Maryville Nurs 623 Exam 1.100%
ACCURATE SOLUTIONS GRADE A+
Basics with skin conditions
•Alopecia
•Rash
•Pruritus
•Uticaria
•Pigmentation change
Skin lesion—New vs. Change
HPI questions for skin problems
Duration of symptoms
Precipitating factors
•Medications
•Food
•Occupation
•Outdoors
•Hobbies/Sport participation
•Exposure to insects
•Jewelry/metals/chemicals
•Family history
Is it:
Local or systemic
Pruritus- all day or worse at night
Uticaria - duration
Pigmented changes
Pigmentation/Changes of the skin Diff diagnosis
Nevi- brown, beige or pink(< 5mm)
Melanoma
Related to pregnancy- melasma (mask of pregnancy)
Addison disease
Side effect of medication- steroid therapy
skin lesions
Macule - flat, nonpalpable (freckle, petechia)
Papule - PALPABLE, solid elevation of skin (elevated nevus)
Nodule - elevated solid mass, deeper and firmer than papule (wart)
,Tumor - solid mass deep in subcutaneous tissue (epithelioma)
Wheal - irregularly shaped, elevated area (hive, mosquito bite
Vesicle - elevation of skin with serous (clear) fluid
Pustule - similar to vesicle but filled with pus (acne)
Ulcer - deep loss of skin (venous statis ulcer)
Atophy - thinning of skin
Bullae-Clear fluid-filled blisters > 10 mm in diameter. These may be
caused by burns, bites, irritant or allergic contact dermatitis, and
drug reactions.
primary versus secondary skin lesions
Primary skin lesions are those which develop as a direct result of
the disease process.
Secondary lesions are those which evolve from primary lesions or
develop as a consequence of the patient's activities.
Parasitic Skin Infections
scabies and lice
Scabies
Highly contagious infestation that occurs mainly in children, young
adults, health care workers, and institutionalized persons of all
ages.
Subjective: Complaints of intense itching that is usually more severe
at night.
Objective:Earliest physical sign is small 1 to 2 mm red papules
located in areas of body most attractive to mites. Itching,
excoriation, , crusting, and scaling may be present making it hard to
see scabies.
Diagnostics:Ink burrow test
Scabies treatment
Permethrin 5% cream (Remember you have 5 fingers)- leave on for 8-14
hours then shower- daily for 7 days.
Oral antihistamines for itching, topical steroids for itching.
, The entire household must be treated. Everything should be washed
with hot water/detergent, treat any infection that is present.
Starve mites by sealing them in a bag for about 10 days.
Lice treatment
Permethrin 1% leave on for 10 mins then rinse. May repeat in 7 days
if needed.
Fungal skin infections
· Candidiasis- bright, beefy red rash treat with topical antifungal,
· Dermatophytoses - the tineas (ringworm)
· Onychomycosis treat with Terbinafine for 6-12 weeks (only 73-79%
effective, educate patient.
· Fungal infections survive on keratin, so considered superficial.
· Pathogens: Epidermophyton, trichophyton, microsporum.
· Those at risk are DM and immunocompromised.
· Diagnostics: KOH
Tinea corporis
(Ringworm of body)
Hx of erythematous round and elevated pruritic lesion that grows in
size & starts to clear in the center
Miconazole 2% cream BID x4 weeks, Clotrimazole 1%, Terbafine 1%
Tinea capitus (ringworm of head)
Children common. Painless bald spot, may have kerion that looks like
honeycomb, inflammation. Boggy mass containing broken hairs and
oozing purulent material from follicular orifices
Systemic antifungals - Griseofulvin BID for 2-4 months or 2 weeks
after negative cultures. Teratogenic - use 2nd method of
contraception.
OR terbinafine cream
Tinea versicolor (skin, AKA pityriasis versicolor)
Round or oval lesions of hypo or hyperpigmentation macule, located
mainly on back chest, arms, sometimes neck/face. Sometimes very fine
scales seen. Agent P oribiculare causes round, pityrosporum ovale
causes oval
Clotrimazole 1% cream and solution BID up to 4 weeks
Bacterial infections of the skin
· Impetigo
· highly contagious
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