Portal de Periódicos da CAPES

Indianapolis

2016; Lippincott Williams & Wilkins; Volume: 8; Issue: 4 Linguagem: Inglês

10.1097/jdn.0000000000000242

1945-760X

Angela L. Borger,

Medicine and Dermatology Studies History

FigureMy annual tradition is to share with Journal of the Dermatology Nurses’ Association (JDNA) readers the highlights of our annual Dermatology Nurses’ Association (DNA) convention. The 34th annual DNA convention was held in Indianapolis, IN, this year and couldn’t have been better! I have always personally felt that Indianapolis is one of my favorite cities to visit, and I am certainly glad that the DNA chose to have our annual convention there. Everyone in attendance would probably agree that there was a sense of enthusiasm for activity going on in the city around us. While there, I rode a double bike around the waterway, randomly saw members of the Orlando Magic arriving in town via their tour bus, hiked around the downtown monuments, and was able to have dinner at The Rathskeller, a Bavarian restaurant/inn/beer hall-type establishment in downtown Indy. Furthermore, while the DNA was there, other fun events were occurring, too, like the NCAA Women’s Final Four playoffs as well as a free Salt-N-Pepa concert in the Convention Center directly across from our hotel! Too bad the Indianapolis 500 wasn’t running the same weekend! Aside from a great location and the coinciding exciting events, there is something to be said for coming together as dermatology nurses, even if only for a few days each spring. The energy that comes from being surrounded by dermatology nurses was palpable, and I always find this experience invigorating. This annual conference is always a reminder that I am not the only one who can talk about dermatology and skin for multiple hours a day! Coming together gives everyone a chance to learn from each other and to share our own knowledge. The dialogue that I heard, and participated in, was amazing. As I am sure I have conveyed before, I think that the unwritten knowledge that dermatology nurses have from years of experience, and from the multitude of patients we’ve taken care of, is immense. I have not made it a secret that, obviously, I will always want each of you to translate your personal knowledge and expertise into articles for the JDNA, because that translation of information and knowledge to others is part of what defines us as a profession. Should you not have had the opportunity to join us in Indianapolis this year, I wanted to share a few of the pearls that I learned while at the convention. While I was furiously trying to type notes on my iPad, I saw others writing (scribbling) notes on paper tablets, whereas I also saw others listening raptly while taking in all the information. Maybe some of the JDNA readers who also were present and took notes would want to share their favorite pearls of knowledge they learned at the 2016 Convention. We are always welcoming to readers who’d like to share. In the meantime, here are some of the pearls I found to be particularly informative from the 34th annual DNA Convention: Multidisciplinary grand rounds are helpful in difficult cases. S100 staining does not always mean melanoma, because it also stains for five other types of cells. INI-1 is a tumor suppressive gene and is retained in melanoma but not in nerve sheath tumor. Don’t use permethrin before 4 months old, but after 4 months, it’s okay to use permethrin from the neck down; in infants less than 4 months old, use sulfur in petroleum. Be concerned with congenital heart block with neonatal lupus; 10% have heart block with 15% mortality in the first month; an EKG is needed. If you see a child with a midline bump on the nose, think of a possible dermoid issue (cyst, sinus, or fistula) and get an MRI of the head; consider if there is CNS involvement. Topicort and triamcinolone are propylene glycol free. Autoimmune diseases coexist. NSAIDS, beta blockers, and lithium are medications that can induce psoriasis flares. Having a chronic disease is expensive. Acne flares with use of topical steroids, anticonvulsants, and lithium. Doxycycline continues to have high levels of efficacy for p. acnes. Benzoyl peroxide in a therapeutic regimen that reduces antimicrobial resistance. For dermatophytes: Allamines are better for dermatophytes, but azoles are better for Candida and pityrosporum. Acute urticaria is often viral. Do not use beta blockers for urticaria. For poison ivy, a typical course of systemic steroids therapy is commonly around 2 weeks to avoid a rebound: 60 mg × 5 days, 40 mg × 5 days, 20 mg × 5 days. The patient has 30–60 minutes after exposure to poison ivy to wash off. We have physiologic steroids at levels of 5–7.5 mg. In seborrheic dermatitis, scalp therapy is essential to gain better facial disease control. You should worry when infantile hemangiomas are periocular—worry about astigmatism, ambylopia, and strabismus, especially if lesion is 1 cm or larger; these should be co-managed with an ophthalmologist; and systemic treatment with beta blockers is the first-line therapy. Small multifocal infantile hemangiomas…when worry about these? Not uncommon for a person to have one to three cutaneous hemangiomas, but five or more indicate risk for visceral hemangiomas. Preterm birth is a big risk factor for hemangiomas. Liver hemangiomas are associated with low TSH and may require even IV thyroid replacement. If you see a lumbosacral hemangioma, look for spinal cord anomalies because tethered spinal cord is most common and about one half have abnormalities. Propranolol is the only FDA medicine approved for treatment of infantile hemangiomas. With propranolol, you will need to monitor blood pressure and blood sugar. Always wean the propranolol to see if hemangioma comes back. You should find out if you have a compounding pharmacist in your area. Herpes is incurable. 