Medication Integumentary Medication EMOLLIENTS AND LOTIONS AEmollients Box 411 1Oily or fatty substances that soften and soothe irritated skin by allowing the skin to retain water ID: 332455
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Slide1
Integumentary MedicationSlide2
Integumentary Medication
. EMOLLIENTS AND LOTIONS
A.Emollients
(
Box 41-1
)
1.Oily or fatty substances that soften and soothe irritated skin by allowing the skin to retain water
2.Available as creams or ointments
3.Used for dry, scaly, itchy inflammatory conditions
B.Solutions
and lotions (
Box 41-2
)
1.Liquid suspensions or dispersions
2.Require shaking before application
3.Although lotions are predominantly water, they have a drying effect on the skin when the water evaporates
4.Used as a wash for the skin, as soaks, or as wet dressings on ulcers or
burns
5.Used for
subacute
inflammatory lesions after the severe
exudate
phase has ceased
6.Medicated lotions are often used as anti-inflammatory agents because they provide a drying, protective, and cooling effect Slide3
EMOLLIENTS AND LOTIONS
BOX 41-1 Emollients
Cold cream
Glycerin
Lanolin
Lubriderm
Petrolatum
Zinc ointment
Vitamin A and D ointment
BOX 41-2 Solutions and Lotions
Aluminum acetate solution (
Burow's
solution)
Calamine lotion (
Caladryl
lotion)Slide4
RUBS AND LINIMENTS
RUBS
AND LINIMENTS (
Box 41-3
)
A.Used
for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia
B.Over
-the-counter (OTC) products contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants
C.Some
products contain
salicylates
and, if used over a large area of the skin, may cause
salicylate
side effects such as tinnitus, nausea, or vomiting
D.A heating pad is not used with these products, because irritation or burning of the skin may occurSlide5
ANTI-INFECTIVE AGENTS
A.Description
1.Includes antiseptics and antibacterial, antifungal, antiviral, and
antiparasitic
medications
2.Topical antibiotics are safe and effective in certain conditions; extensive use may encourage the emergence of resistant bacteria
B.Antiseptics
1.Sodium hypochlorite (Dakin solution)
a.A
chloride solution that loosens, dissolves, and deodorizes necrotic tissue and blood clots
b.It
kills most common bacteria, including spores, amebas, fungi, protozoa viruses, and yeast
c.It
is used for irrigating and cleaning necrotic or purulent
wounds
d.Loses
its potency during storage, so fresh solution is prepared frequently
e.It
should not be in contact with healing or normal tissueSlide6
BOX 41-3 Rubs and Liniments
Aspercreme
Ben-Gay
Icy Hot
MyoflexSlide7
2.Chlorhexidine
gluconate
(
Hibiclens
)
a.Effective
for cleaning wounds caused by staphylococci and other gram-positive bacteria
b.Used
for irrigating and cleansing wounds, but not for packing wounds because it may cause contact dermatitisSlide8
3.Acetic acid
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CHAPTER 41
Integumentary
Medications (page 4 of 33 —
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)
a.Effective
for irrigating, cleansing, and packing wounds infected by
Pseudomonas
aeruginosa
b.Healthy
skin surrounding the wound must be protected with a petroleum barrier because it excoriates the skinSlide9
4.Hydrogen peroxide
a.As
a 3% solution, it has effervescent action that releases gas and breaks up necrotic tissue
b.It
is used to irrigate and clean necrotic tissue and pus from open wounds
c.It
is not used to pack wounds because it decomposes too rapidly
d.When
epithelial tissue begins to form, hydrogen peroxide is discontinued because it inhibits tissue formationSlide10
5.Hexachlorophene (
pHisoHex
,
Septisol
)
a.A
combination of hexachlorophene and alcohol
b.Hexachlorophene
is a
bacteriostatic
agent with activity against staphylococci and other gram-positive bacteria
c.Hexachlorophene
is heavily absorbed through broken skin and can cause neurotoxicity; it should not be used on wounds
d.The
alcohol component dries and irritates tissue, is not a very effective germicide, and forms a film that can actually promote infection
e.All
hexachlorophene products are well rinsed from the skin after their use to prevent systemic absorptionSlide11
C.Antibacterials
(
Box 41-4
)
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CHAPTER 41
Integumentary
Medications (page 5 of 33 —
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)
1.Description: Used for superficial skin infections
2.Mupirocin (
Bactroban
)
a.Topical
antibacterial active against
Staphylococcus
aureus
, beta-hemolytic streptococci, or
Streptococcus
pyogenes
b.Applied
three times daily; if improvement is not observed within 3 to 5 days, it is discontinuedSlide12
D.Antifungals
1.May cause
erythema
, stinging, blistering, peeling,
pruritus
,
urticaria
, and general skin irritation
2.Client is re-evaluated if no results are obtained after 4 weeks of treatmentSlide13
E.Antiviral
: Acyclovir (
Zovirax
)
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Integumentary
Medications (page 6 of 33 —
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)
1.Inhibits DNA replication in the virus
2.Used for herpes simplex virus types 1 and 2,
varicella
-zoster virus, Epstein-Barr virus, and cytomegalovirus
3.Can cause mild pain and transient burning and stinging.
