nur-611-1-exam-1-study-guide-dermatology-and-infections-overview (1 exam questions and answers)

NUR 611 1 - EXAM 1 - REVIEWER ADV PRACTICE NURSING EXAM
QUESTIONS AND ANSWERS
Dermatology

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 xr



■ trauma or surgery xr xr



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


mirabilis) xr


● 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 xr xr xr


◆ Tenderness and redness xr xr


◆ 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 xr xr xr xr



○ Culture
● If MRSA suspected xr xr



○ Culture nares and axilla xr xr xr



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


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




➔ Treatment for Folliculitis xr xr


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


◆ Clindamycin gel xr




➔ Treatment for Purulent SSTI xr xr xr


◆ 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 xr xr xr xr xr xr xr



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




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




➔ 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 xr xr


◆ Imaging to r/o OM xr xr xr




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


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



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



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


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


◆ Clindamycin 300 mg q6h xr xr xr

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



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



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


● Mild ulcer xr


○ Cipro + Clindamycin xr xr




◆ Follow up: 48 HOURS!!! xr xr xr




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


◆ S/s of toxicity xr xr


● T >100.5 xr



● Hypotension
● Sustained tachycardia xr


◆ Rapid progression of erythema xr xr xr


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


◆ Proximity of the lesion to an indwelling medical device (prostethic jt o
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r vascular graft)
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◆ Periorbital cellulitis = INPATIENT TX/ REFER ALWAYS! xr xr xr xr xr xr


◆ 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
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oaks, personal products xr xr xr



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



■ Symptoms: predominantly pruritus xr xr


■ Surface appearance: vesicles and bullae xr xr xr xr



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



○ Irritant
■ Causes: solvents, bleach, alcohol, chemicals in personal productsxr xr xr xr xr xr xr



■ Location: usually hands xr xr



■ Symptoms: burning, pruritus, pain xr xr xr



■ Surface appearance: dry fissured skin xr xr xr xr



■ Lesion borders: less distinct xr xr xr

, ➔ Diagnostics:
◆ Thorough H&P xr


◆ diagnostic/labs - usually not necessary unless infection is suspected
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● KOH
● Culture
● Patch testing to identify contact allergen - dermatologist
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➔ Management:
◆ Symptom management xr


◆ Identify causative agents and avoid
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◆ Prevent infection xr


◆ Pharma:
● Calamine lotion, cool colloidal oatmeal bath to reduce pruritus
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● Benadryl 25-50 mg PO PRN xr xr xr xr



● Mild cases xr



○ Hydrocortisone cream in a non-rx strength eg: 0.1% xr xr xr xr xr xr xr



○ Mid - high potency topical steroids BID: xr xr xr xr xr xr



◆ Triamcinolone 0.1% - Kenalog, Aristocort xr xr xr xr


◆ Clobetasol 0.05% - Temovate xr xr xr


● Barrier cream - Zinc oxide - moisture and protect skin
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◆ Use of RX corticosteroid:
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● No improvement in rash or cont to spread 2-3 days of self-care
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● Itching and/or pain is SEVERE. xr xr xr xr



◆ Use PO or IM systemic therapy:
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● Large portion of skin (20%) xr xr xr xr



● Genital or periorbital area xr xr xr



● If very severe xr xr



● Prednisone 0.5 - 1 mg per kg/day xr xr xr xr xr xr



○ s/s should subside in 12-24 hrs xr xr xr xr xr



○ If tx is effective after initial therapy, dose reduce by 50% x 5-
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7 days xr



◆ Antihistamines - can help w/ pruritus but side effects can help
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➔ Education: NO scratching, identify and avoid causative agent, MOISTURIZE
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● Atopic Dermatitis
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○ Most common in Asian and AA
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➔ Presentation:
◆ Dry skinxr


◆ Flexural surface xr


◆ Lichenification and scaling - chronic xr xr xr xr


➔ Diagnostic criteria:
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