1. What are scabies? What are signs and symptoms?
2. Describe the pathophysiology, clinical manifestations, evaluation, and treatment(s) for psoriasis, lichen planus, pemphigus, seborrheic keratosis, and actinic keratosis.
Pathophysiology
Plantar warts are caused by the human papillomavirus and typically present as small bumps with pain or tenderness when walking. Pemphigus is an autoimmune condition causing blisters, red itchy rash, and pustules (Patterson, 2013). Seborrheic keratosis appears as brown/black scaly patches on the face, chest, and back while actinic keratosis is thickened crusty bumps appearing due to sun exposure.
Clinical manifestations
Psoriasis is a chronic skin condition characterized by thick, scaly, red patches often on elbows knees scalp, and other parts of the body. Symptoms may include itching burning pain or soreness. Lichen planus is an itchy rash that typically appears as flat-topped purple or reddish-purple bumps with silvery scales on the arms legs, back, and sometimes mouth, genitals, hands, and feet. Pemphigus causes blisters filled with fluid called vesicles; red itchy rashes may also accompany them around mucous membranes such as the mouth, throat, eyes, nose, ears, lips genitals, anus, etc. Seborrheic Keratosis presents as wartlike brown to black scaly patches mostly found on the face chest, back, neck, and shoulders. Actinic Keratosis are crusty bump lesions appearing due to sun exposure usually on the face, scalp, back, hands, and arms, among other locations (Hansemann, 2017).
Evaluation
Psoriasis evaluation involves a physical examination, a complete review of medical history, and sometimes biopsy or blood tests. Lichen planus may be diagnosed through physical exam and obtaining a skin sample for analysis; in certain cases, it can also be identified with the use of magnifying glasses called dermoscopy (Patterson, 2013). Diagnosis of pemphigus is typically confirmed through biopsies or blood tests, while seborrheic keratosis can be diagnosed via biopsy confirming suspicious lesions. Actinic Keratosis diagnosis requires a dermatologist to examine the patient’s skin samples under a microscope.
Treatment
Treatment options depend on results from the evaluation; topical creams may reduce symptoms associated with psoriasis & lichen planus whereas systemic medications are often required for treating pemphigus, seborrheic keratosis, or actinic keratosis (Hansemann, 2017).
3. Tinea Capitis:
Pathophysiology: Tinea capitis, also known as scalp ringworm, is a fungal infection primarily caused by dermatophytes, such as Trichophyton and Microsporum species. These fungi invade the hair shafts and the superficial layers of the scalp.
Clinical Manifestations: Common signs include circular or irregularly shaped patches of hair loss, scaling, and erythema on the scalp. It can also cause itching, pustules, and sometimes tender lymph nodes. Some cases may have a black dot appearance due to broken hairs within the affected area.
Evaluation: Diagnosis is usually made through clinical examination and confirmed by microscopic examination of hair samples or fungal culture.
Treatment: Oral antifungal medications, such as griseofulvin, terbinafine, or itraconazole, are typically prescribed for several weeks. Topical antifungal shampoos and creams can also be used as adjunctive therapy.
Atopic Dermatitis (Eczema)
Pathophysiology: Atopic dermatitis is a chronic inflammatory skin condition with a complex and multifactorial etiology. It is associated with an impaired skin barrier function, immune dysregulation, genetic factors, and environmental triggers.
Clinical Manifestations: Common manifestations include dry, itchy, and inflamed skin with redness, scaling, and papules. It often affects flexural areas such as the creases of elbows and knees, but it can occur on any part of the body.
Evaluation: Diagnosis is based on clinical presentation and history. Occasionally, additional tests like skin patch testing may be done to identify potential allergens triggering the condition.
Treatment: Treatment involves a combination of measures to manage symptoms and prevent flare-ups. This may include moisturizing the skin regularly, avoiding triggers (e.g., certain soaps or allergens), using topical corticosteroids or calcineurin inhibitors during flares, and, in severe cases, oral immunosuppressants or biologics.
