Ch. 6 & 32 Flashcards

1
Q

CDC transmission based precautions

A
  • standard
  • contact
  • droplet
  • airborne
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2
Q

contact precautions

A

anyone in the room must wear
- gloves
- gown

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3
Q

droplet precautions

A

any in the room must wear
- surgical mask

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4
Q

airborne precautions

A

any in the room must wear
- N95 respirator

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5
Q

communicable disease: definition

A

an infectious disease transmissible by direct or indirect contact (ie a surface it could be on)

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6
Q

nursing goals with communicable diseases

A
  • assist in the identification of the infectious agent (assessments, history, etc.)
  • identify potentially infectious cases
  • recognize diseases that require medical intervention
  • implement appropriate nursing interventions
  • educate patients and families
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7
Q

prodromal symptoms: definition

A

s/sx of an illness that appear before the characteristic s/sx of the disease

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8
Q

constitutional symtoms: definition

A

symptoms that can affect multiple body systems

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9
Q

incubation period: definition

A

time between exposure and onset of symptoms

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10
Q

examples of prodromal symptoms

A

fever
malaise
anorexia

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11
Q

examples of constitutional symptoms

A

fever
irritability

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12
Q

examples of incubation period

A

2-3 weeks
several days

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13
Q

agent

A

the causative organism

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14
Q

source

A

where it came from
where it can be found

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15
Q

transmission

A

how it is spread

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16
Q

what is needed during the incubation period?

A

quarantine needed
precautions needed

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17
Q

period of communicability

A

how long a person is considered contagious

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18
Q

distribution

A

how it appears on a human
- rash (pattern)
- sx (order of sx)

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19
Q

specific management

A

using a particular medication to treat a specific organism/infection
ie antibiotic for infection

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20
Q

support management medication is

A

medication that is not specific to illness, but resolves general non-specifc symptoms
ie tylenol for fever

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21
Q

complications

A

signs of decline
worsening of condition
- may put patient at risk for hospitalization or death

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22
Q

prevention

A

teach family and patient so that they can prevent illness from occurring again

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23
Q

nursing care of communicable disease

A
  • nursing interventions: what we do to promote/improve health
  • anticipatory guidance: how to prevent, follow-up appt, more tests
  • patient and family education: how to use thermometer, how to set up humidifier
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24
Q

subjective data collection

A
  • known exposure?
  • community exposure?
  • prodromal symptoms?
  • constitutional symptoms?
  • immunization?
  • history of having disease?
  • history of comorbidity/risk factors?
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25
Q

timeline of communicable disease

A
  • stage of susceptibility
  • exposure
  • stage of subclinical disease
  • pathologic changes
  • onset of symptoms
  • stage of clinical disease
  • usual time of diagnosis
  • stage of recovery, disability or death
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26
Q

nursing care management: prevent spread

A
  • institute precautions
  • HW
  • primary prevention (immunization)
  • antibiotics
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27
Q

nursing management: prevent complications

A
  • immunocompromised
  • immunoglobulin
  • booster vaccine
  • antivirals
  • antibiotics
  • vit A supplementation
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28
Q

nursing care management: providing comfort and support

A
  • calm skin manifestations (cool compress, bath, lotion, creams)
  • antipyretics
  • oral symptoms (lozenges, gargling, rinses, magic mouthwash)
  • quiet activity/distraction vs. bedrest
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29
Q

varicella: source

A
  • primary secretions of respiratory tract
  • skin lesions
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30
Q

varicella: transmission

A
  • direct contact
  • droplet (airborne),
  • contaminated objects
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31
Q

varicella: incubation

A

2-3 weeks

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32
Q

varicella: period of communicability

A

1 day before eruption of lesions (prodromal) until 6 days after first crop of crusts form

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33
Q

varicella: prodromal s/sx

A
  • slight fever
  • malaise
  • anorexia
  • macule to papule to vesicle (varying stages at once)
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34
Q

varicella: distribution

A
  • centripetal (starts in center of body)
  • spreads to face and extremities
  • less on distal limbs
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35
Q

varicella: constitutional s/sx

A
  • fever from lymphadenopathy
  • irritability from pruritis
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36
Q

varicella: specific management

A
  • antiviral treatment (Zovirax)
  • immune globulins
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37
Q

varicella: supportive management

A
  • antihistamines
  • skin care to prevent secondary infection
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38
Q

varicella: complications

A
  • secondary infections (cellulitis, PNA: pneumonia, sepsis)
  • skin infections from itching
  • scarring
  • pneumonia
  • encephalitis
  • arthritis
  • ataxia
  • thrombocytopenia
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39
Q

varicella: nursing interventions

A
  • standard, airborne, and contact precautions until crusted
  • skin care
  • nail care
  • watch for respiratory symptoms
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40
Q

varicella: anticipatory guidance

A
  • keep environment cool (decreases # lesions)
  • pressure vs scratching
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41
Q

varicella: patient and family education

A

avoid ASA: aspirin (Reye syndrome)

