Families exam 4 - psychosocial and integumentary Flashcards
How should new situations be introduced to a patient with autism?
slowly
What should you monitor for in a patient with autism?
behavioral changes
How should you communicate with a patient with autism?
- age-appropriate
- brief
- concrete
What should be promoted/encouraged for a patient with autism?
- positive reinforcement
- increasing social awareness
- verbal communication
- setting realistic goals
- opportunities for small successes
- setting clear rules
What are expected findings of ADHD?
- inattention
- hyperactivity
- impulsivity
What type of approach should be used for a patient with ADHD?
- calm
- firm
- respectful
What should be modeled for a patient with ADHD?
acceptable behavior
What should you have before giving a child with ADHD directions?
their attention
What kind of explanations should be given to a patient with ADHD?
short and clear
What should you set/provide for a patient with ADHD?
- set clear limits
- provide consistency
- provide positive feedback and rewards for good behavior
- provide a safe environment
- assist with developing coping mechanisms
How should the environment be modified for a patient with ADHD?
- structured
- decrease stimuli
- use organizational charts
- have a consistent study area
- use steps when assigning chores
- use pastel colors
What medications are used for ADHD?
- methylphenidate, dextroamphetamine (psychostimulants)
- atomoxetine (SNRI)
What are parental characteristics of child abuse?
- young parents
- single parents with a partner unrelated to the child
- low income
- low self-esteem
- lack of knowledge
- substance use disorder
- history of abuse
What are child characteristics of child abuse?
- < 1 year old
- unwanted
- hyperactive
- physical/mental disabilities
- premature infant
What can injuries in various stages of healing mean?
child abuse
What are behavioral characteristics of a child experiencing child abuse?
- fear of parents
- lack of emotional response/reaction
- withdrawn
- aggression
What is the most important thing to assess with a child who has depression?
actual/potential risk to self
- suicide plan
- lethality of the plan
- means to carry out the plan
Where can candidiasis be found?
moist areas
- mouth
- belly
- skin
- vagina
What is used to treat candidiasis?
topical antifungal ointment (miconazole/fluconazole, nystatin)
What color is crust that forms with impetigo?
honey-colored
Where does impetigo usually happen?
on the face around the mouth and nose
What medication is used for less severe cases of impetigo? How long must you use this before you are no longer contagious?
- topical bactericidal or triple antibiotic ointment
- not contagious are 48 hours
What medication is used for more severe cases of impetigo? How long must you use this before you are no longer contagious?
- oral antibiotics
- not contagious after 24 hours
What should be done before applying ointment to impetigo?
remove crusts with warm water and antibacterial soap
Can you share items (towels, hate, combs, brushes, towels) with impetigo?
NO
What is the ost important thing for the nurse and family to do for impetigo?
hand hygiene!!!
What type of shampoo is used for lice?
1% permethrin shampoo
What should not be shared if a child has lice?
- combs/brushes
- hair ties/clips
- hats
How should nits be removed?
with a fine-tooth nit comb
How long should items that cannot be washed be bagged up if a child has lice?
14 days
How should items be washed if a patient has lice?
in hot water with detergent and in a hot dryer for 20 mins
How should items be washed is a patient has impetigo?
on hot with bleach
What does a diaper rash look like?
- bright red
- scaly
- pimples, blisters, ulcers, large bumps, pus-filled sores
What should be used to clean the perineal area with a diaper rash? How should it dry?
non irritating cleanser, let air dry
What type of diapers should be used for diaper rash?
superabsorbent disposable diapers
What skin barriers can be used for diaper rash?
- zinc oxide
- petroleum ointement
- aluminum acetate solution
Should you wash off the skin barrier with each diaper change?
NO
What can diaper rash be a sign of?
neglect
What type of ointments cannot be used for diaper rash?
corticosteroid ointments
What is considered open acne? What is considered closed acne?
- open: blackheads
- closed: whiteheads
Where is acne most common?
- face
- back
- neck
- chest
What type of compress is used for acne?
warm
What must be determined before starting isotretinoin?
if the pt is sexually active
What should you monitor for with isotretinoin?
behavioral changes
- s/sx of depression
- suicidal ideation
- violent behavior
- feelings of isolation
What should be encouraged to help with acne?
- balanced/healthy diet
- sleep/rest
- daily exercise
- frequent shampooing
- washing affected areas 1-2x/day
What should be avoided with acne?
- scrubbing
- abrasive cleansers
- tanning beds
What are adverse effects of taking isotretinoin?
