Chapter 48- Drugs for Skin Disorders

Nutritional counseling for a client experiencing acne includes: a. Avoiding chocolate and caffeine. b. Limiting spicy and fried foods. c. Avoiding concentrated-carbohydrate foods. d. Avoiding foods that make acne worse.

Answer: d. Avoiding foods that make acne worse. Rationale: No special diet is required, but foods that seem to make the acne worse should be avoided. Clients should be encouraged to keep a food log to determine which foods tend to worsen the condition.

The nurse is planning teaching for a client prescribed desoximetasone (Topicort) for atopic dermatitis. The nurse will teach the client to anticipate which possible adverse effects? 1. Localized pruritis and hives 2. Hair loss in the application area contact dermatitis. 3. Worsening of acne 4. Burning and stinging of the skin in the affected area

Answer : 4. Burning and stinging of the skin in the affected area Rationale : Topical reactions such as burning or stinging to the area topical corticosteroids such as desoximetasone (Topicort) are applied are common. Options 1, 2, and 3 are incorrect. The drug should not cause hair loss or worsening of acne. If pruritus and hives occur, they should be evaluated as a sign of possible allergy to the cream or base ingredients

6. After trying many other treatments, a 28-year-old female is started on isotretinoin (Accutane) for treatment of severe acne. While she is on this medication , what explicit instructions must be followed? (Select all that apply.) 1. She must use two forms of birth control and have pregnancy tests before beginning, during, and after she is on the therapy. 2. She must have vision checks performed every 6 months. 3. She must increase intake of vitamin A-rich foods. 4. She must return every 2 to 3 months for laboratory tests. 5. She must delay any future pregnancies for a period of 5 years.

Answer: 1, 2, 4 1. She must use two forms of birth control and have pregnancy tests before beginning, during, and after she is on the therapy. 2. She must have vision checks performed every 6 months. 4. She must return every 2 to 3 months for laboratory tests. Rationale: Isotretinoin is teratogenic and pregnancy must be avoided while on this medication. To be eligible for treatment, female patients must agree to frequent pregnancy tests and commit to using two forms of birth control while on the drug. Because of adverse visual, hepatic, and lipid effects periodic vision screening and laboratory work must be monitored. Options 3 and 5 are incorrect. Isotretinoin is a retinoid closely related to vitamin A. Vitamin A may be toxic when taken in large doses and normal daily intake is usually sufficient to meet the body's needs without supplementation. Women must not become pregnant while taking isotretinoin but do not have to wait 5 years after taking the drug to become pregnant.

The nurse evaluates the client's understanding of the procedure for application of triamcinolone (Kenalog, Aristocort) cream for acute contact dermatitis of the neck, secondary to a reaction to perfume . The client asks why she can't just use up some fluocinonide (Lidex) cream she has left over from a poison ivy dermatitis last month. The nurse's response will be based on which of the following? 1. High-potency corticosteroid creams should be avoided in the neck or face because of the possibility of additional adverse effects. 2. All creams should be discarded after the initial condition has resolved. 3. Fluocinonide cream is too low potency to use for contact dermatitis. 4. Contact dermatitis from perfume is harder to treat than poison ivy dermatitis.

Answer: 1. High-potency corticosteroid creams should be avoided in the neck or face because of the possibility of additional adverse effects. Rationale: High-potency corticosteroid creams such as fluocinonide (Lidex) should be avoided in the highly vascular neck and facial areas because of the possibility of adverse effects. Options 2, 3, and 4 are incorrect. Topical corticosteroid creams may be kept at room temperature until the expiration date unless there are signs of discoloration of the cream, unless otherwise stated on the label or as instructed by the health care provider. Fluocinonide is one of the higher-potency creams available for topical use. Contact dermatitis is a skin reaction to contact with antigenic material and the body's reaction depends on the antigen -antibody response, not necessarily to the antigen itself.

