UAMS P2 - Self-Care Exam 2 SG

Allergic lesions from Poison Ivy/Oak (urushiol) can appear up to ______________ after exposure

3 weeks

urushiol Allergic response produces

itching and redness, skin becomes eczematous and vesicular, can form large fluid filled vesicles

Jewelry, cosmetics, Latex, Benzocain, neomycin, lanolin, and urushiol are examples _______________

Allergic contact dermatitis

Fiber glass, plants with fine hairs, peppers, benzoyl peroxide, soaps are examples of ___________________

Irritant Contact dermatitis

Contributing factors of Diaper Rashes

occlusion, humidity, friction, skin pH, fecal enzymes, candida overgrowth

Diaper Rash presentation

red to bright red skin, dusky maroon or purplish, shiny wet-looking patches

Dermatitis When to Refer

Symptoms longer than 7 days, Extreme itching/severe vesicles, Large area of body, OTCs not helping, Rash appears to clear then returns, Presents around sensitive areas (eyes, nostrils, ears, gentalia)

Diaper Rashes should be referred if:

broken skin or lesions,

bacterial infection signs: satellite lesions, ulcerations, vesicles, erosion,

candida infection suspected: longer than 7 days, intense, violent crying following urination or defecation

Pharm Therapy for Irritant Dermatitis

Skin Protectants: emollients (petrolatum, silicone), colloidal oatmeal

Aluminum acetate (used as wet dressing, compress, or soak)

For Itching: hydrocortisone (lower-age-limit 2 years)

Which Pharm therapy is used for irritant dermatitis that relieves weeping?

Aluminum acetate

Hydrocortisone lower age limit

2 years

Diaper Rash Pharm Therapy

allantoin,

calamine,

cod liver oil,

corn starch,

dimethicone,

kaolin,

lanolin,

petrolatum,

zinc oxide,

talc

For Diaper Rashes, powders ____________________________

should be used with caution due to inhalation risk (can cause chemical inhalation pneumonia)

For Diaper Rashes, What should be avoided?

Powders,

Antifungals,

Antibacterials,

External Analgesics,

Hydrocortisone

Pharm therapies for Diaper Rashes work by:

providing a barrier against moisture absorbinb excess moistures and prevent dryness

Allergic Dermatitis Itching treatment

Hydrocortisone (lower age limit 2 years)

Allergic Dermatitis For weeping and oozing

Aluminum hydroxide (lower age limit 6 months),

Zinc acetate (lower age limit 2 years),

Calamine,

Kaolin,

Zinc Carb,

Zinc oxide,

Sodium bicarb (lower age limit 2 years),

Colloidal oatmeal

Lower age limit of Sodium Bicarb for Allergic Dermatitis

2 years

Lower age limit for Aluminum Hydroxide gel

2 years

Lower age limit for Zinc Acetate for Allergic Dermatitis

2 years

Poison Ivy Prevention Product

Ivy block (bentoquatam) applied at least 15mins before possible contact every 4 hours (wash immediately after contact)

Non Pharm treatment for Allergic Dermatitis

Exposure avoidance (barrier creams),

Washing with mild soap,

Diaper rash: Diaper changes, cleanliness, skin hydration, avoid mechanical irritation, diaper holiday

Counseling advice for Poison ivy exposure

takes a few days before rash clears, need to seek medical care still

Counseling advice for Diaper Rash

usually resolves quickly

When to refer wounds

possibly infected (swelling, heat, redness, pain),

from contaminated environment (farm animals),

Puncture wounds, patients on corticosteroids or immunosuppressants,

extensive abrasions,

animals bites,

no improvement after 7 days

Self-Treatable burns

1st and 2nd degree

1st degree burn Characteristics:

Depth:

Color:

Blisters:

Skin Texture:

Pain:

Depth: superficial epidermis

Color: Pink to dark pink

Blisters: none

Skin Texture: normal

Pain: Yes

2nd degree burn Characteristics:

Depth:

Color:

Blisters:

Skin Texture:

Pain:

Depth: Superficial to Deep partial thickness

Color: pink to bright red or dark red to mottled yellow/white

Blisters: Yes (size varies); smaller blisters present

Skin Texture: Edematous to Thick

Pain: Yes or decreased skin sensation

3rd degree burn Characteristics:

