
Integumentary
NCLEX Clinical Study Booklet · 10 cards
Burns.
EmergencyWhat is Burns?
- Tissue damage from heat, chemicals, electricity, or radiation.
- Classified by depth and % TBSA (Rule of Nines).
What are the Causes / Risk Factors?
- Thermal (fire, scald)
- Chemical
- Electrical
- Radiation
What are the Symptoms?
- Superficial: red, painful (like sunburn)
- Partial-thickness: blisters, very painful
- Full-thickness: white/charred, painLESS
- Fluid shifts → hypovolemia
- Inhalation injury (facial burns, soot)
How is it Diagnosed?
- Rule of Nines (% TBSA)
- Depth assessment
- Monitor airway, fluids, labs
What is the Treatment?
- AIRWAY first (inhalation injury)
- Fluid resuscitation (Parkland formula, LR)
- Pain control; wound care; infection prevention
- Monitor for hypovolemic shock, then overload
NCLEX TipAirway is the priority in burns (inhalation injury). Then aggressive fluid resuscitation. Full-thickness burns are painless.
Pressure Injury.
WoundWhat is Pressure Injury?
- Localized skin/tissue damage over a bony prominence from pressure.
- Staged I–IV (plus unstageable).
What are the Causes / Risk Factors?
- Immobility, prolonged pressure
- Shear / friction
- Moisture, poor nutrition
- Decreased sensation / perfusion
What are the Symptoms?
- Stage 1: non-blanchable redness
- Stage 2: partial-thickness, blister/abrasion
- Stage 3: full-thickness, subcutaneous fat
- Stage 4: exposed muscle / bone
How is it Diagnosed?
- Skin assessment (Braden scale for risk)
- Wound staging
What is the Treatment?
- REPOSITION every 2 hours
- Pressure-relief surfaces; keep skin clean/dry
- Nutrition (protein); manage moisture
- Wound care by stage
NCLEX TipPrevention is key: reposition every 2 hours, keep skin clean and dry, use the Braden scale, and optimize nutrition.
Cellulitis.
InfectionWhat is Cellulitis?
- Bacterial infection of the skin and subcutaneous tissue.
- Usually Streptococcus or Staphylococcus.
What are the Causes / Risk Factors?
- Break in the skin (cut, ulcer, bite)
- Diabetes, poor circulation
- Lymphedema
What are the Symptoms?
- Red, warm, swollen, tender area
- Spreading erythema (mark borders)
- Fever
- Streaking (lymphangitis)
How is it Diagnosed?
- Clinical exam
- ↑WBC
- Wound culture if drainage
What is the Treatment?
- Antibiotics
- Elevate the affected area
- Warm compresses
- Mark borders to monitor spread
NCLEX TipMark the borders of the redness to track whether cellulitis is spreading or improving with antibiotics.
Melanoma / Skin Cancer.
CancerWhat is Melanoma / Skin Cancer?
- Malignancy of melanocytes — the most dangerous skin cancer.
- Can metastasize.
What are the Causes / Risk Factors?
- UV / sun exposure, tanning beds
- Fair skin, many moles
- Family history
- Immunosuppression
What are the Symptoms?
- ABCDE: Asymmetry, Border irregular, Color varied, Diameter >6mm, Evolving
- Changing mole
- New or unusual growth
- Itching / bleeding lesion
How is it Diagnosed?
- Biopsy (definitive)
- Dermoscopy
- Staging if malignant
What is the Treatment?
- Surgical excision
- Immunotherapy, targeted therapy (advanced)
- Sun protection (SPF, avoid peak sun)
- Skin self-exams; monitor for recurrence
NCLEX TipAssess moles with ABCDE: Asymmetry, Border, Color, Diameter >6mm, Evolving. Teach sun protection and skin self-exams.
Herpes Zoster (Shingles).
InfectionWhat is Herpes Zoster (Shingles)?
- Reactivation of the varicella (chickenpox) virus.
- Painful vesicular rash along a dermatome.
What are the Causes / Risk Factors?
- Prior chickenpox (dormant virus)
- Reactivation with age, stress, immunosuppression
What are the Symptoms?
- Unilateral painful vesicular rash along a dermatome (does not cross midline)
- Burning/tingling before the rash
- Fever, malaise
- Postherpetic neuralgia (lingering pain)
How is it Diagnosed?
- Clinical (dermatomal rash)
- Viral culture / PCR
What is the Treatment?
