Nr 511 Midterm Study Guide PDF

# NR 511 Midterm Study Guide ## General Study Tips and Recommendations - Topics and content on guides are intended to focus student attention when reading/studying and some topics may be repeated in multiple chapters. - Multiple test items are derived from the same topic areas to encourage deeper...

# NR 511 Midterm Study Guide ## General Study Tips and Recommendations - Topics and content on guides are intended to focus student attention when reading/studying and some topics may be repeated in multiple chapters. - Multiple test items are derived from the same topic areas to encourage deeper comprehension. - Students must have a broad understanding of content and not simply memorize passages in textbooks or articles. - Information contained in the chapters as well as boxes and table within the chapters may include test items. - Exam questions represent various levels of cognitive learning. You are expected to analyze, synthesis, and evaluate patient scenarios in order to answer the questions. - Students are expected to use clinical decision making to prioritize treatment actions based on the information provided in the exam question. - Read all of the answers BEFORE reading the stem of the question. This will help you focus on the key content and not get distracted by extraneous information. Once you have selected your answer, read the question one more time to ensure that the best answer has been chosen. - Utilize your time well by not rushing. You will have plenty of time to read each question for understanding before you select your final answer. ## Color Key - **BLACK** - from book readings - **PURPLE** - weekly recording Q's - **RED** - midterm recording - **BLUE** - original pg content - **Green** - quizlet - **Orange** - Canvas modules # Chapter 4: The Art and Diagnosis of Treatment ## Specificity and Sensitivity of a Diagnostic Study | Category | Sensitivity | Specificity | |---|---|---| | Definition | Proportion of patients with a disease who test positive | Proportion of patients without the disease who test negative | | 100% (1.0) Means | The test correctly identify every person who has the target disorder | The test correctly identify every person who does not have the target disorder | | Statistical Outcome | True Positive | True Negative | | Positive Test Result | Ideal Test Result | Negative Test Result | | Test Interpretation | They are definitely not positive → They DON'T have it | They are definitely not negative →They DO have it | | The Rule | Rule Out (SnOut) | Rule In (SpIn) | ### Weekly Recording Q's **Week 1 Questions** 1. What does high sensitivity in a diagnostic test indicate? - The test is likely to detect most individuals with the disease. - **Rationale: Sensitivity refers to the test's ability to correctly identify those with the disease (true positives).** 2. Which of the following is true about a test with high specificity? - It is less likely to identify those who don't have the disease as having the disease. - **Rationale: Specificity refers to the test's ability to correctly identify those without the disease (true negatives).** 3. Which of the following combinations is ideal for a diagnostic test used in screening? - High sensitivity, high specificity - **Rationale: Ideally, a screening test should have both high sensitivity (to detect most cases) and high specificity (to avoid false positives).** 4. What is a potential downside of a diagnostic test with low specificity? - It will produce many false positives. - **Rationale: A test with low specificity is more likely to incorrectly identify healthy individuals as having the disease.** 5. What is the most appropriate use of a test with high sensitivity but low specificity? - For screening populations - **Rationale: High sensitivity is crucial in screening to catch as many true cases as possible, even if it means some false positives.** 6. Which of the following factors primarily influences the sensitivity of a diagnostic test? - The number of false negatives - **Rationale: Sensitivity is determined by the test's ability to correctly identity true positives, which is inversely related to the number of false negatives. It reduces the chance of false positives.** 7. What is one of the main benefits of a highly specific diagnostic test? - It reduces the chance of false positives. - **Rationale: High specificity means the test is good at correctly identifying those without the disease, thus reducing false positives.** 8. Why might a highly sensitive test not be ideal for confirming a diagnosis? - It may produce too many false positives. - **Rationale: While sensitivity is crucial for screening, specificity is more important for confirmation to avoid diagnosing healthy individuals as diseased.