NR511-Midterm Review (General Information & Skin Disorders)

What do you see with fungal skin infections?

Papular rash and satellite lesions

How do you diagnose fungal skin infections?

No Diagnostic tests; based on presentation

-Location will tell you (think under the breast, skin rolls etc.)

What is a common fungal infection?

Candida albicans

Treatment for fungal skin infections

anti fungal cream or pill

What is important to remember with fungal skin infections?

Keep area as dry as possible (favors moisture, warmth and poor air circulation)

Who is at risk for fungal skin infections?

-Immunocompromised patients

-Diaper rash

-Diabetics

-Antibiotic therapy

-Conditions that decrease immunity (HIV, DM, Corticosteroids)

-Bone marrow transplant

-Chemotherapy

What is tinea vesicolor?

Flat/slightly elevated brown papules and plaques that scale

-most commonly on trunk and shoulders

*Think of that black pt in clinical*

Balanitis

candidiasis in glans penis

Tinea corpis

"Ring worm"

-Scaly borders/patches

-Exposed skin surfaces or on the trunk

tinea pedis

athlete's foot

tinea cruis

-jock itch

-groin

Onychomycosis (Tinea Unguium)

Fungal infection of the nail bed

Describe Onychomycosis

-White or yellow discoloration

-Thickening and separating of the nail from the bed

Treatment for Onychomycosis?

Topical anti fungal

Who is at risk for dry skin?

Older adults

-Not enough water

-Diuretic use

What patient education can I give for dry skin?

-tepid water

-mild cleansing soap/cream

-Increase fluids

What are the cardinal symptoms for a bacterial skin infection?

-Warm

-Red

-Painful

-Does NOT have sharply demarcated border

What is cellulitis? Who is at risk?

-Infection of epidermis

-Usually after a break in the skin

-Diabetic patients

What is folliculitis?

infection of hair follicle

What are the characteristics for folliculitis?

Papules

Is impetigo contagious? What is it?

-Highly contagious

-Bacterial skin infection

Who does impetigo commonly affect?

Young children

What is non-pharmalogical treatment for impetigo?

Use of solutions to debride lesions and expose skin surface where bacteria is present

What is important to remember with Impetigo?

Lymph nodes can be enlarged

-Face involved? cervical lymph nodes (sometimes pre auricular & submandibular)

-Upper extremities? Axillary lymph nodes

What is the key characteristic with an Epidermal Inclusion Cyst?

Cheesy white discharge with strong odor when expressed

Urticaria

Skin inflammation

What is important to remember with hives?

-Before treating the rash think "ABC"

-Prioritize NP actions

-Is it life threatening?

What is cholinergic urticaria?

-Puritic hives or wheals that occur after exercise, anxiety, elevated body temperature, hot baths and showers

-Occur on the trunk

How do you treat urticaria?

Anti-histamines

What is important when determining rash development?

Patient history

What is atopic dermatitis?

itchy, red, swollen and cracked skin

How is atopic dermatitis characterized?

"The itch that rashes"

-Patient will feel the itch before the rash appears

What is the cardinal sign of atopic dermatitis?

Severe puritis

In children, what are the primary locations for atopic dermatitis?

-Antecubital fossae

-Popliteal fossae

What are the symptoms of herpes simplex?

-Blistering sores

-Itching

-Painful urination (genital herpes)

-Fever

-HA

-Fatigue

-Lack of appetite

What is herpes zoster?

Shingles

What is the characteristic of herpes zoster?

Unilateral vesicular rash along a dermatome

What is the process of herpes zoster?

1. Red

2. Papular lesions

3. Vesicles

4. Rupture

5. Release's infectious fluid

6. Scab

What is the first line treatment for acne?

Benzoyl peroxide

Acne: Who are good candidates for antibiotic treatment?

Those at risk for:

-Pigmentation changes

-Scarring

-Nodulocystic acne

-Quick relief from inflammatory acne

What is important teaching with patients who are using acne medication?

Use sunscreen

What is rosacea?

Causes blushing or flushing and visible blood vessels in the face

What is the treatment for rosacea? What do we have to teach with this?

-Metronidazole

-Can take 6-8 weeks to work

Important patient education with rosacea?

-Identify triggers

-Apply sunscreen

-Protect face from cold, air and wind

What is seborrhea keratosis?

Originate from the horny layer of the epidermis

-NOT malignant

What does seborrhea keratosis look like?

-Brown leision

-Dark keratin plugs

-Firm

-Horny cysts on surface

What is actinic keratosis?

pre-malignant growth

How to diagnose actinic keratosis?

-Presentation

-Flesh colored

-HARD

-Sand-paper like

Where are actinic keratosis lesions typically found?

On sun exposed skin

Treatment for actinic keratosis

cryotherapy

-Burn it off

What is the risk of actinic keratosis turning into something else?

VERY HIGH

-Precancerous lesions that can turn into a squamous cell carcinoma if not treated

Do I need to refer a patient with actinic keratosis to dermatology?

Yes

What is the most aggressive skin cancer?

Malignant melanoma

What is a lipoma?

-BENIGN

-Rubbery, smooth and round mass

-"Fat tumor"

What is scabies?

-Parasitic infection

-caused by a mite

How is scabies transmitted?

Direct contact

What are the differential diagnosis for scabies?

-Atopic dermatitis

-Contact dermatitis

-Folliculitis

What is the treatment for scabies?

Ivermectin

-Systemic treatment

Clinical diagnosis for scabies is almost never made until _____________________ has occurred

hypersensitivity

What is pediculosis?

Lice

-Parasitic

What is a hallmark finding of pediculosis?

-Nits are firmly cemented in place

-Can NOT slide easily on hair shaft

What is important patient teaching with pediculosis?

-Itching may occur for up to a week after successful treatment because of slow resolution of inflammatory reaction

What is a furuncle?

Boil

-Painful red bumps under the skin r/t infection of hair follicle

What is a differential diagnosis for a furuncle that is located in the axilla region?

Hidradentitis suppurativa

What causes warts?

HPV

What is important patient education with warts?

-Do not abrade the skin

-NO vigorous rubbing, shaving and nail biting

What is the major characteristic with warts?

-Easily treatable but reoccur

What is needed to make a sound clinical decision?

-Evidence-based research

-Clinical practice guidelines

-Evidence-based algorithms

What do we want in regards to specificity of a diagnostic test?

-HIGH

This means that a high percentage of healthy individuals will show a normal result

What does low specificity mean?

"False Positive"

-healthy person has a disease when they actually do not

What do we want in regards to sensitivity of a diagnostic study?

-Highly sensitive

-Will result in positive findings for patients with a disease

How do patients cover their out-of-pocket expenses with traditional medicare?

Secondary insurance plan

What are the different parts of medicare?

A) Inpatient hospital, SNF, hospice, home care

B)Outpatient services

C)Wellness services

D)Prescription drugs

What is the reimbursement fee for NP's?

85%

What are the 7 categories for third-party payers?

-Medicare

-Medicaid

-Indemnity insurance companies

-Managed care organizations

-Workman's comp

-Veterans administration

-Auto liability