Exam 3 Dermatology Flashcards
Terms to describe Oral Lesions
1) Erythema =
2) Ecchymosis =
3) Petechiae =
4) Primary lesions (3)
5) Secondary lesions
6) Distribution pattern =
7) Configuration and arrangement =
1) Redness
2) Bruising
3) Pinpoint red or purple spots
4) Macule = flat, distinct, discolored < 1cm
Papule = raised < 1cm
Vesicle = raised, fluid filled < 1cm
5) Caused by scratching or rubbing primary lesion
6) Pattern of lesions on body
7) Size, shape, arrangement of lesion/group of lesions
How to differentiate from petechiae and a rash?
Petechiae does not blanch - if it does, it is more concerning bc could indicated idiopathic thrombocytic purpura = capillary leakage of blood vessels/ rash
Bacterial Skin Infections =
(3)
-Skin normally harbors bacterial flora (2)
= any process leading to breach in the skin barrier (trauma, abrasions, shaving, insect bites)
1) Impetigo
2) Folliculitis, Furuncle, Carbuncle
3) Cellulitis
Risk Factors for Bacterial Skin Infections (2)
- Close contact with active bacterial skin infection
- Immunocompromised (HIV, DM, chemo)
Impetigo =
= Papules -> Vesicles surrounded by erythema -> pustules that break down to form thick adherent crusts with a characteristic golden appearance
Impetigo
- Most frequent in __-__ years
- Lesions usually found where? and are ______
- 2-5 yo
- Face (around mouth and nose) + Extremities, are Pruritic
Tx for Impetigo
1) Topical =
2) Oral =
1) Mupirocin (Bactroben)
2) Oral Cephalosporins
How do you prevent the spread of Impetigo ?
Is it likely to leave scarring?
Hand Washing
No
Folliculitis =
What is formed? (2)
= infection of the hair follicle; purulent material extends into the dermis and subcutaneous tissue
1) Furuncles (small abcesses) -> Carbuncles = several inflamed follicles into a single inflammatory mass
Folliculitis
1) Seen in areas exposed to?
2) What areas does folliculitis occur? (4)
3) Caused by what bacteria? often where?
1) Friction and Perspiration
2) Back of neck, face, axillae, buttocks
3) Pseudomonas aeruginosa, exposure to hot tubs, whirlpools
Tx for Folliculitis = (2)
Never do what?
Antibiotics?
1) Warm compresses to bring drainage
2) Incision and Drainage* - obtain culture to rule out MRSA
- NEVER SQUEEZE! bc can squeeze it squeezes into tissues too
- Role of antibiotic not clear in evidence
Cellulitis =
= Inflammation of the skin and subcutaneous tissue that may involve the upper dermis and superficial lymphatics - usually a complication of a wound or trauma
Characteristics of Cellulitis =
Acronym WIFEES
Warm Inflammation of regional lymph nodes Fever Erythema Edema "Streaking"
2 Types of Cellulitis
1) Periorbital Cellulitis
2) Perianal Cellulitis
Cellulitis may progress to
Systemic infection rapidly -> sepsis
So we want to monitor closely, draw a circle around effected area
Tx for Cellulitis (3)
- Elevate, Rest, Immobilization
- 1st option = Oral Antibiotics
- 2nd option = IV Antibiotics (joints, eyes, face)
Nursing Management for Bacterial Skin Infections (4)
1) Hand Washing
2) Clean clothing that directly touches affected area with hot water, and change daily
3) Discard Razors
3) Prevent child from touching affected area
Viral Skin Infections (2)
Warts
Herpes Simplex
Causes of warts (2)
What is a wart? and what does it look like?
HPV, verruca plantaris (plantar warts)
Papule, gray and brown, raised, circumscribed, firm, rough, lesions of < 1 cm diameter
Tx for Warts =
4
Destructive Therapy
1) Surgical Removal* (best)
2) Cryotherapy with liquid nitrogen
3) Laser Removal
4) Latinoic, Retinoic, Salicylic Acid Solutions
Herpes Simplex (2)
1) Type I = Oral Lesions (mouth sores, fever blisters)
2) Type II = Genital
Characteristics of Herpes
When do they heal?
