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Nursing Management skin 03

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					Nursing Management:
Integumentary System
 George Ann Daniels MS, RN
   Rogers State University
Nursing Management: Dermatologic
           Problems
• Pruritus
  – Makes pruritus worse
     •   Heat and rubbing
     •   Dryness
     •   Restricted clothing
  – Cool environment, corticosteriods
  – Menthol, camphor, or pheno
     •   Numbs the itch receptors
  – Antihistimines
     •   Benadryl
  – Aveeno baths
• Spread of infection
  –   Gloves
  –   good handwashing
  –   Safe disposal of soiled dressings
  –   Avoid scratching of lesion
  –   Trim nails
• Post procedure
  – Keep wound moist and covered
       • Clean with NS
       • Antibiotic ointment
  – Stitches
       • Removed in 4-10 days
Furuncle (Boil)
        • Deep infection of the hair
          follicle – caused by Staph
          Aureus
        • Clinical manifestations:
          small, red, elevated, tender
          nodule.
        • Management: warm wet
          compresses QID, I & D,
          Do not squeeze,
          Antibiotics-topical and/or
          oral
Impetigo
    •   Honey-colored crusts on
        erythematous base
    •   Areas beneath crust-
        glistening, weeping, and
        eroded
    •   Primarily face
    •   Antibiotics-7-10 d
    •   Gently remove crust with
        1:20 Burrow solution
    •   Topical bactericidal
        ointment
    •   Heals without scarring
Cellulitis
     •   Warm, red, swollen and
         painful
     •   Fever, malaise, chills,
         leukocytosis with left
         shift, elevated Sed. Rate
     •   Bedrest, elevation of
         affect part, antibiotics
     •   Resolves in 2 weeks with
         TX
Fungal Infections
 (Dermatophyte)
         •   Fungus infection
         •   Tinea Capitis
             –   Scalp
         •   Scaling area with broken
             hair shafts, plaques,
             pustules
         •   Possible permanent hair
             loss
         •   Oral Griseofulvin
         •   Selenium Sulfide
             shampoos
         •   Topical antifungal agents
Tinea Corporis
       •   Body, arms, legs
       •   Elevated scalilng,
           erythematous,
           serpiginous borders with
           center clearing
       •   Oral Griseofulvin
       •   Cool compresses
       •   Antifungal cream applied
           1 inch beyond lesion for
           1-2 weeks until resolved
           –   Monistat, Lotrimin
Tenia Cruris
      • Groin
      • Sharply demarcated area
        with elevated, scaling
      • Jock Itch
      • Local application of
        Tolnaftate liquid
      • Wet compresses or sitz
        baths may be soothing
      • Teaching r/t personal
        hygiene
Tenia Pedis
      •   Feet
      •   Athlete’s Foot
      •   Between toes and soles
          of the feet
      •   Maceration and fissuring
          between toes
      •   May have pinhead
          vesicles
      •   Oral Griseofulvin
      •   Antifungal powder
      •   Teach
Tenia Unguium
       • Nails
       • Fingernails and
         toenails
       • Separation from the
         nail bed with debris
         under nail
       • Thick, yellow nails
Nondermatophyte Infections
             •   Candidiasis
             •   Glistening, fiery red or
                 moist pink, beefy red
                 with satellite pustules
             •   Severe itching/burning
             •   Skin folds/groin area
             •   Oral-thrush
             •   Diaper rash (dermatitis)
             •   Teach prevention and
                 management
Verrucae (Warts)
        •   Verruca Vulgaris
        •   Hands
        •   Flesh-colored or
            brownish gray scaling,
            vegetative papule
        •   Cryosurgery, chemical
            destruction(salicyclic
            acid), curretage and
            desiccation, laser
Condyloma Acuminatum
          • Soft vegetative
          • Mucocutaneous skin
            in anogential area
          • Cryosurgery,
            Podophyllin 25% in
            benzoin tincture
         Herpes Simplex (HSV)
• Most common virus in humans
• Two types
  – HSV-1
     •   Fever blister and cold sores
     •   Sunlight, trauma, stress, menses
     •   Antiviral
         –   Zovirax, Famvire, Valtrex
     •   Mouth, oral cavity, eyes and brain
  – HSV –2
     •   Genital herpes
HSV-1
   •   Grouped, burning, and
       itching vesicules
   •   Lips, nose, mouth, oral
       mucosa
   •   Teach: spread by kissing,
       oragenital sexual contact,
       contact with fingers
   •   Handwashing
   •   Last 7-10 days
Herpes Zoster
       •   Linear patches along
           dermatome
       •   Grouped vesicles on
           erythema base
       •   trunk
       •   Burning pain
       •   Heals without
           complication, May scar
       •   Antiviral agent
           –   Acyclovir, famiciclovir
       •   Cool compresses,
           analgesia, bedtime
           sedation
Psoriasis
     •   Chronic hereditary
         disorder
     •   Light-skinned race
     •   Environmental factors
         that trigger
         –   Skin injury
         –   Infections
         –   Hormone changes
         –   Stress
         –   Drugs
         –   Alcohol
         –   Smoking
         –   obesity
             Psoriasis Con’t.
• Erythematous plaque     • Management
  with sharp well           – Topical treatment
  defined borders and       – Photo-therapy
  silvery white scales.     – Teach reducing
                              pruritus
• Elbows, knees, scalp,        •   Avoid scratching
  lumbosacral skin, can        •   Room humidifier
  occur anywhere               •   Warm not hot bathing
                               •   Avoid strong soaps
                               •   Lubricate skin
                               •   antihistamines
Insect and animal contacts
             • Scabies (Mites)
                – Mite infestation in the
                  dermis to lay eggs
             • Inflammation and
               itching( worse at
               night)
             • Interdigital, axillary,
               popliteal, ingunial
             • Kwell Lotion
             Pediculosis Capitis
•   Head lice (cooties)
•   School-age children
•   Lives 48 hours
•   Female lays eggs (nits) on the hair shaft
    – Hatch in 7-10 days
• Easily transmitted person to person
    – Does not jump or fly
    – Sharing: combs, hats, caps, scarves, coats, shared
      lockers, slumber parties, or other items used on or
      near hair
    – Can invade all ages
• Manifestations
  – Visual
  – Itching/scratch marks
• Treatment
  – Pediculocides and manual removal of nit cases
     • NIX, RID
                      Teach
• Machine wash all washable clothing, towels, and
  bed linens in hot water, and dry in hot dryer for at
  least 20 minutes
• Thoroughly vacuum carpets, car sets, pillows,
  stuffed animals, rugs, mattresses, and upholstered
  furniture
• Seal non-washable items in a plastic bag for 14
  days if unable to dry clean or vacuum
• Soak combs, brushes, and hair accessories in lice-
  killing products for 1 hours or in boiling water
  for 10 minutes
                       Stings


