MSN Exam for Dermatitis

EXPLANATION

 

✔Correct answer:

Wear UV-blocking sunglasses during the treatment and for 24 hours post-treatment. Photochemotherapy, also known as PUVA (psoralen and ultraviolet A) therapy, involves the administration of a photosensitizing agent (psoralen) followed by exposure to UVA light. This treatment can increase the sensitivity of the eyes to UV light, potentially causing photokeratitis or cataracts if proper precautions are not taken. Wearing UV-blocking sunglasses during and for 24 hours post-treatment helps protect the eyes from harmful UV exposure, minimizing the risk of these complications.

PUVA therapy increases the skin and eyes' sensitivity to UV light due to the photosensitizing effects of psoralen. UV-blocking sunglasses filter out harmful UVA rays, providing a protective barrier for the eyes. This precaution is crucial as UVA light can penetrate deep into the eyes, potentially damaging the cornea and lens if they are not adequately protected.

Think of your eyes as delicate flowers. Just as you would use a sunshade to protect flowers from strong sunlight to prevent them from wilting, wearing UV-blocking sunglasses shields your eyes from harmful UV rays, keeping them safe and healthy.

Instructing a patient undergoing photochemotherapy involves emphasizing several key precautions to ensure safety and effectiveness:

• Wear UV-blocking sunglasses during the treatment and for 24 hours afterward to protect the eyes from UV exposure.
• Apply sunscreen to exposed skin areas to prevent sunburn and photosensitivity reactions.
• Avoid direct sunlight and bright indoor light for at least 24 hours after treatment to minimize the risk of skin and eye damage.
• Follow all instructions regarding the timing and dosage of psoralen administration to ensure optimal therapeutic effects.
• Monitor for any adverse reactions such as redness, swelling, or pain, and report these to the healthcare provider promptly.

 

✘Incorrect answer options:

Wear sunglasses during the treatment and for 4 hours post-treatment. While wearing sunglasses is beneficial, the duration is insufficient. The eyes remain sensitive to UV light for a longer period, necessitating protection for at least 24 hours.

Wear protective goggles during the treatment and avoid bright light exposure for 12 hours post-treatment. Protective goggles are necessary during the treatment, but UV-blocking sunglasses should be worn for 24 hours post-treatment for adequate protection. Twelve hours is not sufficient to protect against prolonged UV sensitivity.

Wear an eye mask during the treatment and for 8 hours post-treatment. An eye mask does not provide adequate protection against UV light. UV-blocking sunglasses are specifically designed to filter out harmful UVA rays and are required for 24 hours post-treatment to ensure eye safety.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Contact dermatitis. Contact dermatitis is an inflammatory skin condition caused by exposure to an allergen or an irritant. It occurs when a substance triggers an allergic reaction or directly irritates the skin. Upon subsequent exposure, the skin may develop a red, itchy rash. Contact dermatitis can be classified into two types: allergic contact dermatitis and irritant contact dermatitis.

In allergic contact dermatitis, the immune system becomes sensitized to a substance (allergen) during initial exposure. Upon subsequent exposure, the immune system reacts, causing inflammation and a rash. Common allergens include poison ivy, nickel, and certain cosmetics. In irritant contact dermatitis, the skin is damaged by direct chemical or mechanical irritation, such as detergents, acids, or prolonged exposure to water, leading to inflammation without involving the immune system.

Think of contact dermatitis like a security system that gets triggered by a specific intruder. The first time the intruder (allergen or irritant) enters, the system remains calm. But once the system recognizes the intruder from previous encounters, it sounds the alarm (inflammation and rash) every time the intruder appears again, leading to the skin's defensive reaction.

Managing contact dermatitis involves identifying and avoiding the offending substance, reducing inflammation, and soothing the affected skin:

• Identifying and avoiding the allergen or irritant causing the reaction.
• Using topical corticosteroids to reduce inflammation and itching.
• Applying emollients to moisturize and protect the skin.
• Using antihistamines to control itching if necessary.
• Educating the patient on proper skin care and avoidance strategies.

