oral exam ncm102

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GroupGroup 2D2 2D2

GroupGroup 2D2 2D2



S igns & Sym pto m s:� Itching & rashes

� Black burrow filled with mite feces

� 1-2 inches long, usually found in betweenfingers & toes, on palms, or in axilla or

groin

SCABIES



T reat m ent:� Caution adolescent that groin infestations

might be spread by physical intimacy

� Wash area with lindane (kwell) lotion or permethrin (elimite)

SCABIES



IMPETIGO



Causative Agent

Incubation Period: 2 to 5 days

Period of Communicability : From

outbreaks of lesions until lesions are

healed

Mode of transmission

Immunity : NONE



beta- hemolytic

streptococcus group A( nonbullous),

Staphylococcus

aureus ( bullous)

BACKBACK



Direct contact with lesions



2 forms

�B

ullous

�Nonbullous



a cutaneous

condition thatcharacteristically

occurs in the

preschooler, andis caused by a

bacterial

infection,

presentingwith bullae. Commonly found on

intertrigenous area such as

the armpit or inguinal area



Causative Agent :

Staphylococcus aureus

lacci transparent

ullae

Painless an flui -

fille listers

The surroun ing skin of

the listers may e re an

itchy ut not sore. When

the listers reak, they scaover with a yellow-colore

crust that lasts longer thansores from other type of

impetigo.



Others:

NO Regional lymph nodes

Adenopathy not palpable

NO Erythema

NO Fever

BACKBACK



IMPETIGO

CONTAGIOSACausative Agent : GABHSor either Streptococcus Or

Staphylococcus species

Nonbullous impetigo begins as a single red macule or papule that quickly

becomes a vesicle. The vesicle ruptures easily to form an erosion, and

the contents dry to form characteristic honey-colored crusts that may be

pruritic (Figures 1 and 2). Impetigo often is spread to surrounding areas

by autoinoculation. This infection tends to affect areas subject toenvironmental trauma, such as the extremities or the face. Spontaneous

resolution without scarring typically occurs in several weeks if the

infection is left untreated.



Figure 1.

Nonbullous impetigo on

the face.

Figure 2.

Nonbullous impetigo in the

groin.



How is Impetigo diagnosed???.

based on a complete medical

history and physical examination

Culture or Gram Stain

Skin scraping



Nursing Diagnosis...

Impaired skin/tissue

integrity

Acute pain

Situational Low esteem

Self- care Deficit

Infection



Complications

Acute Glomerulonephritis

active inflammation in the glomeruli

headache, anorexia, dull back pain,

edema

Cellulitis

a diffuse inflammation of connective tissue with severe

inflammation of dermal and subcutaneous layers of the

skin.

Lymphagitis

inflammation of lymphatic channel

erythematous



Penicillin or Erythromycin orally

administered

Application of mupirocin (Bactroban)

ointment for 7 to 10 days.

Wash the crusts daily with soap and

water for the lesions to heal quickly.

Contact precautions should be

implemented.



Instruct the patient to stay

indoors for a few days to stop any bacteriafrom getting into the blisters and making

the infections worse.

The infected persond s bed linens,

towels, and clothing should be separated

from those of other family members.

The infected person should use separate

towels for bathing and hand washing.



How does impetigo be prevented??.

Good hygiene.

Injured skin areas should

be kept clean and coveredwith clean gauze to prevent

infection

Regular and effective

hand washing practice.

Keep fingernails cut

short.



Prepared by : Bernadette A. Pasive BSN2D2



Juvenile RheumatoidJuvenile Rheumatoid

ArthritisArthritis

P repared b y :

Ch ristine B. C ortez

BSN- 2D2



J uvenile R h eu m atoid J uvenile R h eu m atoid

A rt h ritis A rt h ritis�� unknownunknown

�� combination of factorscombination of factors

± ± environmentenvironment(infection, trauma,(infection, trauma,stress)stress)

± ± autoimmunity autoimmunity ± ± immunogeneticimmunogenetic

( ( E tiolog y and P at h ogenesis E tiolog y and P at h ogenesis ) )



O nset T y pes O nset T y pes� pauciarticular (< 4

joints)

� polyarticular (> 5 joints)

