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
Glomerulonephritis is an acute kidney inflammation that affects both pediatric and adult populations. It commonly arises following an infection by Streptococcus bacteria, with symptoms usually developing about one to one and a half weeks after the initial infection. Nephrolithiasis involves the formation of kidney stones, which can obstruct urinary flow and cause significant pain. Urinary Tract Infections (UTIs) may affect any segment of the urinary tract, including the kidneys, ureters, bladder, or urethra. Urethritis refers to inflammation of the urethra and can be triggered by mechanical irritation, chemicals, viruses, or bacteria. Nongonococcal urethritis (NGU), often caused by Chlamydia, is the most frequently observed type.
1. What are the clinical manifestations, diagnostic criteria, and treatment for urinary tract infections?
| Condition | Clinical Manifestations | Diagnostic Criteria | Treatment |
|---|---|---|---|
| UTI | Uncomplicated: Symptoms include urinary frequency, urgency, painful urination (dysuria), suprapubic pain, foul-smelling urine, and sometimes blood in urine (hematuria). Complicated: Fever, chills, flank pain, tenderness at the costovertebral angle, nausea, and vomiting. | Uncomplicated: Urinalysis and urine culture confirm diagnosis. Sterile pyuria is indicated by positive urinalysis but negative cultures. Complicated: Imaging such as renal ultrasound is used to detect abnormalities like stones or hydronephrosis. Persistent infections require urology referral. | Increase fluid intake. Nonpregnant women: Nitrofurantoin or trimethoprim-sulfamethoxazole are first-line if resistance is low; alternatives include fosfomycin, fluoroquinolones, and cephalosporins. Pregnant women: Cephalexin or amoxicillin-based antibiotics are preferred. Men: Similar antibiotic options as women but tailored based on susceptibility. |
| Urethritis | Men may experience dysuria, increased urinary frequency, urethral discharge, and itching. Women can have frequency, nocturia, dysuria, itching, fever, hematuria, discharge, pelvic discomfort, or back pain. | Diagnosis involves urinalysis, Gram stain, cultures (especially for young men), wet mounts, and specific tests for gonorrhea and chlamydia. | Azithromycin single dose or doxycycline for 7 days are first-line treatments; erythromycin and fluoroquinolones serve as alternatives. |
| Pyelonephritis | Presents with chills, high fever (>100°F), frequent and painful urination, flank and groin pain, nausea, vomiting, dysuria, and urgency. | Diagnostic workup includes urinalysis, urine and blood cultures, complete blood count (CBC), and imaging studies like CT or ultrasound. | Antibiotics for at least 2 weeks; surgical intervention may be necessary if urinary obstruction occurs. |
| Nephrolithiasis | Sudden severe flank or abdominal pain due to obstruction. Intermittent pain suggests partial obstruction; constant pain indicates complete blockage. Other symptoms include nausea, vomiting, hematuria, fever, and costovertebral angle tenderness. | Urinalysis and culture assess pH, bacteria, crystals, and blood presence. Laboratory tests include CBC, metabolic panel, parathyroid hormone, vitamin D levels, and 24-hour urine analysis. Stone analysis is essential. | Treatment includes hydration, pain control, and allowing stone passage. Specific therapies depend on stone composition (thiazides for calcium stones, urine alkalinization for uric acid stones, etc.). Urgent referral for severe symptoms. |
Managing Acute Skin and Nail Disorders
Intertrigo is a superficial inflammation of the skin caused by persistent skin-to-skin contact in areas prone to moisture, warmth, and friction, leading to bacterial or fungal overgrowth. Impetigo, predominantly affecting infants and young children, is a bacterial skin infection presenting as either nonbullous (small vesicles) or bullous forms, commonly due to Staphylococcus aureus. Cellulitis manifests as localized redness, swelling, warmth, and pain, often accompanied by systemic symptoms and possible pus formation.
2. What are the clinical manifestations, diagnostic criteria, and treatments for bacterial skin infections?
| Infection | Clinical Manifestations | Diagnostic Criteria | Treatment |
|---|---|---|---|
| Impetigo | Lesions characterized by honey-colored crusts, translucent vesicles, or pustules on red, moist bases. | Primarily diagnosed through history and physical exam; cultures and Gram stain used for complicated or MRSA cases. Urinalysis is advised for children 2-4 years to rule out nephritis. | Topical mupirocin ointment; oral antibiotics like dicloxacillin or cephalexin for extensive disease; daily antimicrobial washing. |
| Cellulitis | Erythema, swelling, warmth, pain, sometimes with bullae, abscess, or necrosis; systemic signs like fever. | CBC with differential, renal function, cultures of pus if present, blood cultures, and imaging if indicated. | Oral antibiotics, NSAIDs; IV antibiotics for severe cases (targeting MRSA); incision and drainage for abscesses. |
| Intertrigo | Redness, peripheral scaling, macerated plaques with itching, burning, and sometimes odor or discharge. | Clinical diagnosis; KOH prep, Gram stain, and Wood lamp for erythrasma identification. | Topical antifungal or antibacterial agents based on causative organisms. |
| Furuncle/Carbuncle | Tender, warm nodules developing from folliculitis, often with fever and malaise. | Clinical examination. | Incision and drainage; systemic antibiotics if systemic symptoms are present. |
