Test #7 "Integumentary & Alterations in Cognition/Sensation"

TIA Prophylaxis and TX - what medications would we use for TIA? - what if A-fib was involved with TIA what medications would we use?

- TIA: may start aspirin, ticlopidine, clopidogrel, Aggrenox (dipyridamole and aspirin) -A-fib: warfarin, rivaroxaban (Xarelto)

Trigeminal Neuralgia - Cranial Nerve effected? - nursing interventions - s/s - medications "PAINE"

- V - avoid hot or cold (ex: ice cream, hot coffee) we want this patient to have lukewarm foods. increase in protein and calories. Washing the face and oral hygiene is very important. Patient chews on the unaffected side. Eye drop administration to prevent contamination. place NG through the stronger side. inspect all areas of mouth and teeth, test for sensation on the face, ask the patient to describe factors that initiate an episode. - stimulated by hot/cold, intermediate, muscle spasms, facial twitching, grimacing, usually seen on nose cheeks, lips, find patient sleeping a lot to avoid the pain. - med: antiseizure, nerve block "clinical ablation to the nerve, eye drops/patches p: pain is excruciating. a: avoid hot or cold. i: increase protein and calories. n: nerve, cranial V e: eye care

Miliaria - patho. - clinical manifestations - treatment/prognosis

- a common disorder of the eccrine sweat glands that often occurs in conditions of increased heat and humidity. Miliaria is thought to be caused by blockage of the sweat ducts, which results in the leakage of eccrine sweat into the epidermis or dermis. - 3 types: classified according to the level at which obstruction of the sweat duct occurs. - no compelling reason to treat miliaria Crystalina exists because this condition is asymptomatic and self-limited. Miliaria rubra can cause great discomfort, and miliaria profunda may lead to heat exhaustion. Treatment of these conditions is warranted. - topical treatments: calamine, boric acid, or menthol; cool wet to dry compresses; frequent showering with soap (although some discourage excessive use of soap); topical corticosteroids; and topical antibiotics.

Spina Bifida - how can this be caused? - prevention - more prone to what allergy?

- a congenital defect that occurs during early pregnancy when the spinal canal fails to close completely around the spinal cord to protect it - caused by material obesity, material diabetes type 2, folic acid deficiency in the mother - prevention: folic acid supplement "normal level: 0.4, mothers with deficit must take 4.0 if a risk/or have a baby with spina bifida." - more prone to latex allergy

Strabismus "crossed eyes"

- a problem with eye alignment, in which both eyes do not look at the same place at the same time - person cannot consistently focus both eyes simultaneously on the same object - can be fixed with a patch: 2-6 hours "the longer patched the better the results."

Amblyopia "lazy eye"

- a problem with visual acquit, or eyesight - can be fixed with a patch: 2-6 hours "the longer patched the better the results."

Cerebrovascular Accidents "CVA" - Risk Factors

- alternate term for a stroke; when blood circulation to a brain area is blocked, as by a blood clot or a ruptured blood vessel. - Risk Factors: smoking, birth control, heart disease, diabetes, obesity, sleep apnea, lack of physical exercise, poor diet, drugs/alcohol

Culture

- as a nurse, you can obtain cultures using the swab technique. This is done using Levine's technique, which involves rotating a culture swab over a cleansed 1cm 2 area near the center of the wound. use enough pressure to extract wound fluid from deep tissue layers. Take a culture of the clean tissue because exudate and necrotic tissue will not provide an accurate sample. The sample must be sent to the laboratory within 1 hour.

Ticks - patho. - clinical manifestations - treatment/prognosis

- borrelia burgdorferi (spirochete transmitted by ticks in certain areas) causes Lyme disease - spreading, ringlike rash 3-4 week after bite, rash common in groin, buttocks, axillae, trunk, and upper arms and legs, warm, itchy painful rash, flu-like symptoms, cardiac, arthritic, and neurologic manifestations possible, unreliable laboratory test - oral antibiotics, such as doxycycline - IV antibiotics for arthritic, neurologic, and cardiac symptoms - rest and healthy diet - most patients recover

Beta Blockers - adverse Effects - administration interventions - what are the names of these medications?