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42
Q

varicella: prevention

A
  • immunizations
  • antiviral therapy for immunocompromised patients, pregnant women, and newborns
  • no longer contagious after all lesions have scabbed
  • usually managed at home (limit exposure)
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43
Q

varicella: nursing management

A
  • supportive management
  • VS
  • antipyretics, antipruritics prn
  • airborne and contact precautions
  • encourage fluids
  • distraction (to prevent itching)
  • calamine lotion; oatmeal baths, oatmeal soap
  • head to toe assessment includes lungs, cardiac, neuro
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44
Q

varicella is a ____ disease

A

self-limiting

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45
Q

measles is also known as

A

rubella

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46
Q

varicella: agent

A

varicella

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47
Q

varicella is also known as

A

chicken pox

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48
Q

measles: agent

A

virus

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49
Q

measles: source

A
  • resp tract secretions
  • blood and urine of infected person
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50
Q

measles: transmission

A
  • direct contact
  • more common in winter months
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51
Q

measles: incubation

A

10-20 days

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52
Q

measles: period of communicability

A
  • 4-5 days prior to rash
  • prodromal phase
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53
Q

measles: prodromal s/sx

A
  • fever
  • malaise
  • after 24 hours coryza, cough, conjunctivitis, Koplik spots
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54
Q

measles: distribution

A

-rash appears 3-4 days after start of prodromal stage
- begins as maculopapular on face and gradually spreads down body (confluent initially then discrete

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55
Q

measles: constitutional s/sx

A
  • anorexia
  • abdominal pain
  • malaise
  • lymphadenopathy (generalized)
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56
Q

measles: specific management

A

none
- prevention

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57
Q

measles: supportive management

A
  • bed rest while febrile,
  • antipyretics,
  • antibiotics to prevent secondary infection in susceptible children
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58
Q

measles: complications

A
  • OM,
  • bacterial PNA,
  • obstructive laryngitis,
  • laryngotracheitis;
  • encephalitis (rare but often fatal)
  • croup
  • diarrhea
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59
Q

measles: prevention

A

childhood immunizations
- cannot begin until 12 months of age

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60
Q

measles: nursing interventions

A
  • Vitamin A supplementation (dose is age dependent);
  • isolation until day 5 of rash;
  • airborne precautions,
  • rest during fever;
  • quiet play;
  • eye care;
  • vaporizer
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61
Q

measles: anticipatory guidance

A
  • petroleum to nares and lips;
  • skin barrier ointment;
  • bland foods;
  • fluids;
  • dim lights (photophobia)
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62
Q

measles: patient and family education

A
  • clean skin
  • tepid baths
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63
Q

can measles resolve without treatment?

A

yes

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64
Q

how contagious is measles?

A

highly contagious

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65
Q

koplik’s spots

A

small red spots with blue/white centers appear inside mouth

66
Q

first s/sx of measles

A
  • hacking cough
  • watery eyes
  • rhinitis
  • high fever
67
Q

measles rash

A

appears red/brown
- begins on forehead then spreads downward covering the whole body

68
Q

measles: nursing care

A
  • Teaching re: prevention and transmission and contractibility
  • Encourage fluids (clears)
  • IVF
  • I/O
  • Periods of rest
  • Isolation: airborne (per CDC) until 5th day of rash
  • Comfort measures: antipyretics, antipruritics (NO ASPIRIN)
  • Eye care: moist cloths to remove crusting
  • Cool mist humidifier
  • Vitamin A supplementation
  • 2-week recovery time
69
Q

impetago contagiosa: agent

A

bacterial (staphylococci or streptococcus)

70
Q

impetago contagiosa: transmission

A

contact (self-inoculation)

