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FNU PC617 SP2014
Exam 1; Mod1-3 lecture
161
Nursing
Graduate
05/04/2014

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Cards

Term
When dx skin disorders, things to consider include
Definition
inspection, palpation, HPI,
Term
Moist lesions need medication that will
Definition
dry them
Term
dry lesions need meds that will keep them
Definition
moist
Term
There are ______ groups of steroid potency
Definition
7
Term
_______ help to decrease inflammation, increase vasoconstriction, decrease collogen synthesis
Definition
topical corticosteroids
Term
Group 1 of steroids is the _____ potent and group 7 is the ________ of the steroid groups
Definition
most potent and least potent
Term
The higher the potency of steroids the higher the risk for
Definition
adverse reaction
Term
overuse of steroid could lead to
Definition
straie, tissue atropy, and geiactesis, and purpura
Term
In order to make a correct diagnosis, the APRN needs knowledge of the various skin disorders including usual
Definition
type of lesion, location or distribution and how the lesions may change over time.
Term
. HPI should include onset, and progression, associated symptoms, ask questions like-
Definition
-Have you had this before? What type of skin products or make up do you use? New clothes or shoes? Depending on where the lesions are located. Any new soaps or detergents? Have you tried anything to help relieve your rash? What do you think is causing this? And if you think this is an infectious rash--Does anyone else that lives with you have anything that looks like this?
Term
What things need to be considered when inspecting the skin for lesions and rashes?
Definition
Inspect and palpate the skin
You need very good lighting for this!! Undress the patient and look at the distribution, configuration, borders, size, shape, color, and surface characteristics. Feel for size, tenderness, for carbuncle or furuncle--flocculence--is it soft or ready to lance?
Term
Areas like the face, scalp, axilla, scrotum and inflamed skin will need a
Definition
decreased concentration of medication because it is thinner and more permeable.
Term
Topical medications are delivered via a vehicle. List the vehicles.
Definition
Powders
Oils
Ointments
Creams
Lotions
Gels
Term
Powders do what to skin lesions?
Definition
absorb moisture
Term
Oils have
Definition
have emollient action
Term
Ointments are the
Definition
most potent vehicle--act as a lubricant--further enhanced by an occlusive dressing
Term
Creams--less potent than ______, more potent than ______
Definition
ointments and lotions
Term
Lotions- are used in
Definition
moist areas, dermatosis, pruritus, hairy areas, large areas, provide a cooling effect
Term
lotions are a combination of
Definition
water and powder
Term
Gels are oil in water and
Definition
liquefies on contact--often used to deliver medications for acne
Term
Aging skin is
Definition
thinner, less elastic, tends to be drier and more fragile
Term
Androgenic hair loss is
Definition
Male pattern--seen in men and women
Term
Areata hair loss is
Definition
autoimmune-well demarcated hair loss--refer
Term
Vitiligo is a
Definition
disappearance of melanocytes--loss of color--milky white macules that progress to large areas can affect body image especially in dark skinned people. Refer when it begins
Term
Atopic type dermatitis like eczema is a
Definition
IgEmediated reaction-usually a family hx of atopy. It is the "itch that rashes" Itchy red, dry patches with excoriation, crusting, oozing distributed on the face, antecubital fossa, neck, wrists, feet. Treatment is No scratching!! Moisturize. Steroid group 7 sparingly. Elidel for chronic AD.
Term
Uticaria includes
Definition
hives, wheals--vascular reaction in the upper dermis of the skin
Term
What are the 6 "i's"?
Definition
infection, ingestants, injections, insect bites or stings, inhalant, internal disease and latex exposure.
Term
It uticaria is not associated with an analphylactic reaction, then treat with
Definition
H1 receptor antagonist (benadryl) may augment with H2 receptor antagonist zantac or pepcid.

it's best to educate to identify and avoid the triggers.
