NUR410- Professional Nursing III Final Exam
Blueprint
Exam 1: Dermatitis, Psoriasis, Cellulitis, Hepatitis, Meningitis, Fibromyalgia, HIV/AIDS, multiple sclerosis
Exam 2: colorectal cancer, skin cancer, prostate cancer, GERD, celiac disease, gallbladder disease, irritable bowel syndrome, cirrhosis, COPD Exam 3:
Diabetes
Extra: Cardiac assessment, arrhythmias, cardiomyopathies
Dermatitis
- Contact dermatitis o Irritant contact
dermatitis o Allergic contact dermatitis
- Atopic dermatitis
o Eczema
Contact dermatitis
- Inflammatory reaction of the skin d/t contact
with an exogenous substance
- Irritant: 80% of cases
- Allergic: 20% of cases Irritant
- Etiology: inflammatory response of the skin
o Examples
Soaps, detergents,
metals
(nickel), cosmetics
- Clinical manifestations
o Acute
Itching, redness, burning, skin lesions (vesicles), oozing discharge (local to site of
contact)
o Chronic
Scaling, hyperpigmentation of the skin, thinning of skin
o MC on hands and lower arms- d/t bacteria invading areas from easy access to itch and scratch
Allergic Contact Dermatitis
- Delayed (Type IV) hypersensitivity reaction
- Etiology
o Results from contact of skin and allergenic substance has a sensitization period of 10-14 days
- Clinical
manifestations
o Vasodilation of
skin, edema
o Usually on dorsal
aspect of the
hands
Irritant: assessment, diagnosis and treatment
- Assessment
o Onset, relationship to environment and skin care products
- Diagnosis o TRUE test
Patch test- take a little bit of allergen and place on skin and apply
, Patch it over- how allergies are diagnosed- patch usually in place for 2-3 days
Positive reaction- red, pink, dark area with itching under patch
Severe reaction- blister that can sometimes last up to weeks
Get patch clean and dry- can have irritation from patch
- Patient teaching o Keep patch clean and dry, side effects
- Treatment
o Irritant: aluminum acetate, cool compress, corticosteroids, oral antihistamines
o Allergic: hydrophilic cream or petroleum, topical corticosteroids, antibiotics, oral antihistamines
- Lesions
o Ask about new exposures, products used, environmental exposures (new soaps, detergents, etc) o
Lesions- how are they distributed?
- Tx- irritant o Aluminum acetate- burrow’s solution
o Cool compress
o Benadryl
- Tx- allergic o Petroleum
o Topical corticosteroids
o Abx
o Benadryl
Patient Teaching
- Study pattern and location of dermatitis
- Avoid heat, soap, rubbing
- Choose bath soaps, laundry detergents, cosmetics without fragrance
- Avoid fabric softener dryer sheets
- Avoid topic medications, lotions, ointments
- Wash skin immediately after exposure to irritant
- Wear gloves for washing dishes, cleaning that are cotton-lined
- Ask pts about what has touched that area
- Avoid contact with those triggers
- Change in laundry soap can also cause irritant
- Avoid heat- don’t use hot water- dries out skin more
- Stuff without fragrance is best
- Avoid dryer sheets- cause irritation
Atopic Dermatitis
- Eczema
- Chronic, inflammatory allergic skin disorder
- Affects 7% of individuals in US o Half of these patients are affected by asthma, allergic rhinitis, food allergies
- Etiology
o Type I immediate hypersensitivity disorder involving IgE antibodies
o Leaky skin barrier o Defective FLG gene o Atopic march
- FLG gene
o Produced by carotene cells in skin
- Atopic march
o Linked to natural hx of allergic disorders
o If have susceptibility to eczema, then increased risk for allergies to food/environment, rhinitis, etc
Diagnosis
, Diagnosis o Health
history o Skin
lesions o
Clinical signs
- Lab testing o IgE, patch testing
Treatment
- Avoidance of irritant agents
- Avoid triggers o Excessive bathing, hot showers, low humidity environments, animal dander, dust mites, dry
skin, overheating of skin
o Avoiding known irritants/solvents
- Topical corticosteroids
o Mild OTC o More potent
Fluocinoline, triamcinolone, betamethasone (not for use on face) o Severe flare ups
Systemic corticosteroids Meter dose?