- dry skin/eyes/mucous membranes
- decreased night vision
- HA
- photosensitivity
What happens to cholesterol levels when taking isotretinoin?
increased cholesterol and triglycerides
Why is isotretinoin contraindicated in women of childbearing age who are not taking oral BC?
it is TERATOGENIC!!!
If sexually active, what actions have to be taken with isotretinoin?
must use 2 forms of contraception for 1 month before, during, and 1 month after tx
When does stage 1 of lyme disease occur?
3-30 days after the bite
When does stage 2 of lyme disease occur?
3-10 weeks after the bite
When does stage 3 of lyme disease occur?
2-12 months after the bite
What is the “bull’s eye” rash, and when does it occur?
- erythema migrans at the site of the tick bite
- stage 1 of lyme disease
What other s/sx occur in stage 1 of lyme disease?
- HA
- muscle weakness/myalgias/stiff neck
- chills/fever/fatigue
- itching
When does systemic involvement begin with lyme disease?
stage 2
What neurologic symptoms occur in stage 2 of lyme disease?
- cranial nerve palsies (Bell’s)
- meningitis
What musculoskeletal symptoms occur in stage 2 of lyme disease?
- facial weakness/paralysis
- muscle pain
- swelling in large joints (knees)
What cardiovascular symptoms occur in stage 2 of lyme disease?
- myocarditis
- AV block
When does splenomegaly occur with lyme disease?
stage 2
When does arthritis occur with lyme disease?
stage 3
What symptoms occur with stage 3 of lyme disease?
- numbness and tingling (neuropathy)
- arthritis
- encephalopathy
- deafness
- speech problems
What antibiotics are given for stage 1 of lyme disease?
- doxycycline (children 8+)
- amoxicillin (children >8)
- cefuroxime (children >8)
What antibiotic can be given within 72 hours of the tick bite as a single dose?
doxycycline
What antibiotic os given for stage 2-3 lyme disease?
ceftriaxone
How can tick bites be prevented?
- avoid tall grass
- use insect repellant
- avoid contact with insects
- avoid woodpiles
- inspect and treat pets, carpet, furniture
- avoid flowery prints and bright clothing
- avoid perfumes and colgnes
What are the priorities for burns?
- stop the burn
- prevent infection
- fluid replacement
- manage pain
- maintain homeostasis and body temp
What does a third-degree/full-thickness burn damage/destroy?
- entire epidermis
- dermis
- possible damage to SQ tissue
- nerve endings
- hair follicles
- sweat glands
What color are third-degree burns?
red to tan, black, brown, or waxy white
What do third degree burns feel like?
dry and leathery
What happens as a third-degree burn heals?
- might not be painful at first
- as burn heals pain returns and the severity increases
How long does it take for a third-degree or fourth-degree burn to heal?
weeks to months
Do third-degree burns require grafting?
yes
What is damaged by fourth-degree/deep-full thickness burns?
all layers of the skin extending to the muscle, fascia, and bones
What does a fourth-degree burn feel/look like?
- dull and dry
- color variable
- possible visible ligaments, bones, or tendons
Is pain present with fourth-degree burns?
no
What is the tx for fourth-degree burns?
- autografting
- possible amputation
What causes a thermal burn?
- flames
- hot surfaces/liquids
What gets damaged with a thermal burn?
- face/lips
- tracheobronchial tree
What s/sx occur with thermal burns?
- wheezing
- increased secretions
- hoarseness
- wet rales
- singed nasal hairs
- laryngeal edema
- carbonaceous secretions
What should you avoid putting on the burn?
- ice
- greasy lotion/butter
How should a burn be cleansed?
- cool/tepid water
- mild soap
What should be put on the burn after it is cleaned?
- antimicrobial ointment
- dressing
What immunization might be needed for a burn?
tetanus
What is the priority for major burns?
- maintaining the airway and ventilation
- humidified O2 at 100%
When should dressing changes be done for major burns?
- with scheduled analgesia
How can infection be prevented with major burns?
reverse isolation: protect them from what we might have
What nutrition should be increased with major burns?
- protein and calories
- vitamin A, C, zinc
What s/sx of septic shock should be reported for burns?
- confusion
- increased cap refill
- spiking fever
- tachycardia
- tachypnea
- decreased urine output
- mottled/cool extremities
- decreased bowel sounds
What s/sx of infection should be reported for burns?
- discoloration
- edema
- odor
- drainage
What is the parkland formula?
volume of LR solution = 4 mL x BSA% x weight (kg)
- give half of the solution for the first 8 hours
- give the other half of the solution for the next 16 hours