Impetigo Contagiosum
Pathophysiology: Impetigo is a superficial bacterial skin infection primarily caused by Staphylococcus aureus or Streptococcus pyogenes. It typically occurs when the skin is damaged, allowing the bacteria to enter and proliferate.
- Clinical Manifestations: Common manifestations include red, itchy, and crusted skin lesions, often with honey-colored crusts or vesicles that can rupture and form thick yellowish-brown crusts. It most commonly affects the face, especially around the mouth and nose.
- Evaluation: Diagnosis is typically made clinically based on the characteristic appearance of the lesions. In some cases, a bacterial culture or Gram stain may be performed to identify the causative organism.
- Treatment: Topical or oral antibiotics, such as mupirocin or oral cephalexin, are commonly prescribed. Infected individuals should also practice good hygiene, including frequent handwashing, to prevent spreading the infection.
- Thrush (Oral Candidiasis)
Pathophysiology: Thrush is an infection of the mucous membranes caused by the Candida species, particularly Candida albicans. It often occurs when the balance of microorganisms in the mouth is disrupted, allowing the fungus to overgrow.
Clinical Manifestations: Common manifestations include creamy white patches on the tongue, inner cheeks, and other areas of the mouth that can be easily scraped off. The affected areas may be sore, red, and sometimes bleed.
Evaluation: Diagnosis is usually made clinically based on the characteristic appearance of the lesions. In some cases, a microscopic examination or culture may be performed to confirm the presence of Candida.
- Treatment: Antifungal medications, such as nystatin oral suspension or fluconazole, are typically prescribed. Good oral hygiene practices, including brushing the teeth and tongue, are also important to help manage and prevent thrush.
- Molluscum Contagiosum
- Pathophysiology: Molluscum contagiosum is a viral skin infection caused by the molluscum contagiosum virus (MCV), a member of the poxvirus family. It is usually spread through direct contact with an infected person or contaminated objects.
- Clinical Manifestations: Common manifestations include small, flesh-colored, dome-shaped papules with a central depression or umbilication. They are usually painless but can be itchy and may occur anywhere on the body.
Evaluation: Diagnosis is typically made clinically based on the appearance of the lesions. In some cases, a skin biopsy or microscopic examination may be done to confirm the presence of MCV.
Treatment: In many cases, molluscum contagiosum resolves on its own without treatment. However, treatment options may include cryotherapy (freezing the lesions), curettage (scraping), topical medications (e.g., imiquimod or tretinoin), or in some cases, antiviral medications. Treatment is often considered for cosmetic reasons or when lesions are persistent or causing significant symptoms.
4. Evidence-based practice (EBP) has played an instrumental role in health care. The greatest significance has been the improvement in patient outcomes. Extensive research is conducted in order to determine if a certain change in an intervention is beneficial to patient safety and outcomes (Titler, 2008). The prime example of this has been the implementation of hand hygiene prior to and after patient care. EBP helps identify the best practices to deliver high-quality care with an emphasis on continuous learning and professional development by healthcare providers Titler, 2008). There are several reliable, evidence-based sources. Systematic reviews and meta-analyses are wonderful because these apply extensive methods to assess the quality and relevance of individual studies (ahrq.gov, 2018). Clinical practice guidelines are frequently reviewed and integrate the latest EBP. The National Institute of Health (NIH) is an invaluable source. NIH constantly conducts research and publishes guidelines based on EBP (ahrq.gov, 2018).
- 5. Careful, clear, and deliberative application of the best available evidence to actual patient situations is what we call “evidence-based practice” (EBP). What this entails is merging the understanding and experience of individual clinicians with the top notch quality external clinical data gleaned through systematic studies.
- EBP is crucial in the medical field since it has the potential to enhance both the standard of treatment and the final results for patients. By using EBP, medical practitioners are more likely to base their judgments on objective data rather than their own preferences (Shelton et al., 2018). This has the potential to enhance patient outcomes including health, complication rates, and length of stay in the hospital.
- There are various sources of evidence which can be used in EBP. The following include some of the reliable sources;
- Systematic reviews and meta-analysis: The results of these investigations are more reliable because they incorporate data from several other studies.