Depth:

Color:

Blisters:

Skin Texture:

Pain:

Depth: Full thickness

Color: Pearly/translucent/overtly charred

Blisters: None

Skin Texture: Leathery

Pain: No

4th degree burn Characteristics:

Depth:

Color:

Blisters:

Skin Texture:

Pain:

Depth: Subdermal (involves underlying tissues, tendon, bone)

Color: Variable

Blisters: Variable

Skin Texture: Variable

Pain: No (associated with high mortality)

Burns that should be Referred

around face, ears, joints, surface of hands, feet, perineum;

2% or more of body surface area;

Ages 60+ or under 2 years old;

Electrical and Chemical burns (apply first-aid first);

Pts with Diabetes, HTN, Renal disease (can worsen burn prognosis);

Signs of infection;

No improvement after 7 days

First Aid treatment General Approach for Burns

promote moist environment (don't leave it open to air out, increased bacteria risk);

First Aid Treatment for Thermal Burns

remove from heat,

immerse in cool water or cold compress (NO ICE),

dress with sterile bandage or nonadherent dressing,

leave blisters intact,

reassess after 24-48hrs

First Aid Treatment for Chemical Burns

Clean/remove/dilute caustic liquid/powder,

Remove saturated clothing,

Refer

First Aid Treatment for Electrical Burns

Remove from source of electricity with nonconductive tools (broom),

May require airway support,

Call 911 (immediate care required)

First Aid Treatment for Wounds

Wash area with clean tap water, little mechanical force;

Can be apposed: butterfly bandage

Cannot be apposed:

- Dry, lacerations, skin tears, abrasions: Non-adherent Dressing

- Light exudate: Primary Dressing

- Moderate to Heavy exudate: Secondary Dressing

- Nonexudative wounds or superficial: Transparent film

Wounds, Minor burns, Sunburns Treatments:

Pain and Itch Control

Local analgesics, anesthetics, antipruritic

- Camphor, Menthol

- Topical amines and "caines"

- Alcohol/Ketone ingredients

- Topical antihistamines

Systemic Analgesics

(DON'T USE HYDROCORTISONE)

Wounds, Minor burns, Sunburns Treatments:

Topical Antibacterials

For prevention of infection, not for treatment

- Topical Antibiotics

- First-aid Antiseptics

First-Aid Antiseptics for Topical Antibacterial Treatment of Minor Burns, Wounds:

Alcohols

should not applied to large areas;

wash area first to increase efficacy

First-Aid Antiseptics for Topical Antibacterial Treatment of Minor Burns, Wounds:

Camphorated Phenol

Do not bandage

First-Aid Antiseptics for Topical Antibacterial Treatment of Minor Burns, Wounds:

Hydrogen peroxide

Only use during initial care of wound;

Not for puncture wounds (it damages viable tissues and inhibits formation of granulation tissue)

First-Aid Antiseptics for Topical Antibacterial Treatment of Minor Burns, Wounds:

Iodine

Watch for allergy

First-Aid Antiseptics for Topical Antibacterial Treatment of Minor Burns, Wounds:

Phenol

Do not bandage

First-Aid Antiseptics for Topical Antibacterial Treatment of Minor Burns, Wounds:

Chlorhexidine gluconate

for unbroken skin only

First-Aid Antibiotics for Topical Antibacterial Treatment of Minor Burns, Wounds

Bacitracin

Neomycin

- high incidence of contact dermatitis Polymyxin

First-Aid Antiseptics for Topical Antibacterial Treatment of Minor Burns, Wounds: (give full list, 9 things)

Alcohols,

Camphorated Phenol,

Phenol,

Eucalyptol combination,

Hexylresorcinol,

Hydrogen Peroxide,

Iodine,

Quaternary ammonium compounds,

Chlorhexidine gluconate

Skin protectants for Burns and Wounds Treatment

cocoa butter, glycerin, petrolatum

Astringents for Burns and Wounds treatment

Aluminum acetate: for oozing and discharge,

Witch hazel: for bruises, contusions, minor cuts/scrapes,

Aluminum sulfate: stops bleed from minor surface cuts (shaving)

Explain UVA

Tans skin,

penetrates dermis,

Does not produce erythema (sunburn)