- bradycardia, low blood pressure, bronchial constriction, blood sugar masks low, blocks heart 1st degree. "If any of these adverse effects show up STOP medication" - check BP and HR before and after administration

Squamous Cell Carcinoma - patho. - clinical manifestations - treatment/prognosis

- cancer arising from keratinizing epidermal cells. SCC can be aggressive and has the potential to metastasize. It may lead to death if not treated early and correctly. - tumor arising from melanocytes, the cells that make melanin. It causes most skin cancer deaths. - most common on sun-exposed areas such as face and hands, superficial: thin, scaly erythematous plaque without invasion into the dermis, early: firm nodules with indistinct borders, scaling, and ulceration, late: covering of lesion with scale or horn from keratinization, ulceration - surgical excision, cryosurgery, radiation therapy, electrosurgery, laser therapy, and photodynamic therapy. Untreated lesion may metastasize to regional lymph nodes and distant organs. - fluorouracil and imiquimod for noninvasive SCC - chemotherapy for metastatic lesions - high cure rate with early detection and treatment

Candidiasis - patho. - clinical manifestations - treatment/prognosis

- caused by candida albicans, also known as moniliasis, appears in warm, moist areas such as groin area, oral mucosa, and submammary folds, immunosuppression (from HIV infections, chemotherapy, radiation, and organ transplantation) allows yeast to become pathogenic. - mouth: white, cheesy plaque, resembles milk curds - vagina: vaginitis with red, edematous, painful vaginal wall, white patches, vaginal discharge, pruritus, pain on urination and intercourse - skin: diffuse papular erythematous rash with pinpoint satellite lesions around edges of affected area - azole antifungals (fluconazole, ketoconazole) or other specific medication such as vaginal suppository or oral lozenge - sexual abstinence or use of condom - skin hygiene to keep area clean and dry - powder is effective on nonmucosal surfaces of skin to prevent recurrence

Cerebral Palsy - patho. - diagnosis - treatment/prognosis

- cerebral palsy affects a person's ability to move and maintain balance and posture, cerebral palsy is caused by brain damage or abnormal brain development that happens before birth or early in life. Permanent, it is not progressive. - assessment during early infancy until 2 years of age can reveal a deficit especially if history, MRI preferred, Metabolic/genetic testing; early sign: floppy baby - supportive, optimize health: ankle-foot orthoses: reduce and prevent deformity, helps with more efficient gait, controls alignment - wheeled go-carts, manual or powered wheelchairs, stroller if dependent - orthopedic surgery - PT/OT/ST and Nutritional Support - Meds for muscle spasms: example baclofen (implanted pump-intrathecal space for severe spasticity. - Botox injections, dantrolene sodium - meds for seizures; carbamazepine, divalproex, gabapentin.

Reye's Syndrome - who is at risk? - s/s - treatment - nursing interventions

- children recovering from a viral infection such as chickenpox or flu or who have a metabolic disorder are most at risk, especially if they have been taking aspirin. - early symptoms include diarrhea, rapid breathing, vomiting, and severe fatigue. Symptoms such as confusion, seizures, and loss of consciousness need emergency treatment. - there is no specific treatment for Reye's syndrome beyond supportive care and aggressive monitoring for complications. - nursing interventions: LOC, I/O, Labs: PT, PTT, INR

Psoriasis - patho. - clinical manifestations - how can this affect a person - treatment/prognosis

- chronic autoimmune, usually develops in 15-35 y/o, men and women diagnosed equally, highest rates in whites - lesions are distinct and appear as red, scaling papules that merge to form plaques. The affected area is normally rounded, with adherent silver scales that bleed easily when removed. Common sites: the knees, elbows, scalp, hands, feet, and lower back. They are often pruritic and may be painful. - treatment is tailored to meet a person's needs. this varies depending on the location of lesions, severity, patient preferences, and comorbidities. Goals range from improved quality of life to complete disease resolution. Psoriasis for most is more emotionally than physically disabling. It erodes the self-image. The person may be self-conscious and withdraws from social contacts. Quality of life can diminish as people avoid activities. Depression is common. - topical treatment: corticosteroids, tazarotene, calcipotriene, anthralin, calcineurin inhibitors (tacrolimus), intralesional injection of corticosteroids for chronic plaques - systemic treatments: natural or artificial UVB, PUVA (UVA with topical or systemic photosensitizer (psoralen), traditional and oral therapies: antimetabolite (methotrexate), retinoid (acitretin), apremilast (otezla), immunosuppressant (cyclosporine)

Bedbugs - patho. - clinical manifestations - treatment/prognosis

- cimicidae species, feeding periodic, usually at night, present in furniture, walls during day. - wheal surrounded by vivid flare, firm urticaria transforming into persistent lesions, severe pruritus, often grouped in threes appearing on uncovered parts of body, not typically in the skin but on the outer layer. - lesions usually require no treatment, severe itching may require use of antihistamines or topical corticosteroids.