4.Applied completely over the lesion every 3 hours six times daily for 1 week
5.Rubber gloves are used to apply the ointment to prevent the spread of infectionSlide14
F.Antiparasitics
1.Used to treat scabies (mites) and
pediculosis
(lice)
2.May be harmful during pregnancy and in young children
3.May irritate the skin, eyes, and mucous membranes
4.May cause allergic reactions
5.Permethrin 5% (
Elimite
) Slide15
a.Wash
, rinse, and towel dry the hair; apply sufficient volume to saturate the hair and scalp
b.Allow
to remain on the hair 10 minutes and then rinse with water
6.Lindane (
Kwell
)
a.Applied
in a thin layer to the entire body below the head; no more than 30 g (1 oz) should be used
b.The
medication is removed by washing 8 to 12 hours later; usually, only one application is requiredSlide16
BOX 41-4
Antibacterials
,
Antifungals
, Antiviral, and
Antiparasitics
ANTIBACTERIALS
Bacitracin
Chlortetracycline
Chloramphenicol
Erythromycin
Gentamicin
Mupirocin
(
Bactroban
)
Mycitracin
Triple Antibiotic (neomycin,
bacitracin
,
polymyxin
B)
NeomycinSlide17
ANTIFUNGALs
Amphotericin
B (
Fungizone
)
Betamethasone
and
clotrimazole
(
Lotrisone
)
Ciclopirox
olamine
(
Loprox
)
Clioquinol
(
Vioform
)
Clotrimazole
(Lotrimin, Mycelex)
Econazole
nitrate (
Spectazole
)
Haloprogin
(
Halotex
)
Ketoconazole
(
Nizoral
)
Miconazole
(Micatin)
Nystatin
(
Mycostatin
)
Tolnaftate
(Tinactin)
Triacetin
(
Fungoid
)
Undecylenic
acid (Desenex)Slide18
ANTIVIRAL
Acyclovir (
Zovirax
)Slide19
ANTIPARASITICS
Crotamiton
(
Eurax
)
Lindane
(
Kwell
)
Permethrin
5% (
Elimite
)
Malathion
(
Ovide
)Slide20
. ANTIPRURITICS (
Box 41-5
)
A.Used
to relieve itching
B.Applied
as wet dressings, pastes, lotions, creams, or ointments
C.Persons
with dry skin should be instructed to bathe less frequentlySlide21
. KERATOLYTICS (
Box 41-6
)
A.Description
1.Preparations that dissolve keratin
2.Soften scales and loosen the horny layer of the skin, resulting in minimal peeling or extensive desquamation
3.Used to treat superficial fungal infections, dermatitis, psoriasis, and localized dermatitisSlide22
VB.Salicylic
acid
1.Used to treat
seborrheic
dermatitis, acne, psoriasis, and to thin and remove calluses
2.Can be absorbed systematically and can cause
salicylism
, characterized by dizziness and tinnitus; is not applied to large surface areas or open woundsSlide23
C.Podophyllum
resin
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CHAPTER 41
Integumentary
Medications (page 9 of 33 —
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)
1.Used for various types of skin cancer
2.Causes lesions to slough off, leaving a superficial ulcer and moderate dermatitis
3.After the therapy is discontinued, the lesions are treated with a mild antiseptic ointment; healing usually occurs within a few daysSlide24
D.Cantharidin
(
Cantharone
)
1.Used in treating warts
2.Has an exfoliation effect only on epidermal cells
3.May cause tingling, itching, and burning
4.Site may be very tender for a period of 2 to 6 daysSlide25
E.Masoprocol
(
Actinex
)
1.Has
antiproliferative
activity against
keratinocytes
and is used to treat
keratosis
2.Occlusive dressings are not to be used
3.Transient burning may be experienced after administration Slide26
BOX 41-5
Antipruritics
Calamine lotion
Cornstarch or oatmeal baths
Solutions of bismuth salts, aluminum acetate, or boric acid
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CHAPTER 41
Integumentary
Medications (page 10 of 33 —
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)
BOX 41-6
Keratolytics
Cantharidin
(
Cantharone
)
Imiquimod
(
Aldara
)
Masoprocol
(
Actinex
)
Podophyllum
resin
Podofilox
(
Condylox
)
Resorcinol
Salicylic acid
BOX 41-7 Stimulants and Irritants
Coal tar
Compound
benzoin
tinctureSlide27
. STIMULANTS AND IRRITANTS (
Box 41-7
)
A.Description
: Produce a mild irritation to the surface of the skin, causing hyperemia and inflammation that promote the healing process Slide28
VIB.Coal
tar
1.Used in treating psoriasis,
seborrheic
dermatitis, and atopic dermatitis
2.Has an unpleasant odor and frequently stains the skin and hair
3.Can cause
phototoxicitySlide29
C.Compound
benzoin
tincture
1.Protects the skin when the client has bed sores, ulcers, cracked nipples, and fissures of any orifice
2.Causes a mild irritation that produces increased blood flow and healing
Top of FormSlide30
. PROTECTIVES (
Box 41-8
)
A.Description
1.Preparations that provide a film on the skin to protect it from irritations such as light, moisture, air, and dust
2.Promote natural healing without the usual formation of dry crust over the wound
3.Allow
exudate
to collect beneath the dressing, forming an artificial blister
4.Designed to be left in place for up to 7 days or until leakage occurs around the dressing
5.Uniflex and
PolySkin
may be used to cover central and peripheral IV sites
6.Opsite,
Tegasorb
,
Mediskin
, and
Vigilon
may be used for skin
burnsSlide31
BOX 41-8
Protectives
Benzoin
DuoDerm
Mediskin
Opsite
Polyskin
Tegaderm
Tegasorb
Uniflex
Vigilon
Zinc oxide paste (Unna Boot)Slide32
B.Sunscreens
1.Act by absorbing ultraviolet rays
2.Most effective when applied about 30 to 60 minutes before exposure to the sun; should be reapplied every 2 to 3 hours after swimming or sweating
3.Can cause contact dermatitis and photosensitivity reactionsSlide33
C.Nonadherent
dressings
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Integumentary
Medications (page 13 of 33 —
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)
1.Woven or nonwoven dressings that may be impregnated with saline, petrolatum, or antimicrobials
2.Nonadherent dressings include
Adaptic
,
Exu
-Dry,
Sofsorb
,
Telfa
,
vaseline
gauze, and
XeroformSlide34
GROWTH FACTORS
A.Description
1.Used to promote wound healing
2.Stimulate cells to divide and migrate, which results in wound healing, formation of granulation tissue, and new epidermisSlide35
.
