Self-Care II Exam 4: AD/CD/Oral Care/N/V

AD (atopic derm): Corticosteroids

• Risk of tachyphylaxis → use _____ during remission

• AVOID: AD lesions are weeping (_____), Skin is infected, cracked, open, and Refractory cases

• Atopic (eczema): _____ → then back off to _____

• Contact (poison ivy, irritants): _____, max _____

• Recommended:

  • Anti-inflammatory during acute flare-ups

  • Hydrocortisone _____ is general

  • Ointment preferred for _____, _____, or _____ skin

  • DNU in < _____

  • Poision IVY: avoid use over _____ surface areas, eyes/lids, occluding skin, prolong use, not over broken skin

1-2x/week, ointment, BID during flares, 2x/week, TID-QID, 7 days, cream, thickened, dry, scaly, 2 y/o, large

AD (atopic derm): AHs

• Oral diphenhydramine not recommended bc _____ + _____

• Use _____

• Recommended:

  • Can help relieve _____; topical diphenhydramine often use

  • _____ from base; potential risk of _____ dermatitis

lack of efficacy, increased sedation, topical diphenhydramine, pruritus, cooling effect, contact

AD (atopic derm): NON PHARM

• Consider pt specific factors → identify and eliminate

  • Ex. _____, _____, _____, psychologic _____ etc.

• _____

• Avoid sudden, extreme changes in _____

• Short, clean fingernails

• _____ sheets and clothing; laundering thoroughly new sheets and clothes

• Bathing in _____, hypoallergenic/fragrance free soaps (_____)

• _____ for moisture (_____) → especially AFTER bathing 

• Diluted bleach bath (_____)

  • _____ → recc when recurrent skin infections → ½ cup bleach per 40 gal of water (full bathtub)

• Wet wrapping

allergies, astringents, dyes, stress, Humidifiers, temp and humidity, cotton, lukewarm water, dove, emollients, BID, children, BID

ICD (irritant contact dermatitis): _____

• Restores moisture, repairs skin barrier, and protects area

Emollients/Moisturizers

ICD (irritant contact dermatitis): _____

• Prevent water loss, incr skin hydration

Skin Protectants

ICD (irritant contact dermatitis): _____

• Helps with itching

Colloidal Oatmeal Bath

ICD (irritant contact dermatitis): _____

• Reduce inflammation, pruritus, irritation, Lack of evidence to use for ICD, May incr risk of ICD w/chronic use

Topical Corticosteroids

ICD (irritant contact dermatitis): NON PHARM

• Wash the area w/ copious amts of _____

• Cleanse with either → _____ or _____ (cetaphil, dove) OR _____ (1 tsp salt to 1 pt water)

tepid water, mild, hypoallergenic soap, saline soak

ACD (Allergic contact dermatitis) poison oak etc: _____

• Removes urushiol that has bound to the skin

• Effective up to _____ AFTER urushiol exposure → may use AFTER rash formation

• Minimum contact time with skin: _____

Tecnu Outdoor Skin Cleanser, 8 hours, 2 mins

ACD (Allergic contact dermatitis) poison oak etc: _____

• Removes urushiol that has bound to the skin

• Effective _____ urushiol contact

• Wash affected areas until _____ resolves → 75-80% of rash should resolve within _____

• _____ may be necessary if pruritus returns

Zanfeal Poison Ivy Wash, after, pruritus, 24 hours, 2nd application

ACD (Allergic contact dermatitis) poison oak etc: _____

• Useful in reducing oozing/weeping of vesicle fluid 

  • Promotes drying of lesions

  • Reduces edema

  • Cleanses skin

  • Mildly antipruritic

• Ex. _____, _____

Astringents, Aluminum Acetate, Witch Hazel

ACD (Allergic contact dermatitis) poison oak etc: _____

• Apply PRN AAA

• Ex. _____, _____, _____, _____

Skin Protectants, Oatmeal, Zinc Oxide, Titanium Dioxide, Calamine lotion

ACD (Allergic contact dermatitis) poison oak etc: _____

• _____ 0.5-1% _____ x _____

• AVOID use → over large surface areas + eyes/eyelids, occluding skin, prolonged use, over broken skin

