Download MARYVILLE NURS 623 EXAM 1 (2021) QUESTIONS & ANSWERS UPDATED and more Exams Gerontology in PDF only on Docsity!
MARYVILLE NURS 623 EXAM 1 (2021)
QUESTIONS & ANSWERS
1. What is scabies?: -A highly contagious mite infestation
2. Risk factors of scabies: -Overcrowding
-Conditions of poverty -Poor hygiene, malnutrition
3. What is the mode of transmission for scabies?: -Close personal contact
4. Subjective symptoms for scabies: -Itching, worse at night and often does not
respond to treatment -Some will have rash, some will not -Children may be irritable and have changes in feeding -Close contacts may have similar symptoms
5. What are common areas for scabies infection?: -Webs of fingers
-Wrists -Axillary folds -Periumbilical -Pelvic girdle -Penis -Ankles
6. Objective symptoms for scabies: -Early sign: small 1-2mm red papules
-Excoriation from itching, crusting, scaling -Intraepidermal burrows, lichenification
-Burrows will be white with black specks
7. Diagnostic tests for scabies: -Burrow Ink Test: where excess ink will concen-
trate in the mite tunnel -Burrow scraping
8. Management of scabies: -Whole household needs to be treated
-Permethrin 5% cream leave on for 8-12 hours, rinse off, repeat in 1 week -Ivermectin 200mcg/kg x 1 and then repeat in 1-2 weeks in conjunction with topical cream -Antihistamines, topical steroids for itching (triamcinolone 0.1% BID x 7 days) -If concurrent bacterial infection then Dicloxacillin or Cephalexin for 7-10 days
9. Follow-up for scabies: -1 week following initial treatment
-Derm referral for consistent scabetic nodules of crustosa
10. Patient education for scabies: -Trim fingernails to prevent re-infestation
-Do not exceed recommended exposure time for creams -Itching can continue for up to 1 week -Wash bed sheets and clothing in hot soapy water
-When using shampoo: do not exceed exposure time, rinse over the sink -Itching can continue for up to 1 week -Do not need to treat pets -Bedclothes and sheets should be washed in hot soapy water and dried in a hot dryer, vacuum carpets/upholstery -Children can return to school after treatment, screen weekly
18. Risk factors for candidiasis: -Any age/gender
-HIV/AIDS
-DM
-Corticosteroid use
19. Cardinal sign and symptom of candidiasis: -Itching and burning
-Bright red rash with macules or satellite lesions seen on the borders -Other symptoms based on the area of infection
20. Symptoms of intertriginous candidiasis: -Red itchy rash that occasionally
weeps and is moist -Sometimes the rash burns -Macerated skin -Bright red patches with satellite lesions
21. Intertrigo candidiasis: What is this rash?
22. Management of intertriginous candidiasis: -Topical antifungals (powders for
moist infections, creams for dry infections) -(Nystatin, Clotrimazole, Miconazole BID x 2 weeks) -Apply creams sparingly -Systemic antifungal therapy if unresponsive to topicals -(Fluconazole x 10-14 days, Iatroconazole x 2-3 weeks)
23. Follow-up for candidiasis: -Follow-up in 2 weeks to determine response to
treatment, if no response refer to dermatology -If partial response recheck in another 1-2 weeks then dermatology referral if it persists
24. Patient education for candidiasis: -Decrease moisture, warmth, and poor air
circulation -Use clean, dry, white tissue in between skin folds -Keep affected area dry -Can use hair dryer to keep area dry on low
-Gray patchy: patchy alopecia with grey/white scales -Kerion: large, bright red, boggy bump on scalp with drainage
30. Symptoms of tinea corporis: -Ring like lesion with an erythematous elevated
border that is covered in scales, grows in size and has a central clearing -Pruritic -History of another family member with the same infection
31. Symptoms of tinea cruris: -Obese man who complains of pruritic rash on
groin that spreads to upper thigh (spares the scrotom) -Moist lesions that are round to half circle -Can become macerated from infection and scratching
32. Symptoms of tinea pedis: -Strong foot odor
-Macerated soft white skin between the toes -Pruritic and sometimes painful from fissures -Scaling and thickening of skin can also occur -Burning/pruritic and sometimes pain during warm weather with vesicles and bullae
33. Symptoms of tinea versicolor: -Often recognized in the summer
-Hypopigmented spots that do not tan -Pruritus is rare -Usual sites are back, upper chest, arms, neck/face -Oval to round pink or hypopigmented or hyperpigmented macules
34. Tinea capitis: What is this rash?
35. Tinea pedis: What is this rash?
36. Tinea corporis: What is this rash?
37. Tinea cruris: What is this rash?
-Drying foot powders for moisture (miconazole, tolnaftate) -If weeping lesions then compresses of Burow's solution -Expose feet to air as much as possible -Change socks one or two times a day -Severe cases oral itraconazole or terbinafine -Avoid scratching feet, avoid tight shoes/socks, change socks, wear sandals, wash/dry feet thoroughly can use a hair dryer on low, clean shower and sheets
42. Management for tinea versicolor: -Topical selenium sulfide lotion daily x 7
days x 10 min then rinse off x 1 month then monthly for maintenance -Ketoconazole shampoo weekly for maintenance -Will eradicate infection but not remove hypopigmented sports which take longer
to resolve -More aggressive treatment with Fluconazole and itraconazole weekly for 2- weeks -Exposure to sunlight will help pigmentation
43. Follow-up for dermatophytoses: -Follow-up 2 weeks after start of therapy
-For resistant cases confirm diagnosis with fungal cases and/or refer to dermatol- ogy or if pt only on topicals consider systemic therapy -If on systemic therapy check baseline liver fx and repeat in 4 weeks -Pt should be advised of symptoms of hepatotoxicity (anorexia, N/V, malaise, dark urine, jaundice, rash)
44. What is onychomycosis?: -A benign superficial infection of the toenails and
fingernails
45. Symptoms of onychomycosis: -Thick dystropic nails
-Nails with cloudy, white colored patches -Nail discoloration from yellow-green or brown-black -Nail appears dry with sharp borders
