D118 Unit 4 Study Guide

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Western Governors University

D118 Adult Primary Care for the Advanced Practice Nurse

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Date

Unit 4: Acute Illnesses: Urinary, Renal, Dermatologic, Musculoskeletal & Infectious Diseases

Managing Acute Urinary Tract and Renal Disorders

Acute kidney inflammation known as glomerulonephritis can affect individuals of all ages, typically developing about one to one and a half weeks after an infection caused by Streptococcus bacteria. Nephrolithiasis, or kidney stones, involves the formation of calculi that obstruct urinary flow, leading to intense pain. Urinary tract infections (UTIs) may involve any part of the urinary system—kidneys, ureters, bladder, or urethra. Urethritis, an inflammation of the urethra, can result from mechanical irritation, chemicals, viruses, or bacteria, with nongonococcal urethritis (NGU), often caused by Chlamydia, being the most common form.

What are the clinical manifestations, diagnostic criteria, and treatment options for urinary tract infections?

Condition	Clinical Manifestations	Diagnostic Criteria	Treatment
UTI	Uncomplicated: Urinary frequency, urgency, painful urination (dysuria), suprapubic pain, foul-smelling urine, sometimes hematuria. Complicated: Fever, chills, flank pain, costovertebral angle tenderness, nausea, vomiting.	Uncomplicated: Urinalysis and urine culture confirm diagnosis; sterile pyuria indicated by positive urinalysis but negative cultures. Complicated: Imaging (renal ultrasound) to identify stones or hydronephrosis; referral if persistent.	Increase fluid intake. Nonpregnant women: Nitrofurantoin or trimethoprim-sulfamethoxazole if resistance is low; alternatives include fosfomycin, fluoroquinolones, cephalosporins. Pregnant women: Cephalexin or amoxicillin-based antibiotics preferred. Men: Similar antibiotic regimens tailored by susceptibility.
Urethritis	Men: Dysuria, increased frequency, urethral discharge, itching. Women: Frequency, nocturia, dysuria, itching, fever, hematuria, discharge, pelvic discomfort, back pain.	Urinalysis, Gram stain, cultures (especially in young men), wet mounts, and specific gonorrhea and chlamydia testing.	Azithromycin single dose or doxycycline for 7 days first-line; alternatives include erythromycin and fluoroquinolones.
Pyelonephritis	Chills, high fever (>100°F), painful urination, flank/groin pain, nausea, vomiting, dysuria, urgency.	Urinalysis, urine and blood cultures, complete blood count (CBC), imaging (CT or ultrasound).	Antibiotics for at least 2 weeks; surgical intervention if urinary obstruction occurs.
Nephrolithiasis	Sudden severe flank/abdominal pain, intermittent or constant pain indicating partial or complete obstruction, nausea, vomiting, hematuria, fever, costovertebral angle tenderness.	Urinalysis (pH, bacteria, crystals, blood), culture, CBC, metabolic panel, parathyroid hormone, vitamin D levels, 24-hour urine analysis, stone analysis.	Hydration, pain control, stone passage facilitation. Specific treatment depends on stone composition (e.g., thiazides for calcium stones). Urgent referral for severe symptoms.

Managing Acute Skin and Nail Disorders

Intertrigo is a skin inflammation resulting from persistent skin-to-skin contact in warm, moist areas, promoting bacterial or fungal overgrowth. Impetigo, common in infants and young children, is a bacterial infection caused mainly by Staphylococcus aureus, presenting as either nonbullous (small vesicles) or bullous lesions. Cellulitis manifests as localized redness, swelling, warmth, and pain, sometimes with systemic symptoms and pus.

What are the clinical manifestations, diagnostic methods, and treatments for bacterial skin infections?

