NURS 651 Exam 1 Maryville University

12-month-old male Past 3 months increased erythema and pruritus scratches all night, sheets bloody in the am family history of allergic rhinitis and asthma - Acute atopic dermatitis treatment for acute atopic dermatitis - Daily lukewarm bath 5-20min, mild or no soap. pat dry after bath, add emollient, ie. aquaphor Repeat emollient with each diaper change Topical steroids first line, least potent first calcineurini inhibitors to face (tacrolimus, and pimecrolimus) Consider bleach baths and wet wraps 14 year old female, healthy Itchy rash on stomach and feet dryness, erythema, irritated Tried to treat with topical steroids at home, moisturizer and lots of bath and body works creams - Contact dermatitis Treatment for contact dermatitis - Remove offending agent ( nickel allergy to jeans buttons, rubber from latex flip flops) Clean area, treat with emoillents Topical steroids will not recur if agent is avoided can occur from poison ivy, latex, fragrances 11 year old female healthy developed rash over last week intense pruritic circular raised papular rash - Insect bites due to bed bugs Information about bed bugs - Visible to naked eye, small Wingless Yellow to reddish oval shaped, prominent eyes Mostly night feeders, attracted to warm blooded animals and humans Life cycle: egg 4-5 days, nymph state 5 stages, adult 1 year, Can survive 1 year without feeding Hide in luggage, mattresses, box springs, clothing Signs and symptoms of bed bug insect bites - Erythemous papule with or wheal 2- 5mm with punctuate center Most common reaction small inflamed Itchy bump where each bite occurred ( resolves in 1-2 weeks if not exposed further) can become widespread bullies rash Other factors of when to consider bed bug diagnosis - recent travel, pruritic papule noted on awakening, skin reaction with linear configuration Treatment of bed bugs - professional pest management all mattresses should be checked for dark stains usually around the head of bed, use scraper to remove. bag all stuffed animals for 3 days at freeze at 18 degrees or below. Or high heat at 122 degrees Prevention of Bed bugs - Check all hotel mattresses on arrival for small dark stains around head of bed. Keep luggage up and away from bed. Clothes worn in hotel room should be bagged and sealed. Use caution with garage sale items. 5 year old boy known food allergy to milk, egg and peanut. At birthday party came to mom, itchy, coughing and sneezing. Child given Benadryl and brought to your office, Diffuse generalized hives, papular and erythema areas. - Uritcaria and angioedema in setting of anaphylaxis Treatment for Urticaria and angioedema in setting of anaphylaxis - Administer EPI and activate EMS Give Albuterol only after EPI given Monitor VS and airway compromise EPI can be repeated for persistent s/s or return of S/s 12 yr old female with persistent rash on upper arms, cheeks and upper thighs gets worse with age and cold weather. Fine pearly papular rash, with some excoriated lesions, no bleeding or drainage. Skin feels rough, History of allergic rhinitis. - Keratosis Pilaris Signs and symptoms of Keratosis Pilaris - Appears like skin of plucked chicken or goosebumps Genetic disorder of keratinization of hair follicles Very common, benign condition Described as a condition of childhood and teens Usually improves with age Can flare in adolescence Treatment of keratosis pilaris - Prevent skin dryness, mild soaps Avoid hot baths or showers Mild=treat with OTC moisturizers Moderate= treat with topical keratolytics Preparations with salicylic acid, or lactic acid will help soften and flatten papule. 21 year old male with chronic sinusitis most recent infection treated with bactrim 1 month ago. Last week fatigue, cervial lymphadenopathy. CBC lost at lab found after 1 week, showed increased Eosinophil count. Called today dramatic onset erythematous rash, painful, itchy and edematous. Awoke morning after wedding with rash. - DRESS Syndrome What is DRESS syndrome? - Drug Reaction with Eosinophilia and Systemic Symptoms. Rare and potentially life threatening. Drug induced hypersensitivity 2-8 weeks between drug exposure and s/s. can have frequent relapses despite stopping drug. Drugs that cause DRESS syndrome - Sulfonamides, Anit seizure meds, Dapsone, Bactrim, Vancomycin. How to Treat DRESS? - Stop culprit drug. Most recover completely after drug stopped and given weeks to months. Treated with high dose oral and topical steroids, for comfort. Strict Lifetime avoidance of drug. admit if severe. 14 year old female with embarrassing thing behind her ear. Ears pierced one year ago, no history of trauma. Area has grown. - Keloid What are keloids? - Great protrusion of scar tissue that extends beyond wound edges and may form tumor-like masses of scar tissue. Common with piercings, tattoos, can occur a month to a year after trauma, Signs and symptoms of keloid - Focally raised, sometimes itchy and painful. Will not go away on its own, may enlarge over time. More common in those of African or Asian descent.