Diseases of the Hair, Skin and Nails PN

Causes of Skin Disturbances and examples Congenital Inflammation Obstruction Malignant Lesions Unknown Causes Degeneration Aging Trauma

Promotion, maintenance and Restoration Potential Nursing Diagnosis Psycosocial Responses Local Care Pharmathereapeutics Physicial agents

Review of Skin

Epidermis:

Function of the Skin  regulation of body temperature  protective surface  sensory structure  excretion  immunity  blood reservoir  synthesis of vitamin D

Physical Assessment Includes mucous membranes, scalp, hair, and nails Skin is a reflection of overall health Disorders often correspond to disease in other organ systems

General Appearance colour temperature moisture dryness skin texture (rough or smooth) lesions vascularity, mobility, hair, nails

Diagnostic Evaluation Skin Biopsy Immunofluorescence Patch Testing Skin Scrapings Tzanck Smear Wood Light Exam Clinical Photos

Congenital: angiomas

Capillary vascular malformation

Figure Senile (cherry) angiomas

Angiomas(port wine, strawberry lessions) Benign vascular tumors involving the skin and the subcutaneous tissues present at birth violet red patches (port wine) to raised bright red nodular lesions (strawberry) Strawberry-involute in first few years port wine persist

Inflammation: Bacterial Impetigo

Cellulitis of the legs

Boils

Viral: Herpes Simplex

Herpes Whitlow

Herpes Zoster

Viral: Herpes Zoster Shingles on the forehead

molluscum

Warts

Fungal Infections: Thrush Oral Candidiasis (Yeast or Thrush)

Treatment: Fungal Hygiene pharmaceutical prevention of re infection or spread

Tinea pedis and tinea unguium

Athlete's Foot

Mould Infection (aspergillus)

Parasitic Infection Pediculosis

Pubic Lice

Pubic lice in the eye

Scabies

Cradle Cap (Seborrheic)

Dermatitis: eczema

Psoriasis

Corticosteriods Steroids are absorbed at different rates from different parts of the body. A steroid that works on the face may not work on the palm. Conversely, a steroid which works well on the palms may cause side effects on the face.

Topical Absorption For example:  Forearm absorbs 1%  Armpit absorbs 4%  Face absorbs 7%  Eyelids and genitals absorb 30%  Palm absorbs 0.1%  Sole absorbs 0.05%

Long term effects of Cortical Steroid use

Skin Impairment: Obstruction Acne

Pressure Ulcers Tissue damage skin and underlying soft tissue compressed between bone and external surface Over a period of time Sacrum, hip, ankles, any body part Ischemia-infarction-necrosis

Clients At Risk Unable to feel Unable to communicate Limited mobility Can’t change position Friction and shear

Pressure Ulcer Prevention Prevention

Pressure Ulcer Prevention Prevention Assessment Observation Movement Turning positioning Avoid Moisture Avoid soap No massage Nutrition Friction and Shear Mental Status

Pressure Ulcer tx &mx TX and MX Moist, cleanse, dressing Diet; fluid Mattress; room humidifyer DebridmentLift with a lift sheet Infection prevention

Burns Causes: dry; moist; contact; chemical; electrical; radiation

Burns: Rule of 9’s

Burns: the Lund Method Age (Years) Area Head Neck Anterior trunk Posterior trunk Buttock Genitalia Arm Forearm Hand 2½ 2½ 2½ 2½ Thigh 5½ 6½ 8½ 8½ Leg 5 5 5½ 6 Foot 3½ 3½ 3½ 3½

Depth of Burn Traditionally 1st, 2nd, 3rd More accurate to describe the level burned: Superficial Partial thickness full thickness subdermal

Classification <25% = local response >25% = local + systemic response

Burns: Rule of 9’s

How burns heal

Compensatory Respones Inflammatory Sympathetic Nervous System

Figure 68-8 The physiologic actions of the sympathetic nervous system compensatory responses to burn injury (early phase)

Consequences of Burns Cardiac Changes Pulmonary Changes Gastrointestinal Changes Metabolic Changes Immunologic Changes

Nursing Interventions Impaired skin integrity Risk for infection Imbalanced nutrition Impaired physical mobility Disturbed body image

Collaborative problems Grieving Family coping Self-care deficits Sexual dysfunction Disturbed sleep pattern Social isolation Potential for pneumonia; septicemia