NR 511 Sanners Review: Key Terms and Definitions

OLDCARTS

Onset

Location

Duration

Characteristics

Aggravating and Alleviating Factors

Related Symptoms

Treatment

Severity/symptoms

Assess clients history of present illness

What is needed to make a sound clinical decision?

EVP, CPG, published evidence based algorithms

Specificty high

high percentage of healthy individuals will show a normal result.

specificity low

false positive healthy person has a disease when they actually do not.

sensitivity

true positives out of all patients with a designated conditions, leads to positive findings with patients who have the disease.

how clients cover out of pocket expenses when on medicare

secondary insurance plan covers 20% client out of pocket expenses

part A coverage

Inpatient hospital care, skilled nursing facility care, home health care and hospice care

part b coverage

Doctors' services

Outpatient care

Clinical laboratory services

medical equipment, preventative exams

Part c coverage

wellness services, vision exams hearing exams eye glasses

Part D coverage

Prescription drug coverage

How much are NPs reimbursed ?

85%

Medicare advantage plans

offer all the benefits of Medicare, usually offers additional benefits and lower co payments, Medicare advantage carriers are paid subsidies per member for services rendered by centers for Medicare and Medicaid services these carriers offer traditional CMS services in addition to other health services at a lower cost.

reimbursements third party payer

medicare, medicaid, indemnity insurance companies, managed care organization, workers comp, veterans administration, auto liability.

Fungal Skin infection assessment

papular rash, satellite lesions

fungal skin- diagnose

based on presentation common type candida albicans

fungal infections tx

antifungal cream, pill, keep area as dry as possible, favors moisture, warmth and poor air circulation consider the location of the rash

fungal infection who is at risk?

can be opportunistic, pts age, older or younger (diaper rash), diabetics, antibiotic therapy, conditions that alter cellular immunity, AIDS DM, corticosteroid tx. bone marrow transplant chemo, invasive parenteral cath, invasive monitoring devices, in ICU

Tinea vesicolor

flat to slightly elevated brown papules and plaques that scale when they are rubbed along with areas of hypopigmentation;prurtis; most commonly found on trunk and shoulders

balanitis

candidiasis of the glans penis

tinea corporis

annual lescions with a scaly borders and central clearing on the trunk, has ring shaped lesions with scaly borders and central clearing or scaly patches with distinct borders on exposed skin surfaces or on the trunk.

tinea pedis

athletes foot/feet and between toes

tinea cruis

jock itch groin

tinea unguium

white or yellow nail discoloration thickening of the nail and separation of the nail from bed, but its more common for toenails

Tx for tinea unguium (onychomycosis)

nystatin, clotrimazole, miconazole, naftifine, terbinafine ciclopirox.

dry skin- at risk or teachable moment

older adults, encourage the use of tepid water and a mild cleansing cream or soap.

bacterial skin infections presentation

warm, red painful, without sharply demarcated boarder.

cellulitis

infection of the epidermis, subcutaneous tissue that usually begins after a break in the skin

folliculitis

hair follicle bacterial infection papules are characteristics of folliculitis

impetigo

contagious for young children, solutions or substances to debride the lesions, and to expose the skin surfaces where bacteria is present

symptoms of impetigo

burning, pruritis, regional lymphadenopathy, face involved-cervical lymph nodes, enlarged, upper extremities, axillary nodes are enlarged.

epidermal inclusion cyst

same cyst on the same site for months to years, furuncles are an acute process taking serval days to form, cheesy white discharge with a strong odor when it is expressed.

hives assessment and tx

location of rash, need for epi? respiratory symptoms DIB, hoarseness, look at location of rash, neck/face? if it is give epi what should be done first?

cholinergic urticaria

hives/wheals pruritic and occur on the trunk/arms following exercise, anxiety, elevated body temp, hot baths and showers

