The document discusses the skin and psoriasis. It begins by describing the functions of normal skin including protecting deeper tissues, aiding in temperature regulation, and synthesizing vitamin D. It then defines psoriasis as an autoimmune disease causing red, dry plaques of thickened skin commonly on the elbows, knees and scalp. Psoriasis has many treatment options including topical creams and medications, phototherapy, and systemic drugs. Complications can include infections from scratching and psychological distress from the condition.
Privacy & Data Breach: 2012 Recap, 2013 PredictionsResilient Systems
It's been a particularly tough year for data breaches. So far this year, datalossdb.org has tracked over 1,300 breaches which sets an all-time record, beating last year's figure by more than 20%. This year we've witnessed multiple breaches at the same organization, botched response efforts, and large class action lawsuits. The regulatory environment presented challenges as well. Texas and California continued to "innovate," other states had incremental updates, and SEC guidance on data breaches continues to loom on the horizon.
Were 2012 breach levels an anomaly? What might California have up its sleeve for next year? This webinar will review the highlights and lowlights of 2012 and make predictions about what's in store for 2013.
Our featured speakers for this timely webinar are:
-Andrew Serwin, Esq. - Partner, Foley & Lardner LLP. Andy is a well-known, highly regarded figure in the privacy and security realms. His many accomplishments include authoring definitive privacy books, "Information Security and Privacy: A Guide to Federal and State Law and Compliance," and "Information Security and Privacy: A Guide to International Law and Compliance."
-Gant Redmon, Esq. (CIPP/US) - General Counsel & Vice President of Business Development, Co3 Systems. Gant has practiced law for nineteen years; fifteen of those years as in-house counsel for security software companies including: Arbor Networks, Authentica and AXENT. In 1997, Gant was appointed membership on the President Clinton’s Export Counsel Subcommittee on Encryption (PECSENC).
Are you confused by all the social media marketing lingo and terms? You are not alone! SO! What? SOcial introduces the complete glossary of social media terms for those interested in social media marketing. Master these terms and you'll be a social media know-it-all in no time guaranteed!
How To Turbo-Charge Incident Response With Threat IntelligenceResilient Systems
Minutes, hours, days - each one counts when responding to a security incident. Yet most firms have a lot of room for improvement. According to the 2013 Verizon Data Breach Investigations Report, in 66% of cases (up from 56% last year), breaches remained undiscovered for years, and in 22% of cases, it took months to fully contain the incident.
This webinar will review the challenges firms face in trying to create a rapid and decisive incident response (IR) process. It will then highlight the crucial role that timely, contextual threat intelligence can play in turbo-charging incident response, particularly when tightly integrated with the broader IR discipline. Finally, it will reveal the power of this approach by demonstrating Co3's integrated threat intelligence capabilities including intel from industry-leader iSIGHT Partners.
International House of Prayer- IHOPGear.org PresentationRobert Langius
This document advertises personalized baby gear from IHOP Gear, including a hooded towel, diaper bag, infant tee, infant terry bib, and fleece & flannel blankets for a new baby. The baby gear can be customized with the baby's name and size may vary depending on the item purchased.
Privacy & Data Breach: 2012 Recap, 2013 PredictionsResilient Systems
It's been a particularly tough year for data breaches. So far this year, datalossdb.org has tracked over 1,300 breaches which sets an all-time record, beating last year's figure by more than 20%. This year we've witnessed multiple breaches at the same organization, botched response efforts, and large class action lawsuits. The regulatory environment presented challenges as well. Texas and California continued to "innovate," other states had incremental updates, and SEC guidance on data breaches continues to loom on the horizon.
Were 2012 breach levels an anomaly? What might California have up its sleeve for next year? This webinar will review the highlights and lowlights of 2012 and make predictions about what's in store for 2013.
Our featured speakers for this timely webinar are:
-Andrew Serwin, Esq. - Partner, Foley & Lardner LLP. Andy is a well-known, highly regarded figure in the privacy and security realms. His many accomplishments include authoring definitive privacy books, "Information Security and Privacy: A Guide to Federal and State Law and Compliance," and "Information Security and Privacy: A Guide to International Law and Compliance."
-Gant Redmon, Esq. (CIPP/US) - General Counsel & Vice President of Business Development, Co3 Systems. Gant has practiced law for nineteen years; fifteen of those years as in-house counsel for security software companies including: Arbor Networks, Authentica and AXENT. In 1997, Gant was appointed membership on the President Clinton’s Export Counsel Subcommittee on Encryption (PECSENC).
Are you confused by all the social media marketing lingo and terms? You are not alone! SO! What? SOcial introduces the complete glossary of social media terms for those interested in social media marketing. Master these terms and you'll be a social media know-it-all in no time guaranteed!
How To Turbo-Charge Incident Response With Threat IntelligenceResilient Systems
Minutes, hours, days - each one counts when responding to a security incident. Yet most firms have a lot of room for improvement. According to the 2013 Verizon Data Breach Investigations Report, in 66% of cases (up from 56% last year), breaches remained undiscovered for years, and in 22% of cases, it took months to fully contain the incident.
This webinar will review the challenges firms face in trying to create a rapid and decisive incident response (IR) process. It will then highlight the crucial role that timely, contextual threat intelligence can play in turbo-charging incident response, particularly when tightly integrated with the broader IR discipline. Finally, it will reveal the power of this approach by demonstrating Co3's integrated threat intelligence capabilities including intel from industry-leader iSIGHT Partners.
International House of Prayer- IHOPGear.org PresentationRobert Langius
This document advertises personalized baby gear from IHOP Gear, including a hooded towel, diaper bag, infant tee, infant terry bib, and fleece & flannel blankets for a new baby. The baby gear can be customized with the baby's name and size may vary depending on the item purchased.
Molly Parsons took a Predictive Index survey on September 26, 2013. The results show that she will strongly express behaviors focused on following rules carefully, attention to detail, and achieving operational efficiencies. She is driven to protect the company by adhering to established standards. As a manager, Molly would be proactive in bringing the team together to complete work according to accepted policies and on time. She is an enthusiastic team player motivated to work with others to achieve goals. Her influencing style would be convivial and persuasive, utilizing her effective communication skills to build relationships and provide proven solutions tailored to others' needs.
God Store Ministries: Webstore Design Samples. Including Joel Osteen Ministries, Victoria Osteen, Lisa Comes, Lakewood Church, Compass Bible Study, Young at Heart, Womens Ministry, MercyMe, The Hurt and the Healer, Almost There, The Generous Mr. Lovewell, International House of Prayer, IHOP.org, IHOPKC.org, Luke 18 Project, Exodus Cry,
This document provides an overview of the costs associated with data breaches. It begins by introducing the speakers and the agenda. It then discusses what constitutes a data breach and the types of data that may be exposed, such as PII, PHI, intellectual property, and financial information. The document explores the various direct and indirect costs of a breach for different entities. It provides examples of cost estimates from past breaches, which range from thousands to over $170 million depending on the size and type of breach. Patterns in breach cost data are examined, though correlations are weak. Overall, the document deconstructs the complexities involved in understanding and estimating the full costs of a data breach.
The document provides an introduction to Java programming including:
1. A brief history and design goals of the Java programming language including being portable, object-oriented, robust, high performance, and simple.
2. An explanation of interfaces in Java including how they specify methods without implementation and the benefits of organizing code and linking unrelated classes.
3. A discussion of methods in Java including how they are declared with a return type, name, parameters, and body, how void is used, and how methods are called.
Oggi, grazie ai Social Networks, le distanze si sono notevolmente ridotte e i canali di comunicazione si sono ampliati e diversificati.
Nell’era della socialità la presenza sui Social Media è indispensabile per ogni azienda che voglia creare una relazione duratura nel tempo con i propri clienti, ampliare i propri contatti, avere informazioni di prima mano sulle opinioni relative ai servizi/prodotti e ottenere maggior visibilità.
Noi di Ulixe CRM oltre a proporre soluzioni di Social CRM, offriamo consulenze di Social Media Marketing. I nostri servizi vanno dalla proposizione di una strategia di Marketing all’attuazione di Viral Marketing; in particolare ci occupiamo di strutturare campagne mirate in base ad ogni contesto aziendale e settore merceologico, scegliendo insieme ai nostri clienti i canali di comunicazione più adatti alle loro esigenze.
The document provides tips for using Twitter effectively: 1) Engage your industry by sharing advice, news, and Q&A. 2) Do not directly sell on Twitter as this will lose followers. 3) Do not spam as this is a turnoff. 4) Be personal and transparent to connect with others. 5) Be active through quality engagement to increase visibility. 6) Engage with others on Twitter through replies and conversations to increase the chances of gaining new followers.