Topical Corticosteroids, Hydrocortisone, cream TID-QID, 7 days

ACD (Allergic contact dermatitis) poison oak etc: Prevention

• Avoid toxicodendron plants habitats

• Make/use flashcards to quickly and accurately identify sus plants

• Wear protective clothing to prevent accidental contact

• _____ → prevention poison ivy and stuff

  • ADR: Faint _____, _____, Minor _____

  • Pt Counseling:

    • Apply to clean, _____ skin at least _____ exposure risk

    • _____

    • Reapplication necessary after _____

Bentoquatam 5% Lotion, white coloring on skin, erythema, skin irritation, dry, 15 mins before, let dry, 4 hours

ACD (Allergic contact dermatitis) poison oak etc: NON PHARM

• Wash AA w/ _____ → efficacy seen up to _____

• Clip finger nails

• AVOID vigorous scrubbing or use of harsh cleaners

• Wash contaminated clothing 

  • Remove affected clothing 

  • Wash separate from other clothes 

  • Use _____

• Showering beneficial to relieve _____ 

  • Cold or tepid temps (< _____ F)

  • Hypoallergenic soap

  • Scrub _____

• Avoid _____

mild soap and water immediately, 30 mins, regular detergent, pruritus, 90, under fingernails, bathing

Exclusion For ICD and ACD

• < _____ 

• Dermatitis present for > _____; chronic

• Sxs develop _____ exposure

• >_____% BSA effected (ICD); >_____ % BSA effected (ACD)

• Severe Sxs: itching, numerous large vesicle/bullae formation, edema

• Involvement of genitalia, mouth, eyes/eyelids, nose, anus, face, scalp, neck

• Secondary infection present

• Failure of self-care after _____ 

• Impairment of ADLs 

2 y/o, 7 days, after sun, 10, 20, 7 days

Exclusion For AD

• Moderate to severe condition w/ intense _____

• Involvement of _____

• _____ or intertriginous areas of body

• < _____

• Presents of skin infection → S, aureus, S. epidermidis, C bovis, C.mastitidis, Viruses (rare)

pruritus, large area of the body, face, 1 y/o

RAS (canker sore): Non-Pharm

• Maintaining food oral hygiene, avoid exacerbating factors and reducing pain

• If deficiency of _____, _____, or _____ suspected → incr consumption of foods high in deficiency nutrient or take nutritional supplements

• AVOID spicy or acidic food until lesions heal

• AVOID sharp-textured foods that may cause incr trauma to lesion 

• If desired apply ice directly to lesions in _____ increments but no longer than _____ in a given hour 

• DO NOT use _____ → it may spread infection is one is present

• _____ → cleanse, debride, and sooth area

  • 1-3 tsp salt in 4-8 oz water or baking soda pastes

  • Can use _____ applying medication

Fe, Folate, Vitamin B, 10-min, 20 mins, heat, salt rinses, before

RAS (canker sore): Pharm

• Oral debriding/cleansing agents (_____) 

• Products that release _____ = debriefing and cleansing agent for _____ relief of RAS discomfort (direct application)

• Aid in removal of _____, phlegm, music and other mouth secretions

• Cleanse area of minor gum inflammation and ulcers 

  • 1:1 solution of _____

Hydrogen peroxide, O2, temporary, debris, Hydrogen peroxide

_____ (_____ 5-20% for _____, _____, dyclonine, hexylresorcinol)

• effective for temp relief of pain

Topical Oral Anesthetics, Benzocaine, 2 y/o, Benzyl Alc

_____

• Pharmacologically inert substances that coat and can be effective in protecting ulcerations, dcr friction, and temporary Sx relief

• Available as _____ or _____ must be placed against sore of 10-20 seconds and creates a barrier by using a past, or adhering film, or dissolvable patches to cover the lesion

Topical Oral Protectants, patch, dissolving disc

_____

• Provide additional relief of mouth discomfort

• Dose per usual recommendations

Systemic Analgesics (NSAID/ASA/APAP)