� systemic (arthritis

with fever and rash)



L aborator y S tudies L aborator y S tudies�� CBC: normalCBC: normal�� ESR : usually normalESR : usually normal�� ANA : frequently positive ANA : frequently positive

�� RF: usually negativeRF: usually negative�� synovial fluid: class IIsynovial fluid: class II(inflammatory)(inflammatory)

�� xx--ray findings: soft tissueray findings: soft tissueswelling,swelling, periarticularperiarticular

osteoporosis, growthosteoporosis, growthdisturbance, loss of jointdisturbance, loss of jointspacespace



xx--ray findings: soft tissue swelling,ray findings: soft tissue swelling,periarticularperiarticular osteoporosis, growthosteoporosis, growth

disturbance, loss of joint spacedisturbance, loss of joint space



L aborator y features: L aborator y features:

pol y articular pol y articular disease disease�� WBC WBC oo,, HgbHgb qq, platelets WNL, platelets WNL

toto oo

�� ESR ESR oo toto oo oo�� ANA may be positiveANA may be positive�� RF may be positiveRF may be positive�� Synovial fluid: class IISynovial fluid: class II

(inflammatory)(inflammatory)�� XX--ray findings: soft tissueray findings: soft tissue

swelling,swelling, periarticularperiarticularosteoporosis, joint spaceosteoporosis, joint spacenarrowing, erosionsnarrowing, erosions



C linical features: C linical features:

s y ste m ic disease s y ste m ic disease�� 1010--20% of patients with JRA20% of patients with JRA

�� prominent systemicprominent systemic

symptoms: fever, rash,symptoms: fever, rash,

lymphadenopathylymphadenopathy,,

hepatosplenomegalyhepatosplenomegaly,,

pericarditispericarditis,, pleuritispleuritis

�� arthritis may be absent forarthritis may be absent for

months to yearsmonths to years

�� uveitisuveitis uncommonuncommon



TREATMENT

ANDMEDICATIONS



M edications in t h e

T reat m ent of J R A NSAIDNSAID

qqintraintra--articulararticular steroidssteroids

sulfasalazinesulfasalazine

hydroxychloroquinehydroxychloroquine((auranofinauranofin))qq

methotrexatemethotrexate(IM gold)(IM gold)

(D(D--penicillaminepenicillamine))

qqetanerceptetanerceptazathioprineazathioprine

cyclophosphamidecyclophosphamidecyclosporincyclosporin



JUV ENI L E RH E UM A TO I D JUV ENI L E RH E UM A TO I D A R T HR I T IS A R T HR I T IS

T reat m ent: p hy sical m easuresT reat m ent: p hy sical m easuresheat:heat: analgesiaanalgesia

muscle relaxationmuscle relaxationsplinting: provide joint restsplinting: provide joint rest

maintain functionalmaintain functionalpositionpositioncorrect deformitiescorrect deformities

exercise:exercise: passive, activepassive, activeassisted andassisted and

active range of active range of motionmotiongeneral conditioninggeneral conditioning

restrest

BACK



Diabetes Type IDiabetes Type I

DIAGNOSES:DIAGNOSES:�� ImbalancedImbalanced Nutrition: Less/More than BodyNutrition: Less/More than Body

�� RequirementsRequirements

�� IneffectiveIneffective tissue perfusion: Renal,tissue perfusion: Renal,cardiopulmonary, peripheralcardiopulmonary, peripheral

�� ImpairedImpaired urinary eliminationurinary elimination

�� Disturbed sensory perception: Visual, tactileDisturbed sensory perception: Visual, tactile

�� Activity Intolerance Activity Intolerance

�� Ineffective CopingIneffective Coping

�� Sexual dysfunctionSexual dysfunction




Treatment:Treatment:

INSULININSULIN�� InsulinInsulin lowers blood sugar by allowing it to leavelowers blood sugar by allowing it to leave

the bloodstream and enter cells. Everyone needsthe bloodstream and enter cells. Everyone needsinsulin. Peopleinsulin. People

�� Insulin is usually injected under the skin. In someInsulin is usually injected under the skin. In some

cases, a pump delivers the insulin continuously.cases, a pump delivers the insulin continuously.Insulin does not come in pill form.Insulin does not come in pill form.