Down's Syndrome - At Risk For? - Physical Features?

- constipation - congenital heart malformations (septal defects) - respiratory tract infection - thyroid dysfunction (hypothyroidism) - leukemia - small nose, mouth, and ears - slightly bent 5th finger - almond-shaped eyes with skin fold covering inner corner - white spots on colored part of eyes - flat, round face

dysphagia - How can we prevent aspiration?

- difficulty swallowing - thickened liquids - flexed neck to swallow - sit patient up - place food on the unaffected side of the mouth

MRSA "Methicillin-Resistant S. Aureus"

- does not respond to methicillin or penicillin- based therapies - caused by overuse of antibiotics - can be HA or CA - preferred treatment = vancomycin

Seizure Health Promotion - education

- educate patient to identify triggers resulting in a seizure; avoid alcohol - review aura to assist with a plan for safety - educate patient regarding safe medication administration. DO NOT STOP ABRUPTLY - review importance of wearing medical alert bracelet or having an identification card - safety risk assessment prior to discharge.

Triptans "Sumatriptan" - patient education - side effects - what can this medication cause?

- education: take at start of pain or during Oura "flash of lights." - contraindicated for patients with disease or those taking vasoconstrictors. - cause: tremor, decrease respiratory rate

Anti-Parkinson's Agents - Levodopa/Carbidopa - safety interventions - "TREMORS"

- enhances and releases dopamine, or blocking - do not take with meals, limit B6 intake, effects may not happen until weeks- months "occurs in face, eye lids, mouth, tongue, must report mental status changes, heart palpitations, problems urinating, oral hygiene, dry mouth interventions, sugarless gum. t: therapeutic use: the ability to perform ADLs; does NOT halt the progression of Parkinson's disease. r: recommend avoiding high-protein meals and snacks. e: effects of these drugs may not be noticeable for several weeks to several months. m: medication "holidays" may be indicated, but client must be in the hospital to be monitored. o: observe for dyskinesias with Dopaminergic and Dopamine agonists. r: remember to notify provider if symptoms reoccur due to sudden loss of medication effects. s: safety precautions due to risk for drowsiness and/or possible orthostatic hypotension.

Hydrocephalus - Nursing Implementations

- extra CSF in the ventricles - head support with positioning and use of special mattress, donut, or gel pillow. skin care - nutritional needs: requires extra time and care to feed (small, frequent fdgs and burp frequently) - observe for shunt malfunction: temperature, pupil dilated on side of pressure, inc hc, abdominal distention, seizure activity, in older child, headache and decrease loc - teach, support, and offer anticipatory guidance to family - enroll in early childhood developmental program - care is a demanding task for nurse and family - Nsg dx (s): risk for infection, caregiver role strain, and dev delay, anxiety and impaired mobility and tissue perfusion.

Otic Antibiotics Administration

- eye drops can go into ears, but ear drops cannot go into eyes - keep contamination away from the otic antibiotics ad"UP"lt: up and back chil"down": down and back

Apomorphine "Apokyn" - administration directions - how do we stop this medication? - what can we take this medication with? - what should we monitor? - S/E - indication - contraindications

- given through under-the-skin injections up to five times a day, take BP and HR before and after administration - do NOT stop abruptly - take with an ANTIMEDICS but NOT a 5HT3 Antagonist "Zofran/ondansetron." - monitor liver function tests (LFTs) - s/e: may include yawning, drowsiness or sleepiness, dyskinesias, dizziness, nausea and vomiting, and more. - indications: approved to treat off episodes "symptoms worsen" in people with advanced Parkinson's - contraindications: not recommended for people with a known allergy to Apokyn's ingredients, or for use along with nausea treatments.

