Transcript The Examination

PYRAMID POINTS
CHAPTER 50:
INTEGUMENTARY
MEDICATIONS
PYRAMID POINTS
I. Emollients and Lotions
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Emollients
• Used for dry, scaly, itchy inflammatory conditions
Solutions and lotions
• Lotions are predominantly water, but have drying effect
on skin when water evaporates
• Used as wash for skin or as wet dressings on wounds

Therapeutic baths
• Cleanse, soothe the skin
• Provide anti-inflammatory effects if medicated
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II. Rubs and Liniments
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Temporary relief of muscular aches, rheumatism,
arthritis, sprains, neuralgia
Over-the-counter products contain combinations
of antiseptics, local anesthetics, analgesics,
counterirritants
Some products contain salicylates, which can
cause side effects, such as tinnitus, nausea,
vomiting
Do not use heating pad simultaneously
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III. Anti-infective Agents
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Description
• Include antiseptics and antibacterial, antifungal, antiviral,
antiparasitic medications
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Antiseptics
• Sodium hypochlorite (Dakin’s solution)
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Loses potency during storage
Should not come into contact with healing or normal tissue
Should be rinsed off immediately following irrigation
• Chlorhexidine gluconate (Hibiclens)
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Used for irrigating and cleansing wounds, but not for
packing wounds
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III. Anti-infective Agents (continued)
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Antiseptics (continued)
• Acetic acid preparations
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Healthy skin surrounding wound must be protected with petroleum
barrier
• Hydrogen peroxide
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Used to irrigate, clean necrotic tissue, purulent drainage from
open wounds
When epithelial tissue begins to form, use discontinued
• Hexachlorophene (pHisoHex, Septisol)
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Absorbed through broken skin; may cause neurotoxicity
Should be rinsed well from skin after use
Antifungals: May cause erythema, stinging, blistering,
peeling, pruritus, urticaria, general skin irritation
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III. Anti-infective Agents (continued)
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Antibacterials
• Mupirocin calcium (Bactroban): Effective against
Staphylococcus aureus, beta-hemolytic streptococci,
Streptococcus pyogenes
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Antivirals
• Acyclovir (Zovirax)
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Use rubber gloves to apply ointment
Ointment may cause mild pain, transient burning and stinging
Antiparasitics
• Used to treat scabies (mites), pediculosis (lice)
• May be harmful during pregnancy and to young children; may
irritate skin, eyes, mucous membranes
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IV. Antipruritics
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Used to allay itching
Applied as wet dressings, pastes, lotions, creams,
ointments
Persons with dry skin should be instructed to
bathe less frequently
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V. Keratolytics
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Description
• Soften scales, loosen horny layer of skin by dissolving
keratin
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Salicylic acid
• Can be absorbed systemically
• Not applied to large surface areas or open wounds
Masoprocol
• Used to treat keratosis
• Occlusive dressings should not be used
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VI. Stimulants and Irritants
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Description
• Produce mild irritation to skin surface; cause hyperemia
and inflammation, promotes healing process
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Coal tar
• Used to treat psoriasis, seborrheic dermatitis, atopic
dermatitis
• Has unpleasant odor, can stain skin and hair; can cause
phototoxicity
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Benzoin compound
• Protects skin when client has sore, cracked nipples or
fissures
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VII. Protectives
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Description
• Preparations that provide film on skin to protect from
irritants such as light, moisture, air, dust
• Promote natural healing without formation of crust over
wound
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Sunscreens
• Most effective when applied 30 to 60 minutes before
exposure to sun; reapplied every 2 to 3 hours after
swimming or sweating
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Nonadherent dressings
• Woven or nonwoven dressings may be impregnated with
saline, petrolatum, antimicrobials
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VIII. Enzymes
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Description
• Used to promote healing of wounds, débride skin ulcers
 Enzymes used to débride, remove exudates
• Sutilains used to remove nonviable, necrotic tissue, or
purulent enzymes from burns, ulcers, traumatic injury
sites, peripheral vascular disease wounds
• Collagenase (Santyl) used as topical débriding agent
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Discontinued when necrotic tissue gone
• Fibrinolysin and desoxyribonuclease used to débride
wounds.
• Dextranomer (Debrisan) used as cleaning agent
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IX. Corticosteroids
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Topical forms have anti-inflammatory, antipruritic,
vasoconstrictive actions
 Contraindications
• Previous sensitivity to corticosteroids
• Clients with current systemic fungal, viral, bacterial
infections
• Clients with current complications related to
corticosteroid therapy
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Local adverse effects
• Hypopigmentation; contact dermatitis; burning, dryness,
irritation, pruritus of skin; overgrowth of bacteria, fungi,
viruses
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IX. Corticosteroids (continued)
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Systemic adverse effects
• Rare occurrence, but include adrenal suppression,
Cushing’s syndrome
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Interventions
• Wash area prior to administration; increases absorption
• Apply sparingly in light film, rubbing gently
• May apply to skin alone or with dry occlusive dressing as
prescribed
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X. Acne Products
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Description
• Come in variety of forms, including bar soaps
liquid cleansers, creams
• All products should be kept away from eyes, inside of
nose, mucous membranes, hair
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Benzoyl peroxide is keratolytic agent
Tretinoin and Adapalene acids of vitamin A
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X. Acne Products (continued)
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Tretinoin (Retin-A)
• Therapeutic results should be seen after
2 to 3 weeks, with optimal results after 6 weeks
• Teach client to apply liberally to skin, wash hands
thoroughly after applying
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Isotretinoin (Accutane)
• Used to treat severe acne; eliminate alcohol
consumption during therapy; avoid vitamin A; decrease
sun exposure
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continued …
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Local antibiotics
• Include clindamycin (Cleocin T), tetracycline
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May cause contact dermatitis; burning, stinging of skin
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XI. Poison Ivy Treatment
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Treatment includes calamine lotion, aluminum
acetate (Burow solution) compresses, colloidal
oatmeal (Aveeno) baths
Topical corticosteroids; prevent or relieve
inflammation
Oral corticosteroids for severe reactions
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XII. Burn Products
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Nitrofurazone (Furacin)
• Broad-spectrum topical antibiotic
• Applied as 1/16-inch film to area
Mafenide acetate (Sulfamylon)
• Water-soluble cream
• Bacteriostatic for gram-negative, gram-positive
organisms
• Applied as 1/16-inch film directly to burn
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XII. Burn Products (continued)
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Silver sulfadiazine (Silvadene)
• Broad-spectrum bactericidal
• Active against gram-negative, gram-positive bacteria, yeast
• May cause localized side effects, such as rash, itching, and
systemic side effects, such as leukopenia, interstitial nephritis
• Apply 1/16-inch film; burn always kept covered
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Silver nitrate
• Antiseptic solution active against gram-negative bacteria
• Dressings applied to burn, then kept moist with silver nitrate
• Do not apply directly to burn area
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An adolescent client with severe cystic acne has been
prescribed isotretinoin (Accutane). The nurse would correct the
client’s misunderstanding of the medication if the client made
which of the following statements?
1. “I need to be sure to take my vitamin A supplement so that the
treatment will work.”
2. “I will return to the clinic for blood tests.”
3. “If my lips begin to burn, it is probably because of the
medication.”
4. “My eyes may become dry and burn as a result of the
medication.”
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