 

✘Incorrect answer options:

Scleroderma. Scleroderma is a chronic autoimmune disease characterized by hardening and tightening of the skin and connective tissues. It does not result from exposure to allergens or irritants and does not present with a rash upon subsequent exposure.

Sunburn. Sunburn is caused by overexposure to ultraviolet (UV) radiation from the sun, leading to redness, pain, and sometimes blistering. It is not related to an allergic reaction or direct irritation from chemicals.

Frostbite. Frostbite occurs due to prolonged exposure to freezing temperatures, causing damage to the skin and underlying tissues. It does not involve a rash and is not caused by allergens or chemical irritants.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Apply a thin layer of the cream, gently rubbing it into the skin. When administering topical medications such as dexamethasone cream, it is important to apply a thin layer to ensure the medication is adequately absorbed by the skin. Gently rubbing the cream into the affected area allows for even distribution and better penetration of the medication. This technique helps maximize the therapeutic effects while minimizing the potential for side effects.

Topical corticosteroids like dexamethasone work by reducing inflammation and suppressing the immune response in the skin. Proper application ensures that the medication is effectively absorbed into the affected area, allowing it to exert its anti-inflammatory and immunosuppressive effects. Applying too much cream can lead to excessive absorption, increasing the risk of systemic side effects, while applying too little may not provide sufficient therapeutic benefit.

Think of applying the cream like spreading butter on a slice of bread. You want to spread a thin, even layer to cover the entire surface without overloading any one area, ensuring the whole piece gets the right amount.

Proper technique for applying topical medications includes the following steps:

• Wash hands thoroughly before and after applying the medication.
• Clean and dry the affected area before application.
• Apply a thin layer of the cream to the affected area.
• Gently rub the cream into the skin until it is evenly absorbed.
• Use the medication as directed by the healthcare provider, avoiding excessive or prolonged use.
• Monitor the skin for any adverse reactions or signs of infection.

 

✘Incorrect answer options:

Apply a thick layer of the cream and cover it with a gauze pad. Applying a thick layer can lead to excessive absorption of the medication, increasing the risk of side effects. Covering with a gauze pad may be necessary in some cases but is not standard practice for routine application of topical corticosteroids.

Apply the cream only around the edges of the affected area. This technique would leave the central part of the affected area untreated, reducing the effectiveness of the medication and potentially prolonging the condition.

Apply the cream to a cotton ball and dab it onto the skin. Using a cotton ball may not allow for even distribution or adequate absorption of the medication. Direct application and gentle rubbing into the skin are more effective techniques.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Stop giving the infant a new food that was introduced just before the rash appeared. Diaper dermatitis, commonly known as diaper rash, can be aggravated or even caused by new foods that an infant consumes. This is because new foods can change the composition of the infant’s stool, making it more irritating to the skin. By stopping the new food, parents can identify if the food is the culprit and prevent further irritation.

The skin of an infant is delicate and can react to changes in diet. When a new food is introduced, it can lead to changes in the stool's acidity and frequency, increasing the likelihood of diaper dermatitis. Removing the new food can help the skin heal and prevent further outbreaks.

Imagine wearing a new type of sock that causes your feet to sweat more and creates blisters. By stopping wearing those socks, you allow your feet to heal and prevent further blisters, similar to how stopping a new food can help an infant’s skin recover.

Managing diaper dermatitis involves several key steps to promote healing and prevent recurrence:

• Stop any new foods that might be causing the rash.
• Keep the diaper area clean and dry.
• Change diapers frequently to minimize skin exposure to moisture and irritants.
• Use barrier ointments such as zinc oxide to protect the skin.
• Allow the diaper area to air out as much as possible.

 

✘Incorrect answer options:

Avoid applying occlusive ointments to the rash. Occlusive ointments like zinc oxide or petroleum jelly are beneficial for diaper rash as they create a barrier protecting the skin from further irritation and moisture. Avoiding these can delay healing and increase irritation.

Opt for cloth diapers exclusively and rinse them in bleach. While cloth diapers can be a good option for some infants, rinsing them in bleach can leave chemical residues that may irritate the infant’s skin further. It is better to use a mild detergent and ensure thorough rinsing.

