NURS 623 – Summer, 2021 Adult 2 Exam 1
NURS 623 – Summer, 2021 Adult 2 Exam 1
SKIN • HEMATOLOGY • IMMUNE
SKIN
•Alopecia—baldness
Considered autoimmune; may be genetic
Hair growth influenced by estrogen, growth hormone, glucocorticoids, thyroid hormone, retinoid, prolactin, androgens,
medications
Subtype Differential Diagnosis Diagnostics Management
Scarring Alopecia trauma, kerion formation, Autoimmune: RA, ESR, bx.,
discoid lupus, scleroderma, serum , iron studies, TSH/T4,
radiation, lichen planopilaris, CBC
bacterial infection
Nonscarring Alopecia Alopecia areata, drug- induced, Underlying cause if caused Finasteride (Propecia)
trichotillomania, after major by other disease process Minoxidil (Rogaine)
stress, androgenetic baldness,
tinea capitis, hypothyroidism, F—MEN only; birth defects in women; check liver
systemic lupus, Addison’s function; SE: ED, sexual dysfunction
disease M—men & women; SE: irritation, itching, dryness,
scaling, hypertrichosis (excessive body hair
Pigmentation Changes
Cause Description Diagnostics Management
Vitiligo • Total loss of color Family hx. Topical corticosteroid
in patchy areas of Hx of sin trauma, rash Light therapy
body or sunburn Psoralen UVA
• White, CBC, TSH/T4, ANA, eye therapy Topical
macules/patches on sun- exam creams
exposed areas Skin grafting
• Occurs often with
autoimmune diseases
Chloasma “mask of pregnancy” History See textbook pg 149
• ↑estrogen, Wood’s lamp to Multiple creams, laser
progesterone, melanocyte visualize excess melanin treatment, ultrasound
stimulating hormones in epidermis facial
during preg. Sun avoidance
• Worsened by sunlight
pg. 1
,NURS 623 – Summer, 2021 Adult 2 Exam 1
Melasma • Darker patches to Patient history Hydroquinone
any area regardless of Possibly hormone levels Sun avoidance
pregnancy Laser therapy
• Sun exposure Salicylic acid peel
• Hormone changes
Drug-Induced Caused by Zidovudine, Patient’s taking Risk vs. benefit of stopping
cyclophosphamide Amiodarone, medication causing the skin
chlorpromazine, discoloration
antimalarials
Addison’s Disease • Diffuse generalized CBC, CMP, TSH, ANA, ESR, Treat the Addison’s disease
↑pig on skin creases B12, RF, random glucose
• Skin folds, palmar ↑K+/Ca+; ↓Na+, anemia,
creases, pressure points, ↑ACTH
buccal
area, vag/perianal, scars
pg. 2
,NURS 623 – Summer, 2021 Adult 2 Exam 1
Skin Cancer Discussed later…….
•Pruritis—itching accompanied by urge to scratch
• Causes: Local (insect bite, contact dermatitis) or Systemic (CRF, hyperbilirubinemia w/bile salt distribution)
• Often accompanied by other complaints such as rash or other skin lesions
• Differential Diagnosis: MANY!!!
Mild soaps, tepid
o Focus on patient history:
showers, gently towel
▪ Insect Exposures—mosquitoes, fleas, ticks, spiders
dry, moisturize
▪ Contact Outdoors—beach, picnic, camping, swimming
Lubriderm, Eucerin,
▪ Contact w/Plants
Alpha- Keri
▪ Contact w/Jewelry/Metals
Antihistamine
▪ Occupation—gardeners, prison employee, daycare, schools
s
▪ Hobbies & Sports—paints, glues, athletes (fungus)
Antidepressan
▪ Chemical Exposure—pesticides, herbicides, fertilizers, cleaners
▪ Medications
▪ Family Hx—anyone with same symptoms; Social Hx.