• Allergic reactions account for 30 deaths each year
   – Honeybees, bumblebees, wasps, hornets, yellow
     jackets, mud daubers, and fire ants
• Reaction may be immediate or delayed ( after 2
  hours)
• Non-allergic reaction
   – Local edema, erythema pain, itching
   – Resolves in a few hours
• Severe with possible anaphylaxis reaction
   – Generalized urticaria and pruritus, bronchospasms,
     laryngeal edema, shock and death
   – 10-30 minutes post sting
   – Epinephrine 0.1-0.5 mL of 1:1000 sol, may repeat 15-
     15 minutes until symptoms resolve
• Stinger removal
   – Honeybees only leave stingers
   – Clean area
   – Remove by scraping a flat item over stinger against
     the entry.
      •   Avoid breaking or squeezing
• Treatment
   – Ice, elevation, antihistamines
                Neoplasm
•   Benign/Malignant
•   Epidermal
•   Dermal
•   Subcutaneous
•   Pigmented
Epidermal
     • Skin tags
     • Seborrheic keratosis
        Age spots
     • Corns
     • Epidernmal cyst
Dermal/subcutaneous
          •   Cherry Hemangioma
          •   Keloid
          •   Xanthoma
          •   Neurofibroma
          •   Dermatofibroma
          •   Lipoma
Pigmented Lesions
         •   Freckles
         •   Lentigo
         •   Melasma
         •   Pigmented Nevi
             – moles
    Premalignant Lesisons
               • Actinic keratosisSun
                 exposure



•              • Cutaneous Horn
Malignant Neoplasms
          • Basal Cell
          • Pearly, translucent
            rounded border with
            dilated blood vessels
          • Reoccurring
          • Biopsy
          • Curettage and
            desiccation
Squamous Cell Carcinoma
            •   Indurated lesion
            •   Early-thickened area
            •   Slowly enlarges
            •   Central crust
            •   Surgical incision
Cutaneous Malignant melanoma
              • Fatal unless treated early
              • Sunburn, sun exposure
              • Variegated color, irregular
                border, irregular surface
              • Surgical excision with a 2-
                4 mm margin
              • Stage I-localized
              • Stage II- regional node
              • Stage III- disseminated
               Prevention
• Self examination of the skin
• Check skin monthly
• Professional check- up at 3 mo, 6 mo, and
  yearly for life if skin cancer is removed
• Report any changes
• Report development of any new lesions
Progression of Suspicious Moles
         Preventing Skin Cancer
• Avoid sun between 10        • Lip balm SPF >15
  AM and 3 PM
• Start with short sessions   • Protective clothing
   – 15-20 minutes            • Watch out for cloudy
• Sunscreen SPF >15 daily,      days and water
  all year                      reflection
• Reapply after swimming,
  strenuous exercises, or     • Avoid tanning lamps
  prolonged sun bathing         or tanning booths
THE END

				
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