Download Lyme disease

Essentials of Human Diseases
and Conditions
4th edition
Seminar 4
Dr. Lena Watson, RN, MBA/HCM
Learning Objectives
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Explain the functions of the skin.
Describe how seborrheic dermatitis affects
the skin.
Discuss the common causes of contact
dermatitis, atopic dermatitis, and psoriasis.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
1
Learning Objectives (cont’d.)
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Describe the treatment of acne vulgaris.
Cite examples of classifications of fungal infections of
the skin.
List preventative measures for decubitis ulcers.
Name the two most common parasitic insects to
infest man and the occurrence.
Name two common premalignant tumors.
Differentiate the three types of skin cancer.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
2
Learning Objectives (cont’d.)


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
List preventative measures for decubitis
ulcers.
Name the two most common parasitic insects
to infest man and the occurrence.
Name two common premalignant tumors.
Differentiate the three types of skin cancer.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
3
Learning Objectives (cont’d.)
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Describe the guidelines for avoiding
excessive sun exposure.
Name some possible causes of alopecia.
State the cause of warts, nail discoloration,
and ,malformations.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
4
Learning Objectives
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List the functions of the normal skeletal
system.
Distinguish among the pathologic features of
the different types of scoliosis.
Describe the signs and symptoms of the most
common form of arthritis.
Explain the importance of early diagnosis and
treatment of Lyme disease.
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5
Learning Objectives (cont’d.)
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Describe the treatment of bone tumors, both
benign and malignant.
Discuss the specifics of a physical
examination when fibromyalgia is suspected.
Explain why joint disability results from gout.
Describe the picture of osteomyelitis and
explain how it is treated.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
6
Learning Objectives (cont’d.)
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Describe the disability that results from
advanced osteoporosis.
Explain why osteomalacia is termed a
metabolic bone disease.
Distinguish between hallus valgus and hallus
rigidus.
Distinguish between a strain and a sprain.
Explain the importance of proper treatment of
dislocations.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
7
Learning Objectives (cont’d.)
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Describe the cause of shin splints.
List some factors that contribute to the
development of plantar fasciitis.
Explain how torn meniscus is treated.
Describe the signs and symptoms of rotator
cuff tears.
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8
Chapter 6
INTEGUMENTARY SYSTEM
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9
Components of the Integumentary
System
Skin and accessory organs:
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Hair
Nails
Glands
Skin layers
Dermis
Epidermis
Subcutaneous layer
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10
Common Skin Condition Symptoms
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cutaneous lesions or eruptions
pruritis (itching)
pain
edema (swelling)
erythema (redness)
inflammation
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11
A Few Common Skin Lesions
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macule
plaque
cyst
pustule
scale
burrow
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papule
nodule
vesicle
crust
fissure
comedo
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12
Common Diseases of the Skin
Dermatitis
 Seborrheic dermatitis
 Contact dermatitis
 Atopic dermatitis (eczema)
 Psoriasis
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13
Common Diseases of the Skin (cont’d.)

Note the differences between seborrheic
dermatitis and contact dermatitis:


