NURS 6531 Midterm Exam Review (Week 1-6)

NURS 6531 Midterm Exam Review (Week 1-6) Competencies of Advanced Nurse Practitioners • How to apply advanced practice nursing competencies to clinical settings • Theories in nursing practice • SOAP note – 4 parts o Subjective  Chief complaint (CC) – brief statement of purpose of visit  History of present illness (HPI)- describes current condition in narrative form  Review of body systems (ROS) – pertinent negatives  Medical history, surgical history, family history, social history, current medications, smoking status, drug/alcohol use, allergies o Objective  VS  Physical exam  Diagnostic and lab results o Assessment  Summary of main symptoms/diagnosis  Differentials  Etiology of risk factors, assessment of need for therapy o Plan  treatment • Coding and billing in nursing practice Integumentary disorders o Melanoma  Caused by UV exposure  Dark spots or wound that does not heal, changes shape or bleeds.  More likely to travel to distant organs  If recognized early, curable, not can spread to organs.  Benign melanocytic lesions, dysplastic nevus, squamous cell carcinoma, metastatic tumors, blue nevus  Treatments surgery and radiation, chemotherapy drugs o Actinic keratosis  From prolonged sun exposure  Rough, dry or scaly patches of skin change in color of affected area to pink, red, or brown, itching or burning in the affected area  Develops over years, commonly noted on face, lips, ears, hands, forearms, scalp, and neck  Can resolve on its own, creams like diclofenac gel, avoid sun or UV, cover area to prevent exposure to sun, cryotherapy, curettage, scraping o Basal cell carcinoma  UV rays from sun and tanning bed  Pearly white, skin colored or pink bump  Brown, black or blue lesion, flat, scaly, reddish patch  A white, waxy, scar-like lesion  Topical creams and ointments, destruction by electrodessication and curettage (EDC), freezing, surgical excision, Mohs micrographic surgery o Squamous cell carcinoma  Develops in the middle and outer layer of the skin  Caused by mutations in DNA  A firm, red nodule; flat sore with scaly crust; new sore or raised area on an old scar or ulcer; a rough, scaly patch on your lip that may evolve to an open sore  Excision; curettage and electrodessication o Acral-lentiginous melanoma  Common in dark-skinned people  Melanoma that appears on the palms, soles of feet or nails o Venous stasis ulcers  Most common etiology of LLE ulceration  Causes-inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema  Risk factors are older age, obesity, previous leg injuries, DVT, and phlebitis  Treatment-compression therapy, leg elevation, topical negative pressure; ASA, pentoxifyline o Herpes zoster (Shingles)  Infects nerves  From chicken pox but lays dormant for years  Affect small section on one side of body  Pain, burning, numbness or tingling; sensitivity to touch; red rash that begins a few days after pain  Anti-viral meds-acyclovir o Urticaria (Hives)  Allergic reaction in response to histamine  Welts associated – red or flesh-colored; intensely itchy; roughly oval or shaped like a worm; a few millimeters to several inches across o Psoriasis  Causes-family history; bacterial, viral, or fungal; severe burn; stress; obesity; smoking; alcohol abuse; vitamin deficiency; beta blockers, antimalarials, and lithium  Abnormal immune reaction with rapid buildup of skin cells  Red patches with thick, silvery scales which may range from a few spots to large areas of scaly patches  Small scaling spots; dry cracked skin accompanied by bleeding  Itching, burning and painful lesions; swollen joint with stiffness  No treatment just reduces symptoms of pain, inflammation, and scaling-Psoralens with light therapy (methoxsalen) o Impetigo  Transmitted through direct contact; contaminated surfaces, objects, clothing, toys; crowds  Infection by strep or staph  Red sores on face, especially around nose, mouth, on hands & feet  Sores rupture and ooze; mild itching; ruptured sores honey-colored crusts  ATB or ointment – Cephalosporin; Mupirocin o folliculitis  Causes-bacterial infection like staph; fungi like yeast; damage in hair follicles due to skin irritation, shaving, or waxing; friction from clothes; blockage due to sweat, oil or makeup; insects bites  Small red bumps; white-headed pimples; pus filled sores; crusty sores; red skin; inflamed skin  Topical-Clindamycin lotion; Oral-dicloxacillin; antifungal-ketoconazole o Systemic lupus erythematosus  Causes unknown; genetics; environmental factors – exposure to UV rays, viruses, medication, emotional stress, trauma; hormones –  Butterfly rash; appetite, hair loss; fever; fatigue; photosensitivity; Raynaud’s;  Anti-inflammatory meds-Ibuprofen, Naproxen; steroid creams-triamcinolone; immune suppressants-methatrexate o Acne vulgaris  Clogged hair follicles under the skin  Age; excess sebum or oil production; accumulation of dead skin cells; bacterial infection; change in hormone levels; diet  