2. Diseases of the Hair, Skin and Nails PN 111 2007

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

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

5. Review of Skin

6. Epidermis:

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

8. 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

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

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

11. Congenital: angiomas

12. Capillary vascular malformation

13. Figure 66-14 Senile (cherry) angiomas

14. 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

15. Inflammation: Bacterial Impetigo

16. Cellulitis of the legs

17. Boils

18. Viral: Herpes Simplex

19. Herpes Whitlow

20. Herpes Zoster

22. Viral: Herpes Zoster Shingles on the forehead

23. molluscum

24. Warts

25. Fungal Infections: Thrush Oral Candidiasis (Yeast or Thrush)

27. Treatment: Fungal Hygiene pharmaceutical prevention of re infection or spread

28. Tinea pedis and tinea unguium

29. Athlete's Foot

30. Mould Infection (aspergillus)

31. Parasitic Infection Pediculosis

32. Pubic Lice

33. Pubic lice in the eye

34. Scabies

35. Cradle Cap (Seborrheic)

36. Dermatitis: eczema

38. Psoriasis

39. 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.

40. 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%

41. Long term effects of Cortical Steroid use

42. Skin Impairment: Obstruction Acne

43. 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

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

45. Pressure Ulcer Prevention Prevention

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

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

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

49. Burns: Rule of 9’s

50. Burns: the Lund Method Age (Years) Area 0-1 1-4 5-9 10-15 Head 19 17 13 10 Neck 2 2 2 2 Anterior trunk 13 13 13 13 Posterior trunk 13 13 13 13 Buttock 5 5 5 5 Genitalia 1 1 1 1 Arm 4 4 4 4 Forearm 3 3 3 3 Hand 2½ 2½ 2½ 2½ Thigh 5½ 6½ 8½ 8½ Leg 5 5 5½ 6 Foot 3½ 3½ 3½ 3½

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

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

54. Burns: Rule of 9’s

55. How burns heal

56. Compensatory Respones Inflammatory Sympathetic Nervous System

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

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

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

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