oral exam ncm102
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GroupGroup 2D2 2D2
GroupGroup 2D2 2D2
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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
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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
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IMPETIGO
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Causative Agent
Incubation Period: 2 to 5 days
Period of Communicability : From
outbreaks of lesions until lesions are
healed
Mode of transmission
Immunity : NONE
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beta- hemolytic
streptococcus group A( nonbullous),
Staphylococcus
aureus ( bullous)
BACKBACK
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Direct contact with lesions
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2 forms
�B
ullous
�Nonbullous
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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
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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.
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Others:
NO Regional lymph nodes
Adenopathy not palpable
NO Erythema
NO Fever
BACKBACK
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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.
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Figure 1.
Nonbullous impetigo on
the face.
Figure 2.
Nonbullous impetigo in the
groin.
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How is Impetigo diagnosed???.
based on a complete medical
history and physical examination
Culture or Gram Stain
Skin scraping
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Nursing Diagnosis...
Impaired skin/tissue
integrity
Acute pain
Situational Low esteem
Self- care Deficit
Infection
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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
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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.
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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.
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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.
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Prepared by : Bernadette A. Pasive BSN2D2
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Juvenile RheumatoidJuvenile Rheumatoid
ArthritisArthritis
P repared b y :
Ch ristine B. C ortez
BSN- 2D2
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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 ) )
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O nset T y pes O nset T y pes� pauciarticular (< 4
joints)
� polyarticular (> 5 joints)
� systemic (arthritis
with fever and rash)
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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
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xx--ray findings: soft tissue swelling,ray findings: soft tissue swelling,periarticularperiarticular osteoporosis, growthosteoporosis, growth
disturbance, loss of joint spacedisturbance, loss of joint space
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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
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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
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TREATMENT
ANDMEDICATIONS
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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
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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
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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
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Diabetes Type IDiabetes Type I
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.
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Diabetes Type IDiabetes Type I
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.
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Diabetes Type IDiabetes Type I
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.
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Diabetes Type IDiabetes Type I
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.
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Diabetes Type IDiabetes Type I
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.
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Diabetes Type IDiabetes Type I
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))
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Diabetes Type IDiabetes Type I
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
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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.
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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.
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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.
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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.
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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.
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