Clean the infant's skin with commercial baby wipes during each diaper change. Many commercial baby wipes contain alcohol or fragrances that can irritate sensitive skin, especially during a diaper rash. It is better to use water and a soft cloth or wipes specifically designed for sensitive skin.

 

References

• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.
• American Academy of Pediatrics. (2020). Diaper Rash: What It Is and How to Treat It. HealthyChildren.org.

EXPLANATION

 

✔Correct answer:

Vitamin B3. Pellagra is a disease caused by a deficiency of niacin (Vitamin B3) and is characterized by the "three Ds": dermatitis, diarrhea, and dementia. If left untreated, it can also lead to a fourth D, death. Niacin is essential for the metabolism of carbohydrates, fats, and proteins, and it plays a critical role in cellular metabolism and DNA repair.

Niacin is a water-soluble vitamin that is converted into nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), coenzymes essential for energy production and cellular functions. A deficiency in niacin disrupts these metabolic processes, leading to the symptoms of pellagra. The skin, gastrointestinal system, and nervous system are particularly affected due to their high turnover rates and energy demands.

Think of niacin like the fuel needed to keep a machine running smoothly. Without enough fuel, the machine (body) starts to malfunction, showing signs of wear (dermatitis), inefficient operation (diarrhea), and system errors (dementia).

Managing pellagra involves supplementing niacin and addressing dietary deficiencies:

• Administering niacin supplements to correct the deficiency.
• Encouraging a balanced diet rich in niacin, including foods like meat, fish, eggs, green vegetables, and grains.
• Monitoring and managing symptoms such as skin lesions and gastrointestinal disturbances.
• Educating the patient on the importance of maintaining a diet sufficient in essential vitamins to prevent recurrence.

 

✘Incorrect answer options:

Vitamin B1. Deficiency of Vitamin B1 (thiamine) leads to beriberi, which affects the cardiovascular and nervous systems, not pellagra. Symptoms of thiamine deficiency include weight loss, emotional disturbances, impaired sensory perception, weakness, and pain in the limbs.

Vitamin B2. Deficiency of Vitamin B2 (riboflavin) causes ariboflavinosis, which can lead to sore throat, redness and swelling of the lining of the mouth and throat, cracks or sores on the outsides of the lips (cheilosis) and at the corners of the mouth (angular stomatitis), and a moist, scaly skin inflammation (seborrheic dermatitis).

Vitamin B6. Deficiency of Vitamin B6 (pyridoxine) can lead to microcytic anemia, depression, confusion, and weakened immune function. While important, it does not cause pellagra.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Eczema. Atopic dermatitis is commonly known as eczema. It is a chronic skin condition characterized by dry, itchy, and inflamed skin. Eczema often appears in childhood and can persist into adulthood, although its severity can fluctuate over time. The exact cause of atopic dermatitis is not fully understood, but it is believed to involve a combination of genetic and environmental factors.

Atopic dermatitis involves a defective skin barrier, which leads to increased water loss and vulnerability to irritants and allergens. This defect can cause the skin to become dry and prone to inflammation. The immune system also plays a role, as it tends to overreact to certain triggers, causing the characteristic redness, swelling, and itching of eczema.

Think of the skin as a brick wall. In atopic dermatitis, some of the bricks (skin cells) and mortar (lipids) are missing or damaged, making the wall (skin) more prone to letting in irritants and losing moisture.

Managing atopic dermatitis involves a multifaceted approach to control symptoms and prevent flare-ups:

• Regularly moisturizing the skin to maintain hydration.
• Using topical corticosteroids to reduce inflammation during flare-ups.
• Identifying and avoiding triggers such as certain foods, fabrics, or environmental factors.
• Implementing gentle skin care routines, avoiding harsh soaps and hot water.
• Considering antihistamines to manage itching and improve sleep.

 

✘Incorrect answer options:

Pimples. Pimples are a common term for acne, which is a different skin condition characterized by the presence of comedones, pustules, and sometimes cysts due to blocked hair follicles and sebaceous glands.