Term
Type 4 hypersensitivity reaction occurs after
Definition
--sensitization by first exposure, then reaction occurs with second and subsequent exposures
Term
Treatment for type 4 hypersensitivity reactions may need
Definition
only soothing burrow's solution to soothe and cool, may need benadryl, topical steroids, systemic steroids for larger areas
Term
PUPPPs is seen most often in
Definition
white women, in their third trimesters pregnant with a male child
Term
puppps occurs in
Definition
1/200 women
Term
What cures PUPPPS and what can you do to treat the symptoms?
Definition
Cure is delivery, disappears within a few days of delivery. Tx oral antihistamines, skin emollients, topical corticosteroids.
Term
How does scabies spread and how long can they live?
Definition
passed person to person in crowded living conditions. Mites can live up to 3 days on linens and clothes.
Term
How does scabies cause pruritis?
Definition
due to the mite and their exudates from the burrowing
Term
what are the most common sites of scabies infestations?
Definition
finger webs, toes, flexures, genitals, axillae, buttocks
Term
When there is a small infestation of scabies, usual site affected are the
Definition
hands and wrist
Term
What is the treatment for scabies? How should it be carried out?
Definition
Permethrine creme 5% (Elimite) from neck down for 8-12 hours then wash repeat in a week. Everyone in the house!!
Term
fungal infections are also referred to as
Definition
dermatphytes
Term
name the different types of fungal infections
Definition
tinea capitus(head/scalp) , corporus cruris (jock itch) versicolor, pedis unguium (nail) manus. Yeasts--candida albicans most often implicated in intertrigo
Term
what is a common treatment for fugal infections?
Definition
topical lamisil
Term
what is herpes simplex?
Definition
labialis (fever blister) grouped vesicles on an erythematous base
Term
what is thetx for herpes simplex?
Definition
Tx--acyclovir, ice, denavir cream for severe cases.
Term
Herpes Zoster (shingles)
Definition
vesicular rash along a dermatome--reactivation of the varicella zoster virus
Term
describe the manisfestation o shingles and typical duration
Definition
Pain begins before vesicular rash erupts. usually lasts 7-10 days but has been know to last 4 weeks.
Term
what is Post herpetic neuralgia?
Definition
very painful and sensitive area along the dermatome after the shingles rash is gone
Term
what should you do if post herpatic neuralgia effects the facial area?
Definition
. If it affects the 5th cranial nerve--trigeminal neuralgia--then the ophthalmic branch may be affected--refer lesions around eye, nose or forehead to ophthalmologist
Term
what is the tx for shingles and how can it be prevented?
Definition
Tx with antivirals such as acyclovir, famciclovir, valacyclovir--should begin within 72 hours of the rash. Best to prevent--Zostavax for patients 50 y/o and older --population most at risk.
Term
classes of acne include
Definition
. Classes include comedonal, inflammatory, nodular/cystic.
Term
acne is more common in
Definition
MALES
Term
the tx for acne is
Definition
topical keratolytics
Term
propionibacterium acnes is treated with
Definition
with topical antibiotic gels like benzol peroxide, erythromycin, clindamycin or a combination of topical products applied once or twice daily
Term
Inflammatory acne requires
Definition
oral antibiotics minimum 4-6 weeks for improvement. Teach patients that oral antibiotics for 2-3 months has the best efficacy
Term
Acne Rosacea
Definition
occurs in adults 30-50. Comedones do not occur
Term
what are the typical locations of acne rosacea?
Definition
face--forehead and cheeks
Term
What should person with acne rosacea void? How should the face be cleaned?
Definition
neutral soaps to cleanse, avoid things that trigger flushing such as alcohol, hot drinks, spicy food.
Term
What is the tx for acne rosacea?
Definition
. Metronidazole 1% or 0.75% gel, cream or lotion BID or azelaic acid gel BID or oral antibiotics like doxycycline or minocycline may reduce inflammation and relieve symptoms--use 2-3 months.
