Nurse 623 question well tackled 2023/2023

What are the Stages of Lyme Disease? - answersEarly localized Early disseminated Late Lyme Early Localized Lyme Disease - answers-occurs days to months after exposure -Symptoms nonspecific: malaise, fever, cervical stiffness, myalgias, arthralgias -Can have a " bulls eye rash aka "erythema migrans"which is 5cm Early diseminated Lyme Disease - answers-occurs days to 10 months after infection -Systemic manifestations ie: meningitis, cranial nerve palsies (esp. VII) and radiculoneuritis Swelling of joints, numbness in extremities, palpatations adn difficulty concentrating. -NO RASH Late Lyme Disease - answers-occurs months to years after exposure -May have intermittent arthritis -May also experience neurological manifestations ie: encephalopathy, peripheral neuropathy or neurocognitive impairment. S/S of HIV - answers-Majority of acute HIV asymptomatics -Flu like symptoms the firststages 6 days to 6 weeks -Fever, sore throat myalgias, headache, cervival lymphadenopathy and nightsweats Risk Factors for HIV - answersSexual history, sexually transmitted disease, substance abuse, transfusion history, infection history and occupation history Hypersensitivity Reactions - answers Type 1 Hypersensitivity RX - answers Type II Hypersensitivity Rx - answers Type III Hypersensitivity RX - answers Type IV Hypersensitivity Rx - answers MCV - answersthe size of the RBC MCH - answersVolume of RBC MCHC - answersthe concentration % Normocytic anemia - answersMCV 82-92 (normal size) MCH 25-30 (normal color) MCHC 32-36 EX: anemia of chronic disease, sepsis, hemorrhagic, aplastic anemia and heriditary spherocytosis Microcytic Anemia - answers" Small light incompetant" MCV80 (small ) MCH 20-25 (pale) MCHC 27 EX: iron deficiency anemia , Thalassemia Macrocytic Anemia - answers" Big Dark Dumb" MCV96 (large) MCH 30-50 (dark) MCHC 32-36 EX: Pernicious anemia, Vitamin B12 deficiency, folic acid deficiency, Antimetabolite drugs ( methotrexate) Normal H&H Male versus Female - answersMale Hgb:13.5-17.5 HCT: 40-54% Female Hgb: 12-15.5 HCT: 36-48% Lupus - answersMalaise fevers, unexplained WL, ABD pain, depression, sleeplessness, swelling of the joints Rheumatoid Arthritis - answersEarly stages: (bilateral )diffuse arthritis, WL, anorexia, and low grade fevers. May also have pain in extremities painful eyes and CP upon inspiration.... ****Joint pain and swelling present on awakening but improves as the day progresses*** Ankylosing Spondylitis - answersPain in the ankeles, eyesm hips, joints, lower back neck or shoulders. Pain during excercise or rest Eyes can be inflammed or red. Visual disturbances or light sensitivity Fatigue, malaise, inflammed tendons, IBD sleep d/o or physical deformities Osteoarthritis - answers Eczema S/S - answersEarly: symmetrical lesions which ooze, crust , and become excoriated occurs in the folds Later: rash become crusted, scaley thickened and lichenified Psoriasis - answers Eczema treatment - answersGoal: to control S/S because there is no cure ase pruritis nt secondary infection te the patient so they can control the disease themselves hydration er restoring theraphies 6. eliminate triggers Sjogrens Syndrome - answersVery challanging to diagnose because symptoms overlap with many other diseases such as MS., Lupus, chronic fatigue and fibromyalgia S/S: dry gritty burning eyes, dry oral cavities/ tongue, increased dental decay, change in taste or smell digestive problems and debilitating fatigue Allergic Dermatitis Acute: - answersAcute: weeping lesions with numerous tiny vessicles on a erythematous base that is itchy... may burn or sting. Treatment Goal: Symptom relief calamine lotion, topical steroids and oatmeal baths (Aveeno) **if weeping: moist compresses, simple srying agents and calamien lotion several times per day** Allergic dermatitis severe - answerssteroid creams possibly po steroids10-14 days taper Patient education Allergic Dermatitis - answers-do not stop steroids abruptly if given for 5 days -identify the cause, avoid exposure, wear gloves and protective clothing, contact provider for exacerbations Cellulitis defination and treatment - answersusually staph or strep red, warm, and temder to palpate Cellulitis Treatment: 1.Uncomplicated no bite: dicloxaxillin or cephalexin (Keflex 10-14 days) PCN allergy: Erythromycin 