Involves what parts of the body (4)
Clustered, grouped, burning, itching vesicles that dry and form a crust
Spontaneously in 8-10 days
Lips, Nose, Genitalia, Buttocks
Note: Culture first to rule out HSV 1 or 2, if they have genital, consider sexual abuse or that they have type 1 then touched genitals
Tx for Herpes Simplex (3)
1) Penciclovir (topical) - may shorten duration of cold sores
2) Acyclovir (oral antiviral)
3) Valacyclovir (Valtrex) - for recurrent genital herpes
Bacterial vs. Viral Infections
Why is viral harder to treat?
Bc viruses are intracellular -> harder to invade, and also may remain dormant for periods of time
Fungal Skin Infections (3)
1) Tinea Capitis (ringworm of scalp)
2) Tinea Corporis (ringworm of body)
3) Tinea Pedis (ringworm of feet)
Tinea Capitis =
Characteristics of Tinea Capitis
= Ringworm of scalp
Scaly, Circumscribed patches with areas of Alopecia, may be Pruritic
Tinea Capitis
1) High incidence in ____ children (__-__ yo)
2) More likely in girls or boys?
3) In what types of hair?
4) How does it spread child to child?
5) How long does it last?
1) prepubertal (2-10 yo)
2) Boys
3) Coarse
4) CATS AND HATS! Shared hats, combs, brushes, barrettes, rollers, household pets (esp. cats)
5) months-years, bc tends to reoccur
Tx for Tinea Capitis = (1)
- Take it with what? For how long?
Oral Griseofluvin (oral antifungal)
- with fatty snack/meal (milk) for better absorption, for 6-12 wks
Tinea Capitis
1) Allergic reaction to the fungus will result in?
2) What do you give if their allergic to the fungus? for how long?
1) Kerion ( a boggy inflammation)
2) Prednisone, 7-10 days
Tinea Corporis =
How is it transmitted, from what?
Where do lesions occur?
= Ringworm of the Body
- Animal origin from infected pets
- Most often effects non-hairy bod parts: face, trunk, under arms
Characteristics of Tinea Corporis lesions
Acronym = RESP-CMP
- Round, Erythematous, Scaly patches, with Clear center, multiple, pruritic maybe
Tx for Tinea Corporis (2)
How often is it applied/day, for how long?
What if the topical is ineffective?
Micronazole, Clotrimazole (topical antifungals)
- 3x/day for at least 2 wks + 1-2 wks after lesions go away
- Oral Griseofulvin
Tinea Pedis =
- Often follows activities that?
- May be ____, ____, or _____
- Chronic, untreated can cause?
Ringworm of the Feet (Athletes Foot)
- Cause feet to sweat
- Intermittent, recurrent, chronic
- Can cause scaling, spread to the nails
Characteristics of Tinea Pedis Lesions
- Intensely pruritic, erythematous vesicles or bullae btween toes and on soles of feet
Tx for Tinea Pedis
- Topical Antifungal for how long?
- Chronic Tinea Pedis may require? for how long?
Try not to wear what type of shoes?
- 4 weeks, interdigital
- Oral griseofulvin up to 8 weeks
Leather bc not porous
Nursing Management for Fungal Skin Infections
1) Emphasize good h__/h___
2) Avoid exchanging ____ items, __ gear, have own ____
3) Protective ___ __ to prevent spreading fungus to ____
4) Household ___ should be examined for fungus
5) Child may return to school ___ hrs after antifungal med
6) Griseofulvin should be given with?
7) Important to keep areas ____ and ___ as possible
1) health, hygiene
2) grooming items, head gear, have own towel
3) head cap, bedding
4) pets
5) 24
6) high fat foods for better absorption
7) clean, dry
Dermatitis (2) =
= inflammatory changes in the skin
1) Atopic Dermatitis = eczema (triggered by allergies/environments/stress) reaction to IgE
2) Contact = reaction to surfaces/fomites, by touching object
Atopic Dermatitis (Eczema) appears to involve =
1) Onset usually before age ____
2) May have elevated ___ lvls (asctd with asthma) and higher sensitivity to allergens
3) Environmental allergens, irritants, microbes penetrates ____ and comes in contact w _____ cells -> release of ____ mediators
4) is it contagious?