71
Q

impetago contagiosa: incubation

A

7-10 days

72
Q

impetago contagiosa: clinical manifestations

A
  • Quick onset of red macule that becomes vesicular
  • Spreads peripherally
  • Honey exudate that dries into a heavy thick crust
  • Pruritus
  • Regional lymphadenopathy
73
Q

impetago contagiosa: precautions

A

contact
- child is contagious until healed and without drainage
- MRSA

74
Q

impetago contagiosa: treatment

A
  • Topical or systemic ABX
  • Hand washing and hygiene
  • Dilute bleach baths
  • May require hospitalization
75
Q

impetago contagiosa: prevention

A
  • Handwashing
  • avoid touching the area
  • wash clothes, linen and items child uses (ex. toys)
  • wash bug bites and cuts immediately
  • short nails
76
Q

cellulitis: agent

A

bacterial (streptococci, staphylococci), also haemophilus influenza

77
Q

cellulitis: transmission

A
  • not typically contagious
  • self-inoculate
78
Q

cellulitis: clinical manifestations

A
  • Erythema, pain, edema at site
  • Firm infiltration
  • Lymphangitis “streaking”
  • Regional lymphadenopathy
  • Fever, malaise
  • Can abscess
79
Q

cellulitis: treatment

A
  • oral or parenteral antibiotics
  • Rest
  • Hospitalization if systemic
80
Q

cellulitis: prevention

A
  • Skin and hand hygiene
  • Minimize risk factors
81
Q

cellulitis: treatment (if symptomatic…)

A
  • warmth
  • antipyretics
82
Q

cellulitis: risk factors

A
  • Skin openings
  • Underlying skin condition
  • Contact sports
  • Decreased immunity
  • IV drug use
83
Q

conjunctivitis

A

non-vaccine communicable disease, not always communicable
- inflammation of the conjunctiva

84
Q

causes of conjunctivitis

A
  • viral
  • bacteria
  • chemical
  • allergic
  • foreign body
85
Q

“pink eye” is caused by

A

bacterium

86
Q

s/sx of “pink eye”

A
  • purulent drainage: green/yellow
  • crusting of lids
  • swelling and inflammation
    (bacterial form)
87
Q

conjunctivitis: treatment

A

based on cause
- antibiotics (bacterial)
- eye drops (bacterial/foreign body)
- antihistamine (if allergic reaction)
- nothing if viral

*needs to be on medication for 24hr before returning to daycare/school

88
Q

conjunctivitis: prevention

A
  • prevent complications
  • hand and eye hygiene
  • not spreading infection from one eye to other eye
  • not spreading infection from child to child/child to parent, etc.
89
Q

conjunctivitis: nursing care

A
  • comfort and supportive care
  • encourage eye and hand hygiene
  • should not be touching medication directly to infected eye- can spread
90
Q

viral infections are

A
  • communicable
  • symptomatic treatment
  • often associated with rashes
  • rashes have unique characteristics
  • some viruses are preventable with vaccines
91
Q

bacterial infections

A
  • increased risk with autoimmunity concerns
  • may be caused by staph or strep (common flora on skin)
  • often due to break in skin integrity
  • role of nurse- prevent spread and complications
  • education (ie. not to break follicles, hygiene, antibiotics, comfort measures)
92
Q

fungal skin infections: agents

A
  • Typically dermatophystoses;
  • tinea or candidia
93
Q

fungal skin infections: transmission

A
  • Contact, Invasion in susceptible skin, corneum, hair, or nails
  • May be transmitted from infected animals or people
94
Q

fungal skin infections: diagnosis

A

microscopic exam

95
Q

fungal skin infections: treatment

A

topical or systemic anti-fungal

96
Q

fungal skin infections: types

A
  • Tinea capitis (scalp)
  • Tinea corporis (body or nails)
  • Tinea cruris (groin)
  • Tinea pedis (feet)
  • Thrush (oral)
  • Candidiasis (vaginal, diaper dermatitis)
97
Q

dermatophytoses is a ___ infection

A

fungal infection

98
Q

dermatophytoses: clinical manifestations

A
  • Dry flaky rash-scaly
  • Inflamed border
  • Pruritus
  • When in scalp may present with alopecia
99
Q

dermatophytoses: precautions

A

contact
- child is contagious until resolved

100
Q

dermatophytoses: prevention

A
  • avoid contact
  • good hygiene
  • wash clothes in hot water
  • At risk of contracting from public sources (gym mats, seatbelts)
101
Q

fungal infections: locations

A

can exist in various locations
- scalp: tinnea capitis
- around armpit
- foot: tinnea pedis
- groin area: tinnea curus