Using Tape on Multi-Part Items
The document provides instructions for using tape to attach multiple items such as a book and DVD case. The items are lined up with flush bottoms and spines and taped on the outside spine. Tape is then applied to the inside of the hinge to avoid exposed sticky parts. This allows the items to be attached as one piece and sit nicely on the shelf while still allowing the case to be replaced if damaged.
This document lists numerous properties for sale and rent in various locations. There are listings for ready to move apartments, independent houses, plots of land, commercial space, and more. Price ranges are provided for properties of different sizes in areas like DLF, South City, Unitech, Ansal, and others. Contact information is given for some commercial listings.
Oggi, grazie ai Social Networks, le distanze si sono notevolmente ridotte e i canali di comunicazione si sono ampliati e diversificati.
Nell’era della socialità la presenza sui Social Media è indispensabile per ogni azienda che voglia creare una relazione duratura nel tempo con i propri clienti, ampliare i propri contatti, avere informazioni di prima mano sulle opinioni relative ai servizi/prodotti e ottenere maggior visibilità.
Noi di Ulixe CRM oltre a proporre soluzioni di Social CRM, offriamo consulenze di Social Media Marketing. I nostri servizi vanno dalla proposizione di una strategia di Marketing all’attuazione di Viral Marketing; in particolare ci occupiamo di strutturare campagne mirate in base ad ogni contesto aziendale e settore merceologico, scegliendo insieme ai nostri clienti i canali di comunicazione più adatti alle loro esigenze.
A graphic designer requires a variety of skills including an understanding of color theory, composition, typography and the ability to choose visual elements that complement a design. Most importantly, a graphic designer must have a strong imagination to take ordinary designs and make them extraordinary.
The Indian ice cream industry is valued at Rs. 3000 crore with organized players accounting for 75% of the market led by Amul with 37% share. Per capita consumption of ice cream in India is low at 350ml compared to other countries. Key challenges for the industry are processing and packaging difficulties due to infrastructure issues, irregular demand patterns, and rising input costs. However, the industry is growing due to factors such as rising disposable incomes, impulse buying, new product launches, and expanding distribution channels including push carts, retailers, distributors, and parlors. Amul is expected to continue dominating the market through competitive pricing and supply chain management. The recommendations focus on enhancing brand loyalty and experience, leveraging impulse
The Women's Leadership Programme is a 4-day course for female professionals who have potential for leadership roles but face barriers. It aims to boost confidence, help overcome challenges like balancing work and family, and provide strategies for career success. The programme includes coaching, discussions, and a year of membership to additional leadership events and resources.
Master Spas WI is your top provider of Hot tub Appleton. With our brilliant customer support and all complete range of Spa & hot Tub. http://masterspaswi.com/hot-tubs-appleton
This document discusses acne vulgaris. It provides information on:
- The prevalence of acne in adolescents being as high as 95% with 20-35% having moderate to severe acne.
- Risk factors like genetics and obesity.
- The pathogenesis which is multifactorial involving increased sebum production, P. acnes bacteria, altered keratinization and inflammation.
- Types of acne lesions and different forms of the disease.
- Treatment involving topical and oral medications to induce remission and prevent relapse.
Dr. Brad Yentzer, MD is a Dermatologist in Freeville, NY and has over 17 years of experience in the medical field. Dr. Yentzer has extensive experience in Skin Cancer & Excision, Cosmetic Skin Procedures, and Skin Conditions. He graduated from Thomas Jefferson University in 2006. He is affiliated with Cayuga Medical Center at Ithaca. His office accepts new patients
Psoriasis is a chronic, inflammatory skin condition characterized by thickened patches of red skin covered by silvery scales. It occurs when the immune system causes skin cells to grow too quickly. The document defines psoriasis and describes the main types, risk factors, diagnosis, and treatment options including topical therapies, phototherapy, and systemic medications that target the immune system. Treatment aims to reduce inflammation and scaling based on the severity and location of symptoms.
Amputation For G.N.M 2nd & B.Sc.2nd & 3rd Year Nursing Student.Kush Joshi
The document discusses amputation, including its definition as the removal of a limb by trauma, illness, or surgery. It describes the purposes of amputation as removing tissues without blood supply, malignant tumors, or severe trauma. The key aspects of nursing management for amputation patients are pain management, psychological counseling, wound dressing, skin care, and exercises to prevent deformity and maintain range of motion.
This document discusses the management of the first stage of labor. It recommends evaluating the patient's condition and reviewing records before beginning management. Management includes ensuring comfort, monitoring vital signs and fetal heart rate, and allowing rest and ambulation. Non-pharmacological pain relief methods like labor support, baths, sterile water injections, and positions are encouraged initially. Pharmacological methods like epidurals may be considered if needed but can prolong labor. The status of the cervix and membranes is assessed through vaginal exams to monitor labor progress.
Molly Parsons took a Predictive Index survey on September 26, 2013. The results show that she will strongly express behaviors focused on following rules carefully, attention to detail, and achieving operational efficiencies. She is driven to protect the company by adhering to established standards. As a manager, Molly would be proactive in bringing the team together to complete work according to accepted policies and on time. She is an enthusiastic team player motivated to work with others to achieve goals. Her influencing style would be convivial and persuasive, utilizing her effective communication skills to build relationships and provide proven solutions tailored to others' needs.
God Store Ministries: Webstore Design Samples. Including Joel Osteen Ministries, Victoria Osteen, Lisa Comes, Lakewood Church, Compass Bible Study, Young at Heart, Womens Ministry, MercyMe, The Hurt and the Healer, Almost There, The Generous Mr. Lovewell, International House of Prayer, IHOP.org, IHOPKC.org, Luke 18 Project, Exodus Cry,
This document provides an overview of the costs associated with data breaches. It begins by introducing the speakers and the agenda. It then discusses what constitutes a data breach and the types of data that may be exposed, such as PII, PHI, intellectual property, and financial information. The document explores the various direct and indirect costs of a breach for different entities. It provides examples of cost estimates from past breaches, which range from thousands to over $170 million depending on the size and type of breach. Patterns in breach cost data are examined, though correlations are weak. Overall, the document deconstructs the complexities involved in understanding and estimating the full costs of a data breach.
The document provides an introduction to Java programming including:
1. A brief history and design goals of the Java programming language including being portable, object-oriented, robust, high performance, and simple.
2. An explanation of interfaces in Java including how they specify methods without implementation and the benefits of organizing code and linking unrelated classes.
3. A discussion of methods in Java including how they are declared with a return type, name, parameters, and body, how void is used, and how methods are called.
Oggi, grazie ai Social Networks, le distanze si sono notevolmente ridotte e i canali di comunicazione si sono ampliati e diversificati.
Nell’era della socialità la presenza sui Social Media è indispensabile per ogni azienda che voglia creare una relazione duratura nel tempo con i propri clienti, ampliare i propri contatti, avere informazioni di prima mano sulle opinioni relative ai servizi/prodotti e ottenere maggior visibilità.
Noi di Ulixe CRM oltre a proporre soluzioni di Social CRM, offriamo consulenze di Social Media Marketing. I nostri servizi vanno dalla proposizione di una strategia di Marketing all’attuazione di Viral Marketing; in particolare ci occupiamo di strutturare campagne mirate in base ad ogni contesto aziendale e settore merceologico, scegliendo insieme ai nostri clienti i canali di comunicazione più adatti alle loro esigenze.
The document provides tips for using Twitter effectively: 1) Engage your industry by sharing advice, news, and Q&A. 2) Do not directly sell on Twitter as this will lose followers. 3) Do not spam as this is a turnoff. 4) Be personal and transparent to connect with others. 5) Be active through quality engagement to increase visibility. 6) Engage with others on Twitter through replies and conversations to increase the chances of gaining new followers.
Using Tape on Multi-Part Items
The document provides instructions for using tape to attach multiple items such as a book and DVD case. The items are lined up with flush bottoms and spines and taped on the outside spine. Tape is then applied to the inside of the hinge to avoid exposed sticky parts. This allows the items to be attached as one piece and sit nicely on the shelf while still allowing the case to be replaced if damaged.
This document lists numerous properties for sale and rent in various locations. There are listings for ready to move apartments, independent houses, plots of land, commercial space, and more. Price ranges are provided for properties of different sizes in areas like DLF, South City, Unitech, Ansal, and others. Contact information is given for some commercial listings.
Oggi, grazie ai Social Networks, le distanze si sono notevolmente ridotte e i canali di comunicazione si sono ampliati e diversificati.
