Medical Nursing Week 6

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Medical Nursing Week 6
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2012-10-05 15:51:08
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Medical Nursing Week 6
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  1. Dermatology
    Anatomy
    • Epidermis
    • Ears
    • Hair coat
    • Glands
  2. Dermatology
    Prupose
    • Protection
    • Temperature Regulation
    • Behavior
  3. Dermatology
    Terminology
    • Alopecia- Hair loss
    • Pruritis- Itching and scratching
    • Pustule- Raised nodule with pus
    • Lichenification- thick dlephant like skin
    • Seborrea- greasy, oily dermitis
  4. Dermatology
    Clinical Signs
    • Pruuitis
    • Alopecia
    • Fleas
    • Foul smell and discharge
    • Redness
    • Scabs, crust and parasites
  5. Dermatology
    Diagnosis
    • Skin scrape and fungal cultures
    • Blood profile- organ related problems will cause skin problems
    • Allergy test
    •    Intradermal
    •    RAST (radioallergosorbent test) Not as accurate as Intradermal
    • Skin Biopsy

    Skin problems can also be caused by ie. Hypothyroid or diabetes
  6. Dermatology
    Disease
    Pyoderma (hotspots, FAD (flea allergy dermatits) atopy
    Etiology
    • Parasites- fleas and sarcoptes
    • Allegic
    • Irritation
    •    Hair mats
    •    Bite wounds
  7. Dermatology
    Disease
    Pyoderma (hotspots, FAD (flea allergy dermatits) atopy
    Pathophysiology
    • Irritation casues itching and scratching
    • Self induced trauma casues hair loss and exudation
    • Lesions develop
    • Secondary infection by staphylococcus occurs
  8. Dermatology
    Disease
    Pyoderma (hotspots, FAD (flea allergy dermatits) atopy
    Clinical signs
    • Red, moist skin with pus like exudate
    • Hair loss
    • Scratching and moist area
    • Painful and febrile
  9. Dermatology
    Disease
    Pyoderma (hotspots, FAD (flea allergy dermatits) atopy
    Treatment
    • Clip and clean if localized (hot spot)
    •   Clean with antiseptic
    •        Chlorhexiderm
    • Treat primary cause
    •       Parasites, fleas, etc.
    • Antibiotics
    •      Cephalexin, baytril, amoxicillin and clavamox
    • Short term corticosteroids
    •     Prednisone
    •     Vetalog
    • E-collar to reduce chewing
    • Medicated bedding
    •       Nolvasan shampoo
    •       Oxydex
    •            Benzol peroxide
    •            astringents
    • Antihistamaines- not for cats
    •      Benadryl (diphenhydramine) and Hydroxyzone (anthrax)
  10. Dermatology
    Abscess
    Definition
    Deep suppurative infections- under the epidemis
  11. Dermatology
    Abscess
    Etiology
    • Mostly cats, from cat fight wounds
    • Penetrating wounds
    •      Bites, foreign body
    • Self infliction
    •      Skin infections
    •      Dermatitis
    • Trauma
    •      HBC (hit by car)
    • Aerobic organisms
    •      Pasteurella- in their mounth, most common
    •      Actinomyces
    •      Streptococci
    • Anaerobic organisms
    •      Clostridium
    •      Bacteroides
  12. Dermatology
    Abscess
    Clinical Signs
    • Depression and febrile
    • Anorexia
    • Tissue edema and swollen region
    • Ruptured purulent discharge
  13. Dermatology
    Abscess
    Treatment
    • Surgery
    •    Debride necrotic tissue
    •    Provide drainage with penrose drain
    •    Drain stays in 2-3 days before removal
    • Antibiotics
    • Supportive Care
    •     Fluids
    •     Nutritional Support

    Azotemia is a medical condition characterized by abnormally high levels of nitrogen -containing compounds, such as urea, creatinine
  14. Dermatology
    Anal Sac Disease
    Definition
    • Impactation
    • Infection
    • Abcess
  15. Dermatology
    Anal Sac Disease
    Etiology
    • Large quantity thick secretion
    • Infection
    • Poor Grooming
    • Small ducts
  16. Dermatology
    Anal Sac Disease
    Pathophysiology
    • Anal sacs become impacted
    • Secondary infection
    • Abcess and rupture
  17. Dermatology
    Anal Sac Disease
    Clinical Signs
    • Scratching, licking, or dragging anal region
    • Tail chasing
    • Tenesmus
