Transcript PN 124 Day 5, Inflammatory Skin Disorders

INFLAMMATORY DISORDERS
Objectives






Explain dermatitis and psoriasis
Discuss the education plan for a client with
inflammatory disorders
List drugs used for treatment of inflammatory
disorders
Identify foods causing allergies
Identify topical drugs used for the client with
disorders of the skin
Discuss components of a client education plan
for the self-use of topical medications
DERMATITIS


Contact dermatitis from
tape.
Poison ivy dermatitis.
CONTACT DERMATITIS

PATHOPHYSIOLOGY:
-direct contact with agents in the environment
that a person is hypersensitive to
-epidermis becomes inflamed and damaged
by the repeated contact
-soaps, industrial chemicals, plants ,etc.
POISON OAK
SIGNS AND SYMPTOMS
-lesions at the point of contact.
-burning, pain, itching, and swelling.
-red with papules
-small, raised , solid skin lesions less than 1 cm.
in diameter
ASSESSMENT

SUBJECTIVE DATA
-history of the pt.’s activities
-ask for a log of the past 48 hours before the
s/s developed.
ASSESSMENT






SUBJECTIVE DATA
-tried a new soap.
-traveling and using different personal items.
-working with plants or flowers.
-severe itching.
-difficulty moving the affected area.
ASSESSMENT






OBJECTIVE DATA:
-erythema.
-papules /vesicles that generally ooze and
weep a clear fluid.
-scratch marks.
-edema of the area.
DIAGNOSTIC TESTS
-health history to identify the agent.
-intra-dermal skin testing.
-elimination diets are used to identify food allergies.
-elevated serum IgE levels and eosinopilia.
NURSING DIAGNOSES


Impaired skin integrity, related to scratching
Pain, related to pruritis
TREATMENT








MEDICAL MANAGEMENT
-identify the cause of the hypersensitive
reaction.
-treat symptomatically
-swelling, itching, discomfort.
-oral antihistamines
-corticosteroids topically.
-prophylactic treatment for asthma
NURSING INTERVENTIONS
-protect the inflamed area from further harm.
-rest the affected area.
-wet dressings (Burrow’s solution)
-use medical aseptic technique when applying the
corticosteroids to the open lesions.
-provide a cool environment with humidity.
-cold compresses
-deceases the circulation and cause vasoconstriction
-this relieves the pruritis
NURSING INTERVENTIONS, CONT.
-daily baths with an application of oil.
-cut the fingertips
-decreases excoriation from scratching
- wear mittens or gloves).
-clothing should be lightweight and loose.
TEACHING
-keep a history of possible predisposing offensive
agents.
-avoid the causative agent once it has been
identified.
-avoid any rubbing of the area
-any excessive heat
-any soaps
-these can all cause itching which could easily
re-open the wound
PROGNOSIS




-removal of the offensive agent results in full
recovery
-if there is a recurrence, then the pt. may need
to be desensitized.
DERMATITIS VENENATA, EXFOLIATIVE DERMATITIS,
AND DERMATITIS MEDICAMENTOSA
Inflammatory Disorders of the Skin

Dermatitis venenata, exfoliative dermatitis, and
dermatitis medicamentosa
 Etiology/pathophysiology
 Dermatitis
venenata:
 -Contact with certain plants
 Exfoliative dermatitis:
 -Ingestation of heavy metals, antibiotics, aspirin,
 codeine, gold, or iodine
 Dermatitis medicamentosa:
 -Hypersensitivity to a medication
DERMATITIS VENENATA
-Contact with certain plants
- poison oak /poison ivy.
-Mild-severe erythema with pruritis
-Body undergoes a sensitizing antigen formation
on first exposure
-Lymphocytes to release irritating chemicals
- inflammation
- edema
- vesiculation
EXFOLIATIVE DERMATITIS
-Ingestation of heavy metals, or by antibiotics, - aspirin, codeine, arsenic, mercury gold or
iodine.
-Skin sloughs off
-swollen/reddened
 -severe pruritis
 -fever
-Patients are hospitalized
-Treatment is individualized.
EXFOLIATIVE DERMATITIS
-Cause should be removed and treated
-Prevent secondary infections
-Avoid further irritation.
-Maintain fluid balance.
DERMATITIS MEDICAMENTOSA
-Medication causes a hypersensitive reaction
-Any drug can cause a reaction
-penicillin, codeine, and iron.
DERMATITIS MEDICAMENTOSA

