Nursing Care of Clients with Common Skin Disorders

Download Report

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