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