NR 577/NR577 Exam 1 Primary Care Management of Adolescents and Adults Final Exam Review| Guide with Verified Answers| Latest 2026/ 2027| Chamberlain.

NR 577/NR577 Exam 1 Primary Care Management of Adolescents and Adults Final Exam Review| Guide with Verified Answers| Latest 2026/ 2027| Chamberlain. Q. def/scope of palliative care ANSWER - relief from pain and other distressing issues - early identification and intervention -quality of life of patients and families -neither hastens or postpones death -support system -team approach to address needs of patients and their families -may positively influence the course of illness Q. modern medicine has a strong bias towards ANSWER A) curative medicine B) palliative care C) pharmaceutical medicine D) non-pharmaceutical medicine A) curative medicine Q. low and middle income countries are limited to ANSWER palliative care and active management Q. Four Aspects of Essential Practice ANSWER •Physical Care •Emotional/Spiritual/Social •Care Planning & Coordination •Communication Q. Palliative Care Services Should ANSWER •Identify patients with PC needs •Assess & reassess patients and family •For physical, emotional, social and spiritual distress •Relieve pain and other distressing physical symptoms •Address spiritual, psychological and social needs •Clarify the patient's values and determine culturally appropriate goals of care Q. highest burden of palliative care ANSWER A) cancer B) HIV/AIDS C) cardio vascular disease D) diabetes E) chronic lung disease C) cardio vascular disease Q. lowest burden of palliative care ANSWER A) cancer B) HIV/AIDS C) cardio vascular disease D) diabetes E) chronic lung disease D) diabetes Q. ____ of people who need palliative care do not receive it ANSWER A) 83% B) 86% C) 98% D) 95% B) 86% Q. ____ of the worlds population lack access to pain relief ANSWER A) 83% B) 86% C) 98% D) 95% A) 83% Q. ____ number of children needing palliative care live in low and middle income countries ANSWER A) 83% B) 86% C) 98% D) 95% C) 98% Q. which age group is in need most of palliative car (69%) ANSWER A) adults 60+ B) children 1-14 C) adults 15-59 A) adults 60+ Q. which income level is most in need of palliative care (48.5%) ANSWER A) low income B) high income C) upper middle income D) lower middle income D) lower middle income Q. adults need palliative care more in ANSWER European Q. children need palliative care more in ANSWER african Q. Barriers to Palliative Care ANSWER •Policy •Education •Medication Availability •Implementation •Psychological, Social/Financial, Cultural Q. Types of policies needed include: ANSWER -Laws that acknowledge that PC is part of the healthcare system -National standards of PC care -Clinical guidelines and protocols -Establishment of PC as a recognized medical specialty/sub-specialty with accompanying licensing provisions -National strategy on PC implementation -National education programs addressing knowledge gaps and cultural barriers Q. PC education is needed at five levels: ANSWER -Society at large -Patients & Families -Basic training for health professionals -Intermediate training for those working with patients with life-threatening illnesses -Specialist training to manage patients with complex PC needs Q. key indicators of opioid availability ANSWER •Overly strict regulation •Limitations on available forms of medication particularly oral opioids •Lack of supply and distribution systems •Limitations on who can prescribe •Fear of law enforcement intervention into medical use Q. 80% lack adequate access to opioid medications for pain control ANSWER •Australia, Canada, New Zealand, the United States, and several European countries account for more than 90% of the global consumption Q. Implementation Barriers (Individual Level) commonest perceived barriers ANSWER - uncertain prognosis (55%) -family not ready to accept incurable condition (51%) -language barriers (47%) -time constraint (47%) Q. Implementation Barriers (Individual Level) frequent barriers ANSWER - family preferences for more life-sustaining treatment compared to staff members - staff shortages - problems with communication between family and staff, within staff regarding treatment goals -insufficient education in pain and palliative care -absence of a palliative care team Q. Psychological, Social/Financial, Cultural Barriers ANSWER •PC development limited by human factors •Informing patients of life-threatening diagnosis prohibited or discouraged •Financial Impact of Life-threatening illness Q. Stages of Loss ANSWER -Denial -Anger -Bargaining -Depression -Acceptance -(Shock/Disbelief & Guilt have been added) Q. which stage is usually the first stage of