Exam 3 Flashcards
(ND) mosquitoes s/s
Welt and itching, large blisters
(ND) fleas s/s
Erythematous, intense itching
(ND) scabies s/s
Papular rash and intense itching, contagious
(ND) bedbugs s/s
Intense itching and irritation
(ND) chiggers s/s
Red papules, intense itching
(ND) ticks s/s, remove with ___
- Intense itching, can transmit Rocky mtn spotted fever & Lyme disease
- Remove with fine tweezers
(ND) insect bite: nonpharmacological treatment
- DEET insect repellent (X kill)
- Apply after sunscreen
- Do not use in children <2 mo
(ND) DEET formulation % and its uses
- <30%: children
- 10-35%: adults in routine situations
- > 20%: prevent tick bites
- > 50%: no benefit
(ND) insect bite: pharmacological treatment options
Local anesthetics, topical antihistamines, counterirritants, hydrocortisone, skin protectants
(ND) insect bite: local anesthetics agents
- Pramoxine, benzyl alcohol: less AEs
- Dibucaine: allergen, toxic
- Phenol: avoid in preg & children
(ND) insect bite: topical antihistamine agent
Diphenhydramine
(ND) insect bite: counterirritant agents
- Camphor: avoid in children
- Menthol: safe and effective antipruritic
(ND) insect bite: skin protectants agents
- Zinc oxide, calamine
- Good for adults, children, infants (best)
(ND) insect bite: selfcare exclusions
- Hypersensitivity to insect bites
- <2 yrs
- Hx of tick bites and systemic effects
- Signs of secondary infections
- Suspected spider bite requiring medical attention
(ND) insects that sting
Wild honeybees, wasps, hornets, yellow jackets
(Bumblebees do not sting)
(ND) insect stings nonpharmacologic treatment
Remove stinger by scraping, ice, hydrogen peroxide or alcohol
(ND) insect stings pharmacologic treatment
- Local anesthetics, topical antihistatmines, counterirritants, hydrocortisone, skin protectants
- Oral diphenhydramine 25-50 mg
(ND) insect stings selfcare exclusions
- Hypersensitivity to insect bites
- <2 yrs
- Significant allergic response away from sting site
- Personal or FH of significant allergic rxn
- Hives, excessive swelling, dizziness, weakness, N, difficulty breathing
- Previous sting by honeybee, wasp, or hornet
(ND) pediculosis three types
- Head lice
- Body lice: “cooties”, transmit infections
- Pubic lice: “crabs”, through high-risk sexual contact
(ND) pediculosis nonpharmacologic treatment
- Visual inspection of hair
- FDA approved nit comb
- AirAlle applies heat to hair and scalp to dehydrate and kill lice
- Clothing and bedding washed in hot water
- Vacuum carpets and rugs
(ND) pediculosis pharmacological treatment (2)
- Pyrethrins: for head & pubic lice, do not use in <2 yrs, apply for 10 mins –> rinse/shampoo –> lice comb –> repeat in 7-10 days
- Permethrin: for head lice only, do not use in <2 mo, re-treatment not required
(ND) pediculosis selfcare exclusions
- <2 mo for permethrins, <2 yrs for pyrethrins
- Active tumors
- Secondary skin infection in lice-infested area
- Life infestation of eyelids or eyebrows
- Regional resistance to pediculicides
- Hypersensitivity to chrysanthermums, ragweed, or pediculicide ingredients
- Pregnancy or breastfeeding
(ND) sunburn s/s
- Acute reaction to excessive UVR exposure: inflammation
- Erythema, swelling, pain
- Max response at 6-24 hrs
- Resolves in 72 hrs
(ND) sunburn prevention 5 S’s
- Slip on protective clothing
- Slop on SPF 30+
- Slap on a hat
- Seek shade
- Slide on sunglasses
(ND) sunscreen SPF formulations
- 2-14: help prevent sunburn, must carry skin cancer/aging alert
- > 15: decreased risk of skin cancer and early skin aging, will be required to meet min UVA/B protection
- > 60: benefit up to 60, 60-80 must go through NDA
(ND) sunscreen age exclusion
<6 mo
(ND) sunscreen application
- 15-30 mins before UV exposure
- Reapply Q2H
- Apply 22.5 mL or 4.5 teaspoons (~2 fingers) total in each application
(ND) sunburn counseling points
- Apply sunscreen 15 mins before exposure
- Avoid sun exposure & other UVR sources
- Sun rays are the most direct & damaging from 10 am - 4 pm
- Sunburn on cloudy or overcast day: 0-90% of UVR penetrates clouds
- SPF 15 provides the greatest protection, wear protective clothing
- Check expiration date
(ND) types of burns
- Thermal
- Electrical, chemical –> refer to emergency department
(ND) types of wounds
- Abrasions: rubbing/friction on the epidermal layer of skin
- Lacerations: cuts/punctures from sharp edged objects piercing through skin layers
- Rule of Nine Method: estimate BSA into multiples of 9%
(ND) burns nonpharmacologic treatment
Continuous cooling
- Running water
(ND) wounds nonpharmacologic treatment
Wound cleansing
- Clean tap water
- Do not pull loose or burned skin (small blisters <6 mm)