�� Insulin preparations differ in how fast they startInsulin preparations differ in how fast they startto work and how long they last. The health careto work and how long they last. The health careprofessional will review your blood glucose levelsprofessional will review your blood glucose levelsto determine the appropriate type of insulin youto determine the appropriate type of insulin youshould use. More than one type of insulin mayshould use. More than one type of insulin may

be mixed together in an injection to achieve thebe mixed together in an injection to achieve thebest blood glucose control.best blood glucose control.




DIET People with type 1 diabetes should eat at

about the same times each day and try to

be consistent with the types of food theychoose. This helps to prevent blood sugar

from becoming extremely high or low.

PHY SICAL ACTIVIT Y PHY SICAL ACTIVIT Y Regular exercise helps control the amount of Regular exercise helps control the amount of

sugar in the blood. It also helps burn excesssugar in the blood. It also helps burn excess

calories and fat to achieve a healthy weight.calories and fat to achieve a healthy weight.

Ask your health care provider before starting Ask your health care provider before starting

any exercise program. Those with type 1any exercise program. Those with type 1diabetes must take special precautions before,diabetes must take special precautions before,

during, and after intense physical activity or during, and after intense physical activity or

exercise.exercise.




SELF SELF--TESTING TESTINGSelf Self--testing refers to being able to check your bloodtesting refers to being able to check your blood

sugar at home yourself. Regular self sugar at home yourself. Regular self--testing of your testing of your

blood sugar tells you and your health care provider blood sugar tells you and your health care provider how well your diet, exercise, and diabeteshow well your diet, exercise, and diabetes

medications are working. This is also called self medications are working. This is also called self--

monitoring of blood glucose, or SMBG.monitoring of blood glucose, or SMBG.

A health care provider or diabetes educator will help A health care provider or diabetes educator will helpset up a testing schedule for you at home.set up a testing schedule for you at home.

��Your doctor will help you set a goal for what level your Your doctor will help you set a goal for what level your

blood sugar should be during the day. blood sugar should be during the day.

��The results can be used to adjust meals, activity, or The results can be used to adjust meals, activity, or

medications to keepmedications to keep blood sugar levels blood sugar levels within anwithin an

appropriate range. Tests are usually done before meals andappropriate range. Tests are usually done before meals andat bedtime. More frequent testing may be needed when youat bedtime. More frequent testing may be needed when you

are sick, under stress, or adjusting your insulin dosing.are sick, under stress, or adjusting your insulin dosing.




FOOT CARE FOOT CARE Diabetes causes damage to the bloodDiabetes causes damage to the blood

vessels and nerves. This can reduce your vessels and nerves. This can reduce your

ability to feel injury to or pressure on the foot.ability to feel injury to or pressure on the foot.

You may not notice a foot injury until severe You may not notice a foot injury until severeinfection develops. Diabetes can also damageinfection develops. Diabetes can also damage

blood vessels. Small sores or breaks in theblood vessels. Small sores or breaks in the

skin may progress to deeper skin ulcers.skin may progress to deeper skin ulcers.

Amputation of the affected limb may beAmputation of the affected limb may be

needed when these skin ulcers do notneeded when these skin ulcers do notimprove or become larger or deeper.improve or become larger or deeper.




SUGAR SUGAR

Hypoglycemia can develop quickly inHypoglycemia can develop quickly in

people with diabetes.people with diabetes.

Symptoms typically appear when the bloodSymptoms typically appear when the blood

sugar level falls below 70 mg/sugar level falls below 70 mg/dLdL. If you. If you

have symptoms:have symptoms:

��Do a blood sugar check.Do a blood sugar check.

��If the level is low or you have symptoms of If the level is low or you have symptoms of

hypoglycemia, eat something with sugar: 4hypoglycemia, eat something with sugar: 4

ounces of fruit juice, 3ounces of fruit juice, 3 -- 4 Lifesavers candies, or 4 Lifesavers candies, or

4 ounces of regular soda.4 ounces of regular soda. OvertreatingOvertreating a milda mild

low blood sugar reaction can lead to problemslow blood sugar reaction can lead to problems

with high blood sugar and difficult blood sugar with high blood sugar and difficult blood sugar

control overall.control overall.