= genetic defect in proteins supporting epidermal barrier
1) 5
2) IgE
3) skin, immune, inflammatory
4) Not contagious
Characteristics of Atopic Dermatitis
- R___, S___, C___ lesions
- P
- Can include ____
- May have ___ marks
- ____ skin throughout
Where does it occur on the body? (5)
Avoid putting __’s in these areas
- Red, Scaly, Crusted lesions
- Pruritic
- Can include vesicles
- scratch
- dry
- Antecubital, Popliteal fossae, neck, around eyes, ankles
- avoid IV’s
Tx for Atopic Dermatitis
1) Eliminate _____ factors
2) Weather: Excessive ____, __ humidity, emotional ____, ____ of skin, exposure to ____
3) Maintain skin hydration (2)
4) Controlling pruritis (1)
5) Therapy for inflammation (1)
6) Management of infection (1)
We prefer what type of steroids? why?
1) exacerbating
2) bathing, low, stress, overheating, detergent
3) Aquaphor, Eucirin*
4) Antihistamines
5) Corticosteroids
6) Antibiotics
Topical steroids, bc systemic steroids cause immunosuppression
Note: common OTC medication not included in ppt = saravae, aveno
Contact Dermatitis =
= inflammatory reaction of the skin d/t chemical substances (natural or synthetic)
Contact Dermatitis usually happens where on the body? (5)
Causes (3)
Typically on exposed region: face, neck, back of hands, forearms, lower legs
1) Diapers (diaper dermatitis)
2) Plants (poison ivy)
3) Irritants (wool, furs, metals, oils, dyes, cosmetics, perfumes, soaps)
Characteristics of Contact Dermatitis lesions
Acronym: EveryBody Says Cats Pee
- Erythemetous
- Bullae
- Swollen base
- Constant Pruritis
Diaper Dermatitis =
1) Is it common?
2) Peak age = __-__ months
3) Where does it appear? On ___ surfaces or in ___ of skin
4) However, the folds are spared from? (2)
5) Avoid using __ to clean, use what instead?
= due to prolonged, repetitive exposure to urine, feces, soaps, friction
1) Very common
2) 9-12 months
3) Convex surfaces, folds of skin
4) urine, feces
5) wipes, soap and water instead
Tx for Diaper Dermatitis =
- If it progresses to _____ (what does it look like), must treat with _____
- Keep area ___ and ___ to ____
Zinc Oxide Ointment*
- Candidiasis (beefy red central erythema with satellite pustules), Nystatin cream (antifungal)
- Dry, expose to air - encourage fam to keep dry for 20 min before putting on new diaper
Nursing management for All Dermatitis = Avoid _____
1) What do you do for wetness and fecal irritants?
2) Use _____ disposable diapers
3) Use skin ___ __ with each diaper change
4) Avoid ____ and ____ soaps (can irritate)
5) Use ____ and ____ soap to clean
= Avoid irritant
1) Change diaper frequently, leave open to air in between changes
2) super-absorbent
3) barrier cream
4) wipes, perfumed
4) water, mild
Skin Disorders d/t Mite/Insect Contact (3)
Scabies
Head Lice
Lyme Disease
Scabies =
= infestation of skin caused by scabies mite (sarcoptes scabei)
Scabies Prevalence
1) Can you see scabies with the naked eye?
2) An _____: it effects over 300 million ppl worldwide
3) What season are they more common in, why?
4) ____ conditions can increase prevalence
Transmitted =
1) No, microscopic
2) Epidemic
3) Winter, bc mites survive longer in cold termperatures
4) Crowded
Direct Contact
Scabies lesions are =
1) Where do they usually occur? (3)
2) They feel ____ (often severe/worse at __)
3) “____ ____” presentation
4) Will find _____ in infants and small children bc they do not scratch
Small, erythematous, papules
1) Between fingers, hands and wrists, feet ankles
2) Itchy (night)
3) “Hockey Stick”
4) Burrows
Tx for Scabies = *
Teach them how to apply =
Apply when? For how long? When do you wash it off?