Acne. Acne is a distinct skin condition involving inflammation of the sebaceous glands and hair follicles, leading to pimples, blackheads, and sometimes cysts, primarily affecting teenagers and young adults.

Psoriasis. Psoriasis is another chronic skin condition, but it is characterized by thick, red, scaly patches on the skin, usually found on the elbows, knees, scalp, and lower back. It involves an accelerated skin cell production cycle and is different from the dry, itchy, and inflamed presentation of eczema.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Infants and young children. Atopic dermatitis, also known as eczema, is most commonly seen in infants and young children. The condition often begins in early childhood, with many cases developing before the age of 5. It typically presents as red, itchy patches of skin, often on the face, scalp, and extensor surfaces of the limbs in infants. As children grow older, the distribution of eczema may change, frequently affecting the flexural areas such as the elbows and knees.

The exact cause of atopic dermatitis is not fully understood, but it involves a combination of genetic predisposition, immune system dysregulation, and environmental factors. The skin barrier in individuals with atopic dermatitis is often impaired, leading to increased water loss and vulnerability to irritants and allergens. This results in the characteristic inflammation and itching.

Think of a new wooden fence (infant’s skin) that hasn't been properly sealed. Over time, exposure to rain, sun, and other elements can cause the wood to crack and splinter (develop dermatitis). Proper sealing (skin care and management) can help protect and maintain the fence (skin) in good condition.

Managing atopic dermatitis in infants and young children involves a combination of strategies to soothe the skin and reduce flare-ups:

• Regularly moisturizing the skin to maintain hydration.
• Using gentle skin care products free from harsh chemicals and fragrances.
• Applying topical corticosteroids or other prescribed medications to control inflammation.
• Identifying and avoiding known triggers such as certain foods, fabrics, or environmental factors.
• Educating parents and caregivers on proper skin care routines and strategies to manage itching and prevent scratching.

 

✘Incorrect answer options:

Teenagers. While atopic dermatitis can persist into adolescence, it is less likely to first develop during the teenage years. Many children with atopic dermatitis see an improvement in their symptoms as they grow older.

Adults aged 20 to 49. Atopic dermatitis can continue into adulthood, but it is less common for it to first appear in this age group. Adult-onset eczema is possible but less prevalent compared to cases beginning in early childhood.

Older adults. Atopic dermatitis is uncommon as a new diagnosis in older adults. Skin changes and other dermatological conditions are more likely to develop due to aging, but new-onset atopic dermatitis is rare.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

An underlying emotional disorder. In the past, it was mistakenly believed that atopic dermatitis, also known as eczema, was caused by underlying emotional disorders or psychological stress. This misconception led to treatments focusing on addressing the supposed emotional causes rather than the actual physiological and immunological factors involved in the condition.

Atopic dermatitis is now understood to be a chronic inflammatory skin condition that involves a complex interplay of genetic, environmental, immunological, and skin barrier factors. It is characterized by dry, itchy, and inflamed skin. The immune system plays a critical role, with an overactive response leading to inflammation and skin symptoms. Genetic mutations affecting the skin barrier, such as those involving the filaggrin protein, also contribute to the condition.

Imagine the skin as a brick wall. In atopic dermatitis, some bricks are missing or damaged (genetic factors), and the wall is constantly attacked by strong winds (immune response). Blaming emotional stress for the damaged wall ignores the real structural and environmental problems causing it.

Managing atopic dermatitis involves addressing multiple aspects of the condition:

• Moisturization: Regularly applying emollients to maintain skin hydration and barrier function.
  Anti-inflammatory Treatments: Using topical corticosteroids or calcineurin inhibitors to reduce inflammation.
• Avoiding Triggers: Identifying and avoiding environmental and dietary triggers that can exacerbate symptoms.
• Patient Education: Teaching patients about proper skincare routines, the importance of avoiding scratching, and recognizing early signs of flare-ups.
• Monitoring and Follow-up: Regularly assessing the patient’s condition and adjusting treatment plans as necessary to manage symptoms effectively.

 

✘Incorrect answer options:

Excessive exposure to sunlight. Excessive exposure to sunlight has not been a common misconception as a cause of atopic dermatitis. In fact, sunlight can sometimes help improve symptoms in some individuals due to its anti-inflammatory effects.