Infection	Clinical Manifestations	Diagnostic Criteria	Treatment
Impetigo	Honey-colored crusts, translucent vesicles or pustules on red, moist bases.	History and physical exam primarily; cultures and Gram stain for complicated or MRSA cases; urinalysis in children 2–4 years to exclude nephritis.	Topical mupirocin ointment; oral antibiotics (dicloxacillin, cephalexin) for extensive disease; antimicrobial washes.
Cellulitis	Erythema, swelling, warmth, pain; may include bullae, abscess, necrosis; fever possible.	CBC with differential, renal function tests, pus and blood cultures if abscess or systemic symptoms; imaging if necessary.	Oral antibiotics and NSAIDs; intravenous antibiotics for severe or MRSA cases; incision and drainage for abscesses.
Intertrigo	Redness, peripheral scaling, maceration, itching, burning, sometimes odor or discharge.	Clinical diagnosis; KOH prep, Gram stain, Wood lamp exam for erythrasma.	Topical antifungals or antibacterial agents depending on pathogen.
Furuncle/Carbuncle	Tender, warm nodules from folliculitis, often with fever and malaise.	Clinical examination.	Incision and drainage; systemic antibiotics if systemic symptoms present.

Viral Skin Infections

Warts caused by human papillomavirus (HPV) present as small, firm, skin-colored papules frequently found on hands and feet. Plantar warts are usually thicker and rougher on the soles. Diagnosis is clinical, often confirmed by pinpoint capillaries visible during lesion debridement. Treatments include topical agents, cryotherapy, laser ablation, or surgical excision.

What are the clinical features, diagnosis, and treatments for viral skin infections such as warts?

Warts are identifiable by their characteristic appearance and confirmed clinically. Various therapeutic methods exist including topical salicylic acid, cryotherapy, and excision based on size and location.

Fungal Infections

Superficial fungal infections display diverse clinical features and require appropriate diagnostic tools and treatments.

What are the clinical presentations and management strategies for superficial fungal infections?

Fungal Infection	Clinical Presentation	Diagnostic Criteria	Treatment
Dermatophyte tinea	Annular or arcuate scaly plaques with central clearing; itching or burning.	KOH microscopy and Wood lamp for species identification.	Topical antifungal creams; oral antifungals for scalp or nail involvement.
Tinea versicolor	Hypo- or hyperpigmented scaly patches on trunk and neck, often asymptomatic.	KOH prep, Wood lamp, cultures; liver function tests if systemic therapy planned.	Topical antifungals first; systemic antifungals for widespread or resistant cases.
Candidiasis	White/gray plaques on mucous membranes (oral thrush); vaginal itching/discharge.	KOH prep, cultures; biopsy if unclear.	Oral nystatin or fluconazole for oral infections; topical/systemic antifungals for others.

Dermatological Office Procedures

Cryosurgery uses liquid nitrogen to freeze and eliminate skin lesions but is contraindicated in cold intolerance or hematologic disorders and may cause pigment changes, especially in darker skin tones. Electrocautery applies electrical currents for tissue removal or coagulation, ideal for vascular lesions and some skin cancers. Curettage involves scraping lesions, often under local anesthesia, used for seborrheic keratoses, warts, molluscum contagiosum, and certain cancers.

What are the indications, contraindications, precautions, and preparation steps for dermatologic procedures?

These procedures require patient history screening for contraindications, preparation of the lesion site, and informed consent discussing risks like pigment alteration or scarring. Protective strategies are essential near sensitive areas such as the face or genitals.

Parasitic Infestations

Common parasitic skin infestations include scabies, pediculosis (lice), and bed bug bites.

What clinical signs and treatments are associated with common parasitic skin infestations?

Infestation	Clinical Signs	Treatment
Scabies	Small papules, serpiginous burrows, intense itching; crusted scabies in immunocompromised patients.	Topical permethrin 5% cream; oral ivermectin in severe cases.
Pediculosis capitis	Intense itching; visible lice and nits near neck and behind ears.	Permethrin shampoo or prescription medications appropriate for children.
Bed bug infestation	Itchy wheals, blood stains on bedding.	Eradication of infestation and symptomatic relief.

