Derm final

What are exclusions for self-care?

• Chronic wound

• Foreign matter

• diabetes

• infection

What are the risk factors for chronic wounds?

• Excessive pressure

• Immobility

• diabetes

• Poor circulation

• Increased age

• Obesity

What medication increases risk for chronic wounds?

• sedative/hypnotics

• diuretics

• anticholinergics

• immunosuppressive

• corticosteroids

What are the four types of chronic wounds?

• Venous Statis

• Arterial

• Neuropathic

• Pressure

What is a venous statis ulcer?

It is due to lack of venous flow (pools)

• large and often on the inner side of the ankle

What is the treatment for Venous Statis Ulcers?

• Improve venous return

• Compression and elevation

• Dressings to adsorb excess fluid

What is an arterial ulcer?

Due to inadequate blood flow in the associated area of the body

• common in feet and often painful

• Dry wound

what is the treatment arterial ulcer?

• help decrease risk factors (quit smoking)

• Vascular surgery

• Dressing to add moisture to wound

What are the risk factors for Neuropathic Ulcers?

• neuropathy, trauma, and diabetes

Where does Neuropathic ulcers usually occur?

Bottom of the foot

What is the treatment of neuropathic ulcers?

• risk management (diabetes)

• Reduce pressure

• maintain a moist wound environment

What is a pressure ulcer?

Most common type of chronic wound

• found primarily in immobile patients and older patients

Where do pressure ulcers usually occur?

Boney parts of the body

what is the role of pharmacist in wound care?

• help with product selection

  these are based off cause of wound, the size, stage of healing, and cost

What are the goals of treatments?

• promote healing

• protect wound from infection

• protect from trauma

• minimize scarring

What is the treatment of chronic wounds?

• cleanse wound

• determine if infection

• debride if needed (take away dead tissue)

What is the best for wound cleaning?

Normal saline

what is gauzed used for?

it is a secondary dressing

inexpensive

What are the two dressings that absorb fluid

• alginates

• foams

what is an alginate dressing?

• absorbs fluid and becomes a gel

• used in heavily draining wounds

What are an advantages of alginate products?

• good for heavily draining wounds

• Available in many different forms

  • Sheets and ropes

What is the disadvantage of alginate products?

• may over drain a wound

• Requires a secondary dressing

• Expensive

What products are an example of alginates?

• Kaltostat

• Algisite M

What are the characteristics of foams?

Foam with open cells that absorbs excess fluid

• best used for wounds that are moderate to heavy fluid

What is the advantage of foams?

• Many different foams

• can be placed under compression stockings

What is the disadvantage of foams?

• Difficult to position in some sites of the body

• you cannot see the wound

What products are foams?

• Mepilex

• Allevyn

What type of dressings protects and maintain?

• Hydrocolloids

• Transparent films

What are the characteristics of hydrocolloids?

Compound formulations of adhesive and gelling agents

• top layer is waterproof

• Melts into wound

When is the best time to use a hydrocolloid?

Good for moderately draining wounds

• provides skin protection and pressure relief

(pressure ulcers)

what are the advantages of hydrocolloids?

• can be 3-4 days between dressing changes

• Protective

• Adhesive

What is the disadvantage of hydrocolloids?

• cannot see wounds

• wound is not looked at everyday

What are examples of products for hydrocolloids?

• replicare

• Duoderm

What are the characteristics of transparent films?

It is a semi-permeable polymer sheet with adhesive coating on one side, and it is gas permeable

What is the best time to use transparent films?

superficial wounds with little to no drainage

• stage 1 pressure ulcers

• secondary dressing

• IV sites

What is an advantage of transparent films?

• allows you to see the wound

• inexpensive

What is a disadvantage of transparent films

• does not absorb fluids

What products are examples of transparent films?

• bioclusive

• Tegaderm

What are the dressings that hydrate wounds?

• Hydrogel sheets

• Amorphous Hydrogels

What are the characteristics of hydrogel sheets

3-D network of cross-linked hydrophilic polymers donate moisture to wounds

When is the best time to use hydrogel sheets?

• burn and other painful wounds

• Dry and dehydrated wounds

What is the advantage of hydrogel sheets?

has a cooling effect

• able to be refrigerated for added cooling effect

What are disadvantages of hydrogel sheets?

• slippery-moves arounds if not using the adhesive products

• needs secondary dressings

What products are examples of hydrogel sheets?

• Mckesson

• AquaDerm

What are the characteristics of amorphous hydrogels?

ointment like and usually in a tube or single use container

When is the best time to use amorphous hydrogels?

• to get moisture into dry and dehydrated wounds

• To facilitate autolytic debridement of dry wounds

What are the advantages of amorphous hydrogels?

BEST agent to get moisture to dry wounds

What is a disadvantage of amorphous hydrogels?

Most cover with a secondary dressings

What products are examples of amorphous hydrogels?

• Solosite

• Intrasite

What are the 4 different types of burns?

• Sunburns

• Thermal

• Electro burn

• Chemical

What are the two types of burns that are an automatic referral?

• chemical

• electro burn

What are the characteristics of sunburns?