** 9. What is a primary consideration when evaluating the cost-effectiveness of a diagnostic test? - The ratio of the test's cost to its clinical utility. - **Rationale: Cost-effectiveness involves weighing the test's price against the benefits it provides in guiding treatment decisions.** # Chapter 5: Evidence-Based Practice - Sources that NPs use to help with clinical decision-making (i.e. evidence-based research, clinical practice guidelines) # Chapter 10: Infectious and Inflammatory Neurological Disorders (p. 131-134) ## Assessment and Diagnosis of Herpes Zoster ### Herpes Zoster - Caused by varicella-zoster characterized by painful rash with blisters. - Herpes zoster is characterized by a unilateral vesicular rash along a dermatome, most commonly a thoracic or lumbar dermatome. The rash begins as erythema, then changes to papular lesions that rapidly form vesicles. The vesicles rupture, releasing infectious fluid, and then form scabs. ### Assessment and diagnosis of herpes zoster - Also known as shingles - Infection by the varicella-zoster virus occurring along dermatomal pathways and resulting in a vesicular skin rash. - Becomes latent in the neurons of sensory ganglia after a primary infection of chickenpox; it then reactivates later in life - Varicella-zoster virus, which causes chickenpox, - Herpes zoster is a frequent complication of HIV infection. ### Clinical Presentation - The pain is described as constant or intermittent and may have a tingling or stabbing quality. - Usually 48 to 72 hours before eruption of the classic vesicular skin rash. - Pain becomes progressively worse at night or with changes in temperature - Herpes zoster ophthalmicus is a common complication of shingles in the V1 distribution of the trigeminal nerve. This condition can cause blindness and requires immediate referral to an ophthalmologist - Acute neuritis along the path of the rash dermatome. PHN occurs in approximately 25% to 50% ### Objective - Unilateral vesicular rash along a dermatome, most commonly a thoracic or lumbar dermatome. - Rash begins as erythema and then changes to papular lesions that rapidly form vesicles. The vesicles rupture, releasing infectious fluid, and then form scabs. Occasionally, the vesicles coalesce to form bullae. The skin lesions usually continue to develop for 3 to 5 days, and the entire disease course usually lasts 10 to 15 days. ### Management - Manage the healed vesicles, obtain pain relief, and prevent secondary infection and other complications. Initial management of herpes zoster involves the use of antiviral agents. - Early intervention in the treatment of herpes zoster produces the best results, and antiviral therapy should be started within the first 72 hours of symptom onset. Famciclovir (Famvir), acyclovir (Zovirax), or valacyclovir (Valtrex) may be used. - Corticosteroids are ineffective - Not recommended for the treatment of uncomplicated herpes zoster. - Skin lesions should be kept clean, dry, and covered to prevent secondary bacteria - PHN is a persistent pain resulting from shingles that lasts more than 3 months after the disease has run its course. - Topical capsaicin cream is approved by the U.S. Food and Drug Administration (FDA) for relief of PHN. Topical lidocaine patches may be helpful. If pain is persistent, chronic PHN may respond to a regional block with or without corticosteroids. Ideally, the patient should be referred to a pain center - Nortriptyline or amitriptyline taken each night may help if simple analgesics are ineffective and can be used long-term. - Herpes zoster presents with unexplained pain along a dermatome 48-72 hours before eruption of a vesicular skin rash. - The rash progresses from erythema to papular lesions to vesicles to rupture to scab over. - Usually lasts 10-15 days. - Herpes zoster ophthalmicus is a common complication of shingles in the V1 distribution of the trigeminal nerve. - Rash on forehead and swelling of the eyelid, eye pain and redness, inflammation of the conjunctiva, cornea, or uvea, photophobia, mucoid discharge, fever. - Treatment with Acyclovir within 72 hours of rash onset, refer to ophthalmology. - Prevention with vaccination. - Differential diagnosis: varicella zoster (chicken pox), psoriasis. # Chapter 11: Common Skin Complaints ## Assessment and diagnosis of common skin complaints ### Health Teaching for Patients with Pruritus - Pruritus, the sensation of itching accompanied by the urge to scratch - Pruritus generally has either a local (e.g., insect bite, contact