Skin Disorders Flashcards
Fungal transmission
- implementation
- inhalation
- taking abx
fungal infections most common in
elderly and immuno compromised
- proliferates more easily in pt w vascular indwelling catheters, organ transplant recipients, chemo pts
superficial fungal infections organisms
- tinea pedis
- tinea captitis
- tinea versicolor
- canadiasis
superficial fungal infections include
- mycoses or dermatophytes
- infect hair, skin, nails
treatment of superficial fungal infections
topical
yeasts
candida albicans
superficial dermatophytes
tineas
tinea pedis characteristics
- dry scaling pruritic lesions
- skin affected may only be in web spaces
risk factors of tinea pedis
- coming into contact w infected skin or fungus in the env
prevention of tinea pedis
- shower shoes
- cleaning tubs and showers after use
treatment of tinea pedis
- topical antifungals usually
- systemic for resistance (oral/IV)
tinea capitis characteristics
- scaly erythematous lesions and hair loss
- can cause permanent alopecia
- most common for peds dermatophyte
affects scalp, eyebrows, eyelashes
treatment for tinea capitis
PO systemic antifungals bid 4-6 wks
- topicals not effective
tinea vericolor patho
ring worm that affects skin of upper chest, back, arms
- rash occurs and then yeast grows out of control
tinea vericolor risk factors
hot climate, sweating, oily skin, weakened immune system
- not contagious
characteristics of tinea versicolor
acidic bleach that causes discoloration
- spots or patches that are white pink, red, brown
treatment of tinea veriscolor
topical antifungals
- shampoo
- selsum blue
candidiasis risk factors
immunosuppression or abx use
candidiasis appearance
- white lesions in the mouth
- beefy red satellite lesions in intertrigous areas (skin on skin)
candidiasis treatment
topical anti fungals
systemic fungal infections where
- aggressive treatment
- affect internal organs (intestines, urinary, lungs, brain)
systemic fungal infections lungs
- histoplasmosis
- blastomycosis
- pneumocystis
systemic fungal infections lungs and meninges
cryptococcosis
viral skin infections
- herpes zoster
- herpes simplex
herpes zoster
shingles
herpes zoster infections
- lies dormant on a dermatome segment after infection w chickenpox
- virus becomes reactivated by immunosuppression, stress, illness
prodrome
burning/tingling along dermatome
- rash develops with vesicles that dry and crust over
- usually unilateral
characteristics of shingles
vesicles on red base that follow dermatomal distribution asymmetric
- xtremely painful
- clear 2-3 wks
- typically over 50 but anyone w chicken pox
- most contagious when weeping
treatment for shingles
anti viral
complications of shingles
post herpetic neuralgia persistent pain in the area where rash was
bacterial skin infections
- impetigo
- abscess
- furuncle
- cellulitis
- MRSA
impetigo
acute and contagious infection where the organisms infect the nose
- cause vesicles, pustules, honey colored crust on red base
- staphylococcus and streptococcus
treatment for impetigo
topical antibacterial
- bactroban
abscess
inflamed, tender skin with redness and a collection of pus
- area often raised w palpable border
- may drain purulent discharge or feel fluctuant (fluid filled)
treatment for abscess
incision, drainage, abx
furuncle
bacterial infection of hair follicle
carbuncle
painful deep swelling of the skin caused by bacteria
treatment of furuncle and carbuncle
incision, drainage, abx
cellulitis cause
bacterial infection of the skin and surrounding tissue
- usually staph or strep
- may be initial injury or wound that becomes infected (animal or insect bites often on lower extremity
cellulitis: contagious?
