NUR 611 1 - Exam 1 Study Guide : Dermatology and Infections Overview with Complete Solutions
NUR 611 1 - Exam 1 Study Guide: Dermatology and Infections Overview with Complete Solutions
Dermatology
Skin and Soft Tissue Infections: (SSTI)
● 2 most common bacteria that cause skin infections: S. Aureus & S. pyogenes
○ Gram (+) - Staph - most common - can cause MRSA
○ Gram (-) - present in wound infections caused by:
■ animal bites
■ trauma or surgery
■ exposed to infected water (E.coli, pseudomonas aeruginosa, proteus
mirabilis)
● Skin infections can be non-purulent or purulent
Folliculitis, Furuncle, Carbuncle
● Most commonly caused by S. Aureus - MRSA
● Common in athletes, shaving, waxing, hot tubs
● Occurs in areas with coarse hair
➔ Presentation:
◆ Pustules in hair shaft
◆ Tenderness and redness
◆ If recurrent - ask if pt has DM
◆ No diagnostics/labs needed - usually
● If recurrent furuncles and carbuncles
○ Culture
● If MRSA suspected
○ Culture nares and axilla
➔ Treatments:
◆ Hygiene
◆ Warm, moist compress
◆ Betadine/Hibiclens wash (Antiseptic wash)
➔ Treatment for Folliculitis
◆ Benzoyl Peroxide 5%, Bactroban TID
◆ Clindamycin gel
➔ Treatment for Purulent SSTI
◆ 1st line - Incision & Drainage (I&D)
◆ C&S
Page 1 of 30
,NUR 611 1 - Exam 1 Study Guide : Dermatology and Infections Overview with Complete Solutions
➔ Treatments for Furuncle and Carbuncle (PO)
◆ Keflex 500mg (Cephalosporin 1st Gen) q12 x 10-14 days
◆ MRSA
● Bactrim DS OD (Sulfonamide) x 10 -14 days
● Clindamycin 300 mg q6h x 14 days
Cellulitis
● Most caused by MRSA, Strep, H. Flu
● Differential DX:
○ Gout
○ Dermatitis
○ Herpes Zoster
➔ Presentation:
◆ Erythema
◆ Warmth
◆ Pain
◆ Lymphedema
◆ Fissuring
◆ Abscess
➔ Diagnostic test/Labs:
◆ C&S
◆ CBC (Leukocytosis)
◆ Blood CX, ESR
◆ Imaging to r/o OM
➔ Management:
◆ Hygiene, elevation, moist heat
◆ Pharma:
● Uncomplicated/nonsystematic:
○ PCN 500 mg q6
○ Keflex 500 mg q12 x 10-14 days
◆ IDSA - rx min 5 days, extend if no improvement
○ MRSA:
◆ Bactrim DS OD x 10-14 days
◆ Clindamycin 300 mg q6h
Page 2 of 30
, NUR 611 1 - Exam 1 Study Guide : Dermatology and Infections Overview with Complete Solutions
◆ Pt w/ comorbidity: DM/HF
● Non-ulcer
○ Amoxicillin/Clavulanate 500 mg q12h x 7-10 days
○ Quinolone - Cipro 500-750 mg q12h x 7-14 days
◆ Gram (-) and anaerobic coverage
● Mild ulcer
○ Cipro + Clindamycin
◆ Follow up: 48 HOURS!!!
➔ Refer to ID /Hospitalize pts if:
◆ Immunocompromised pt = HOSPITAL ALWAYS!
◆ S/s of toxicity
● T >100.5
● Hypotension
● Sustained tachycardia
◆ Rapid progression of erythema
◆ Rapid progression of clinical findings after 48hrs of antibx tx
◆ Inability to tolerate oral therapy
◆ Proximity of the lesion to an indwelling medical device (prostethic jt
or vascular graft)
◆ Periorbital cellulitis = INPATIENT TX/ REFER ALWAYS!