CO M PLICATIONSCO M PLICATIONS

Your doctor may prescribe medications toYour doctor may prescribe medications to

reduce your chances of developing eyereduce your chances of developing eyedisease, kidney disease, and other conditionsdisease, kidney disease, and other conditions

that are more common in people withthat are more common in people with

diabetes.diabetes.--An ACE inhibitor (or ARB) is often An ACE inhibitor (or ARB) is often

recommended as the first choice for those withrecommended as the first choice for those withhigh blood pressure and those with signs of high blood pressure and those with signs of

kidney disease. ACE inhibitors include:kidney disease. ACE inhibitors include:

��BenazeprilBenazepril ((LotensinLotensin))

��CaptoprilCaptopril ((CapotenCapoten))��EnalaprilEnalapril ((VasotecVasotec))

��GuinaprilGuinapril ((Accupril Accupril))

��LisinoprilLisinopril ((PrinivilPrinivil,, ZestrilZestril))




STRESS STRESSIf you're stressed, it's easy to abandon your usualIf you're stressed, it's easy to abandon your usual

diabetes management routine. You might exercisediabetes management routine. You might exercise

less, eat fewer healthy foods or test your bloodless, eat fewer healthy foods or test your bloodsugar less oftensugar less often ²² and lose control of your bloodand lose control of your blood

sugar in the process. The hormones your body maysugar in the process. The hormones your body may

produce in response to prolonged stress may evenproduce in response to prolonged stress may even

prevent insulin from working properly, which onlyprevent insulin from working properly, which only

makes matters worse.makes matters worse.

What to do:What to do:

��Look for patterns.Look for patterns. Log your stress level on a scaleLog your stress level on a scale

of 1 to 10 each time you log your blood sugar level.of 1 to 10 each time you log your blood sugar level.

A pattern may soon emerge. A pattern may soon emerge.

��Take control.Take control. Once you know how stress affectsOnce you know how stress affectsyour blood sugar level, fight back. Learn relaxationyour blood sugar level, fight back. Learn relaxation

techniques. Prioritize your tasks. Set limits. Mosttechniques. Prioritize your tasks. Set limits. Most

importantly, take good care of yourself.importantly, take good care of yourself.

BACK



It is an autoimmune disease thatIt is an autoimmune disease that

occurs as a reaction to a group A occurs as a reaction to a group A

betabeta-- hemolytichemolytic streptococcalstreptococcal

infection.infection.

It occurs most often in children 6 to 15It occurs most often in children 6 to 15

years of age, with a peak incidence at 8years of age, with a peak incidence at 8

years. It is seen most often in poor,years. It is seen most often in poor,

crowded, urban areas, because childrencrowded, urban areas, because children

do not develop immunity todo not develop immunity to

streptococcal infections, that is why itstreptococcal infections, that is why it

recur and so as the rheumatic fever.recur and so as the rheumatic fever.



from mitral

insufficiency.

sudden

involuntary movement of the

limbs due to inflammation of basal

ganglia. It occurs most often in

children ages 7 and 14 years old.

demonstrated by asking the child to

count rapidly. They usually begins

with clear speech, but thensuddenly the sounds become

garbled or they cannot speak for

several seconds.

If asked to

children cannot keep

from making undulating, jerky

movements.



If asked to , the facial expression may

change rapidly from a cheshire cat grin to a

flat, expressionless grimace.

a macular

rash found predominantly on the

trunk.

subcutaneous nodules or

painless lumps on tendon sheaths bythe joints and swollen large joints.

If asked to

, they soon

hyperextend their wrists andfingers.

may be weak or may

consist of spasmodic contractions

and relaxation.



during the acute phase of

illness or until congestive heart

disease is not present.

Because pulse rate is a valuable

sign of improvement,

is

essential during the acute

phase.

It may be ordered when the

child is asleep as well as when the

child is awake to measure the effect

of activity on the pulse rate.

is used to eliminate

group A- hemolytic streptococci

completely.



Risk for non- adherence to drug therapy

related to knowledge deficit about

importance of long- term therapy.

Situational low self- esteem

related to chorea movements

secondary to rheumatic fever.

oral exam ncm102

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