B.Procuren
solution
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Integumentary
Medications (page 14 of 33 —
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)
1.Promotes healing by actively stimulating growth and granulation tissue, capillaries, and epithelium
2.Applied to the wound and covered with petrolatum-impregnated gauze
3.Left in place for 12 hours and then washed off; during the remaining 12 hours of the day, the wound is covered with sulfadiazine (
Silvadene
)Slide36
ENZYMES
A.Description
1.Used to promote healing of wounds and to
debride
skin ulcers
2.Reduce inflammation resulting from trauma and infection
3.Dissolve fibrin clots, which helps reduce the size of surface hematomas
4.To be effective, must be in contact with affected tissue in adequate concentrations for a sufficient length of time
5.Wound may need to be surgically
debrided
prior to application; if not administered to a clean,
debrided
wound, healing may be delayedSlide37
BOX 41-9 Enzymes That Promote Wound Healing
Hyaluronidase
(
Wydase
)
Papain
(
Panafil
,
Panafil
White)Slide38
B.Enzymes
that promote wound healing (
Box 41-9
)
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CHAPTER 41
Integumentary
Medications (page 15 of 33 —
printed page 495
)
1.Papain (
Panafil
,
Panafil
White)
a.Does
not injure or affect healthy tissue or cells
b.Enzyme
must be in immediate contact with the purulent wound material
c.Wounds
are cleansed with prescribed irrigating solution between applications
d.Hydrogen
peroxide cannot be used to irrigate the wound, because it inactivates the
papain
e.Light
dressings and cellophane wrap may be used over the wound to prevent soiling of clothing
f.Dressings
are changed frequently to prevent contamination and to remove necrotic debrisSlide39
2.Hyaluronidase (
Wydase
)
a.Facilitates
the absorption of fluid administered by subcutaneous
hypodermoclysis
b.Can
be injected subcutaneous into an infiltrated IV site when a potent vasoconstrictor such as
norepinephrine
(
Levophed
) or
metaraminol
(
Aramine
) has infiltrated
c.It
reduces the sloughing of tissue likely to occur secondarily to infiltrationSlide40
C.Enzymes
to
debride
and remove exudates (
Box 41-10
)
1.Description
a.Alter
the thick, purulent drainage to a thin, liquid material that can be easily wiped or irrigated off the wound
b.Enzyme
contact with the wound is necessary to promote wound healing
c.Wound
needs to be cleansed; cross-hatching of
eschar
on
burns
is performed prior to applicationSlide41
2.Sutilains (
Travase
)
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CHAPTER 41
Integumentary
Medications (page 16 of 33 —
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)
a.Used
to remove nonviable or necrotic tissue and purulent enzymes from
burns
, ulcers, traumatic injury, and peripheral vascular disease wounds Slide42
BOX 41-10 Enzymes to
Debride
and Remove Exudates
Collagenase
(
Santyl
)
Dextranomer
(
Debrisan
)
Fibrinolysin
and
desoxyribonuclease
(
Elase
)
Sutilains
(
Travase
)
b.Inactive
on viable tissue
c.The
wound is moistened with normal saline or sterile water before applicationSlide43
3.Collagenase (
Santyl
)
a.Used
as a topical
debriding
agent
b.Provides
effective debridement of the collagen tissue at the wound edges where necrotic tissue is anchored
c.Encourages
the formation of granulation tissue at the wound edges and quicker
epithelization
of wounds
d.Apply
with a tongue depressor directly into deep wounds
e.Prior
to application, cleanse wound of debris by gently rubbing with a gauze pad with sterile water or Dakin solution, followed by sterile normal saline
f.Remove
all excess ointment each time dressing is changed
g.Apply
only to injured area; causes
erythema
in healthy tissues
h.Protect
healthy tissue by applying zinc oxide paste
i.Discontinued
when necrotic tissue is goneSlide44
4.Fibrinolysin and
desoxyribonuclease
(
Elase
)
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CHAPTER 41
Integumentary
Medications (page 17 of 33 —
printed page 496
)
a.Used
to
debride
wounds, including
burns
,
decubitus
ulcers, and inflamed or infected lesions
b.Clean
wound with sterile water, pat dry; flush away necrotic debris with normal saline, then apply a thin layer and cover with petrolatum gauzeSlide45
D.Dextranomer
(
Debrisan
)
1.Not a
debriding
agent but a cleansing agent that actually absorbs peptides and proteins
2.Effective in wet wounds only
3.It is not packed tightly into the wound because maceration of surrounding tissue may occur from contact with the agentSlide46
. CORTICOSTEROIDS
A.Have
anti-inflammatory,
antipruritic
, and
vasoconstrictive
actions
B.Contraindications
1.Clients demonstrating previous sensitivity to corticosteroids
2.Those with current systemic fungal, viral, or bacterial infections
3.Those with current complications related to corticosteroid therapySlide47
XC.Local
adverse effects
1.Hypopigmentation
2.Acneform eruptions
3.Contact dermatitis
4.Burning, dryness, irritation, itching
5.Overgrowth of bacteria, fungi, and viruses
6.Skin atrophySlide48
D.Systemic
adverse effects
1.Occur rarely
2.Adrenal suppression
3.Cushing's syndrome
4.Striae, skin atrophy
5.Ocular effects (glaucoma and cataracts)Slide49
E.Topical
steroids
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CHAPTER 41
Integumentary
Medications (page 19 of 33 —
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)
1.Monitor plasma
cortisol
levels if prolonged therapy is necessary
2.Wash area just prior to application to increase medication penetration
3.Apply sparingly in a light film, rubbing gently
4.May apply to skin alone or with a dry occlusive dressing if prescribed by the physician
5.Instruct the client to report burning, irritation, or signs of infection to the physicianSlide50
ACNE PRODUCTS (
Box 41-11
)
A.Description
1.Mild acne can be treated with bar soaps, soap-free cakes, liquid cleansers, lotions, gels, and creams
2.For moderate acne, topical anti-inflammatory medication such as
benzoyl
peroxide,
tretinoin
(
Retin
-A),
isotretinoin
(
Accutane
),
azelaic
acid (
Azelex
), and
adapalene
(
Differin
) may be prescribed; antibiotics may also be prescribed
3.Side effects can include excessive redness, extreme dryness of the skin leading to blistering and crusting, temporary pigmentation changes, and peeling of the skin
4.All products are kept away from the eyes, inside the nose, mucous membranes, and hairSlide51
.