Signs and symptoms
-mild to severe erythema
-pruritus.
-vesicles/eruptions
-respiratory distress
-especially with medicamentosa
VESICLES
ASSESSMENT


SUBJECTIVE:
-Complaints of pruritis/burning pain in the
involved area
OBJECTIVE:
-Lesions are white in the center/red on the
periphery.
-Vesicles
-Severe dyspnea caused by respiratory distress
DIAGNOSTIC TESTS


Patient history.
A laboratory exam for serum IgE and eosinopilia.
NURSING DIAGNOSES



Impaired skin integrity, related to crusted, open
lesions
Risk for infection, related to break in skin
Deficient knowledge, related to the cause and
spread of the disease
TREATMENT



-Therapeutic baths
-Administration of corticosteroids.
-Treatment is directed at the cause.


NURSING INTERVENTIONS:
Dermatitis venenata-Wash the affected area immediately after
contact with the offending allergen
-Cool, open, wet dressings to the lesions
-Calamine lotion
NURSING INTERVENTIONS
-Therapeutic baths with colloid solution, lotions, and
ointments
- alleviates the itching
-Emotional support
- the physical appearance is difficult for both the
patient/family to accept.
NURSING INTERVENTIONS
Dermatitis medicamentosa
-center around the causative drug and
discontinuation
-if the drug cannot be identified
-no drugs should be given
-lesions will disappear after the medication has
been stopped
-PCP must be notified for further orders
TEACHING
-Wear a medical alert bracelet/necklace showing
the name of the allergen
-Inspect the lesions daily
-exudate, size, and body part.
-Fever
-have the pt. check his temperature
-Medical asepsis/aseptic hand washing
technique
TEACHING
-Appropriate application of topical meds
-Keep the involved areas dry when giving care
-Own personal items that are not to be shared –
-linens, towels, comb, etc.
-Family must be involved with the teaching
PROGNOSIS


Full recovery
-when the offending agent is gone
Inflammatory Disorders of the Skin

Urticaria (Wheals/Hives)
 Etiology/pathophysiology
 Allergic







reaction
-release of histamine in an antigen-antibody reaction
-drugs
-food
-insect bites
-inhalants
-emotional stress
-exposure to heat or cold
Inflammatory Disorders of the Skin
Clinical
manifestations/assessment
 Pruritus
 Burning
pain
 Wheals/ hives
 - release of histamine
 - capillaries to dilate
 - increased permeability
WHEALS OR HIVES
ASSESSMENT

.
SUBJECTIVE:
-pruritis
-edema
-burning pain
-shortness of breath
ASSESSMENT

OBJECTIVE DATA:
-Wheals of varying shapes and sizes
-pale centers/red edges
-Intense scratching
-Respiratory status may be compromised.
Inflammatory Disorders of the Skin
Diagnostic tests
-Health history
-Allergy skin test
-IgE (serum immunoglobulin E)
- check for its elevation.
ALLERGY SKIN TESTING
TREATMENT
 Medical
management/nursing interventions
 -Identify and alleviate cause.
 -Antihistamine (Benadryl).
 -Therapeutic bath.
 -Epinephrine.
 -Teach patient possible causes.
 -Teach preventive measures.
TEACHING
.




Signs and symptoms of a anaphylactic reaction.
-shortness of breath
-wheezing
-cyanosis
PROGNOSIS


Full recovery when the obnoxious agent is
removed/avoided.
Patient must comply with the treatment regimen.
Inflammatory Disorders of the Skin

Angioedema

Etiology/pathophysiology
 -form of urticaria
 -subcutaneous tissue
 -same offenders as urticaria
 -eyelids, hands, feet, tongue, larynx, GI, genitalia,
 or lips
 -angioedema is a local edema of an entire area
 rarely occurs in more than a single area at one
 time
Inflammatory Disorders of the Skin


Angioedema
Clinical manifestations/assessment
 -burning
/pruritus
 -lesions that are normal on the outer skin
 -edema
 -acute pain -in the GI tract
 -respiratory distress -in the larynx
 -edema of an entire area -eyelid, feet, lips, etc.
ANGIOEDEMA
DIAGNOSTIC TESTS
-patient history.
-history of allergies are more likely to have
angioedema.
TREATMENT
 Medical
management/nursing interventions
-cold compresses.
-antihistamines
-epinephrine
-corticosteroids
-assess respiratory function for s/s of
distress.
TEACHING