Impetigo - patho. - clinical manifestations - treatment/prognosis

- group A B-hemolytic streptococci, staphylococci, or combination of both, associated with poor hygiene, primary or secondar infection, contagious - vesiculopustular lesions that develop thick, honey-colored crust surrounded by erythema, pruritic, most common on face as primary infection - topical: wound care with warm saline or aluminum acetate soaks followed by soap-and-water removal of crusts and application of topical antibiotic cream or ointment (mupirocin, retapamulin (altabax), meticulous hygiene essential - systemic antibiotics: cephalosporins, erythromycin, amoxicillin, clindamycin, for widespread infections or systemic manifestations - we must first remove the crust then apply

Cellulitis - patho. - clinical manifestations - treatment

- inflammation of subcutaneous tissues, may be a primary infection or secondary complication, often following break in skin, staphylococcus aureus and streptococci usual causative agents, deep inflammation of subcutaneous tissue from enzymes produced by bacteria - hot, tender, red, edematous area with diffuse borders, chills, malaise, fever "we will draw around the area to see how much it spreads." - topical: moist heat, immobilization, and elevation - systemic: systemic antibiotic therapy, hospitalization if severe for IV antibiotic therapy based on culture and sensitivity, progression to gangrene possible if untreated

Tinea Pedis "Athlete's Foot" - clinical manifestations - treatment

- interdigital scaling and maceration - scaly plantar surfaces sometimes with erythema and blistering - may be pruritic and painful - topical antifungal cream, gel, solution, spray, or powder - treat the shoe as well

Transient Ischemic Attack "TIA"

- is a short-term problem in your brain. It is caused by a lack of blood flow to part of your brain. - a TIA is similar to a stroke except that a TIA doesn't cause long-lasting brain damage. However, a TIA may be a warning sign of a future stroke. - TIAs come on suddenly and go away in an hour or less - The causes and symptoms of TIAs are the same as for strokes but a TIA ends before you brain is damaged. - you get different symptoms depending on what part of your brain was affected.

Otitis Media "Basic Ear Infection"

- malfunction of the Eustachian Tube - infected fluid in middle ear - if repeated ear infections: child could possibly go deaf

Tension-Type Headache "Stress Headache" (TTH)

- most common type of headache - characterized by bilateral frontal-occipital location and pressure, tightening quality - usually mild to moderate intensity - episodic or chronic - can cause neck pain, light and sound sensitivity

Basal Cell Carcinoma - patho. - clinical manifestations - treatment/prognosis

- most common type of skin cancer; related to excessive sun exposure, genetic skin type, x-ray radiation, scars, and some type of nevi "mole." No maturation or normal keratinization. - nodular and ulcerative: small, slowly enlarging papule, borders semitranslucent or "pearly" with overlying telangiectasia, erosion, ulceration, and depression of center, superficial, erythematous, pearly, sharply defined, barley elevated plaques. - surgical excision, electrodessication and curettage, cryosurgery, radiation therapy, laser therapy, and photodynamic therapy, - vismodegib (erivedge) or sonidegib (odomzo) for metastatic or recurrent locally invasive lesions. - fluorouracil and imiquimod for superficial lesions

Anencephaly

- most serious neural; fatal defect and fatal - provide comfort measures for infant, emotional support, counseling opportunities for the parents - this is found early - is not a lot you can do for this child - brain is exposed

Otitis Externa "Basic Swimmer Ear"

- narrowing of the ear canal from inflammation

Melanoma - patho. - clinical manifestations - treatment/prognosis

- neoplastic growth of melanocytes anywhere on skin, eyes, or mucous membranes. Classification according to major histologic mode of spread, potential invasion and widespread metastases - irregular color, surface, and border, variegated color, including red, white, blue, black, gray, brown. Flat or elevated. Eroded or ulcerated. Often <1cm in size. Most common sites in males are back, then chest. In females are legs, then back. - surgical excision and possible sentinel lymph node evaluation, adjuvant therapy after surgery if lesion >1.5mm in depth, correlation between survival rate and depth of invasion, poor prognosis unless diagnosed and treated early. Spreading by local extension, regional lymphatic vessels, and bloodstream.

Risk Factors for CVA - non-modifiable & modifiable

- non-modifiable: age, gender, race, genetics/family hx - modifiable: heart disease "a-fib", smoking, obesity, lack of physical activity, drug/alcohol abuse, birth control pills.

Bell's Palsy - cranial Nerve effected? - nursing interventions -how long does this last? - S/S

- not born with it, it just happens - VII (7) - maintain positive self-imaging, methylcellulose "eye drops for the affected eye", eye patch "if can't take eye drops patch must be used.", analgesics, give eye care, evaluate ability to eat, oral hygiene "affected side." - s/s: only one side effected at a time, muscle weakness, drooping of the mouth, decrease of taste, cannot close the affected sides eye.

