Linda S. Williams / Paula D. Hopper Copyright © F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 54 Nursing Care of Patients with Skin Disorders

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pressure Ulcers  Pathophysiology  Pressure Against Skin  Tissue Anoxia  Etiology  Pressure  Friction  Shear

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Risk Factors  Immobility  Impaired Circulation  Impaired Sensory Perception  Elderly  Very Thin or Obese

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Prevention  Assess Daily  Cleanse and Dry Daily and PRN  Lubricate Daily  Clean Incontinence Promptly  Use Moisture Barrier PRN  Do Not Massage Reddened Areas  Shift every Weight every 15 min

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Prevention (cont’d)  Turn/Reposition at Least every 2 hr  Keep Heels Off Bed  Pad/Protect Bony Prominences  Use Pressure-Reducing Mattress  Use Lift Sheet to Move  Provide Nutrition and Hydration

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Braden Scale  Sensory Perception Moisture  Activity  Mobility  Nutrition  Friction and Shear

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Pain  Open Ulcerated Area  Color Tip  Black: Necroses  Yellow: Infection  Red: Healing

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Physical Examination  Culture and Sensitivity  Blood Supply Studies  Wound Biopsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Remove All Pressure  Debride  Mechanical  Enzymatic  Autolytic  Surgical  Cleanse  4 – 15 PSI

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Dressings  Types  Hydrogel  Polyurethane Film  Hydrocolloid Wafer  Biological  Alginate  Gauze  Moist Environment  Caution with Tape

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Negative Pressure Wound Therapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stages  Deep Tissue Injury  I – Skin Intact, Red, Does Not Blanch  II – Partial Thickness Skin Loss  III – Full Thickness Skin Loss, May Have Eschar  IV – Damage to Muscle, Bone, or Support Structures  Unstageable

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Stages (cont’d)

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Impaired Skin Integrity  Risk for Infection  Pain

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Dermatitis  Pathophysiology  Inflammation of the Skin  Etiology  Allergens  Irritants  Heredity  Stress

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Types of Dermatitis  Contact  Irritant  Allergic  Atopic  Seborrheic

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Rash, Itching  Lesions  Scales  Crusts  Fissures  Macules  Papules  Pustules

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Infection  Sepsis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  Culture and Sensitivity

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Antihistamines  Analgesics  Antipruritics  Steroids  Colloidal Oatmeal Baths  Wet Dressings

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Impaired Skin Integrity  Disturbed Body Image  Deficient Knowledge

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Psoriasis  Pathophysiology  Inflammatory Disorder  Proliferation of Epidermal Cells  Scaling

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aggravating Factors  Stress  Strep Pharyngitis  Hormone Changes  Cold Weather  Skin Trauma  Some Drugs

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Papules, Plaques  Silvery Scales  Itching

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Infection, Fever, Chills  Arthritis  Nail Changes  Lymphadenopathy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Physical Assessment  Rule Out Infection

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Tub Baths  Corticosteroids  Salicylic Acid  Keratolytics  Vitamin D Creams  Retinoids  Coal Tar, Anthralin  UV Light  Chemotherapy  Occlusive Dressings  Fish Oil Supplements

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Herpes Simplex  Pathophysiology  Viral Infection  HSV1 – Above Waist  HSV2 – Below Waist

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Herpes Simplex (cont’d)  Primary Infection  Direct Contact  Respiratory Droplet  Fluid Exposure  Lies Dormant  Recurs with Stress

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Prodromal Phase  Burning, Tingling  Vesicles and Pustules  Burning, Itching, Pain  Contagious Until Scabs Form

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  Culture

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Antiviral Agents (Acyclovir/Zovirax)  Topical  Oral  Antibiotics for Secondary Infection  Avoid Triggers of Recurrence

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Herpes Zoster (Shingles)  Pathophysiology  Acute Inflammation/Infection  Painful Vesicules  Follows Nerve Distribution  Usually One-sided

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Etiology  Reactivation of Varicella Zoster Virus (Chickenpox Virus)  Occurs with Reduced Immune Function  Elderly  AIDS  Immunosuppressed

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Prevention  Avoidance of Infected Persons  Varicella Vaccine (Varivax)  Zostavax