seborrheic dermatitis – idiopathic condition
resulting in overproduction of sebum
contact dermatitis – localized redness and
swelling caused by an irritant or allergen
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14
Clicker Question
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One of the most common skin disorders
marked by an inflammatory condition of the
sebaceous glands is
a. psoriasis.
b. atopic dermatitis (eczema).
c. impetigo.
d. seborrheic dermatitis.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
15
Clicker Question
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The most common dermatitis during infancy,
which is called cradle cap, is a form of:
a. psoriasis.
b. atopic dermatitis (eczema).
c. impetigo.
d. seborrheic dermatitis.
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
16
Common Diseases of the Skin
(cont’d.)
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Acne vulgaris: an inflammatory disease of
the sebaceous glands and hair follicles
Herpes zoster (shingles): an acute
inflammatory dermatomal eruption of painful
vesicles
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Common Diseases of the Skin (cont’d.)
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Chickenpox is a precursor to shingles.
Both are caused by the herpes varicellazoster virus.
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Common Diseases of the Skin (cont’d.)
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Impetigo: contagious, superficial skin
infection
Cellulitis: acute, diffuse, bacterial infection of
the skin and subcutaneous tissue
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Dermatophytoses
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Tinea capitis
Tinea corporis (ringworm)
Tinea unguium
Tinea pedis (athlete’s foot)
Tinea cruris (jock itch)
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Clicker Question
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_____ is a common contagious superficial
skin infection caused by either Streptococcus
or Staphylococcus aureus.
a. Psoriasis
b. Atopic dermatitis
c. Impetigo
d. Seborrheic dermatitis
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
21
Clicker Question
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____is a type of inflammation of the skin that
tends to occur in persons with a family history
of allergic conditions. Hint: AKA Eczema
a. Psoriasis
b. Atopic dermatitis
c. Impetigo
d. Seborrheic dermatitis
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.
22
Other Diseases of the Skin
Decubitis ulcers (bed sores): localized areas
of dead skin
Scabies: infestation by parasitic insects called
itch mites
Pediculus: infestation by lice; wingless
parasites that feed on human blood
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23
Other Diseases of the Skin (cont’d.)
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Species that infest the head and body
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Pediculus humanus capitis – lice that infest the
head
Pediculus humanus corporis – lice that infest the
body
Phthirus pubis – pubic lice (crabs)
Sarcoptes scabiei – itch mites
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24
Benign Tumors
Seborrheic keratosis: benign growths
originating in the epidermis
Dermatofibroma: benign, asymptomatic
growths that can be found anywhere on the
body
Achrochordon (skin tag): common benign
skin growths found mainly on the axilla, neck,
and inguinal areas of the body
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Clicker Question
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Itch mites and lice spread easily from one
person to another by close physical contact.

A) True
B) False

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Premalignant Tumors
Actinic keratosis: common pre-malignant
lesions found on sun-exposed areas of the
body
 Indications: an area of rough, vascular skin,
which later forms a yellow crust.
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Skin Carcinomas
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Non-melanoma skin cancers
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Basal cell carcinoma (BCC)
Squamous cell carcinoma (SCC)
Malignant melanomas
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The ABCs of malignant melanoma:
• A = asymmetry
• B = border
• C = color
• D = diameter
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Protection of Skin from the Sun
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Avoid exposure 10 a.m.– 3 p.m.
Plan outdoor activities for early morning or
late afternoon
Wear protective clothing
Use sunscreen
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Clicker Question
Appearance and location of the lesions
confirm the diagnosis of each of the three
types of skin carcinoma.
A) True
B) False

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Clicker Question
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The ABCDEs of malignant melanoma include
a. family history, sunburn, large moles,
bleeding, and previous cancer.
b. asymmetry, border, color, diameter, and
elevation.
c. neither of the above.
d. both a and b.
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Abnormal Skin Pigmentation
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albinism: inability to produce melanin (inherited)
vitiligo: pale, irregular patches (may be an immune
system disorder)
melasma (chloasma): patches of darker skin on the
face
hemangiomas: benign lesions of highly vascularized
skin; they may be flat (port-wine stains), elevated, or
protuberant
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Abnormal Skin Pigmentation (cont’d.)
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nevi (moles): small, dark collections of melanocytes
pityriasis: fungal infection; causes patches of flaky, light, or
dark skin on the trunk
abnormal suntan: unusual darkening of the skin resulting from
properly used medications
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33
Clicker Question

A precursor to skin cancers is:
a. squamous cell carcinoma.
b. basal cell carcinoma.
c. pityriasis
d. actinic keratosis.
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34
Clicker Question
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_____ is a serious form of skin cancer that
often ulcerates, forms a crust, and has a
tendency to metastasize if allowed to reach
an advanced stage.
a. Squamous cell carcinoma
b. Basal cell carcinoma
c. Malignant melanoma
d. Actinic keratosis
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35
Causes of Alopecia (Baldness)
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heredity
aging process
systemic illness
dermatitis
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More Common Diseases of the Skin
Verrucae (warts): warts are elevated growths
of the epidermis that result from hyperplasia
Deformed or discolored nails: any unusual
thickening, color variation, or change in
shape of fingernails or toenails
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37
Chapter 7
MUSCULOSKELETAL SYSTEM
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Fibromyalgia
Fibromyalgia: a chronic pain condition associated with
stiffness and tenderness that affects muscles,
tendons, and joints throughout the body. The cause
is unknown.
•
Eighteen tender points used in diagnosis
•
Treatment options
•
•
•
Stress reduction
Physical activity
Medications
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39
Major Spinal Disorders
Lordosis: an exaggerated inward curvature of
the spine
Kyphosis: an abnormal outward curvature of
the spine
Scoliosis: a lateral (sideways) curvature of the
spine
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Clicker Question
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A lateral curvature of the spine is known as:
a. kyphosis.
b. lordosis.
c. lumbago.
d. scoliosis.
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41
Lordosis - Treatment Options
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Weight loss
Exercises to strengthen abdomen
Pelvic tilt exercises
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Kyphosis - Treatment Options
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Exercises to strengthen muscles and
ligaments
Back brace to stabilize condition
Spinal fusion and temporary immobilization
Vertebroplasty
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Scoliosis - Treatment Options
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Exercise to strengthen weak muscles
Back brace
Fusion of the vertebrae
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Osteoarthritis
Osteoarthritis: the breakdown and eventual loss of
cartilage of one or more joints
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Causes:
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
aging process
heredity
injury
chronic diseases such as diabetes and obesity
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Osteoarthritis (cont’d.)
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Signs and symptoms
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Diagnosis