Cholinergic urticaria tx

antihistamines take hx for rash development

atopic dermatitis

inflammation of skin itchy red swollen cracked skin, low threshold for pruritis and is the itch that rashes, itch before rash and itch worsens it, sign is severe pruritus, in children location is the antecubital fossae and popliteal fossae

herpes simplex symptoms and tx

blistering sores, itching, pain during urination, fever, headache, tiredness, lack of appetite, tx with famciclovir goal of tx is to suppress.

herpes zoster

varicella zoster, unilateral vesicular rash, begins as erythema, then papular lesions, to vesicles that rupture releasing infectious fluid, then form scabs

acne

clogged/plugged hair follicles, small to large, benzoyl peroxide first line, oral abx for at risk for pigmentation changes or scarring relief from inflammation. teaching is wear sunscreen, wash with antibacterial soap x2 day.

rosacea what it is and tx and teaching

small pus filled bumps blushing/flushing, visible blood vessels in the face. familial tendency neurovascular dysregulation, infection, factors that trigger (chronic sun exposure) metronidazole cream mainstay for therapy 6-8 hours, clients should be taught to identify triggers, apply sunscreen and protect face from cold air and wind.

seborrhea keratosis at risk, what they are

lesions are superficial epithelial growths from the horny layer of the epidermis, benign proliferation of immature keratinocytes, at risk older white women itchiness and constant irritation, dark keratin plugs or firm horny cysts on their surface. epidermal tumors, but they are not considered malignant.

actinic keratosis

precancerous, assess: inspection flesh colored, hard, sand paper like

treatment cryotherapy, at risk sun exposure, can turn into squamous cell carcinoma, refer to dermatologist.

malignant melanoma

at risk- increasing age, immunosuppression, indoor tanning, most aggressive skin cancer the thickness of the lesion impacts prognosis

lipoma

rounded growth of adipose tissue in the skin benign can grow anywhere fat is present neck, shoulders. armpits, thigh

scabies

intensely itchy rash, caused by mite sarcoptes scabie, several days or weeks, direct contact, hypersensivity occurs, differential dx: atopic dermatitis, contact dermatitis, folliculitis, ivermectin is the most common tx

pediculosis

nits, they are firmly cemented in place and dont slide easily on the hair shaft, sebaceous plugs result from plugged oil glands on the scalp and unlike nits do not originate on the hair shaft, pt education is itching may continue up to a week after successful tx bc of the slow resolution of the inflammatory reaction caused by the lice infestation.

furuncle boil

a type of abscess; localized region of pus surrounded by inflamed tissue due to infection of hair follicles or in oil glands, located on axilla differential dx is hidradenitis suppurativa- painful bumps under the skin, armpits groin, buttocks breast.

warts

Warts are growths on your skin caused by an infection with human papilloma virus, or HPV abrading, vigorous rubbing, shaving, nail biting can spread the virus, characteristics are filiform digitate warts that are easily treatable but reoccur.

what causes conjunctivitis

adenovirus, can be present with or without cold symptoms

Symptoms of conjunctivitis

Pain, swelling, redness and discharge that may cause the eyelids to stick together, or none, preauricular lymph nodes swelling and tenderness is hallmark of viral conjunctivitis.

HSV-1, HSV-2 conjunctivitis

corneal infection with a dendrite appearance

conjunctivitis teaching

how to put drops, avoid touching the tip of the bottle to any conjunctival surface or skin, women instructed to throw away eye makeup, disposable contact lenses should be discarded, bacterial conjunctivitis is very contagious, stay home until 24h of abx tx or as soon as clinical improvement occurs.

