NURS 6531 Midterm Exam Review (Week 1-6)
Competencies of Advanced Nurse Practitioners
• How to apply advanced practice nursing competencies to
... [Show More] clinical settings
• Theories in nursing practice
• SOAP note – 4 parts
o Subjective
▪ Chief complaint (CC) – brief statement of purpose of visit
▪ History of present illness (HPI)- describes current condition in narrative form
▪ Review of body systems (ROS) – pertinent negatives
▪ Medical history, surgical history, family history, social history, current medications, smoking status, drug/alcohol use, allergies
o Objective
▪ VS
▪ Physical exam
▪ Diagnostic and lab results
o Assessment
▪ Summary of main symptoms/diagnosis
▪ Differentials
▪ Etiology of risk factors, assessment of need for therapy
o Plan
▪ treatment
• Coding and billing in nursing practice
Integumentary disorders
o Melanoma
▪ Caused by UV exposure
▪ Dark spots or wound that does not heal,
changes shape or bleeds.
▪ More likely to travel to distant organs
▪ If recognized early, curable, not can spread to organs.
▪ Benign melanocytic lesions, dysplastic nevus, squamous cell
carcinoma, metastatic tumors, blue nevus
▪ Treatments surgery and radiation, chemotherapy drugs
o Actinic Keratosis
▪ From prolonged sun exposure
▪ Rough, dry or scaly patches of skin change
in color of affected area to pink, red, or brown, itching or burning in the affected area
▪ Develops over years, commonly noted on face, lips, ears,
hands, forearms, scalp, and neck
▪ Can resolve on its own, creams like diclofenac gel, avoid sun or UV, cover area to prevent exposure to sun, cryotherapy, curettage, scraping
o Basal Cell Carcinoma
▪ UV rays from sun and tanning bed
▪ Pearly white, skin colored or pink bump
▪ Brown, black or blue lesion, flat, scaly, reddish patch
▪ A white, waxy, scar-like lesion
▪ Topical creams and ointments, destruction by electrodessication
and curettage (EDC), freezing, surgical excision, Mohs micrographic surgery
o Squamous Cell Carcinoma
▪ Develops in the middle and outer layer of the skin
▪ Caused by mutations in DNA
▪ A firm, red nodule; flat sore with scaly crust; new sore or raised
area on an old scar or ulcer; a rough, scaly patch on your lip that may evolve to an open sore
▪ Excision; curettage and electrodessication
o Acral-Lentiginous Melanoma
▪ Common in dark-skinned people
▪ Melanoma that appears on the palms, soles of feet or nails
o Venous Stasis Ulcers
▪ Most common etiology of LLE ulceration
▪ Causes-inflammatory processes resulting in
leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema
▪ Risk factors are older age, obesity, previous leg injuries, DVT,
and phlebitis
▪ Treatment-compression therapy, leg elevation, topical negative pressure; ASA, pentoxifylline
o Herpes Zoster (Shingles)
▪ Infects nerves
▪ From chicken pox but lays dormant for
years
▪ Affect small section on one side of body
▪ Pain, burning, numbness or tingling; sensitivity to touch; red
rash that begins a few days after pain
▪ Anti-viral meds-acyclovir
o Urticaria (Hives)
▪ Allergic reaction in response to histamine
▪ Welts associated – red or flesh-colored; intensely itchy; roughly oval
or shaped like a worm; a few millimeters to several inches across
o Psoriasis
▪ Causes-family history; bacterial, viral, or fungal; severe burn; stress; obesity; smoking;
alcohol abuse; vitamin deficiency; beta blockers, antimalarials, and lithium
▪ Abnormal immune reaction with rapid buildup of skin cells
▪ Red patches with thick, silvery scales which may range from a
few spots to large areas of scaly patches
▪ Small scaling spots; dry cracked skin accompanied by bleeding
▪ Itching, burning and painful lesions; swollen joint with stiffness
▪ No treatment just reduces symptoms of pain, inflammation, and
scaling-Psoralens with light therapy (methoxsalen)
o Impetigo
▪ Transmitted through direct contact; contaminated surfaces, objects, clothing, toys; crowds
▪ Infection by strep or staph
▪ Red sores on face, especially around nose, mouth, on hands & feet
▪ Sores rupture and ooze; mild itching; ruptured sores honey-colored
crusts
▪ ATB or ointment – Cephalosporin; Mupirocin
o Folliculitis
▪ Causes-bacterial infection like staph; fungi like yeast; damage in hair follicles due to
skin irritation, shaving, or waxing; friction from clothes; blockage due to sweat, oil or makeup; insects bites
▪ Small red bumps; white-headed pimples; pus filled sores; crusty
sores; red skin; inflamed skin
▪ Topical-Clindamycin lotion; Oral-dicloxacillin; antifungal- ketoconazole
o Systemic lupus erythematosus
▪ Causes unknown; genetics; environmental factors – exposure to UV rays, viruses, medication, emotional stress, trauma; hormones
▪ Butterfly rash; appetite, hair loss; fever; fatigue; photosensitivity; Raynaud’s
▪ Anti-inflammatory meds-Ibuprofen, Naproxen; steroid creams- triamcinolone; immune suppressants-methatrexate
o Acne vulgaris
▪ Clogged hair follicles under the skin
▪ Age; excess sebum or oil production;
accumulation of dead skin cells; bacterial [Show Less]