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Spur formations on fingers
Degeneration of spinal vertebrae and pelvic joints
Radiographic testing to exclude other causes
Treatment

Reduce inflammation, minimize pain
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46
Lyme Disease

Lyme disease: an infectious bacteriological disease
spread by deer tick bites
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Caused by the bacterium Borrelia burgdorferi
Characterized by red, itchy rash with a red circle center
(“bull’s-eye” rash)
Often characterized by flu-like symptoms such as headache,
fever, joint pain, and fatigue
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Lyme Disease (cont’d.)
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Treatment
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removal of tick
oral antibiotics
intravenous antibiotics
bed rest and physical therapy
Prevention

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avoid tick bites by wearing long clothing
inspect clothes and body for ticks
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48
Osteomyelitis
Osteomyelitis: a serious infection of bone that
requires aggressive antibiotic treatment
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Caused by bacterial organisms, viruses, and fungi
Characterized by inflammation, swelling, redness,
pain, localized heat, and tenderness
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49
Clicker Question
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The following statement(s) about fibromyalgia
is(are) true.
a. It is a painful debilitating syndrome that
causes chronic pain in muscles and soft
tissues surrounding joints.
b. The cause is unknown.
c. Diagnosis includes pain at specific tender
points.
d. All of the above are true.
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Osteomyelitis (cont’d.)
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Treatment
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long-term antibiotic treatment
increased intake of proteins and vitamins A, B,
and C
bed rest
control of chronic conditions
Immobilization of affected part
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51
Gout
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Gout: a chronic disorder of uric acid
metabolism that manifests an acute, episodic
form of arthritis
Causes
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Overproduction or decreased excretion of uric acid
high levels of uric acid in the blood
high levels of uric acid in synovial fluid in joints
and tissues
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Clicker Question
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A tick-carried bacteria causes _____, which is
characterized by symptoms of arthritis,
malaise, myalgia, and neurologic and
cardiovascular signs.
a. ankylosing spondylitis
b. Lyme disease
c. systemic lupus erythematosus
d. kyphosis
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Gout (cont’d.)
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Treatment
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bed rest to reduce pressure on affected joints
application of ice to inflamed joints
NSAIDs and corticosteroids
low-purine diet and frequent fluid intake
antihyperuricemic medications
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54
Musculoskeletal Tumors
Bone tumor: any abnormal growth (whether
benign or malignant) in the bone
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chondrogenic (from cartilage)
osteogenic (from bone)
fibrogenic (from fibrous tissue)
Muscle tumor: muscle neoplasms, benign or
malignant sarcomas, that may arise at any
site in the body
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Musculoskeletal Tumors (cont’d.)

Symptoms

Malignant tumors have characteristic signs

palpable mass; dull, localized pain
 pathologic fracture, commonly in acetabulum or proximal femur

Diagnosis

radiographic studies,MRI, CT scan, biopsy
 elevated serum alkaline phosphatase
 elevated serum calcium

Treatment

surgical excision
 chemotherapy/radiation therapy
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56
Osteoporosis
Osteoporosis: a condition characterized by
loss of normal bone mass and density due to
imbalance between breakdown of old bone
tissue and manufacture of new bone
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57
Osteoporosis (cont’d.)

