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211 Cards in this Set
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Balneotherapy - Bath/Soak are useful when
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areas of skin are affected....remove crusts, scales and previously applied topical meds and relieve inflammation and itching that accompany acute dermatoses.
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High concentrations of some meds can be applied
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directly to the affected site with little systemic reaction and few side effects
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Some topical meds are readily absorbed through the skin and produce
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systemic effects
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Topical preps may induce
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allergic contact dermatitis in sensitive patients....report and discontinue
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Lotions/creams
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subactue stage
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ointments
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inflammation has become chronic and skin dry with scaling
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Lichenification
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dry with scaling
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Lotions
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replenish skin oil or relieve pruritus...usually applied directly but a dressing soaked in lotion can be placed....apply every 3-4 hours....if longer may crust and cake
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Two types of lotions
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suspensions and liniments
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Suspensions (lotions)
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powder in water requires shaking and clear solutions containing completely dissolved active ingredients
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Calamine lotions
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rapid cooling and drying effect as it evaproates...leaves a thin medicinal layer of powder
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Liniments are lotions with
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oil added to prevent crusting
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Powders usually have a
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talc, zinc oxide, bentonite or cornstarch base...dusted on skin with shaker or cotton sponge....act as HYGROSCOPIC agents that absorb and retain moisture from the air and reduce friction
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Creams may be suspensions of
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oil in water or emulsions of water in oil with add ingredients to prevent bacterial and fungal growth....may cause allergic reaction such as contact dermatitis
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Oil in water are
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easily applied and usually are the most cosmetically acceptable to the pt.
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Oil in water can be
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used on the face but have drying effect
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Water in oil emulsions are
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greasier and are preferred for drying and flaking dermatosis
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Gels are
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semisolid emulsions that become liquid when applied to skin or scalp....cosmetically acceptable...not visible...greaseless and nonstaining....new gels less stinging....especially useful for acute dermatitis where there is weeping exudate (poison ivy)
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Pastes
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mixturs of powders and ointments...used in inflammatory bilsitering conditions...adhere to skin and may be difficult to remove with oil...olive or mineral....pastes applied with wooden tongue depressor or gloved hand
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Ointments
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retard water loss and lubricate and protect the skin...preferred vehicle for deliver med to chronic or localized dry skin...eczema or psoriasis...applied with wooden tongue depressor or gloved hand
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Spray and aerosol preps
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used on any widespread dermatologic condition....evaporate on contact and used infrequently
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Corticosteroids provide
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anti-inflammatory, antipruritic and vasoconstrictive effects....apply according to strict guidelines use sparing but RUB into area thorougly...absorb enhanced when skin hydrated or area covered by occlusive or moisture-retentive dressing....
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Inappropriate use of corticosteroids can result in
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local and systemic side effects, especially when med absorbed through inflamed and excoriated skin, used under occlusive dressings or used for long periods on sensitive skin
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S/E Corticosteroids (Local)
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skin atrophy and thinning, striae (bandlike streaks) and telangiectasia (small, red lesions due to dilation of BV).
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Thinning of skin results from
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the ability of corticosteroids to inhibit skin collagen synthesis...reversed by discontinuing but STRIAE and TELANGIECTASIA are PERMANENT
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Systemic side effects Corticosteroids
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hyperglycemia and Cushing's syndrome
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Caution app of Corticosteroids in around eyes
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1) Long term use may cause glaucoma or cataracts
2) anti-inflammatory effect may mask existing viral or fungal infections |
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Concentrated corticosteroids
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NEVER applied on face or intertriginous areas (axilla and groin)....due to THINNER STRATUM CORNEUM absorb med quickly.
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Persistent use concentrated corticosteroids may produce
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acne-like dermatitis (steroid-induced acne) and hypertrichoisis (excessive hair growth)
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Intralesional therapy consists of
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injecting a sterile suspension of med (usually a corticosteroid) into or just below a lesion....anti-inflammatory effect but LOCAL ATROPHY may result if injected into subcutaneous fat.
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Skin lesions treated with intralesional therapy include
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psoriasis, keloids and cystic acne....sometimes immunotherapeutic and antifungal administered as intralesional therapy
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Systemic meds (corticosteroids)
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short-term therapy for contact dermatitis
long-term therapy for chronic dermatosis (pemphigus vulgaris |
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Cytotoxic means
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destructive of cells
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health history, direct observation and complete physic...
