Term
| When dx skin disorders, things to consider include |
|
Definition
| inspection, palpation, HPI, |
|
|
Term
| Moist lesions need medication that will |
|
Definition
|
|
Term
| dry lesions need meds that will keep them |
|
Definition
|
|
Term
| There are ______ groups of steroid potency |
|
Definition
|
|
Term
| _______ help to decrease inflammation, increase vasoconstriction, decrease collogen synthesis |
|
Definition
|
|
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
|
|
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
|
|
Term
|
Definition
|
|
Term
|
Definition
| most potent vehicle--act as a lubricant--further enhanced by an occlusive dressing |
|
|
Term
| Creams--less potent than ______, more potent than ______ |
|
Definition
|
|
Term
|
Definition
| moist areas, dermatosis, pruritus, hairy areas, large areas, provide a cooling effect |
|
|
Term
| lotions are a combination of |
|
Definition
|
|
Term
| Gels are oil in water and |
|
Definition
| liquefies on contact--often used to deliver medications for acne |
|
|
Term
|
Definition
| thinner, less elastic, tends to be drier and more fragile |
|
|
Term
|
Definition
| Male pattern--seen in men and women |
|
|
Term
|
Definition
| autoimmune-well demarcated hair loss--refer |
|
|
Term
|
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
|
Definition
| hives, wheals--vascular reaction in the upper dermis of the skin |
|
|
Term
|
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
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
|
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
|
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
|
Definition
| . Classes include comedonal, inflammatory, nodular/cystic. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
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
|
|
Term
| treatment for acne inversa includs |
|
Definition
| combination of steroids, antibiotics, surgery, laser surgery, isotretinoin--best handled by dermatologist--Refer |
|
|
Term
|
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
|
|
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
|
|
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
|
Definition
| raised shiny with pearly borders |
|
|
Term
|
Definition
| roughened scaling area that does not heal and bleeds easily |
|
|
Term
|
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
|
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
|
|
Term
| Warts are a________________, they are ____________, and there are________. |
|
Definition
| benign epidermal neoplasms caused by HPV. Asymptomatic. Over 100 subtypes |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
| RBCs are classified by the MCV level. What determines normocytic, microcycti, and macrocytic anemia? |
|
Definition
normo: 80-100
micro: <80
macro: >100 |
|
|
Term
|
Definition
| erythrocyte volume is filled with hemoglobin |
|
|
Term
|
Definition
|
|
Term
|
Definition
| hypo(<31) hyperchromic anemias (>36) |
|
|
Term
| what is the gold standard for dx of IDA? |
|
Definition
|
|
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
|
|
Term
| Total iron binding capacity determines the |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| normal TIBC levels range between |
|
Definition
|
|
Term
| the reticulocyte count represent |
|
Definition
|
|
Term
| normal retic count is ______ and is _________ in IDA of chronic disease |
|
Definition
|
|
Term
| normal retic counts indicates |
|
Definition
| a person is producing RBCs |
|
|
Term
|
Definition
| plasma iron concentration levels |
|
|
Term
| serum iron is_________in IDA |
|
Definition
|
|
Term
| normal serum iron levels are |
|
Definition
|
|
Term
| give an example of microcytic anemia |
|
Definition
|
|
Term
| if you give a pt with thallasemia iron, what could happen? |
|
Definition
|
|
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
|
|
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
|
|
Term
|
Definition
| microcytic, hypochromic anemia |
|
|
Term
| what is the most common cause of anemia, worldwide? |
|
Definition
|
|
Term
|
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
|
|
Term
|
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
|
|
Term
| B12 deficiency is an ________ disorder caused by malabsorption. |
|
Definition
|
|
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
|
|
Term
| vegetarians are at increased risk or |
|
Definition
|
|
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
|
|
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
|
|
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
|
Definition
| Confidentiality: respect for privileged information |
|
|
Term
|
Definition
| autonomy: personal liberty of action and self-determination and respect for all persons as individuals |
|
|
Term
|
Definition
| provision of benefits and a balancing of harms and benefits; requires choice of positive action |
|
|
Term
|
Definition
| Fidelity: keeping promises |
|
|
Term
|
Definition
|
|
Term
|
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
|
Definition
| Looks at relationships among variables, correlational studies |
|
|
Term
|
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 |
|
|
