Nursing Care of Clients with Common Skin Disorders Chapter 45

The Client with Psoriasis 4 Definition –chronic –non-infective –raised reddened round plaques covered by silvery white scales –most common on scalp, arms, legs 4 Diagnosed –skin biopsy

Psoriasis

The Client with Psoriasis 4 Treatment –topical corticosteriods to decrease inflammation –phototherapy exposure to ultraviolet light decreases the growth rate of epidermal cells 4 Nursing Care –Impaired skin integrity –Body Image Disturbance

Infections and Infestations 4 Bacterial Skin Infection –causative agent gram+ staph aureus – and beta-hemolytic streptococci 4 Furuncle –boils, inflammation of hair follicle 4 Carbuncles –group of infected hair follicles 4 Cellulitis - localized infection of dermis

Infections and Infestations 4 Diagnosis –assessment –culture and sensitivity 4 Treatment –antibiotics

Fungal Foot Infection

Fungal Infections of the Skin 4 Tinea pedis - athlete’s foot 4 Tinea capitis - scalp - ringworm 4 Tinea corporis - body 4 Candidiasis Infections –yeast like fungus, pustules, red rash –skin folds, mouth, peri areas –treatment - antifungal - nystatin, diflucan

Ring Worm

Inflammatory Disorders 4 Dermatitis –inflammation of the skin characterized by erythema, pain and pruritus 4 Contact Dermatitis –caused by hypersensitivity response or chemical irritation 4 Treatment –topical oints and therapeutic baths

Toxic Epidermal Necrolysis (TEN) 4 Rare, life threatening disease in which the skin peels off 4 leaves large areas of denuded skin 4 can also occur internally to mucose membranes 4 Treatment –ICU, Burn Unit

Toxic Epidermal Necrolysis (TEN 4 Surgery –skin graphing 4 Fluid replacement –IV therapy, TPN 4 Medications –Antibiotics -treat sepsis –Anelgesics - pain management

Neoplastic Skin Disorders 4 Benign lesions - moles, cysts, keloids, skin tags keratoses 4 Malignant lesions - skin cancers –over time damage from ultraviolet radiation and chemicals –basal cell carcinoma, squamous cell and melanoma

Risk Factors 4 Environmental –ultraviolet radiation –pollution, chemicals viruses, trauma 4 Host Factors –skin pigmentation –life style

Skin Changes Normal Skin Aged Skin Sun Damaged Skin

Basal Cell Carcinoma 4 Tumor that originates from basal layer 4 Most common but least aggressive 4 Tend to recur but rarely metastasize

Basal Cell Carcinoma

Squamous Cell Carinoma 4 Arises from squamous epithelium 4 Occurs on exposed areas of skin 4 More aggressive, faster growth rate 4 Harden nodule may ulcerate and bleed

Skin Cancer Model

Interdisciplinary Care 4 Labs and Diagnostics –biopsy 4 Treatment –surgical excision –curettage and electrodesiccation –cryosurgery –radiation therapy

Malignant Melanoma 4 Arises from melanocytes 4 is life threatening 4 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 4 Assessment –A = asymmetry –B = border irregularity –C = color variation –D = diameter >6mm –E = elevation 4 Labs and Diagnostics –biopsy

Interdisciplinary Care 4 CT Scan, MRI, CXR, Bone Scan 4 Blood work - CBC, Liver function 4 Surgery –wide excision of lesion –regional lymph node dissection 4 Chemotherapy and Radiation Therapy

Interdisciplinary Care 4 Nursing Care –Impaired skin Integrity –Hopelessness –Anxiety –Teaching for Home Care wound care avoid exposure follow up appointments

Skin Trauma 4 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 4 Causes –External pressure –Shearing

Pressure areas on bed bound client

Pressure Ulcers 4 Staging –Stage 1 intact skin non-blanchable erythema –Stage 2 open, partial layer skin loss ulcer, abrasion, blister, shallow crater

Pressure Ulcers 4 Stage 3 –full-thickness, damage or necrosis to subcutaneous tissue –deep crater 4 Stage 4 –full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, can have sinus tracts

Pressure Ulcers 4 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

Heel Ulcer

Stasis Ulcer --Venous Insufficiency

Nursing Care 4 Assessment - Identify those at risk 4 Assessment of skin –systematic once a day 4 Clean the skin –keep hydrated - use lotion 4 Avoid massage over bony prominences

Nursing Care 4 Minimize exposure to moisture 4 Avoid friction and shearing 4 Ensure adequate nutritional intake 4 Maintain activity level –What can you do for a client on bedrest?

Measuring Pressure Ulcers

Documentation 4 Site 4 Size 4 Stage 4 Appearance –color –drainage –odor

Turn me

Help me keep my skin intact

Pressure relieving devices

Hair and Nail Disorders 4 Hirsutism –excessive body hair 4 Alopecia –loss of hair or baldness 4 Nail Disorders –discolored, malformed, infected or separated from underlying tissue

Fungal Infection of the Toe Nail

Burns – get ready for 3 rd semester