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due to visibility...emotional distress...major goals...maintenance of skin therapy, relief of discomfort, restful sleep, self-acceptance, knowledge of skin care and avoid complications
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Nursing management
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teach pt how to wash and pat dry, apply med while skin moist, cover with plastic (telfa pad, plastic wrap, vinyl glove, plastic bag)...cover with elastic bandage, dressing or paper tape to seal edges
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dressings that contain or cover a topical corticosteroid should be
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removed for 12 of every 24 hours to prevent skin thinning, striae and telangiectasia (red lesion dilation of BV)
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other forms of dressing to cover topical meds include
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soft cotton cloth and stretchable cotton dressing (surgitube, tubegauz...that can be used for fingers, toes, hands, feet
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hands can be covered
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with disposable polyethylene or vinyl gloves sealed at wrists....
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feet can be wrapped
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in plastic bags covered by cotton socks
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gloves and socks impregnanted with emollients make app
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to hands and feet more convenient
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Large areas of the body
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must boe covered, cotton cloth topped by an expandable stockinette....
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disposable diapers or cloths folded in diaper fashion are useful for
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dressing the groin and perineal areas
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axillary dressings can be made of
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cotton cloth or commercially prepared dressing and taped in place or held by dress shields
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turban or plastic shower cap used
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to hold dressings on the scalp
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face mask made from gauze with holes cut out may be held in place
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with gauze ties looped through holes cut in the four corners of the mask
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Pruritus (itching) is one of the most common symptoms of dermatologic disorders.....itch recepts are
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unmyelinated, penicillate (brushlike) nerve endings found exclusively in the skin, mucous membranes and cornea
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Pruritus is usually cuased by
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primary skin disease with resultant rash or lesions...may also occur without a rash or lesions....referred to as essential pruritus....generally rapid onset, may be servere and interferes with ADL
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pruritus may be the first indications of systemic internal disease such as
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DM, Blood disorder or cancer (occult malignancy of breast/colon) lymphoma...may also accompany renal, hepatic and thyroid disease
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Pruritis (common oral meds) such as
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aspirin, antibiotics, hormones (estorgen, testosterone or oral contraceptives)
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Pruritis (OPIOIDS) MAY
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morphine or cocaine may cause pruritus directly or by increasing sensitivity to ultraviolet light
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other causes pruritis
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certain soaps, chemicals, radiation therapy, prickly heat (miliaria) and contact with wool
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Pruritis may also be caused by
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excessive stress (psychological) in family or work situations
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Elderly (pruritis)
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due to dry skin.....may have systemic illness that triggers pruritis....or that are at higher risk for occult malignancy and are more likely to be taking multiple meds
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Scratching (pruritis) may cause the
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inflamed cells and nerve endings to release histamine, producing more puritis,,,vicisious itch-scratch cycle....scratching may alter integrity of skin causing excoriation, redness, raised areas (wheals, infection or changes in pigmentation).
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Pruritis is more severe
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at night...less frequently reported during the day....probably due to distractions
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History and exam usually provide clues to underlying cause pruritis
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hay fever, allergy, recent admin of new med or change cosmetic/soap...treatment should relieve.
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signs of infection and environmental clues (pruritis) include
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warm dry air, irritating bed linnens....washing with soap and HOT WATER AVOIDED. Bath oils containing a surfactant (Lubath, Alpha-Keri) may be sufficient for cleaning
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Elderly or unsteady patient should avoid
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adding oil to bath due to danger of slipping in tub
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Warm bath (pruritis) with mild soap follwed by app of a
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bland emollient to moist skin can control xerosis (dry skin).
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Application (pruritis) of a
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cold compress, ice cube or cool agent (menthol and camphor (constrict BV)) may also help relieve pruritis.
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Topical corticosteroids may be beneficial as anti-inflammatory agent to relieve
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itching
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oral antihistamines are even more effective because they
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overcome effects of histamine release from damaged mast cells.
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Antihistamine (benadryl, atarax) prescribed in sedative dose at
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bedtime.
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Non-sedating antihistamine meds (Allegra) are appropriate for
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daytime
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Tricyclic antidepressants (Sinequan) are for
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pruritis of neuropsychogenic origin.