B.Benzoyl
peroxide: A
keratolytic
agent that is
bacteriostatic
and may decrease the production of irritant free fatty acids in the follicle
C.Tretinoin
(
Retin
-A) and
adapalene
(
Differin
): Acids of vitamin A that are used to treat acne
vulgaris
; may also be used to treat skin cancer and aging of the skin
D.Tretinoin
(
Retin
-A)
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Integumentary
Medications (page 20 of 33 —
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)
1.Decreases cohesiveness of the epithelial cells, increasing cell mitosis and turnover; potentially irritating, particularly when used correctly
2.Within 48 hours of use, the skin generally becomes red and begins to peel
3.Temporary
hyperpigmentation
and
hypopigmentation
can occur
4.Client should avoid sun exposure because photosensitivity may occur
5.Applied liberally to the skin; hands are washed thoroughly immediately after applying
6.Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks
7.Client may use cosmetics, but the skin needs to be cleaned thoroughly before applying the cosmeticsSlide52
BOX 41-11 Acne Products
CLEANSERS
Acnomel
Brevoxyl
Clearasil
Fostex
pHisoDerm
Stri-Dex
DRYING AGENTS
Acnomel
Ionax
Listerex
MISCELLANEOUS
Adapalene
(
Differin
)
Alpha
hydroxy
acids
Antibiotics
Azelaic
acid (
Azelex
)
Bensulfoid
cream (
benzoyl
peroxide and sulfur)
Benzamycin
gel (
benzoyl
peroxide and sulfur)
Benzoyl
peroxide wash, gel
Isotretinoin
(
Accutane
)
Rosorcinol
(as an ingredient in other preparations)
Salicylic acid (as an ingredient in other preparations)
Tazarotene
(
Tazorac
)
Tretinoin
(
Retin
-A)Slide53
E.Isotretinoin
(
Accutane
)
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Integumentary
Medications (page 21 of 33 —
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)
1.A metabolite of vitamin A
2.Used to treat severe cystic acne; its use is reserved for persons who have not responded to other therapies, including systemic antibiotics
3.Can cause
xerosis
and facial desquamation,
palmoplantar
desquamation,
pruritus
, brittle nails, and hair loss
4.Administered with meals two times daily for a 15- to 20-week course; if another course of therapy is needed, an 8-week interval should occur
5.Photosensitivity may occur, so the client needs to be instructed to decrease sun exposure
6.Alcohol consumption should be eliminated during therapy because alcohol may potentiate serum triglyceride elevation Slide54
BOX 41-12 Poison Ivy Treatment Products
Calamine lotion
Calomox
IV-
Chex
Ivy-Rid
Rhuli
cream, spray, gelSlide55
F.Local
antibiotics
1.Used to treat acne; include
clindamycin
(
Cleocin
T), erythromycin, tetracycline (
Topicycline
), and
meclocycline
(
Meclan
)
2.Therapeutic response generally requires 6 to 12 weeks of therapy
3.Side effects include acute contact dermatitis, transient stinging or burning, staining of the skin,
erythema
, and skin tendernessSlide56
BURN PRODUCTS(
Box 41-13
)
A.Nitrofurazone
(
Furacin
)
1.Applied topically to the
burn
as a solution, ointment, or cream
2.Has a broad spectrum of antibacterial activity
3.Used in
burns
when bacterial resistance to other agents is a problem
4.Topical: Apply 1/16-inch film directly to
burn
5.Side effects: Contact dermatitis, rash
6.Less common side effects:
Pruritus
, local edemaSlide57
.
B.Mafenide
(
Sulfamylon
)
1.A water-soluble cream that is
bacteriostatic
for both gram-negative and gram-positive organisms
2.Is used to treat
burns
to reduce the bacteria present in
avascular
tissues
3.Diffuses through the
devascularized
areas of the skin; may precipitate metabolic acidosis (usually compensated by hyperventilation)
4.Apply 1/16-inch film directly to the burn
5.Side effects can include local pain, rash
6.Systemic effects include bone marrow depression, hemolytic anemia, metabolic acidosis
7.Keep
burn
covered with
mafenide
at all times
8.Notify physician if hyperventilation occurs; if acidosis develops,
mafenide
is washed off the skinSlide58
XIIIC.Silver
sulfadiazine (
Silvadene
)
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CHAPTER 41
Integumentary
Medications (page 23 of 33 —
printed page 498
)
1.Has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast
2.Released slowly from the cream, which is selectively toxic to bacteria
3.Used primarily to prevent sepsis in clients with
burns
Slide59
4.Is not a carbonic
anhydrase
inhibitor and therefore does not cause acidosis
5.Rash and itching occurs from topical application
6.Apply 1/16-inch film; keep
burn
covered at all times with silver sulfadiazine
7.Systemic effects include
leukopenia
, interstitial nephritis
8.Monitor complete blood cell (CBC) count, particularly white blood cells (WBCs) frequently; if
leukopenia
develops, the medication is discontinuedSlide60
BOX 41-13 Burn Products
Mafenide
(
Sulfamylon
)
Nitrofurazone
(
Furacin
)
Silver nitrate
Silver sulfadiazine (
Silvadene
)Slide61
D.Silver
nitrate
1.An antiseptic solution active against gram-negative bacteria
2.Dressings are applied to the
burn
, which are then kept moist with silver nitrate; this stains anything that it comes into contact with; this discoloration is not usually permanent
3.Used on extensive
burns
that may precipitate fluid and electrolyte imbalances
4.Apply to dressing; do not apply to wounds, cuts, or broken skinSlide62
1.A camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse tells the children that sunscreen is most effective when applied:
1.
One hour before exposure to the sun
2.
Immediately before exposure to the sun
3.
15 minutes before exposure to the sun
4.
Immediately after swimmingSlide63
1.Answer:
1
Rationale:: Sunscreens are most effective when applied about 30 to 60 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or
sweating.Test
-Taking Strategy: Use the process of elimination. Recalling that sunscreens need to penetrate the skin will assist in eliminating options 2 and 3. From the remaining options, noting the key words,
most effective
, will direct you to option 1. Review protective skin measures if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Health Promotion and
MaintenanceIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1125. Slide64
2.The nurse is assigned to care for a client with a burn injury to the lower legs.
Nitrofurazone
(
Furacin
) is prescribed to be applied to the sites of injury. The nurse plans to:
1.
Apply saline-soaked dressings over the medication
2.
Apply 1-inch film directly to the burn sites
3.
Apply 1/16-inch film directly to the burn sites
4.
Apply 1/2-inch film directly to the burn sites after cleansing the woundsSlide65
2.Answer:
3
Rationale::
Furacin
is applied topically to the burn and has a broad spectrum of antibiotic activity. It is used in a burn injury when bacterial resistance to other agents is a real or potential problem. A film of 1/16 inch is applied directly to the burn. Saline-soaked dressings are not
used.Test
-Taking Strategy: Use the process of elimination. Option 1 can be eliminated because infection is a major concern with the burn client and a wet dressing can more easily harbor bacteria. Recalling that a very thin film is required will direct you to option 3 from the remaining options. Review the use of this medication for burn therapy if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
PlanningContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1135. Slide66
3.Mafenide (
Sulfamylon
) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. The nurse would:
1.
Discontinue the medication
2.
Notify the registered nurse immediately
3.
Apply a thinner film than prescribed to the burn site
4.