Term
What is Acne Inversa--Hidradinitis?
Definition
Hyperkeratosis of the sebaceous gland follicles with secondary infection of the apocrine sweat gland. Cell mediated disorder
Term
acne inversa is a ________ disease with ____________formation in the_____.
Definition
chronic, recurrent abcess and axilla
Term
at what age does spontaneous remission occur in ance inversa?
Definition
after 35
Term
treatment for acne inversa includs
Definition
combination of steroids, antibiotics, surgery, laser surgery, isotretinoin--best handled by dermatologist--Refer
Term
Psoriasis is
Definition
Inflammatory papulsquamous eruptions-well circumscribed, erythematous maculopapular lesion covered with silvery white scale
Term
what does psoriasis do to the finger nails?
Definition
Nail dystrophy--Pitting nails!
Term
30% of individuals develop__________ who have psoriasis
Definition
psoriatic arthritis
Term
at what age does the first episode of psoriasis occur?
Definition
First episode around 18-22 y/o Chronic disorder with familial component
Term
those with psoriasis are most prone to
Definition
to Inflammatory bowel disease, CV disease, overweight, HTN, DM, dyslipidemia, depression and suicidal thoughts
Term
what is the tx or psoriasis? What is the best vehicle?
Definition
topical corticosteroids--moderate to high potency triamcinolone, Ointment is best vehicle because it is moisturizing--use an occlusive dressing on large lesions
Term
scalp lesions for psoriasis can be treated with
Definition
--shampoo coal tar is an old but effect tx in the 1% concentration. exfoliant salicylic acid reduces scales and improves med penetration.
Term
large psoriatic lesions are best handled by
Definition
a dermatologist
Term
psoriatic skin lesions can be treated with
Definition
topical Vit D (Dovonenx) and retinoid (tazorac ) are used tazorac is used for facial lesions.
Term
what are the ABCDEs of cancer diagnosis?
Definition
assymmetr boarder, color, diameter, and evaluation
Term
Basal Cell Carcinoma
Definition
raised shiny with pearly borders
Term
Squamous cell carcinoma
Definition
roughened scaling area that does not heal and bleeds easily
Term
Malignant Melanoma
Definition
Malignant Melanoma--asymmetric, irregular border, variable color, > 6 mm, elevated especially recently raised--
Term
what are the best locations to look for malignant carcinoma in dark complected people?
Definition
look at nails, hands and feet for this
Term
Actinic keratosis is a
Definition
premalignant lesion but should be referred as should all malignant lesions
Term
describe actenic keratinosis
Definition
usually between 2-6 mm, may be skin toned, dark, pink or red, appears on any sun-exposed area such as face, neck, back, shoulders or forearms. It is thick, scaly, crusty and feels rough.
Term
Treatment for cancerous lesions is
Definition
referral for excision and further treatment including actinic keratosis
Term
describe seborrhic dermtitis
Definition
--yellow brown greasy scale on erythematous base
Term
where is seborrheic dermatitis usu seen?
Definition
Seen on face, post auricular or intertigenous area
Term
what is the treatment for seborrheic dermatitis?
Definition
Tx Nizoral shampoo for dandruff. Some need very short term class 7 topical steroid after washing with shampoo.
Term
seborrheic dermatitis is a ________ skin lesion see in _________
Definition
benign and older adults
Term
Warts are a________________, they are ____________, and there are________.
Definition
benign epidermal neoplasms caused by HPV. Asymptomatic. Over 100 subtypes
Term
How are warts spread?
Definition
Transmitted via direct contact with viral particles in other humans or inanimate objects. Broken or traumatized skin allows entry
Term
warts are ______ and are typically seen on what areas of the body.
Definition
skin colored hyperkeratotic papule on a stalk. seen on hands, nail borders, knees. Plantar wart--bottom of the foot--weight bearing area under toes
Term
What is the tx for warts?