-wear a medical alert bracelet or necklace.
-prevent recurrent episodes.
PROGNOSIS

-With treatment ,the prognosis is excellent
ECZEMA
Inflammatory Disorders of the Skin

Eczema (atopic dermatitis)
 Etiology/pathophysiology
 -Allergen
causes histamine to be released
 -antigen-antibody reaction
 -Primarily occurs in infants.
 -chocolate, orange juice, eggs, wheat.
ALLERGENS
ASSESSMENT
-Papules/vesicles
-edged with redness
-ruptures
-discharges a yellow, thick exudate
-dries, becomes crusted
-infected
-skin becomes shiny, de-pigmented
-dry scales.
ASSESSMENT

SUBJECTIVE:
-pruritis
-scratching
-children are more fussy/irritable
-anorexic.
-skin is tender to the touch.
-family history of allergies
-asthma is often associated with children who
have eczema.
ASSESSMENT
-Papules and vesicles
-scalp, forehead, cheeks, neck, and extremities.
-Erythematic/dryness of area.
-Pruritis.
Inflammatory Disorders of the Skin

Eczema (atopic dermatitis)
 Diagnostic
tests
 Health
history (heredity is a primary factor).
 Diet elimination.
 Skin testing and IgE serum tests.
 Medical
 Reduce
management/nursing interventions
exposure to allergen
 Hydration of skin
 Topical steroids
 Lotions—Eucerin, Alpha-Keri, Lubriderm, or Curel 3-4
times/day
ECZEMA (atopic dermatitis)
NURSING DIAGNOSES



Impaired skin integrity, related to open lesions
Risk for situational low self-esteem, related to
change in body image
Risk for infection, related to open lesions
NURSING INTERVENTIONS
-therapeutic
baths
-occlusive preparations
-wet dressings
-maximizes the hydration of the skin
-topical steroids
-lesions healed-lotions are used
-Eucerin, Alpha Keri, Lubriderm, Curel
- apply 3-4 times/day.
NURSING INTERVENTIONS
-monitor emotions
-anger, depression anxiety, embarrassment, guilt,
etc.
-encourage the pt. to verbalize his feelings
-use effective listening skills
-open-ended questions.
WET DRESSING, OCCLUSIVE DRESSING
Inflammatory Disorders of the Skin

Acne vulgaris
Etiology/pathophysiology
-Occluded oil glands (the sebaceous glands)
-The cause is unknown
-Androgens increase the size of the oil gland
-It primarily occurs in adolescents
-Influencing factors
-Diet
-Stress
-Heredity
-Overactive hormones
Inflammatory Disorders of the Skin

Acne vulgaris
 Clinical
manifestations/assessment
 -Tenderness and edema
 -Oily, shiny skin
 -Pustules
 -Comedones
 -blackheads
 - the effect of oxygen on sebum, not dirt
 -Scarring from traumatized lesions
COMEDONES
ASSESSSMENT

SUBJECTIVE DATA:
-how is the acne affects his/her lifestyle.
-face and chin.
-lesions increase with emotional upsets/
stress
ASSESSMENT

OBJECTIVE:
Note the presence of edema in the involved area.
DIAGNOSTIC TESTS
 Diagnostic
tests
Blood samples for androgen level
Health history
Inspection of lesion
NURSING DIAGNOSES



Impaired skin integrity, related to occluded oil
glands
Situational low self-esteem, related to physical
appearance
Social isolation, related to decreased self-esteem
Inflammatory Disorders of the Skin

Acne vulgaris

Medical management/nursing interventions
 Keep skin clean
 Keep hands and hair away from area
 Wash hair daily
 Water-based makeup
 Topical therapy
 Benzoyl peroxide, vitamin A acids, antibiotics, sulfurzinc lotions
 Systemic therapy
 Tetracycline, isotretinoin (Accutane)
ACUTANE
ORAL MEDICATION, WATER-BASED MAKE-UP
TOPICAL MEDICATIONS
NURSING INTERVENTIONS
-Adolescents may not comply with long-term
treatment regimens.
-Evaluate the pt.’s understanding/reaction to his
acne disorder.
-What does acne mean to the pt.?
-Focus on:
-skin care
-compliance
-emotional support
NURSING INTERVENTIONS
-Prevention
-identification of factors that directly increase
acne
-Cleanliness decreases infection/promotes healing.
-The skin should be washed 2-3 times/ day with a
medicated soap
-Improvement is slow so compliance is hard.
MEDICATED SOAP
NURSING INTERVENTIONS
-Often it takes 3 weeks of treatment
-Family support
-Primary cause for low self-esteem
-Not comparing oneself with others
-Give positive reinforcement
-Focus on his strengths
TEACHING
-Both the physical and emotional needs of the pt.
-Diet, hygiene, stress reduction, makeup, and
medications.
-Coping skills.
-Adolescent should talk about his feelings
-decreases any long-term effects that acne may have
on his personality.
PROGNOSIS