Permetherin
- Apply ALL OVER body including fingernails, toenails, behind ears - bc will travel to unaffected areas, and burrow
- Overnight, 8-14 hrs, wash off in the morning (shower)
Nursing Management for Scabies
1) How should we prevent re-infestation?
2) How long/in what conditions do scabies survive?
3) How do you kill the mites?
1) Treat entire family
2) 24-36 hrs off body, longer in cold
3) Bag clothing, bedding, stuffed animals for at least 72 hours, to suffocate them then wash in hot water, hot dryer
Head Lice = aka ___ ____
Head Louse Characteristics
1) Color? How Big? Life span?
2) Lays how many eggs/day?
3) How do they attach?
4) How long can they survive off the body?
5) How are they transmitted?
Pediculosis Capitis
1) Gray-white, 2-4 mm insect, female 1 month
2) 7-10 eggs/day
3) Attach to hair and suck blood from scalp
4) 48 hours off body
5) Don’t jump or fly, transmitted from direct
contact on items like hats, coats, scarves
Eggs (nits)
- Where can you see them? Color? When do they hatch?
- Cement firmly to base of hair, white and more visible, 8 days
Note: drawn to coarse hair
Head Lice S/S (2)
Nits (eggs) can be seen where? (3)
- Most are Asymptomatic
- Pruritis may occur
Nits (eggs) can be seen on hair shaft (occipital area), behind ears, nape of neck
Tx for Head Lice = * (2)
1) How many times should you wash your hair?
2) Apply insecticide ___ or ____ liberally to scalp and leave on for ____ min before rinsing with water
3) How should you remove the lice? How often? (add a _____: ___, ___ rinse)
4) ___ ___ treatment = how long ___ is ____% effective
5) Home remedies effective? List some.
= Topical Pediculocide - Rid, Nix
1) Twice! more effective
2) Cream, gel, 10
3) Wet comb, every 2-3 days after, add lubricant: oil, cream rinse
4) Hot air, 30 min, 100%
5) NOT effective = petroleum jelly, oils, vinegar, butter, alcohol, mayonnaise
Nursing Management for Head Lice
1) Everyone in ____ needs to be _____
2) Anyone in the same ____ should be treated
3) Clothing, bedding, towels used within ___ hrs before should be ->
4) ____ carpet, furniture, car seats
5) What about items that can’t be washed or vacuumed?
6) ____ combs, brushes, hair accessories for __ min
1) Home, examined
2) bed
3) 48 hrs, washed hot water, hot dryer
4) Vacuum
5) sealed inside plastic bag for 2 weeks
6) Boil, 10
Lyme Disease =
____ ticks (maine -> virginia)
= Tick-borne illness caused by spirochete Borrelia burgdoferi
Deer
Manifestations of Lyme Disease
- ____ _____ lesion =
- Serologic test = ____ and ___ antibodies to _____
- Erythema Migrans lesion = annular red rings
- IgG, IgM antibodies to borrelia burgdorferi
Stages of Lyme Disease
1)
2)
3)
1) Erythema migrans at site of bite
- within 1 month following tick bite
2) Early Disseminated Disease
- multiple erythema migrans lesions
- occurs days - weeks after infection
- neuro + cardio findings weeks after cutaneous phase
3) Late Lyme Disease
- may develop months to years after infection
- Arthritis involving one or few large joints + Neurologic problems (encephalopathy)
Tx for Lyme Disease (2)
Tx for how long? ___-___ days
- < 8 = Amoxicillin
- > 8 = Doxycycline
14-21 days
Teach parents how to protect children from exposure to ticks (3)
Perform
- Wear light colored clothing
- Tuck pant legs into socks
- wear long sleeved t-shirts tucked into pants
Regular tick checks