loss A)Denial B)Anger C)Bargaining D)Depression E)Acceptance ANSWER A)Denial Q. what is the following stage of loss survival mechanism, helps to survive initial shock of loss, the world becomes meaningless/overwhelming, wondering how/why to go on, as you accept the loss and start asking question healing process begins A)Denial B)Anger C)Bargaining D)Depression E)Acceptance ANSWER A)Denial Q. what is the following stage of loss Initial grief feels like being lost at sea: no connection to anything Then you get angry at someone or something A)Denial B)Anger C)Bargaining D)Depression E)Acceptance ANSWER B)Anger value of anger stage The more you truly feel it, the more it will begin to dissipate and the more you will heal. -Gives temporary structure to the nothingness of loss what is the following stage of loss Attempts to Control an Uncontrollable Situation. May take the form of a temporary truce. "What if I devote the rest of my life to helping others. Guilt is often the companion of this stage A)Denial B)Anger C)Bargaining D)Depression E)Acceptance C)Bargaining what is the following stage of loss Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined• We withdraw from life in intense sadness, wondering if there is any point in going on?•This expression is too often seen as unnatural: a state to be fixed, something to snap out of A)Denial B)Anger C)Bargaining D)Depression E)Acceptance D)Depression what is the following stage of loss often confused with the notion of being "OK" with what has happened. This stage is about accepting the reality that our loved one or our future is gone A)Denial B)Anger C)Bargaining D)Depression E)Acceptance E)Acceptance which cultures believe death as a taboo subject - filipino -south east asian -somali -islamic -mexican -indian Collective Decision Making Collective decision-making is the norm in many cultures, but it often clashes with the American value of autonomy and an individual's right to make one's own decisions about health and dying Family may expect information to be given to them first so they can make the health care decisions -Korean/SEA -Mexican-American -Pacific Islander Perception of Doctors' Status some countries the physician makes all the health decisions and patients are not asked to choose or question the physicians treatment cultural perception of pain pain may be seen as something positive. pain can equal body fighting towards recovery, a test of ones faith. asking for pain medication can be sign of weakness. some wait to be asked rather than ask Types of Undertreated Pain -Postoperative pain -Cancer pain -Chronic Non-cancer Pain body surface pain A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain A) superficial pain deep inside of the body A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain B) deep pain result of injuries to skin, bone, muscle, connective tissue A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain C) somatic pain originates in and around the organs of the body A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain D) visceral pain radiates to lower extremities w/ transmission along spinal nerve A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain E) radicular pain spreads to area of the body which is not the source A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain F) referred pain diffuse pain widespread A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain G) diffused pain restricted to one identifiable area A) superficial pain B) deep pain C) somatic pain D) visceral pain E) radicular pain F) referred pain G) diffused pain H) localized pain H) localized pain painful sensations felt with no evident stimulus A) spontaneous pain B) allodynia C) hyperalgesia D) dysaethesia E) paraesthesia A) spontaneous pain pain due to a stimulus which does not normally provoke pain ( touching, moving, cold, heat) A) spontaneous pain B) allodynia C) hyperalgesia D) dysaethesia E) paraesthesia B) allodynia an increased response to a stimulus which is normally painful ( pinprick) A) spontaneous pain B) allodynia C) hyperalgesia D) dysaethesia E) paraesthesia C) hyperalgesia an unpleasant abnormal sensation, whether spontaneous or evoked (shooting sensation) A) spontaneous pain B) allodynia C) hyperalgesia D) dysaethesia E) paraesthesia D) dysaethesia an abnormal sensation that is not unpleasant whether spontaneous or evoked ( tingling, buzzing, vibrating) A) spontaneous pain B) allodynia C) hyperalgesia D) dysaethesia E) paraesthesia E) paraesthesia types of nociceptive pain - visceral -somatic (superficial, deep) -radicular from visceral organs, deep cramping sensation that may be reffered to other sites