The complete review for Integumentary system for nursing board exam.

1. Integumentary
Bienes, lyco nino

2. Diagnostic Test
A. Skin biopsy

1. methods: punch, exisional, incisional

and shave
2. Obtain informed consent

3. cleanse site as prescribed

4. use surgically aseptic technique for

biopsy site dressing
5. assess the biopsy site for bleeding

and infection
6. keep dressing in place at least 8 hrs


3. B. Wood’s light examination

 1. skin is viewed under UV through a
special glass (Wood’s glass) to identify
superficial infections
 2. darken the room before the examination
 3. assist the client during the adjustment
form the darkened room

4. C. Skin Testing

1. administration of an allergen

2. by patch, scratch or intradermal techniques

3. D/C systemic corticosteroids and

antihistamine therapy for 5 days
4. obtain informed consent

5. site should be dry

6. if patch is applied, avoid activities that may

produce sweat
7. record the date and time for follow-up site

reading
8. provide least of potential allergens


5. D. Tzanck’s Smear

 1. fluids and cells from vesicles and
bullae
 2. viral infections such as herpes
E. Scabies Scraping

 1. unscratched lesion looking fro the
mite, eggs or feces

6. Skin disorders
A. Dermatitis

 1. inflammatory response of the skin
that produces skin changes after
contact with a specific antigen
 2 types
 A. Allergic contact dermatitis
 -eruptions from allergy to poison
ivy, oak, drugs, fiber clothing, plants
and dyes

7. B. Primary irritant dermatitis

 -occurs when the skin is in contact
with strong chemicals such as solvent
or detergent
2. Assessment
a. Pruritus with burning sensation
b. Edema
c. Erythema
d. Signs of infection
e. Vesicles with drainage

8. 3. Medical Management
 1. removal of the substance causing
the reaction
 2. topical lotions, such as calamine or
systemic drugs
 3. moisturizing creams for lubrications
 4. wet dressings with astringent
solution, such as Burow’s solution for
severe cases

9. 4. Nursing management

 a. Elevate the ext. to reduce edema
 b. Apply cool dressings and tepid
baths
 C. Cool environment
 d. Protect area from trauma
 e. Prevent scratching and rubbing
 f. Avoid contact with allergens
 g. Advise to wear rubber gloves when
in contact

10. Measures to reduce itching or
preserve integrity of the
1. keep nails short and clean

 2. use light cotton bedding and
clothing that allow normal evaporation
of moisture
 3. wear white cotton gloves if prone to
scratching
 4. use hypoallergenic soaps
 5. pat rather then rub the skin during
TSB

11. Acne Vulgaris
1. self limiting

 2. unknown. Androgenic influence on
sebaceous gland, inc sebum produced
and proliferation of Propionibacterium
acnes
 3. exacerbation coincides with
menstrual cycle
 4. heat, humidity and excessive
perspiration have a role in increased
acne
 5. aggravated by cosmetics, picking

12. A. Assessment

 1. appears in chest, face and back
 2. closed comedones – whiteheads
 3. open comedones – blackheads
B. Medical and surgical management

 1. topical application of tretinoin
(Retin-A) derivative of Vit. A
 2. Oral administration of isotretinoin
(Accutane) – CI with preg
(teratogenic)

13. C. Nsg Management

 1. skin cleansing method
 2. not to squeeze, prick or pick at
lesions
 3. keep hair short, clean and away
from the face and forehead
 4. wash the hair frequently
 5. avoid makeups, lotions, hair sprays
and skin care products

14. Furuncles and Carbuncles
1. furuncle is a boil (dermis), caused

by staph
 2. carbuncle is a furuncle from which
pus drains. (subcutaneous)
 3. boils occur on the face, neck
arms, legs and groin
(irritation, pressure, frictiona and
excessive perspiration)

15. B. Assessment

 1. redness on the skin
 2. swollen, tender and painful
 3. a yellow or white center at the
furuncle
 4. fever
C. Medical Management

 1. hot wet soaks to localize the
infection
 2. surgical incision or drainage may be

16. C. Nursing Management

 1. not to be squeezed
 2. good handwashing technique
 3. apply hot moist compresses wunitl
drainage occurs
 4. use of separate bath linens
 5. clothing should be washed
separately from family laundry
 6. if at perineum, bed rest is
necessary
 7. fatal pyemia