    •    Painful defication
  18. Dermatology
    Anal Sac Disease
    Diagnosis
    • Palpate distended anal sacs
    • Fluid normally clean tan or yellow
    • Abcess seen
  19. Dermatology
    Anal Sac Disease
    Treatment
    • Medical
    •    Express anal sacs and flush with dilute nolvasan or betadine
    • Topical anti-inflammatory
    •    Panalog
    •    Otomax
    • Antibiotics
    •  
  20. Dermatology
    Anal Sac Disease
    Surgery
    • Abscess
    • Reoccuring problem
    •    Analsacculectomy
  21. Dermatology
    Dermatophytosis  (ringworm)
    Definition
    • Infection of keratinaceous structure (hair, nails, skin) by parasitic fungi
    • Ringworm
  22. Dermatology
    Dermatophytosis
    Etiology
    • Microsporum canis
    •     50-70% infection in dogs and cats
    •     90-98% in cats
    • microsporum gypseum
    • Trichophytan metagrophytes
  23. Dermatology
    Dermatophytosis
    Pathophysiology
    • Infection usually young and immunosuppred animals
    • Highly contagious (zoonotic)
    • Transmission is contact from spores to skin
  24. Dermatology
    Dermatophytosis
    Clinical Signs
    • Pruritis
    • Irregular or circular areas of skin with alopecia and scales
  25. Dermatology
    Dermatophytosis
    Diagnosis
    • Fungal Culture
    •    Dermatophyte media (DTM)
    •     Agar turns orange to red if positive
    •              Dermatophyte causes PH change
    •   Observe daily, can take up to a week to turn red
    • Woods lamp
    •    M. Canis fluresce 50-80% times
    •    Not an absolute test
    • Skin Biopsy
  26. Dermatology
    Dermatophytosis
    Treatment
    • Topical
    •    Use antiseptic baths
    •    2 times weekly
    •    Ketoconazole or miconazole formulation
    •    Local miconazole creams
    • Systemic
    •    Griseofulvin
    •         10-30 mg/kg PO BId for 4-6 weeks
    •         Side Effects
    •                Hepatotoxicity
    •                 Teratogen
    •                 Cats extremely sensitive
    • Ketoconazole
    •     10mg/kg PO Sid for 3-4 weeks
    • Intraconazole
    •    10mg/kg PO SID for 3-4 weeks
    • Treat 1-2 weeks post negative culture or clinical signs
  27. Dermatology
    Demodicosis
    Etiology
    • Transmission can occur from the mother to neonate during the first 2-3 days of life.
    • Infects hair follicles and caused by immunosuppression
    • Caused by demodex canis or demodex cati
    • Demodex occurs in 3 forms
    •     Generalized demodicosis
    •                 Normally caused by immunosuppression on underlying disease
    •                Juvenile onset
    •                     3-12 months
    •                Adult onset
    •                 >1 year
    • Pododemodicosis
    •    Chronic interdigital disease
    • Localized demodicosis
    •    Animals < 1 year of age
    •    Usually resolves spontaneously in 4-8 months
  28. Dermatology
    Demodicosis
    Clinical Signs
    • Localized demodicosis
    •    Non parasitic
    •    Lesions on muzzle, head, ears, and forelegs
    • Generalized demodicosis
    •     Begins local and spreads
    •     Diffuse, alopecia, scabs, and erythema
    •     pyoderma and pruitis
    •    Generalized lymphadenopathy
    • Pododemodicosis
    •     Digital and interdigital pain, erythema and swelling
  29. Dermatology
    Demodicosis
    Diagnosis
    • Skin scrape
    •    Alligator- cigar shaped with six legs
    • Skin biopsy
  30. Dermatology
    Demodicosis
    Treatment
    • Localized demodicosis
    •    Bathing
    •   Nolvasan shampoo
    •    Amitraz (mitaban dip)
    • Generalized Demodicosis
    •    Mitaban dip
    •       Body clip
    •       Amatraz dip weekly
    •       Skin scrap every 2-4 weeks
    •       Continue dips 3-4 weeks following first negative scrape
    • Ivermectin
    •    0.4-0.6mg/kg PO SID for 1 month past negative skin scrape
    • 0.2-0.3 mg/kg SQ of 2 weeks apart

    • Pododemodicosis
    • Mitaban dip- soad feet daily
    •     Usually do not use mitaban dip in animals less than 4 months of age
    •     Long term antibiotics
    •    May use lime sulfur dips- very young animals only and cats
  31. Dermatology
    Sarcoptic Mange
    Etiology
    • Caused by sarcoptes scabei (scabies)