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Nurse interventions (pruritis)
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use warm NOT HOT water, shake off excess water and blot in intertriginous areas (body folds) with towel. DO NOT RUB removes water from stratum corneum....immediately after bath lubricated skin with emollient to trap moisture
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Nurse interventions
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pt instructed to avoid situations that cause vasodilation...exposure to overly warm environment, alcohol, hot foods and liquids....USE HUMIDIFIER if air dry....activities causing perspiration are limited....wear cotton clothing at night....room should be cool and humidified....vigorous scratching avoided and trim nails...if tests needed, nurse explains each test and expected outcome.
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Pruritis (genital/anal) may be caused by
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small particles of fecal material lodged in perianal crevices are attached to anal hairs.
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Genital/Anal pruritis may also be caused by
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scratching, moisture, decreased skin resistance due to corticosteroid or antibiotic therapy...scabies/lice, hemorrhoids, fungal or yeast and pinworm, diabetes mellitus, anemia, hyperthyroidism and pregnancy
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nursing interventions direct pt to
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follow proper hygiene measures
discontinue home and over the counter remedies perineal/anal area should be rinsed with lukewarm water and blotted dry with cotton balss premoistened tissue used after defecation cornstarch applied in skinfold to absorp perspiration |
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Baths (pruritis) DO NOT USE
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hot water, bubble baths, sodium bicarbonate and detergent soaps....aggravate dryness....no synthetic underwear no alcohol caffeine or wool clothing....EAT ADEQUATE FIBER TO SOFTEN STOOLS
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Main secretory functions of skin are performed by
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sweat glands to help regulate body temperature...excrete perspiration that evaporates, thereby cooling
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Trunk sweat glands respond to
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thermal stimulation
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palm soles sweat glands
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nervous stimulation
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axillae and forehead sweat glands
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respond to thermal and nervous
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Normal perspiration
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NO ODOR
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Body odor is produced by
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increase in bacteria on skin and interaction of bacterial waste products with chemicals of perspiration
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Moist skin
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warm
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dry skin
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cool, but not always true...not unusal to observe warm dry in dehydrated and hot dry in febrile
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antiperspirants are
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aluminum salts that block the opening to the sweat duct
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pure deodorants
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inhibit bacterial growth and block metabolism of sweat...they have no antiperspirant effect
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Hidradenitis suppurative is a
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chronic suppurative folliculitis of the perianal, axillary and genital areas or under the breasts....develops after puberty....can produce abscesses or sinuses with scarring....cause unknown may be GENETIC
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Abnormal blocking of sweat glands causes (Hidradenitis suppurative)
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recurring inflammation, nodules, and draining sinus tracts. Hypertorphic bands of scar tissue form in area of sweat glands
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Clinical manifestations (Hidradenitis Suppurative) condition occurs most frequents
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in inguinal folds on mons pubis and around the bottom....extremely uncomfortable with multiple lesions in small area
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Management (Hidradenitis Suppurative)
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Hot compresses and oral antibiotics Accutane/Sotret or Soriatane....careful monitor S/E....incision and draining of large suppurating areas with gauze packs to facilitate drainage....rarely entire area ecised.....removing scar tissue and any infection (THIS SURGERY IS DRASTIC AND PERFORMED ONLY AS LAST RESORT)
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Seborrheic Dermatoses is
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excessive production of sebum (secretion of sebaceous glands)....large numbers face scalp eyebrows eyelids sides of nose and upper lip, malar regions (cheeks) ears, axillae, under breasts, groin, gluteal crease.....CHRONIC INFLAMMATORY DISEASE OF TH ESKIN WITH PREDILECTION FOR AREAS WELL SUPPLIED WITH SEBACEOUS GLANDS OR LIE BETWEEN SKIN FOLDS WHERE BACTERIA COUND IS HIGH
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Two forms of seborrheic dermatoses
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oily and dry....may start in childhood and continue through life
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oily form seborrheic
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moist/greasy...patches of sallow, greasy skin, with or without scaling, slight erythema, mostly on forehead, nasolabial fold, bear area, scalp, and between adjacent skin surfaces in axillae, groin and breasts....small pustules or papulopustules resembling acne may appear on trunk
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dry form seborrheic
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flaky desquamation of the scalp with a profuse amount of fine powdery scales is commonly called DANDRUFF........GENETIC PREDISPOSITION (SEBORRHEIC)....Hormones, nutritional status, infections and emotional stress influence course....remissions and exacerbations should be explained.....no previous history...severe outbreak....complete history and phy exam should be conducted
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Seborrhea NO CURE management of symptoms so
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skin can repair
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seborrheic dermatitis of body and face may respond to
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topical applied corticosteroid cream which allays secondary inflammatory response...use caution near EYES....due to possible glaucoma/cataracts.....may develop secondary....CANDIDAL (YEAST) INFECTIONS
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Persistent candidiasis should be evaluated for
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diabetes
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Dandruff treatment
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proper, frequent shampooing (three times weekly) with medicated shampoos....use 2 to 3 different types of shampoo to prevent resistance...leave on 5 - 10 minutes....as condition improves, treatment can be less frequent...