46. Onychomycosis: What is this?
47. Management of onychomycosis: -Topical: ciclopirox 8% BID x 6-18 mo or
efinaconazole 10% once daily x 48 weeks -Systemic: Itraconazole and terbinafine
53. Symptoms of impetigo: -Pruritus
-Red, crusty rash that spreads -Usually rash is on the face or extremities -Plaques begin as vesicles that break down, leave shallow erosions with yellow crusts, erythematous margins, lymphadenopathy, burning, itching -Bullous form may present as bullae that rupture fast
54. Impetigo: What is this rash?
55. Diagnostic tests for impetigo: -Not needed
-Can do bacterial culture and gram stain -Can obtain viral culture to r/o HSV
56. Management of impetigo: -Nonpharm: to debride lesions and expose skin
normal saline, plain tap water, Burow's solution for 10-20min TID -Pharm topical: Mupirocin 2% cream BID x 5 days after washing with Hibiclens -Pharm systemic used when fever or toxicity or large area of skin involved: Di- cloxacillin or Cephalexin x 7 days -If MRSA suspected then: Doxycycline, Clindamycin, or Bactrim
57. Follow-up for impetigo: -For uncomplicated cases follow-up in 10-14 days
-Patients with fever watch closely -Recurrent cases test for MRSA carrier
58. Patient education for impetigo: -Good handwashing and personal hygiene
measures -Keep fingernails short
-Do not participate in contact sports -Do not attend daycare or school until 24 hours of abx therapy
59. What is folliculitis?: -A superficial to deep skin infection of the hair follicles
60. What are the main pathogens in folliculitis?: -Staph
-Klebsiella -E. Coli
61. Risk factors for folliculitis?: -DM, obesity, chronic staph carrier
-Poor hygiene, exposure to chemicals -Trauma from shaving -Immunocompromised
62. Symptoms of folliculitis: -Primary lesion are small pustules surrounded by
1-2mm of erythema over pilosebaceous orifce sometimes perforated by a hair -Most common sites are eyelids, face, scalp, extremities
70. Risk factors for furuncles/carbuncles: -Immunocompromised
-DM
-Poor hygiene, incarceration -Chronic staph carrier -Moisture, occluded skin
71. Symptoms of furuncle: -Hot, tender, bright red bump that may come to a head
or drain spontaneously -Initially appears as 0.5-1cm, red, indurated nodule as it grows it develops yellow central plug and becomes conical
72. Symptoms of carbuncle: -Initially appear as multiple furuncles that develop
into large erythematous lump that drains pus from multiple follicular openings
73. Diagnostic tests for furuncles/carbuncles: -Gram stain and culture
74. Management for furuncles/carbuncles: -Carbuncles must drain before heal-
ing will occur (usually occurs spontaneously in 2 weeks) -Warm compresses to furuncles to help with rupture -Topical abx: Mupirocin or Neosporin BID until resolution -Systemic abx only needed if surrounding cellulitis -Fluctuant furuncles treated with I&D then warm compresses BID -Carbuncles always get systemic abx (Dicloxacillin, Cephalexin, Bactrim, Doxycy- cline
75. Follow-up for furuncles/carbuncles: -Within a few days to 1 week
-Subsequent visit in 7-10 day -Do not pop, squeeze, or manipulate
76. Furuncle: What is this?
77. Carbuncle: What is this?
78. What is cellulitis?: -A bacterial infection of the skin involving the dermis and
subcutaneous tissue
79. What are common organisms in cellulitis?: -S. Aureus
82. Diagnostics in cellulitis: -Gram stain if discharge present
-CBC if systemic symptoms
83. Management of cellulitis: Uncomplicated: Penicillin VK, Dicloxacillin, Clin-
damycin, Cephalexin x 5 days PCN allergy: Clindamycin, Azithromycin, Clarithromycin Animal bites: Augmentin x 2 weeks Complicated: ED
84. Follow-up for cellulitis: -Improvement usually noted within 48-72hrs
-Mark borders during initial visit -Seen weekly until resolved -If no response within 48-72 hrs of pt appears toxic--ED
85. Patient education for cellulitis: -Call PCP if infection worsens or fever per-
sists despite abx for 48hrs -Report progress to clinic within 3 days -Elevate limp as much as possible to decrease swelling
86. Cellulitis: What is this?
87. What are warts?: -Contagious skin lesion formed by infected keratinocytes
caused by HPV
-HPV serotypes 1-5, 7, 27, 29
88. What is the mode of transmission of warts?: -Touch, trauma to skin tissue
89. Risk factors for warts: -Walking barefoot
-Biting nails -Using public showers/pools -Immunocompromised
90. Symptoms of warts: -Small bump for weeks-years
-Small or large -Fleshy or firm growth -Can be raised, flat, single, multiple -Centrally located capillaries (black dots) -Commonly occurs on hands, knees