Inform the client that this is normalSlide67
3.Answer:
4
Rationale::
Mafenide
acetate is
bacteriostatic
for both gram-negative and gram-positive organisms and is used to treat burn injuries to reduce bacteria present in
avascular
tissues. The client should be informed that the medication will cause local discomfort and
burning.Test
-Taking Strategy: Use the process of elimination. Eliminate options 1 and 3 because it is not within the scope of nursing practice to alter or discontinue a medication. From the remaining options, recalling that this is a normal expected occurrence will direct you to option 4. If you had difficulty with this question, review this
medication.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1135. Slide68
4.A burn client is receiving treatments of topical
mafenide
(
Sulfamylon
) to the site of injury. The nurse would suspect that a systemic effect has occurred if which of the following is noted in the client?
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 25 of 33 —
printed page 498
)
1.
Local pain at the burn site
2.
Local rash at the burn site
3.
Hyperventilation
4.
Elevated blood pressureSlide69
4.Answer:
3
Rationale::
Mafenide
acetate can suppress renal excretion of acid and cause acidosis, evidenced by hyperventilation. Clients receiving this treatment should be monitored for acid-base status and, if the acidosis becomes severe, the medication is discontinued for 1 to 2 days. Options 1 and 2 describe local rather than systemic effects. An elevated blood pressure may be expected in the client with
pain.Test
-Taking Strategy: Use the process of elimination. Note the key words,
systemic effect
. Options 1 and 2 can be eliminated because these are local rather than systemic effects. From the remaining options, recall that the client in pain would likely have an elevated blood pressure. This should direct you to option 3. Review the systemic effects of this medication if you had difficulty with this
question.Level
of Cognitive Ability:
AnalysisClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/Data
CollectionContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1135. Slide70
5.Sodium hypochlorite (Dakin solution) is prescribed for a client with a leg wound containing purulent drainage. The nurse is assisting in developing a plan of care for the client and includes which of the following in the plan?
1.
Apply the solution to the wound and on normal skin tissue surrounding the wound
2.
Allow the solution to remain in the wound following irrigation
3.
Soak a sterile dressing with solution and pack into the wound
4.
Ensure that the solution is freshly prepared before useSlide71
5.Answer:
4
Rationale:: Dakin solution is a chloride solution that is used for irrigating and cleaning necrotic or purulent wounds. It can be used for packing necrotic wounds. It cannot be used to pack purulent wounds, because the solution is inactivated by copious pus. It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. Solutions are unstable and must be prepared fresh for each
use.Test
-Taking Strategy: Use the process of elimination. Note the key words,
purulent drainage
. Eliminate options 2 and 3 first because they are similar. It makes sense to ensure that the solution is freshly prepared; therefore, select option 4. If you are unfamiliar with the use of this solution, review this
content.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
PlanningContent
Area:
PharmacologyReferences
:
Black, J., & Hawks, J. (2005)
.
Medical-surgical nursing: Clinical management for positive outcomes
(7th ed.). Philadelphia: W.B. Saunders, p. 409.
McKenry, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1202. Slide72
6.Tretinoin (
Retin
-A) is prescribed for a client with acne. The client calls the physician's office and tells the nurse that the skin has become very red and is beginning to peel. The nurse responds by telling the client:
1.
To come to the clinic immediately
2.
To discontinue the medication
3.
To notify the physician
4.
That this is a normal occurrence with the use of this medicationSlide73
6.Answer:
4
Rationale::
Tretinoin
decreases cohesiveness of the epithelial cells, increasing cell mitosis and turnover. It is potentially irritating particularly when used correctly. Within 48 hours of use, the skin generally becomes red and begins to
peel.Test
-Taking Strategy: Use the process of elimination. Options 1 and 3 can be eliminated first because they are similar. Eliminate option 2 next because it is not within the scope of nursing practice to advise a client to discontinue a medication. Review the effects of this medication if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
Hodgson, B., &
Kizior
, R. (2005)
.
Saunders nursing drug handbook 2005
. Philadelphia: W.B. Saunders, p. 1072. Slide74
7.A nurse provides instructions to a client regarding the use of
tretinoin
(
Retin
-A). Which statement by the client indicates the need for further instructions?
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 26 of 33 —
printed page 499
)
1.
“I should wash my hands thoroughly after applying the medication.”
2.
“Optimal results will be seen after 6 weeks.”
3.
“I should apply a very thin layer to my skin.”
4.
“I should cleanse my skin thoroughly before applying the medication.”Slide75
7.Answer:
3
Rationale::
Tretinoin
is applied liberally to the skin. The hands are washed thoroughly immediately after applying. Therapeutic results should be seen after 2 to 3 weeks but may not be optimal until after 6 weeks. The skin needs to be cleansed thoroughly before applying the
medication.Test
-Taking Strategy: Use the process of elimination and note the key words,
need for further instructions
. These words indicate a false response question and that you need to select the incorrect client statement. Eliminate options 1 and 4 first using the principles of asepsis. From the remaining options, knowledge regarding the use of the medication will assist in directing you to option 3. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
ComprehensionClient
Needs: Health Promotion and
MaintenanceIntegrated
Process: Teaching/
LearningContent
Area:
PharmacologyReference
:
Hodgson, B., &
Kizior
, R. (2005)
.
Saunders nursing drug handbook 2005
. Philadelphia: W.B. Saunders, p. 1071. Slide76
8.Isotretinoin (
Accutane
) is prescribed for a client to treat severe cystic acne. The nurse tells the client that the length of the usual prescribed course of treatment is:
1.
1 month
2.
8 weeks
3.
15 to 20 weeks
4.
1 yearSlide77
8.Answer:
3
Rationale::
Isotretinoin
is administered two times daily for 15 to 20 weeks. If needed, a second course may be given, but not until 2 months have elapsed after completing the first
course.Test
-Taking Strategy: Knowledge regarding the use of this medication is required to answer this question. Remember,
isotretinoin
is administered two times daily for 15 to 20 weeks. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Health Promotion and
MaintenanceIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
Hodgson, B., &
Kizior
, R. (2005)
.
Saunders nursing drug handbook 2005
. Philadelphia: W.B. Saunders, p. 596. Slide78
9.Isotretinoin (
Accutane
) is prescribed for a client with severe acne. Before the administration of this medication, the nurse would expect that which laboratory test will be prescribed?
1.
Complete blood count
2.
White blood cell count
3.
Triglyceride level
4.