4. The teaching plan for a 24-year-old female who is receiving tretinoin (Avita, Retin -A, Trentin-X) for treatment of acne should include which of the following instructions? (Select all that apply.) 1. Obtain 20 to 30 minutes of sun exposure per day to help dry the skin and prevent breakouts. 2. Wash the face with a mild soap, avoiding scrubbing, twice a day. 3. Use oil-free sunscreens, sun hats, and protective clothing to avoid sun exposure. 4. Expect some dryness, redness, and peeling while on the drug but report severe skin irritation . 5. Cover the area with a light dressing covered in plastic wrap to prevent the cream from rubbing off.

Answer: 2, 3, 4 2. Wash the face with a mild soap, avoiding scrubbing, twice a day. 3. Use oil-free sunscreens, sun hats, and protective clothing to avoid sun exposure. 4. Expect some dryness, redness, and peeling while on the drug but report severe skin irritation Rationale: Washing the face gently with a mild soap and using sunscreens and protection from sun exposure are part of the care required for clients who are taking tretinoin. Mild dryness, redness, and peeling skin are all possible adverse effects that are expected but any severe skin irritation or pain should be reported. Options 1 and 5 are incorrect. Sun exposure should be avoided unless specifically instructed to do so by the health care provider. The heat trapped by the plastic wrap may exacerbate the acne.

A 15-year-old client started using topical benzoyl peroxide (Benzaclin, Fostex) 1 week ago for treatment of acne and is discouraged that her acne is still visible. What is the nurse's best response? 1. "The cream should've started working by now. Check with your provider about switching to a different type." 2. "Some improvement will be noticed quickly but full effects may take several weeks to a month or longer." 3. "Acne is very difficult to treat. It may be several months before you notice any effects." 4. "If your acne is not gone by now, you may need an antibiotic too. Ask your provider."

Answer: 2. "Some improvement will be noticed quickly but full effects may take several weeks to a month or longer." Rationale: Initial drying of the skin caused by benzoyl peroxide will help begin to clear acne lesions in the early stages of treatment but it may take several weeks before full effects are visible. Options 1, 3, and 4 are incorrect. One week of keratolytic therapy for acne should demonstrate the beginning of therapeutic effects. Most acne is responsive to keratolytic therapy but may need an antibiotic included as part of the treatment plan after a full course of the keratolytic has been tried. Only in severe cases is oral drug therapy usually considered after other treatment options have not been successful.

The client is treated for head lice with permethrin (Nix). Following treatment, the nurse will reinforce which of the following instructions ? 1. Remain isolated for 48 hours. 2. Inspect the hair shaft, checking for nits daily for 1 week following treatment. 3. Shampoo with permethrin three times per day. 4. Wash linens with cold water and bleach.

Answer: 2. Inspect the hair shaft, checking for nits daily for 1 week following treatment. Rationale: To ensure the effectiveness of drug therapy, clients should inspect hair shafts after treatment, checking for nits by combing with a fine-toothed comb after the hair is dry. This procedure must be conducted daily for at least 1 week after treatment. Options 1, 3, and 4 are incorrect. The client does not require isolation and permethrin solution is applied once and allowed to remain in the hair for approximately 10 minutes. Linens should be washed with hot water; bleach is not required.

Careful attention to directions for application of lindane (Kwell) is emphasized by the nurse. Signs of overapplication include: a. Nausea and vomiting. b. Drowsiness. c. Eye irritation. d. Diaphoresis.

Answer: a. Nausea and vomiting. Rationale: The directions for scabicides and pediculicides must be followed carefully. If overapplied, wrongly applied, or accidentally ingested, the client could experience headaches; nausea or vomiting; irritation of the nose, ears, or throat; dizziness; tremors; restlessness; or convulsions.

Methotrexate (Amethopterin) is prescribed for a client with psoriasis vulgaris. During the physical examination, the nurse expects to find the lesions on the client's: a. Scalp, elbows, and knees. b. Upper trunk and extremities. c. Fingers and toes at distal interphalangeal joints. d. Palms of the hands and soles of the feet.