Allergies to certain foods. While food allergies can trigger or exacerbate atopic dermatitis in some individuals, they are not considered a primary cause of the condition. Food allergies are one of many factors that can influence the severity of symptoms.

None of the listed options. This option is incorrect because there is indeed a historical misconception that atopic dermatitis was caused by an underlying emotional disorder.

 

References

• Leung, D. Y. M., & Bieber, T. (2003). Atopic dermatitis. *The Lancet*, 361(9352), 151-160.
• Eichenfield, L. F., Tom, W. L., Chamlin, S. L., Feldman, S. R., Hanifin, J. M., Simpson, E. L., ... & Sidbury, R. (2014). Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. *Journal of the American Academy of Dermatology*, 70(2), 338-351.

EXPLANATION

 

✔Correct answer:

Both asthma and allergies. Atopic dermatitis is often part of a group of related conditions known as the "atopic triad," which includes atopic dermatitis, asthma, and allergic rhinitis (allergies). Individuals with atopic dermatitis are at a higher risk of developing asthma and allergies due to their underlying genetic predisposition and immune system characteristics. These conditions are interconnected through shared inflammatory pathways and immune responses.

Atopic dermatitis is characterized by a chronic inflammatory response in the skin, often triggered by allergens, irritants, or stress. The immune dysregulation seen in atopic dermatitis can also affect the respiratory system, leading to asthma, and the nasal passages, causing allergic rhinitis. This is due to a type of immune cell called T-helper 2 (Th2) cells, which are involved in both skin inflammation and respiratory hypersensitivity reactions.

Think of the body’s immune system as a security system. In someone with atopic dermatitis, the security system is overly sensitive and not only reacts to skin invaders but also to allergens in the airways, leading to asthma and allergies.

Managing atopic dermatitis along with asthma and allergies involves a comprehensive approach:

• Implementing regular skin care routines to manage atopic dermatitis and prevent flare-ups.
• Using medications like antihistamines to control allergic reactions and prevent asthma attacks.
• Educating patients and families on avoiding known allergens and triggers in both the environment and diet.
• Coordinating care with dermatologists, allergists, and pulmonologists to provide holistic management of these interconnected conditions.

 

✘Incorrect answer options:

Asthma. While it is correct that individuals with atopic dermatitis frequently have asthma, this option is incomplete because it does not include allergies, which are also common.

Allergies. Similar to asthma, allergies are frequently seen in individuals with atopic dermatitis, but this option is incomplete because it does not include asthma.

Acne. Acne is not typically associated with atopic dermatitis. Acne is caused by different factors, such as hormonal changes, excess oil production, and bacterial infection, and is not part of the atopic triad.

 

References

• Hockenberry, M. J., & Wilson, D. (2018). *Wong's Nursing Care of Infants and Children*. Elsevier.
• Levy, M. L. (2007). *Atopic dermatitis: Understanding the disease and its management*. Current Medical Research and Opinion, 23(12), 3091-3103.

EXPLANATION

 

✔Correct answer:

Angioneurotic edema. Angioneurotic edema, also known as angioedema, is characterized by diffuse swelling that affects the deeper layers of the skin, often around the eyes and lips, and sometimes the throat. This condition results from an allergic reaction that causes blood vessels to leak fluid into surrounding tissues. Angioedema can be life-threatening if it involves the airways, leading to difficulty breathing.

Angioedema involves the rapid swelling of the dermis, subcutaneous tissue, mucosa, and submucosal tissues. It is often associated with the release of histamine and other inflammatory mediators from mast cells and basophils in response to allergens. The increased vascular permeability allows fluid to accumulate in the tissues, causing the characteristic swelling.

Think of angioedema like a sponge soaking up water and swelling quickly. When an allergic reaction occurs, the body's tissues act like a sponge, rapidly absorbing fluid and swelling as a result.