Platelet
countSlide79
9.Answer:
3
Rationale::
Isotretinoin
can elevate triglyceride levels. Blood triglyceride levels should be measured prior to treatment and periodically thereafter until the effects of the medication on the triglycerides have been
evaluated.Test
-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first because a complete blood count will also measure the white blood cell count. From the remaining options, it is necessary to know that the medication can affect triglyceride levels in the client. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
AnalysisClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
PlanningContent
Area:
PharmacologyReference
:
Hodgson, B., &
Kizior
, R. (2005)
.
Saunders nursing drug handbook 2005
. Philadelphia: W.B. Saunders, p. 596. Slide80
10.A client with severe acne is seen at the physician's office. The physician prescribes
isotretinoin
(
Accutane
). The nurse reviews the client's health record and would notify the physician if the client is presently taking which of the following medications?
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 27 of 33 —
printed page 499
)
1.
Digoxin (
Lanoxin
)
2.
Phenytoin (
Dilantin
)
3.
Vitamin A
4.
Furosemide (
Lasix
)Slide81
10.Answer:
3
Rationale:: Vitamin A, a derivative of
isotretinoin
, can produce generalized intensification of
isotretinoin
toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued prior to
isotretinoin
therapy.Test
-Taking Strategy: Use the process of elimination. Recalling that
isotretinoin
is a derivative of vitamin A will easily direct you to the correct option. If you are unfamiliar with this medication, review the contraindications associated with its
use.Level
of Cognitive Ability:
ApplicationClient
Needs: Safe, Effective Care
EnvironmentIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
Hodgson, B., &
Kizior
, R. (2005)
.
Saunders nursing drug handbook 2005
. Philadelphia: W.B. Saunders, p. 597. Slide82
11.Fibrinolysin and
desoxyribonuclease
(
Elase
) dry powder is prescribed to treat a skin ulcer. The nurse assists in developing a plan of care for the client and includes which intervention in the plan?
1.
Clean the wound with tap water before applying the medication
2.
After applying the medication, cover the wound with a dry, sterile dressing
3.
Apply a thick layer of medication, followed by a second layer
4.
Apply a thin layer of medication and cover with a petrolatum gauzeSlide83
11.Answer:
4
Rationale:: The wound should be cleansed with a sterile solution and gently patted dry. A thin layer of
Elase
is applied and covered with a petrolatum gauze. If a dry powder is used, the solution should be prepared just prior to
use.Test
-Taking Strategy: Use the process of elimination. Noting the word “thin” in option 4 should assist in directing you to this option. Review the method of application of this medication if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
PlanningContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1146. Slide84
12.Sutilains (
Travase
) is prescribed to treat the ulcer. The nurse avoids which action when performing the dressing change?
1.
Cleans the wound with a sterile solution
2.
Dries the wound and covers the
Travase
application with a dry sterile dressing
3.
Moistens the wound with sterile normal saline and then applies the
Travase
4.
Places the
Travase
in the refrigerator following useSlide85
12.Answer:
2
Rationale:: The wound should be cleansed with a sterile solution prior to treatment. The nurse then thoroughly moistens the wound with normal saline or sterile water, applies a thin film of
Travase
extending ¼ to ½ inch beyond the area to be
debrided
, and then applies a loose thin dressing. The ointment should be
refrigerated.Test
-Taking Strategy: Note the key word,
avoids
, in the stem of the question. This word indicates a false response question and that you need to select the incorrect action. Recalling that the wound is moistened prior to applying the
Travase
will direct you to the correct option. Review the method of application of
Travase
if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReferences
:
Black, J., & Hawks, J. (2005)
.
Medical-surgical nursing: Clinical management for positive outcomes
(7th ed.). Philadelphia: W.B. Saunders, pp. 411-412.
McKenry, L., & Salerno, E. (2001)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1146. Slide86
13.A nurse employed in a physician's office is collecting data from a client. The nurse notes that the client is taking
azelaic
acid (
Azelex
). Because of the medication prescription, the nurse suspects that the client is being treated for:
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 28 of 33 —
printed page 499
)
1.
Herpes simplex
2.
Acne
3.
Eczema
4.
Hair lossSlide87
13.Answer:
2
Rationale::
Azelaic
acid is a topical medication used to treat mild to moderate acne. It appears to work by suppressing the growth of
Propionibacterium
acnes
and by decreasing proliferation of
keratinocytes.Test
-Taking Strategy: Knowledge regarding the use of
azelaic
acid is required to answer this question. Remember,
Azelaic
acid is a topical medication used to treat mild to moderate acne. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
AnalysisClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/Data
CollectionContent
Area:
PharmacologyReference
:
Lehne
, R. (2004)
.
Pharmacology for nursing care
(5th ed.). Philadelphia: W.B. Saunders, p. 1113. Slide88
14.Collagenase (
Santyl
) is prescribed for a client with a severe burn to the hand. The nurse provides instructions to the client regarding the use of the medication. Which statement by the client indicates an accurate understanding of the use of this medication?
1.
“I will apply the ointment once a day and leave it open to the air.”
2.
“I will apply the ointment once a day and cover it with a sterile dressing.”
3.
“I will apply the ointment twice a day and leave it open to the air.”
4.
“I will apply the ointment at bedtime and in the morning and cover it with a sterile dressing.”Slide89
14.Answer:
2
Rationale::
Collagenase
is used to promote debridement of dermal lesions and severe burns. It is applied once daily and covered with a sterile
dressing.Test
-Taking Strategy: Note the key words,
indicates an accurate understanding
. Knowledge regarding the use of this medication will direct you to option 2. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
AnalysisClient
Needs: Health Promotion and
MaintenanceIntegrated
Process: Teaching/
LearningContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1145. Slide90
15.Dextranomer (
Debrisan
) is prescribed for a client with a
decubiti
ulcer. The nursing instructor asks the nursing student preparing to perform the treatment about the medication and the procedure. Which statement, if made by the student, indicates a need for further research?
1.
“It is effective in wet wounds only.”
2.
“It should be packed lightly into the wound.”
3.
“Maceration of tissue surrounding the wound can occur from the medication.”
4.