- Antivirals (acyclovir) — start early
- Pain control
- Keep lesions clean and dry
- Airborne + contact precautions if disseminated; vaccine prevents
NCLEX TipShingles follows a dermatome and doesn't cross the midline. Start antivirals early; contagious to non-immune people until crusted.
Psoriasis.
ChronicWhat is Psoriasis?
- Chronic autoimmune skin disorder — rapid skin cell turnover.
- Silvery, scaly plaques.
What are the Causes / Risk Factors?
- Autoimmune
- Genetic
- Triggers: stress, infection, cold, skin trauma
What are the Symptoms?
- Silvery scaly plaques (elbows, knees, scalp)
- Itching, sometimes painful
- Nail pitting
- Remissions / exacerbations
- Psoriatic arthritis (some)
How is it Diagnosed?
- Clinical exam
- Skin biopsy if unclear
What is the Treatment?
- Topical corticosteroids, vitamin D analogs
- Phototherapy (UV)
- Systemic / biologics (severe)
- Moisturize; manage triggers & stress
NCLEX TipPsoriasis = silvery scaly plaques from rapid cell turnover. It is not contagious. Treat with topicals, phototherapy, or biologics.
Stevens-Johnson Syndrome.
EmergencyWhat is Stevens-Johnson Syndrome?
- Severe, life-threatening skin reaction (often drug-induced).
- Widespread blistering and skin sloughing.
What are the Causes / Risk Factors?
- Medications (sulfa, anticonvulsants, allopurinol, antibiotics)
- Infections
What are the Symptoms?
- Flu-like prodrome
- Painful red/purple rash → blisters
- Skin sloughing (like a burn)
- Mucous membrane involvement (mouth, eyes)
- +Nikolsky's sign
How is it Diagnosed?
- Clinical
- Skin biopsy
- Identify the causative drug
What is the Treatment?
- STOP the causative drug immediately
- Supportive care (treat like a major burn — fluids, wound care)
- Often ICU / burn unit
- Infection & fluid management
NCLEX TipStevens-Johnson is a dermatologic emergency — stop the offending drug immediately and treat like a major burn.
Eczema / Atopic Dermatitis.
ChronicWhat is Eczema / Atopic Dermatitis?
- Chronic inflammatory skin condition with dry, itchy skin.
- Part of the atopic triad (asthma, allergies).
What are the Causes / Risk Factors?
- Genetic / atopic tendency
- Irritants, allergens
- Dry skin, stress, heat
What are the Symptoms?
- Dry, red, intensely itchy skin
- Scratching → lichenification
- Flexural areas (elbows, knees)
- Exacerbations & remissions
How is it Diagnosed?
- Clinical exam
- History of atopy
What is the Treatment?
- Moisturize frequently (key)
- Topical corticosteroids
- Avoid triggers/irritants; lukewarm baths
- Antihistamines for itch; keep nails short
NCLEX TipMoisturizing is the cornerstone of eczema care. Avoid hot water and irritants; keep nails short to reduce scratching damage.
Wound Healing.
WoundPhases
- Hemostasis (clotting)
- Inflammatory (redness, swelling — normal early)
- Proliferative (granulation tissue, new skin)
- Maturation / remodeling (scar strengthens)
Healthy vs Concerning
- Healthy: pink/red granulation, decreasing drainage
- Infection: increasing redness/warmth, purulent/foul drainage, fever
- Dehiscence: wound edges separate
- Evisceration: organs protrude (emergency)
Nursing Care
- Sterile technique for dressing changes
- Nutrition: protein, vitamin C, zinc
- Keep wound moist (not wet); manage drainage
- Evisceration: cover with sterile saline gauze, NPO, notify surgeon
NCLEX TipSigns of wound infection: increasing redness/warmth, purulent or foul drainage, and fever. Protein and vitamin C support healing.
Contact Dermatitis.
ChronicWhat is Contact Dermatitis?
- Localized skin inflammation from contact with an irritant or allergen.
- Irritant vs allergic.
What are the Causes / Risk Factors?
- Allergens (poison ivy, nickel, latex)
- Irritants (chemicals, soaps)
- Cosmetics, plants
What are the Symptoms?
- Red, itchy rash at the contact site
- Vesicles, weeping (allergic)
- Burning / stinging
- Well-demarcated to the exposure area
How is it Diagnosed?
- History of exposure
- Patch testing (allergic)
What is the Treatment?
- Remove / avoid the offending agent
- Topical corticosteroids
- Antihistamines; cool compresses
- Wash the skin after exposure
NCLEX TipIdentify and remove the offending agent. Wash the skin after exposure; topical steroids and antihistamines relieve symptoms.
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