Adnexal Diseases (Hair, Sweat Glands, Nails)

Acne vulgaris presents with comedones, papules, pustules, and nodules on the face, neck, and upper trunk. Treatment targets abnormal keratinization, sebum reduction, and inflammation via topical retinoids, antibiotics, or hormonal therapies.

Rosacea is characterized by facial flushing, erythema, papules, pustules, and ocular symptoms. Management involves topical metronidazole, oral antibiotics, and lifestyle modifications.

Hyperhidrosis involves excessive sweating, affecting quality of life, treated with topical aluminum chloride, oral anticholinergics, or botulinum toxin injections.

Hidradenitis suppurativa causes painful abscesses in apocrine gland-rich areas, managed by antibiotics, anti-inflammatory drugs, and sometimes surgery.

Minor Burns

Burns are classified by depth into first-degree (epidermal redness and pain), second-degree (dermal blistering and severe pain), and third-degree (full-thickness with nerve damage). Examination includes airway, breathing, circulation, burn depth, total body surface area, and associated injuries, with special attention to circumferential burns.

Management involves topical antimicrobials like silver sulfadiazine, non-adherent dressings, analgesics, and tetanus prophylaxis.

Dermatitis and Other Skin Conditions

What are the clinical presentations and management strategies for different types of dermatitis?

Dermatitis Type	Clinical Features	Physical Exam Findings	Management
Eczematous (Atopic)	Itchy, red, dry patches with scaling; chronic scratching leads to thickened skin.	Poorly defined lesions with crusting, oozing, lichenification.	Education, trigger avoidance, antihistamines, topical steroids, emollients.
Contact Dermatitis	Itching, burning, redness, swelling with clear borders; vesicular/scaly lesions.	Localized inflammation; sometimes linear patterns (e.g., poison ivy).	Avoid irritants/allergens; topical corticosteroids; symptomatic relief.
Seborrheic Dermatitis	Red, flaky patches on scalp, face, ears, trunk; yellowish/white greasy scales.	Typical cradle cap in infants.	Antifungal shampoos, topical steroids, keratolytics.
Cutaneous Drug Reactions	Mild rash to severe forms like Stevens-Johnson Syndrome.	Erythema, pustules, bullae, systemic symptoms vary.	Immediate drug cessation, supportive care, corticosteroids, hospitalization if severe.

Additional conditions include stasis dermatitis (due to poor circulation), treated with leg elevation and compression, and urticaria (hives), managed by trigger avoidance, antihistamines, and epinephrine for severe reactions.

Clinical Presentation, Physical Examination, and Management of Corns and Calluses

Aspect	Details
Clinical Manifestation	Corns: Painful lesions on toes/dorsal foot; Calluses: Painless thickened skin.
Examination	Corns appear as tender red lesions often linked to deformities; calluses are thickened areas masking underlying problems.
Management	Avoid tight shoes, use pressure-relieving pads, regular debridement, moisture control, orthotics for deformities, surgery if necessary. Close monitoring for diabetic or vascular patients.

Nail Disorders

Herpetic whitlow causes painful vesicles on distal fingers, often with tingling or numbness. Examination includes nails and lymph nodes; genital herpes evaluation if suspected. Management involves drainage if necessary, cold compresses, and preventing viral spread.

Paronychial infections cause pain, swelling, pus around the nail fold, with discoloration indicating possible bacterial involvement (Pseudomonas). Treatment includes warm soaks, drainage if abscessed, and topical antibiotics.

Onychomycosis results in thickened, brittle, discolored nails, treated primarily with oral antifungals supported by topical agents.