not contagious but can become dangerous if spreads to lymph nodes and blood stream
cellulitis appearance
- red, painful, swollen, warm to touch
- blisters sometimes form
mark to make sure not spreading
treatment of cellulitis
PO systemic antibiotics
IV depending on severity
MRSA
bacteria that is resistant to many abx
- can be hospital associated from invasive procedures like surgery, IV tubing, artificial joints
- can be community acquired which often begin as a pain full boil spread by person to person contact (wrestlers, child care workers, crowded conditions)
symptoms of MRSA
- warm to touch
- purulent draining
- fever
- abscess can develop quickly
potentially life threatening, infection can burrow deep in body, in bones, joint, surgical wounds, bloodstream, heart valves, lungs
treatment of MRSA
- hospital acquired: IV vancomycin, Zyvox
- community acquired: bactrim, dicloxacillin
- prophylaxis: bactroban nasal ointment prior to surgery
types of skin cancer
- basal cell
- squamous cell
- melanoma
precancerous lesions
- actinic keratosis
- solar lesions
actinic keratosis
- benign lesions due to damage from UV rays
- common in fair skin
- rough, scaly, red plaques
solar lesions
- benign lesions also known as liver/age spots
basal cell
most common but often least malignant
- most curable and usually non metastasizing
squamous cell
2nd most common, can metastasize to remote areas
- curable w early treatment
- can metastasize to lymph nodes and internal organs
- inc risk w sun exposure
melanoma
cancer of melanocyte
- rarer but high rate of metastasizing
- grows radially in epidermis but can go vertically deep into the dermis
skin lesion characteristics
- asymmetry
- border
- color
- diameter
- evolution/elevation
characteristics of basal cell
nodular form that begins as small flesh colored or pink dome shaped bump
- translucent, shiny, pearly nodule
*ulcer w shiny border
characteristics of squamous cell
red and scaling
- keratotic, slightly elevated lesion w irregular border, usually shallow chronic ulcer
risk factors of melanoma
fam history
- red/blond hair
- freckling of upper back
- blistering sun burns before 20
- 3 or more years of outdoor job as teen
where does melanomas invade
- blood and lymphatic vessels
- metastasizes to distant sites
melanoma characteristics
- A: lesions vary in size and shape
- B: irregular
- C: varies, brown, black, tan, sometimes red, white, blue
- D: greater than 6 mm (size of pencil eraser)
- E: looks different that the rest and can change in size, color, shape
most deadly type of skin cancer
- superficial spreading type= 70%
- nodular form = most aggressive
eczema
group of skin conditions that cause skin to be inflamed or irritated
- not contagious
- thought to be caused by overactive immune system
atopic eczema
- most common type
- inherited tendency to develop eczema, asthma, hay fever
characteristics of eczema
puritis, rash on face back knees wrists hands feet, skin thickens or becomes scary
- lesions appear red then burn, can ooze and crust over
- can be exacerbated by heat, cold, detergents, URI, stress
treatment of eczema
relieving ithcing/preventing infection
- lotions and creams to keep skin moist
- cold compress
- OTC hydrocortisone cream or prescription strength
- immune modulator meds
psoriasis
long term chronic condition that typically begins in young adult caused by an overactive immune system
- not contagious
- 1-3% of population
- caused by overactive immune system, may be autoimmune
- link btw obesity, cardiovascular disease
characteristics of psoriasis
skin cells grow too quickly causing skin to be thick, white, silvery, or have red patches of skin
- plaques
- normal skin cells grow gradually and flake off about q 4 wks
treatment of psoriasis
- keep skin moist
- uv light phototherapy
- corticosteroid cream
- topical med
- imune modulating meds
four major classes of anti fungal
- polyenes
- pyrmidine
- azoles
- mics agents
nystatin class
polyene
nystatin indications
- superficial candida infections of mouth, oral mucosa, vagina, skin
forms of nystatin
- creams
- powders
- topical
- vaginal
can nystatin be given parenteral
NO too toxic
side effects of nystatin
not many
- mild skin irritation
- NDV if oral
- poor GI absorption
amphotericin B class
polyene
amphotericin B indication
more often used for systemic mycoses
amphotericin B MOA
binds to ergosterol causing cell wall o become leaky and ultimately destroy it
amphotericin B route
- PO
- parenteral (usually IV)
amphotericin B nursing considerations
- high alert drug
- iv admin must be diluted and admin slowly
- monitor BUN, Cr, cardiac
- must be given q other day for several months
- pre treat w diphenhydramine, acetaminophen, aspirin to dec fever, pain, N, headache
amphotericin B synergetic w
flucytosin
- allows to dec dose which allows a dec symptoms associated
flucytosine class
pyrimidine
flucytosine moa
inhibits fungal DNA synthesis
flucytosine indications
allows for lower dose of amphotericin B to help dec se
azoles meds
- ketoconzaole
- miconazole
- clotrimazole
- itraconazole
- fluconazole
azoles moa
interrupts the integrity of the cell wall by interfering w synthesis of ergosterol
azoles indications
superficial and less serious fungal infections
azoles side effects
topical
- redness, buring, itching
systemic
- severe GI upset (NVD)
- liver toxicity
azoles admin
- take w food
- oral: separate at least 2 hours from antacids
fluconazole advantages
- rapidly and completely absorbed when given orally so able to reach bones, CNS, eyes, respiratory, urinary track
- much less toxic than amphotericin *
fluconazole disadvantages
- narrow spectrum
- many drug interactions (CYP450 pathway)
nursing implications fluconazole
- do not mix IV fluconazole
- monitor coags
- watch for hypoglycemia
- inc haldol and dilantin levels
grisefulvin/fulvicin moa
inhibits fungal mitosis by binding to keratin
- does not affect the cell wall or membrane
grisefulvin/fulvicin side effects
- bone marrow suppression
- rash
- CNS changes
- NVD
- anorexia
grisefulvin/fulvicin indications
- resistant germatophyte infection of scalp, skin, nails