Biopsy - risk factor "BLEEDING"

- one of the most common diagnostic tests used to evaluate a skin lesion. A biopsy is needed when cancer is suspected, or a specific diagnosis is questionable. Techniques include punch, incisional, excisional, and shave biopsies. The method used depends on factors such as the site of the biopsy, cosmetic result desired, and type of tissue needed. b: bleeding should be evaluated after procedure. l: look for bleeding; apply pressure and sterile dressing over site as appropriate. e: educate the client to report excessive bleeding and/or s/s of infection. e: educate client to check incision daily. keep it clean, dry and intact. d: determine if there are any complications from bleeding such as HR increase or BP decrease. s: signed informed consent from client prior to procedure.

Tinea Unguium "Onychomycosis" - clinical manifestations - treatment

- only few nails on one hand may be affected. toenails more commonly affected. - scaliness under distal nail plate - brittle, thickened, broken, or crumbling nails with yellowish discoloration - oral antifungal (terbinafine (lamisil), itraconazole (sporanox) - topical antifungal cream or solution (minimal effectiveness) if unable to tolerate systemic treatment - thinning of toenails if needed - nail avulsion (removal) is an option

Parkinson's Disease - onset - assessment findings

- onset usually gradual, after age 50 "slowly progressive" - blank expression, dysarthria, tremor "upper limb hand or arm, occurs at rest or may occur with voluntary movement, pill rolling, aggravated by stress, head may be involved-side to side twitching." - stooped posture, shuffling, propulsive gait, bradykinesia "loss of normal arm swing while walking, decrease blinking of the eye lids, loss of ability to swallow, blank expression, difficulty initiating movement." - muscle rigidity "increase resistance to passive movement, COG wheel, jerky slow movement."

Assessment of Skin Reveals the Patient's Health Status R/T? - what could they look like?

- oxygenation "cyanosis" - circulation "dusty, pale" - nutrition - damage - hydration

What is the PRIORITY nursing concern for a patient experiencing a migraine headache?

- pain

Lice - patho. - clinical manifestations - treatment/prognosis

- pediculosis humanus capitis = head lice - pediculosos humans corporis = body lice - phthirus pubis = pubic lice or crabs - obligate parasites that suck blood, leave excrement and eggs on skin and hair, live in seams of clothing (if body lice) and in hair as nits. Transmission of pubic lice often by sexual contact. - minute, red, noninflammatory, points flush with skin, progression to papular wheal-like lesions, pruritus, secondary excoriation, especially parallel linear excoriations in intrascapular region. Nits and eggs are firmly attached to hair shaft in head and body. - y-benzene hexachloride or pyrethrins to treat various parts of body - spinosad (natroba) topical suspension 0.9% to treat scalp and hair - screen and treat close contacts (bed partners and playmates) as needed - do not share head gear

Important Information to Obtain from History Include What from the Derm Patient?

- personal or family history of atopy (suggesting atopic dermatitis) - occupational exposures (contact dermatitis) - long-term exposure to sunlight or other forms of radiation (benign and malignant skin tumors) - systemic disease (diabetes and candida or tinea, hepatitis C, and cryoglobulinemia) - sexual history (syphilis and gonorrhea) - use of drugs (stevens-Johnson syndrome, toxic epidermal necrolysis) - travel history (Lyme disease, skin infections) - the history of the particular skin lesions is also important, including time and site of initial appearance, spread, change in appearance, and triggering factors.

Risk Factors for Altered Integument - High Risk Factors?

- pressure - medications - moisture High Risk: - neurological impairments - chronic illness - poor tissue oxygenation - low cardiac output - inadequate nutrition - ortho/vascular injuries

Prevention of Parasitic Infections

- preventing insect bites by avoidance or using repellants is somewhat effective. - meticulous hygiene related to personal articles, clothing, bedding, and examination and care of pets, as well as careful choice of sexual partners, can reduce the incidence of infestations. - prompt, routine skin inspection is necessary in geographic areas where there is a risk for tick bite.