Nell’era della socialità la presenza sui Social Media è indispensabile per ogni azienda che voglia creare una relazione duratura nel tempo con i propri clienti, ampliare i propri contatti, avere informazioni di prima mano sulle opinioni relative ai servizi/prodotti e ottenere maggior visibilità.
Noi di Ulixe CRM oltre a proporre soluzioni di Social CRM, offriamo consulenze di Social Media Marketing. I nostri servizi vanno dalla proposizione di una strategia di Marketing all’attuazione di Viral Marketing; in particolare ci occupiamo di strutturare campagne mirate in base ad ogni contesto aziendale e settore merceologico, scegliendo insieme ai nostri clienti i canali di comunicazione più adatti alle loro esigenze.
A graphic designer requires a variety of skills including an understanding of color theory, composition, typography and the ability to choose visual elements that complement a design. Most importantly, a graphic designer must have a strong imagination to take ordinary designs and make them extraordinary.
The Indian ice cream industry is valued at Rs. 3000 crore with organized players accounting for 75% of the market led by Amul with 37% share. Per capita consumption of ice cream in India is low at 350ml compared to other countries. Key challenges for the industry are processing and packaging difficulties due to infrastructure issues, irregular demand patterns, and rising input costs. However, the industry is growing due to factors such as rising disposable incomes, impulse buying, new product launches, and expanding distribution channels including push carts, retailers, distributors, and parlors. Amul is expected to continue dominating the market through competitive pricing and supply chain management. The recommendations focus on enhancing brand loyalty and experience, leveraging impulse
The Women's Leadership Programme is a 4-day course for female professionals who have potential for leadership roles but face barriers. It aims to boost confidence, help overcome challenges like balancing work and family, and provide strategies for career success. The programme includes coaching, discussions, and a year of membership to additional leadership events and resources.
Master Spas WI is your top provider of Hot tub Appleton. With our brilliant customer support and all complete range of Spa & hot Tub. http://masterspaswi.com/hot-tubs-appleton
This document discusses acne vulgaris. It provides information on:
- The prevalence of acne in adolescents being as high as 95% with 20-35% having moderate to severe acne.
- Risk factors like genetics and obesity.
- The pathogenesis which is multifactorial involving increased sebum production, P. acnes bacteria, altered keratinization and inflammation.
- Types of acne lesions and different forms of the disease.
- Treatment involving topical and oral medications to induce remission and prevent relapse.
Dr. Brad Yentzer, MD is a Dermatologist in Freeville, NY and has over 17 years of experience in the medical field. Dr. Yentzer has extensive experience in Skin Cancer & Excision, Cosmetic Skin Procedures, and Skin Conditions. He graduated from Thomas Jefferson University in 2006. He is affiliated with Cayuga Medical Center at Ithaca. His office accepts new patients
Psoriasis is a chronic, inflammatory skin condition characterized by thickened patches of red skin covered by silvery scales. It occurs when the immune system causes skin cells to grow too quickly. The document defines psoriasis and describes the main types, risk factors, diagnosis, and treatment options including topical therapies, phototherapy, and systemic medications that target the immune system. Treatment aims to reduce inflammation and scaling based on the severity and location of symptoms.
Amputation For G.N.M 2nd & B.Sc.2nd & 3rd Year Nursing Student.Kush Joshi
The document discusses amputation, including its definition as the removal of a limb by trauma, illness, or surgery. It describes the purposes of amputation as removing tissues without blood supply, malignant tumors, or severe trauma. The key aspects of nursing management for amputation patients are pain management, psychological counseling, wound dressing, skin care, and exercises to prevent deformity and maintain range of motion.
This document discusses the management of the first stage of labor. It recommends evaluating the patient's condition and reviewing records before beginning management. Management includes ensuring comfort, monitoring vital signs and fetal heart rate, and allowing rest and ambulation. Non-pharmacological pain relief methods like labor support, baths, sterile water injections, and positions are encouraged initially. Pharmacological methods like epidurals may be considered if needed but can prolong labor. The status of the cervix and membranes is assessed through vaginal exams to monitor labor progress.
1) Vitiligo is a chronic skin disorder characterized by loss of skin pigmentation and the appearance of white patches on the skin.
2) It affects different parts of the body and can start progressing at any age. While it does not cause physical harm, it can cause psychological issues like low self-esteem.
3) Treatments include topical corticosteroids, immune-modulators like tacrolimus, phototherapy using UV light, and cosmetic cover-ups. Many patients prefer traditional ayurvedic and homeopathic treatments as well.
1. Acne is a common skin disorder of hair follicles and sebaceous glands caused by excess sebum production, abnormal keratinization, and P. acnes bacteria. It presents with inflamed lesions like papules, pustules, and nodules on the face, neck, back and chest.
2. Pemphigus vulgaris is a chronic autoimmune blistering disease caused by IgG antibodies. It presents with flaccid blisters that rupture easily, causing raw areas and possible infection.
3. Psoriasis is a chronic inflammatory skin condition characterized by red, scaly plaques, often located on the scalp, elbows, knees, and
This document discusses various types of acute rhinosinusitis. It defines acute rhinosinusitis as lasting less than 4 weeks with complete resolution of symptoms. The most common types are described as acute viral rhinosinusitis, acute bacterial rhinosinusitis, acute maxillary sinusitis, acute frontal sinusitis, and acute ethmoid and sphenoid sinusitis. For each type, the causes, symptoms, diagnosis, and treatment options are outlined. Complications are also discussed if the infections are not properly treated.
Psoriasis is a chronic skin disease characterized by recurring exacerbations and remissions of skin lesions. The lesions appear as erythematous papules and plaques covered with silvery scales. Genetic and environmental factors contribute to its development, and stress, infections, and injuries can trigger flare-ups. Treatment focuses on slowing skin cell production through topical creams, light therapy, oral medications, and managing symptoms, as there is no permanent cure. Patients require education on application of treatments, stress management, and prevention of exacerbations to help control the condition.
Cellulite is caused by fat deposits under the skin that give a dimpled appearance, especially on thighs and buttocks. It is most common in women due to hormonal factors. While many treatments claim to reduce cellulite, medical studies found no significant difference between cellulitic fat and normal fat. Endermologie and body wraps provide temporary water loss but effects are not long lasting. Liposuction and lipodissolve are more effective at permanently removing fat deposits that cause cellulite.
The document discusses cellulite, including its history, physiology, causes, grading stages, medical evaluation and treatments. It notes that cellulite is caused by fat deposits under the skin that give a dimpled appearance, mostly seen in women due to hormones. Early medical studies found no difference between cellulite fat and normal fat. A growing multi-billion dollar industry markets various anti-cellulite products and devices, though many claims lack scientific evidence and some products were found to have no effect or risks. Endermologie treatments showed some temporary reduction in body circumference in studies but require many sessions and ongoing maintenance.
Carbuncle is a confluent folliculitis that is infection affecting multiple hair follicles leading to multiple
sinuses discharging pus. It is commonly seen on the back of immuno-compromised patients. Admission to
hospital with aggressive treatment, both systemic and locally is necessary. Optimisation of co-morbidities
such as diabetes, adequate hydration, and antibiotics and are mainstay of initial treatment. Surgical
intervention in the form of debridement and desloughing followed by wound care is the next line of
management. Patient education at the time of discharge is necessary for prevention of recurrence.
The document provides information about Wilms tumor and acute renal failure for a nursing group. It begins with general and specific objectives for the group to understand the conditions and provide appropriate nursing care. It then covers anatomy and physiology of the kidney, definitions of Wilms tumor and acute renal failure, causes, manifestations, incidence, pathophysiology, diagnosis, staging, histology, treatment including surgery, chemotherapy and radiation therapy, prognosis, and nursing management for pre-operative, post-operative and ongoing care.
Acne vulgaris is a common chronic inflammatory skin condition that affects the pilosebaceous units. It has a prevalence of 9.4% worldwide and most commonly affects adolescents. The pathophysiology involves increased sebum production, abnormal keratinization, Propionibacterium acnes bacteria, and inflammation. Clinical features include comedones, papules, pustules, nodules, and scarring. Treatment involves a combination of topical retinoids and antibiotics. For severe acne, oral isotretinoin may be used. While acne typically improves by age 25, some experience persistence into adulthood.
Skin Ailments Psoriasis By Dr. Darbha Aneeta
This is part of the HELP Talk series at HELP,Health Education Library for People, the worlds largest free patient education library www.healthlibrary.com.
This is a seminar conducted by 4th year medical student under supervision of a lecturer. Sorry for not attaching the references.