- Duplimumab (for moderate to severe)
- Antibiotics for S. Aureus
- IL4/IL3 antagonists- mab
- Monoclonal antibodies
- Usually for those over 12 years old
Psoriasis
- Chronic inflammatory multisystem disorder of the skin
- Affects approximately 3.2% of Americans
- Characterized by silvery plaques
- Onset may occur at any age o Median onset 28 years
- Prevalence: white American women
- Genetic predisposition
- Characterized by periods of remission and exacerbation
Pathophysiology
- Autoimmune basis
- Emotional stress, anxiety aggravate
o Triggers
Trauma, infections, seasonal hormonal changes
- Epidermis becomes infiltrated by activated T cells and cytokines o Results in vascular engorgement,
proliferation of keratinocytes o Epidermal hyperplasia results o Rapid turnover of poorly matured cells with
minimal adherence
o Results in plaque-like lesions with silvery, scaly, and flakey appearance
Clinical Manifestations
- Range in severity
- Red, raised patches of skin covered with silvery scales
, Patches are not moist, and may be pruritic
- Nails often involved
- Mild 5% of BSA, moderate 10%, severe >10%
- Placement can be anywhere
- Can be physically disabling
Complications
- Asymmetric rheumatoid factor o Negative arthritis of multiple joints (42%)
- Typical joints o Hands or feet
- Rheumatology consult for diagnosis, treatment - Elbows, knees and hips can also be involved -
Negative arthritis- don’t have arthritis? Assessment and Diagnosis
- Assessment
o Presence of silvery plaque like lesions o Assess for signs of nail/scalp involvement o
Family history?
- Diagnosis
o Biopsy not of much diagnostic value o Physicians will calculate BSA involved??
Medical Management
- Assess
o Lifestyle, manage emotional factors
-Remov
e
o Remove
scales
Baths with oils, oatmeal preparations, coal tar preparations
- Skin
o Skin care routine
- Condition can be disabling
- Goal
o Decrease rapid turnover of cells- ensure cells have natural progression
- NO CURE
- Can remove scales with oils, oatmeal, coal tar
- Cera ve- salicylic acid
- Use regular skin care- every day or every few days Pharmacologic therapy
- Topical
- Phototherapy
- Systemic
Topical agents
- Used to slow overactive
epidermis
- Topic corticosteroids used for anti-
inflammatory effects
o Application of occlusive dressings, plastic bags,
vinyl jogging suit- increases effectiveness
- High potency corticosteroids not for use on face
Limit to 4 weeks, twice daily
- High potency for long term use
- Inspect skin for atrophy, hypopigmentation, striae, telangiectasis
Blueprint
Exam 1: Dermatitis, Psoriasis, Cellulitis, Hepatitis, Meningitis, Fibromyalgia, HIV/AIDS, multiple sclerosis
Exam 2: colorectal cancer, skin cancer, prostate cancer, GERD, celiac disease, gallbladder disease, irritable bowel syndrome, cirrhosis, COPD Exam 3:
Diabetes
Extra: Cardiac assessment, arrhythmias, cardiomyopathies
Dermatitis
- Contact dermatitis o Irritant contact
dermatitis o Allergic contact dermatitis
- Atopic dermatitis
o Eczema
Contact dermatitis
- Inflammatory reaction of the skin d/t contact
with an exogenous substance
- Irritant: 80% of cases
- Allergic: 20% of cases Irritant
- Etiology: inflammatory response of the skin
o Examples
Soaps, detergents,
metals
(nickel), cosmetics
- Clinical manifestations
o Acute
Itching, redness, burning, skin lesions (vesicles), oozing discharge (local to site of
contact)
o Chronic
Scaling, hyperpigmentation of the skin, thinning of skin
o MC on hands and lower arms- d/t bacteria invading areas from easy access to itch and scratch
Allergic Contact Dermatitis
- Delayed (Type IV) hypersensitivity reaction
- Etiology
o Results from contact of skin and allergenic substance has a sensitization period of 10-14 days
- Clinical
manifestations
o Vasodilation of
skin, edema
o Usually on dorsal
aspect of the
hands
Irritant: assessment, diagnosis and treatment
- Assessment
o Onset, relationship to environment and skin care products
- Diagnosis o TRUE test
Patch test- take a little bit of allergen and place on skin and apply
, Patch it over- how allergies are diagnosed- patch usually in place for 2-3 days
Positive reaction- red, pink, dark area with itching under patch
Severe reaction- blister that can sometimes last up to weeks
Get patch clean and dry- can have irritation from patch
- Patient teaching o Keep patch clean and dry, side effects
- Treatment
o Irritant: aluminum acetate, cool compress, corticosteroids, oral antihistamines
o Allergic: hydrophilic cream or petroleum, topical corticosteroids, antibiotics, oral antihistamines
- Lesions
o Ask about new exposures, products used, environmental exposures (new soaps, detergents, etc) o
Lesions- how are they distributed?