Viral Skin Infections
3. What are the clinical features, diagnosis, and treatments for viral skin infections such as warts?
Warts caused by human papillomavirus (HPV) appear as small, firm, skin-colored papules commonly on the hands and feet. Plantar warts tend to be thicker and rougher on the soles. Diagnosis is clinical, often confirmed by the presence of pinpoint capillaries seen during lesion debridement. Treatment options include topical agents, cryotherapy, laser ablation, or surgical excision.
Tinea corporis, or ringworm, presents as red, ring-shaped plaques with raised borders and central clearing. Tinea versicolor causes cosmetic hypopigmented or hyperpigmented scaly patches, predominantly on the trunk and arms, generally without symptoms.
Fungal Infections
4. What are the clinical presentations and management of superficial fungal infections?
| Fungal Infection | Clinical Presentation | Diagnostic Criteria | Treatment |
|---|---|---|---|
| Dermatophyte tinea | Annular or arcuate scaly plaques with central clearing and possible pustules; itching or burning sensations may be present. | KOH microscopy and Wood lamp examination for species identification. | Topical antifungal creams for skin; oral antifungals for scalp or nail involvement. |
| Tinea versicolor | Hypo- or hyperpigmented scaly papules and plaques mainly on the trunk and neck. | KOH prep, Wood lamp, skin cultures, and liver function tests if systemic treatment is considered. | Topical antifungals first; systemic antifungals for widespread or resistant cases. |
| Candidiasis | White or gray plaques on mucous membranes (oral thrush); vaginal itching and discharge. | KOH prep and cultures; biopsy if diagnosis is unclear. | Oral nystatin or fluconazole for oral infections; topical or systemic antifungals for other sites. |
Dermatological Office Procedures
5. What are the indications, contraindications, precautions, and preparation involved in dermatological procedures?
Cryosurgery involves the use of liquid nitrogen to freeze and destroy skin lesions. It is contraindicated in patients with cold intolerance or certain hematologic conditions and poses pigment alteration risks, especially in darker skin tones. Protective measures must be taken near sensitive areas.
Electrocautery applies electric currents for tissue cutting or cauterization, useful for vascular lesions and some skin cancers. Curettage entails scraping lesions with a curet, commonly for seborrheic keratoses, warts, molluscum, and some cancers, usually performed under local anesthesia.
Parasitic Infestations
6. What are the clinical signs and treatment options for common parasitic skin infestations?
Scabies presents with small papules and characteristic serpiginous burrows, primarily in typical locations, accompanied by intense itching. Crusted scabies, a severe form, occurs in immunocompromised patients and is highly contagious. Treatment includes topical permethrin 5% cream or oral ivermectin.
Pediculosis capitis (head lice) causes intense itching, with visible lice and nits near the neck and behind the ears. Treatment involves permethrin or prescription medications appropriate for children.
Bed bug infestations cause itchy wheals and blood stains on bedding. Management centers on eradication of infestation and symptomatic relief.
Adnexal Diseases (Hair, Sweat Glands, Nails)
7. What are the presentations and treatments for common adnexal disorders such as acne, rosacea, and hyperhidrosis?
Acne vulgaris is characterized by comedones, papules, pustules, or nodules, mainly on the face, neck, and upper trunk. Treatment focuses on normalizing keratinization, reducing sebum, and controlling inflammation using topical retinoids, antibiotics, or hormonal therapy.
Rosacea manifests with facial flushing, erythema, papules, pustules, telangiectasia, and ocular symptoms. Management includes topical metronidazole, oral antibiotics, and lifestyle adjustments.
Hyperhidrosis refers to excessive localized sweating that affects quality of life. Treatment options include topical aluminum chloride, oral anticholinergics, and botulinum toxin injections.
Hidradenitis suppurativa is a chronic condition involving painful abscesses in areas rich in apocrine glands, managed through antibiotics, anti-inflammatory agents, and sometimes surgical intervention.
Minor Burns
8. What are the clinical features, examination steps, and management for minor burns?
Burns are classified by depth:
- First-degree burns affect only the epidermis and appear red, glossy, and painful (e.g., sunburn).
- Second-degree burns involve the dermis, causing blistering and severe pain.
- Third-degree burns extend into subcutaneous tissue with dry, white or charred appearance and nerve damage leading to insensitivity.
Examination involves assessing airway, breathing, circulation, burn depth, total body surface area, and associated injuries. Circumferential burns require particular attention due to possible vascular compromise.
