NURS 623 Review
Guide Exam 1
DERM:
Folliculitis: Superficial to deep infection of the hair follicle.
Description: Small pustules surrounded by erythema located over base of the hair follicle. A hair
in the center of pustule sometimes perforates the lesion. “bumpy rash” located on face, eyelid,
scalp, back of earlobes, neck, shoulder, buttock, torso, or extremities.
Diagnostic: Gram stain and culture of purulent discharge. Fungal culture, if fungal is suspected.
Treatment:
-Gentle cleaning twice a day with antibacterial soap.
-Mupirocin (Bactroban) 2-4 times a day for 10 days.
-MRSA: Altabax BID x2weeks.
Follow-up: If doesn’t respond to therapy.
Patient Education:
-Good hand washing and personal hygiene.
-Friction can predispose them to recurrence of folliculitis.
-Electric shaver may cause fewer breaks in skin. Avoid old razor blades.
Impetigo: Highly contagious bacterial infection usually caused by Group A Strep or Staph
aureus or a mix of both (Gram Postitive). Common in children 2-5yo. Surface organisms
entering skin through abrasions, bites, or minor trauma. Can be transferred by skin or lesions in
the upper resp. tract. Located on face or extremities.
Description: Discrete red, purulent vesicles that rupture and crust over. Can be nonbullous or
bullous (blister). Lesions heal slowly and leave depigmented areas. Moist honeycrust.
Diagnostics: Gram stain and culture of purulent discharge. Patient febrile/systemic symptoms
obtain CBC with diff.
Treatment: Without treatment, usually heals within 2-3 weeks.
Few lesions
-Mupirocin 2% (Bactroban/Centany) TID x7days.
-Retapamulin (Altabax) BID x5days: impetigo caused by MRSA.
-with combination of cleansing (chlorhexidine) and debridement of lesions.
Multiple lesions; Fever or toxicity.
-Dicloxacillin, Amoxicillin-clavulanate, Cloxacillin
-First/second generation cephalosporin. Cephalexin for children.
-MRSA bacteria: Clindamycin, Vancomycin, and Bactrim (not for children <11yo)
Follow-up:
-Uncomplicated: 10 days-2weeks.
-Fever/toxic follow closely, consult/refer with physician.
,Patient Education:
-Wash affected skin areas with bactericidal soap 2-3 times a day before applying mupirocin.
-Keep lesion dry. Good hand washing and personal hygiene. Wash linens with soap and hot
water.
-Keep fingernails short. Do not shar personal items with others.
-If MRSA is involved, stay home and do not handle food until 24 hours on antibiotics.
Complications:
-Acute glomerulonephritis requires referral to kidney specialist. S/S: proteinuria, hypertension,
edema, azotemia, and RBCs in urine. (streptococcal induced acute glomerulonephritis)
Cellulitis: Usually forms from a skin wound: insect bite, incision, abrasion, or trauma. Caused
by Group A Strep or Staph aureus. Improves within 48-72 hours.
Description: Warm, bright red, tender to the touch, edematous area with sharply demarcated
borders. Lower legs most common location in adults (look for tinea pedis).
Diagnostics: Open wound- gram stain and culture. Systemic symptoms- CBC.
Treatment:
-Augmentin for 14 days: infected with animal or human bite.
-Uncomplicated cases: Dicloxacillin or Cephalexin (Keflex) for 10-14 days.
-If PCN allergy: Erythromycin.
-MRSA: Bactrim, Vancomycin.
Follow-up:
-If responding to tx, follow up outpatient.
-Recheck in 48 hours or earlier for sicker pt. Then follow up in 1wk, and weekly until resolved.
Patient Education:
-Call HCP if infection worsens or if fever persists despite antibiotic tx for at least 24 hours.
-Call in 3 days to report progress of simple cellulitis infection.
-Elevate affected limb as much as possible to decrease swelling.
Patient Education:
-Only use noncomedogenic products, makeup, moisturizers, sunscreens, and so forth.
-Was face gently BID with antibacterial soap. Avoid excessive scrubbing of the face.
-Wait at least 30 minutes after washing face before applying topical to minimize skin irritation.
-Sunscreen should be used with all acne medications.
-Tretinoin may cause irritation and temporary flare-up initially and takes 6-8weeks for
improvement to be seen. Should not be used in pregnant women or on children.
Herpes Zoster: Acutely painful condition caused by the varicella-zoster virus. Resolves in 14-
21 days. Can leave behind scaring and postherpetic neuralgia.