- Tx- irritant o Aluminum acetate- burrow’s solution
o Cool compress
o Benadryl
- Tx- allergic o Petroleum
o Topical corticosteroids
o Abx
o Benadryl
Patient Teaching
- Study pattern and location of dermatitis
- Avoid heat, soap, rubbing
- Choose bath soaps, laundry detergents, cosmetics without fragrance
- Avoid fabric softener dryer sheets
- Avoid topic medications, lotions, ointments
- Wash skin immediately after exposure to irritant
- Wear gloves for washing dishes, cleaning that are cotton-lined
- Ask pts about what has touched that area
- Avoid contact with those triggers
- Change in laundry soap can also cause irritant
- Avoid heat- don’t use hot water- dries out skin more
- Stuff without fragrance is best
- Avoid dryer sheets- cause irritation
Atopic Dermatitis
- Eczema
- Chronic, inflammatory allergic skin disorder
- Affects 7% of individuals in US o Half of these patients are affected by asthma, allergic rhinitis, food allergies
- Etiology
o Type I immediate hypersensitivity disorder involving IgE antibodies
o Leaky skin barrier o Defective FLG gene o Atopic march
- FLG gene
o Produced by carotene cells in skin
- Atopic march
o Linked to natural hx of allergic disorders
o If have susceptibility to eczema, then increased risk for allergies to food/environment, rhinitis, etc
Diagnosis
, Diagnosis o Health
history o Skin
lesions o
Clinical signs
- Lab testing o IgE, patch testing
Treatment
- Avoidance of irritant agents
- Avoid triggers o Excessive bathing, hot showers, low humidity environments, animal dander, dust mites, dry
skin, overheating of skin
o Avoiding known irritants/solvents
- Topical corticosteroids
o Mild OTC o More potent
Fluocinoline, triamcinolone, betamethasone (not for use on face) o Severe flare ups
Systemic corticosteroids Meter dose?
- Duplimumab (for moderate to severe)
- Antibiotics for S. Aureus
- IL4/IL3 antagonists- mab
- Monoclonal antibodies
- Usually for those over 12 years old
Psoriasis
- Chronic inflammatory multisystem disorder of the skin
- Affects approximately 3.2% of Americans
- Characterized by silvery plaques
- Onset may occur at any age o Median onset 28 years
- Prevalence: white American women
- Genetic predisposition
- Characterized by periods of remission and exacerbation
Pathophysiology
- Autoimmune basis
- Emotional stress, anxiety aggravate
o Triggers
Trauma, infections, seasonal hormonal changes
- Epidermis becomes infiltrated by activated T cells and cytokines o Results in vascular engorgement,
proliferation of keratinocytes o Epidermal hyperplasia results o Rapid turnover of poorly matured cells with
minimal adherence
o Results in plaque-like lesions with silvery, scaly, and flakey appearance
Clinical Manifestations
- Range in severity
- Red, raised patches of skin covered with silvery scales
, Patches are not moist, and may be pruritic
- Nails often involved
- Mild 5% of BSA, moderate 10%, severe >10%
- Placement can be anywhere
- Can be physically disabling
Complications
- Asymmetric rheumatoid factor o Negative arthritis of multiple joints (42%)
- Typical joints o Hands or feet
- Rheumatology consult for diagnosis, treatment - Elbows, knees and hips can also be involved -
Negative arthritis- don’t have arthritis? Assessment and Diagnosis
- Assessment
o Presence of silvery plaque like lesions o Assess for signs of nail/scalp involvement o
Family history?
- Diagnosis
o Biopsy not of much diagnostic value o Physicians will calculate BSA involved??
Medical Management
- Assess
o Lifestyle, manage emotional factors
-Remov
e
o Remove
scales
Baths with oils, oatmeal preparations, coal tar preparations
- Skin
o Skin care routine
- Condition can be disabling
- Goal
o Decrease rapid turnover of cells- ensure cells have natural progression
- NO CURE
- Can remove scales with oils, oatmeal, coal tar
- Cera ve- salicylic acid
- Use regular skin care- every day or every few days Pharmacologic therapy
- Topical
- Phototherapy
- Systemic
Topical agents
- Used to slow overactive
epidermis
- Topic corticosteroids used for anti-
inflammatory effects
o Application of occlusive dressings, plastic bags,
vinyl jogging suit- increases effectiveness
- High potency corticosteroids not for use on face
Limit to 4 weeks, twice daily
- High potency for long term use
- Inspect skin for atrophy, hypopigmentation, striae, telangiectasis