nociceptive- visceral from tissues such as skin, muscle, joint capsules, and bone nociceptive- somatic well localized sharp, pricking or burning sensation nociceptive- cutaneous somatic widespread dull or aching sensation nociceptive- deep somatic caused by abnormal signal processing in PNS and CNS. Nervous system injury or impairment, Nerves not functioning correctly neuropathic pain -peripheral (mononeuropathy, polyneuropathy) -central -sympathetically maintained pain types of neuropathic pain -Distribution of one peripheral nerve -Sciatic nerve or Ulnar nerve entrapment -Bell's Palsy (paralysis one side of face) -Lancinating Pain (Trigeminal Neuralgia) neuropathy--peripheral -- mononeuropathy -Symmetrical on both sides of body -Diabetic neuropathy -Guillain-Barre (immune system attacks nerves) neuropathy--peripheral -- polyneuropathy pain due to loss of sensory input into the central nervous system, Increases sensitivity & irritability of downstream sensory neurons neuropathic-- central -- deafferentation Peripheral & Central involvement. Complex interaction between tissue components and nervous system. Changes in circulation, temperature , sweating patterns ex. menopause neuropathic-- -Sympathetically Maintained Pain common causes of neuropathic pain -Trauma & Inflammation -Metabolic diseases (e.g., diabetes) -Infections (e.g., herpes zoster) -Tumors &Toxins -Primary neurological disease no known physical cause, constant discomfort does not respond well to medication, difficult to describe location, usually underlying factors such as anxiety and depression psychogenic pain how is psychogenic pain reported -Difficult to describe location/quality/depth -no specific area just shows larger areas "complex, unpleasant experience with emotional and cognitive, as well as sensory, features that occur in response to tissue trauma" acute pain definition common causes of acute pain -Trauma, -surgery -labor -medical procedures -acute disease states - 3 months - rapid onset, typically localized -Resolves with healing of the underlying injury -Predictable, physiological warning that something is wrong - accompanied by: Pupil Dilation, Diaphoresis. Increase BP/HR, Adrenaline, Anxiety, Muscular tension/tightness -usually nociceptive, may be neuropathic acute pain characteristics -pain that extends beyond healing period -amount of pain disproportionate to injury -disrupts normal living - no purpose unlike acute pain and harder to treat - nociceptive, neuropathic, or both -not typically vital sign changes more behavior changes (distress, depression, anorexia, insomnia) chronic pain causes of chronic pain -Injury (trauma, surgery) -Malignant conditions -Chronic non-life-threatening conditions (arthritis, fibromyalgia, neuropathy) -subtype of chronic pain -persistent Pain Not Associated With Cancer --Mild to Excruciating -Patients report levels poorly corresponding to identifiable levels of tissue pathology -Often responds poorly to standard treatments -can Affect Any Body System: chronic non-cancer pain causes of chronic non-cancer pain -Acute injury à chronic pain (whiplash) -Various chronic conditions -Sometimes no detectable cause •Pain is considered the disease -Pain associated with potentially life-threatening conditions - difficult to classify by duration or pathology -"Pain associated with HIV infection" -"Pain associated with cancer" -painful diagnostic procedures/treatment Cancer Pain ('Malignant Pain') causes of Cancer Pain ('Malignant Pain') Pain caused by the disease itself -Tumor invasion of tissue -Compression/infiltration of nerves/blood vessels -Organ obstruction -Infection -Inflammation WILDA pain assessment approach 1.Words 2.Intensity 3.Location 4.Duration 5.Aggravating/Alleviating Factors - Achy, throbbing, dull -Typically well localized patient description of Nociceptive Pain (Somatic) -Squeezing, pressure, cramping, distention, dull, deep, and stretching -After abdominal or thoracic surgery patient description of Nociceptive Pain (Visceral) -Burning, shooting, tingling, radiating, lancinating, numbness. -Like a fire or an electrical jolt patient description of Neuropathic Pain duration of pain - stable continuous pain is always there duration of pain - breakthrough -Transitory exacerbation -Flare of pain -Patient already analgesics for continuous stable pain duration of pain - Intractable -Chronic -Resistant to cure or relief Assessing Pain in Cognitively-Impaired or Non-Verbal Patients -self report or nonverbal cues(moaning, frowning) may not be reliable - Can obtain voluntary non-verbal feedback (head-nod, squeeze finger, move eyes) - predicting pain (review history reason to suspect patient in pain) -past