102
Q

scabies: agent

A

scabies mite
Sarcoptes scabiei

103
Q

scabies: transmission

A

contact (prolonged)

104
Q

scabies: clinical manifestations

A

Maculopapular lesions often located in folds of skin or where skin touches other skin
Pruritus (intense)
Inflammation
Excoriation and burrows
Discrete inflammation between finger webs, neck folds, groin

105
Q

scabies: precautions

A

avoid contact

106
Q

scabies: treatment

A
  • wear goves
  • Scabicide: Older than 2 mo.  Permethrin 5% cream × 8 to 14 hr.
  • Hygiene of linens and clothing with high heat
  • Supportive care for pruritus 2 to 3 weeks.
  • Treat all in close contact.
107
Q

scabies: prevention

A

avoid contact
good hygiene
wash clothes/linens in hot water
At risk of contracting from public sources (gym mats, seatbelts)

108
Q

most frequent infections worldwide

A

intestinal parasites

109
Q

who is at the highest risk for intestinal parasites

A

young children

110
Q

most common intestinal parasites in the US

A
  • pinworms
  • giardiasis (diarrheal presentation)
111
Q

intestinal parasites: nursing management

A

Assist with identification, treatment, and prevention
Fecal smears are diagnostic
Treat family members
Provide education and support to prevent reinfection

112
Q

intestinal parasites: manifestations

A
  • stomach pains
  • constant hunger
  • malnutrition
  • wasting
  • stunting
  • little or no energy
  • vomiting
  • diarrhea
  • lack of focus
113
Q

enterobiasis is

A

pinworms

114
Q

enterobiasis: agent

A

nematode Enterobius vermicularis

115
Q

enterobiasis: transmission

A

Inhalation or ingestion of eggs from contaminated hands

116
Q

enterobiasis: overview

A

oral-fecal transmission by contaminated hands, shared toys, bedding, clothing, toilet seats

117
Q

enterobiasis: incubation

A

1-2 months

118
Q

enterobiasis: diagnosis

A

tape test (early AM)

119
Q

enterobiasis: clinical manifestations

A
  • intense perineal itching*
  • general irritability
  • restlessness
  • poor sleep
  • bed-wetting
  • distractibility
  • short attention span
  • perianal dermatitis and excoriation secondary to itching
  • if worms migrate, possible vaginal (vulvovaginitis) and urethral infection
120
Q

pinworms: clinical manifestations

A

May be asymptomatic
Anal itching esp. at night
Weight loss
Enuresis

121
Q

pinworms: diagnosis

A

visualization

122
Q

pinworms: treatment

A

Pyrantel pamoate OR
Single oral dose of albendazole. Repeat in 2 weeks (age restrictions under age 2)

123
Q

pinworms: prevention of reinfection

A

Am bathing (recommended)
Freq. underwear changes
Freq. bedding changes
Personal hygiene: short nails, no nail biting or thumb sucking
Handwashing!!
Treat all family members

124
Q

pediculosis capitis: agent

A

Pediculus humanus capitis

125
Q

pediculosis capitis: transmission

A

Prolonged close contact when a female louse is able to obtain blood meal at scalp and deposit eggs on hair shaft at night.

126
Q

pediculosis capitis: clinical manifestations

A

Intense pruritus of scalp (behind ears or nape of neck)
Nits attached to hair shaft

127
Q

pediculosis capitis is

A

head lice

128
Q

pediculosis capitis: treatment

A

Pediculicide shampoo and removal of nits (comb)
Family may attempt homeopathic treatment regimens
Education and support to families
Advocacy and support for school attendance

129
Q

pediculosis capitis: prevention of reinfection

A

Soak hairbrushes
Hot water linen washes
Vacuuming
Seal non washables in a plastic bag x 10-14 days
Bedmates must be treated

**Not a sign of poor hygiene or poverty

130
Q

coxsackie virus is

A

common viral illness
- children <5 years are most commonly infected
- may be asymptomatic (older children and adults) but are still contagious
- easy to dehydrate (enc. fluids)

131
Q

HFMD

A

hand-foot and mouth disease
- rash on bottom of feet and inside mouth
- highly contagious