Antiseizure Medications - prevention/treatment - acute/prn

- prevention/treatment: *Phenytoin (Dilantin), Carbamazepine (Tegretol), Phenobarbital, tonic clonic and focal onset *Ethosuximide (zarontin): generalized onset nonmotor and myoclonic *Neurontin (gabapentin): add on treatment for focal but not indicated for monotherapy *Valproate: absence or partial - acute/PRN *Lorazepam (Ativan) *Diazepam (Valium)

Ergotamine - s/s - triggers to avoid

- prevents dilation and inflammation - s/s: headache, vomiting, diarrhea, gangrene (fingers and toes) "if gangrene occurs stop the medication and contact the HCP. Numb and cold, vomiting from the mouth and nose. - triggers: smells, alcohol, cheese, wine, caffeine, chocolate, peperoni

Headaches "Chronic Neurologic Problem" - primary - secondary

- primary headaches: are not caused by disease or another medical condition ex: migraine headache - secondary headaches: are caused by another condition or disorder ex: sinus infection, neck injury

Migraine Headache - What are the two categories?

- recurring - unilateral throbbing pain - premonitory symptoms or triggers "they need to know what they are so they can be avoided." - onset ages 25-55 years 2 Categories 1. without Oura: common migraine 2. with Oura: classic migraine

Ropinirole - safety precautions - PARK DOPE

- safety: fall precautions p: pill rolling. a: about to fall. r: rigidity k: can't swallow/speak (drools), feels like a DOPE with these medications. d: decreases Parkinson's syndrome. o: orthostatic hypotension p: psychosis (visual hallucinations, nightmares) e: effects of drugs may be undesirable and result in nausea and/or dyskinesia.

Scabies - patho. - clinical manifestations - treatment/prognosis

- sarcoptes scabiei, mite penetrates stratum corneum, deposits eggs, allergic reaction to eggs, feces, mite parts, transmission by direct physical contact, sometimes by shared personal items, rarely seen in dark-skinned people - severe itching, especially at night, usually not on face, presence of burrows, especially in interdigital webs, flexor surface of wrists, genitalia, and anterior axillary folds, erythematous papules (may be crusted), possible vesiculation, interdigital web crusting - 5% permethrin topical lotion, 1 overnight application with second application 1 week later, may yield 95% eradication - treat all family members, treat environment with plastic covering for 5 days, launder all clothes and linen with bleach - treat sexual partners - antibiotics, if secondary infections present - possible residual pruritus up to 4 weeks after treatment - recurrence possible if inadequately treated

Abnormal Cell Proliferation Disorders - risk factors for skin cancer

- skin cancer is the most commonly diagnosed cancer. 3 skin cancers are either nonmelanoma or melanoma. - risk factors for skin cancer include: 1. having fair skin, blond or red hair with blue eye color 2. history of outdoor sunbathing 3. living near the equator or at high altitudes 4. family or personal history of skin cancer 5. having an outdoor occupation 6. spending a lot of time in outdoor recreation activities 7. indoor tanning

Transient Ischemic Attack "TIA" Prognosis and Key Management Considerations

- the ABCD2 score is a risk assessment tool designed to improve the prediction of short-term stroke risk after a transient ischemic attack "TIA." The score is optimized to predict the risk of stroke within 2 days after a TIA, but also predicts stroke risk within 90 days. The ABCD2 score is calculated by summing up points for five independent factors. 1. age > or 60 y/o 2. blood pressure (systolic >140, diastolic >90) 3. clinical features of TIA: unilateral weakness with or without speech impairment or speech impairment without unilateral weakness. 4. duration: >60 minutes or 10-59 minutes 5. Diabetes

Phenytoin "Dilantin" - therapeutic level - administration - adverse effects

- therapeutic level 10-20 - administration: IV/ use a filter, and can only give with normal saline, cardiac monitor if infusion - adverse effects: monitor gums for gentahydroplasia, GI disturbances, liver enzymes, ataxia, risk for hypocalcemia, decrease absorption of vitamin D.

Atopic Dermatitis - patho. - treatment/prognosis

- type 1 hypersensitivity response, genetically influenced, chronic, relapsing disease, exaggerated by a skin response to environmental allergens, associated with allergic rhinitis and asthma - lubrication of dry skin, topical immunomodulators (pimecrolimus (elidel), tacrolimus (protopic), reduction of stress reduces flares, corticosteroids, phototherapy for severe inflammation and pruritus, antibiotics for secondary infection as needed.

