1. Integumentary System

2. Objective Differentiate between decubitus ulcers and stasis ulcers

3. Decubitus Ulcer - Pathophysiology Pressure   Blood flow  Tissue Hypoxia / ischemia  Tissue necrosis  Tissue “sloughs off”  Open wound

4. Stasis Ulcer – Pathophysiology Poor circulation   Blood flow  Tissue Hypoxia / ischemia  Tissue necrosis  Tissue “sloughs off”  Open wound

5. Stasis Ulcer Venous insufficiency  Stasis (stagnation)

6. Stasis Ulcer - Manifestations

7. Decubitus vs. Stasis Ulcer How will tx be different? Decubitus Focus on  Reliving pressure Stasis Ulcer Focus on   circulation

8. Stasis Ulcers: What would you expect of healing? Poor wound healing!

9. Stasis Ulcer - Rx Anticoagulants Action S/E

10. Stasis ulcer – Prevention Compression socks Exercises Elevate

11. Objective Describe the medical, surgical and nursing management for the burn patient

12. Burns: Loss of skin  – Pathogens – Fluid loss

13. Burns: Fluid shifts:  Intracellular  interstitial space Hypovolemic shock   B/P   Cardiac output

14. If the fluid shifts from intracellular to interstitial space, what will happen to the viscosity of the blood? A.Blood will become thicker B.Blood will become thinner

15. A patient with “thick blood” is at risk of what? A.Hemorrhaging B.Blood clots C.Oxygen toxicity D.Decubitus ulcers E.Anemia

16. Fluid shifts  electrolyte imbalance Watch K+ levels closely!

17. Burns - Rx Morphine (MS) – Action Analgesic – S/E  respiration PAIN!

18. Objective Describe the types of skin cancer symptoms, treatment and prognosis of each

19. Types of Skin Cancer Non-melanoma  Basal cell carcinoma  Squamous cell carcinoma Melanoma

20. Skin CA – S&S ABCDE A.Asymmetry B.Border irregular C.Color variations D.Diameter >5mm E.Evolution

21. Skin CA - Tx Surgery – Curettage – Cryosurgery Radiation Chemotherapy

22. Objective Identify the following common skin disorders, including etiology, symptoms, treatment and nursing interventions: – Acne

23. Acne Disorder of the sebaceous gland Acne vulgaris  Young adult

24. Acne Disorder of the sebaceous gland Acne vulgaris  Young adult Acne rosacea  Older adult

25. Objective Identify the following common skin disorders, including etiology, symptoms, treatment and nursing interventions: – Psoriasis

26. Psoriasis Plaque – Red, raised with silvery white scales – Scalp, elbows, knees Autoimmune

27. Psoriasis Plaque – Red, raised with silvery white scales – Scalp, elbows, knees Autoimmune

28. Psoriasis Plaque – Red, raised with silvery white scales – Scalp, elbows, knees Autoimmune

29. Psoriasis Plaque – Red, raised with silvery white scales – Scalp, elbows, knees Autoimmune

30. Psoriasis Plaque – Red, raised with silvery white scales – Scalp, elbows, knees Autoimmune

31. Objective Identify the following common skin disorders, including etiology, symptoms, treatment and nursing interventions: – Eczema

32. Eczema  histamine S&S – Chronic lichenification (thickness) – Erythema – Scaling – Pruritus

33. Eczema  histamine S&S – Chronic lichenification (thickness) – Erythema – Scaling – Pruritus

34. Eczema  histamine S&S – Chronic lichenification (thickness) – Erythema – Scaling – Pruritus

35. Objective Identify the following common skin disorders, including etiology, symptoms, treatment and nursing interventions: – Impetigo

36. Impetigo S&S – Blisters on face, neck, hands, & diaper area

37. Impetigo Pathophysiology  Streptococcus pyogenes or  Staphylococcus aereus

38. Impetigo Pathophysiology  Streptococcus pyogenes or  Staphylococcus aereus

39. Impetigo Pathophysiology  Streptococcus pyogenes or  Staphylococcus aereus

40. What type of pathogen is streptococcus? A.Bacteria B.Virus C.Parasite D.Fungus E.Auto-immune

41. Objective Identify the following common skin disorders, including etiology, symptoms, treatment and nursing interventions: – Pediculosis

42. Pediculosis - Lice Unhatched eggs – Nits Body lice – Pediculosis corporis

43. Pediculosis - Lice Unhatched eggs – Nits Body lice – Pediculosis corporis

44. Pediculosis corporis

47. Pediculosis - Lice Unhatched eggs – Nits Head lice – Pediculosis capitis

48. Pediculosis capitis

49. Pediculosis - Lice Unhatched eggs – Nits Pubic lice – Pediculosis pubis – “crabs” – STD

50. Pediculosis pubis

52. Objective Identify the following common skin disorders, including etiology, symptoms, treatment and nursing interventions: – Scabies

53. Scabies Female mites All people, $, age Spread  Skin-to-skin

54. Scabies Location – Btw fingers – Inner wrist & elbow – Axillae – Gluteal crease

55. Objective Identify the following common skin disorders, including etiology, symptoms, treatment and nursing interventions: – Lupus erythematosus

56. Lupus erythematosus Auto-immune disease Butterfly rash over cheeks & nose –  in sunlight

57. Lupus erythematosus

58. Objective Discuss nutritional needs of the patient with a skin disorder

59. Which food groups are most important for a patient with a NRS Dx of impaired skin integrity? Protein Calories Iron Fluids

60. Objective Discuss pharmacological interventions appropriate in treatment for skin disorders

61. Pruritus Antihistamine – Diphenhydramine (Benadryl) – S/E Drowsy

62. Psoriasis Corticosteroids – S/E Na+ & H2O retention

63. Impetigo Anti-biotics

64. Pediculosis Topical anti-parasitic agents

65. Objective Discuss factors that affect the emotional health of the patient with skin disease

66. Disturbed Body Image Est. relationship w/ nrs Enc. express feelings Enc. interaction with S.O.