Nursing Care of Clients with Common Skin Disorders

1. Nursing Care of Clients with Common Skin Disorders Chapter 45

2. The Client with Psoriasis • Definition • chronic • non-infective • raised reddened round plaques covered by silvery white scales • most common on scalp, arms, legs • Diagnosed • skin biopsy

3. Psoriasis

4. The Client with Psoriasis • Treatment • topical corticosteriods to decrease inflammation • phototherapy • exposure to ultraviolet light • decreases the growth rate of epidermal cells • Nursing Care • Impaired skin integrity • Body Image Disturbance

5. Infections and Infestations • Bacterial Skin Infection • causative agent gram+ staph aureus • and beta-hemolytic streptococci • Furuncle • boils, inflammation of hair follicle • Carbuncles • group of infected hair follicles • Cellulitis - localized infection of dermis

6. Infections and Infestations • Diagnosis • assessment • culture and sensitivity • Treatment • antibiotics

7. Fungal Foot Infection

8. Fungal Infections of the Skin • Tinea pedis - athlete’s foot • Tinea capitis - scalp - ringworm • Tinea corporis - body • Candidiasis Infections • yeast like fungus, pustules, red rash • skin folds, mouth, peri areas • treatment - antifungal - nystatin, diflucan

9. Ring Worm

10. Inflammatory Disorders • Dermatitis • inflammation of the skin characterized by erythema, pain and pruritus • Contact Dermatitis • caused by hypersensitivity response or chemical irritation • Treatment • topical oints and therapeutic baths

11. Toxic Epidermal Necrolysis (TEN) • Rare, life threatening disease in which the skin peels off • leaves large areas of denuded skin • can also occur internally to mucose membranes • Treatment • ICU, Burn Unit

13. Toxic Epidermal Necrolysis (TEN • Surgery • skin graphing • Fluid replacement • IV therapy, TPN • Medications • Antibiotics -treat sepsis • Anelgesics - pain management

16. Neoplastic Skin Disorders • Benign lesions - moles, cysts, keloids, skin tags keratoses • Malignant lesions - skin cancers • over time damage from ultraviolet radiation and chemicals • basal cell carcinoma, squamous cell and melanoma

17. Risk Factors • Environmental • ultraviolet radiation • pollution, chemicals viruses, trauma • Host Factors • skin pigmentation • life style

18. Skin Changes Normal Skin Aged Skin Sun Damaged Skin

19. Basal Cell Carcinoma • Tumor that originates from basal layer • Most common but least aggressive • Tend to recur but rarely metastasize

20. Basal Cell Carcinoma

21. Squamous Cell Carinoma • Arises from squamous epithelium • Occurs on exposed areas of skin • More aggressive, faster growth rate • Harden nodule may ulcerate and bleed

22. Skin Cancer Model

23. Interdisciplinary Care • Labs and Diagnostics • biopsy • Treatment • surgical excision • curettage and electrodesiccation • cryosurgery • radiation therapy

24. Malignant Melanoma • Arises from melanocytes • is life threatening • precursor lesions • atypical moles (dysplastic nevi) • congenital nevi - present at birth • lentigo freckle - tan or black mole, usually on the side of the face, slow growing

26. Interdisciplinary Care • Assessment • A = asymmetry • B = border irregularity • C = color variation • D = diameter >6mm • E = elevation • Labs and Diagnostics • biopsy

27. Interdisciplinary Care • CT Scan, MRI, CXR, Bone Scan • Blood work - CBC, Liver function • Surgery • wide excision of lesion • regional lymph node dissection • Chemotherapy and Radiation Therapy

28. Interdisciplinary Care • Nursing Care • Impaired skin Integrity • Hopelessness • Anxiety • Teaching for Home Care • wound care • avoid exposure • follow up appointments

29. Skin Trauma • Pressure Ulcer • ischemic lesions of the skin and underlying tissue caused by external pressure that impairs blood and lymph flow • ischemia causes tissue necrosis then ulcerations • Causes • External pressure • Shearing

30. Pressure areas on bed bound client

31. Pressure Ulcers • Staging • Stage 1 • intact skin • non-blanchable erythema • Stage 2 • open, partial layer skin loss • ulcer, abrasion, blister, shallow crater

32. Pressure Ulcers • Stage 3 • full-thickness, damage or necrosis to subcutaneous tissue • deep crater • Stage 4 • full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, can have sinus tracts

33. Pressure Ulcers • Eschar • black, leathery necrotic skin • when is present, unable to accurately stage ulcer • needs to be debrided - surgical, wet-to-dry normal saline drsg changes.

34. Pressure Ulcer Staging

35. Stage ?

36. Stage 2 Pressure Ulcer

37. Stage ? On coccyx

38. Stage ? On coccyx

39. Heel Ulcer

40. Stasis Ulcer --Venous Insufficiency

41. Nursing Care • Assessment - Identify those at risk • Assessment of skin • systematic once a day • Clean the skin • keep hydrated - use lotion • Avoid massage over bony prominences

42. Nursing Care • Minimize exposure to moisture • Avoid friction and shearing • Ensure adequate nutritional intake • Maintain activity level • What can you do for a client on bedrest?

43. Measuring Pressure Ulcers

44. Documentation • Site • Size • Stage • Appearance • color • drainage • odor

45. Turn me

47. Help me keep my skin intact

48. Pressure relieving devices