17. Psoriasis
1. chronic noninfectious, involving a

faster keratinocytes proliferation
resulting to psoriatic patches
 2. genetic predisposition
 3. triggering mechanism – systemic
infection, injury to the
skin, stress, injection and climate
changes
 4. Koebner’s phenemenon- devt of
psoriatic lesions at the site of injury

18. A. Assessment

 1. pruritus or may not be present
 2. shedding, silvery, white scales on a
raise, Reddened plaque at the
scalp, knees, elbows and sacral
regions
 3. a yellow discoloration and
thickening of the nails, if affected
 4. psoriatic arthritis

19. B. Medical Management

 1. salicylic acid, corticosteroids, vit D
prep and retinoid compound –
suppress epidermopoieses and cause
sloughing
 2. occlusive dressings
 3. systemic therapy – antimetabolites
 4. Photochemotherapy – UV A and
psoralen drug

20. C. Nsg Management –gentle removal

 1. wet compresses, coal tar and soft
brush
 2. emollient creams or salicylic may be
applied to soften the thick scales
 3. not to scratch and to keep
lubricated
 4. to wear light clothing over the area
 5. patting rather than rubbing

21. Scabies
1. coexist with pediculosis

 2. infestation of Sarcoptes scabiei (itch
mite)
 3. risk factors: close personal contact
and sexually active
A. Assessment

 1. threadlike, brownish, linear burrows
up to 1 cm caused by female itch mite

22. 2. intense pruritus that worsens at night

B. Medical Management

1. lotions – lindane (Kwell, Scabene) or

permethrin 5%
- applied thinly from neck down

and to leave for 8 to 12 hrs. To repeat
the ttt after 1 week
Lindane – CI to children younger than

age 2
Permethrin 5% (Nix, Elimite) – from

head
to sole

23. Erysipelas – an acute, superficial

rapidly spreading inflam of the dermis
caused by GABHS
 Cellulitis – deeper into the dermis and
SQ fats caused by Strep pyogenes
 Vitiligo - hypopigmentation

24. Alopecia aka Baldness
Causes

 - neoplastic drugs, inadequate
diet, tinea infection, improper
application of hair care products or
styling
 Two types
 A. Alopecia areata – i
- autoimmune disorder

characterized by patchy area of hair
loss

25. B. Androgenic alopecia - e

-genetically acquired
Management
1. Minoxidil (rogaine) – promote hair
growth

26. Head lice / Pediculosis capitis
Assessment
A.
Intense pruritus
1.
Presence of tiny silver or gray
2.
specks that are visible and firmly
attached to the hair shaft near the
scalp, behind the ears, nape of the
neck
B. Medical Management
- pediculicide shampoo
- permithrin rinse (Nix)

27. C. Nsg Management

 1. clothing and bedding should be
changed daily and should be washed
separately from family laundry
 2. furnitures, maps and carpets should
be vacuumed frequently
 3. all contacts of the infested patient
should be examined ( every 2 weeks)

28. Nail Disorder
Onychocryptosis aka Ingrown Toenail
Assessment
A.
redness, swelling and pain
1.
Compensatory gait and postural
2.
change
3. Local pressure from abnormal growth
B. Causes
1. trauma, external pressure (tight
shoes), internal pressure ( deformed
toes), infection

29. B. Nsg management

 1. tripping straight across
 2. filing the corners
 3. prevent pressure from the
surrounding
 4. warm wet soaks
 5. visit a podiatrist
C. Surgical management


30. Fungal Infections/ mycotic/
Tineas
A. Tinea Pedis ( Athlete’s Foot)

 -most common
 -soaks of Burow’s sol saling and K
permanganate to remove crust
T. Corporis – body
B.
C. T. Capitis – scalp
D. T. Cruris (jock itch)- inner
groin, buttocks
E. T. Unguium ( onychomycosis) - nails

31. Management

 1. keeping the area dry and clean
 2. avoid sharing of personal clothings
 3. administration of antifungal

32. Decubitus Ulcer
- skin lesions resulting from prolonged

pressure which then deprives the
skins of oxygen
 -common locations: skin over bony
promninces
Measures that reduce conditions

under which pressure sores are likely
to form
 1. TTS every 2 hrs
 2. keeping client’s skin clean and dry

33. 3. massaging bony prominence if the

client’s skin blanches with pressure
relief
 4. using moisturizing skin cleanse
rather than soap
 5. applying pressure – relieving
devices to the bed and chairs
 6. padding body areas that are subject
to pressure and friction
 7. avoid shearing