND CLINICAL JUDGMENT
Read the following case study and answer the questions.
Mr. Patel is a 45-year-old patient in a burn unit. He was
admitted this morning with a 20% electrical burn over his
right arm, right shoulder, right leg, and right foot. The entry
wound is on his right shoulder, and the exit wound is on his
right foot. When you check on him at the beginning of your
shift, you find his right radial pulse is diminished and his
right forearm has a small spot that is beginning to change
color to a whitish gray.
1. What might be causing his change in circulation?
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. What additional data should you collect?
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. What interventions are important to perform right
away?
_______________________________________________________
_______________________________________________________
_______________________________________________________
4. What renal complication can arise if Mr. Patel is not
given adequate fluid resuscitation?
_______________________________________________________
_______________________________________________________
_______________________________________________________
5. Develop an SBAR report to give to the health-care
provider on call (who does not know Mr. Patel).
S:__________________________________________________
____________________________________________________
B:__________________________________________________
____________________________________________________
A:__________________________________________________
____________________________________________________
R:__________________________________________________
____________________________________________________
REVIEW QUESTIONS
Choose the best answer unless directed otherwise.
1. Which type of burn is caused by a hot liquid?
1. Radiation
2. Contact
3. Scald
4. Chemical
2. During morning report, a nurse is assigned a patient 8. While caring for a 28-year-old patient newly admitted
who is in stage 3 burn care. What care can the nurse for burns received in a household fire, the nurse
anticipate providing during the shift? would be most concerned by which of the following?
1. Dressing changes 1. Hematocrit is 48%.
2. Debridement 2. Blood pressure is 92/40 mm Hg.
3. Pain management 3. Pulse is 96 beats per minute.
4. Exercises 4. Respiratory rate is 22 per minute.
3. A patient is brought to the emergency department
with burns over 40% of the body from an apartment
fire. Which data collection should take priority?
1. Burn depth
2. Percent of body surface burned
3. Respiratory status
4. Circulatory status
4. A home health-care nurse visits an 82-year-old
patient. On entering the home, the nurse finds that
the patient has just dropped a pot of boiling water on
both legs. What action should the nurse take first?
1. Call 911.
2. Remove the clothing from the affected area.
3. Place ice on the affected area.
4. Assess the extent of the burn.
5. A patient has a burn encircling the left thigh from a
motorcycle accident. When the nurse enters the room
during rounds, the patient appears very anxious and
reports a funny feeling in the left foot. What should
the nurse do first?
1. Check circulatory status in the foot and report
changes.
2. Explain that numbness and tingling in the
affected extremity are normal after a burn.
3. Check the burn dressing for an increase in
drainage.
4. Determine the cause of the patient’s anxiety.
6. A homebound patient is receiving intravenous
antibiotics for an infected burn site. Instructions are to
use gravity to infuse 100 mL over 1 hour. How many
drops per minute should the nurse administer if the
tubing has a drip factor of 15? ____________
7. A nurse is providing care for a patient with burns
across 30% of the body. Which of the following
observations would cause the nurse to contact the
registered nurse or physician?
1. Urinary output is 50 mL in the past 2 hours.
2. Patient reports pain of 6/10; oral narcotic is due
in 10 minutes.
3. Respiratory rate is 20, and oxygen saturation is
94%.
4. Blood sugar is 175 mg/dL.