Information were from few textbooks, google and also from previous dermatology posting group's seminar.
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The document provides information about Velasmooth® treatment for cellulite. It defines cellulite and discusses its causes. It then describes the Velasmooth® treatment which uses radio frequency and infrared light to heat the skin and fat tissues. This promotes fat metabolism and lymphatic drainage to reduce the appearance of cellulite. The treatment schedule and parameters are outlined along with expected improvements seen after 6-10 sessions.
Juvenile arthritis and gouty arthritis are two types of inflammatory joint diseases. Juvenile arthritis most often presents as juvenile idiopathic arthritis in children under 16, causing joint pain, stiffness, and possible complications in the eyes. Gouty arthritis causes sudden, severe attacks of pain and inflammation in joints, often in the big toe. Both involve inflammatory processes in the joints and are treated with medications, therapies, or surgery to reduce symptoms and improve quality of life.
Tuberculosis, or TB, is a major health problem in the Philippines. It is the 6th leading cause of death, killing 73 Filipinos every day. An estimated 200,000 to 600,000 Filipinos have active TB. Each person with active TB can infect 10 others annually, exacerbating the spread. Despite efforts to increase detection and treatment, TB remains a serious issue due to its highly infectious nature and the large number of affected people. Proper treatment and preventative measures such as ventilation are needed to control the disease.
There are four main types of arthritis: rheumatoid arthritis, osteoarthritis, juvenile arthritis, and gouty arthritis. Rheumatoid arthritis is an autoimmune disorder that causes painful swelling in the joints and can damage bone and cartilage over time. It most commonly affects smaller joints and is more prevalent in women than men. Osteoarthritis is the most common form of arthritis and occurs when cartilage between bones wears down, causing pain, stiffness, and loss of flexibility in the joints. While there is no cure for types of arthritis, treatment aims to reduce inflammation, maximize function, and prevent further joint damage through medications, therapy, surgery, and home care techniques.
The document discusses the effects of smoking in the Philippines. It provides statistics from the 2009 Philippine Global Adult Tobacco Survey (GATS) that estimate 17.3 million Filipinos aged 15 and older smoke, with 13.8 million smoking daily. It notes cigarettes contain over 70 carcinogens and the average smoker spends P326 monthly and smokes 10.6 cigarettes per day. It outlines various health risks of smoking like cancer, heart disease, and effects on reproductive health. The document also examines reasons people smoke like stress relief, peer pressure, and advertising influences.
This document provides background information on Cheryl Tatano Beck, a prominent nursing theorist known for her work on postpartum depression. It outlines her educational background and career achievements, which involved extensive research focused on women's experiences in labor, birth, and the postpartum period. Her work resulted in a substantive theory of postpartum depression and the development of assessment tools. The document then describes the major concepts and assumptions of Beck's postpartum depression theory.
Program planning involves determining the need for an educational program, identifying the target audience, and selecting appropriate speakers, dates, times, and locations. The key steps are:
1. Assess the needs and learning styles of the target audience. Failure to understand their needs may reduce interest.
2. Involve relevant stakeholders in planning based on the topic, length, and complexity of the program.
3. Select speakers with appropriate expertise who can present at the right level for the audience. Confirm details on objectives and methods with speakers.
4. Consider availability of speakers and audiences when choosing dates and times, and select accessible locations based on the expected number of participants and teaching methods.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
2. 1. PROTECTS DEEPER TISSUES FROM:
A. MECHANICAL DAMAGE
B. CHEMICAL DAMAGE
C. BACTERIAL DAMAGE
D. ULTRAVIOLETRADAIATION
E. THERMAL DAMAGE
F. DESICCATION
2. AIDS IN BODY HEAT LOSS OR HEAT RETENTION
3. AIDS IN EXCRETION OF UREA AND URIC ACID
4. SYNTHESIZES VITAMIN D
INTEGUMENTARY SYSTEM
3. WHAT IS PSORIASIS???
PSORIASIS
*AN AUTOIMMUNE DISEASE THAT AFFECTS THE SKIN
*IS A NONCONTAGIOUS SKIN CONDITION THAT PRODUCES RED, DRY
PLAQUES OF THICKENED SKIN
*COMMONLY AFFECTS THE SKIN OF THE ELBOWS, KNEES, AND SCALP
*CONTROLLABLE WITH MEDICATION
*THERE ARE MANY PROMISING THERAPIES, INCLUDING NEWER
BIOLOGIC DRUGS
4. 1. NON-PUSTULAR PSORIASIS
A. PSORIASIS VULGARIS *
*CHRONIC STATIONARY PSORIASIS
*MOST COMMON FORM OF PSORIASIS.
B. PSORIATIC ERYTHRODERMA *
*ERYTHRODERMIC PSORIASIS
2. PUSTULAR PSORIASIS
A. GENERALIZED PUSTULAR PSORIASIS *
B. PERSISTENT PALMOPLANTAR PUSTULOSIS * *
C. ANNULAR PUSTULAR PSORIASIS *
D. ACRODERMATITIS CONTINUA *
E. IMPETIGO HERPETIFORMS *
CLASSIFICATION
5. 3. ADDITIONAL TYPES OF PSORIASIS:
A. DRUG INDUCED PSORIASIS
B. INVERSE PSORIASIS
C. NAPKIN PSORIASIS *
D. SEBBORRHEIC-LIKE PSORIASIS
E. GUTTATE PSORIASIS *
F. NAIL PSORIASIS *
G. PSORIATIC ARTHRITIS *
6. T CELLS OR T LYMPHOCYTES ARE TYPE OF WHITE BLOOD CELL THAT
NORMALLY WARDS OFF FOREIGN INVADERS (VIRUSES AND BACTERIA)
AND FIGHTS INFECTION. IN PSORIASIS, T CELLS ARE MISTAKENLY
ACTIVATED (AS IF TO HEAL A WOUND OR TO FIGHT AN INFECTION) AND
TRIGGER OTHER IMMUNE RESPONSES THAT SPEED UP THE GROWTH
CYCLE OF SKIN CELLS. A NORMAL SKIN MATURES AND FALLS OFF THE
BODY’S SURFACE IN 28-30 DAYS, BUT A PSORIATIC SKIN CELL TAKES
ONLY 3-4 DAYS TO MATURE AND MOVE TO THE SURFACE. INSTEAD OF
FALLING OFF (SHEDDING), THE CELLS PILE UP AND FORM LESIONS.
PATHOPHYSIOLOGY
7. OVERACTIVE T CELLS TRIGGER OTHER IMMUNE RESPONSES. THE
EFFECTS INCLUDE DILATION OF BLOOD VESSELS IN THE SKIN AROUND
THE PLAQUES AND AN INCREASE IN OTHER WHITE BLOOD CELLS THAT
CAN ENTER THE OUTER LAYER OF SKIN. THESE CHANGES RESULT IN AN
INCREASED PRODUCTION OF BOTH HEALTHY SKIN CELLS AND MORE T
CELLS AND OTHER WHITE BLOOD CELLS. THIS CAUSES AN ON-GOING
CYCLE IN WHICH NEW SKIN CELLS MOVE TO THE OUTERMOST LAYER OF
SKIN TOO QUICKLY — IN DAYS RATHER THAN WEEKS. DEAD SKIN AND
WHITE BLOOD CELLS CAN'T SLOUGH OFF QUICKLY ENOUGH AND BUILD
UP IN THICK, SCALY PATCHES ON THE SKIN'S SURFACE. THIS USUALLY
DOESN'T STOP UNLESS TREATMENT INTERRUPTS THE CYCLE.
8. THE CAUSE OF PSORIASIS ISN’T FULLY KNOWN, BUT IT'S THOUGHT
TO BE RELATED TO THE IMMUNE SYSTEM AND ITS INTERACTION WITH
THE ENVIRONMENT IN PEOPLE WHO HAVE THE GENETIC SUSCEPTIBILITY.
COMPROMISED SKIN BARRIER FUNCTION HAS A ROLE IN PSORIASIS
SUSCEPTIBILITY.