Prognosis is good.
Lasting psychological effects can occur from the
scarring that may result.
In rare cases, eczema may develop from taking
med: for acne, such as isotretinoin.
Psoriasis
Psoriasis
Etiology/pathophysiology
 Noninfectious.
 Skin cells divide more rapidly than normal
 -normal– skin replaced every 28 days
 -psoriasis-skin replaced every 7 days.
 -occur at any age.
 -hereditary.
 -at the epidermis.
 -no known predisposing factors.
 -severe scaling is the result of the rapid cell division.
ASSESSMENT

SUBJECTIVE:
-pruritis.
-feelings of depression, frustration, loneliness.
-people may stare at them.
ASSESSMENT
 Clinical
manifestations/assessment
 -raised,
erythematous, circumscribed, silvery, scaling plaques
 -scalp, elbows, knees, chin, and trunk
 -primary lesion is papular.
DIAGNOSTIC TESTS


-no special tests.
-observation of the patient/symptoms.
TREATMENT

Goal-slow the proliferation of the epithelial layers
of the skin.
 Topical
steroids
 Keratolytic agents
 -occlusive wet dressings to decrease inflammation



Tar preparations
Salicylic acid
Reduces shedding of the outer layer of skin
 Photochemotherapy

PUVA
 Oral psoralen
 Ultraviolet light
NURSING DIAGNOSES



Impaired skin integrity, related to proliferation of
epithelial cells
Situational low self-esteem, related to appearance
Social isolation, related to decreased self-esteem
NURSING INTERVENTIONS







-Administration of the treatment modality.
-Rest
-Promote psychological well-being
-counseling, exercise, etc.
-Focus on positive attributes.
-Medical asepsis.
-Conceal obvious lesions.
TEACHING





-Nature of the disease
-Treatments
-Compliance with medical care.
-Disease is not CURABLE
-Patient needs to understand this.
PROGNOSIS






-Chronic disease.
-Clinical course is variable
-less than 50% will have a prolonged remission.
-Severity:
-cosmetic problem to a life-threatening
emergency
Systemic Lupus Erythematosus
(SLE)
 Etiology/pathophysiology
 Autoimmune
disorder
 - antibodies against its own cells
 Inflammation of almost any body part.

Skin, joints, kidneys, and serous membranes
 Affects
women more than men
 -9 times more women than men
 Contributing factors


Immunological, hormonal, genetic, and viral.
Origin still remains a mystery.
SLE






-Disease of exacerbations and remissions
-triggered by contributing factors.
-Inflammatory lesions
-affect several organ systems
-skin, joints, kidneys, and serous membranes.
-T-suppressor cells decrease
SLE
Clinical
manifestations/assessment
Erythema
butterfly rash over nose and
cheeks
Alopecia
Butterfly rash
 - occurs in 10-50% of patients
Photosensitivity
Organic brain syndrome
SLE
 Polyarthralgias
and polyarthritis
 -90-95% of patients
 Pleuritic pain
 Pleural effusion
 Pericarditis
 Vasculitis
 Oral ulcers
 Anemia
 -most common.
SLE
Neurological
signs (seizures)
Renal disorders
Hematological disorders
Figure 3-11
(From Habif, T.P., et al. [2005]. Skin disease: diagnosis and treatment. [2nd ed.]. St. Louis: Mosby.)
Systemic lupus erythematosus (SLE) flare.
SLE
Diagnostic
 Antinuclear
Tests
antibody (ANA)
 DNA antibody
 Complement
 CBC
 Erythrocyte
sedimentation rate (ESR)
 Coagulation profile
 Rheumatoid factor
DIAGNOSTIC TESTS
 Rapid
plasma reagin
 Skin and renal biopsy
 C-reactive protein (CRP)
 Coomb’s test
 LE cell prep (lupus erythematosus)
 Urinalysis
 Chest x-ray
NURSING DIAGNOSES

Impaired skin integrity, related to skin rash, hair
loss, skin atrophy, discoid lesions involving other
parts of the body.
NURSING DIAGNOSES