COUNSELING Oral debriding and wound cleansing agents 

• Do not use for longer than _____ (swish and spit _____)

• Chronic use can cause _____ irritation, _____ enamel

• _____

7 days, 3-4x/day, tissue, decalcification, do not swallow meds

Cold Sore: Non-Pharm

• Keep lesions clean → gently washing with mild soap solutions

• Hand washing → prevents lesion contamination and minimizes autoinoculation of herpes

• Involved skin should be kept MOIST to prevent drying and fissure (cracking) → bc susceptible to secondary bacterial infections 

• Factors that delay healing should be avoided if known: Stress, local trauma, excessive wind or sun exposure, fatigue 

• Pt who identify sun exposure as precipitating event should be advised to routinely use an appropriate sunscreen product on lips and face

KNOW

Cold Sore: Pharm

• _____

  • Protects lesions from infection, relieves dryness, and keep the involved soft tissue but

  • DO NOT reduce _____

  • Use _____ PRN

• NO MORE THAN _____

Topical Skin Protectants, Sx duration, 3-4x/day, 10 days

Cold Sore: Pharm

• _____ 

  • Ex. benzocaine 5%–20%, dibucaine 0.25%–1%, dyclonine hydrochloride 0.5%–1%, benzyl alcohol 10%–33%, camphor 1%–3%, and menthol 0.1%–1%

  • Relieve the discomfort of _____, _____, and _____

  • NO MORE THAN _____

Topical oral Anesthetics, burning, itching, pain, 10 days

Cold Sore: Pharm

• _____

  • Only FDA-approved non-Rx product PROVEN to reduce _____ of Sxs

  • Inhibits direct fusion between the herpes virus and human cell plasma → preventing viral replication

  • Reduces medial healing time to healing by approximately _____ → reduces symptoms severity by _____%

  • Apply at first sign of an outbreak (prodromal stage) _____ until lesion is healed

• NO MORE THAN _____

Docusanol 10% (Abreva Cream), duration and severity, 1 day, 20, 5x/day, 10 days

Xerostomia → dry mouth, tooth hypersensitivity, decay: Non-Pharm

• AVOID use of cigarettes and smokeless tobacco

• Do NOT drink or use products that contain alc (including mouth rinses) or meds that cause depletion of salivary flow 

• AVOID food or drinks that contain caffeine or hot and spicy food

• LIMIT consumption of sugary, starchy, and acidic foods to help prevent tooth decay and caries. 

  • Use a very soft toothbrush to reduce abrasion of the teeth

• Chew gum sweetened with xylitol to help incr flow of saliva and drink plenty of water

• Use a cool mist humidifier at home to help moisten the air

KNOW

Xerostomia → dry mouth, tooth hypersensitivity, decay: Pharm

• _____ (w/ _____) are primary agents for relieving the discomfort of dry mouth + presents tooth decay

  • Mimic natural salvia both chemically and physically

  • Does NOT contain digestive and bactericidal enzymes present in innate saliva

  • Does NOT stimulate salivary glands to incr natural saliva production 

  • Can be used on an PRN (after all meals and before bed)

• Ex. _____ dry mouth lozenges, _____ dry mouth oral rinse, entertainer’s secret spray, _____ dry mouth gum

Artificial Saliva products, fluoride, ACT, Biotene, Biotene

Fluoride use → _____ 

• Incr resistance to enamel demineralization by acids

• Remineralizes early carious lesions of enamel

• Interferes with bacterial cariogenic process with _____ 

• Benefits: fewer decayed missing or filled teeth, better tooth retention; lower incidence of root carries 

• _____ → children ingest excess amt of any fluoride product for a sufficient period during tooth formation (pitted looking)

• Avoid use in < _____

• SF = sodium fluoride SMFP = Sodium monofluoride phosphate  STF = Stannous fluoride

Strengthens Enamel, plaque adhearence, Dental Fluorosis, 6 y/o

All: SF = sodium fluoride SMFP = Sodium monofluoride phosphate  STF = Stannous fluoride