CAUSATIVE FACTORS
9. 1. INFECTIONS, SUCH AS STREP THROAT OR THRUSH
2. INJURY TO THE SKIN, SUCH AS A CUT OR SCRAPE, BUG BITE, OR A
SEVERE SUNBURN
3. STRESS
4. COLD WEATHER
5. SMOKING
6. HEAVY ALCOHOL CONSUMPTION
7. CERTAIN MEDICATIONS — INCLUDING LITHIUM, WHICH IS
PRESCRIBED FOR BIPOLAR DISORDER; HIGH BLOOD PRESSURE
MEDICATIONS SUCH AS BETA BLOCKERS; ANTIMALARIAL DRUGS; AND
IODIDES
PRECIPITATING FACTORS
10. 1. WHITE FLAKY LAYER OF SILVERY WHITE SCALES OVER THE PATCHED OF
INFLAMED SKIN (ERUPTIONS, USUALLY IN A SYMMETRICAL
DISTRIBUTION, COMMONLY LOCATED ON THE SCALP, ELBOWS,
KNEES, GENITAL AND SACRAL REGIONS)
2. KOEBNER’S PHENOMENON- LESIONS DEVELOP AT THE SITE OF INJURY
(TRAUMA, REPEAT RUBBING OR ABRASIONS)
3. AUSPITZ SIGN- A SPECIAL DIAGNOSTIC SIGN IN PSORIASIS; PULLING
OF ONE OF THESE SMALL DRY WHITE FLAKES OF SKIN CAUSES A TINY
BLOOD SPOT ON THE SKIN
4. ITCHING, BURNING OR SORENESS
5. GENERALIZED ERUPTION (IN SEVERE PSORIASIS VULGARIS)
CLINICAL MANIFESTATIONS
11. 6. GENERALIZED, STERILE CUTANEOUS PUSTULES OR PUS-FILLED,
YELLOWISH, SMALL BLISTERS (IN PUSTULAR PSORIASIS)
7. PINPOINT DEPRESSIONS OR WHITE SPOTS ON THE NAIL OR AS
LARGER YELLOWISH-BROWN SEPARATIONS OF THE NAIL BED CALLED
"OIL SPOTS" (NAIL PSORIASIS)
8. SEVERE DANDRUFF WITH DRY FLAKES AND RED AREAS OF SKIN
(SEBORRHEIC-LIKE PSORIASIS)
9. INFLAMMATION OF ANY JOINTS (PSORIATIC ARTHRITIS)
10. PSYCHOLOGICAL DISTRESS CAN LEAD TO SIGNIFICANT DEPRESSION
AND SOCIAL ISOLATION
12. 1. METABOLIC SYNDROME- A CLUSTER OF CONDITIONS THAT INCLUDE
HIGH BLOOD PRESSURE AND ELEVATED INSULIN LEVELS
2. INFLAMMATORY BOWEL DISEASE
3. CARDIOVASCULAR DISEASE
4. CANCER
5. THICKENED SKIN AND BACTERIAL SKIN INFECTIONS CAUSED BY
SCRATCHING IN AN ATTEMPT TO RELIEVE SEVERE ITCHING
6. FLUID AND ELECTROLYTE IMBALANCE IN THE CASE OF SEVERE
PUSTULAR PSORIASIS
7. DEPRESSION
COMPLICATIONS
14. 1. PHARMACOLOGICAL MANAGEMENT
A. TOPICAL
*TOPICAL CORTICOSTEROIDS (STEROIDS, SUCH AS
HYDROCORTISONE)
*VITAMIN D ANALOGUE CREAM CALLED CALCITRIOL
*MOISTURIZERS, ESPECIALLY WITH THERAPEUTIC
CONCENTRATIONS OF SALICYLIC ACID, LACTIC ACID,
UREA, AND GLYCOLIC ACID
*IMMUNOMODULATORS (TACROLIMUS AND PIMECROLIMUS)
*BATH SALTS OR BATHING IN HIGH-SALT-CONCENTRATION
WATERS *
* COAL TAR
* ANTHRALIN
MEDICAL MANAGEMENT
15. *Coal tar- A major advantage with tar is lack of skin thinning *
*Anthralin
16. B. SYSTEMIC DRUGS
*METHROTREXATE- IMPROVEMENTS IN THREE TO SIX WEEKS.
SEVERAL MONTHS MAY BE REQUIRED BEFORE MAXIMAL
BENEFITS ARE ACHIEVED.
*ACITRETIN- IMPROVEMENTS IN EIGHT TO SIXTEEN WEEKS,
THOUGH SEVERAL MONTHS MAY BE REQUIRED FOR
MAXIMAL BENEFIT.
*CYCLOSPORIN- IMPROVEMENTS IN AS FEW AS TWO WEEKS OF
TREATMENTS, BUT MAY REQUIRE SEVERAL MONTHS TO
ACHIEVE MAXIMUM BENEFIT. IN SOME CASES, PATIENTS
MAY CONTINUE WITH A MAINTENANCE LEVEL DOSAGE
AFTER CLEARANCE OCCURS.
17. TRADITIONAL SYSTEMIC DRUGS TEND TO HAVE ONE OR MORE OF
THE FOLLOWING SIDE EFFECTS:
DECREASED KIDNEY FUNCTION
HIGH CHOLESTEROL
HIGH BLOOD PRESSURE
LIVER DAMAGE
DEPRESSION
UPSET STOMACH OR NAUSEA
SKIN CANCERS (PATIENTS WHO TAKE CYCLOSPORINE AFTER PUVA
THERAPIES HAVE A HIGHER INCIDENCE OF SQUAMOUS CELL SKIN
CANCER. THE RISKS ARE GREATEST WITH LONG-TERM AND PREVIOUS
USE OF PUVA, METHOTREXATE, OR OTHER IMMUNOSUPPRESSANTS.)
EYE PROBLEMS
19. 2. PHOTOTHERAPY
A. UVB/ UVA PHOTOTHERAPY *
PRESENT IN NATURAL SUNLIGHT, UVB IS AN EFFECTIVE
TREATMENT FOR PSORIASIS. UVB PENETRATES THE SKIN AND SLOWS
THE GROWTH OF AFFECTED SKIN CELLS. TREATMENT INVOLVES
EXPOSING THE SKIN TO AN ARTIFICIAL UVB LIGHT SOURCE FOR A SET
LENGTH OF TIME ON A REGULAR SCHEDULE. THIS TREATMENT IS
ADMINISTERED IN A MEDICAL SETTING OR AT HOME.
20. THERE ARE TWO TYPES OF UVB TREATMENT, BROAD BAND AND
NARROW BAND. THE MAJOR DIFFERENCE BETWEEN THEM IS THAT
NARROW BAND UVB LIGHT BULBS RELEASE A SMALLER RANGE OF
ULTRAVIOLET LIGHT. NARROW-BAND UVB IS SIMILAR TO BROAD-BAND
UVB IN MANY WAYS. SEVERAL STUDIES INDICATE THAT NARROW-BAND
UVB CLEARS PSORIASIS FASTER AND PRODUCES LONGER REMISSIONS
THAN BROAD-BAND UVB. IT ALSO MAY BE EFFECTIVE WITH FEWER
TREATMENTS PER WEEK THAN BROAD-BAND UVB.
21. B. HOME UVB PHOTOTHERAPY
LIKE PHOTOTHERAPY IN A CLINIC, IT REQUIRES A CONSISTENT
TREATMENT SCHEDULE. INDIVIDUALS ARE TREATED INITIALLY AT A
MEDICAL FACILITY AND THEN BEGIN USING A LIGHT UNIT AT HOME. IT
IS CRITICAL WHEN DOING PHOTOTHERAPY AT HOME TO FOLLOW A
DOCTOR'S INSTRUCTIONS AND CONTINUE WITH REGULAR CHECK-
UPS. HOME PHOTOTHERAPY IS A MEDICAL TREATMENT THAT REQUIRES
MONITORING BY A HEALTH CARE PROFESSIONAL. ALL PHOTOTHERAPY
TREATMENTS, INCLUDING PURCHASE OF EQUIPMENT FOR HOME USE,
REQUIRE A PRESCRIPTION. SOME INSURANCE COMPANIES WILL COVER
THE COST OF HOME UVB EQUIPMENT. VENDORS OF HOME
PHOTOTHERAPY EQUIPMENT OFTEN WILL ASSIST YOU IN WORKING
WITH YOUR INSURANCE COMPANY TO PURCHASE A UNIT.
22. C. SUNLIGHT *
ALTHOUGH BOTH UVB AND ULTRAVIOLET LIGHT A (UVA) ARE
FOUND IN SUNLIGHT, UVB WORKS BEST FOR PSORIASIS. UVB FROM THE
SUN WORKS THE SAME WAY AS UVB IN PHOTOTHERAPY TREATMENTS.