    • Notoedres cati (feline scabies)
    •   Primarily on head and neck
    • Cheyletiella
    •    Walking dandruff
    •    Scotch tape test
    •   Highly contagious and pruritic
    •  Zoonotic
    •   Burrowing mite
    •   Transmission is by contact
    • Mite causes intense pruritus by mechanical irritation
  32. Dermatology
    Sarcoptic Mange
    Clinical Signs
    • Intense pruritus
    • Alopecia
    • Scabs, crust and pyoderma
  33. Dermatology
    Sarcoptic Mange
    Diagnosis
    • Skin scrape
    •    50-75% of skin scrape may be negative
  34. Dermatology
    Sarcoptic Mange
    Treatment
    • Topical
    • 1. Body clip and shave
    • 2. Lime sulfur 2% dip every 2 weeks
    •      Young animal
    • 3. Mitaban dip every 2weeks
    • Systemic
    •    Ivermectin 0.2-0.3 mg/kg SQ every 2 weeks for 2 treatments
    • Amatraz Dip
  35. Dermatology
    Otisis externa
    Etiology
    • Parasites
    • foreign bodies
    •   Fox tails, hair, dirt
    • Atopy- allergies
    •   >50% otitis externa
    • Food allergy
    • Neoplasia
    • Conformation abnormalities
    •    Cocker spaniels, labs, most spaniels
    •     Have greater number of apocrine glands (sweat gland)and hair
    •    Narrow ear canals
    • Bacterial infection
    •    Staphlococcus
    •    Streptococci
    •   Fungi
    •   Malassezia pachydermititis (a yeast)
    •        Gram stain= peanut shape
  36. Dermatology
    Otisis Externa
    Pathophysiology
    • Ear canal becomes inflamed and erythematous (redness)
    • Sebacious and apocrine glandular activity is increased
    • Combination of increased epidermal thickness and increased glandular activity leads to wax production and entrapement into cnal causing bacterial and yeast infection
    • Chronic inflammation leads to permanent changes as calcification of auricular cartilage and stenosis (colliflower ears)
  37. Dermatology
    Otisis Externa
    Clinical Signs
    • Pruritus and head shaking
    • Painful ear and head tilt
    • Discharge or foul odor from ear
  38. Dermatology
    Otisis Externa
    Diagnosis
    • Otoscope exam
    •    Inflammation and discharge
    • Ear culture
    • Cytology of ear canal exudate
    •    Wright- giemsa stain
    •    Bacteria, yeast, fungal
  39. Dermatology
    Otisis Externa
    Treatment
    • Ear cleaning
    •   Clip and remove hair
    •   Ear flushing and cleaning
    •     Remove wax and pus
    •     Nolvasan otic
    •    Oto clens
    •    Clean with ear loops or currettes
    • Topical cleaning
    •    Otomax
    •    Panalog ointment
    • Systemic therapy
    •    Antibiotics
    •    Corticosteroids
    •    Antifungal
    •       Ketoconazole for malassezia
    • Surgery  
    •    lateral ear resection
    •   Total ear ablation and bulla osteotomy
    • Water soluble only if tympatic is ruptured
    • Auri flush
  40. Opthalmology
    Anatomy
    • Globe
    • eye
    • Eyelids
    • Conjunctiva
    • Nictating Membrane (3rd eyelid)
    • Lacrimal Glands
  41. Opthalmology
    Function
    • Vision
    • Tears for defense mechanism
  42. Opthalmology
    Terminology
    • Conjunctivitis- Inflammed red conjuntiva
    • Chemosis- edema of conjunctiva
    • Cataract- opacity of lens
    • Canthus- angle at either end of the eyelid
    • Ectropian- eversion and turning of the eyelid
    • Entropian- inward inversion of eyelis
    • epiphora- overflow of tears
    • Glaucoma- increased intraocular pressure
    • Hyphema- hemmorage in anterior chamber
    • Keratisis- corneal inflammation
    • Miotic- pupil constriction
    • Myosis- pupil dilation
    • Photophobia- abnormal sensitiation to light
    • Ptosis- droopy upper eyelid
    • Synechia- adhesion of iris to cornea or lens
    • Uvea- entire vascular eye-iris, ciliary body and choroid
    • Uveitis- inflammation of uvea
    • Blepharospasm- inability to open eyelids/ closed eye (horses)
    • Ciliary body- circumferential tissue inside the eye
  43. Opthamology
    Patholigcal Symptoms
    • Ocular and nasal dishcarge
    • Conjunctiviti and epiphora
    • Keratitis
    • Corneal opacity
    • Ocular pain and swelling
    • cataract
    • Hyphema-blood in the front (anterior) chamber of the eye.