Definition
no cure, will regress over time. They can be chemically destroyed, frozen or excised.
Term
MCV measures
Definition
the size of RBCs
Term
normal MCV levels are
Definition
80-100
Term
RBCs are classified by the MCV level. What determines normocytic, microcycti, and macrocytic anemia?
Definition
normo: 80-100
micro: <80
macro: >100
Term
MCHC measures how fully
Definition
erythrocyte volume is filled with hemoglobin
Term
normal MCHC levels are
Definition
31-36
Term
MCHC defines
Definition
hypo(<31) hyperchromic anemias (>36)
Term
what is the gold standard for dx of IDA?
Definition
serum ferritin levels
Term
what is the body's major iron storage protein?
Definition
serum ferritin; correlates with body's total body iron stores
Term
What are normal serum ferritin levels for men and women?
Definition
16-300 and 4-161
Term
Total iron binding capacity determines the
Definition
ability to bind iron
Term
TIBC is calculated from
Definition
transferrin levels
Term
TIBC is ______ in IDA
Definition
increased
Term
normal TIBC levels range between
Definition
250-460
Term
the reticulocyte count represent
Definition
immature RBCs
Term
normal retic count is ______ and is _________ in IDA of chronic disease
Definition
33-137 and decreased
Term
normal retic counts indicates
Definition
a person is producing RBCs
Term
Serum iron indicates
Definition
plasma iron concentration levels
Term
serum iron is_________in IDA
Definition
decreased
Term
normal serum iron levels are
Definition
50-175
Term
give an example of microcytic anemia
Definition
thallasemia
Term
if you give a pt with thallasemia iron, what could happen?
Definition
iron overload
Term
normocytic anemia is most commonly seen in
Definition
anemia of chronic disease acute blood loss, and sickle cell disease
Term
normocytic anemia may also be seen in _____ because it takes time for the cells to change in size.
Definition
IDA
Term
what is the most common macrocytic anemia?
Definition
Vit B12; pernicious anemia is the most common form
Term
what is the most common cause of IDA in men and post-menopausal women?
Definition
chronic GI blood loss
Term
IDA is described as a
Definition
microcytic, hypochromic anemia
Term
what is the most common cause of anemia, worldwide?
Definition
IDA
Term
s/s of IDA include
Definition
fatigue, weakness, dyspnea with exerticion, and lightheadedness
Term
physical symptoms of IDA include
Definition
skin pallor, poor cap refill, pale conjunctiva, angular glossitis, tachycardia, atrpic glossitis, pulmonary edema in heart failure,
Term
splenomegly and hepatomegaly are often seen in
Definition
ida
Term
tx for IDA includes
Definition
txing the underlying cause, increase dietary iron, and oral supplementation
Term
what are some things to consider if a pt does not respond to iron tx after 3 wks?
Definition
nonadherence, blood los,additional complicating factors, and incorrect diagnosis.
Term
how longs does it take to achieve normal hemoglobin levels when txing IDA?
Definition
2 months unless there is continued blood loss; continue iron tx for 6 months in severe deficiency
Term
iron absorbency is increased with
Definition
vit c(ascorbic acid). take between meals; at least 30mins before or 2hrs before or after
Term
thalasemias are most common in
Definition
Asian, African, and meditarranean descents
Term
the most severe symptoms of the thalasemias are seen in individuals with
Definition
alpha or beta intermedia or major
Term
thalassemia major or intermedia are dx
Definition
within the first few years of life
Term
thalassemia minor symptoms include
Definition
minor anemi, rbc is normal or increased. the retic count is normal
Term
iron overload can lead to
Definition
lifethreatening organ damage
Term
people with thalassemia are often misdx with
Definition
IDA; iron levels are usu normal and do not respond to iron tx
Term
what is the tx for thalassemia?
Definition
none; just education about the disordr
Term
genetic counseling is recommended for those with
Definition
thalasemia
Term
B12 deficiency is an ________ disorder caused by malabsorption.