Randomized controlled trials: These studies are considered to be the most reliable since they include a random assignment of subjects to treatment groups.
Observation studies: Even if these studies do not use a random method to divide people into treatment groups, they nonetheless produce useful data.
Decisions concerning treatment can also be informed by the healthcare provider’s own clinical skills as well as the patient’s unique values and circumstances. The importance of evidence-based practice (EBP) in healthcare is rising. Guidelines for incorporating EBP into clinical practice have been released by a variety of groups, as well as the organization of Medicine and the “Agency for Healthcare Research and Quality”. The prevalence of evidence-based practice (EBP) is associated with improved patient outcomes.
- 6. I can say that I now have a significant amount of knowledge in the development process of a research proposal. Prior to this course, I essentially had minimal to no knowledge of the amount of time and work that goes into preparing a research proposal. Now that I understand the process and the information necessary, I think that I would be able to create further research proposals; however, I like to always be honest, and I know that being a nurse researcher is not the field for me. Certain components of the process, like the literature review and statistical review, were a stretch for me. While I’m thankful for new knowledge, I prefer working more hands-on with patients. But I understand the importance of research because it can have a direct effect on what treatment I may implement for a patient. One question I have regarding conducting research is who funds the research. This is more applicable to smaller entities that may not have a financial foundation that a large corporation does.
- 7. Research Proposal
- I feel confident for developing my research proposal in near future. This is geared by the fact that as part of my future profession as a nurse practitioner , I will need to prepare a study proposal, and I am convinced that I can do so successfully. I have gained a lot of knowledge about the procedure of developing a research proposal, and I am convinced that I will be able to follow the procedures needed in order to produce a proposal that is well written and convincing. I am also certain that I will be able to choose a research topic that is relevant to the nursing profession and that I will be able to construct a study that will provide an answer to that research question.
- Despite this, I still have a few inquiries and worries about the process of performing research in nursing. For instance, I am not really sure how to handle the ethical concerns that arise during research with human volunteers. As for myself, I am not really sure how to go about securing financial support for my research endeavors. As I continue my schooling and training to become a nurse researcher, these are the kinds of issues that I will need to find answers to.
In general, the possibility of carrying out research in the field of nursing excites me very much. I am excited to make a contribution to the existing body of knowledge in the field of nursing since I feel that research plays a crucial role in enhancing the quality of care that nurses give.
Expert Solution Preview
Introduction:
As a medical professor, it is my responsibility to design assignments and provide answers for medical college students. In this content, we will explore various dermatological conditions and their pathophysiology, clinical manifestations, evaluation, and treatment options. Additionally, we will discuss the significance of evidence-based practice in healthcare and the reliable sources that can be utilized.
Content:
1. Scabies:
Scabies is a highly contagious skin condition caused by the Sarcoptes scabiei mite. It is primarily transmitted through close skin-to-skin contact. The signs and symptoms of scabies include intense itching, especially at night, and the presence of small, red, thread-like burrows on the skin. Other common symptoms include small, raised bumps, blisters, and sores.
2. Dermatological Conditions:
2.1 Psoriasis:
Pathophysiology: Psoriasis is a chronic autoimmune disease characterized by an accelerated skin cell growth cycle. This results in the rapid accumulation of skin cells, leading to the formation of thick, scaly, red patches on the skin.
Clinical Manifestations: The clinical manifestations of psoriasis include raised, inflamed patches covered with silvery scales. These patches commonly occur on the elbows, knees, scalp, and lower back. Itching, burning, pain, or soreness may also be present.
Evaluation: Diagnosis is usually based on the appearance of the skin lesions. A skin biopsy may sometimes be performed to confirm the diagnosis.
Treatment: Treatment options for psoriasis include topical corticosteroids, moisturizers, and vitamin D analogs for mild cases. Systemic medications, such as methotrexate or biologic agents, may be prescribed for moderate to severe cases.