Explain UVB

Produces erythema (sunburn),

Peaks in intensity 6-20hrs after exposure

SPF Protection Duration Formula

Time to sunburn (10mins) * SPF Rating = New Time to sunburn

(10mins * SPF 30 = 300mins till sunburn)

SPF Characteristics

Ratio of UVB protection calculated by comparing time need to produce minimum skin reddening from sun with time required without sunscreen;

Assume product is not washed or sweated off and adequate layer applied;

Reapplication DOES NOT extend total allowable time in sun;

Higher SPF rating gives longer duration out in sun

Sunscreen is contraindicated in infants younger than (also know why)

6 months

- can not move themselves (just avoid sun)

- dermal melanin is low so protection from UV is far less than adults/older children

- most babies cannot sweat to reduce body heat

- metabolic and excretory systems of infants are not fully developed

Proper application of Sunscreen

1 ounce of sunscreen per total body application,

at least 15-30mins before sun exposure (allows time for chemical to bind to skin),

Reapply every 2 hours to replace sunscreen,

use lip balm with high SPF value

Sun Avoidance Characteristics

Avoid sun when UV irradiation is at maximum (11am-4pm),

80% of rays still reach skin under 3ft of water,

Reflect surfaces (snow, water, concrete sand) may require higher SPF,

80% of rays penetrate clouds, 50% of UVA exposure occurs out of direct sunlight in the shade,

Dark fabrics safer than lighter fabrics (light reduces SPF),

Some meds increase risk of burns

Name the Characteristic of Insect Bite: Mosquito (4 things)

Wheal and flare reaction,

begins 10-15mins after bite,

itching persists 1-2 hours,

severe swelling or papules lasting for several days

Name the Characteristic of Insect Bite: Fleas (4 things)

Present in warmer areas with high humidity (winter possible from pets),

jump from carpet,

bites occur around ankles, shoulders, under elastic bands,

often in groups of 3

Name the Characteristic of Insect Bite: Chiggers (3 things)

Live in warmer climates (woody or grassy areas),

Itching may last 7-10 days,

Bite where clothing tightly fits

Name the Characteristic of Insect Bite: Bedbugs (4 things)

lay eggs during day,

bite at night,

like to bite in a line along a major vein,

bites can range from irritation at the site to small dermal hemorrhage

Name the Characteristic of Insect Bite: Scabies (4 things)

No OTC treatment available,

Mites burrow up to 1cm into the skin,

usually affect interdigital spaces of fingers,

flexors of wrists, male genitalia buttocks,

inflammation and intense itching

4 Points to diagnose Scabies Case

1) Type of Lesion: Burrows in linear tunnel up to 1cm

2) Sites: Wrists, waist, feet, ankles (facial and palm oplantar is unique to infantile scabies)

3) Symptoms: Itching, most severe at night

4) Itching takes approximately 4-6 weeks to develop

Name the Characteristic of Insect Bite: Centipedes (2 things)

Intensely painful, should be referred

Name the Characteristic of Insect Bite: Ticks (4 things)

Bite has low impact but disease possible,

Some bites could cause fatal paralysis,

Lyme Disease:

- caused by a spirochete from a deer tick

- Bullseye rash

- Flu-like symptoms

- Arthalgia/Myalgias

- Can Necrose

Rocky Mountain Spotted Fever:

- Wood, Dog, Lone Star tick

- abrupt fever

- rash develops

- headaches, malaise, myalgias, nausea

Name the Characteristic of Insect Bite: Spiders (4 things)

mild local reaction with little consequence

- black widow and brown recluse are exceptions

Tick Removal Process

1) Exposure attached tick

2) grasp tick close to head as possible with tweezers

3) pull with steady pressure without twisty (tick should release grip)

4) save tick in a labeled jar

Black widow bites are cause ____________________ symptoms

Systemic

Symptoms of Black Widow Bites

Local

- within 20-30mins

- inflammation of lymph nodes

- sweating

- burning

Radiating

- 30-60mins after bite

- severe pain

- cramping

- muscle contractions

Systemic Symptoms

- 4-6hrs after bite

Treatment for Black widow Bites

Referred to ER

- IV calcium gluconate, muscle relaxants, narcotics, antivenin (usually not deadly but still possible)