Answer: a. Scalp, elbows, and knees. Rationale: Lesions of psoriasis vulgaris are papules that form into erythematous plaques that are thick silver or grey, which bleed when removed. The lesions are found primarily over the scalp, elbows, and knees.

The teaching plan for a 24-year-old female receiving isotretinoin (Accutane) for treatment of acne must include: a. Avoiding the use of oral contraceptives while taking this drug. b. Avoiding pregnancy while taking this drug. c. Avoiding using makeup until the treatment is completed. d. Washing the face with cool water only.

Answer: b. Avoiding pregnancy while taking this drug. Rationale: Isotretinoin (Accutane) is a vitamin A metabolite that aids in reducing the size of sebaceous glands, thereby decreasing oil production and the occurrence of clogged pores. Isotretinoin is not recommended during pregnancy, due to potential harmful effects to the fetus.

A client with a history of diabetes mellitus is receiving isotretinoin for treatment of acne. Which of the following assessments might indicate a side effect of the drug? a. Dyspnea b. Blood glucose 268 mg/dL c. Blood pressure 148/88 d. Jaundice

Answer: b. Blood glucose 268 mg/dL Rationale: Encourage clients to disclose their health history and medications. Concurrent use of isotretinoin and hypoglycemic agents could lead to loss of glycemic control as well as increased triglyceride levels.

The client is treated for head lice with lindane (Kwell). Following treatment, the nurse reinforces instructions to: a. Remain isolated for 48 hours. b. Inspect hair shafts, checking for nits daily, for one week following treatment. c. Shampoo with Kwell three times per week. d. Wash linens with cold water and bleach.

Answer: b. Inspect hair shafts, checking for nits daily, for one week following treatment Rationale: In order to ensure the effectiveness of drug therapy, clients should inspect hair shafts after treatment, checking for nits by combing with a fine-toothed comb after the hair is dry. This must be conducted daily for at least a week after treatment.

A 3-month-old infant is treated for eczema. The nurse expects to discover that _________. a. The infant was premature b. The infant was formula-fed c. The infant was breastfed d. The mother experienced gestational diabetes

Answer: b. The infant was formula-fed Rationale: About three-fourths of clients with atopic dermatitis will have had an initial onset before 1 year of age. In those infants predisposed to eczema, breastfeeding seems to offer a protection, as it is very rare for a breastfed child to develop eczema before the introduction of other foods.

The client reports using benzoyl peroxide (Fostex) for treatment of acne. The action of this drug is: a. Sebum suppression. b. Antimicrobial. c. A keratolytic effect. d. Skin-abrading.

Answer: c. A keratolytic effect. Rationale: Benzoyl peroxide (Fostex) is the main OTC medication used to treat acne-related disorders. Benzoyl peroxide has a keratolytic effect, which helps dry out and shed the outer layer of epidermis.

A priority nursing diagnosis for a 16-year-old client with severe acne is: a. Anger related to disfigurement. b. Health Maintenance, Ineffective related to drug therapy. c. Body Image, Disturbed related to facial lesions. d. Self-Care Deficit related to medication regimen.

Answer: c. Body Image, Disturbed related to facial lesions. Rationale: The nurse working with teenagers with acne should establish rapport, as many clients with acne might be embarrassed, or have an altered body image or self-esteem disturbance because of their acne.

The nurse evaluates the client's understanding of the procedure for application of lindane (Kwell). Which of the following statements requires intervention by the nurse? a. "The cream should be left on 8-12 hours before rinsing." b. "I will leave the shampoo on for five minutes before rinsing." c. "The lotion takes longer to work." d. "I will leave the lotion on for about 30 minutes before rinsing."

Answer: d. "I will leave the lotion on for about 30 minutes before rinsing." Rationale: Creams or lotions take longer to produce their effect; therefore, they are usually left on the body for about 8-12 hours before rinsing. Lindane shampoo is applied and left on for at least five minutes before rinsing.