Overexposure of UV rays or tanning beds/lamps

What are the characteristics of thermal?

from flames, hot liquids, hot objects

What are the characteristics of electro burns?

Burn from electricity flowing through the body and causing damage

What are the characteristics of chemical?

exposure to corrosive or reactive chemicals causing damage

What is the palmar method?

A way to get a rough estimate if the burn is covering 2 percent of the body = refer

• Use palm to determine (1 palm = 1%)

What special population causes more consideration when self-treating burns?

• diabetes

• elderly patients

What degree of burn do we refer at?

After 2nd degree we will refer the patient to PCP or ER

• 2nd degree is described as cheesy or white picture

What are the exclusions for self-treatment?

• Over 2 percent of BSA

• Chemical or Electro burns

• over 2nd degree burns

• signs of infections

• elderly patients

• Sites at the hands, feet, face, or groin

What are the non-pharmacologic treatments

• clean damaged area

  • Cool but not ice-cold water for 20 minutes

• Prevent scarring

  • keep moist

  • Avoid UV light

What are the main pharmacologic management for burns?

• APAP

  • For pain

• Skin protectants

  • promote wound healing, protect againist friction

• Topical antibiotics

  • Prevent infection

• Topical Anesthetics

  • For pain

• Antispetics

  • Cell death

What are the three complementary therapies?

• Honey

  • moist healing enviroment

• Aloe Vera

  • has been used for many years

• Calendula

  • anti-inflammatory and antibacterial

What are the basics for sun protection?

• Cover skin

• Zinc Oxide sunscreens

  • SPF means it takes that much longer for skin to burn

What are the characteristics of mosquito bites?

Welt/itching that may expand to large blisters

What are the characteristics of fleas bites?

Redness/intense itching

• usually multiple and grouped usually around the ankles or legs

What are the characteristics of bedbugs bites?

Severe itching on the exposed areas of skin

• may see small dermal hemorrhages

What are the two bites that are referral to PCP?

• spider

• Ticks

What are the characteristics of tick bites?

Intense itching papules

What is important for tick removal?

• Recommend the use of tweakers (pull the tick straight out)

• The tick needs 72 hours to infect the person

• After the removal of the tick the area should be cleaned with rubbing alcohol or washed with soap of water

What are the self-care recommendations of bites?

• avoid scratching

• Use Ice pack for up to minutes

What are the products to use for bites for patients over 2 years of age?

• Anesthetics

• antihistamine

• steroids

• counterirritants

• skin protections

• antiseptics/antibiotics

What should you avoid in pregnancy and children?

Phenol

What should not be placed under bandages?

Local Anesthetics

How long should you use topical antihistamine?

3-4 weeks

What should you keep in mind when using topical steroids?

In patients with bacterial or fungal infections can be worsen or mask the disorder

What are skin protectants used for?

To reduce inflammation and promote healing

What is the treatment for post tick-bites?

want to wait and watch for most cases

what are the three things needed for a high risk bite?

• tick bite was from an identified lxodes spp. (lyme disease)

• occurred in a high endemic area

• tick was attached for over 36 hours

What is an antibiotic prophylaxis dose for all ages?

single dose of oral doxycycline within 72 hours of removal

• 200 mg

What are the characteristics of lyme diseases?

• Red ring-like or expanding rashes

• Flu-like symptoms

  • Malaise, headache, fever, myalgia, arthralgia

What is the treatment for lyme disease?

Doxy 100 mg Q12H for 10-14 days

What is a side effect of doxy?

May cause photosensitivity

How do you protect against bites?

• wear light covered clothes

• fan to repel

• clear brush, mow grass, remove standing water

What is Permetarin used for?

bug repellant

• Do not spray on clothes

• needs to be reapplied after 5 washes

Can you use permethrin when pregnant?

Yes

what agent for insect repellant for skin application has a foul odor and damages plastics?

DEET

What agent smells pleasant and is well tolerated on the skin?

Picaridin

What bite causes the most deaths worldwide?

Malaria

What is the health belief model?

psychological framework developed to explain and predict health behaviors by focusing on individuals’ attitudes and beliefs

What is perceived seriousness?

individual’s belief about the seriousness or severity of a disease or condition

What is perceived susceptibility?

an individual belief about the likelihood of getting a disease or condition

What is perceived benefits?

a person’s belief of the value or usefulness or a behavior in decreasing the threat of a disease

What is perceived barrier?

an individual’s own evaluation of the obstacles to a considered behavior or outcome

What is modifying variables?

characteristics of individuals and environmental factors that can affect health behaviors

What are cues to action?

events, people, or things that move people to change their behavior

What is Self Efficacy?

A person’s confidence in their own ability to change/perform a behavior

What is the Social Cognitive Theory? (SCT)

Widely used to frame social science studies

-It explains how people acquire and maintain certain behaviors through the dynamic interplay of personal, behavioral, and environmental influences.

What is Incentive motivation?

the use and misuse of rewards and punishments to modify behavior

What is Type A (predictable) reactions?

80 percent of all ADR

• overdose

• side effects

• drug interactions

What is type B(unpredictable) reactions?

20 percent of all ADRs

• Drug intolerance

• hypersensitivity reactions