Allergic Contact Dermatitis - patho. - clinical manifestations - treatment/prognosis

- type IV delayed hypersensitivity response, absorbed agent acts as antigen, sensitization occurs after one or more exposures, appearance of lesions 2-7 days after contact with allergen - red papules and plaques, sharply circumscribed with occasional vesicles, usually pruritic "itchy", area of dermatitis often takes shape of causative agent "metal allergy and bandlike dermatitis on ring finger, nickel." - topical or oral corticosteroids, antihistamines, skin lubrication, elimination of contact allergen, avoidance of irritating affected area, systemic corticosteroids if sensitivity severe

Tinea Corporis "Ringworm" - clinical manifestations - treatment/prognosis

- typical annular (ringlike) scaly appearance, well-defined margins, erythematous - cool compresses - topical antifungals for isolated patches. Creams or solutions of miconazole, ketoconazole, clotrimazole, butenafine

Seizures - Risk

- uncontrolled electrical discharge of neurons in the brain. - risk: SIADH, DI, Hypo/Hypernatremia, Pregnancy-induced Hypertension, Epilepsy, Febrile seizures for an infant, heat stroke, infection resulting in sepsis with hyperthermia.

Cluster Headache

- unilateral pain - pattern suggests dysfunction of hypothalamus - triggers can include alcohol, strong odors - can last for min-3 hours - up to 8 times a day - sharp, stabbing, tense pain - eye swelling, teary on the affected side

Clinical Photographs

- used in adjunct to documentation and promote communications among the interprofessional team. - assess and monitor skin conditions - determine if the condition is improving or declining - follow agency protocol regarding patient's consent to photograph

Clinical Teaching for Skin Cancer

- usually not infectious - limit sun exposure (wear hats, sunscreen) - avoid tanning beds - seek dermatologist - SPF 50 even on cloudy days - wear long sleeves - avoid exposure between hours of 11-2 (most dangerous)

Dermatological Exam

- visual inspection is the central evaluation tool; many skin disorders are diagnosed by the characteristic appearance or morphology of the lesions. A full skin examination, including examination of the scalp, nails, and mucous membranes, is done to screen for skin cancers and to detect clues to the diagnosis of a widespread eruption. - a hand-held dermatoscope with built-in lighting is particularly useful in evaluating lesions. Further information can be gathered by using diascopy or a wood light "can determine fungus."

Tinea Cruris "Jock Itch" - clinical manifestations - treatment

- well-defined scaly plaque in groin area - does not affect mucous membranes - topical antifungal cream or solution

Classifications of Seizures - 2 types

1. Generalized Onset (involving both hemispheres of brain) - motor - nonmotor (absence) 2. Focal-Onset (involving one hemisphere of brain) - aware - impaired awareness - motor onset - nonmotor onset

Dermatitis - two types

1. irritant contact dermatitis results from direct chemical injury to the skin 2. allergic contact dermatitis is an antigen-specific, type IV delayed hypersensitivity response

Labs

CBC: leukocytosis, anemia, and/or thrombocytopenia Serum protein, albumin, prealbumin, and transferrin levels to assess the patient's nutritional status.

ABCDE's Of Melanoma

a: asymmetry b: border irregularity c: color variegation d: diameter greater than 6mm e: evolving or changing in some way.

Seizures Assessment - CAESAR

c: consciousness level a: affected body parts: where seizure started and the progression. e: eyes for pupil response s: salivation is altered. a: alteration in skin color and urination (incontinence) r: reduced muscle tone

Acne

chronic papular and pustular eruption of the skin with increased production of sebum

Psoriasis

chronic skin condition producing red lesions covered with silvery scales.

Divalproex "Depakote"

d: depression, suicidal thoughts-monitor for s/sx e: elevated liver enzymes- watch for ALT, AST p: pancreatitis a: abdominal pain k: know weight. o: oral contraceptives: avoid pregnancy d/t neural tube defects. t: thrombocytopenia, leukopenia e: extended-release formula "don't crush/break apart."

diplopia

double vision

CVA Immediate Attention - "FAST"

f: face, ask the client to smile and look for drooping of either side. a: arms should be raised together to look for weakness or inability. s: speak name and address and watch for slurring. t: time is brain! if any of the first 3 are deficient, call 911. - we must have interventions at least 3 hours into symptoms "the quicker the better."