• Helps with _____ demineralization of tooth

• Helps to _____

• Keep teeth healthy

• Reduces _____ 

• Improve tooth sensitivity

reducing, strengthen enamel, gingivitis

• SF → produces like _____ type paste or coating over tooth to protect teeth from plaque adhering to it → 

• Stannus fluoride = _____ that can build up and cause tooth discoloration (not staining) → will clean off at dentist

mineral, protective layer

Exclusion For RAS (canker sores)

• Lesions associated with underlying patho

• Lesions present > _____

• _____ lesions

• S/sx of _____

• Failure of self-treatment > _____ or Sxs worsen

2 weeks, frequent recurring, systemic illness, 7 days

Exclusion For HSL (cold sores)

• Lesions present > _____

• _____ of outbreaks

• _____

• Sxs of _____

• _____

2 weeks, increased frequency, immunosuppression, Infection, no previous diagnosis

Exclusion For Xerostomia

• Tooth _____, _____, and _____

• Candidiasis, _____, or periodontitis

• Reduced _____ time

• Mouth _____

• Severe _____ triggered by _____, _____, or _____

• _____ or _____

• _____ teeth, _____ gums, broken or knocked out teeth, other trauma

• _____ syndrome

• Salivary _____

• If sx severity does NOT dcr w/ treatment

erosion, decalcification, decay, gingivitis, denture wearing, soreness, tooth pain, hot, cold, chewing, fever, swelling, loose, bleeding, Sjogren, gland stones

Tooth hypersensitivity treatment

• NON PHARM

  • Identification and elimination of predisposeing factor 

    • Ex acid exposure + improper or aggressive tooth brushing tech

    • IF correct brushing techniques with fluoride toothpaste does not improve → use desensitizing toothpaste

• PHARM

  • Potassium salt-based toothpastes (5% most common)

    • Diffuses along dentin tubules to dcr excitability of intradental nerves and ALTER MEMBRANE POTENTIAL 

  • Arginine/Calcium, fluoride, oxalate, strontium salt-based toothpastes

    • Occluding the exposed dentinal tubes, PREVENTS fluid from mounting into the tubules (fluid moves into tubes = hypersensitivity)

• Exclusion

  • Toothache (caused by bacteria) 

  • Mouth soreness associated with poor-fitting dentures

  • Presence of fever or swelling

  • Loose teeth or broken/knocked out teeth

  • Severe tooth pain triggered/worsened by stim

  • Trauma to mouth (bleeding, swelling, soreness)

KNOW

Tooth hypersensitivity

• COUNSELING 

  • Relief may take several days - weeks (4) → if pt is better at removing bacterial plaque then quicker the sensitivity will resolve

  • Dentifrice for as long as dentist recommends then switch to low-abrasion (nonwhitening) fluoride dentifrice

  • Some may require long term treatment or repeated treatment

  • DO NOT use potassium nitrate or desensitizing toothpastes in children < 12 y/o

  • Do NOT use high-abrasion toothpastes (whitening or stain-removing cosmetic pastes)

  • REFER to pcp if pain worsens or new Sxs develop during treatment

KNOW

Teething

• NON PHARM

  • Massaging the gums around the erupting tooth 

  • Giving cold (not frozen) teeth ring, pacifier, spoon or washcloth

  • Dry toast or teething biscuits (if child can tolerate solid food)

• PHARM

  • Oral pain reliever 

    • Pediatric doses of NSAID or APAP

  • Topical anesthetics (benzocaine) 

    • Available in 5-20% 

    • CAUTION: Benzocaine 20% TOO POTENT for infants and can CAUSE DEATH from OD

    • FDA and AAP no LONGER recommend benzocaine for teething due to possible interference with gag reflex, causing choking

• Exclusion

  • ADA recommends regular dental checkups, including a visit within 6 months of eruption of the child’s 1st tooth and no later than the child's 1st birthday

  • If baby is vomiting or has diarrhea, fever, nasal congestion, malaise, pain or other Sxs not typical of teething

  • If both nonpharm + nonscript does not relive s/sx within 2 days

KNOW