Musculoskeletal Injuries and Illnesses

Condition	Clinical Manifestation	Examination Findings	Management
Sprains and Strains	Pain, swelling, muscle spasm (strain), bruising (sprain)	Deformity, limited ROM, guarding	Rest, Ice, Compression, Elevation (RICE), splinting, NSAIDs, PT
Fractures	Pain, swelling, deformity, discoloration	Neurovascular status, palpable deformity	Immobilization, surgery if necessary, pain control
Bursitis	Swelling, warmth, erythema, pain	Localized tenderness, swelling	NSAIDs, antibiotics if infected, aspiration, corticosteroids
Carpal Tunnel / De Quervain’s Tenosynovitis	Pain near thumb base, radiating pain	Tenderness, reduced ROM	Splinting, NSAIDs, physical therapy, corticosteroids
Sciatica	Radiating leg pain, limited motion	Neurological deficits	NSAIDs, rest, physical therapy
Joint Pain (Hand/Wrist/Elbow/Shoulder)	Localized pain, numbness, weakness	ROM, grip strength, neurological testing	NSAIDs, physical therapy, injections, surgery if indicated
Neck and Low Back Pain	Pain with limited movement, possible neurological signs	Posture, gait, ROM, neurological exam	NSAIDs, rest, physical therapy, imaging if needed

Infectious Diseases: Clinical Presentation, Examination, and Management

Disease	Clinical Manifestation	Examination Features	Management
Lymphadenopathy	Swollen, painful, or firm lymph nodes	Size, location, tenderness, symmetry	Treat underlying cause; biopsy if malignancy suspected
Fever (Pyrexia)	Elevated body temperature	Variable depending on infection	Supportive care, antipyretics, treat cause
Infectious Mononucleosis	Fever, sore throat, lymphadenopathy	Cervical lymphadenopathy, splenomegaly	Supportive care; steroids if severe; avoid antibiotics to prevent rash
Tuberculosis	Chronic cough, weight loss, night sweats, fever	Rales, pleural effusion, lymphadenopathy	Prolonged multidrug therapy
Lyme Disease	Expanding circular rash (erythema migrans), flu-like symptoms, joint pain	Rash and regional lymphadenopathy	Early oral antibiotics (e.g., doxycycline), supportive care
Rocky Mountain Spotted Fever	Fever, rash, headache	Petechial rash, systemic signs	Prompt antibiotic therapy
Zika Virus	Fever, rash, conjunctivitis	Possible neurological symptoms	Supportive care, mosquito control
Influenza	Fever, chills, malaise, cough	Usually normal chest exam	Symptomatic treatment, antivirals if early
Mosquito-Borne Illnesses	Weakness, paralysis, rash, conjunctivitis	Rash, jaundice, lymphadenopathy	Supportive care, vector control, public health measures

Summary Table: Infectious Disease Management

Disease Category	Treatment Highlights
Bacterial infections	Antibiotics tailored to specific pathogens
Viral infections	Supportive care and symptom management
Tick-borne diseases	Early antibiotic treatment (e.g., doxycycline)
Mosquito-borne illnesses	Vector control and symptomatic management
Tuberculosis	Extended multi-drug antibiotic therapy

References

Bickley, L. S. (2017). Bates’ Guide to Physical Examination and History Taking (12th ed.). Wolters Kluwer.

Bolognia, J. L., Schaffer, J. V., & Cerroni, L. (2017). Dermatology (4th ed.). Elsevier.

Centers for Disease Control and Prevention. (2023). Lyme Disease. Retrieved from https://www.cdc.gov/lyme/index.html

Fitzpatrick, T. B., Johnson, R. A., & Wolff, K. (2019). Fitzpatrick’s Dermatology in General Medicine (9th ed.). McGraw-Hill.

Habif, T. P. (2015). Clinical Dermatology (6th ed.). Elsevier.

James, W. D., Berger, T. G., & Elston, D. M. (2015). Andrews’ Diseases of the Skin: Clinical Dermatology (12th ed.). Elsevier.

D118 Unit 4 Study Guide

James, W. D., Berger, T. G., & Elston, D. M. (2018). Andrews’ Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier.

Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (2018). Harrison’s Principles of Internal Medicine (20th ed.). McGraw-Hill Education.

Tintinalli, J. E., et al. (2020). Tintinalli’s Emergency Medicine: A Comprehensive Study Guide (9th ed.). McGraw-Hill.

UpToDate. (2023). Management of common skin infections and inflammatory skin disorders. Retrieved from https://www.uptodate

.com

McCance, K. L., & Huether, S. E. (2021). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.