Final(new material) Flashcards
Herpes zoster
Shingles
-Caused by chicken pox virus(rubella zoster)
-Travels on dermatome=maculopapular vesicular rash, medical emergency in eye=blindness
-Rash does not typically cross midline, usually thoracic dermatomes
herpes zoster teaching prevention
Shingles vaccine-2 shots “shingrix” for older adults 50 and above(recombinant zoster)
-varicella vaccine (VZV) for children
A/E: local rxn at injection site, HA
Contraindications: clients who are immunocompromised, pregnancy, tx with meds that alter immune system
-contact with vesicular fluid or breathing in virus particles from blisters until they dry and scab over
Herpes zoster teaching
Rash=painful itchy blisters that scab over in 7-10 days, clearing up within 2-4 weeks
-contact with vesicular fluid or breathing in virus particles from blisters until they dry and scab over
Herpes zoster tx
-most effective in 72 hours of s/s onset
-Antivirals to accelerate lesion healing and reduce lesion production and viral shedding, decreasing acute pain severity]
-acyclovir,valacyclovir,famiciclovir
herpes zoster complications/manifestations
long-term nerve pain(postherpetic neuraliga, PHN)
Serious complications: vision loss (if rash on face), pneumonia, hearing problems, encephalitis, death
S/S: fever, HA, chills, upset stomach
psoriasis description
Dry scaly skin (plaques)
-patchy,itchy, flaky(inc cell production)
-thickened skin with silvery white scales with bilateral distribution
Psoriasis vulgaris
lifelong disorder with exacerbations/remissions
-scaling disorder r/t dermal inflammation
-abnormal growth of epidermal cells in outer skin layers
-caused by inc cell division
-autoimmune rxn/genetic predisposition
psoriasis tx
-topical steroids(betamethasone or triamcinolone)=reduce secondary inflammatory response of lesions and suppresses cellular division/proliferation
-topical tar(made from coal and trees)=suppress cellular division/prliferation and reduce inflammation
-UV light
actinic keratosis description
Premalignant lesions
-Rough, scaly patch caused by years of sun exposure
-usually affects older adults and men
-commonly on face, lips, ears, back of hands, forearms, scalp, neck
actinic keratosis prevention teaching
reduce sun exposure
-spf, hats, UV shirts, limiting exposure in peak sunshine hours
-usually removed as precaution since it can become cancerous
Tx=photodynamic therapy, freezing, tissue scraping, topical anti tumor meds, chemo, NSAIDs
contact dermatitis description
-Acute or chronic
-red inflammatory vesicular rash
contact dermatitis causes
-secondary to contact with an irritant/allergen
-Cell mediated immune rxn
contact dermatitis tx
OBTAIN HX-attempt to identify causative agent
-avoidance therapy
-steroid therapy(topical, systemic-IV,PO,IM) to suppress inflammation
-cool/moist dressings over topical steroids can increase absorption
-occlusive dressings should be avoided with steroid
skin cancer-ABCDE
asymmetry, border irregularity(well defined and shaped odd), color(dark?), diameter(>6mm), evolution(does it change?) can be elevated
skin cancer-basal cell
metastasis=rare
Chronic irritation, genetic predisposition, starts at small fleshy bumps
-basal cell layer of epidermis
skin cancer-squamous cell
Cancer of epidermis
Metastasis=common
-can be r/t chronic skin damage
-most common skin CA in persons with darker skin
basal cell carcinoma manifestations
small fleshy bump, elevated
Looks like a mole or a wart
Small, waxy nodule with superficial blood vessels and well defined borders
squamous cell carcinoma manifestations
crusty, flat breaking of the skin (like a sore that wont go away), open red and flakey
-rough, scaly lesion with central ulceration and crusting
tx-basal cell
Topical chemotherapy with iniquitous
-stimulates production of interferon , which attacks cancer cells
tx-squamous cell
prevention teaching-basal cell
annual dermatology screenings
prevention teaching squamous cell
malignant melanoma
irregular shape and borders with multiple colors
-new moles or change in an existing mole
-itching, cracks, ulcerations bleeding
-common pin upper back and lower legs; palms and soles for darker skin clients -rapid invasion and metastasis with high morbidity andmortality
tx for malignant melanoma
Nursing interventions following surgical removal-malignment melanoma
pressure ulcers-staging
scabies-describe and tx
8 legged mite that burrows linearly in skin, poop causes inflammation
caring for EOL-hospice
caring for EOL- palliative
caring for EOL- respite care
Non-pharmacological interventions-EOL
common problems at end of life
dyspnea, constipation, fatigue,anorexia, cachexia, cough, N/V, anxiety, deliriumn
nursing interventions EOL-dyspnea
nursing interventions EOL-constipation
nursing interventions EOL-fatigue
nursing interventions EOL-anorexia
nursing interventions EOL-cachexia
nursing interventions EOL cough
nursing interventions EOL-N/V
nursing interventions EOL-anxiety
nursing interventions EOL-delirium
Advanced directives
end of life issues
signs of death
care of body-EOL
chronic pain-pharmacological interventions-long acting
chronic pain pharmacological interventions-short acting
SE of long acting pain meds
SE of short acting pain meds
routes of long acting meds-chronic pain
routes of short acting meds-chronic pain
non-pharmacological interventions-chronic pain
management of acute vs chronic pain: how do they differ
best tx for each- acute vs chronic pain
Main focus for HF pt
FVO
-oral diuretics
-fluid restriction
-daily weights
-low sodium diet
- Beta blockers(inc CO to avoid fluid retention)
HF exacerbation interventions
diurese-IV
-echocardiogram
-telemetry
-smoking cessation
HF medications
furosemide, ACE inhibitors, ARBs, Beta blockers, CCB, Digoxin
furosemide-HF
monitor K+, potassium wasting
Lisinopril- HF
ACE inhibitor
Causes dry cough
Monitor BP and for hyperkalemia
Losarstan-HF
ARB
Lowers BP, monitor for hyperkalemia
Metoprolol-HF
beta blocker, lowers HR and BP
Hold if HR <60bpm
amlodipine-HF
CCB, rhythm regulator, affects HR and BP
digoxin-HF
inc strength of myocardial contractions, affects HR
-narrow therapeutic index=monitor levels for toxicity
-toxicity= yellow halos, N/V
-hold if HR<60bpm
A-fib
irregularly irregular
Both the spacing of complexes and the QRS abnormal
-missing p wave
-stable vs unstable
a-fib risk…
clotting-> atrial appendage=stroke, PE, DVT
stable a-fib intervention
cardiovert with chemicals-adenosine
-perfuming well, no LOC changes
what HR is perfuseable?
60-100, above 150 not perfuming well
RVR
> 150bpm, not perfuming
Cardiovert with vagal stimulation, adenosine IVP, amiodarone drip OR electrical hard reset mechanically
a-fib medications
anticoagulants, digoxin, CCB, Beta blockers, adenosine,amiodarone
warfarin blood monitoring
PT/INR
Vit K levels (antidote)
Xa inhibitor
anticoagulant, golden standard bc no restrictions except bleeding precautions
-Rivaroxaban, xarelto, eloquence
-not great for high fall risk or high risk of injury bc of bleeding risks
adenosine administration needs…
fast slam IVP with flush following
-telemetry, defibrillator and monitor
-IV, crash cart
-oxygen
-rapid response/code team
difference between a-fib and a-flutter
has P wave and QRS is regular and evenly spaced
