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NURP 423 - Exam 3 Study Guide.
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NURP 423 - Exam 3 Study Guide.
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Bacterial infections on skin (usually because areas are already open) caused by MRSA, staph aureus,Group A strep (pyogenes), Methicillin sensitive staph aureus, less common= pseudomonas, H flu.,
corynebactor
Primary INF:
Impetigo-primary infection by staph aureus or strep bacterial infection
Ecthyma-thighs or buttocks-pustular
Folliculitis-staph – klebsiella-hair follicle gets infected-staph, MRSA- or pseudomonas from water
(pool or hot tub). Folliculitis=TX with clindamycin and Erythromycin (topical).
Follicular eczema-allergic response
Cellulitis-group a strep, staph aureus, H. influenza
Furuncle-boil =use warm compress
More than one-carbuncle-caused by staph/MRSA
Secondary from open skin (ulcer/abrasion/surg wound/eczema)
MRSA
staph aureus
streptococci
enterococci
Anerobes
KNOW DIFFERENCE /B/ primary and secondary inf.
Methicillin sensitive staph aureus, Strep pyogenes, methicillin resistant staph aureus are the
most common causes of skin infection in the __________ setting.
a) Hospital
b) NSG home
c) Primary care
TX: NON PHARM-
Chlorhexidine baths, keep clean, warm compresses for pustules, bleach baths, Incise and
drainFIRST-culture to guide antibiotic choice
Impetigo: Bacitracin-not as effective-USE BACTROBAN-
ORAL abo for skin infection-Keflex-cephalosporin, dycloxicilin, Cipro
Pseudomonas? Cipro or beta lactam and macrolide
First class cellulitis-keflex-cephalexin-first gen cephalosporin
Which of the following is the first line treatment for cellulitis?
a) Vanco
b) Keflex (it’s a cef)
c) Omnicef
,MRSA-give Bactrim in outpatient or clindamycin, linezolid
Decolonization: bouncing around in families-treat everyone-bactroban in nares bid, chlorhexidine wash,
or bleach bath.
Abscesses and Carbuncle-I & D first (Its primary tx for them)
Incision and drainage is the primary treatment for:
a) Abscess (note that carbuncles need I&D as well)
b) Acne
c) Dematitis
MRSA-Bactrim-4-6mg/kg per dose-START WITHAllergic to Bactrim? Give doxycycline- OR clindamycin
Treating MRSA in the outpatient setting includes:
a) Azithromycin
b) Amoxicillin
c) Bactrim
Acne-Inflammatory or non-inflammatory-disorder of pylo sebaceous unit-gets plugged-bacteria grows
and causes inflammation> pustule=worse inflame. If cysts=deratologist
Define pustular acne.
Pustular acne refers to the appearance and spread of one of the main lesions of acne: pustules. Pustules
are inflammatory lesions and when left untreated they can morph into nodules. Find out the right
treatment for pustular acne.
Inflammation is the phase found with:REVIEW ACNE PHASES
a) Pustular acne
b) Dormant acne
c) Cellulitis
These can become cystic, d/t abscess formation, & scarring may occur, then would refer to dermatology
If Pustular acne-inflammation-Treat-non-pharmacological-ask about skin regimen to see if there is a
cause-hair product, moisturizer, conditioning hair, hygiene
Teach them to gently wash face bid with mild soap-do not scrub or rub
Med for acne- 1st choice-benzo peroxide topical (a keratolytic)-may cause irritation or scaling-
can give a different form
Irritation and scaling are side effects of:
a) Keflex
b) Benzoyl peroxide
, c) Rocephin
Meds:
1. Keratolitic-first line, antibacterial, reduce hyperkeritinization
2. Retinoid-Retin-second class A-effective for acne and reverses abnormal keratinization-
3. ATB’s
1. Keratolytic:
benzyl peroxide-OTC, comes in all kind of forms-acne wash
Salicylic acid-acne wash
Axelaic acid
Sulfur (rarely used d/t odor).
2. Retinoids: causes local irritation that gets better with time-most therapies make the acne
worse before it gets better. Pea sized amount around entire face. Start slow. Once a week.
Then twice a week. Etc.
Tretinoin (Retin-A): causes local irritationthat gets better with time. MUST BE WORN
WITH SUN SCREEN.
Differin (Adapalene)- less irritation but more expensive.
Tazarotene (Tazorac): used when pts have trouble with other options.
3. Topical ATBs: (gel, solution, or lotion) MUST BE USED WITH BENZOYL PEROXIDE TO AVIOD
DRUG RESISTANCE & KERATINIZATION.
Erythromycin & Clindamycin (Erythromycin, clindamycin. MUST BE used together.)
Sulfacetamide
4. Oral ATB’s: for severe acne. Give this and send to Derm!
Tetra, doxy, and mino-cycline
5. ACCUTANE: Severe cystic acne only!!!
Prego cat X!!!
Monitor prego test (HCG levels), lipids, depression/mood changes, and OP.
cause irritation, scaly
Step wise treatment-
always start with non- pharmacological care > Topical Keratolytic> nightly topical (RETIN-A) not
together with a keratolytic> Topical ATB with item 2 in the AM and item 3 in HS> systemic
ATB>Isotretoin (Accutane)
Infestations:
Scabies-put on Elimite cream at night and then wash clothes and bedding in AM with hot H2O
Pediculosis-Head lice-prometherine-otc-SE: skin irritation and neurotoxicity-if patient does not want
neurotoxin risk, give a lotion-Fear of neurotoxicity-
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