SHORT, MULTIPLE EXPOSURES TO SUNLIGHT ARE RECOMMENDED. START
WITH FIVE TO 10 MINUTES OF NOONTIME SUN DAILY. GRADUALLY
INCREASE EXPOSURE TIME BY 30 SECONDS IF THE SKIN TOLERATES IT. TO
GET THE MOST FROM THE SUN, ALL AFFECTED AREAS SHOULD RECEIVE
EQUAL AND ADEQUATE EXPOSURE. REMEMBER TO WEAR SUNSCREEN
ON AREAS OF YOUR SKIN UNAFFECTED BY PSORIASIS. IT CAN TAKE
SEVERAL WEEKS TO SEE IMPROVEMENT.
23. D. PUVA/ PHOTOCHEMOTHERAPY *
LIKE UVB, ULTRAVIOLET LIGHT A (UVA) IS PRESENT IN SUNLIGHT.
UNLIKE UVB, UVA IS RELATIVELY INEFFECTIVE UNLESS USED WITH A
LIGHT-SENSITIZING MEDICATION PSORALEN, WHICH IS
ADMINISTERED TOPICALLY OR ORALLY. THIS PROCESS, CALLED PUVA,
SLOWS DOWN EXCESSIVE SKIN CELL GROWTH AND CAN CLEAR
PSORIASIS SYMPTOMS FOR VARYING PERIODS OF TIME.
STABLE PLAQUE PSORIASIS, GUTTATE PSORIASIS, AND PSORIASIS OF
THE PALMS AND SOLES ARE MOST RESPONSIVE TO PUVA
TREATMENT. THE MOST COMMON SHORT-TERM SIDE EFFECTS OF
PUVA ARE NAUSEA, ITCHING AND REDNESS OF THE SKIN. DRINKING
MILK OR GINGER ALE, TAKING GINGER SUPPLEMENTS OR EATING
WHILE TAKING ORAL PSORALEN MAY PREVENT NAUSEA.
ANTIHISTAMINES, BATHS WITH COLLOIDAL OATMEAL PRODUCTS OR
APPLICATION OF TOPICAL PRODUCTS WITH CAPSAICIN MAY HELP
RELIEVE ITCHING. SWELLING OF THE LEGS FROM STANDING DURING
PUVA TREATMENT MAY BE RELIEVED BY WEARING SUPPORT HOSE.
25. 1. DEFICIENT KNOWLEDGE OF DISEASE AND ITS TREATMENT
A. EXPLAIN WITH SENSITIVITY THAT THERE IS NO CURE AND THAT
LIFETIME MANAGEMENT IS NECESSARY; THE DISEASE PROCESS CAN
USUALLY BE CONTROLLED.
B. REVIEW PATHOPHYSIOLOGY OF PSORIASIS AND FACTORS THAT
PROVOKE IT: ANY IRRITATION OR INJURY TO THE SKIN (CUT,
ABRASION, SUNBURN), ANY CURRENT ILLNESS, EMOTIONAL STRESS,
UNFAVORABLE ENVIRONMENT (COLD), AND DRUG (CAUTION PATIENT
ABOUT NONPRESCRIPTION MEDICATION).
NURSING DIAGNOSIS &
ITS MANAGEMENT
26. 2. IMPAIRED SKIN INTEGRITY RELATED TO LESIONS AND INFLAMMATORY
RESPONSE
A. EXAMINE THE SKIN IN GENERAL CIRCUMSTANCES
B. INSTRUCT THE PATIENT TO NOT PINCH OR SCRATCH THE SKIN AREA
C. PATIENT'S MOTIVATION FOR CONSUMING NUTRIENTS: HIGH IN
CALORIES AND HIGH IN PROTEIN
D. ENCOURAGE PATIENT TO PREVENT THE SKIN FROM DRYING OUT; DRY
SKIN CAUSES PSORIASIS TO WORSEN (KEEP SKIN MOIST)
27. E. INFORM PATIENT THAT WATER SHOULD NOT BE TOO HOT AND
SKIN SHOULD BE DRIED BY PATTING WITH A TOWEL.
F. TEACH PATIENT TO USE BATH OIL OR EMOLLIENT CLEANSING
AGENT FOR SORE AND SCALING SKIN.
3.DISTURBED BODY IMAGE RELATED TO EMBARRASSMENT OVER
APPEARANCE AND SELF-PERCEPTION OF UNCLEANLINESS
A. INTRODUCE COPING STRATEGIES AND SUGGESTIONS FOR
REDUCING OR COPING WITH STRESSFUL SITUATION TO FACILITATE
A MORE POSITIVE OUTLOOK AND ACCEPTANCE OF THE DISEASE.
28. 4. RISK FOR INFECTION RELATED TO HYPOPROTEINAEMIA
A. MONITOR VITAL SIGNS
B. EXAMINED FOR SIGNS OF INFECTION
C. PATIENT'S MOTIVATION TO IMPROVE NUTRITION: HIGH IN
CALORIES AND HIGH IN PROTEIN.
D. KEEP THE WOUND CLEAN
E. COLLABORATION ANTIBIOTICS
29. 1. PROMOTING HOME AND COMMUNITY-BASED CARE/TEACHING PATIENT
SELF-CARE
A. INSTRUCT THE CLIENT TO AVOID SUN EXPOSURE DURING
PHOTOCHEMOTHERAPY. THIS REGIMEN OF PHOTOTHERAPY WITH
ULTRAVIOLET A (PUVA) LIGHT DECREASES CELLULAR PROLIFERATION. PUVA
THERAPY RESULTS IN PHOTOSENSITIVITY AND THE CLIENT SHOULD AVOID
EXPOSURE TO SUNLIGHT DURING THIS TIME.
B. BE KNOWLEDGEABLE ABOUT TREATMENT, AND GIVE THE CLIENT
WRITTEN INSTRUCTIONS.
C. ADVISE PATIENT THAT THE TOPICAL AGENT ANTHRALIN LEAVES A
BROWNISHI-PURPLE STAIN THAT SUBSIDES WHEN TREATMENT STOPS.
LESIONS SHOULD BE COVERED TO PREVENT STAINING CLOTHING,
FURNITURE, AND BED LINENS.
ADDITIONAL
MANAGEMENT
30. D. ADVISE PATIENT THAT TOPICAL CORTICOSTEROID PREPARATIONS
ON FACE AND AROUND EYES PREDISPOSE TO CATARACT DEVELOPMENT.
FOLLOW STRICT GUIDELINES TO AVOID OVERUSE.
E. PROVIDE HELPFUL TIPS ON APPLICATION OF TAR PREPARATIONS.
F. TEACH PATIENT TO AVOID EXPOSURE TO SUN WHEN UNDERGOING
PUVA TREATMENTS.
G. REMIND PATIENT TO SCHEDULE OPHTHALMIC EXAMINATIONS ON A
REGULAR BASIS.
31. H. ADVISE FEMALE PATIENTS OF CHILDBEARING AGE THAT PUVA
THERAPY IS TERATOGENIC (CAN CAUSE FETAL DEFECTS). THEY MAY
WANT TO CONSIDER USING CONTRACEPTIVES DURING THERAPY.
I. ENCOURAGE PATIENT TO JOIN A SUPPORT GROUP AND TO
CONTACT THE NATIONAL PSORIASIS FOUNDATION FOR INFORMATION.
32. 1. DEMONSTRATES KNOWLEDGE AND UNDERSTANDING OF
DISEASE AND ITS TREATMENT
2. DEMONSTRATE SELF-ACCEPTANCE
3. ACHIEVES SMOOTHER SKIN AND CONTROL OF LESIONS
4. EXPERIENCES RELIEF OF ITCHING AND DISCOMFORT
5. EXPERIENCES NO COMPLICATIONS
EXPECTED PATIENT
OUTCOMES
33. WHAT IS SKIN CANCER??? *
-UNCONTROLLED GROWTH OF ABNORMAL SKIN CELLS
-GENERALLY DEVELOPS IN THE EPIDERMIS (THE OUTERMOST LAYER OF SKIN), SO
A TUMOR CAN USUALLY BE SEEN
-MOST COMMONLY DIAGNOSED TYPE OF CANCER. IT ACCOUNTS FOR NEARLY
HALF OF ALL CANCERS IN THE UNITED STATES. MORE THAN 2 MILLION CASES OF
BASAL AND SQUAMOUS CELL SKIN CANCER ARE FOUND IN THIS COUNTRY EACH
YEAR. MELANOMA, THE MOST SERIOUS TYPE OF SKIN CANCER, WILL ACCOUNT
FOR MORE THAN 75,000 CASES OF SKIN CANCER IN 2012.
