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INFLAMMATORY DISORDERS

INFLAMMATORY DISORDERS. Objectives. Explain dermatitis and psoriasis Discuss the education plan for a client with inflammatory disorders List drugs used for treatment of inflammatory disorders Identify foods causing allergies

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INFLAMMATORY DISORDERS

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  1. INFLAMMATORY DISORDERS

  2. Objectives • Explain dermatitis and psoriasis • Discuss the education plan for a client with inflammatory disorders • List drugs used for treatment of inflammatory disorders • Identify foods causing allergies • Identify topical drugs used for the client with disorders of the skin • Discuss components of a client education plan for the self-use of topical medications

  3. DERMATITIS • Contact dermatitis from tape. • Poison ivy dermatitis.

  4. CONTACT DERMATITIS • PATHOPHYSIOLOGY: -direct contact with agents in the environment that a person is hypersensitive to -epidermis becomes inflamed and damaged by the repeated contact -soaps, industrial chemicals, plants ,etc.

  5. POISON OAK

  6. SIGNS AND SYMPTOMS -lesions at the point of contact. -burning, pain, itching, and swelling. -red with papules -small, raised , solid skin lesions less than 1 cm. in diameter

  7. ASSESSMENT • SUBJECTIVE DATA -history of the pt.’s activities -ask for a log of the past 48 hours before the s/s developed.

  8. ASSESSMENT • SUBJECTIVE DATA • -tried a new soap. • -traveling and using different personal items. • -working with plants or flowers. • -severe itching. • -difficulty moving the affected area.

  9. ASSESSMENT • OBJECTIVE DATA: • -erythema. • -papules /vesicles that generally ooze and • weep a clear fluid. • -scratch marks. • -edema of the area.

  10. DIAGNOSTIC TESTS -health history to identify the agent. -intra-dermal skin testing. -elimination diets are used to identify food allergies. -elevated serum IgE levels and eosinopilia.

  11. NURSING DIAGNOSES • Impaired skin integrity, related to scratching • Pain, related to pruritis

  12. TREATMENT • MEDICAL MANAGEMENT • -identify the cause of the hypersensitive • reaction. • -treat symptomatically • -swelling, itching, discomfort. • -oral antihistamines • -corticosteroids topically. • -prophylactic treatment for asthma

  13. NURSING INTERVENTIONS -protect the inflamed area from further harm. -rest the affected area. -wet dressings (Burrow’s solution) -use medical aseptic technique when applying the corticosteroids to the open lesions. -provide a cool environment with humidity. -cold compresses -deceases the circulation and cause vasoconstriction -this relieves the pruritis

  14. NURSING INTERVENTIONS, CONT. -daily baths with an application of oil. -cut the fingertips -decreases excoriation from scratching - wear mittens or gloves). -clothing should be lightweight and loose.

  15. TEACHING -keep a history of possible predisposing offensive agents. -avoid the causative agent once it has been identified. -avoid any rubbing of the area -any excessive heat -any soaps -these can all cause itching which could easily re-open the wound

  16. PROGNOSIS • -removal of the offensive agent results in full • recovery • -if there is a recurrence, then the pt. may need • to be desensitized.

  17. DERMATITIS VENENATA, EXFOLIATIVE DERMATITIS, AND DERMATITIS MEDICAMENTOSA

  18. Inflammatory Disorders of the Skin • Dermatitis venenata, exfoliative dermatitis, anddermatitis medicamentosa • Etiology/pathophysiology • Dermatitis venenata: • -Contact with certain plants • Exfoliative dermatitis: • -Ingestation of heavy metals, antibiotics, aspirin, • codeine, gold, or iodine • Dermatitis medicamentosa: • -Hypersensitivity to a medication

  19. DERMATITIS VENENATA -Contact with certain plants - poison oak /poison ivy. -Mild-severe erythema with pruritis -Body undergoes a sensitizing antigen formation on first exposure -Lymphocytes to release irritating chemicals - inflammation - edema - vesiculation

  20. EXFOLIATIVE DERMATITIS -Ingestation of heavy metals, or by antibiotics, - -aspirin, codeine, arsenic, mercury gold or iodine. -Skin sloughs off -swollen/reddened • -severe pruritis • -fever -Patients are hospitalized -Treatment is individualized.

  21. EXFOLIATIVE DERMATITIS -Cause should be removed and treated -Prevent secondary infections -Avoid further irritation. -Maintain fluid balance.