precendent (When the patient experienced pain in the past, how did they act) Person acts as if they have an illness by deliberately producing, faking, or exaggerating symptoms to attain a patient's roll. to obtain sympathy/attention A) malingering B) factitious disorder C) munchausen's syndrome by proxy D) munchausen's syndrome B) factitious Disorders Patient wishes to obtain external gains such as disability payments or to avoid an unpleasant situation, such as military duty A) malingering B) factitious disorder C) munchausen's syndrome by proxy D) munchausen's syndrome A)malingering Produce symptoms by contaminating urine samples, taking hallucinogens, injecting themselves with fecal material to produce an abscess, etc A) malingering B) factitious disorder C) munchausen's syndrome by proxy D) munchausen's syndrome D) munchausen's syndrome •Factitious disorder imposed on another •Deliberately produces, feigns, or exaggerates the symptoms of someone in their care A) malingering B) factitious disorder C) munchausen's syndrome by proxy D) munchausen's syndrome C) munchausen's syndrome by proxy -recurring, real, multiple, current somatic complaints -long and complicated primary care - treat with cognitive behavioral therapy - can be due to: Heightened biologic sensitivity? -Body's attempt to cope with mental/emotional pain? -Cognitive theories: catastrophic thinking Somatization Disorder -At least 1 symptom of altered voluntary motor/sensory function -'Hysterical Blindness,' Paralysis, Abnormal Movement, Seizure, Amnesia, Incontinence •Anxiety 'converted' to physical symptom Conversion Disorder -Mental disorder -- Some aspect of one's health or appearance is severely flawed & requires extreme measures -Real or imagined flaw Pervasive and intrusive obsession Body Dysmorphic Disorder (BDD) -Inordinately worried about having a serious illness -Inaccurate perception of condition of body/mind despite absence of actual medical diagnosis -Persists even after a physician has evaluated and reassured -Serious illnesses or deaths of family members or friends to trigger hypochondria Hypochondriasis -Psychological stress -- Chronic pain in one or more areas, sometimes for years •Trauma/Abuse •Child's role in family is 'the sick one' •More common in social settings where psychological distress is not as accepted pain disorder the process by which a painful physical or chemical stimulus is transformed into a signal that can be carried to the central nervous system and perceived as pain by sensory receptors called nociceptors transduction transmission of neural signals from periphery to the spinal cord and brain transmission analgesics target what neuron activity dorsal horn neuron appreciation of signals arriving in higher structures as pain the central processing of sensory stimuli into a meaningful pattern. perception descending inhibitory and facilitory input from brain that modulates nociceptive transmission at the level of the spinal cord the ability to reduce the sensation of sharp pain by activating low-threshold mechanoreceptors modulation especially for chronic treatment, is generally preferred because it is convenient, flexible, and associated with stable drug levels oral administration of drugs are useful in patients who cannot take medications by mouth rectal administration of drugs has multiple disadvantages (e.g., pain, erratic absorption, fluctuating drug levels, tissue fibrosis) least desirable route intramuscular administration of drugs provides rapid onset IV administration of drugs application of a medicine or drug through the skin. a drug is placed on top of the skin, where it is absorbed into the bloodstream transdermal administration of drugs produce consistent drug blood levels The administration of a fluid into a blood vessel, usually over a prolonged period of time. continuous infusions administration of drugs WHO analgesic ladder STEP 1: mild pain - non opioid agents (paracetamol, NSAIDS) STEP 2: moderate pain - mild opioid (codeine phosphate +/- non opioid) STEP 3: severe pain - opioid (morphine sulphate +/- non opioid) non-opioid analgesics - acetaminophen (tylenol) -aspirin/salicylic acid derivatives -NDAIDs(ibruprofen, naproxen, diclofenac, celecoxib) anti-inflamatory non-opioid analgesics characteristics -All have anti-inflammatory, anti-pyretic (fever reducer) analgesics effects -Relieve a variety of types of acute and chronic pain - Combine with opioids to facilitate lower opioid dosing & bi-modal analgesia Analgesia ceiling the dose beyond which there is no additional analgesic effect. Higher doses do not provide any additional pain relief but may increase the likelihood of side