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Vesicles, Plaques  Irritation  Itching  Fever  Malaise  Pain

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Complications  Postherpetic Neuralgia  Persistent Dermatomal Pain  Hyperesthesia  Opthalmic Herpes Zoster  Sepsis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  Culture

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Acyclovir  IV, Oral, Topical  Analgesics  Anticonvulsants/Antidepressants  Antihistamines  Corticosteroids  Antibiotics for Secondary Bacterial Infection

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Fungal Infections  Pathophysiology/Etiology  Direct Contact with Fungus  Overgrowth with Antibiotic Therapy  Grows in Warm Moist Environment

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Types  Tinea Pedis  Tinea Capitas  Tinea Corporis  Tinia Cruris  Candidiasis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Keep Skin Clean and Dry  Topical Antifungals  Oral Antifungals  Corticosteroids  Teach to Avoid Spread

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Cellulitis  Pathophysiology  Inflammation of Skin/Connective Tissue  Infection  Staphylococcus/MRSA  Streptococcus  Etiology  Open Wound/Trauma  May be Unknown

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Warmth  Redness  Edema  Pain, Tenderness  Fever  Lymphadenopathy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Culture and Sensitivity  Blood Cultures

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Antibiotics  Topical  Systemic  Debridement

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acne Vulgaris  Increased Sebum Production  Obstruction of Pilosebaceous Ducts

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Acne Vulgaris (cont’d)  Signs and Symptoms  Comedones  Open  Closed  Therapeutic Interventions  Benzoyl Peroxide  Vitamin A Acid  Antibiotics  Estrogen Therapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Skin Infections  Risk for Spread of Infection  Acute Pain

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pediculosis  Pathophysiology/Etiology  Infestation by Lice  Transmission by Direct Contact

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Types  Pediculosis Capitis  Pediculosis Corporis  Pediculosis Pubis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Itching  Papular Rash  Presence of Lice, Nits, and Excreta

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  History and Physical  Test for STD if Pediculosis Pubis

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Pediculosides  Permethrin, Pyrethrin, Lindane  Mechanical Removal  Antipruritics  Topical Corticosteroids

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Patient Education  Self Medication  Removal of Nits  Cleaning of Clothing and Objects  Inspection of Family and Friends

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Scabies  Pathophysiology  Sarcoptes Scabiei Mites  Burrow into Skin  Etiology  Contact with Infected Clothing or Animals

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Itching  Rash  Burrows

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Shaving of Lesion  Microscopic Evaluation

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Topical Scabicides  Permethrin  Crotamiton  Antipruritics

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Patient Education  Self Medication  Treat Family Members  Wash Clothing and Linens  Itching May Continue 2 Weeks Following Treatment

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pemphigus  Pathophysiology/Etiology  Autoimmune Disorder  Bullae on Skin and Mucous Membranes  Triggers  Sun  Some Drugs or Foods

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms  Bullae  Mucous Membranes  Spread to Skin  Rupture  Raw Wounds  Pain  Burning  Itching

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Positive Nikolsky’s Sign  Biopsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Corticosteroids  Cytotoxic Agents  Antibiotics  Analgesics  Antipruritics  Fluid Replacement  High Protein, High Calorie Diet

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Care  Monitor Fluid Balance  Monitor Diet  Administer Wet Dressings or Baths  Control Pain  Maintain Oral Hygiene  Provide Psychosocial Support

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Malignant Skin Lesions  Cancer Arising From  Basal Cell Layer  Basal Cell Carcinoma  Epidermis  Squamous Cell Carcinoma  Menalocytes  Malignant Melanoma

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Basal Cell Carcinoma

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Squamous Cell Carcinoma

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Malignant Melanoma

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Lentigo Maligna Melanoma

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Risk Factors  Ultraviolet Rays  Fair Skin  Genetic Tendency  X-Ray Therapy  Chemicals  Immunosuppressive Therapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Prevention  Limit Exposure to UV Rays  Use Sunscreen  Wear Protective Clothing  Report Changes in Moles

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnosis  Examination  Biopsy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions  Surgical Excision  Chemotherapy  Radiation Therapy

Copyright © F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Dermatological Surgery  Rhinoplasty  Blepharoplasty  Rhytidoplasty  Otoplasty