nur-611-1-exam-1-study-guide-dermatology-and-infections-overview Questions and Answers

Dermatology NUR 611 1 - EXAM 1 - REVIEWER

Skin and Soft Tissue Infections: (SSTI)
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● 2 most common bacteria that cause skin infections: S. Aureus & S. pyogenes
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○ Gram (+) - Staph - most common - can cause MRSA
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○ Gram (-) - present in wound infections caused by:
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■ animal bites tf



■ trauma or surgery tf tf



■ exposed to infected water (E.coli, pseudomonas aeruginosa, proteus tf tf tf tf tf tf tf tf


mirabilis)
● Skin infections can be non-purulent or purulent
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Folliculitis, Furuncle, Carbuncle
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● Most commonly caused by S. Aureus - MRSA
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● Common in athletes, shaving, waxing, hot tubs
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● Occurs in areas with coarse hair
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➔ Presentation:
◆ Pustules in hair shaft tf tf tf


◆ Tenderness and redness tf tf


◆ If recurrent - ask if pt has DM
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◆ No diagnostics/labs needed - usually
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● If recurrent furuncles and carbuncles tf tf tf tf



○ Culture
● If MRSA suspected tf tf



○ Culture nares and axilla tf tf tf



➔ Treatments:
◆ Hygiene
◆ Warm, moist compress tf tf


◆ Betadine/Hibiclens wash (Antiseptic wash) tf tf tf




➔ Treatment for Folliculitis tf tf


◆ Benzoyl Peroxide 5%, Bactroban TID tf tf tf tf


◆ Clindamycin gel tf




➔ Treatment for Purulent SSTI tf tf tf


◆ 1st line - Incision & Drainage (I&D)
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◆ C&S

, ➔ Treatments for Furuncle and Carbuncle (PO)
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◆ Keflex 500mg (Cephalosporin 1st Gen) q12 x 10-14 days
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◆ MRSA
● Bactrim DS OD (Sulfonamide) x 10 -14 days tf tf tf tf tf tf tf



● Clindamycin 300 mg q6h x 14 days tf tf tf tf tf tf




Cellulitis
● Most caused by MRSA, Strep, H. Flu
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● Differential DX:
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○ Gout
○ Dermatitis
○ Herpes Zoster tf




➔ Presentation:
◆ Erythema
◆ Warmth
◆ Pain
◆ Lymphedema
◆ Fissuring
◆ Abscess

➔ Diagnostic test/Labs:
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◆ C&S
◆ CBC (Leukocytosis)
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◆ Blood CX, ESR tf tf


◆ Imaging to r/o OM tf tf tf




➔ Management:
◆ Hygiene, elevation, moist heat tf tf tf


◆ Pharma:
● Uncomplicated/nonsystematic:
○ PCN 500 mg q6 tf tf tf



○ Keflex 500 mg q12 x 10-14 days tf tf tf tf tf tf



◆ IDSA - rx min 5 days, extend if no improvement tf tf tf tf tf tf tf tf tf


○ MRSA:
◆ Bactrim DS OD x 10-14 days tf tf tf tf tf


◆ Clindamycin 300 mg q6h tf tf tf

, ◆ Pt w/ comorbidity: DM/HF
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● Non-ulcer
○ Amoxicillin/Clavulanate 500 mg q12h x 7-10 days tf tf tf tf tf tf



○ Quinolone - Cipro 500-750 mg q12h x 7-14 days tf tf tf tf tf tf tf tf



◆ Gram (-) and anaerobic coverage tf tf tf tf


● Mild ulcer tf


○ Cipro + Clindamycin tf tf




◆ Follow up: 48 HOURS!!! tf tf tf




➔ Refer to ID /Hospitalize pts if:
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◆ Immunocompromised pt = HOSPITAL ALWAYS! tf tf tf tf


◆ S/s of toxicity tf tf


● T >100.5 tf



● Hypotension
● Sustained tachycardia tf


◆ Rapid progression of erythema tf tf tf


◆ Rapid progression of clinical findings after 48hrs of antibx tx
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◆ Inability to tolerate oral therapy tf tf tf tf


◆ Proximity of the lesion to an indwelling medical device (prostethic jt or v
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ascular graft) tf



◆ Periorbital cellulitis = INPATIENT TX/ REFER ALWAYS! tf tf tf tf tf tf


◆ Refer to ID: hand infection, infection from bites (consider admission)
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Dermatitis:
● Contact Dermatitis
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○ Allergic
■ Causes: Nickel (jewelry), medications (topical cream/ointments), poison tf tf tf tf tf tf tf


oaks, personal products tf tf



■ Location: exposed areas, usually hands tf tf tf tf



■ Symptoms: predominantly pruritus tf tf


■ Surface appearance: vesicles and bullae tf tf tf tf



■ Lesion borders: distinct angles, line, and borders tf tf tf tf tf tf



○ Irritant
■ Causes: solvents, bleach, alcohol, chemicals in personal products tf tf tf tf tf tf tf



■ Location: usually hands tf tf



■ Symptoms: burning, pruritus, pain tf tf tf



■ Surface appearance: dry fissured skin tf tf tf tf



■ Lesion borders: less distinct tf tf tf