Managing angioedema requires prompt recognition and intervention to ensure patient safety:

• Administering antihistamines and corticosteroids to reduce the allergic reaction and swelling.
• Providing epinephrine in cases of severe reaction involving airway compromise.
• Monitoring respiratory status closely and being prepared to intubate if necessary.
• Identifying and avoiding triggers that may have caused the reaction.
• Educating the patient on the importance of carrying an emergency epinephrine injector if they have a history of severe allergic reactions.

 

✘Incorrect answer options:

Urticaria. Urticaria, commonly known as hives, involves raised, itchy welts on the skin's surface. Unlike angioedema, urticaria does not typically affect the deeper layers of the skin. It is also caused by an allergic reaction but presents with superficial, rather than deep, swelling.

Pitting edema. Pitting edema is characterized by swelling that retains an indentation when pressed. It is typically associated with conditions such as heart failure, liver disease, or chronic venous insufficiency, rather than an allergic reaction.

Contact dermatitis. Contact dermatitis is a localized skin reaction resulting from direct contact with an irritant or allergen. It presents with redness, itching, and sometimes vesicles, but does not typically involve the deeper layers of skin as seen in angioedema.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Linear streaks or patterns corresponding to the contact area. Contact dermatitis typically presents with linear streaks or patterns that correspond to the area of skin that came into contact with the allergen or irritant. This presentation is due to the direct exposure of specific skin areas to the offending substance, leading to localized inflammation, redness, itching, and sometimes vesicles or blisters along the line of contact.

Contact dermatitis is an inflammatory reaction in the skin caused by exposure to an external substance. In allergic contact dermatitis, the immune system becomes sensitized to the allergen, causing an inflammatory response upon re-exposure. In irritant contact dermatitis, the substance directly damages the skin cells, causing inflammation. The distribution of the rash reflects the areas of contact with the substance.

Imagine drawing a line with a marker on your skin. If the marker's ink is irritating, you would see a line of redness and itching exactly where the marker touched, similar to how contact dermatitis shows up where the skin came into contact with the irritant or allergen.

Confirming and managing contact dermatitis involves several steps:

• Identifying and avoiding the offending substance to prevent further exposure and worsening of the condition.
• Using topical corticosteroids to reduce inflammation and alleviate itching.
• Applying emollients to moisturize and protect the affected skin.
• Providing antihistamines if itching is severe and interferes with daily activities or sleep.
• Educating the patient on proper skin care and how to recognize and avoid potential allergens or irritants.

 

✘Incorrect answer options:

Circular patches with a central clearing and raised borders. This presentation is characteristic of tinea (ringworm) infections, not contact dermatitis. Tinea typically presents with annular, scaly patches with central clearing and raised, defined borders.

Widespread redness and swelling without defined borders. This presentation is more typical of conditions such as cellulitis or systemic allergic reactions rather than contact dermatitis, which is usually localized to the contact area.

Small, clustered blisters that spread to unaffected areas. This presentation is more characteristic of conditions such as herpes simplex virus infections or dyshidrotic eczema. Contact dermatitis typically does not spread beyond the contact area unless there is continued exposure.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Viral infection. The use of topical corticosteroids is contraindicated in the presence of viral infections. Viral infections such as herpes simplex virus (HSV) or varicella-zoster virus (chickenpox) can worsen or spread when treated with topical corticosteroids because these medications suppress the local immune response, allowing the virus to replicate more freely. This can lead to complications such as eczema herpeticum, a severe and potentially life-threatening condition caused by widespread HSV infection in patients with atopic dermatitis.

Topical corticosteroids work by reducing inflammation and suppressing the immune response in the skin. While this is beneficial for controlling eczema, it can impair the skin's ability to fight off viral infections. The suppression of the local immune response can lead to unchecked viral replication and dissemination, exacerbating the infection and potentially causing systemic illness.

Imagine trying to stop a small fire (eczema) with water (topical corticosteroids), but if there is an electrical fire (viral infection), using water can make it worse and cause more damage. You need a different approach to safely manage the situation.