effects as well as the cost of treatment non-opioid analgesics side effects Cardiac, bleeding, GI, kidney dysfunction opioids Morphine Methadone, Buprenorphine, Hydrocodone, Oxycodone, Tramadol which group of medication has 'analgesia ceiling' non-opioid analgesics side effects of opioids -Binding to opioid receptors in other parts of body (CNS, GI) -- sedation, mental clouding, confusion, respiratory depression, nausea, vomiting, constipation, pruritis, urine retention -Tolerance, Dependence, Addiction -Most S/E subside with time (except constipation) Adjuvant Analgesics •Anti-Epileptic Drugs (AEDs) (Phenytoin, Carbamazepine, Gabapentin) •Tricyclic Antidepressants (Amitriptyline, Nortriptyline, Imipramine) •Local Anesthetics (Lidocaine, Bupivacaine) •Herbal Derivative (Capsacin) •Corticosteroids (Prednisone) •Triptans & Beta-blockers (Sumatriptan, Metoprolol) •Novel Agents (Ziconotide) Non-Pharmacological Management of Pain Without Medications 1.Education & Psychological Counseling -To reduce procedural pain 2.Hypnosis 3.Comfort Therapy 4.Heat & Cold 5.Physical & Occupational Therapy 6.Psychosocial Therapy & Counseling 7.Neurostimulation 8.Religious & Spiritual 9.Nutritive 10.Herbal -Use appropriately—not in place of an explanation of what to expect -Usually used to help children, especially babies •Colors, moving objects, songs, stories, books, videos -Watching TV -Music -Smartphone non-pharmacological Hypnosis distraction when should you stop monitoring pain Until There is No More Pain: •Ongoing Monitoring –Occurring at regular intervals •Individualized •Documented palliative care issues arising from gastrointestinal - anorexia -thirst -constipation & obstruction -diarrhea -nausea & vomiting - mouth issues -hiccups Gastrointestinal: Anorexia -Cause considerable anxiety to patient and family -Preservation of optimal nutrition may delay the onset of cachexia, which is an independent risk factor for poor survival Treatment of anorexia focus first on treating reversible causes -Pain/dyspepsia -Disordered taste/smell -Malodour (e.g. from ulcer or fungating tumour) -Nausea or vomiting -Metabolic causes, including hypercalcaemia and uraemia -Constipation -Gastric stasis -Anxiety, depression or confusion -Iatrogenic causes role of caregivers with anorexia patients Carers can play a vital role in encouraging the patient to eat small, visually appealing meals in a comfortable environment thirst - the desire to drink -Self-reported and has high individual variability Xerostomia dry mouth) can contribute to thirst, not all patients with dry mouth have thirst and vice versa management of thirst in dying patients -Attention to mouth care and moistness will address thirst in the final hours/days of life -Daily oral care and sips of oral fluid administered for comfort can improve thirst -Contradictory literature on whether fluid administration will even help reduce thirst in dying patients complex syndrome with weight loss, lipolysis, loss of muscle and visceral protein, anorexia, chronic nausea, and weakness Cachexia cachexia treatment -Intensive nutrition - Eat regularly + snacks; set alarm - Select energy-dense foods; juices/sugary foodsà insulin surge àhunger; salty foods -Pharmacological treatment •Corticosteroids improve anorexia and weakness, not accompanied by improved caloric intake •Short-lasting (3-4 weeks) well tolerated even in very ill patients -Progestational Drug •Megestrol (takes several weeks to manifest) weight loss issues Cachexia = wasting (decreased caloric intake)Xerostomia = dry mouth that can contribute to thirstAnorexia = (cachexia is ultimate result) NOT wanting to eatObstruction = causes digestive dysfunction Gastrointestinal: Constipation & Obstruction Mechanical Obstruction -Bowel tumors; ovarian cancer -- external compression, paralytic ileus, diverticuli, hernia -Normally requires surgical solution -Avoid prokinetic/motility agents! Gastrointestinal: Constipation & Obstruction Functional/Incomplete Obstruction -Ischemic bowel, IBD, tuberculosis, endometriosis -May resolve with conservative treatment •Dexamethasone reduces bowel wall edema •Prokinetic •Stool softener & hydration •NG tube if vomiting is distressing Gastrointestinal: Constipation & Obstruction Constipation -Immobility, age, weakness, low fiber intake & dehydration, depression, obstructive causes, drugs -Stool softener (docusate) + motility agent (senna) •Avoid bulking agents osmotic laxatives (lactulose; may cause cramps and require large amounts of H2O -Relieve impaction before starting laxatives Gastrointestinal: Nausea & Vomiting side effects -nausea -vomiting -retching -regurgitation -rumination -dyspepsia Nausea -Subjective experience: 'sensation that precede vomiting' Vomiting -Highly specific event: 'forceful evacuation of gastric contents out of the mouth' -Usually (not always) preceded by nausea Retching -Repetitive contraction of the abdominal musculature, generating pressure gradient which leads to evacuation of stomach contents -"Dry Heaves" Regurgitation -Passive, retrograde flow of esophageal contents into the mouth -Reflux or esophageal obstruction Rumination -Under-diagnosed chronic motility -Effortless regurgitation of meals following consumption, due to involuntary contraction of the muscles around the abdomen -Occurs repetitively after meals, not preceded by nausea or associated with the physical phenomena normally accompanying vomiting Dyspepsia –Chronic or recurrent pain or discomfort centered in the upper abdomen –Structural: Acid-related –Functional: Dysmotility-related Mouth Issues: Dry Mouth (Xerostomia) Treat reversible causes (dehydration & candida); discontinue drug causes; sip & suck ice chips; saliva substitutes; Pilocarpine only effective if existing salivary function Mouth Issues: Candidiasis [adherent white plaques]- Local factors = poor hygiene, xerostomia, dentures - Systemic factors = malnutrition, steroids, immunosuppression, diabetes Treat with topical antifungals (nystatin); systemic only in immunocompromised Mouth Issues: Painful Mouth Mucositis, xerostomia, vitamin C or iron deficiency, ulceration, tumors Localized pain choline salicylate gel, carmellose paste, lidocaine spray or lozenges Generalized pain benxyamine mouthwash, diclofenac dispersible tablets, systemic analgesics Mouth Issues: Mouth Ulcers Aphthous ulcers [Canker sores] treated with topical corticosteroids (hydrocortisone lozenges) For resistant aphthous ulcers, doxycycline mouthwashes Infective ulcers treated with an anti-fungal, antiviral, or antibacterial agent persistent hiccups last 48 hours intractable hiccups last 1 month dyspnea a subjective experience of air hunger (shortness of breath) dyspnea pharmacologic Interventions -Short-acting opioids -Methotrimeprazine -Benzodiazepines (lorazepam or midazolam) -Corticosteroids -Bronchodilators (oral/inhaler/nebulizer) -Supplemental Oxygen (in some cases) dyspnea non- pharmacologic Interventions Calm reassurance -Fluid restriction -Elevating head of the bed -Smoke-free, dust-free, low-humidity -Cool air on face -Distraction/relaxation techniques -Breathing training (pursed-lip breathing) -Reduced physical exertion/ O2 demand -Adjust/open airway -Acupuncture to sternal points ways to control respiratory secreations many pharmaceutical and non-pharmaceutical ways. Least desirable: Suction (almost always not helpful; distressing) prevention of skin breakdown/ulcer –Coconut Oil, Emollients –Skin hygiene –Dry & cool –Soft bedding –Mobility –Stoma & perineal care –Continence –Cut nails –Extra care (if reduced sensation) Promote healing for skin breakdown/wounds -Nutrition -Silver, Charcoal -Honey, Granulated Sugar -Zinc Oxide -Improve circulation •Exercise •Compression stockings/wraps -Elastic bandage -Wet dressings -Elevate legs Skin Manifestations in PC Systemic Infections with Skin Manifestations -HIV ~Rash, swollen lymph nodes, tired; topical antihistamines, soothing cream; alter medication -Cutaneous TB ~6-12 months of antibiotics -Herpes (Erythema Multiforme) ~Steroids -Streptococcus (Erythema Nodosum) ~NSAIDs -Larva Migrans ~Anti-helminth Some cancers can trigger PARANEOPLASTIC SYNDROME malignancy plus weird, seemingly unrelated skin manifestations Pruritoceptive Itch •Generated in periphery; exogenous causes –Dry skin –Contact irritation –Histamine activation •Allergy •Worm infestation –Treat as for dermatitis Neurogenic/Neuropathic Itch •Generated in PNS/CNS; central causes –Psychogenic itch –Cholestasis (accumulation of bile acids + increase endogenous opioids) –Drugs (Opioids) –Treat as for neuropathic pain Humans are pain-oriented Pain impulses take priority over itch true allergies to opioids are rare Principles of primary care Primary care focuses on healthcare that is essential, universally accessible, and evidence-based. It is the first level of care that patients receive by trained and qualified providers who focus on the management of the Principles of primary care Primary care focuses on healthcare that is essential, universally accessible, and evidence-based. It is the first level of care that patients receive by trained and qualified providers who focus on the management of the most common health problems. Coordinated referral systems are accessed by providers when more in-depth workup is required for the patient. In these cases, the patient is