Disturbed body image, related to baldness, skin
pattern pathologies
TREATMENT
GOALS:
-Relief /managaement of symptoms.
-Inducement of remission.
-Prevention of complications.
-Suppression of inflammation.
SLE
 Medical
 No
management/nursing interventions
cure
 -treat symptoms, induce remission, alleviate
 exacerbation.
 Medications
 Nonsteroidal ant-inflammatory agents.
 anti-malarial drugs (hydroxychloroquine).
 corticosteroids ( prednisone)
 -Peak amounts of steroids help to achieve remission
 Anti-neoplastic agents ( Imuran, Cytoxan).
 Topical corticosteroid creams are used for the rash.
MEDICATIONS











Anti-infective drugs
-treat/prevent infections
-specific agent depends on the infection site
-Cipro for a UTI.
Dialysis for pts. with renal involvement.
Lab Tests
-assess renal function (BUN/serum creatinine)
Analgesics
-pain
Diuretics
-fluid retention
TREATMENT
 Balance
rest and exercise
 Balanced diet
 Avoid direct sunlight
NURSING INTERVENTIONS
-Thorough assessment
-multi-systemic disease.
-Skin care
-avoiding direct sunlight
-protective clothing
-sunscreen.
-Balance rest and activity.
-Recognize s/s of exacerbation
-fever, rash, cough
NURSING INTERVENTIONS
-Recognize the s/s of infection.
-Reduce stress.
-Balanced diet
-Reduction of sodium intake.
NURSING INTERVENTIONS
-emotional, psychosocial, and spiritual support.
-activity level
-prevention of infection
-potential complications
-information on living a normal life.
Pharmacology for the treatment of
inflammatory skin disorders
Corticosteroids
 Emollients
 Antipsoriatics

Corticosteroids







-local inflammatory disorders
-Topical administration
-avoids systemic adverse effects
-the inflammatory site must be localized and
accessible
-effective and relatively safe form of therapy
-prescription and non-prescription products
NURSING INTERVENTIONS
-Monitor site for healing-increased use of topical steroids decreases
vasoconstriction
-decreases the absorption of the steroid
-requires a higher amount/more frequent usage
-Monitor for increased facial redness when decreasing the
amount of topical steroid secondary to tolerance.
-Skin atrophy, striae (stretch marks), steroid allergies or skin
infections
-Fungal infections will not resolve with the use of topical steroids
Emollients
-Dry skin
-infections, excessive bathing or strong soaps/detergents
-pruritus, cracking, and predisposition to skin disorders
-prevent the loss of additional skin moisture be forming a
occlusive barrier on the skin surface
-waxes, fats and/or oils
-urea-enhances the skin’s ability to hold moisture
-Oils, creams, lotions, bath oils
-daily after showering of bathing
-do not apply to skin lesions that are moist/exudative
Antipsoriatics
Alefacept-first antibiological therapy for moderate to severe chronic
plague psoriasis
-provides longer remissions the other treatments
-adverse effects- serious infection
Efalizumab



-immunosuppressive recombinant monoclonal antibody
-stimulates the bodies immune system’s ability to fight
disease
-adverse effects- thrombocytopenia, hypersensitivity,, headache,
fever, chills, nausea and myalgia
Food Allergies





Definition:
-Ingestion of food that the person’s immune system
incorrectly identifies as harmful
- 4% of adults have food allergies
-6-8% of children age 4 years of younger







-Immune system creates food specific antibodies.
-Antigens which are foreign substances (food)
-produces the immune response
-antibodies start destroying the antigens
-immune system discharges large amounts
of histamine and chemicals
-cause the allergic reaction
Allergic Reaction










Respiratory
-Tongue swelling, dyspnea
Gastrointestinal
-Nausea, abdominal pain, diarrhea
Skin
-Hives, rash
Cardiovascular
-Tachycardia, hypotension
Neurological
-Anxiety, loss of consciousness
Anaphylaxis
-Severe reaction to allergen
 -Swelling of the lips, tongue, throat

-blocks the upper airway resulting in

suffocation
 -Emergency situation












Common allergy foods:
-Eggs, peanuts, tree nuts, fish, shellfish, wheat,
soy
-Peanuts and tree nuts- severe reactions!
-0.6% of Americans are allergic to peanuts
-young children
-allergic to eggs, milk, peanuts, tree nuts and soy.
-outgrow their allergies
-usually be allergic to peanuts and tree nuts for the
rest of their life.
-are hereditary
-a child having allergies increases when both
parents have allergies
-allergic to the common foods eaten in their countries
-rice allergies are common in Japan