Managing a patient with atopic dermatitis who has a concurrent viral infection requires careful consideration of treatment options:

• Avoiding the use of topical corticosteroids if a viral infection is present or suspected.
• Using antiviral medications if appropriate to treat the underlying viral infection.
• Implementing alternative therapies to manage eczema symptoms, such as non-steroidal topical treatments (e.g., calcineurin inhibitors) or systemic treatments under medical guidance.
• Monitoring for signs of eczema herpeticum and providing prompt medical intervention if it occurs.
• Educating the patient on the importance of avoiding contact with known viral infections and practicing good hygiene.

 

✘Incorrect answer options:

Bacterial infection. While bacterial infections need to be treated appropriately, topical corticosteroids are not absolutely contraindicated. They can be used in combination with antibacterial treatments, but care must be taken to address the bacterial infection.

Spirochete infection. Spirochete infections, such as Lyme disease, require specific antibiotic treatment. Topical corticosteroids are not typically used for spirochete infections but are not a direct contraindication.

Parasite infection. Parasite infections involve specific antiparasitic treatments. Topical corticosteroids are generally not used for parasitic infections but are not explicitly contraindicated unless there is a secondary complication.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Taking measures to protect the infant from infection. Atopic dermatitis, also known as eczema, is a chronic skin condition that causes inflamed, itchy, and red skin. In infants, it often appears on the face, scalp, and sometimes other areas of the body. The skin barrier in atopic dermatitis is compromised, making it more susceptible to infections. Therefore, preventing infections is a primary focus in the care plan for infants with this condition. This includes maintaining skin integrity, using appropriate moisturizers, and monitoring for signs of infection.

Atopic dermatitis is associated with a defective skin barrier and an immune response that leads to inflammation. The condition is characterized by dry, itchy, and scaly skin. The impaired skin barrier allows allergens and irritants to penetrate more easily, leading to increased risk of infection. Common pathogens include Staphylococcus aureus, which can exacerbate the condition.

Think of the skin as a brick wall protecting a house. In atopic dermatitis, the mortar between the bricks is weak, allowing water and pests to get in. Protecting the house involves fixing the mortar and keeping pests out to prevent further damage.

For managing atopic dermatitis in infants, several interventions are critical:

• Regularly apply emollients to keep the skin hydrated and enhance the skin barrier.
• Use gentle, fragrance-free skin care products to avoid irritation.
• Monitor for signs of infection such as increased redness, warmth, or discharge, and seek medical attention if they occur.
• Educate caregivers on the importance of hand hygiene and keeping the infant's environment clean to reduce infection risk.

 

✘Incorrect answer options:

Restricting the infant's intake of fluids by mouth. Fluid restriction is not a relevant intervention for atopic dermatitis. In fact, maintaining proper hydration is important for overall skin health.

Providing medications to reduce fever. While fever management is important, it is not a primary focus in the care of atopic dermatitis unless the fever is due to an infection secondary to the skin condition. The main focus is on skin care and preventing infection.

Ensuring the infant's skin remains dry and free from moisture. This is incorrect as dry skin can worsen atopic dermatitis. The goal is to keep the skin moisturized to maintain the skin barrier and prevent cracking and infection.

 

References

• Hockenberry, M. J., & Wilson, D. (2018). *Wong's Nursing Care of Infants and Children*. Elsevier.
• Levy, M. L. (2007). *Atopic dermatitis: Understanding the disease and its management*. Current Medical Research and Opinion, 23(12), 3091-3103.

EXPLANATION

 

✔Correct answer:

It goes through cycles of flares and remissions. Atopic dermatitis, commonly known as eczema, is characterized by chronic inflammation of the skin that goes through cycles of flares and remissions. During flares, symptoms such as itching, redness, and scaling become more intense, while during remissions, symptoms may diminish or disappear completely. This pattern of episodic exacerbation and improvement is a hallmark of atopic dermatitis.

Atopic dermatitis is a multifactorial condition involving a compromised skin barrier, immune system dysregulation, and environmental triggers. The impaired skin barrier allows allergens and irritants to penetrate more easily, provoking an immune response that leads to inflammation. This cycle of inflammation and healing results in the characteristic flares and remissions.

Think of atopic dermatitis like a campfire that occasionally flares up when more wood is added (triggers), but then settles down when the wood burns out (remission).