-SECOND MOST COMMON CANCER IN YOUNG ADULTS AGED 15–34 IN THE UK
-NON-MELANOMA SKIN CANCERS ARE THE MOST COMMON SKIN CANCERS. THE
MAJORITY OF THESE ARE BASAL CELL CARCINOMAS
SKIN CANCER
34. 1. BASAL CELL CARCINOMA- PEARLY TRANSLUCENCY TO FLESHY COLOR,
TINY BLOOD VESSELS ON THE SURFACE, AND SOMETIME ULCERATION
WHICH CAN BE CHARACTERISTICS. THE KEY TERM IS TRANSLUCENCY. THIS
FORM OF SKIN CANCER IS THE LEAST DEADLY AND WITH PROPER
TREATMENT CAN BE COMPLETELY ELIMINATED, OFTEN WITHOUT SCARRING.
*
2. SQUAMOUS CELL CARCINOMA- COMMONLY PRESENTS AS A RED,
CRUSTED, OR SCALY PATCH OR BUMP. OFTEN A VERY RAPID GROWING
TUMOR. ULCERATION AND BLEEDING MAY OCCUR. WHEN SCC IS NOT
TREATED, IT MAY DEVELOP INTO A LARGE MASS. SQUAMOUS CELL IS THE
SECOND MOST COMMON SKIN CANCER. *
CLASSIFICATION
35. 3. MALIGNANT MELANOMA- ON APPEARANCE IS AN ASYMMETRICAL
AREA, WITH AN IRREGULAR BORDER, COLOR VARIATION, AND OFTEN
GREATER THAN 6 MM DIAMETER. MOST MELANOMAS ARE BROWN TO BLACK
LOOKING LESIONS. WARNING SIGNS OF MALIGNANT MELANOMA INCLUDE
CHANGE IN THE SIZE, SHAPE, COLOR OR ELEVATION OF A MOLE. OTHER
SIGNS ARE THE APPEARANCE OF A NEW MOLE DURING ADULTHOOD OR
NEW PAIN, ITCHING, ULCERATION OR BLEEDING. AN OFTEN-USED
MNEMONIC IS "ABCDE", WHERE A= ASYMMETRICAL, B= "BORDERS"
(IRREGULAR= "COAST OF MAINE SIGN"), C= "COLOR" (VARIEGATED), D=
"DIAMETER" (LARGER THAN 6 MM—THE SIZE OF A PENCIL ERASER) AND E=
"EVOLVING.“ *
37. THE ROOT CAUSE OF SKIN CANCER HAS NOT BEEN DISCOVERED
BUT IT’S THOUGHT TO BE RELATED TO CELLULAR DNA MUTATION AND
FAILURE OF THE IMMUNE SYSTEM TO RESPONSE.
CAUSATIVE FACTORS
38. 1. LIGHT SKIN COLOR
2. SMOKING TOBACCO
3. HPV INFECTIONS
4. HISTORY OF SUNBURNS
5. EXCESSIVE SUN EXPOSURE
6. MOLES
7. CHRONIC NON-HEALING WOUNDS (CALLED MARJOLIN'S ULCERS)
8. PRECANCEROUS LESIONS
9. FAMILY HISTORY OF SKIN CANCER
10. WEAKENED IMMUNE SYSTEM
11. EXPOSURE TO RADIATION
12. AGING ( 50 & ABOVE)
13. EXPOSURE TO CERTAIN SUBSTANCES SUCH AS ARSENIC
PRECIPITATING FACTORS
39. 1. A SORE THAT WON’T HEAL
2. PRURITUS, PAIN ON THE SKIN
3. CHANGES IN EXISTING MOLE
4. A PEARLY OR WAXY BUMP (BCC)
5. STIFF AND PLAQUE PAPULE IN EARLY STAGE (BCC)
6. MARGINAL TRANSLUCENCY POTENTIAL ULCER (BCC)
7. A FLAT, FLESH-COLORED OR BROWN SCAR-LIKE LESION (BCC)
8. A FIRM, RED NODULE (SCC)
9. THE MARGIN OF ULCER ELEVATES AND FEATURES RED AND STIFF,
WHICH MANIFESTING AS CIRCULAR OR CAULIFLOWER-LIKE (SCC)
CLINICAL MANIFESTATION
40. 10. A FLAT LESION WITH A SCALY, CRUSTED SURFACE (SCC)
11. A LARGE BROWNISH SPOT WITH DARKER SPECKLES (M)
12. A MOLE THAT CHANGES IN COLOR, SIZE OR FEEL OR THAT
BLEEDS(M)
13. A SMALL LESION WITH AN IRREGULAR BORDER AND PORTIONS
THAT APPEAR RED, WHITE, BLUE OR BLUE-BLACK(M)
14. DARK LESIONS ON YOUR PALMS, SOLES, FINGERTIPS OR TOES,
OR ON MUCOUS MEMBRANES LINING YOUR MOUTH, NOSE,
VAGINA OR ANUS(M)
41. THE ABCD RULE :
IF YOU NOTICE ANY OF THE FOLLOWING SIGNS, THEN SEE YOUR
DOCTOR WITHOUT DELAY.
ASYMMETRY THE TWO HALVES OF YOUR MOLE DO NOT LOOK THE SAME.
BORDER THE EDGES OF YOUR MOLE ARE IRREGULAR, BLURRED OR
JAGGED.
COLOUR THE COLOUR OF YOUR MOLE IS UNEVEN, WITH MORE THAN
ONE SHADE.
DIAMETER YOUR MOLE IS WIDER THAN 6MM IN DIAMETER (THE SIZE OF
A PENCIL ERASER).
42. 1. CELLULITIS
2. RISK OF RECURRENCE
3. BRAIN METASTASES
4. CHEMOTHERAPY SIDE EFFECTS
5. FATIGUE
6. LIVER METASTASES
7. LUNG METASTASES
8. METASTASIS
9. STRESS, ANXIETY AND DEPRESSION
COMPLICATIONS
43. 1.SKIN EXAMINATION- THE DOCTOR WILL NOTE THE SIZE, SHAPE,
COLOR, AND TEXTURE OF THE SUSPICIOUS AREA. HE OR SHE WILL THEN
EXAMINE YOUR LYMPH GLANDS TO CHECK FOR SWELLING, A POTENTIAL
SIGN OF CANCER. *
2.SKIN BIOPSY
METHODS:
A. SHAVE BIOPSY *
B. PUNCH BIOPSY *
C. INCISIONAL BIOPSY *
D. EXCISIONAL BIOPSY *
DIAGNOSTIC
TESTS/EXAMS
44. 3. BLOOD TEST FOR LDH (LACTATE DEHYDROGENASE) LEVELS
4. MAGNETIC RESONANCE IMAGING
5. POSITRON EMISSION TOMOGRAPHY SCAN
6. SENTINEL LYMPH NODE MAPPING OR FINE NEEDLE ASPIRATION
7. STAGING
STAGE 0: THE CANCER INVOLVES ONLY THE TOP LAYER OF SKIN. IT IS
CALLED MELANOMA IN SITU.
STAGE I: THE GROWTH IS LESS THAN TWO MILLIMETERS DEEP.
STAGE II: THE GROWTH IS MORE THAN TWO MILLIMETERS DEEP.
STAGE III: THE CANCER HAS SPREAD BELOW THE SKIN TO CARTILAGE,
MUSCLE, BONE, OR TO NEARBY LYMPH NODES. IT HAS NOT
SPREAD TO OTHER PLACES IN THE BODY.
STAGE IV: THE CANCER HAS SPREAD TO OTHER PLACES IN THE BODY.
45. 1.PHARMACOLOGICAL MANAGEMENT
A.FLUOROURACIL CREAM (BRAND NAME CARAC OR EFUDEX)- A
TOPICAL ANTINEOPLASTIC
B.IMIQUIMOD (BRAND NAME ALDARA)- TOPICAL CREAM
ACTIVATES YOUR BODY'S OWN IMMUNE SYSTEM VIA A
MOLECULE CALLED TOLL-LIKE RECEPTOR 7 (TLR7), WHICH IN
TURN ACTIVATES INTERFERON-ALPHA TO FIGHT THE
CANCEROUS CELLS. IT IS USED TO TREAT SUPERFICIAL BASAL CELL
CARCINOMA.
MEDICAL MANAGEMENT
46. 2.SURGICAL MANAGEMENT AND OTHER THERAPIES
A.EXCISIONAL SURGERY *
B.LASER THERAPY *
C.MOHS SURGERY *
D.CURETTAGE AND ELECTRODESICCATION *
E.RADIATION THERAPY *
F.CHEMOTHERAPY
G.PHOTODYNAMIC THERAPY (PDT)
H.BIOLOGICAL THERAPY
47. 1.RISK FOR IMPAIRED SKIN/TISSUE INTEGRITY RELATED TO CUTANEOUS
LESIONS
A. ASSESS SKIN FREQUENTLY FOR SIDE EFFECTS OF CANCER THERAPY;
NOTE BREAKDOWN/DELAYED WOUND HEALING. EMPHASIZE
IMPORTANCE OF REPORTING OPEN AREAS TOCAREGIVER.