  22. DERMATITIS MEDICAMENTOSA -Medication causes a hypersensitivereaction -Any drug can cause a reaction -penicillin, codeine, and iron.

  23. DERMATITIS MEDICAMENTOSA • Signs and symptoms -mild to severe erythema -pruritus. -vesicles/eruptions -respiratory distress -especially with medicamentosa

  24. VESICLES

  25. ASSESSMENT • SUBJECTIVE: -Complaints of pruritis/burning pain in the involved area • OBJECTIVE: -Lesions are white in the center/red on the periphery. -Vesicles -Severe dyspnea caused by respiratory distress

  26. DIAGNOSTIC TESTS • Patient history. • A laboratory exam for serum IgE and eosinopilia.

  27. NURSING DIAGNOSES • Impaired skin integrity, related to crusted, open lesions • Risk for infection, related to break in skin • Deficient knowledge, related to the cause and spread of the disease

  28. TREATMENT • -Therapeutic baths • -Administration of corticosteroids. • -Treatment is directed at the cause.

  29. NURSING INTERVENTIONS: • Dermatitis venenata- -Wash the affected area immediately after contact with the offending allergen -Cool, open, wet dressings to the lesions -Calamine lotion

  30. NURSING INTERVENTIONS -Therapeutic baths with colloid solution, lotions, and ointments - alleviates the itching -Emotional support - the physical appearance is difficult for both the patient/family to accept.

  31. NURSING INTERVENTIONS Dermatitis medicamentosa -center around the causative drug and discontinuation -if the drug cannot be identified -no drugs should be given -lesions will disappear after the medication has been stopped -PCP must be notified for further orders

  32. TEACHING -Wear a medical alert bracelet/necklace showing the name of the allergen -Inspect the lesions daily -exudate, size, and body part. -Fever -have the pt. check his temperature -Medical asepsis/aseptic hand washing technique

  33. TEACHING -Appropriate application of topical meds -Keep the involved areas dry when giving care -Own personal items that are not to be shared – -linens, towels, comb, etc. -Family must be involved with the teaching

  34. PROGNOSIS • Full recovery • -when the offending agent is gone

  35. Inflammatory Disorders of the Skin • Urticaria (Wheals/Hives) • Etiology/pathophysiology • Allergic reaction • -release of histamine in an antigen-antibody reaction • -drugs • -food • -insect bites • -inhalants • -emotional stress • -exposure to heat or cold

  36. Inflammatory Disorders of the Skin • Clinical manifestations/assessment • Pruritus • Burning pain • Wheals/ hives • - release of histamine • - capillaries to dilate • - increased permeability

  37. WHEALS OR HIVES

  38. ASSESSMENT • SUBJECTIVE: -pruritis -edema -burning pain -shortness of breath .

  39. ASSESSMENT • OBJECTIVE DATA: -Wheals of varying shapes and sizes -pale centers/red edges -Intense scratching -Respiratory status may be compromised.

  40. Inflammatory Disorders of the Skin Diagnostic tests -Health history -Allergy skin test -IgE (serum immunoglobulin E) - check for its elevation.

  41. ALLERGY SKIN TESTING

  42. TREATMENT • Medical management/nursing interventions • -Identify and alleviate cause. • -Antihistamine (Benadryl). • -Therapeutic bath. • -Epinephrine. • -Teach patient possible causes. • -Teach preventive measures.

  43. TEACHING . • Signs and symptoms of a anaphylactic reaction. • -shortness of breath • -wheezing • -cyanosis

  44. PROGNOSIS • Full recovery when the obnoxious agent is removed/avoided. • Patient must comply with the treatment regimen.

  45. Inflammatory Disorders of the Skin • Angioedema • Etiology/pathophysiology • -form of urticaria • -subcutaneous tissue • -same offenders as urticaria • -eyelids, hands, feet, tongue, larynx, GI, genitalia, • or lips • -angioedema is a local edema of an entire area • rarely occurs in more than a single area at one • time

  46. Inflammatory Disorders of the Skin • Angioedema • Clinical manifestations/assessment • -burning /pruritus • -lesions that are normal on the outer skin • -edema • -acute pain -in the GI tract • -respiratory distress -in the larynx • -edema of an entire area -eyelid, feet, lips, etc.

  47. ANGIOEDEMA

  48. DIAGNOSTIC TESTS -patient history. -history of allergies are more likely to have angioedema.

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