132
Q

coxsackie virus: agent

A

enterovirus group of viruses (Coxsackievirus A16 is the most common cause; also Enterovirus 71)

133
Q

coxsackie virus: transmission

A

nose and throat secretions (such as saliva, sputum, or nasal mucus),
blister fluid
feces (stool)

134
Q

coxsackie virus: prodromal s/x

A

fever; anorexia; sore throat; malaise (unwell feeling)

135
Q

coxsackie virus: contagious

A

Contagious during 1st week of illness but can continue to be even after s/sx disappear

136
Q

coxsackie virus: distribution

A

1-2 days after fever begins painful oral sores develop (herpangina);
- begin as small red spots that blister and become ulcerated;
- skin rash with red spots (and blisters) may develop over 1-2 days on palms and soles;
- may also appear on knees, elbows, buttocks, & genitalia

137
Q

coxsackie virus: complications

A

*uncommon but may include:
Viral or “aseptic” meningitis
Encephalitis
polio-like paralysis can occur, but this is even rarer

138
Q

coxsackie virus: prevention

A

HW
Disinfect contaminated surfaces
Avoid kissing/close contact/sharing utensils with infected persons

139
Q

coxsackie virus: treatment

A

Symptom mgmt.
Avoid aspirin; pain relievers PRN
Magic mouthwash; numbing sprays

140
Q

diaper dermatitis: principle factors in development

A
  • acute inflammatory
141
Q

diaper dermatitis: therapeutic management (presentation)

A
  • compound presentation (yeast)
142
Q

diaper dermatitis: nursing considerations

A

do’s and don’ts

143
Q

seborrheic dermatitis: cause, type

A
  • unknown cause
  • chronic, recurrent, inflammatory
144
Q

diaper dermatitis: manifestation

A

pruritis leads to irritability

145
Q

diaper dermatitis: locations

A

Scalp—cradle cap (most common location)
Eyelids—blepharitis
External ear—otitis externa
Nasolabial folds
Inguinal region

146
Q

atopic dermatitis is also called

A

eczema

147
Q

atopic dermatitis is a ____ of dermatologic diseases

A
  • category
    *not a specific etiology
148
Q

atopic dermatitis

A

Chronic, recurrent, inflammatory
Usually associated with allergy or hypersensitivity
Seasonal flare-ups
Hereditary tendency (atopy)

149
Q

atopic dermatitis: diagnostic criteria

A

(pruritus and 3 of the following:)
Hx of generalized dry skin
Asthma or allergic rhinitis
Flexural involvement
Rash before age 2

150
Q

atopic dermatitis: therapeutic management

A

Hydrate the skin
Relieve pruritus
Reduce inflammation
Prevent and control secondary infection (impetigo)

151
Q

most common adolescent skin disorder

A

acne
- more common in M vs. F
- Self-limiting

152
Q

acne: pattern of development

A

Midface (mid-forehead, nose, chin)
Lateral cheeks, lower jaw, back, chest

153
Q

acne: severity

A

ranges from several comedones (open=whitehead; closed=blackhead) to severe outbreaks (including pustules, and cysts)

154
Q

acne: causes

A

Hereditary
Hormonal changes (ex. Premenstrual flare-ups)
Dietary triggers (dairy, high glycemic, oils)
Cosmetics

155
Q

what is adolescent’s concern about acne?

A
  • social acceptance
156
Q

acne: nursing management

A
  • adolescent concerns
  • discuss triggers: stress
  • Discourage manipulation of acne to avoid secondary infection and scaring
  • Pediatrician/APRN can manage most cases
157
Q

acne: improvement

A

6-8 weeks before improvement if compliance with treatment
- Abrasives can damage skin and worsen condition

158
Q

acne: treatments

A

Treatments include: gentle cleanser, topical products and systemic antibiotics depending upon type of lesions and severity, and diet changes

159
Q

acne treatment: isotretinoin (accutane)

A
  • requires contraception contract
    Treatment x 20 weeks
    Numerous side effects including photosensitivity and dry skin
    Monitor for depression and suicidal ideation
160
Q

the Ipledge Program

A

for patients considering taking accutane

all patients must:
- sign consent forms
- keep appointments
- agree to follow

161
Q

the Ipledge Program goals

A
  • prevent fetal exposure to isotretinoin **
  • inform prescribers, pharmacists, patients about isotretinoin’s serious risks and safe-use conditions