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Antiseborrheic shampoos include
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those containing selenium sulfide suspension, zinc pyrithione, salicyclic acid or sulfur compounds and tar shampoo that contains sulfur or salicyclic acid
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Nurse management seborrheic dermattitis instructs pt to
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avoid external irritants, excessive heat, perspiration, rubbing, scratching....avoid secondary air the skin and keep folds clean/dry
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Frequent shampooing may be contrary to
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some cultural practices....pt cautioned that seborrheic dermatitis is chronic condition that tends to reappear.....those who become discouraged....encourage them to express their feelings
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Acne vulgaris is a
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common disorder of hair follicles most common on face, neck and upper truck
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Comedones
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(primary acne lesions) both closed and open and by papules, pustules, nodules and cysts
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Acne is the most common
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encountered skin condition in adolescents and young adults between 12 and 35. accounts for 15% of all dermatologic visits
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Onset of acne earlier
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in females because they reach puberty at a younger age...more marked during adolescence because the endocrine glands that influence the secretions of sebaceous glands are function at PEAK activity.
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Acne appears to stem from
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interplay of genetic, hormonal and bacterial factors....most cases family history
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During puperty (acne)
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adrogens stimulate the sebacous glands, causing them to enlarge, secrete a natural oil, sebum, which rises to the top of the follicle and flows out onto skin surface
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In adolescents who develop acne
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androgenic stimulation produces a heightened response in the sebaceous glands so acne occurs wehn accumulated sebum plus the pilosebaceous ducts
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primary lesions of acne
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comedones....
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closed comedones
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white heads from from impacted lipids or oils and keratin that plug the dilated follicle....closed may evolve to open
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open comedones
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black heads result from accumulation of lipid, bacterial and epithelial debris....some may rupture resulting in inflammatory reaction cause dby leakage of follicular contents (sebum, keratin, bacteria) into the dermis
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Resultant inflammation of open comedones is seen clinically as
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erythematous papules, inflammatory pustules, and inflammatory cysts
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mild papules and cysts
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drain and heal without treatment
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deeper paules and cysts cause
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scarring of the skin....acnes is usally graded as mild, moderate or severed based on number and type of lesions
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Diagnosis of acne based on
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history and phy exam, evidence of lesions and age...women may have flare up a few days before menses
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presence of comedones with
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oil skin is characterisitic. oil is more prominent in mid facial, other parts of face may be dry.....multipe lesions some open pt may exude a distinct sebaceous odor...biopsy seldom necessary
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Goals of management acne
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reduce bacterial colonies, decrease sebaceous gland activity, reduce inflammation, combat secondary infection, minimize scarring and eliminate factors that predispose the person to acne
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Therapeutic regime acne depens on
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type of lesion (comedones, papule, pustule, cyst)...the duration of treatment depends on the extent and severity
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Acne (DIET is NOT believed to play major role....