▪ Management: identify correct diagnosis and treat accordingly
•Rash—clinical manifestations of inflammation with multiple etiologies
• Autoimmune disease
• Gram + bacterial infection
• Viruses
• Differential Diagnosis: too many!!!
o Focus on patient history:
▪ Onset of skin lesions
▪ Spread of lesions
▪ Change in lesions
▪ Associated Symptoms
▪ Treatment
▪ Food or Medications
▪ Alternative Medicine
▪ Atopic hx
▪ Infectious Disease Exposure
▪ Systemic Symptoms
pg. 3
, NURS 623 – Summer, 2021 Adult 2 Exam 1
pg. 4
NURS 623 – Summer, 2021 Adult 2 Exam 1
SKIN • HEMATOLOGY • IMMUNE
SKIN
•Alopecia—baldness
Considered autoimmune; may be genetic
Hair growth influenced by estrogen, growth hormone, glucocorticoids, thyroid hormone, retinoid, prolactin, androgens,
medications
Subtype Differential Diagnosis Diagnostics Management
Scarring Alopecia trauma, kerion formation, Autoimmune: RA, ESR, bx.,
discoid lupus, scleroderma, serum , iron studies, TSH/T4,
radiation, lichen planopilaris, CBC
bacterial infection
Nonscarring Alopecia Alopecia areata, drug- induced, Underlying cause if caused Finasteride (Propecia)
trichotillomania, after major by other disease process Minoxidil (Rogaine)
stress, androgenetic baldness,
tinea capitis, hypothyroidism, F—MEN only; birth defects in women; check liver
systemic lupus, Addison’s function; SE: ED, sexual dysfunction
disease M—men & women; SE: irritation, itching, dryness,
scaling, hypertrichosis (excessive body hair
Pigmentation Changes
Cause Description Diagnostics Management
Vitiligo • Total loss of color Family hx. Topical corticosteroid
in patchy areas of Hx of sin trauma, rash Light therapy
body or sunburn Psoralen UVA
• White, CBC, TSH/T4, ANA, eye therapy Topical
macules/patches on sun- exam creams
exposed areas Skin grafting
• Occurs often with
autoimmune diseases
Chloasma “mask of pregnancy” History See textbook pg 149
• ↑estrogen, Wood’s lamp to Multiple creams, laser
progesterone, melanocyte visualize excess melanin treatment, ultrasound
stimulating hormones in epidermis facial
during preg. Sun avoidance
• Worsened by sunlight
pg. 1
,NURS 623 – Summer, 2021 Adult 2 Exam 1
Melasma • Darker patches to Patient history Hydroquinone
any area regardless of Possibly hormone levels Sun avoidance
pregnancy Laser therapy
• Sun exposure Salicylic acid peel
• Hormone changes
Drug-Induced Caused by Zidovudine, Patient’s taking Risk vs. benefit of stopping
cyclophosphamide Amiodarone, medication causing the skin
chlorpromazine, discoloration
antimalarials
Addison’s Disease • Diffuse generalized CBC, CMP, TSH, ANA, ESR, Treat the Addison’s disease
↑pig on skin creases B12, RF, random glucose
• Skin folds, palmar ↑K+/Ca+; ↓Na+, anemia,
creases, pressure points, ↑ACTH
buccal
area, vag/perianal, scars
pg. 2
,NURS 623 – Summer, 2021 Adult 2 Exam 1
Skin Cancer Discussed later…….
•Pruritis—itching accompanied by urge to scratch
• Causes: Local (insect bite, contact dermatitis) or Systemic (CRF, hyperbilirubinemia w/bile salt distribution)
• Often accompanied by other complaints such as rash or other skin lesions
• Differential Diagnosis: MANY!!!
Mild soaps, tepid
o Focus on patient history:
showers, gently towel
▪ Insect Exposures—mosquitoes, fleas, ticks, spiders
dry, moisturize
▪ Contact Outdoors—beach, picnic, camping, swimming
Lubriderm, Eucerin,
▪ Contact w/Plants
Alpha- Keri
▪ Contact w/Jewelry/Metals
Antihistamine
▪ Occupation—gardeners, prison employee, daycare, schools
s
▪ Hobbies & Sports—paints, glues, athletes (fungus)
Antidepressan
▪ Chemical Exposure—pesticides, herbicides, fertilizers, cleaners
▪ Medications
▪ Family Hx—anyone with same symptoms; Social Hx.
▪ Management: identify correct diagnosis and treat accordingly
•Rash—clinical manifestations of inflammation with multiple etiologies
• Autoimmune disease
• Gram + bacterial infection
• Viruses
• Differential Diagnosis: too many!!!
o Focus on patient history:
▪ Onset of skin lesions
▪ Spread of lesions
▪ Change in lesions
▪ Associated Symptoms
▪ Treatment
▪ Food or Medications
▪ Alternative Medicine
▪ Atopic hx
▪ Infectious Disease Exposure
▪ Systemic Symptoms
pg. 3
, NURS 623 – Summer, 2021 Adult 2 Exam 1
pg. 4
