Chapter 75 Skin Disorders

1. Chapter 75Skin Disorders

2. The Integumentary System • Integumentary system • Composed of the epidermis and dermis and its accessory organs, including epithelial and connective tissue, nerves, and sweat and oil glands • Dermatology • The study of skin diseases • Dermatologist • Dermatologic nurses

3. Common Terminology to Know • Abrasion • Dermatitis • Desquamation • Escar • Excoriation • Laceration • Pruritus –know prevention and treatment in practice 1199 • Purpura

4. Images

5. Diagnostic Tests • Allergy skin testing • Laboratory tests for blood dyscrasias • Blood glucose tests for diabetes mellitus • Wood’s light examination • Tzanck’s smear • Biopsy • Scabies scraping

6. Woods lamp

7. Common Medical Treatments • Assisting the client who has pruritus • Pruritus is often a symptom of a skin disease. • Scratching can lead to skin breaks, which can become infected and cause scarring. • Educate the proper use of medications: Antianxiety drugs, antihistamines, or topical corticosteroids. • Follow Standard Precautions and appropriate Transmission-Based Precautions.

8. Common Medical Treatments (cont’d) • Therapeutic baths • Applies medication to the entire body at one time • Cleanses the body and soothe the skin • Promotes wound healing, relieves itching • Helps remove eschar; use medicated bath oil instead of soap • Provides warmth for physical therapy and range-of-motion exercises more comfortably • Whirlpool bath increases circulation, helps remove dead skin cells, and promotes healing.

9. Important medications • Antihistamines- Allegra etc.….Nursing considerations pg 1198 • Benadryl –Bronchospasms if given IV avoid in acute asthma attack • vistaril (hydroxyzine) • Bendadryl( diphenhydramine) • Claritin ( loratadine) • decadron ( dexamethasone

10. Question Is the following statement true or false? When providing a therapeutic bath to a client with pruritus, it is important to use soap.

11. Answer False A nurse should use medicated bath oil instead of soap, as soap has drying effects, which can aggravate pruritus.

12. Common Medical Treatments (cont’d) • Applying moist dressings • To reduce swelling and weeping in acute dermatitis • To soften and remove exudate and crusts • To relieve pruritus and discomfort • These dressings may be • Clean or sterile • Closed or open

13. Question Is the following statement true or false? The nurse must always use a bed cradle when applying packs to the client’s legs or torso and then place blankets over the cradle.

14. Answer True Keeping the linens off the client’s legs or torso prevents wicking of the solutions into the linens. Wet areas can cause a loss in body temperature and skin cooling due to the effects of evaporation, convection, and conduction. Extra blankets over a bed cradle can keep in warm air, minimize heat loss, and protect the client from chilling.

15. Common Medical Treatments (cont’d) • Debriding a wound • Sterile procedure to remove loose skin, crust, denuded tissue, or eschar • Performed when changing moist packs • Methods –know these for testing purposes • Autolysis • Enzymatic debridement • Mechanical debridement • Surgical debridement

16. Common Surgical Treatments • Plastic surgery or reconstructive surgery • Used for cosmetic effects, to repair congenital defects, to repair the results of trauma • Skin and tissue grafts • Transplant of skin that is placed on clean, viable tissue • Used to cover areas of skin lost through wounds, burns, or infections • Freegraft, pedicle graft

17. Nursing Considerations • Preoperative • Explain to the client what he or she can expect. • Postoperative • Pay scrupulous attention to aseptic technique. • Protect the grafts. • Keep new grafts immobilized. • Prevent infection at donor sites. • Provide emotional support and reassurance.

18. The Nursing Process • Data collection • Fluid and electrolyte balance • Allergies • Emotional support for clients with skin disorders • Planning and implementation • Evaluation

19. Acute and Chronic Skin Conditions • Urticaria or hives • Sudden appearance of edematous, raised pink areas called whealsthat itch and burn • Chronic urticaria, angioedema • Vitiligo • Areas of the skin completely lack pigmentation, melanocytes cannot be detected, more susceptible to sunburn and skin cancers • Mini-grafting, melanocyte transplantation • Warts-electrodesiccation

20. Question Is the following statement true or false? Angioedema associated with urticaria is extremely dangerous.

21. Answer True Angioedema associated with urticaria can become life threatening. Medications and emergency interventions may be necessary in case of extreme swelling of the lips, swelling around the eyes, or dyspnea.