“The wound bed must be thoroughly dried prior to applying the medication.”Slide91
15.Answer:
4
Rationale::
Debrisan
is a cleansing rather than a
debriding
agent. It is effective in wet wounds only. It is not packed tightly into the wound because maceration of surrounding tissue may
result.Test
-Taking Strategy: Use the process of elimination. Note the key words,
indicates a need for further research
. These words indicate a false response question and that you need to select the incorrect statement. Noting that option 1 indicates that the wound should be wet and option 4 indicates that the wound should be dry provides the clue that one of these options is correct. If you are unfamiliar with the use of
Debrisan
, review the procedure associated with its
use.Level
of Cognitive Ability:
AnalysisClient
Needs: Physiological
IntegrityIntegrated
Process: Teaching/
LearningContent
Area:
PharmacologyReferences
:
Black, J., & Hawks, J. (2005)
.
Medical-surgical nursing: Clinical management for positive outcomes
(7th ed.). Philadelphia: W.B. Saunders, pp. 411-412.
McKenry, L., & Salerno, E. (2001)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1147. Slide92
16.Coal tar has been prescribed for a client with a diagnosis of psoriasis, and the nurse provides instructions to the client about the medication. Which statement by the client indicates a need for further instructions?
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 29 of 33 —
printed page 499
)
1.
“The medication has an unpleasant odor.”
2.
“The medication can stain the skin and hair.”
3.
“The medication can cause systemic effects.”
4.
“The medication can cause
phototoxicity
.”Slide93
16.Answer:
3
Rationale:: Coal tar is used to treat psoriasis and other chronic disorders of the skin. It suppresses DNA synthesis, mitotic activity, and cell proliferation. It has an unpleasant odor, can frequently stain the skin and hair, and can cause
phototoxicity
. Systemic toxicity does not
occur.Test
-Taking Strategy: Use the process of elimination and note the key words,
need for further instructions
. These words indicate a false response question and that you need to select the incorrect client statement. The name of the medication will assist in eliminating options 1 and 2. From the remaining options, it is necessary to know that the medication does not cause systemic effects. Review this treatment if you had difficulty with this
question.Level
of Cognitive Ability:
AnalysisClient
Needs: Physiological
IntegrityIntegrated
Process: Teaching/
LearningContent
Area:
PharmacologyReferences
:
Black, J., & Hawks, J. (2005)
.
Medical-surgical nursing: Clinical management for positive outcomes
. (7th ed.). Philadelphia: W.B. Saunders, p. 1393.
Lehne, R. (2004)
.
Pharmacology for nursing care
(5th ed.). Philadelphia: W.B. Saunders, p. 1116. Slide94
17.A client is diagnosed with herpes simplex. The physician tells the nurse that a topical medication for treatment will be prescribed. The nurse expects that which of the following medications will be prescribed?
1.
Triple antibiotic
2.
Acyclovir (
Zovirax
)
3.
Mupirocin (
Bactroban
)
4.
Masoprocol (
Actinex
)Slide95
17.Answer:
2
Rationale:: Acyclovir is a topical antiviral agent that inhibits DNA replication in the virus. It has activity against herpes simplex virus types 1 and 2,
varicella
-zoster virus, Epstein-Barr virus, and cytomegalovirus. Triple antibiotic would not be effective in treating
herpesvirus
.
Mupirocin
is a topical antibacterial active against impetigo caused by staphylococcus or streptococcus.
Masoprocol
is a
keratolytic.Test
-Taking Strategy: Use the process of elimination. Recalling that herpes simplex is a virus will direct you to the option that identifies an antiviral medication. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
AnalysisClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/
PlanningContent
Area:
PharmacologyReference
:
Hodgson, B., &
Kizior
, R. (2005)
.
Saunders nursing drug handbook 2005
. Philadelphia: W. B. Saunders, p. 12. Slide96
18.Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse suspects the presence of systemic toxicity from this medication if which of the following occurs in the client?
1.
Decreased respirations
2.
Diarrhea
3.
Constipation
4.
TinnitusSlide97
18.Answer:
4
Rationale:: Salicylic acid is readily absorbed through the skin and systemic toxicity (
salicylism
) can result. Symptoms include tinnitus,
hyperpnea
, dizziness, and psychological disturbances. Constipation and diarrhea are not associated with
salicylism.Test
-Taking Strategy: Use the process of elimination. Noting the name of the medication will assist in directing you to the correct option if you can recall the toxic effects that occur with acetyl
salicylic
acid (aspirin). If you are unfamiliar with the toxic effects of salicylic acid, review this
content.Level
of Cognitive Ability:
AnalysisClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/Data
CollectionContent
Area:
PharmacologyReference
:
Lehne
, R. (2004)
.
Pharmacology for nursing care
(5th ed.). Philadelphia: W.B. Saunders, p. 1108. Slide98
19.A hospitalized client with severe
seborrheic
dermatitis is receiving treatments of topical
glucocorticoid
applications followed by the application of an occlusive dressing. The nurse monitors for which systemic effect that can occur from this treatment?
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 30 of 33 —
printed page 500
)
1.
Adrenal suppression
2.
Adrenal hyperactivity
3.
Local infection
4.
Thinning of the skinSlide99
19.Answer:
1
Rationale:: Topical
glucocorticoids
can be absorbed in sufficient amounts to produce systemic toxicity. Principal concerns are growth retardation (in children), and adrenal suppression in all age groups. Options 3 and 4 identify local rather than systemic
reactions.Test
-Taking Strategy: Use the process of elimination. Options 3 and 4 can be eliminated first because they are local reactions. From the remaining options, recalling the concerns related to systemic toxicity is required to answer the question. Review these systemic effects if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/Data
CollectionContent
Area:
PharmacologyReferences
:
Lehne
, R. (2004)
.
Pharmacology for nursing care
(5th ed.). Philadelphia: W.B. Saunders, p. 1108.
McKenry, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 852. Slide100
20.A nurse is applying a topical
glucocorticoid
to a client with eczema. The nurse monitors for systemic absorption of the medication if the medication is being applied to which of the following body areas?
1.
Back
2.
Axilla
3.
Palms of the hands
4.
Soles of the feetSlide101
20.Answer:
2
Rationale:: Topical
glucocorticoids
can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp,
axilla
, face, eyelids, neck, perineum, genitalia), and lower from regions where penetrability is poor (back, palms, soles).Test-Taking Strategy: Focus on the issue of the question, “systemic absorption.” Eliminate options 3 and 4 because these body areas are similar in terms of skin characteristics. From the remaining options, think about permeability of the skin area. This will direct you to option 2. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Nursing Process/Data
CollectionContent
Area:
PharmacologyReference
:
Lehne
, R. (2004)
.