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howevr elimination of food associated with flare up chocolate cola fried or mild should be promoted.....good nutrition equips immune system for effective action against bacteria
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Mild cases acne
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wash twice each day with cleansing soap....oil free cosmetics/creams should be chosen
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over the counter acne meds
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contain either salicylic acid or benzoyl peroxide....effective at removing sebaceous follicular plugs
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Benzoyl peroxide is
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widely used produce a rapid and sustained reducion of inflammatory lesions....they depress sebum production and promote breakdown of comedo polugs and have antibacterial effect
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Initially benzoyl peroxide causes
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redness and scaling but skin adjusts quickly.....benzoyl applied ONCE daily.....Benzamycin and Sulfoxyl availble OTC
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Vitamin A (tretinoin)
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applied topically clears keratin plugs from pilosebaceous ducts....symptoms may worsen during early wks of therapy because inflammation, erythema and peeling may occur....no sun exposure...may cause exaggerated sunburn...improvement 8 - 12 wk
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Topical antiboiotic treatment
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for acne common....topical suppresses bacterail growth, reduce superficial free fatty acid levels, decrease comedones, papules and pustules.....NO SYSTEMIC SIDE EFFECTS
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Oral antibiotics in small doses over long period are effective (acne)
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in treating moderate to severe....especially when inflammatory and results in pustules, abscesses and scarring...therapy months to years
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TETRACYCLINE FAMILY OF ANTIBIOTICS (ACNE)
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CONTRAINDICATED IN CHILDREN YOUNGER THAN 12 AND PREGNANT WOMEN
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Admin of tetracycline for pregnant women can
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affect the development of teeth, enamel hypoplasia and permanent discolor in infants
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S/E tetracycline
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photosensitivity, nausea, diarrhea, cutaneous infection in either gender, and vaginitis in women
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Some women, broad-spectrum antibiotic may suppress
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normal vaginal bacteria and cause candidiasis, a fungal infection
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Synthetic Vitamin A (retinoids)
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dramatic results pt with nodular cystic acne...one compound is isotretinoin....used for active inflammatory popular pustular acne that has tendency to scar....isotretinoin reduces sebaceous gland size and inhiits sebum production....causes epidermis to shed (epidermal desquamation)...unseating and expelling existing comedones
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Most common S/E of almost all patients is
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cheilitis (inflammation of the lips)....dry, chafed skin and mucous membranes are frequent s/e...reversible with withdrawal of med.....ISOTRETINOIN (TERATOGENIC) ADVERSE EFFECT FETUS.....contraception during therapy and 4-8 weeks after therapy. DO NOT TAKE VITAMIN A SUPPLEMENTS while taking isotretinoin
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Estrogen therapy
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progesterone-estrogen preps....suppress sebum production and reduces skin oiliness....usually reserved for young women when acne begins somwhat later than usual and tens to falre up at certain times menstrual cycle.
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Estrogen- dominant oral contraceptive compounds may be administered
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on a prescribed cyclic regimen
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Estrogen for men
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NOOOOOOO.....enlargement of breasts and decrease in body hair
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SURGICAL - ACNE
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Comedo extraction, injections of corticosteroids into inflamed lesions, and incision and drainage of large, fluctuant (moving in palpable waves) nodular cystic lesions
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Cyrosurgery acne
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freezing with liquid nitrogen may be used for nodular and cystic forms of acne
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patients with deep acne scars may be treated with
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deep abrasive therapy (dermabrasion) in which epi and some superficial dermis are removed down to the level of the scars
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Comedones may be removed with
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comedo extractor. site first cleaned with alcohol...opening of extractor placed over lesion, and idrect pressure is applied to cause extrusion of the plug through the extractor.
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removal of comedones leads to erythema
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which may take several wks to subside
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recurrence of comedones after extraction
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is common
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Nursing care pts with acne consists largely of
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monitoring and managing potential complications of treatments....nursing activities include pt. ed., proper skin care, managing potential problems or therapy...provide positive reassurance, listen attentively and be sensitive
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Ultimate goal acne
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prevention of scarring.....
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Severe acne
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25=50 comedones, papules or pustules....long term therapy with systemic antibiotic or isotretinoin....manipulation of comedones, papules increases potential for scarring
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Acne surgery may cause
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further scarring (hyperpigmentation or hypopigmentation may affect tissue involved)
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Home care
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wash face and other affected areas with mild soap and water twic each day to remove oil and prevent obstruction of oil glands
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Mild abrasive soaps and drying agents are
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prescribed to eliminate the oil feeling
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Instructions acne
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do not prop hands agains face, rub face , wear tight collar or helmet...avoid manipulation, squeezing worsens the problem, because portion of black head pushed down into skin which may cause follicle to rupture....shaving cream, lotion and cosmetics should be avoided
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Infectious dermatoses (Pyodermas)
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pus-forming bacterial infections of the skin....primary originate normal appearing skin and are usually caused by single organism....secondary arise from previous skin disorder or from disruption of skin integrity from injury or surgery....staphylococcus aureus, group A streptococci. MOST COMMON BACTERIAL SKIN INFECTIONS ARE IMPETIGO AND FOLLICULITIS....folliculitis may lead to furuncles or carbuncles
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impetigo is a superficial infection of the skin caused by
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staphylococci, streptococci or multiple bacteria
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bullous impetigo
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more deep seated infection of skin caused by S. aureus (characterized by formation of bullae (large, fluid filled bliesters)...Bullae rupture leaving raw, red areas
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bullous impetigo usually appears on
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body face hands neck and extremities that exposed
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IMPETIGO IS CONTAGIOUS
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MAY SPREAD to other parts of the patient's skin or to other family members who touch or use towel or combs soiled with exudate from the lesions
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Impetigo is seen in people of all ages
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it is particularly common in children living in poor conditions....often follows PEDICULOSIS CAPITIS (HEAD LICE) SCABIES (ITCH MITES) HERPES, INSECT BITES, POISON IVY OR ECZEMA.....antibacterial soap may create resistant bacteria and contribute to problem
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Impetigo lesions begain as
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small red macules that become discrete thin walled vesicles that rupture and become covered with loosely adherent honey-yellow crust...removed easily to reveal smooth red moist sufrace where new crusts soon develop....if SCALP involved....hair is MATTED....DISTINQUISHINGFROM RINGWORK
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IMPETIGO - MED MANAGEMENT
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Systemic antibiotic therapy....reduces contagious spread, treats deep infections and prevents glomerulonephritis (kidney disease)....may occurs due to streptococcal skin disease.