  44. Opthamology
    Diagnostic tests
    • Opthalmic exam
    • Tonometer
    •    Pressure for glaucoma
    • Corneal stain
    •     Ulcer
    • Shirmer Tear test
    •   Dry eye
    •   Decreased tear production
    • Conjunctival scrape
    • Biopsy- looking for cancer
  45. Opthamology
    Diseases
    Corneal ulcer
    Causes
    Corneal damage or abrasion

    • Trauma
    • Infection
    • Foreign body
    • Chemical burn
  46. Opthamology
    Diseases
    Corneal ulcer
    Diagnosis
    Corneal Stain
  47. Opthamology
    Diseases
    Corneal ulcer
    Treatment
    • Antibiotics
    •   Topical and systemic
    • Atropine- stop ocular pain
    • Surgery
    •   3rd eyelid
    •   Conjunctival flap
  48. Opthamology
    Diseases
    Entropion
    Inward inversion of eyelid margins causing conjunctivitis and corneal ulcers
  49. Opthamology
    Diseases
    Entropion
    Causes
    • Congenital
    • Breeds
    •    Bradycephalic breeds
    •   Chows, shar pei, rottweilers, english bull dogs
  50. Opthamology
    Diseases
    Entropion
    Clinical Signs
    • Epiphora, conjunctivitis and chemosis
    • Corneal ulcer and scarring
    • Ulcerative keratitis
  51. Opthamology
    Diseases
    Entropion
    Diagnosis
    Ocular exam
  52. Opthamology
    Diseases
    Entropion
    Treatment
    • Medical
    •   Ulcer treatment
    •   Lubrication
    • Surgery
    •   Corrective entropion surgery preferred to prevent secondary eye damage
  53. Opthamology
    Diseases
    Conjunctivitis
    • Inflammation of ocular mucous membranes
    • Red eye or pink eye
  54. Opthamology
    Diseases
    Conjunctivitis
    Causes
    • Infectious- bacterial, chlamydia, virus
    • Foreign body
    • Trauma
    • Irritants
    •   Dust, distichia
    • Immune mediated
    •    Allergies
    • Keratoconjunctivitis sicca KCS
  55. Opthamology
    Diseases
    Conjunctivitis
    Clinical Signs
    • Ocular dishcarge and scleral congestion
    • Chemosis and photophobia
    • Epiphora
  56. Opthamology
    Diseases
    Conjunctivitis
    Diagnosis
    • History and eye exam
    • Corneal stain
    • Topical anesthetic
    • Tear test
    • cytology
  57. Opthamology
    Diseases
    Conjunctivitis
    Treatment
    • Treat primary disease
    • Systemic drugs
    •    Antibiotic
    •    Corticosteroids
    •         allergic, chemosis
    • Topical
    •    Cyclosporine (optimmune)
    •        KCS
    •   Antibiotic
    •      Gentocin, bacitracin, and neomycin (BNP)
    • Antiinflammatory combinations
    •    BNP-HC, gentocin durafilm

    BNP- made by your heart and shows how well your heart is working.