22. Acute and Chronic Skin Conditions (cont’d) • Eczema or atopic dermatitis • Associated with heredity, allergy, and emotional stress • Applying moisturizing creams, corticosteroid ointments, tar solutions, wet dressings to inflamed skin, or using starch baths • Antihistamines, antianxiety drugs

23. Acute and Chronic Skin Conditions (cont’d) • Psoriasis • Chronic, noncontagious, proliferative skin disorder • Therapeutic baths, wet dressings, or lubricating ointments • Application of emollient creams and specialized shampoos • Corticosteroids may be injected • Ultraviolet (UV) light treatment or sun exposure • Methotrexate and oral retinoids

24. Infections • Warts or verrucae • Small, flesh-colored, brown or yellow papules caused by the HPV • Electrodesiccation, curettage, cryosurgery, application of keratolytic agents • Bacterial skin infections: Impetigo • Folliculitis • Deep folliculitis, superficial folliculitis, furuncle, carbuncle

25. Parasitic Infestations • Scabies • Caused by mites that burrow under the outer layer of the host’s skin • Acquired primarily through close personal contact • Transmitted through clothing, linens, or towels • Bathe and towel dry to remove crusts and open infected spots • Application of the prescribed medication to the entire body and cover all body surfaces

26. Parasitic Infestations • Lice • Pediculosis, body lice, pubic lice • Over-the-counter or prescription medications • Bedbug or Cimex lectularius • Usually bite the legs and feet, causing itching and burning • Bites often appear in groups of three. • Lotions containing menthol, phenol, or 0.5% hydrocortisone are applied to bitten areas.

27. Question Is the following statement true or false? When treating a client with a parasitic infestation, treat the client’s family as well.

28. Answer True It is necessary to examine and treat all family members for scabies simultaneously, as most parasites can live a long time without a host and usually get into bed clothing and personal garments. Treat the infected person immediately to prevent transmission to others.

29. Sebaceous Gland Disorders • Sebaceous cysts • Small hard nodules formed when sebaceous glands become plugged • Seborrhea • Excessive sebaceous discharge that forms large scales or cheese-like plugs on the body • Seborrheic Dermatitis: Scaling of the scalp • Dandruff: Dry form of seborrheic dermatitis

30. Burns • Mechanism of injury • Thermal burns, electrical burns, chemical burns, radiation burns • Burn depth and size • Partial-thickness, full-thickness, first-, second-, and third-degree burns • Rule of nines • Phases of burn injury management- know what to expect in each one as far as nursing care • Resuscitative, acute, rehabilitative

31. Burn Injury: Resuscitative Phase • Vital signs • Respiratory status • Initiate oxygen therapy • Fluid and electrolyte balance what type of diet would you give to a patient with a third degree burn? • Record I&O accurately • Renal function • Infection • Pain management

32. Burn Injury: Acute Phase • Topical agents • Debridement • Skin grafting • Other care management priorities

33. Burn Injury: Rehabilitative Phase • Services • Complications • Emotional aspects • Discharge planning • Prognosis

34. First Aid for Minor Burns • Cool the area for 10 or more minutes or until the pain diminishes. Do NOT use ice. • Cover the burn loosely with sterile gauze. • Relieve pain. • Monitor.

35. Neoplasms • Neoplasm • New growth or tumor, may be malignant or benign • Nonmalignant tumors, moles or pigmented nevi, angiomas or birthmarks, keloids • Skin cancer • Basal cell carcinoma, squamous cell carcinoma, malignant melanoma • ABCDE rule for evaluating a mole • Asymmetry, Border, Color, Diameter, Elevation/Evoloution

36. ABCs • ABCDEs of Melanoma Skin Cancer • THE ABCDES OF MELANOMASKIN CANCER ARE: • Asymmetry. One half doesn't match the appearance of the other half. • Border irregularity. The edges are ragged, notched, or blurred. • Color. The color (pigmentation) is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to a mottled appearance. • Diameter. The size of the mole is greater than 1/4 inch (6 mm), about the size of a pencil eraser. Any growth of a mole should be evaluated. • Evolution. There is a change in the size, shape, symptoms (such as itching or tenderness), surface (especially bleeding), or color of a mole.

37. Question Is the following statement true or false? Exposure to sun rays between 10:00 AM to 3:00 PM can be harmful for the skin.

38. Answer True UVA and UVB rays from the sun are strongest during the summer months between the hours of 10:00 AM and 3:00 PM, so exposure during those times should be avoided. Exposure to both ultraviolet A (UVA) and ultraviolet B (UVB) rays of the sun is the leading cause of skin cancer; such cancer is linked with excessive and/or multiple sunburns throughout a person’s lifetime.

39. Questions • What is a skin graft made from cadaver skin? • What topical agent is good for first degree burns of the face ? • What are skin cancer prevention techniques? • What are types of nonmalignant tumors? • What are the types to applying a moist dressing • DO’s and don’t of topical medication

40. Topical medications • DO not excessively rub in the medications • Consider the skin condition, break down , age, sweat, fever, area careful of face , groin areas • Nitroglycerin –dermatitis • Male and female hormone medications / pill form also may be included • Also include this considerations with patches • Derma bond and others keep away from mucus membranes

41. End of Presentation