Managing atopic dermatitis involves a comprehensive approach to control symptoms and prevent flares:

• Maintaining skin hydration with regular use of emollients.
• Applying topical corticosteroids or calcineurin inhibitors to reduce inflammation during flares.
• Identifying and avoiding triggers, such as allergens, irritants, and stress.
• Implementing gentle skin care routines, avoiding hot water and harsh soaps.
• Considering systemic treatments, such as antihistamines or immunosuppressants, in severe cases.

 

✘Incorrect answer options:

It can leave pockmarks on the skin. Pockmarks, or deep scars, are typically associated with conditions like severe acne or chickenpox, not atopic dermatitis. While eczema can cause skin thickening and discoloration due to chronic scratching, it does not usually leave pockmarks.

It tends to worsen during the autumn season. Atopic dermatitis does not have a specific seasonal pattern that applies to all patients. While some individuals might experience worsening symptoms in colder, drier months, others might find their symptoms flare in different conditions. The seasonal impact varies among individuals.

It predominantly affects the face compared to other body areas. Atopic dermatitis can affect various parts of the body and its distribution can change with age. In infants, it often appears on the face and scalp, but in older children and adults, it commonly affects the flexural areas such as the elbows, knees, and wrists.

 

References

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Elsevier.
• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. Elsevier.

EXPLANATION

 

✔Correct answer:

Related to the skin absorbing the topical corticosteroid. The primary concern with the use of potent topical corticosteroids, especially under occlusive dressings, is the increased absorption of the medication through the skin. This can lead to systemic effects such as adrenal suppression, skin thinning (atrophy), and other potential side effects. By including "related to the skin absorbing the topical corticosteroid," Nurse Thompson accurately identifies the main risk factor that contributes to the "Risk for injury" diagnosis.

When corticosteroids are applied topically, they work by reducing inflammation and suppressing the immune response in the skin. However, when these potent corticosteroids are absorbed into the systemic circulation, they can suppress the hypothalamic-pituitary-adrenal (HPA) axis. This suppression can lead to decreased production of endogenous corticosteroids, causing potential adrenal insufficiency and other systemic effects such as hyperglycemia, hypertension, and Cushing's syndrome.

Think of the skin as a sponge. Applying a potent corticosteroid is like soaking the sponge in water. When the sponge (skin) absorbs too much water (corticosteroid), it becomes heavy and affects the entire structure (body).

Addressing the risk for injury associated with topical corticosteroid use involves several key steps:

• Monitor for Side Effects: Regularly check for signs of skin atrophy, increased bruising, or other local skin changes.
• Assess Systemic Effects: Monitor for symptoms of systemic absorption, such as weight gain, fluid retention, or signs of adrenal suppression.
• Educate the Patient: Provide thorough education on the correct application of the corticosteroid, emphasizing the importance of following prescribed durations and areas of application.
• Avoid Sensitive Areas: Instruct the patient to avoid applying the corticosteroid to sensitive areas like the face, neck, and skin folds unless specifically directed by the physician.
• Use Sparingly: Encourage the use of the minimal effective amount of corticosteroid to reduce the risk of absorption.

 

✘Incorrect answer options:

Related to the application of the topical corticosteroid to sensitive areas such as the face, neck, and skin folds. While applying corticosteroids to sensitive areas can increase the risk of local side effects such as skin thinning, the primary concern with "Risk for injury" is systemic absorption, which is not specific to these areas alone.

Related to the blood vessel-widening effects of the topical corticosteroid. Topical corticosteroids do not primarily cause blood vessel widening (vasodilation); they are more associated with vasoconstriction, which helps reduce inflammation and redness. This option does not accurately reflect the primary risk.

Related to possible interactions between the topical corticosteroid and other medications the client is taking. While drug interactions are a valid concern, the specific risk for injury in this context is more directly related to the absorption and systemic effects of the corticosteroid rather than interactions with other medications.

 

References

• Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). *Medical-Surgical Nursing: Assessment and Management of Clinical Problems*. Elsevier.
• Hinkle, J. L., & Cheever, K. H. (2018). *Brunner & Suddarth's Textbook of Medical-Surgical Nursing*. Wolters Kluwer.