dermatitis) or systemic (e.g., chronic renal failure, hyperbilirubinemia with skin deposition of bile salts) etiology. Treatment of urticaria - Treatment of pruritus depends on the correct diagnosis. The goal of treatment of pruritus is to relieve the itch, break the itch-scratch cycle, and maintain the barrier protection of the skin. - Patients should be educated to avoid scratching, use cool compresses and apply pressure to itchy areas, and keep hands clean and fingernails trimmed. Wearing cotton gloves while sleeping may be advised to avoid the skin trauma from nighttime scratching. - Hydroxyzine (Vistaril), one of the most effective treatments for pruritus, given three to four times per day. Cyproheptadine is used two to three times per day. OTC antihistamines include loratadine, desloratadine, cetirizine, and fexofenadine, which can all be taken once daily. - Symptomatic treatment for dry skin and resulting pruritus consists of avoidance of strong soaps; taking shorter, tepid showers (10 to 20 minutes) instead of hot baths; and the use of effective emollients. Mild, bland soaps (e.g., Dove, Basis, Purpose, Cetaphil, Neutrogena) are recommended. - To seal moisture into the skin, applying a bland emollient such as petroleum jelly, Eucerin, Lubriderm, or Alpha-Keri immediately after dabbing the skin with a towel to partially pat dry is helpful. - Other systemic treatments for persistent pruritus may include antidepressants such as the tricyclic doxepin or mirtazapine, as well as anticonvulsant/nerve pain agents such as gabapentin (Neurontin). The antinausea/antiemetic aprepitant (Emend) has also been shown to be effective in treating the itch of atopic dermatitis and prurigo nodularis. ### Weekly Recording Q's **Week 1 Questions** 1. What is a common clinical feature of atopic dermatitis? - Erythematous patches with intense itching are characteristic of atopic dermatitis. Honey-colored crusts are typical of impetigo, while silvery scales are associated with psoriasis. - **Rationale: Erythematous patches with intense itching are characteristic of atopic dermatitis. Honey-colored crusts are typical of impetigo, while silvery scales are associated with psoriasis.** 2. Which area is commonly affected by atopic dermatitis in infants? - Face and scalp are commonly affected in infants with atopic dermatitis. - **Rationale: Face and scalp are commonly affected in infants with atopic dermatitis. In older children and adults, flexural areas are more commonly involved.** 3. What is the first-line treatment for mild atopic dermatitis? - Moisturizers and emollients are first-line treatments for mild atopic dermatitis to help restore the skin barrier and reduce dryness. - **Rationale: Moisturizers and emollients are first-line treatments for mild atopic dermatitis to help restore the skin barrier and reduce dryness.** 4. When should systemic treatment be considered for atopic dermatitis? - Systemic treatment should bet considered when topical treatments fail and symptoms are severe or widespread. - **Rationale: Systemic treatment should be considered when topical treatments fail and symptoms are severe or widespread.** 5. What is a common trigger for atopic dermatitis flare-ups? - Viral infections, such as the common cold, are common triggers for flare-ups of atopic dermatitis. - **Rationale: Viral infections, such as the common cold, are common triggers for flare-ups of atopic dermatitis.** 6. What is a characteristic feature of psoriasis palques? - Silvery scales over red plaques are characteristic of psoriasis. - **Rationale: Silvery scales over red plaques are characteristic of psoriasis. Honey-colored crusts are typical of impetigo. Vesicles with central clearing are seen in tinea.** 7. Which treatment is commonly used for moderate to severe psoriasis? - Phototherapy is commonly used for moderate to severe psoriasis when topical treatments are insufficient. - **Rationale: Phototherapy is commonly used for moderate to severe psoriasis when topical treatments are insufficient.** 8. Which laboratory test is useful in monitoring psoriasis? - Erythrocyte sedimentation rate (ESR) can be elevated in inflammatory conditions like psoriasis, providing an indication of disease activity. - **Rationale: Erythrocyte sedimentation rate (ESR) can be elevated in inflammatory conditions like psoriasis, providing an indication of disease activity.** 9. What is the role of biologics in the treatment of psoriasis? - Biologics are used for severe psoriasis and target specific immune pathways to reduce inflammation and plaque formation. - **Rationale: Biologics are used for severe psoriasis and target specific immune pathways to reduce inflammation and plaque formation.