  58. Opthamology
    Disease
    Prolapse of third eyelid gland (cherry Eye)
    • Protrusion of gland of third eyelid
    •    May be unilateral or bilateral
  59. Opthamology
    Disease
    Prolapse of third eyelid gland (cherry Eye)
    Causes
    • Genetic and breed predisposition
    •    Cocker spaniel, poodle, shar pei, bull dogs
    •   Bradycephalic breeds
    • Cats- Burmese
  60. Opthamology
    Disease
    Prolapse of third eyelid gland (cherry Eye)
    Clinical Signs
    • Pink mass protruded from medial canthus
    • Ocular discharge and conjunctivitis
  61. Opthamology
    Disease
    Prolapse of third eyelid gland (cherry Eye)
    Treatment
    • medical management provides only temporary relief
    •   Systemic and topical therapy
    •        antibiotics and corticosteroids
    • Surgical repair is recommended
    •    Removal of gland or securing gland down
    •    Tack down
    • Complete removal of gland can cause KCS
  62. Opthamology
    Disease
    Keratonconjunctivistis Sicca KCS
    • Inflammatory and degenerative changes of the cornea and conjuctiva caused by reduced tear secretion
    • KCS may be primary (Lacrimal secreation failure) or Secondary (failure of tear delivery)
  63. Opthamology
    Disease
    Keratonconjunctivistis Sicca KCS
    Causes
    • Primary
    •   Infection
    •   Immune mediated (genetic)
    •      Cocker spaniels, shitzu, bull dog, Llasa apso
    • Drug toxicity- sulfa products
    • Truama
    • Secondary
    •    Infection
    •    allergic
    •    Chemical
  64. Opthamology
    Disease
    Keratonconjunctivistis Sicca KCS
    Clinical signs
    • Conjunctivitis and ocular discharge
    •  Corneal ulcer
    • Neovasculariazation and corneal scarring
    • Loss of vision
  65. Opthamology
    Disease
    Keratonconjunctivistis Sicca KCS
    Diagnosis
    • Schirmer Tear Test
    •   Diagnostic if low tear production
    •     <21 mm/min
    • Corneal stain
    • Conjunctival scrape and culture
  66. Opthamology
    Disease
    Keratonconjunctivistis Sicca KCS
    Treatment
    • Stimulate lacrimation
    •        Topical cyclosporine
    • Provide lubrication
    •        Methylcellulose or polyvinyl alcohol
    • Treat for bacterial infection
    •        Antibiotics
    • Reduce conjunctivis
    •       Costicosteroids
  67. Opthamology
    Disease
    Glaucoma
    • Elevation of intraocular pressure causing buphthalmos
    • Normal intraocular pressure (IOP)
    •    15-30 mmhg
    • Glaucoma
    •   Primary
    •    Genetically determined
    • Secondary
    •   any ocular disease that results in the obstruction of aqueous outlfow
  68. Opthamology
    Disease
    Glaucoma
    Causes
    • Primary- unknown and genetic
    • Secondary
    •    Uveitis
    •   Lens luxation
    •   Tumors
    •  
  69. Opthamology
    Disease
    Glaucoma
    Clinical Signs
    • Acute Glaucoma
    •   Ocular discharge and pain
    •   Conjunctivitis
    •   Vascular congestion
    •   Blindness
    • Chronic glaucoma
    •    Globe enlargement (buphthalmus)
    •    Corneal edema- turns white
    •   Lens luxation
    •   Tapetal hyperreflexivity
    •   Irreversible vision loss
  70. Opthamology
    Disease
    Glaucoma
    Diagnosis
    • Measure intraocular pressure
    •    Schiotz tonometer
    • Gonioscopy
  71. Opthamology
    Disease
    Glaucoma
    Treatment
    • Immediate control for pressures over 50mmhg
    •   Hyperosmotic
    •    Mannitol 1-2g/kg IV over 30-45 min.
    • Carbonic Anhydrase inhibitors
    •    Decrease aqueous production
    •    Dichlorphenamide (Daranide)
    •    dog 2-4mg/kg PO Bid- TID
    •     Cat 1-2 mg/kg PO Bid- Tid
    •    Methazolamide
    •    Acetazolamide
    • Topical autonomic agents
    •     Timolol
    •     Pilocarpine 2%
    • Treatment for secondary ocular disease
    • Long Term Treatment
    •    medical
    •     Carbonic anhydrase inhibitors
    •     Pilocarpine
    •     Rarely effective for long term
    • Surgical
    •   Laser cyclophotocoagulation
    •      Destroys ciliary body, thus reducing aqueous production
    •   Transscleral cyclocryotherapy
    •    Freeze ciliary body
    •  Enucleation
    •    Salvage for pain
    • Athropine never with an animal on Glaucoma

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