Brown Recluse Bites cause ________________________ symptoms

Mostly local

Characteristics of Black Widow Bite

usually unnoticed,

slight pinprick or pinching feeling,

20% show no visible bite mark

Brown Recluse bite Characteristics

Venom contains 8-9 cytoxic enzymes and proteins,

worse in fatty area than lean area

- abdomen, thighs, buttocks

- Neck and Face: produces local edema

Hallmark Symptom of Brown Recluse Bites

Necrosis of tissues (or ulceration of tissues)

- most prominent in fatty areas

- occurs within hours to weeks

- black necrotic lesion with pale halo, area of edema present

- can progress to need debridement or reconstructive surgery

Symptoms of Brown Recluse Bites

Necrosis of tissue,

fluid filled blisters over function site,

minor burning which worsens over several hours (erythema, pain, pruritus),

systemic symptoms present if enough venom injected (occurs within 72-96hrs)

Treatment of Brown Recluse Bites

Refer to ER,

Steroids,

nitro patches,

dapsone,

hyperbaric oxygen,

electric shock,

packed RBCs,

platelets,

surgery

(AVOID HEAT - Toxin can spread further)

T/F: Ants cause stings

True

Charactersitcs of Honey bees

dies after stinging

- only sting once, barbed stinger must be removed

Factors of Africanized bees (Killer Bees)

very aggressive

- often swarm, Venom is not more toxic than other bees

Factors of Scorpion Stings

Neurotoxic and Cardiotoxic venom

Which Consequence of stings is impossible to predict?

Anaphylaxis

Immediate Reactions of Stings

immediate sharp burning pain,

local erythema and edema,

disappears after a few hours but could last for 7 days

Late reactions of Stings

evolve into papules, vesicles, or bullae intense itching/pain flu-like symptoms

Anaphylaxis Responses from Stings

Cutaneous: urticaria, angioedema, flushing

Shock: bronchospasm, circulatory collapse, epileptic attacks, hypotension

More common in patients younger than 20

More deadly in the elderly

Insect Bites that Should be Referred

Brown Recluse

Black Widow

Tick Bite

Centipedes

Scorpion

Severe Fire Ants

Severe Africanized Bees

Hives that don't show signs of anaphylaxis, do not have unusual color, do not appear bruised/blistered

Symptoms that last longer than 7 days

All Pharmacotherapy options (except skin protectants) for Bites and Stings are not approved for Children younger than

2 years old

Counterirritants for Bites and Stings

Allyl isothiocyanate,

Ammonia Water,

Methyl salicylate,

Turpentine oil,

camphor,

menthol,

histamine HCl,

Methyl nicotinate,

Capsaicin

Local anesthetics for Bites and Stings

Caines,

Benzoyl Alcohol,

Pramoxine,

Phenol,

Resorcinol

Topical Antihistamines for Bites and Stings

Diphenhydramine 0.5-2%

Topical Corticosteroid for Bites and Stings

Hydrocortisone 0.25-1%

Astringents for Bites and Stings

Aluminum Acetate

Witch Hazel

Skin Protectants for Bites and Stings

Sodium Bicarb

Colloidal Oatmeal

Zinc oxide

Calamine

Titanium Oxide

Prevention for Bites and Stings

DEET

Picardin

Permethrin

Pharm Therapy Treatment (just classes) for Bites and Stings

External Analgesics

Astringents

Skin Protectants

Systemic Antihistamines

Systemic Analgesics

Local anesthetics for use of Bites and Stings are approved for ___________________-

3-4 times up to 7 days

"Caine" anesthetics:

don't use large quantities over raw surfaces or blistered areas

can carry toxic rxns

Benzocaine is the safest (no toxic rxn occurs)

Dibucaine is most potent and long lasting (greatest toxic risk)

Tetracaine cause greater myocardial depression

Lidocaine can cause typical toxicities

Which product used for bites and stings can causing sloughing of the skin

Phenol

Phenol Application Instructions

don't apply to large areas of body or bandage

(not required for Na Phenolate cause of different irritation potential)

Resorcinol Application Instructions

toxic if ingested or too much on skin,

do not apply to large areas of body

Counterirritants are all approved for ________________

3-4 times up to 7 days

Counterirrtants that Produce Redness

allyl isothiocyanate

Ammonia Water

Methyl salicylate

Turpentine Oil

Counterirrtants that cool

Camphor

Menthol