** 10. Which of the following is a common comorbidity associated with psoriasis? - Diabetes mellitus is a common comorbidity associated with psoriasis due to shared inflammatory pathways. - **Rationale: Diabetes mellitus is a common comorbidity associated with psoriasis due to shared inflammatory pathways. Erythematous patches with honey-colored crusts are characteristic of impetigo. Silvery plaques are associated with psoriasis, while vesicular rashes are seen in herpes.** 11. What is the typical appearance of impetigo lesions? - Erythematous patches with honey-colored crusts are characteristic of impetigo. - **Rationale: Erythematous patches with honey-colored crusts are characteristic of impetigo. Silvery plaques are associated with psoriasis, while vesicular rashes are seen in herpes.** 12. What is the primary causative agent of non-bullous impetigo? - Staphylococcus aureus and Streptococcus pyogenes. - **Rationale: Staphylococcus aureus and Streptococcus pyogenes.** 13. What is the recommended initial treatment for localized impetigo? - Topical antibiotics, such as mupirocin, are recommended for localized impetigo to target the bacteria directly. - **Rationale: Topical antibiotics, such as mupirocin, are recommended for localized impetigo to target the bacteria directly.** 14. Which factor increases the risk of developing impetigo? - Having atopic dermatitis or eczema increases the risk of developing impetigo due to compromised skin barrier function and increased susceptibility to bacterial infections. - **Rationale: Having atopic dermatitis or eczema increases the risk of developing impetigo due to compromised skin barrier function and increased susceptibility to bacterial infections.** ## Assessment and Diagnosis of Alopecia - Alopecia can be scarring or non-scarring. - Alopecia areata is an autoimmune condition that affects hair follicles. - Androgenic alopecia is male pattern baldness. - Trichotillomania is compulsive pulling of hair. - Treatment includes corticosteroids and Minoxidil (Rogaine) # Chapter 12: Parasitic Skin Infections - Assessment and diagnosis of common parasitic skin infections - Pharmacological management of common parasitic skin infections - Health promotion and teaching for patients with common parasitic skin infections ## Characteristics of Scabies - An intensely itchy rash caused by a mite known as Sarcoptes scabie - Can last several days or weeks - Transmitted through direct contact ## Differential Diagnoses for Scabies - Clinical diagnosis of scabies is almost never made until hypersensitivity has occurred. - Differential diagnoses for scabies includes atopic dermatitis, contact dermatitis and folliculitis ## Systemic Treatment of Scabies - Ivermectin (Stromectol) is the most common and best systemic treatment for scabies. ## Pediculosis-Differentiating Between Lice and Dandruff - A hallmark of nits is that they are firmly cemented in place and, therefore, do not slide easily on the hair shaft, compared with dandruff scales. Sebaceous plugs result from plugged oil glands on the scalp and (unlike nits) do not originate on the hair shaft. - Patient education is essential when treating pediculosis: itching may continue for up to a week after successful treatment because of the slow resolution of the inflammatory reaction caused by the lice infestation. # Chapter 13: Fungal Skin Infections ## Risk Factors for Developing a Fungal Skin Infection - Especially with immunocompromised patients. They don't have the immune system to fight off. These pesky little. - The older the person is the more immunocompromised they are to be, or their immune system doesn't respond as quick very young. So really opposite end of the age spectrum. Like, it could be diabetics who are prone to fungal infections. - Due to if they have like, high sugar content, high sugar content, a bacteria fun guy, they love a very hyperglycemic environment. They thrive off of it. So those patients can be very much at risk patients taking antibiotic therapy. - Where the antibiotics knocks out the normal flora and so they get it risk for getting a fungal infection. Anything that alters cellular immunity, AIDS, diabetes, steroid treatment that reduces the inflammatory response. So that sets them up. - Bone marrow transplant - Invasive parenteral catheterization ## Assessment Findings of Fungal Skin Infections - Popular rash, satellite lesions (small, itchy, red spots or blister-like lesions that appear along the edges of a fungal skin infection rash) common in fungal skin infections ## Pharmacological Management of Common Fungal Skin Infections - Treatment is pretty basic antifungal cream typically, or it can be given in a pill form and keeping the area as dry as possible with these fungal skin infections because they love warm, moist, dark environment where there's just a lot of poor circulation and it's important to consider the. ## Treatment: Onychomycosis aka Tinea unguium, - Fungal Infections of the Nail Beds - That's a tinea infection as well. And it's, it's either like a white or yellow nail discoloration if it's not treated or if it's if it's allowed to progress over a long period of time those nails. - Very, very thick, and you can see separation from the nail bed and it's usually toenails that's involved in this. Although the fingernails can be, but usually the toenails. - Nail is usually yellow-white, with yellow streaks - Nail is thin and crumbling and may separate from the nail bed - Treatment: onychomycosis - Topical treatment, - Systemic - Fungal culture - Direct microscopy - Paronychia ## Treatment for Onychomycosis - Butenafine (Mentax) 1% cream, apply to the affected area once daily for 2-4 weeks - Clotrimazole (Lotrimin AF) 1% cream or lotion, apply to the affected area twice daily 2-4 weeks - Ketoconazole (Nizoral) 2% cream, foam, or shampoo, apply once daily for 2-4 weeks - Terbinafine (Lamisil) 250 mg by mouth daily for 2-4 weeks - Treatment: Topical antifungals such as nystatin (Nyamyc, Pedi-Dri, Nystop; effective for Candida only), clotrimazole (Lotrimin), miconazole (Monistat-Derm), naftifine (Naftin), terbinafine (Lamisil), and ciclopirox (Loprox) are effective in treating onychomycosis ## Common Types of Fungal Infections, Consider Appearance and Distribution | Type | Assessment | |---|---| | Tinea vesicolor | Flat to slightly elevated brown papules and plaques that scale when they are rubbed along with areas of hypopigmentation; pruritic; most commonly found on trunk and shoulders | | Balanitis | Candidiasis in the glans of the penis | | Tinea Corporis | Annual lesions with scaly borders and central clearing on the trunk; has ring-shaped lesions (ring worm) with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk. | | Tinea Pedis | Athlete’s foot-feet and between toes | | Tinea Cruis | Jock itch-groin | ## Client Education Includes - Vinegar or Burrows solution soaks help decrease pruritus associated with tinea pedis and tinea manuum - Treat shoes with over the counter (OTC) antifungal spray during and after therapy - Use OTC miconazole nitrate (Zeabsorb) powder to reduce friction, absorb moisture, and prevent tinea cruris - Follow-up with clients on oral antifungal therapy to ensure improvement ## Dry Skin - Dry skin is another condition, and we see that a lot of the older adults who may just have dry skin, because they're not drinking enough fluid or they are on diuretics, like patients with heart failure or what have you? They are very diuretic are they diarrhea and they have dry dry skin. - **Who is at risk?** - older adults - **Teachable moments** - encourage the use of tepid water and a mild cleansing cream or soap. # Chapter 14: Bacterial Skin Infections - Like warm, red painful. There would not be a sharply demarcated border. ## Focused and Comprehensive Health Histories - Determining the scope of the patient assessment ## Characteristics of Cellulitis - Spreading infection in the epidermis and subcutaneous tissue that usually begins after skin break - Superficial bacterial skin infection that spreads to underlying tissue - Nonpurulent - Presents with skin tenderness, swelling, and redness - May cause fever and chills - Keflex – 500mg x4/day = 7 days (adults) ## Causes and Characteristics of Folliculitis - Bacterial infection of the hair follicle; papules are characteristic of folliculitis - Folliculitis is a superficial to deep skin infection of the hair follicles. Bacteria infect the hair follicle at a superficial level which leads to the clinical presentation of little pustules or erythema surrounding the base of the hair follicle. - Folliculitis may occur anywhere on the skin as a result of trauma or damage to the hair follicle from chronic irritation or friction. Shaving folliculitis is the result of sebaceous follicles which are colonized by gram negative bacteria become infected due to trauma from shaving. “Hot tub" folliculitis is a form of folliculitis that is caused by pseudomonas aeruginosa, which can withstand temperatures of up to 107 degrees F and chlorine levels up to 3mg/L. - Most cases of folliculitis are made be clinical diagnosis. Gram stain and culture may be used to differentiate folliculitis from other bacterial infections. If a fungal origin is suspected, a