B. BATHE WITH LUKEWARM WATER AND MILD SOAP.
C.ENCOURAGE PATIENT TO AVOID VIGOROUS RUBBING AND
SCRATCHING AND TO PAT SKIN DRY INSTEAD OF RUBBING.
D. RECOMMEND WEARING SOFT, LOOSE COTTON CLOTHING; HAVE
FEMALE PATIENT AVOID WEARING BRA IF IT CREATES
PRESSURE.
NURSING DIAGNOSIS
AND ITS MANAGEMENT
48. E.ENCOURAGE LIBERAL USE OF SUNSCREEN/BLOCK AND BREATHABLE,
PROTECTIVE CLOTHING.
F.USE APPROPRIATE PERIPHERAL OR CENTRAL VENOUS CATHETER, DILUTE
ANTICANCER DRUG PER PROTOCOL AND ASCERTAIN THAT IV IS
INFUSING WELL;
G.ASSESS SKIN/IV SITE AND VEIN FOR ERYTHEMA, EDEMA, TENDERNESS;
WELTLIKE PATCHES, ITCHING/BURNING; OR SWELLING, BURNING,
SORENESS; BLISTERS PROGRESSING TO ULCERATION/TISSUE
NECROSIS.
H.WASH SKIN IMMEDIATELY WITH SOAP AND WATER IF ANTINEOPLASTIC
AGENTS ARE SPILLED ON UNPROTECTED SKIN (PATIENT OR
CAREGIVER)
49. I.ADVISE PATIENTS RECEIVING 5-FLUOROURACIL (5-FU) AND
METHOTREXATE TO AVOID SUN EXPOSURE. WITHHOLD
METHOTREXATE IF SUNBURN PRESENT.
J.REVIEW EXPECTED DERMATOLOGIC SIDE EFFECTS SEEN WITH
CHEMOTHERAPY, E.G., RASH, HYPERPIGMENTATION, AND PEELING
OF SKIN ON PALMS.
K.INFORM PATIENT THAT IF ALOPECIA OCCURS, HAIR COULD GROW BACK
AFTER COMPLETION OF CHEMOTHERAPY, BUT MAY/MAY NOT
GROW BACK AFTER RADIATION THERAPY.
L.ADMINISTER APPROPRIATE ANTIDOTE IF EXTRAVASATION OF IV SHOULD
OCCUR.
50. 2.RISK FOR INFECTION RELATED TO SURGICAL WOUND
A.TEACH THE PATIENT HOW TO CARE FOR THE WOUND
ASEPTICALLY.
B.COORDINATE A CONSISTENT, STANDARD PLAN SO THAT THE PATIENT
CAN BEGIN TO ASSUME CARE FOR THE WOUND.
C.IF THE WOUND IS LARGE AND INFECTED, KEEP IT DRY AND CLEAN. IF
IT HAS AN ODOR, CONTROL THE ODOR WITH ODOR-MASKING
SUBSTANCES SUCH AS OIL OF CLOVES OR BALSAM OF PERU IN THE
ROOM.
D.PROMOTE GOOD HAND-WASHING PROCEDURES BY STAFF AND
VISITORS. SCREEN AND LIMIT VISITORS WHO MAY HAVE
INFECTIONS.
51. E.EMPHASIZE PERSONAL HYGIENE.
F.MONITOR TEMPERATURE.
G.ENCOURAGE FLUIDS.
H.ASSESS ALL SYSTEMS (E.G., SKIN, RESPIRATORY, GENITOURINARY) FOR
SIGNS AND SYMPTOMS OF INFECTION ON A CONTINUAL BASIS.
I.MONITOR CBC WITH DIFFERENTIAL WBC AND GRANULOCYTE COUNT
AND PLATELETS, AS INDICATED.
52. 3.DEPRESSION/ANXIETY/LOW SELF-ESTEEM RELATED TO DIAGNOSIS OF SKIN
CANCER
A.LISTEN TO THE PATIENT’S FEARS AND ANXIETIES AND ACCEPT THE
PATIENT’S PERCEPTION OF HER OR HIS APPEARANCE.
B.ASSIST THE PATIENT AND SIGNIFICANT OTHERS TO HAVE REALISTIC
EXPECTATIONS.
C.HELP THE PATIENT PRESENT A PLEASANT APPEARANCE BY ASSISTING
WITH HAIR CARE AND CLOTHING. SOME PATIENTS EXPERIENCE
INCREASED SELF-ESTEEM WHEN THEY WEAR THEIR OWN CLOTHING
RATHER THAN HOSPITAL-ISSUED CLOTHING, IF HOSPITALIZATION IS
NEEDED.
53. D.IF HAIR LOSS OCCURS DURING RADIATION, ENCOURAGE THE PATIENT TO
WEAR ANY TYPE OF HEAD COVERING THAT IMPROVES BODY IMAGE,
SUCH AS BASEBALL CAPS, WIGS, SCARVES, OR BANDANAS.
E.IF IT IS APPROPRIATE, ARRANGE FOR THE PATIENT TO INTERACT WITH
OTHERS WHO HAVE A SIMILAR PROBLEM.
F.IF THE PATIENT HAS END STAGE DISEASE, LISTEN TO THE PATIENT’S AND
SIGNIFICANT OTHERS’ FEARS AND CONCERNS. IDENTIFY THE NEEDS
OF THE FAMILY, AND INVESTIGATE MECHANISMS FOR SUPPORT
FROM THE CHAPLAIN, THE AMERICAN CANCER SOCIETY, OR A LOCAL
HOSPICE.
54. 4.ACUTE/CHRONIC PAIN RELATED TO SURGERY/THERAPY/DISEASE PROCESS
A.DETERMINE PAIN HISTORY, FOR EXAMPLE, LOCATION OF PAIN,
FREQUENCY, DURATION, AND INTENSITY USING A RATING SCALE
(SCALE OF 0–10), OR VERBAL RATING SCALE—“NO PAIN” TO
“EXCRUCIATING PAIN”; AND RELIEF MEASURES USED. BELIEVE
CLIENT’S REPORT.
B.DETERMINE TIMING AND PRECIPITANTS OF “BREAKTHROUGH” PAIN
WHEN USING AROUND-THE-CLOCK AGENTS, WHETHER ORAL,
INTRAVENOUS (IV), TOPICAL, TRANSMUCOSAL, EPIDURAL, OR
PATCH MEDICATIONS.
C.EVALUATE PAINFUL EFFECTS OF PARTICULAR THERAPIES, SUCH AS
SURGERY, RADIATION, CHEMOTHERAPY, OR BIOTHERAPY. PROVIDE
INFORMATION TO CLIENT AND SO ABOUT WHAT TO EXPECT.
55. D.PROVIDE NONPHARMACOLOGICAL COMFORT MEASURES SUCH AS
MASSAGE, REPOSITIONING, AND BACK RUB; AS WELL AS
DIVERSIONAL ACTIVITIES, SUCH AS MUSIC, READING, AND TV.
E.ENCOURAGE USE OF STRESS MANAGEMENT SKILLS AND
COMPLEMENTARY THERAPIES SUCH AS RELAXATION TECHNIQUES,
VISUALIZATION, GUIDED IMAGERY, BIOFEEDBACK, LAUGHTER,
MUSIC, AROMATHERAPY, AND THERAPEUTIC TOUCH.
F.PROVIDE CUTANEOUS STIMULATION, SUCH AS HEAT AND COLD PACKS,
OR MASSAGE.
G.BE AWARE OF BARRIERS TO CANCER PAIN MANAGEMENT RELATED TO
CLIENT, AS WELL AS THE HEALTHCARE SYSTEM.
H.REFER TO STRUCTURED SUPPORT GROUP, PSYCHIATRIC CLINICAL NURSE
SPECIALIST, PSYCHOLOGIST, OR SPIRITUAL ADVISOR FOR
COUNSELING, AS INDICATED.
56. 1. DEMONSTRATES KNOWLEDGE AND UNDERSTANDING OF
DISEASE AND ITS TREATMENT
2. DEMONSTRATES SELF-ACCEPTANCE
3. PREVENT INFECTION
4. ABLE TO MANAGE/CONTROL PAIN
EXPECTED PATIENT
OUTCOMES