Transcript Nursing Care of Clients with Common Skin Disorders

Nursing Care of Clients with
Common Skin Disorders
Chapter 45
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
Psoriasis
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
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
Infections and Infestations
 Diagnosis
– assessment
– culture and sensitivity
 Treatment
– antibiotics
Fungal Foot Infection
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
Ring Worm
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
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
Toxic Epidermal Necrolysis
(TEN
 Surgery
– skin graphing
 Fluid replacement
– IV therapy, TPN
 Medications
– Antibiotics -treat sepsis
– Anelgesics - pain management
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
Risk Factors
 Environmental
– ultraviolet radiation
– pollution, chemicals viruses, trauma
 Host Factors
– skin pigmentation
– life style
Skin Changes
Normal Skin
Aged Skin
Sun Damaged Skin
Basal Cell Carcinoma
 Tumor that originates from basal layer
 Most common but least aggressive
 Tend to recur but rarely metastasize
Basal Cell Carcinoma
Squamous Cell Carinoma
 Arises from squamous epithelium
 Occurs on exposed areas of skin
 More aggressive, faster growth rate
 Harden nodule may ulcerate and bleed
Skin Cancer Model
Interdisciplinary Care
 Labs and Diagnostics
– biopsy
 Treatment
– surgical excision
– curettage and electrodesiccation
– cryosurgery
– radiation therapy
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
Interdisciplinary Care
 Assessment
– A = asymmetry
– B = border irregularity
– C = color variation
– D = diameter >6mm
– E = elevation
 Labs and Diagnostics
– biopsy
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
Interdisciplinary Care
 Nursing Care
– Impaired skin Integrity
– Hopelessness
– Anxiety
– Teaching for Home Care
• wound care
• avoid exposure
• follow up appointments
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
Pressure areas on bed bound
client
Pressure Ulcers
 Staging
– Stage 1
• intact skin
• non-blanchable erythema
– Stage 2
• open, partial layer skin loss
• ulcer, abrasion, blister, shallow crater
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
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.
Pressure Ulcer Staging
Stage ?
Stage 2 Pressure Ulcer
Stage ? On coccyx
Stage ? On coccyx
Heel Ulcer
Stasis Ulcer --Venous
Insufficiency
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
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?
Measuring Pressure Ulcers
Documentation
 Site
 Size
 Stage
 Appearance
– color
– drainage
– odor
Turn me
Help me keep my skin intact
Pressure relieving devices
Hair and Nail Disorders
 Hirsutism
– excessive body hair
 Alopecia
– loss of hair or baldness
 Nail Disorders
– discolored, malformed, infected or separated
from underlying tissue
Fungal Infection of the Toe Nail
Burns – get ready for
rd
3
semester