Definition
autoimmune
Term
B12 malabsorption results from a lack of _______ due to _________
Definition
intrinsic factor and atrophic gastritis
Term
b12 malabsorption may also be related to
Definition
alcoholism, h pylori, antacid use, PPI, metformin use, or h2 antagonist
Term
what psychiatric components are associated with vit b12 deficiency?
Definition
irritability, memory loss, depression, psychosis, personality changes
Term
sensory deficit and parathesias are seen in
Definition
b12 deficiecy
Term
vegetarians are at increased risk or
Definition
b12 deficiency
Term
B12 deficiency can cause what to the tongue?
Definition
smooth, red, shiny beefy tongue
Term
B12 deficiency can show a normal or elevated
Definition
MCV
Term
what labs can you use to verify B12 deficiency dx?
Definition
presence of anti-IF or anti-parietal cells
Term
Tx of B12 is supplementation with
Definition
oral 1000-2000 mcg/day
IM 100-1000mch once daily every other day for 2 wks than q1-3monts
intranasally as one spray 500mcg once weekly after labs are normalized by IM injections
Term
B12 supplementation may not improve
Definition
neurological damages
Term
primary care is described as
Definition
A. Health promotion
B. Disease prevention
C. Health maintenance
D. Counseling
E. Patient education
F. Diagnosis and treatment of acute and chronic illness in a variety of health care setting
Term
what is evidenced based practice?
Definition
Basis of moving research findings into clinical practice
Term
1. What is the purpose of primary care?
Definition
To encourage wellness, prevent illness, treat acute and chronic disease, and provide palliative and end of life care
Term
2. What is holistic care?
Definition
care respects each individual’s reality of health, health beliefs, health practices, and values
Term
Confidentiality is
Definition
Confidentiality: respect for privileged information
Term
autonomy is
Definition
autonomy: personal liberty of action and self-determination and respect for all persons as individuals
Term
beneficience is
Definition
provision of benefits and a balancing of harms and benefits; requires choice of positive action
Term
Fidelity is
Definition
Fidelity: keeping promises
Term
Veracity is
Definition
truth telling
Term
Justice is
Definition
Justice: fairness; like cases should be treated alike
Term
nonmaleficence is defined as
Definition
nonmaleficence: above all “do no harm”
Term
3. Explain "AskMe3" and what it does
Definition
Encourages patients to ask providers three main questions to enhance patient-provider communication
• What is my main problem
• What do I need to do
• Why is it important for me to do this
Term
1. Define health literacy
Definition
The ability of individuals to obtain, to process, and to understand basic information and servces needed to make appropriate health decisions
Term
2. What are the risks of inadequate health literacy?
Definition
Misunderstood consent forms, missed appointments, poor use of preventive health measures, including recommended health screenings, inadequate knowledge about personal health conditions, higher hospitalizations rates, and decreased self-management skills
Term
List the measures to reduce barriers to health literacy.
Definition
Screen pts for health literacy, provide written pt educational materials at reading level appropriate for every patient, use pictographs and symbols to convey information in patient education materials, use the talk-back method to assess patient’s understanding of instructions and explanations, always address the following with patients; their main problem, what they need to do, and why it is important for them to do this.
Term
There are four levels of research. Which are the weakest? Strongest?
Definition
one is the weakest and four is the strongest
Term
Level 1 research is defined as
Definition
descriptive account of interesting phenomenon
Term
Level 2 research
Definition
Looks at relationships among variables, correlational studies
Term
level 3 research
Definition
Establishes cause and effect
Tests a hypothesis
Term
level 4 research helps determine the
Definition
effectiveness of an intervention
by using RCTs
Term
common error in type 1 level of research
Definition
Find significant differences when in reality none exist.
Term
common error in type 2 level of research
Definition
Failure to detect significant differences when they do exist
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