Symptoms



asymptomatic until bone breaks
spontaneous fractures and loss of height are the most
common signs
Treatment

increased intake of calcium and vitamin D
 estrogen replacement therapy
 bisphosphonate medications
 moderate exercise
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Osteomalacia
Osteomalacia: a disease characterized by a
defective mineralization of the bones, causing
them to become soft, flexible, and deformed

When osteomalacia occurs in children, it affects
the growing skeleton and is called rickets
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59
Osteomalacia (cont’d.)
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Symptoms
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
general fatigue
muscle weakness
progressive stiffness
tender, painful bones
Treatment



vitamin D supplements
add vitamin D, calcium, and calcitonin to diet
exposure to sunlight
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60
Hallus Valgus & Hallus Rigidus
Hallus Valgus (Bunion): a localized area of
enlargement of the inner portion of the
metatarsophalangeal (MTP) joint at the base
of the big toe
Hallus Rigidus (Rigid Big Toe): a stiff big toe
that develops as a result of degeneration of
the cartilage of the first metatarsophalangeal
(MTP) joint
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Hallus Valgus & Hallus Rigidus (cont’d.)

Symptoms
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
painful bunions
MTP joint becomes stiff, painful, and swollen
Treatment




wearing shoes with more room
application of ice
anti-inflammatory agents
for hallux rigidus, treatment is removal.
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Clicker Question

What is another common term for hallux
rigidus?

A) Bunion
B) Hammertoe
C) Bone Spur
D) Bone fixation



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Traumatic and Sports Injuries

Fractures (broken bones): caused by stress
on the bones resulting from a traumatic insult
to the musculoskeletal system, severe muscle
spasm, or bone disease
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Clicker Question
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
A vitamin D deficiency can cause this
abnormal metabolic bone disease
a. osteoporosis.
B. osteogenesis imperfecta.
c. osteomalacia.
d. osteoclasis.
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65
Traumatic and Sports Injuries (cont’d.)

General treatment of fractures depends on
location, severity, type, and cause



simple fracture of long bone: reduction and
immobilization
compound fracture: cleaning, debriding, reduction,
immobilization
internal fixation (open reduction)
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66
Traumatic and Sports Injuries (cont’d.)

Strains: injured tendons, muscles or other
tissues resulting from overuse,
overstretching, or excessive forcible
stretching of the tissue beyond its functional
capacity

Sprains: acute partial tears of a ligament
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Treatment of Strains and Sprains
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Elevation and rest of affected limb
Immobilization with elastic bandage
Application of ice
Analgesics and anti-inflammatory agents
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Traumatic and Sports Injuries (cont’d.)
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
Dislocation: the forcible displacement of a
bone from its joint, causing loss of joint
function
Treatment

Proper repositioning of joint within 30 minutes of
injury
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Traumatic and Sports Injuries (cont’d.)

Severed tendon: caused by injury or
laceration; involves the forearm, hand, calf, or
foot. The severed ends snap away from each
other.


Symptoms: immediate, severe pain, inflammation
and immobility
Treatment: tenorrhaphy (suturing of the two ends
of the tendon)
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Traumatic and Sports Injuries (cont’d.)

Shin splints: a painful condition involving
inflammation of the periosteum, the extensor
muscles of the lower leg, and the surrounding
tissues


Symptoms: inflammation, edema, pain on inner
aspect of the tibia
Treatment: rest plus applications of ice or heat
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Traumatic and Sports Injuries (cont’d.)

Plantar fasciitis: an inflammatory response
at the bottom of the heel bone, generally
caused by overuse


Symptoms: pain on bottom of foot
Treatment:
• application of ice
• anti-inflammatory medication
• heel pads
• cortisone
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72
Clicker Question

A strained muscle is more serious than a
sprained muscle.

A) True
B) False

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Traumatic and Sports Injuries (cont’d.)

Torn meniscus: a crack or fissure to the
meniscus cartilage in the knee joint

Symptoms
• acute pain when putting full weight on affected leg and
knee
• snapping or clicking on flexion or extension

Treatment
• immobilization and elevation
• surgery
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Traumatic and Sports Injuries (cont’d.)

The rotator cuff: the four tendons of the
rotator cuff, formed by the muscles of the
shoulder, partially surround the head of the
humerus and stabilize it in the glenoid cavity
of the socket

Rotator cuff tears: tears to any of the rotator
cuff tendons that limit the function of the
shoulder
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