potassium hydroxide preparation test (KOH prep) may be performed. When clients present with deeper forms of folliculitis, especially in the presence of positive blood cultures or systemic symptoms, a referral to the emergency department is warranted for intravenous (IV) antibiotics and potential hospitalization. - Treatment - Topical antibiotic creams or ointments - Clearance of nasal colonization of S. Aureus with intranasal mupirocin twice a day (BID) x 5 days significantly reduces the incidence of recurrent folliculitis - Gentle cleansing twice daily with antibacterial soap ## Diagnosing a Cyst - The client with an epidermal inclusion cyst will report a history of the cyst on the same site for months to years. In contrast, furuncles are an acute process, taking only several days to form. Another characteristic of an epidermal inclusion cyst is a cheesy white discharge with a strong odor when it is expressed. ## Hidradenitis Suppurativa and Furuncle (boil) - Furuncle - Furuncles are an acute process, taking only several days to form. - Painful red bumps under the skin due to infection of hair follicles or in oil glands. It starts as red, tender lump at the infection area and may grow to form pus-filled lumps. - Deep bacterial infection of a hair follicle with abscess - Commonly occur on the axillae, neck, and buttocks - Carbuncle is a large, multi-loculated abscess, comprised of multiple furuncles in a confined area. - Almost exclusively caused by gram-positive S. aureus. - Systemic antibiotics is not necessary for healthy individuals without surrounding cellulitis. - Most spontaneously drain pus and resolve with warm compresses. = treatment requires incision and drainage to express the exudate. Gram stain and culture of the exudate should be completed after incision and drainage to identify possible MRSA. - Warm compresses twice daily to encourage drainage. - Dry sterile dressing ## Differential Diagnosis of Swollen Lymph Nodes Under the Arm - If the furuncle or carbuncle is located on the axilla, a differential diagnosis to consider is Hidradenitis suppurativa (A long-term skin condition characterised by painful bumps under the skin. It usually occurs in the armpits, groin, buttocks or breasts) ## Assessment Findings for Impetigo - Highly contagious bacterial skin infection and most commonly affects young children, although anyone can get it if infected; - Honey-colored crust - Non-pharmacologic management involves the use of solutions or substances to debride the lesions and to expose the skin surfaces where the bacteria are present. - Both bullous and nonbullous types of impetigo produce symptoms such as burning and pruritus. In addition, regional lymphadenopathy is seen. When the face is involved, the cervical lymph nodes (and sometimes the preauricular and submandibular nodes) are enlarged; when the lesions are present on the upper extremities, the axillary nodes become enlarged. ## First-Line Topical Treatments for Impetigo - Mupirocin 2% cream or ointment (Bactroban), as well as etapamulin 1% ointment (Altabax) - Mupirocin is applied three times daily for 5 days in children 12 years and olde - Retapamulin (Altabax) is effective against mupirocin-resistant strains. - Retapamulin is applied twice daily for 5 days in children 9 months of age and older. ## Other Important Considerations - Affects infants and children - not common in adults - Washing with chlorhexidine (Hibiclens) is a valuable adjunct because of its bactericidal properties. The patient should be instructed to wash the affected skin area with the bactericidal soap two to three times a day before the affected skin area with the bactericidal soap two to three times a day before the mupirocin cream is applied. Dilute bleach baths (i.e., one-fourth cup of bleach added to a half-filled bathtub) may also be considered. In recurrent cases of impetigo, mupirocin (Bactroban Nasal) may be utilized to treat nasal carriage. ## Patient Teaching for a Child with Impetigo - Good hand washing and personal hygiene are strongly recommended to reduce the likelihood of bacterial spread. - The fingernails should be kept short so that there is less likelihood of spread to other areas of the body through self-inoculation. - Children and family members should be educated about the contagious nature of impetigo. Frequent hand washing is imperative. - Affected individuals should be told to refrain from participation in any contact sport or activity that might spread the infection. - Children should not attend day care or school for 24 hours after antibiotic therapy is started - Family members should not share clothing or personal hygiene