- Large blisters may rupture on their own: wash with soap and water, apply moist wound dressing
(ND) burns and wounds pharmacologic treatment: topical anesthetics
- Temporary relief of pain, rapid onset
- Benzocaine, lidocaine, pramoxine
(ND) burns and wounds pharmacologic treatment: systemic analgesics
- Short term for minor skin injury
- ASA, naproxen, ibuprofen, APAP
(ND) burns and wounds pharmacologic treatment: skin protectants
- Emollients, moisturizers
- Protect from irritation, promote moist healing, prevent scarring
- Petrolatum, dimethicone, zinc oxide, glycerin, cocoa butter
(ND) burns and wounds pharmacologic treatment: first aid antiseptics
- Antibiotic activity
- Chlorhexidine, hydrogen peroxide, povidone-iodine solution
(ND) burns and wounds pharmacologic treatment: first line antibiotics
- Prevention, not treatment
- Bacitracin, neomycin, polymixin B
(ND) minor burns self care exclusion
- Suspected non-accidental injury
- Chemical, electrical, or inhalation burns
- Skin injury that worsens/ does not heal in 7 days
- Deep partial or full thickness, or subdermal injury
- Signs of infection
- Circumferential burns
- Pre-existing conditions that could prolong recovery/ mortality
- Injuries larger than 3 in in diameter
- Site of injury: face, hands, feet, major joints, genitals
(ND) wounds selfcare exclusion
- Suspected non-accidental injury
- Injuries larger than 3 in in diameter
- Wound secondary to animal bite
- Deep partial or full thickness, or subdermal injury
- Signs of infection
- Chronic wounds
- Pre-existing conditions that could prolong recovery/ mortality
- Wound containing foreign matter after irrigation
- Site of injury: face, hands, feet, major joints, genitals
- Skin injury that worsens/ does not heal in 7 days
(ND) Atopic Dermatitis (AD) s/s
Scaly, erythematous, edematous, papular, crusty
(ND) AD nonpharmacologic treatment
- Depends on age, severity, sites of lesions
- Education on trigger avoidance and skin hydration
- Lifestyle changes: avoid irritating fabrics/fragrances, lukewarm & short baths, mild nonsoap cleaners, moisturize
- Moisturizer: hypoallergenic/fragrance free, lotions have higher water content (can be drying), ointments more effective in dermal penetration (can be greasy and less tolerable)
(ND) AD pharmacologic treatment
- Topical hydrocortisone: safe for short period of time, >2 yrs, cream is most tolerable, ointments preferred for thick skin or lesions that are dry/lichenified/scaly
- If no improvement >2-3days –> refer
- Antipruritics not recommended
(ND) AD exclusions
- Moderate-severe condition with intense pruritus
- Involvement of large area of body
- <1 yr
- Infection
- Face or intertriginous areas
(ND) Xerosis s/s
Roughness, scaling, cracking, fissuring, erythema, pruritus
(ND) Xerosis nonpharmacological treatment
- Bathing & moisturizing: tepid water, w/i 3 mins out of shower apply body moisturizer, moisturize at least 3x during the day
- Environmental factors: humidity, hydration, limit alcohol, caffeine, spicy foods
- Cleansers: gentle, non-soap, glycerin soap
- Moisturizers: humectants, emollients, occlusives, skin protectants
(ND) Xerosis nonpharmacologic product selections
- Ointments: dry, scaly skin
- Creams: less potent but less oily
- Avoid gels, foams, mousses
(ND) Xerosis pharmacological treatment
Hydrocortisone
- If needed for excessive itching
- Apply a thin layer under moisturizer 1-2x daily for no more than 7 days
- If no improvement after 7 days –> refer
(ND) Dandruff s/s
Scalp scaling –> sloughing of small white/gray loosely bound flakes
(ND) Dandruff treatment
- Routine shampooing: mild-moderate
- Cytostatic agent: pyrithione zinc, selenium sulfide
- Non-rx ketoconazole shampoo
- Keratolytic agent: salicylic acid, sulfur
(ND) seborrheic dermatitis s/s
- Demarcated, dull, yellowish, oily, scaly areas on reddened skin
- Infantile form: cradle’s cap with scalp concentration
- Darker skinned individuals may have hypopigmentation and lack yellow scales
(ND) seborrheic dermatitis treatment
Similar to dandruff, but more aggressive due to inflammatory nature
- 1st line = antifungal ketoconazole
- If scales difficult to remove: olive or mineral oil
- Regular use of medicated shampoo: pyrithione zinc and selenium sulfide
- Keratolytic agents: salicylic acid, sulfur
(ND) seborrheic dermatitis treatment: infants
Usually self-limiting so oil massages + non-medicated shampoo → refer
(ND) Psoriasis s/s
- Symmetrical lesions
- ~90% pts have a plaque
- Well demarcated and covered with a silvery-white scales
- Painful and itchy
- Common sites: extensor surface of elbows/knees, lumbar region of the back, scalp, genital area
- Auspitz Sign: when scale is lifted and pinpoint bleeding occurs