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