Management includes topical antimicrobials like silver sulfadiazine, non-adherent dressings, analgesics, and tetanus prophylaxis.
Dermatitis and Other Skin Conditions
9. 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 often with scaling; chronic scratching leads to thickened skin. | Poorly defined lesions with crusting, oozing, and lichenification. | Patient education, trigger avoidance, antihistamines, topical steroids, and emollients. |
| Contact Dermatitis | Itching, burning, redness, swelling with clear borders; vesicular or scaly lesions. | Localized inflammation, sometimes with linear patterns (e.g., poison ivy). | Avoid irritants/allergens; topical corticosteroids; symptomatic treatment. |
| Seborrheic Dermatitis | Red, flaky patches on scalp, face, ears, and trunk. | Yellowish or white greasy scales; cradle cap in infants. | Antifungal shampoos, topical steroids, keratolytic agents. |
| Cutaneous Drug Reactions | Ranges from mild rash to severe conditions like Stevens-Johnson Syndrome. | Erythema, pustules, bullae, and systemic symptoms depending on severity. | Immediate drug cessation, supportive care, corticosteroids, hospitalization for severe cases. |
Additional Dermatitis Conditions
- Stasis Dermatitis occurs due to poor circulation in the lower limbs, leading to skin discoloration, itching, and ulcer formation. Treatment includes leg elevation, compression stockings, corticosteroids, and surgery if needed.
- Urticaria (Hives) presents as transient, raised, itchy wheals anywhere on the body. Management involves avoiding triggers, antihistamines, and epinephrine for severe cases.
Clinical Presentation, Physical Examination, and Management of Corns and Calluses
| Aspect | Details |
|---|---|
| Clinical Manifestation | Corns are painful lesions on toes or dorsal foot surfaces; calluses are generally painless thickened skin. |
| Examination | Corns appear as red, tender lesions often associated with deformities like hammertoes. Calluses are thickened skin that may mask underlying issues. |
| Management | Prevention by avoiding tight shoes, use of pressure-relieving pads, regular debridement, moisture control, orthotics for deformities, and surgery if necessary. Diabetic or vascular disease patients need close monitoring. |
Nail Disorders
Herpetic Whitlow manifests as painful vesicles on the distal finger, often accompanied by tingling or numbness. Examination includes assessing nails and lymph nodes; genital herpes should be checked if symptoms suggest. Management involves drainage if needed, cold compresses, and preventing viral spread.
Paronychial Infections involve pain, swelling, and sometimes pus around the nail fold. Tenderness and discoloration (greenish for Pseudomonas) are common. Treatment includes warm soaks, drainage if abscessed, and topical antibiotics.
Onychomycosis presents with thickened, brittle, discolored nails. Oral antifungals are preferred, with topical agents as adjuncts.
Musculoskeletal Injuries and Illnesses
| Condition | Clinical Manifestation | Examination Findings | Management |
|---|---|---|---|
| Sprains and Strains | Pain, swelling, muscle spasm (strain), bruising (sprain) | Deformity, limited range of motion (ROM), guarding | Rest, Ice, Compression, Elevation (RICE), splinting, NSAIDs, physical therapy |
| Fractures | Pain, swelling, deformity, discoloration | Neurovascular status, palpable deformity | Immobilization, surgery if needed, 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 along tendon | Tenderness, reduced ROM | Splinting, NSAIDs, physical therapy, corticosteroids |
| Sciatica | Radiating leg pain with 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 necessary |
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 as immune response | Variable based 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, 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 within 48 hours |
| 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
Bolognia, J. L., Schaffer, J. V., & Cerroni, L. (2017). Dermatology (4th ed.). Elsevier.
James, W. D., Berger, T. G., & Elston, D. M. (2015). Andrews’ Diseases of the Skin: Clinical Dermatology (12th 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.
D118 Unit 4 Study Guide
Habif, T. P. (2015). Clinical Dermatology(6th ed.). Elsevier.UpToDate. (2023). Management of common skin infections and inflammatory skin disorders. Retrieved from https://www.uptodate.com
Centers for Disease Control and Prevention. (2023). Lyme Disease. Retrieved from https://www.cdc.gov/lyme/index.html
McCance, K. L., & Huether, S. E. (2021). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
Fitzpatrick, T. B., Johnson, R. A., & Wolff, K. (2019). Fitzpatrick’s Dermatology in General Medicine (9th ed.). McGraw-Hill.
James, W. D., Berger, T. G., & Elston, D. M. (2018). Andrews’ Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier.
Tintinalli, J. E., et al. (2020). Tintinalli’s Emergency Medicine: A Comprehensive Study Guide (9th ed.). McGraw-Hill.
Bickley, L. S. (2017). Bates’ Guide to Physical Examination and History Taking (12th ed.). Wolters Kluwer.