◆ Refer to ID: hand infection, infection from bites (consider admission)
Dermatitis:
● Contact Dermatitis
○ Allergic
■ Causes: Nickel (jewelry), medications (topical cream/ointments), poison
oaks, personal products
■ Location: exposed areas, usually hands
■ Symptoms: predominantly pruritus
■ Surface appearance: vesicles and bullae
■ Lesion borders: distinct angles, line, and borders
○ Irritant
■ Causes: solvents, bleach, alcohol, chemicals in personal products
■ Location: usually hands
■ Symptoms: burning, pruritus, pain
■ Surface appearance: dry fissured skin
■ Lesion borders: less distinct
Page 3 of 30
NUR 611 1 - Exam 1 Study Guide: Dermatology and Infections Overview with Complete Solutions
Dermatology
Skin and Soft Tissue Infections: (SSTI)
● 2 most common bacteria that cause skin infections: S. Aureus & S. pyogenes
○ Gram (+) - Staph - most common - can cause MRSA
○ Gram (-) - present in wound infections caused by:
■ animal bites
■ trauma or surgery
■ exposed to infected water (E.coli, pseudomonas aeruginosa, proteus
mirabilis)
● Skin infections can be non-purulent or purulent
Folliculitis, Furuncle, Carbuncle
● Most commonly caused by S. Aureus - MRSA
● Common in athletes, shaving, waxing, hot tubs
● Occurs in areas with coarse hair
➔ Presentation:
◆ Pustules in hair shaft
◆ Tenderness and redness
◆ If recurrent - ask if pt has DM
◆ No diagnostics/labs needed - usually
● If recurrent furuncles and carbuncles
○ Culture
● If MRSA suspected
○ Culture nares and axilla
➔ Treatments:
◆ Hygiene
◆ Warm, moist compress
◆ Betadine/Hibiclens wash (Antiseptic wash)
➔ Treatment for Folliculitis
◆ Benzoyl Peroxide 5%, Bactroban TID
◆ Clindamycin gel
➔ Treatment for Purulent SSTI
◆ 1st line - Incision & Drainage (I&D)
◆ C&S
Page 1 of 30
,NUR 611 1 - Exam 1 Study Guide : Dermatology and Infections Overview with Complete Solutions
➔ Treatments for Furuncle and Carbuncle (PO)
◆ Keflex 500mg (Cephalosporin 1st Gen) q12 x 10-14 days
◆ MRSA
● Bactrim DS OD (Sulfonamide) x 10 -14 days
● Clindamycin 300 mg q6h x 14 days
Cellulitis
● Most caused by MRSA, Strep, H. Flu
● Differential DX:
○ Gout
○ Dermatitis
○ Herpes Zoster
➔ Presentation:
◆ Erythema
◆ Warmth
◆ Pain
◆ Lymphedema
◆ Fissuring
◆ Abscess
➔ Diagnostic test/Labs:
◆ C&S
◆ CBC (Leukocytosis)
◆ Blood CX, ESR
◆ Imaging to r/o OM
➔ Management:
◆ Hygiene, elevation, moist heat
◆ Pharma:
● Uncomplicated/nonsystematic:
○ PCN 500 mg q6
○ Keflex 500 mg q12 x 10-14 days
◆ IDSA - rx min 5 days, extend if no improvement
○ MRSA:
◆ Bactrim DS OD x 10-14 days
◆ Clindamycin 300 mg q6h
Page 2 of 30
, NUR 611 1 - Exam 1 Study Guide : Dermatology and Infections Overview with Complete Solutions
◆ Pt w/ comorbidity: DM/HF
● Non-ulcer
○ Amoxicillin/Clavulanate 500 mg q12h x 7-10 days
○ Quinolone - Cipro 500-750 mg q12h x 7-14 days
◆ Gram (-) and anaerobic coverage
● Mild ulcer
○ Cipro + Clindamycin
◆ Follow up: 48 HOURS!!!
➔ Refer to ID /Hospitalize pts if:
◆ Immunocompromised pt = HOSPITAL ALWAYS!
◆ S/s of toxicity
● T >100.5
● Hypotension
● Sustained tachycardia
◆ Rapid progression of erythema
◆ Rapid progression of clinical findings after 48hrs of antibx tx
◆ Inability to tolerate oral therapy
◆ Proximity of the lesion to an indwelling medical device (prostethic jt
or vascular graft)
◆ Periorbital cellulitis = INPATIENT TX/ REFER ALWAYS!
◆ Refer to ID: hand infection, infection from bites (consider admission)
Dermatitis:
● Contact Dermatitis
○ Allergic
■ Causes: Nickel (jewelry), medications (topical cream/ointments), poison
oaks, personal products
■ Location: exposed areas, usually hands
■ Symptoms: predominantly pruritus
■ Surface appearance: vesicles and bullae
■ Lesion borders: distinct angles, line, and borders
○ Irritant
■ Causes: solvents, bleach, alcohol, chemicals in personal products
■ Location: usually hands
■ Symptoms: burning, pruritus, pain
■ Surface appearance: dry fissured skin
■ Lesion borders: less distinct
Page 3 of 30