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Med Non-Bullous impetigo
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Benzathine penicilling or oral penicillin Cloxapen....penicillin allergic ERYTHROMYCIN
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TOPICAL ANTIBACTERIAL IMPETIGO
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BACTROBAN WHEN SMALL AREA...APPLY SEVERAL TIMES DAILY FOR A WEEK.....TOPICAL NOT AS EFFECTIVE AS SYSTEMIC IN PREVENTING THE SPREAD OF STREPTOCOCCI FROM THE RESPIRATORY TRACT....increasing risk for glomerulonephritis
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Topical therapy impetigo
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lesions are soaked or washed with soap solution to removeal central site bacterial growth...giving topical therapy an opportunity to reach infected site. After crust removed, topical antibiotic cream applied....gloves are worn....Betadine may be used to clean the skin
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Impetigo - Nurse
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Instructs pt and family members to bathe at least 1 time daily with bactericidal soap...separate towel and washcloth
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Folliculutis is an infections
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of bacterial or fungal origin in hair follicules....may be superficial or deep. single or multiple papules or pustules appear close to hair follicle.
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Folliculitis commonly affects
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beard area of men, women's legs, axillae, trunk and buttocks....usually caused by staphylococci,,,,immune system impaired caused organism may be gram-negative bacilli
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Pseudofolliculitis barbae (shaving bumps)
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occur predominantly on faces of african american and other curly haired men due to shaving. sharp ingrowing hairs have curved root grows at acute angle and pierces the skin.....TREATMENT....AVOID SHAVING...other treatments....special lotions or antibiotics or using hand brush to dislodge the hairs mechanically....use depilatory cream or electric razor
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Furuncle (boil) is an acute inflammation
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arising deep in 1 or more hair follicles and spreading into the surrounding dermis....DEEP FORM OF FOLLICULITIS
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Furunculosis refers to
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multiple or recurrent lesions.....occur anywhere but usually in areas subjected to irritation, pressure, friction, perspiration, neck axillae and bottom.
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Furuncle may start as a
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small red raised painful pimple....infection progresses and involves the skin and sub fatty tissue, causing tenderness, pain and surrounding cellulitis....area of redness and inflammation is an effort of the body to keep the infection local
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Furuncle (staphylococci)
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produce necrosis of the invaded tissue....pointing of boil follows in a few days...center becomes yellow or black....boil came to head
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Carbuncle is an
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abscess of the skin and sub tissue representing an extension of a furuncles that has invaded sever follicles and is large and deep seated....caused by staphylococcal infections
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Carbuncles appears
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where skin is thick and inelastic (neck and bottom) extensive inflammation prevents a complete walling off of infection, purulent material may be absorbed resulting in high fever, pain, leukocytosis, and extension of infection to bloodstream
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In treating staphylococcoal infections
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DO NOT RUPTURE OR DESTROY protective wall of induration....NEVER SQUEEZE. ANTIBIOTIC THERABY ....culture and sensitivity study
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Oral cloxacillin and dicloxacillin for carbuncles
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first line meds
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Carbuncles meds
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cephalosporins and erythromycin are also effective.....comfort....BED REST FOR BOIL ON PERINEUM OR ANAL....COURSE OF SYSTEMIC ANTIBIOTIC THERAPY
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Carbuncle pus has localized and is fluctuant
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small incision with scalpel speeds resolution by relieving tension and esnuring direct evacuation of pus and debris.....COVER DRAINING LESION WITH DRESSING
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CARBUNCLES, FOLLICULITIS, FURUNCLES - NURSING MANAGEMENT
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IV fluids, fever reduction for patients acutely ill from infection, apply warm moist compress....skin may be cleanses with antibacterail soap and antibacterial ointment may be applied.