3.Humanand dog bites : Augmentin Abcess definition and treatment - answers Folliculitis - answerssuperficial to deep skin infection of the hair follicle with staph or strep Goal: Make skin inhospitable to pathogens Treatment; 1.Wash skin BID with antibacterial soap skin softens open large pustules and trim necrotic tissue 3. Bactroban for secondaryinfected skin lesions ****systemic ABX not advantageous to topical**** Pustule - answerselevated lesion semilar to a vessicle but filled with purulent fluid ie: acne, impetigo Macule - answersflat circumcised area that is a change in the skin color less than 1 cm. ie: freckle, flat mole petichea Patch - answersflat, nonpalpable irregular shaped macule 1cm ie: vitallago, port wine stains, mongolian spots Keloid - answersirreg shaped, enlarging scar form excessive collagen formation Papule - answerselevated firm circumcised area less 1cm ie: wart, elevated mole, insect bite Eccymoisis - answerssmall hemmoraghic spot round irreg blue or purple patch Hematoma - answerslocalized collection of blood , usually clotted in an organ or space or tissue due to a break in the wall of a blood vessell Acute viral syndrome - answersgeneral viral syndrome that has no clear cause S/S: fever, chills, runny nose, cough, sor throat, HA, SOB, wheezing, N./V, decreased appetite. Treatment Antipyuretics: fever Antihistamines: rash, itching trouble breathing Decongestant: stuffy nose antitussives: cough Relapsing fever - answersSudden fever within 2 weeks of infection transmitted via louse or tick (borellia species) characterized by repeated episodes of fever s/s: Rocky mountain spotted fever - answerscaused by bacterium Rickettsia can cause potential fatal illness amercian dog tick, ricky nountain wood tick and brown dog tick s/s: starts 2-14 days of tick N/v/fevern ABd pain, rash on wrist FA and ankles 2-5 days afer onset of feversometimes on trunk and palms of hands low platelet count, low NA and elevated LFT's treatment: doxy 100 mg BID x7 days, 10-14 days more serious cases TRBF - answersTick: ornithodorous tick Africa, spain saudi arabia, asia and regions of the US and Canada each fever may alst up to 3 days. may have a fever 2 weeks leave and return Diagnosis: Blood smear test Treatment: Tetracycling 500 mg q6, doxy 100 BID or if tera contraindicated erythromycin every 6 hours 7-10 days LBRF - answersLouse: body lice Asia, Africa, Central and south amercia fever 3-6 days often followed by single milder episode Diagnosis: blood smear test Treatment :single dose of tetracycline 500mg, doxy 200 or if tetra contraindicated use erythromycin 500 mg Tinea corporis - answersringworm of the body Tinea versicolor - answersdevelopment of discolored patches of the skin, Thes patches may be lighter or darker than the surrounding skin tinea capitus - answersringworm of the scalp Tinea pedis - answerstinea of the feet " atheletes feet" tinea manumus - answerstinea of the hands Tinea treatment - answersMost cases respond well to 2-4 weeks of treatment with " azole" . If systemic fungus use oral antifungal... Labs should be obtained due to risk of hepatoxicity inlcuding LFT's and CBC. Repat labs 4 weeks after treatment . Griseoulvin is chosen course of treatment but can cause granuocytopenia and leukopenia. Herpes Zoster - answersAKA" shingles" Most affected: elderly, immunocompromised history of pox can be triggered by stress Treatment: Acyclovir, Nsaids Complications: Post Herpetic Neuralgia--- treat with Gabapentin herpes simplex - answers impetigo - answers" golden crust" Mono - answersresults from the Eppstien Barr virus and less likely CMV Transission via saliva " Kissing disease" Diagnositics: CBC, heterophile antbody test (Monospot), rapid plasam reagin Monospot can take up tp 3 weeks to be positive Mono treatment - answersSupportive Measures (rest and recovery) Hydration, NSAIDS, salt water gargles adn throat lozenges. If worried aout airway use prednisone 40 mg po followed by taper. Steroids decrease viral shedding but does not affect symptom duration Leukemia acute versus Chronic - answers CLL - answers ALL - answers CML - answers AML - answers SIckle Cell Disease - answerssickle shaped RBC's block the blood vessels blood and ocxygen cant get to the tissues which cauess pain and organ failures S/s: Pain, nausea,anorexia, anxiety, heart palpattaions and SOB