Description: Blistering lesion occurring on dermatome. Pustules and crusts. Does not cross
midline= UNILATERAL. Pain, burning, throbbing, stabbing or intense itch.
, Treatment:
-Antiviral therapy: High dose Acyclovir, Valacyclovir, or Famcyclovir within 48-72 hours of the
outbreak.
-Systemic corticosteroids= Prednisone may also be given to reduce acute pain.
For post-herpetic neuralgia:
-Pregabalin (Lyrica)
-Notriptyline- Tricyclic antidepressant
-Topical lidocaine
-Gabapentin
Patient Education:
Herpes zoster vaccine can be used in patients 60 years of age and older to boost their waning
immunity to the varicella virus, decreases the symptoms and decreases the risk of postherpetic
neuralgia.
Complications:
Posttherpetic neuralgia is pain that persists after resolution of cutaneous eruption.
Contact Dermatitis: Caused by irritant or allergies.
Description: Pruritic erythematous rash. Weeping lesions with numerous vesicles on an
erythematous base that is pruritic or has burning/stinging sensation. Usually develops 6-12 hours
after contact with irritant.
Diagnostics: Rule-out other causes by skin scraping and cultures. Laboratory test that are done
by specialists include the scratch and intradermal tests.
Treatment:
-Dry lesions: calamine lotion, topical steroids <10% area, 3 times a day for 2-3weeks or until the
dermatitis and pruritus resolves.
-Weeping lesions: moist compresses and simple drying agents/antipruritic lotions.
-Oral steroids >10% area= Prednisone.
Patient Education:
-Avoid sources of known allergens (nickel, gold, fragrance, neomycin, etc.)
Complications:
-Left untreated, dermatitis may spread, causing debilitating pruritus.
Eczema (Atopic dermatitis): Usually begins as infantile eczema. Type 1 hypersensitivity
reaction causing degradation of the mast cell and release of histamine resulting in vasodilation,
mucous gland stimulation, and tissue swelling. Caused by exposure to metal (nickel), rubber
additives, toiletries, and topical medications. RAST test may be done on serum to quantify levels
of allergen-specific IgE. *Associated with people who have asthma*. Family history.
Guide Exam 1
DERM:
Folliculitis: Superficial to deep infection of the hair follicle.
Description: Small pustules surrounded by erythema located over base of the hair follicle. A hair
in the center of pustule sometimes perforates the lesion. “bumpy rash” located on face, eyelid,
scalp, back of earlobes, neck, shoulder, buttock, torso, or extremities.
Diagnostic: Gram stain and culture of purulent discharge. Fungal culture, if fungal is suspected.
Treatment:
-Gentle cleaning twice a day with antibacterial soap.
-Mupirocin (Bactroban) 2-4 times a day for 10 days.
-MRSA: Altabax BID x2weeks.
Follow-up: If doesn’t respond to therapy.
Patient Education:
-Good hand washing and personal hygiene.
-Friction can predispose them to recurrence of folliculitis.
-Electric shaver may cause fewer breaks in skin. Avoid old razor blades.
Impetigo: Highly contagious bacterial infection usually caused by Group A Strep or Staph
aureus or a mix of both (Gram Postitive). Common in children 2-5yo. Surface organisms
entering skin through abrasions, bites, or minor trauma. Can be transferred by skin or lesions in
the upper resp. tract. Located on face or extremities.
Description: Discrete red, purulent vesicles that rupture and crust over. Can be nonbullous or
bullous (blister). Lesions heal slowly and leave depigmented areas. Moist honeycrust.
Diagnostics: Gram stain and culture of purulent discharge. Patient febrile/systemic symptoms
obtain CBC with diff.
Treatment: Without treatment, usually heals within 2-3 weeks.
Few lesions
-Mupirocin 2% (Bactroban/Centany) TID x7days.
-Retapamulin (Altabax) BID x5days: impetigo caused by MRSA.
-with combination of cleansing (chlorhexidine) and debridement of lesions.
Multiple lesions; Fever or toxicity.
-Dicloxacillin, Amoxicillin-clavulanate, Cloxacillin
-First/second generation cephalosporin. Cephalexin for children.
-MRSA bacteria: Clindamycin, Vancomycin, and Bactrim (not for children <11yo)
Follow-up:
-Uncomplicated: 10 days-2weeks.
-Fever/toxic follow closely, consult/refer with physician.