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Nurse - BOILS FACE
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Boils on face drain directly into the cranial venous sinuses.....SINUS TRHOMBOSIS WITH FATAL PYEMIA CAN DEVELOP....INFECTION CAN TRAVEL THROUGH SINUS TRACT AND PENETRATE BRAIN CAVITY CAUSING BRAIN ABSCESS
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Staphy infection (home care) carbuncles, furuncles and folliculitis
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actively draining lesions - the mattress and pillow should be covered with plastic and wiped with disinfectant daily....linens laundered after each use.....antibacterail soap and shampoo for indefinite period.....recurrent infection is stopped with long term antibiotic therapy (3 months).....Purulent exudate source of reinfection or transmission to caregivers.....RECURRENT PT TREAT WITH BACTROBAN
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Herpes Zoster (shingles) is an infection
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caused by the varicella-zoster virus (VZVs) members of a group of DNA viruses....viruses that cause CHICKEN POX and HERPES are indistinguishable...henze the 2 part name
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Herpes is characterized by a
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painful vesicular eruption along the area of distribution of the sensory nerves from 1 or more posterior ganglia.
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After chickenpox runs its course
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the VZV responsible for outbreak lies dormant inside nerve cells near the brain and spinal cord
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When latent viruses reactivated (chicken pox)
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due to declining cellular immunity they travel by way of the peripheral nerves to the skin where virus multiplies and create a red rash of small fluid filled blisters
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Elderly (natural immunity to varicella wanes)
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allowing virus to reactive and maintaining it in the population.
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Herpes Zoster develops in about
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10% of adults usually after 50 years of age
50% of peoply by 85 years of age Local and have few complications |
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African Americans are effected
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much less frequently, if developed usually at younger age.
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Increased frequency of Herpes with weakened immune systems such as
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HIV and cancer causing widespread significant complications
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Herpes (chickenpox) usually accompanied or preceded by
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pain, radiate over entire region by affected nerves....burning,lancinating (tearing or sharply cutting) stabbing or aching....some have no pain, but ithcing and tenderness
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herpex chickenpox
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malaise and GI disturbances may precede eruption....patches of grouped vesicles appear on red sowllen skin....early vesicles containing serum may later become purulent, rupture and form cursts.
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herpex chicken inflammation
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usually unilateral, involving the thoracic, cervical or cranial nerves in a bandlike configuration....blisters usually confined to narrow region of face/trunk....course varies from 1-3 wks....opthalmic nerve - eye pain....inflammation and rash TRUNK - PAIN WITH SLIGHTEST TOUCH....healing 7 - 26 days
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Complication herpes
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postherpetic neuraglia - 20% of cases, more common elderly. 50% older than 60 have persisten pain lasting longer than 6 months
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Herpes zoster infection can be stopped
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if oral antiviral agents (Zovirax, Valtrex, Famvir) are administered within 24 hours of initial eruption....IV acycloiver (Zovirax) is effective in significantly reducing pain and stopping progression of disease
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Goal herpes zoster management are to
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relieve pain and reduce or avoid complication including infection, scarring and postherpatic neuralgia and eye complications. pain controlled with analgesics....to prevent persistent pain patterns.
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Herpes (Elderly) meds
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Systemic corticosteroids for pts older than 50 to reduce incidence and duration of postherpetic neuralgia.....Aristocort, Kenacort, Kenalog injected subcut under painful areas is effective as anti-inflammatory agent
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Opthalmic herpes zoster
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EMERGENCY ...referred to opthalmologist immediately to prevent keratitis, uveitis, ulceration and blindness.
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Immunization
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developed in 1970 for children...more potent formulation of vaccine developed to boost VZV cellular immunity in people over 55
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Nurse management
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pt and family instructed to take antiviral agents and keep follow-up.....assess pt discomfort and response to med and collaborates with phy to make adjustments....pt taught how to apply wed dressings or med to lesions and hand hygiene, diversionary and relaxation tech are encourages to ensure restful sleep and alleviate discomfort.