Bacterial conjunctivitis

red/crusty, visual acutiy is normal. watery itchy eyes, photophobia

cataracts

gradual, painless, progressive loss of vision or none, vitamin E, C and beta carotene. age related tend to be bilateral in nature, blurred vision, or distorted vision, c/o glare when driving or bright light

blepharitis

inflammation of eyelid, causing redness, crusting, and swelling along lid margins, staph infection, bacitracin 0.5% ointment, resistant needs a quinolone abx ointment or sulfa/corticosteroid like erythromycin

Chilazion

cyst or small lump, blockage in the gland, persists for more than 4 weeks, ophthalmologist for incision and drainage biopsy local injection of glucocorticoids.

dry eyes

history taking, current meds, fever, genital discharge, rash/joint pain, smoking, feeling of sand in the eyes, c/o of blurred vision, lack of tears, slit lamp examination a schirmer test to quantify lacrimal secretions and first level tx is client edu. self care is wear goggles when swimming, artificial tears, frequent rest periods from computer and hand held electronic devices.

epiphora

overflow of tears, at risk elderly, treatment of excessive tearing secondary to trauma or infection includes the use of topical abx do not use corticosteroid or anesthetic eye drops bc they block healing and inc risk of infection

subconjunctival hemorrhage

bleeding between the conjunctiva and the sclera risk Valsalva maneuvers, blood thinners, diabetes htn, resolves on its own, visual changes go to er or ophthalmologist.

Herpes Zoster Ophthalmicus

shingles around eyes, rash of forehead, swelling of eye lid pain redness, photophobia, mucoid discharge, fever cornea may be clear or cloudy, first line is vaccination. next is antiviral medication within 72 hours of rash onset.

hordeolum stye

small red painful lump on the edge of eyelid, bacterial infection, red hot tender swelling most get better on their own and do not require tx.

sinusitis

infection of an adjacent structure require referral, ethmoid sinus pain behind eye and high on the nose. maxillary sinus pain pressure over cheek discolored nasal discharge, poor response to decongestants, URI for 7 days presence of 2 or more symptoms confirm dx, viruses may produce this but the 7 day are more likely to have bacterial than viral

otitis media

inflammation of the middle ear TM is red bulging, external auditory canal is red/erythematous, amoxicillin, f/u in 48/72h if symptoms have not resolved, AOM hearing threshold change greater than 25 db referral may be necessary, otitis externa PAIN in pinna/tragus hx of recent swimming

acute angle closure glaucoma

inc IOP, emergency causes blindness, dramatic onset of blurred vision, headache halos photophobia, vision loss NP must asses vision loss upon presentation, sudden and severe IOP causes severe damage to the optic nerve.

relieve middle ear pressure due to barotrauma

barotrauma of auditory canal abnormal middle ear pressure relieved by nasal steroids and oral decongestants.

hearing loss

sensoneural hearing loss exposure to loud noises, ear infections tumors familial and aging, any person presents with sudden sensoneural referral to otolaryngologist. conductive hearing loss bone conduction is greater than air conduction pt reports bone conduction sound greater than air conduction sound. serous otitis media produces conductive hearing loss, cerumen impaction. weber test- conductive bad ear, sensorineural loss in the good ear.

tinnitus

ringing in the ears, fluid in middle ear, associated with depressive disorders, screen for psychologic disorders.

mononeucleosis

fatigue sore throat and low grade fever, nasal throat redness. enlarged tonsils both sides, inflamed posterior cervical lymph nodes, diff dx viral pharyngitis persistent symptoms, without response for tx, monospot test,

epiglottis

A flap of tissue that seals off the windpipe and prevents food from entering. severe throat pain without cough erythema, pediatric stridor restlessness, nasal flaring emergency

pharyngitis

discomfort scrachiness, pain difficulty swallowing, if accompanied by cervical lymphendopathy evaluate by monospot stept test throat culture, tx w/ NKA is PCN 10 day course 500 mg x2 or 250 mg 4x, ben penicillin 1.2m IM once.

Hoarseness (dysphonia)

overuse of voice, viruses or growths GERD, laryngescopy papillomatosis is diff dx of horseness related to infection.

Peritonsillar abscess

Unilateral sore throat, hot potato voice, trismus, displaced uvula. I&D

rhinitis

inflammation of the nose type 1 hypersensitivity airborne irritants. avoid environmental triggers, overuse of decongestant nasal sprays can cause rebound stop and does resolve in 2 to 3 weeks. watery eyes runny nose itchy eyes

atopic triad

asthma/allergic rhinitis/atopic dermatitis personal or family history