items such as towels, robes, razors, or shavers. Towels and bed linens should be washed with soap and hot water and dried on high heat. - Gently clean the crusts from the lesions with antibacterial soap before applying mupirocin 2% cream or retapamulin. - Nighttime application is also advised. Cover dressings should be used to prevent contact with the exudate; - Discarded carefully to prevent the spread of infection - Good persona hygiene and cleanliness, along with prompt attention to skin trauma, may help prevent future breakouts of impetigo # Chapter 15: Viral Skin Infections ## Focused and Comprehensive Health Histories - Blistering sores - either oral or genital - Itching - Pain during urination - in case of genital herpes - Fever - Headache - Tiredness - Lack of appetite ## Determining the Scope of the Patient Assessment - Caused by the human papillomavirus; most warts re-occurring despite treatment. - Abrading the skin can spread the virus; vigorous rubbing, shaving, and nail biting, can do the same - The major characteristic of filiform/digitate warts is that they are easily treatable but recur. ## Pharmacological Management of Genital Herpes - Immunocompromised clients are treated with Famciclovir (Famvir) or Valacyclovir (Valtrex) (Remember the goal of treatment is to suppress) # Chapter 16: Dermatitis ## Assessment and Diagnosis of Dermatitis ## Atopic Dermatitis - Is a long-term type of inflammation of the skin. It results in itchy, red, swollen, and cracked skin. - Is characterized by an extremely low threshold for pruritus and has been referred to as "the itch that rashes." Almost always, the itch occurs before the rash appears, and scratching the rash worsens it clinically. - The cardinal sign of atopic dermatitis is severe pruritus. - In children, the primary locations are the antecubital fossae and Location of atopic dermatitis in children - Atopic triad-asthma, eczema and allergic rhinitis - A genetic predisposition toward allergic reactivity may be the most important etiological factor in all atopic conditions. - A personal or family history of all or part of the "atopic triad"-asthma, allergic rhinitis, and eczema-is often present. ## Skin Inflammations: Urticaria - Hives: Look at the location of the rash; the first step is to determine the need for epinephrine; Look for respiratory symptoms, difficulty breathing, hoarseness; look at location of rash; is it on the neck, around the face, etc.; if it is, epinephrine must be administered. - Sometimes all choices may seem correct; in that case, the question is prompting you to prioritize your NP actions. Look for what should be done first. - Cholinergic urticaria: Cholinergic urticaria are hives or wheals that are pruritic and occur on the trunk and arms following exercise, anxiety, elevated body temperature, hot baths and showers. - Treated with antihistamines - History taking is important in determining rash development - Type type 1 hypersensitivity response and if you remember type 1, you kind of will understand the symptoms that they are exhibiting. So, in the case of hives, it's really important to look at the location of that rash because if it's on a location or. - Down the airway around the face that can signify that they're going into anaphylactic reaction. And so because of that, in terms of that location 1 of our 1st steps. # Chapter 17: Skin Lesions ## Assessment and Diagnosis of Common Skin Lesions ## Treatment of Acne/Acne Vulgaris - Results from clogged or plugged hair follicles present under the skin. - Small to large, red bumps on the skin which may be painful and pus-filled in some cases. ## Health Teaching for Patients with Common Skin Lesions (Acne) - Benzoyl peroxide (Benzac) is first-line treatment for acne - Good candidates for oral antibiotic treatment include hose at risk for pigmentation changes or scarring, nodulocystic acne and those who want quick relief from inflammatory acne. - Teaching: Sunscreen should be used with all acne medications. - Other key information includes washing the face gently at least twice a day with an antibacterial ## Causes and Characteristics of Actinic Keratosis - Pre-Cancerous lesions: Actinic Keratosis - Assessment - Inspection: the question may provide a description of the rash; flesh colored, hard, sand-paper like - Diagnose: - Based on presentation-Lesions are found on sun-exposed areas of skin that have been damaged be cumulative sun exposure. - Treat: - Most often cryotherapy - Who is at risk? - Sun exposure (cumulative sun exposure) - What is the risk of it developing into something else? Pre-cancerous lesion that can progress to a squamous cell carcinoma - High risk - these are pre-cancerous lesions - Do I need to refer the patient? To dermatologist to help prevent its progression ## Treatment of Rosacea - A common skin condition that causes blushing or flushing and visible blood vessels in the face - May also produce small, pus-filled bumps that flare-up for weeks-months and then subside - There is a familial tendency, and several genes have been identified. Neurovascular dysregulation, infection, and factors that trigger altered innate and adaptive immune response are involved (i.e., chronic sun exposure and damage, heat, drinking alcohol or hot beverages, hormonal fluctuations, Demodex folliculorum [mites] colonization, and mental stress and anxiety). ## Patient Teaching for Rosacea - **Metronidazole cream is the mainstay of therapy, but it may take up to 6 to 8 weeks for a therapeutic response to be seen** - Clients should be taught to identify triggers, how to apply sunscreen and how to protect the face from cold air and wind. ## Characteristics of Seborrhea Keratosis - Lesions are superficial epithelial growths that originate from the horny layer of the epidermis and are the result of a benign proliferation of immature keratinocytes. - Inspection of the lesions may reveal dark keratin plugs or firm, horny cysts on their surface. - These are epidermal tumors, but they are not considered malignant or premalignant because they do not undergo transformation into cancerous lesions. - The differential diagnoses for seborrheic keratosis include benign pigmented nevi, pigmented basal cell carcinoma (BCC), and malignant melanoma. ## Individuals at Risk for Seborrhea Keratosis - Who is at-risk? Although seborrheic keratosis occurs in both men and women, the typical client is an older white woman who complains of the cosmetic effects of the lesion. The client typically complains of the unsightliness of the lesion, itching, and constant irritation from friction or clothing. - These are epidermal tumors, but they are not considered malignant or premalignant because they do not undergo transformation into cancerous lesions. - The differential diagnoses for seborrheic keratosis ## Differential Diagnoses for Seborrhea Keratosis ## Assessment of Lipoma - Is a benign rubbery, smooth and round mass of compressible tissue with soft texture - Benign tumors of fat, formed between the skin and the underlying muscle. Lipomas can grow anywhere in the body where fat cells are present. Most seen in neck, shoulders, armpits, and thigh. ## Risk Factors for Malignant Melanoma - Who is at-risk? Increased age, immunosuppression and exposure to indoor tanning are risk factors for malignant melanoma. - Is the most aggressor skin cancer; the thickness of the lesion impacts prognosis # Chapter 18: Common Eye Complaints ## Assessment and Diagnosis of Common Eye Complaints ## Evaluation of a Red Eye - Red eyes are caused by dilated blood vessels in the sclera and are often accompanied by itchiness, pain, discharge, edema, and visual acuity changes. ## Bacterial vs. Viral Conjunctivitis ### Viral Conjunctivitis - The causative organism of viral conjunctivitis is adenovirus. - It can present with or without cold symptoms. Patients' complaint of itchy, red eyes and may have clear to no discharge. - Preauricular lymph node swelling and tenderness is hallmark for viral conjunctivitis. - Red, itchy eyes are associated with this condition, as is a watery discharge. - Skin vesicles (if present) and a corneal infection with a "dendrite" appearance are hallmark characteristics of HSV-1 or HSV-2 conjunctivitis. - It is important to teach the patient how to put drops in and advise to avoid touching the tip of the bottle to any conjunctival or skin surface. Women should be instructed to throw away all eye makeup products due to contamination and to start with new products when the infection clears. Likewise, disposable contact lens wearers will need to discard the contacts, refrain from wearing any during treatment, and start with a new pair when clinical symptoms resolve. Bacterial conjunctivitis is very contagious, so the patient should stay home from work or school until 24 hours of antibiotic treatment or as soon as clinical improvement (decreased redness and discharge) is noted. - See Table 19.1 for medications used to treat conjunctivitis ### Caused by Adenovirus, Highly Contagious - Communicable 10-14 days - Treatment - supportive measures - Contact precaution - Eye hygiene – washing hands, disinfect techniques (pillows, washcloths, towels) avoid swimming - Avoid rubbing the eyes which may worsen itching or result in corneal abrasion - Topical ophthalmic antihistamines