2.2 Lichen Planus:
Pathophysiology: Lichen planus is an immune-mediated disorder that affects the skin and mucous membranes. The exact cause is unknown, but it is thought to involve an abnormal immune response.
Clinical Manifestations: Lichen planus presents as purple or reddish-purple, itchy, flat-topped bumps with white, lacy lines on the surface. These lesions commonly occur on the arms, legs, back, and sometimes the mouth, genitals, hands, and feet.
Evaluation: Diagnosis is usually based on clinical examination and may be confirmed by a skin biopsy or dermoscopy.
Treatment: Treatment options for lichen planus include topical corticosteroids, oral antihistamines for itching, and oral corticosteroids or immunosuppressant drugs for severe cases.
2.3 Pemphigus:
Pathophysiology: Pemphigus is an autoimmune blistering disorder characterized by the production of antibodies that target desmosomal proteins of the skin and mucous membranes.
Clinical Manifestations: Pemphigus presents with painful, fragile blisters that rupture easily, leaving behind raw, red, weeping surfaces. These blisters commonly occur on the skin and mucous membranes, such as the mouth, throat, eyes, nose, ears, lips, genitals, and anus.
Evaluation: Diagnosis of pemphigus is typically confirmed through skin biopsies or blood tests to detect the presence of specific autoantibodies.
Treatment: Treatment for pemphigus involves the use of systemic corticosteroids, immunosuppressant drugs such as azathioprine or mycophenolate mofetil, and sometimes intravenous immunoglobulin therapy for severe cases.
2.4 Seborrheic Keratosis:
Pathophysiology: Seborrheic keratosis is a benign skin growth caused by an overgrowth of epidermal cells.
Clinical Manifestations: Seborrheic keratosis appears as brown or black, raised, stuck-on, waxy lesions with a rough, scaly, or wart-like texture. These lesions are commonly found on the face, chest, back, neck, and shoulders.
Evaluation: Diagnosis of seborrheic keratosis is usually based on clinical examination. If there is uncertainty or suspicion of malignancy, a biopsy may be performed.
Treatment: Seborrheic keratosis does not require treatment unless it is causing symptoms or cosmetic concerns. Options for removal include cryotherapy, curettage, electrocautery, or laser therapy.
2.5 Actinic Keratosis:
Pathophysiology: Actinic keratosis is a precancerous skin condition caused by long-term sun exposure.
Clinical Manifestations: Actinic keratosis presents as rough, scaly, or wart-like patches on the skin. These lesions are typically red or brown and can vary in size. Common sites include the face, scalp, back, hands, and arms.
Evaluation: Diagnosis is usually made through a visual examination. If there is suspicion of malignancy, a biopsy may be performed.
Treatment: Treatment options for actinic keratosis include cryotherapy, topical medications (such as imiquimod or 5-fluorouracil), chemical peels, or photodynamic therapy. Surgical removal may be necessary for lesions that are suspicious for skin cancer.
3. Tinea Capitis:
Pathophysiology: Tinea capitis, also known as scalp ringworm, is a fungal infection primarily caused by dermatophytes, such as Trichophyton and Microsporum species.
Clinical Manifestations: Common signs of tinea capitis include circular or irregularly shaped patches of hair loss, scaling, and erythema on the scalp. It may also cause itching, pustules, and sometimes tender lymph nodes. In some cases, broken hairs within the affected area can give a black dot appearance.
Evaluation: Diagnosis is usually made through clinical examination and confirmed by microscopic examination of hair samples or fungal culture.
Treatment: Oral antifungal medications, such as griseofulvin, terbinafine, or itraconazole, are typically prescribed for several weeks. Topical antifungal shampoos and creams can also be used as adjunctive therapy.
Conclusion:
In conclusion, dermatological conditions can present with various signs and symptoms. Diagnosis typically involves a thorough evaluation, which may include physical examination, microscopic examination, or biopsies. Treatment options vary depending on the specific condition and can include topical or systemic medications, as well as procedural interventions. As medical professionals, it is crucial to stay updated with the latest evidence-based practices to provide the best possible care to our patients.
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