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herpes Simplex
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common skin infetion: 2 types of causative virus, identified by viral typing....type 1 occurs on the mouth and type 2 in the genital area....bot both viral types can be found in both locations
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85% adults herpes simplex
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are seropositive for type 1...type 2 is lower....type 2 usually appears at onset of sex.
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Herpes simplex is classified as a
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true primary infections, non-primary or recurrent
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True herpes simplex
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initial exposure to virus
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non-primary herpes simplex
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initial episode type 1 or 2 in a person previously infected with the other type
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Orolabial herpes also called
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fever blisters or cold sores consists of erythematous based clusters of grouped vesicles on the lips....prodrome of tingling/burning with pain may precede by up to 24 hrs. Triggers such as sunlight increased stress may cause recurrent.
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Fewer than 1% of people with primary orolabial herpes develop
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herpetic gingivostomatitis....most common in children/young adults...onset high fever, regional lymphadenopathy and malaise.
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Another complication of orolabial herpes is the development
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of erythema multiforme...acute inflammation of skin, mucous membranes which appear as targets (concentric red rings with white bands between the red rings)
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Genital type 2 herpes manifests with broad spectrum of signs
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Minor - may have no symptoms...severe type 1 can cause flulike....lesions appear as grouped vesicles on an erythematous base initially involving the vagina, rectum or penis....new lesions can appera for 7 to 14 days. Lesions symmetric and cause regional lymphadenopathy...fever and flulike symptoms common....recurrence begins with prodrome of burn, tingle, itch about 24 hours before vesicles....as vesciles rupture, erosions and ulcerations begin to appears....severe infections can cause extensive erosions of the vaginal or anal canal
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Confirmation of herpes simplex
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appearance of skin eruption, viral cultures and rapid assays, type of test depends on lesion morphology...Acute lesions react more positively to rapid where older cursted patches are better with viral cultures....need enough viral cells for testing, careful collections.....all crusts gently removed or vesicle unroofed....sterile cotton swab premoistened in viral culture preservative is used to swab the base of the vesicle.
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Eczema herpeticum is a condition
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which pt with eczema contract herpes that spreads throught the eczematous areas
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Excema herpeticum is managed with
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oral or IV acyclovir
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Herpetic whitlow is an infection
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of the pulp of a finger tip with hepres type 1 or 2....tenderness and erythema of cuticle...deep seated vesicles within 24 hours.
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Genital herpes - MOMS -
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Fetal anomalies include skin lesions, microcephaly, encephalitis and intracerebral calcifications
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Oralabial herpes
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avoid the sun....topical treatment with drying agents may accelerate healing....intermittent treatment with 200 mg acyclovir five times each day for 5 days as soon as earliest symptoms
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Mild rare outbreakes genital herpes
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no treatment may be required
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More severe genital herpes but infrequent
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intermittent treatment....reduces the duration by only 24 to 36 hrs.....initiate treatment within 24 hours of appearance
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Genital - more than 6 per year may benefit from
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suppressive therapy.....ACYCLOVIR, VALACYCLOVIR OR FAMCICLOVIR suppresses 85% of recurrences and 20% are free of recurrences....suppressant therapy reduces viral shedding by almost 95&....prevents recurrent erythema multiforme (acute eruption of macules, papules and vesicles with a multiform appearance.
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management genital herpes PREGNANT....ROUTINE CULTURE
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DO NOT PREDICT SHEDDING AT DELIVERY. do not use scalp electrodes during delivery due to risk of infection.....risk greater in women with initial episode during prenancy,,,,SUPPRESSION THERAPY SHOULD BE STARTED to reduce outbreak during 3rd trimester.....all women with active outbreak undergo....C-SECTION
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Fungi (fungal mycotic skin infections)
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tiny members of a subdivision of the plant kingdom that thrive in organic matter....affect skin and hair and nails....sometimes internal organs are involved....may be life threatening......Secondary infections with Candida may occur
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most common skin infection is
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tinea....ringworm ring or rounded tunnel under skin....affect head, body, groin, feet and nails
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obtain specimen for ringworm
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lesion is cleaned and a scalpel or glass slide is used to remove scales form the margin of the lesion. scales dropped onto slide to which potassium hydroxide has been added.....looking for spores or hyphae or by isolating organisms....WOOD'S LIGHT spec of infected hair is fluorescent.....
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