Impetigo Patient Education - "HONEYBEES"

h: handwashing is a MUST! o: oral antibiotic therapy; treatment of course n: not treated appropriately may lead to glomerulonephritis. e: erosions: pustule-like lesions with moist honey-colored crusts surrounded by redness. y: yes, these lesions may appear on body, but most commonly on face. b: beta-hemolytic streptococci: cause, mupirocin "Bactroban" cream, if only a few lesions are found. e: educate family that lesions will not scar. e: encourage to take the full course of antibiotics. s: staphylococcus aureus cause

Seizures Safety Interventions - HARMM

h: harm protection; remove unsafe objects. a: airway patency (suction, ambu bag, mask, airway equipment, etc.) r: restraining is inappropriate. Record and observe event. "Turn patient on their side." m: mouth should never have anything placed in it during a seizure. m: monitor compliance with taking anticonvulsant medications. Teach danger of stopping abruptly. "They stop it because they don't like the s/e of the medication, or they think they can stop the medication due to not having a seizure."

Dermatitis

inflammation of the skin

Furuncles

large, tender, swollen areas caused by a staphylococcal infection around hair follicles or sebaceous glands, boils.

Nursing Interventions for Migraine - "MIGRAINE"

m: medication administration when headache starts. i: identify triggers. g: GI complication (constipation) with verapamil (Calan) and amitriptyline-- increase fluids r: review importance of lying down in a dark, quiet room. a: alcohol is to be avoided since it is a trigger. Assess pain, location, duration, intensity, and associated symptoms. i: important not to drive until level of cognitive response from med has been determined. n: notify provider of care of signs and symptoms. e: evaluate HR and BP prior to administering verapamil (calan). s: stimuli in room needs to be reduced: quiet, dark to decrease complications.

ipsilateral

on the same side of the body

Seizure Interventions "PROTECTS"

p: protect privacy and protect from injury; protect from falls. r: review respiratory status. restrictive clothing should be loosened. restraints aren't used. do not force anything into their mouth or open jaw. No padded tongue blades. o: oral pharyngeal airway; maintain patency. t: turn on side to decrease risk of aspiration after the seizure. e: equipment available, educate patient regarding aura to assist with a plan to provide safety. review post-ictal so patient understands what to be expected following a seizure. c: check VS, NC, injuries, reorient post seizure. t: the onset and after seizure should be documented. s: suction oral secretions. seizure precautions.

paraplegia

paralysis from the waist down

quadriplegia

paralysis of all four limbs

hemiplegia

paralysis of one side of the body

System-Specific Assessments "THE S'S"

s: stooped posturing s: slow, shuffling, propulsive gait s: swallowing and chewing difficulty. "Smaller frequent meals, sitting upright when eating, thickened liquids to prevent aspiration. "High protein/calorie intake" s: swing in moods, suction at bedside 24/7. s: shows progressive impairment with ADLs. s: slow, monotonous speech s: shows a mask-like expression. s: symptoms (autonomic): orthostatic hypotension, flushing, diaphoresis s: safety: electric razors, adequate lightening, rugs need to be in place.

Pruritus

severe itching

bradykinesia

slow movement

dysarthria

slurred speech

Tegretol "Carbamazepine"

t: trigeminal neuralgia, Tonic-clonic seizures e: evaluate for undesirable effects: anorexia, nausea, dizziness, sedation, headaches, sore throat, bruising, skin rash, jaundice. g: give with food, milk to reduce GI distress. r: review levels, maintain- between 4-12 micrograms/mL. e: evaluate AST, ALT, and CBC t: tablet: chewable; do not swallow whole, chew. take extended-release capsules whole- no crushing or breaking. o: do not open extended released capsules. l: look there is B in CarBamazepine to remind you to assess for BLOOD dyscrasias. (leukopenia=sore throat, increase WBC; anemia=Fatigue, decrease Hgb: thrombocytopenia=bleeding, decrease platelets

Antifungals "Antimycotic" - ZOLE

z: zole: many drug interactions can occur. o: observe hygiene measures to control infection. l: liver function tests: monitor e: educate to take with food. - destroys fungal infections!

Anticholinergic Drugs "Benztropine" - nursing interventions - when should we stop this medication? - S/E

"Dries everything up." - interventions: obtain baseline VS: tachycardia side effects with larger doses, assess UOP: urinary retention may occur, check health history: contraindicated with narrow-angle glaucoma, obstructive GI disorders. - STOP if swallowing problems occur - S/E: decreased secretions, constipation, drowsiness