20% of adults in the United States have been infected by HSV-2. Nearly all individuals with genital HSV-2 will develop recurrences. With syphilis, when one has enlargement of local lymph nodes, they will be firm and painless. Pemphigus used to be 100% fatal before prednisone. Subcutaneous fat = 85% of total body fat. There is no normal sun-exposed skin. Many people mix up ethical versus moral problems—ethics is a discipline, and you can learn this. Ethics is what is right, and morals is what you do about what is right. Ethical practice integrates code of ethics, standards of practice, and colleagues. In ancient times, nurses would promise in the public market to act in the best interest of their patient or client; be masters of their craft throughout their lifetime; and cherish colleagues and to live life in partnership with them. Ethics is designed to protect the vulnerable from the powerful. Don’t mix up a moral problem with an ethical problem. The first obligation in ethical analysis is to gather as much accurate information as possible. Hypothyroidism can affect nails and mimic onychomycosis. Not every abnormal toe is a fungus. Terbinafine is the gold standard of onychomycosis treatment. Other medication is available but not FDA approved. With onychomycosis, nails can scar over time and may never be normal. Picato needs to be refrigerated. When using lidocaine, use within 24–48 hours—your patients will tolerate better. Hair gel is a fire hazard with electrocautery in surgery. Be careful in evaluating your patients. Use a pressure dressing, even during a small surgery, if the patient is prone to bleeding. Consider a stretching stitch; this will help to approximate the edges, and you can then take it out if you don’t want to keep it, even only use for a few moments when you are completing the stitches. Moisture-associated skin damage (MASD)—we need to start using this term. Stress, depression, and sleep disorders are factors that affect wound healing. Physical assessment is 90% history. The goal may not always be to heal a wound. Charcoal dressings may help wound odor. 40% of melanomas develop in preexisting moles. Stage 1 melanomas are not 100% curable. Depth is the number 1 risk factor in melanoma because this relates to access to blood vessels. Do not use Clark level, only Breslow level. Melanoma under 1-mm thickness has the best prognosis. Melanoma survival is based on lymph node involvement. Satellite lesions of melanoma are not usually pigmented, automatically Stage IIIb. Melanoma stages IIB and IIc are high risk; need to see medical oncology. www.Melanomaprognosis.org is a useful tool but does have considerations for use. New guidelines for melanoma are coming next year. Speaker Krista Rubin says, “In my world everything is melanoma until proven otherwise.” When thinking about new generation cancer therapies, use agents earlier in diagnosis. We are using immunotherapies and targeted therapies in melanoma. Cancer is a disease of DNA. Targeted therapies have dermatology side effects. The goal of our immune system is balance. Immunotherapy works on the cancer immune system, not the patient’s immune system. Be sure to look distal to the melanoma for other lesions. If melanoma is in the differential, do not do a shave biopsy! Indoor tanning is going down, but tanning in gyms is occurring frequently. Indoor tanning is resulting in these individuals getting melanoma within a decade. Tanning devices have been becoming more carcinogenic over time. The melanoma epidemic can be expected to continue unless indoor tanning is restricted and reduced. The labia changes throughout life. Labia atrophy risk factors include smoking, no sex, and nulliparity. The last few educational pearls that I learned in April come from one of the DNA’s regular convention speakers, Stephen E. Wolverton, MD. During one of his lectures, he outlined a few common-sense hints that can help offices avoid a malpractice lawsuit. These include the following: Establish strong clinician–patient relationships Obtain proper written informed consent Maintain your continuing education Maintain up-to-date patient information in chart Maintain precise and comprehensive documentation Hire qualified staff with careful guidelines Follow up with patients who miss appointments Ask for feedback from patient Be highly organized in office Obtain malpractice insurance Finally, because this is one of my favorite topics to consider, I wrote down the five basic elements of informed consent that were reviewed with us: Assess patient competence Include patient education Discuss potential risks, benefits, and uncertainties of proposed treatments and potential alternatives Verify patients’ understanding Confirm patient consent as evidenced by their signature The DNA speaker reminded us to be sure to use clear, concise, and easy-to-understand language when talking to patients and to “realize the dialogue is the evidence of informed consent and not the patient signature.” In reviewing all these clinical pearls, I was able to relive the excitement of sitting in the convention classrooms, side-by-side with my dermatology nurse colleagues. Planning for the 35th annual DNA convention is well underway, and I am sure DNA members will soon be hearing about Early Bird Convention Registration; I would strongly encourage you to consider attending next year’s meeting that will be on March 1–4, 2017, at the Caribe Royal in Orlando, Florida. Set aside the time on your 2017 schedule and plan to be with us for the next chapter in dermatology nursing education. As in previous years, our JDNA Publisher, Wolters Kluwer-Lippincott Williams & Wilkins, is sponsoring three JDNA Writing Awards for articles published in 2016. There will again be three awards given: the Best Clinical Article, the Best Research Article, and the People’s Choice Award. Like last year, you as a JDNA reader will be helping to vote on the People’s Choice Award so keep reading and keep your favorite articles in mind. There is still time to submit a manuscript in 2016 to be eligible for one of these awards; please submit your best work for consideration! These writing awards will be presented at the annual DNA Convention next year in Orlando, and we hope you can be with us for the celebration. Looking forward to hearing from you, Angela L. Borger Editor in Chief E-mail: [email protected]