Diagnosis
-family history of allergies
-food diary
-scratch test
-RAST (radioallergosorbant test)
-measures the presence f food-specific IgE
in the blood
-elimination of food from the diet
-food challenge
-capsules of different foods and a placebo
-ingested and then followed to see if an allergic
reaction occurs (rarely done)





Treatment-avoid foods that cause allergies
Prognosis
-not curable but manageable
-multiple medications being researched
Nursing Considerations






-Carefully reading food labels
-Inquire of the food ingredients when eating out.
-Counseling by a dietician on the foods that their
children need to avoid
-Medical alert bracelet with the name of food
allergy


Epinephrine injection
-carried at all times

- person, parents of children

- severe/ anaphylactic reaction to foods or medications

Epi-pen auto injection

-pre-measured epinephrine injection

- costs $50

Along with a Epi-pen the person should carry:

-food allergies

-3 emergency contacts

-Physicians name and telephone number

-description of how to treat the reaction
Pharmacology of skin disorders






Topical antiseptics/germicides
Topical Anti-Infectives
Topical Cortico-steroids
Topical Local Anesthetics
Topical Enzymes
Keratolytics
Topical Antiseptics and Germicides


Long history of usage
-spices, vegetable oils and extracts of trees/plants








-1800’s Pastuer, Koch
-substances that slowed or destroyed pathogenic
organisms
Definition:
-an agent that kills or inhibits the growth of
microorganisms that is applied to living tissue













Types-Hibiclens
-Alcohol
-Phisohex
-Hydrogen
-Peroxide
-Iodine
-Mercurochrome
-Betadine
-Silver Nitrate
-Silvadene
-Dakin’s Solution
-Septi-Soft




Nursing implications-Specific to the type of antiseptic
-Observe for hypersensitivity
-Skin staining/bleaching
Topical Anti-infectives






-Prevent infection-minor skin abrasions
-treat superficial skin infections
-Several antibiotics are combined in a single
product
-produces a broad spectrum coverage for
multiple organisms










Types-Bacitracin
-Polymyoxin
-Neomycin
-Gentamycin
-Tetracycline
-Erythromycin









Nursing Considerations
-hypersensitivity
-systemic absorption if applying to a
extensively damaged skin
-Neomycin -observe for changes in renal
function:
-decreased urine output
-elevated Creatine and BUN
- changes in hearing.
Topical Local Anesthetics











Inhibits the conduction of nerve impulses from sensory nerves
- reduces pain/pruritis
-insect bites, burns and plant allergies
-patches, ointments, creams, sprays, liquids of jelly
form
-Types- “caine”
-Lidocaine
-Benzocaine
-Tetracaine
-Cocaine














Nursing Considerations
-absorbed systemically through damaged or
diseased skin
-local or systemic adverse effects
-if the medication is applied to a large area of
skin
-systemic hypersensitivity
-CNS stimulant
-hypotension
-slow heart rate
-possible cardiac arrest
-avoid in clients
-hypersensitivity to “caine” medications
-severely traumatized skin
Topical Enzymes






Remove dead tissue
-enhances the formation of new tissue
- promotes wound healing
Selectively digest dead tissue
Specifically digest protein of dead tissue
Destroys components of the necrotic tissue mass.
Types Collagenase (Santyl)
 -digests collagen that 75% of skin tissue
 Fibrinolysin/Desoxyribonuclease (Elase)
 -dissolves the fibrin structure of blood clots/

DNA strands

- make up necrotic tissue.

Nursing considerations








SantylThe wound must be free of antiseptic/
antibacterial medications
Compatible with triple antibiotic medication
Apply Burrows solution to stop the enzymatic
action
ElaseObserve for hypersenitivity/allergic reaction
Keratolytics
Remove excess keratin layer of skin
-acne, warts, psoriasis, corns calluses and
fungal infections
 Breaks down the protein structure of the keratin
layer
-easier removal of the compacted cellular
material
 TypesSalicylic Acid, Lactic acid

Nursing Considerations







-Apply after bathing
-Soaked in water for several minutes
-Occlude with a dressing/plastic wrap after
applying medication
-Apply overnight and remove in the morning
-Repeated applications will probably control the
hyperkeratinic skin growth
-occasional reapplications may be needed for
reoccurrence