Quiz 4 Flashcards
What diagnostic studies can be done for the skin?
Wood’s light exam (UV light for fungal)
Skin and culture sensitivity
Biopsy (punch/shave/excisional)
Patch test
Why are biopsies done?
to confirm or rule out malignancy
What is psoriasis?
chronic autoimmune skin disease
What happens if psoriasis is not controlled?
can lead to psoriatic arthritis
xray of the hands show pencil in cup deformities
What are the risk factors of psoriasis?
infections
stress
hormones
obesity
skin trauma
seasons
meds
genetics
What are the clinical manifestations of psoriasis?
scaly, thick, silvery, elevated lesions (plaque) on scalp, elbows, or knees
bilateral distribution
pruritic (itchy)
bleeding w/ removal of scales
What therapeutic procedure can be done for psoriasis?
photochemotherapy and ultraviolet light (PUVA)
- methoxsalen 1 hr before (makes skin sensitive to radiation)
- tx 2-3x/week (not consecutive)
What should a nurse teach a patient who is receiving PUVA?
eye and skin care
SE:
- more easily burned
- cataracts
- skin malignancies
What topical medications are used for psoriasis?
corticosteroids (triamcinolone, betamethasone)
tar (coal tar)
vitamin D analog (calcipotriene, calcitriol)
vitamin A (tazarotene)
anti-psoriasis agent (anthralin)
everything except corticosteroids decrease cell turnover = less scales
What systemic medications are used for psoriasis?
cytotoxic meds
- methotrexate (immunosuppressant)
- acitretin (slows autoimmune reactions)
biologics
- etanercept
- infliximab
immunosuppressants
- cyclosporine
- azathioprine
What are the nursing interventions for psoriasis?
teach lifestyles modifications
teach not to scratch/pick (tx: mittens but don’t tie down)
use emollient thick/oily
provide emotional support
What is acne?
acne vulgaris
obstructed sebaceous glands where bateria settles in and causes inflammation/whiteblackheads
What are the risk factors of acne?
puberty/pregnancy
bacteria overgrowth (sweat)
genetics
stress
How is acne classified?
noninflammatory: comedones (blackhead)
inflammatory: papules/pustules (whitehead), nodular, cystic
What topical medications are used for acne?
benzoyl peroxide
antimicrobials (erythromycin/clinda)
retinoid (isotretinoin - accutane)
intralesional corticosteroids
What systemic medications are used for acne?
oral antibiotics
combined contraceptives
anti-androgen agent (spironolactone)
retinoid
What are the side effects of spironolactone?
larger breast
orthostatic hypotension
hyperkalemia
What are the nursing interventions for acne?
use mild, moisturizing, lipid-free cleansers
avoid hot water and scrubbing
practice hand hygiene
don’t pick or squeeze
8 oz of water
What is contact dermatitis?
one time event
caused by direct exposure to allergen, chemical, or mechanical irritation
ex: nickel based jewelry
What is the clinical manifestation of contact dermatitis?
demarcated localized rash
What is atopic dermatitis?
aka: eczema
caused by allergens or chronic skin disease
What are the risk factors of atopic dermatitis?
genetics
stress
What are the clinical manifestations of atopic dermatitis?
infancy:
- red rash w/ serous exudate
- face, shoulder, chest
adults:
- dry, scaly, pruritic rash
- elbows/knees (on or behind)
acute stage:
- bright red
- oozing vesicles
- extremely itchy
chronic stage:
- chronic rash
- lichenification (skin turns dense/leathery)
- face, neck, upper torso, skin folds)
What medications are used for atopic dermatitis?
steroids
- hydrocortisone
- prednisone
- betamethasone
- triamcinolone
antihistamines
- diphenhydramine
- cetirizine
immunosuppressants
- tacrolimus
- pimecrolimus
What are the nursing interventions for atopic dermatitis?
elimination of allergen
trim nails
lukewarm baths
pat dry
moisturize immediately
cotton clothing (not tight)
humidifier
What is urticaria?
the result of type 1 hypersensitivity
standard allergic reaction
often part of anaphylaxis
highly pruritic
What medications are used for urticaria?
epinephrine (only buys time, pt needs to go to hospital to completely stop allergic reaction)
antihistamines
- diphenhydramine
- hydroxyzine
- loratadine
- cetirizine
- fexofenadine
corticosteroids
- prenidolone
- methylprednisolone ( IV acute attacks)
immunosuppressants
- cyclosporine
What are the nursing interventions of urticaria?
check for angioedema (anaphylactic reaction)
administer epinephrine if angioedema present
teach client to avoid triggers