Pharmacology for nursing care
(5th ed.). Philadelphia: W.B. Saunders, p. 1108. Slide102
21.A topical
glucocorticoid
is prescribed for a client with dermatitis. The nurse provides instructions to the client regarding the use of the medication. Which of the following, if stated by the client, would indicate a need for further instruction?
1.
“I need to apply the medication in a thin film.”
2.
“I should gently rub the medication into the skin.”
3.
“I should place a bandage over the site after applying the medication.”
4.
“The medication will help to relieve the inflammation and itching.”Slide103
21.Answer:
3
Rationale:: Clients should be advised not to use occlusive dressings (bandages or plastic wraps) to cover the affected site following the application of the topical
glucocorticoid
, unless the physician specifically prescribes wound coverage. Options 1, 2, and 4 are accurate statements related to the use of this
medication.Test
-Taking Strategy: Use the process of elimination and note the key words,
need for further instruction
. Eliminate option 4 knowing that this is the action for
glucocorticoids
. The words “thin” in option 1 and “gently” in option 2 should assist you in eliminating these options. If you had difficulty with this question, review this
medication.Level
of Cognitive Ability:
AnalysisClient
Needs: Health Promotion and
MaintenanceIntegrated
Process: Teaching/
LearningContent
Area:
PharmacologyReference
:
Lehne
, R. (2004)
.
Pharmacology for nursing care
(5th ed.). Philadelphia: W.B. Saunders, p. 1108. Slide104
22.Lindane (
Kwell
) is prescribed for the treatment of scabies. The nurse would question the order if the medication were prescribed for which of the following clients?
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 31 of 33 —
printed page 500
)
1.
A 42-year-old female
2.
An older client
3.
A 6-year-old child
4.
A 52-year-old male with hypertensionSlide105
22.Answer:
3
Rationale::
Lindane
can penetrate the intact skin and can cause convulsions if absorbed in sufficient quantities. Clients at highest risk for convulsions are premature infants, children, and clients with preexisting seizure disorders.
Lindane
should not be used on pediatric clients unless safer medications have failed to control the
infection.Test
-Taking Strategy: Knowledge regarding the contraindications associated with the use of
lindane
is required to answer this question. Remember,
lindane
should not be used on pediatric clients unless safer medications have failed to control the infection. If you are unfamiliar with these contraindications, review this
content.Level
of Cognitive Ability:
AnalysisClient
Needs: Safe, Effective Care
EnvironmentIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1137. Slide106
23.A client is seen in the clinic for complaints of skin itchiness that has been persistent over the past several weeks. Following data collection, it has been determined that the client has scabies.
Lindane
(
Kwell
) is prescribed and the nurse is asked to provide instructions to the client regarding the use of the medication. The nurse tells the client to:
1.
Leave the cream on for 8 to 12 hours and then remove by washing
2.
Apply a thick layer of cream to the entire body
3.
Apply the cream as prescribed for 2 days in a row
4.
Apply to the entire body and scalp, excluding the faceSlide107
23.Answer:
1
Rationale::
Lindane
is applied in a thin layer to the entire body below the head. No more than 30 g (1 oz) should be used. The medication is removed by washing 8 to 12 hours later. Usually, only one application is
required.Test
-Taking Strategy: Knowledge regarding the use of
lindane
is required to answer this question. Remember, the medication is removed by washing 8 to 12 hours after application. If you are unfamiliar with the use of this medication, review this
procedure.Level
of Cognitive Ability:
ApplicationClient
Needs: Health Promotion and
MaintenanceIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
McKenry
, L., & Salerno, E. (2003)
.
Mosby's pharmacology in nursing
(21st ed.). St. Louis: Mosby, p. 1136. Slide108
24.An outbreak of
pediculosis
capitus
has occurred at the local school. The nurse is helping provide instructions to the mothers of the children attending the school regarding the application of
permethrin
5% (
Elimite
). The nurse tells the mothers to:
1.
Apply at bedtime and rinse off in the morning
2.
Apply prior to washing the hair
3.
Avoid saturating the hair and scalp when applying
4.
Allow to remain on the hair 10 minutes and then rinse with waterSlide109
24.Answer:
4
Rationale:: The instructions for the use of
permethrin
include wash, rinse, and towel-dry the hair; apply sufficient volume to saturate the hair and scalp; allow to remain on the hair 10 minutes and then rinse with water. Options 1, 2, and 3 are incorrect
instructions.Test
-Taking Strategy: Note that both options 1 and 4 address a time frame for allowing the medication to remain on the hair. Recognizing this may provide you with the clue that one of these options is correct. From this point, it is necessary to know the procedure for this treatment. If you are unfamiliar with this treatment, review this
content.Level
of Cognitive Ability:
ApplicationClient
Needs: Health Promotion and
MaintenanceIntegrated
Process: Nursing Process/
ImplementationContent
Area:
PharmacologyReference
:
Lehne
, R. (2004)
.
Pharmacology for nursing care
(5th ed.). Philadelphia: W.B. Saunders, p. 1055. Slide110
25.The physician has prescribed
Myoflex
topical cream for a client with a diagnosis of rheumatism who is complaining of muscular aches. Which of the following information does the nurse provide to the client regarding this medication?
Top of Form
Bottom of Form
CHAPTER 41
Integumentary
Medications (page 32 of 33 —
printed page 500
)
1.
Apply a heating pad to the area after applying the medication
2.
The medication acts by decreasing muscle spasms
3.
The medication is prescribed to cause the skin to peel
4.
The medication will act as a local anestheticSlide111
25.Answer:
4
Rationale::
Myoflex
is one of the many products used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. These types of products contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants. A heating pad should not be applied because irritation or burning of the skin may occur. These medications do not act in a systemic manner (option 2). They are not prescribed to cause the skin to peel and, if this sort of reaction occurs, the physician should be
notified.Test
-Taking Strategy: Use the process of elimination. Noting the key words,
topical cream
, may assist in eliminating option 2. Eliminate option 3, knowing that this is not an expected therapeutic effect. Recalling the principles related to the application of heat will assist in eliminating option 1. Review this medication if you had difficulty with this
question.Level
of Cognitive Ability:
ApplicationClient
Needs: Physiological
IntegrityIntegrated
Process: Teaching/
LearningContent
Area:
PharmacologyReference
:
Kee
, J., & Hayes, E. (2003)
.
Pharmacology: A nursing process approach
(4th ed.). Philadelphia: W.B. Saunders, pp. 254-255.