Commonly on face, forehead, chest, upper back and shoulders  Small to large red bumps on skin, may be painful and pus  Retinoids; ATB; oral contraceptives o Tinea cruris (Jock itch)  Fungi called dermatophytes; remaining in sweat-soaked clothes after exercising  Creases in upper thigh and does not involve the scrotum or penis; can spread to the anus  Red, raised, scaly patches that may blister and ooze  Self-care; keep skin clean and dry; do not wear clothing that rubs o Eczema  Atopic dermatitis-overreact to certain triggers like dyes, fabrics, soaps, animals, and other irritants  Red, inflamed, peeling, cracked, blistered, or pus-filled  Not covered with scaly dead skin o Scabies  mite – sarcoptes scabies, variety hominis  Itchy red papules; itching worse at night; palms and soles, wrist and axilla, umbilicus and between web spaces  Itchy lumps or nodules in armpits and groin  Linear or curved skin burrows  Topical ointment – leave on for 8 hrs. to kill scabies; permethrin cream or lindane lotion;  Self-care soak skin in cool water to minimize itching; apply soothing lotion like calamine; antihistamines o Syphilis  Caused by bacteria temponema pallidum due to direct contact with infected people during sex, kissing, cuts, abrasions, wounds,  Primary stage – enlarged lymph nodes near groin; small painless sores on skin including rectum and vagina  Secondary stage-small, reddish-brown sores on skin, sores in mouth, vagina, or anus, fever, swollen lymph glands, weight loss, hair loss, HA and muscle aches, extreme tiredness  Latent – no symptoms  Tertiary stage- permanent organ damage; death  ATB-PCN, doxy; self-care, safe sex o Tinea versicolor  Fungus, hot, humid weather  Sharp borders and fine scales; often dark reddish or tan in color; found on back, underarms, upper chest, and neck  OTC antifungal creams o Cellulitis  Bacteria that enters through a cut, abrasion or break; strep or MRSA  Red area that expands rapidly; swelling; tenderness; pain; warmth; fever; red spots; blisters; skin dimpling  Treatment with self-care, ATB amoxicillin; dicloxacillin o Rhus dermatitis (Urushiol-induced contact dermatitis)  Allergic rashes produced by oil from various plants  Redness, swelling, papules, vesicles, blisters, and streaking  Wash with soap, water and friction; soak in cool water; topical corticosteroids; oral corticosteroids HEENT o Otitis externa (Swimmers ear)  Caused by swimming in unclean water  Caused by Pseudomonas and other bacteria  Redness of outer ear, itching, pain when touching or moving pinna, pus drainage is yellow-green, foul smelling  Ear canal is red and swollen, skin inside ear may be scaly or shedding  Touching or moving outer ear is painful, positive tug sign, ear drum may be perforated or hard to see due to edema in externa  Treatment antibiotic drops for 10-14 days o Snellen chart – used to measure visual acuity.  Normal is 20/20  Top number references distance in feet from chart  bottom number distance in which normal eyesight can read o Types of conjunctivitis (Pink eye)  Bacterial/Viral • Redness, itching, gritty feeling, discharge that forms a crust during night, tearing • Antibiotic drops for eyes,  Allergic • Inflammation due to an allergy • Redness, edema of conjunctiva, itching, and increased lacrimation  Treatment – no contacts, antihistamines, antibiotic eye drop (ciprofloxacin), prednisolone o Amaurosis fugax – transient monocular blindness  painless temporary loss of vision in one or both eyes  embolic, hemodynamic, ocular, neurologic, and idiopathic o Criteria for strep throat  Centor criteria • C = Absence of cough • E = Tonsillar exudates • N = Anterior cervical adenopathy • T = History of fever • OR – young or old modifier (under 15 add 1 pt, over 44 subtract 1)  1 point = no culture or antibiotic  2-3 points= throat culture and treat if positive  4-5 = rapid strep/culture o Cornea abrasion – scratch to surface of the cornea  Pain, redness, light sensitivity, feels like foreign body in eye  Remove debris from eye, wash eye out, antibiotic eye drops, Tylenol, ibuprofen for pain o Iritis – inflammatory condition of the iris  Causes are eye injury, trauma, autoimmune disorders like rheumatoid arthritis, ankylosing spondylitis, inflammatory disorders like Kawasaki disease, Crohn’s disease, eye infection, cancer  Swelling of uvea, redness, pain, sensitivity to light, floaters, decrease in vision, blurred vision, alteration in color of iris, small pupil  Anti-inflammatory drugs – corticosteroids  Antibiotics – Besifloxacin or Gemifloxacin  Immunosuppressive drugs – Chlorambucil or Azathioprine o Subconjunctival hemorrhage – bleeding underneath the conjunctiva  Violent coughing, sneezing, heavy lifting, vomiting  Bright red patch appearing in white of eye  No symptoms or treatment o Allergic rhinitis (hay fever)  Inflammation in nose after hypersensitive reaction to an allergen  Contact with outside or indoor allergen ...............................................