Final exam format.docx - cushNURS 6541 Comprehensive Final...

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cushNURS 6541 Comprehensive Final Exam Review (Week 1-11)You will be tested over weeks 1-11 on this Blackboard Exam****For weeks 1-6, review Midterm Study Guide****Week 7: Dermatology disordersBug bites and bee stings – Dog bites, cat bites – Dog Bite: about the circumstances surrounding the bite including the type of animal, domesticated orferal animal, provoked or unprovoked attack, and location of the attack. History of drug allergies andimmunization status of the child also should be ascertained.Physical Examination.The wound should be assessed for the type, size, and depth of injury. Explore for the presence of foreignmaterial and the status of underlying structures. If the bite is on an extremity, assess its range of motion andsensory intactness. Likewise, assess functioning of the facial nerve with deep facial bite injuries. At minimum, adiagram of the injury should be recorded in the child's chart (Ginsburg, 2011). If possible, it is best to photographthe injury for documentation.Diagnostic Studies.Aerobic and anaerobic cultures should be obtained from wounds exhibiting signs of infection (Buttaravoli andLeffler, 2012). A radiograph of the affected part should be obtained if it is likely that a bone or joint could havebeen penetrated or fractured or if retained foreign material may be present.Differential DiagnosisThe differential diagnosis includes lacerations or puncture wounds from other causes.ManagementManagement involves both physical and psychological care of the child and includes the following (Mandt andGrubenhoff, 2014):• Administer tetanus booster and rabies prophylaxis if indicated (consult with local animal control or public health department).• Provide/administer appropriate analgesia or anesthesia.• Débride avulsed or devitalized tissue and remove foreign matter.• Using normal saline, irrigate the wounds using high pressure (greater than 4 pounds per square inch) and high volume (greater than 1 L).• Isolated puncture wounds should not be irrigated, instead soak the wound in a diluted solution of tap water and povidone-iodine for 15 minutes.• Prescribe a 3- to 5-day course of prophylactic antibiotics for all human and cat bites, and for the following typesof bite or wound characteristics: hand, puncture, overlying bone fracture, substantial crushing tissue injuries or if requiring débridement, or those involving tendons, muscles, or joint spaces. In addition, antibiotic coverage isneeded for wounds in children who are immunosuppressed. For outpatients, prescribe a broad-spectrum
antibiotic, such as amoxicillin clavulanate (first choice). Penicillin-allergic individuals should be treated with an extended spectrum cephalosporin or trimethoprim-sulfamethoxazole plus clindamycin (Hodge, 2010).1137• Rabies exposure prophylaxis also should be considered if there is any question about possible exposure. The CDC provides guidelines on prophylaxis for possible rabies (see Additional Resources).The local health department is also a good resource for guidance on postexposure prophylaxis for rabies.

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