referred to a qualified specialist. The primary care provider remains involved in overseeing the patient's care during and after the provision of care by the specialist. Two of the most important outcomes of primary care include the reduction of risk factors and mortality rates in vulnerable populations. primary care focuses on the following: A fundamental assumption in primary care is that the patient is involved in all aspects of their care. To ensure that the individual's participation in their care is successful, primary care focuses on the following: health promotion prevention of illness management of those who become sick advocacy for all patients community involvement primary care providers strive to ensure: equitable distribution of health care community participation effective coordination of services with appropriate health care and community sectors appropriate use of technology The attributes of primary care. Accountable Acceptable Appropriate Continuous Accessible Affordable Adequate Complete Available Adolescence Adolescence is the period when individuals pass from childhood into adulthood. It is a period of rapid physical, emotional, cognitive, and social growth and development. In westernized nations, adolescence begins with the onset of puberty, usually around the age of 13 years, with females beginning earlier than males. Adolescence Females show physical signs of puberty with either thelarche (breast budding) or adrenarche (development of pubic hair). Menarche signifies the primary event in female puberty and is associated with changes in self-identity. Girls experience menarche at different ages. However, on average, menarche occurs at 12 ½ years of age Adolescence Adolescence can take until the age of 18 years to complete in females and the age of 21 years in males. (Maaks et al., 2020). Adolescence is marked by more than physical changes. Peers and outside activities become critical to adolescents and mark typical social development. The struggle for independence between parents or guardians and adolescents is also typical but should be monitored for qualities that hinder development in other areas or the achievement of the closure of adolescence. Goals of adolescence: Goals of adolescence: Completion of puberty and growth Social, emotional, and cognitive development Development of abstract thinking Establishment of independent identity Preparation for career or life work Healthy People 2030 goals for adolescent Healthy People 2030 goals for adolescents fall into three categories:: Baseline, The U.S. Department of Health and Human Services (n.d.) has set goals of care for adolescents as part of the Healthy People 2030 campaign. These goals are intended to promote the development of physical, mentally, emotionally, and behaviorally healthy adults. Healthcare providers are critical in tracking development to identify problems early to facilitate expeditious support. Healthy People 2030 goals for adolescents fall into three categories: Healthy People 2030 goals for adolescents fall into three categories:Baseline Increase the proportion of adolescents who have an adult they can talk to about serious problems — AH‑03Links to an external site. Reduce chronic school absence among early adolescents — AH‑07Links to an external site. Increase the proportion of children and adolescents who receive care in a medical home — MICH‑19Links to an external site. Increase the proportion of adolescents who walk or bike to get places — PA‑11Links to an external site. Increase the proportion of children and adolescents who play sports — PA‑12Links to an external site. Increase the proportion of high school students who get enough sleep — SH‑04Links to an external site. Development Increase the proportion of trauma-informed early childcare settings and elementary and secondary schools — AH‑D01Links to an external site. Increase the proportion of schools with policies and practices that promote health and safety — EH‑D01Links to an external site. Reduce the number of young adults who report 3 or more adverse childhood experiences — IVP‑D03Links to an external site. Research Increase the proportion of adolescents in foster care who show signs of being ready for adulthood — AH‑R02Links to an external site. Increase the proportion of 8th-graders with reading skills at or above the proficient level — AH‑R04Links to an external site. Increase the proportion of 8th-graders with math skills at or above the proficient level — AH‑R05Links to an external site. Increase the proportion of parents who follow AAP recommendations on limiting screen time for children aged 6 to 17 years — PA‑R02Links to an external site.