,Patient Education:
-Wash affected skin areas with bactericidal soap 2-3 times a day before applying mupirocin.
-Keep lesion dry. Good hand washing and personal hygiene. Wash linens with soap and hot
water.
-Keep fingernails short. Do not shar personal items with others.
-If MRSA is involved, stay home and do not handle food until 24 hours on antibiotics.
Complications:
-Acute glomerulonephritis requires referral to kidney specialist. S/S: proteinuria, hypertension,
edema, azotemia, and RBCs in urine. (streptococcal induced acute glomerulonephritis)
Cellulitis: Usually forms from a skin wound: insect bite, incision, abrasion, or trauma. Caused
by Group A Strep or Staph aureus. Improves within 48-72 hours.
Description: Warm, bright red, tender to the touch, edematous area with sharply demarcated
borders. Lower legs most common location in adults (look for tinea pedis).
Diagnostics: Open wound- gram stain and culture. Systemic symptoms- CBC.
Treatment:
-Augmentin for 14 days: infected with animal or human bite.
-Uncomplicated cases: Dicloxacillin or Cephalexin (Keflex) for 10-14 days.
-If PCN allergy: Erythromycin.
-MRSA: Bactrim, Vancomycin.
Follow-up:
-If responding to tx, follow up outpatient.
-Recheck in 48 hours or earlier for sicker pt. Then follow up in 1wk, and weekly until resolved.
Patient Education:
-Call HCP if infection worsens or if fever persists despite antibiotic tx for at least 24 hours.
-Call in 3 days to report progress of simple cellulitis infection.
-Elevate affected limb as much as possible to decrease swelling.
Patient Education:
-Only use noncomedogenic products, makeup, moisturizers, sunscreens, and so forth.
-Was face gently BID with antibacterial soap. Avoid excessive scrubbing of the face.
-Wait at least 30 minutes after washing face before applying topical to minimize skin irritation.
-Sunscreen should be used with all acne medications.
-Tretinoin may cause irritation and temporary flare-up initially and takes 6-8weeks for
improvement to be seen. Should not be used in pregnant women or on children.
Herpes Zoster: Acutely painful condition caused by the varicella-zoster virus. Resolves in 14-
21 days. Can leave behind scaring and postherpetic neuralgia.
Description: Blistering lesion occurring on dermatome. Pustules and crusts. Does not cross
midline= UNILATERAL. Pain, burning, throbbing, stabbing or intense itch.
, Treatment:
-Antiviral therapy: High dose Acyclovir, Valacyclovir, or Famcyclovir within 48-72 hours of the
outbreak.
-Systemic corticosteroids= Prednisone may also be given to reduce acute pain.
For post-herpetic neuralgia:
-Pregabalin (Lyrica)
-Notriptyline- Tricyclic antidepressant
-Topical lidocaine
-Gabapentin
Patient Education:
Herpes zoster vaccine can be used in patients 60 years of age and older to boost their waning
immunity to the varicella virus, decreases the symptoms and decreases the risk of postherpetic
neuralgia.
Complications:
Posttherpetic neuralgia is pain that persists after resolution of cutaneous eruption.
Contact Dermatitis: Caused by irritant or allergies.
Description: Pruritic erythematous rash. Weeping lesions with numerous vesicles on an
erythematous base that is pruritic or has burning/stinging sensation. Usually develops 6-12 hours
after contact with irritant.
Diagnostics: Rule-out other causes by skin scraping and cultures. Laboratory test that are done
by specialists include the scratch and intradermal tests.
Treatment:
-Dry lesions: calamine lotion, topical steroids <10% area, 3 times a day for 2-3weeks or until the
dermatitis and pruritus resolves.
-Weeping lesions: moist compresses and simple drying agents/antipruritic lotions.
-Oral steroids >10% area= Prednisone.
Patient Education:
-Avoid sources of known allergens (nickel, gold, fragrance, neomycin, etc.)
Complications:
-Left untreated, dermatitis may spread, causing debilitating pruritus.
Eczema (Atopic dermatitis): Usually begins as infantile eczema. Type 1 hypersensitivity
reaction causing degradation of the mast cell and release of histamine resulting in vasodilation,
mucous gland stimulation, and tissue swelling. Caused by exposure to metal (nickel), rubber
additives, toiletries, and topical medications. RAST test may be done on serum to quantify levels
of allergen-specific IgE. *Associated with people who have asthma*. Family history.
