Adult Health Test 1 Integumentary part 3

Contact Dermatitis

• Caused by an allergic reaction to a substance the person has contacted.
• Common causes include changes in soap, detergent, chemicals, plants, new clothes, metals, and food.
• Symptoms: Erythema, edema, ruptured vesicles, encrustation, severe pruritus, burning, and pain.
• Objective data: Erythema, papules, vesicles, excoriations, and edema.
• Management: Identify the cause and treat symptoms.
• Nursing interventions:
  • Use cool, wet dressings with Burrow's solution to prevent dryness.
  • Apply cold compresses for edema.
  • Perform daily baths to cleanse the skin.
  • Keep fingernails trimmed short.
  • Advise wearing lightweight, loose-fitting clothing.
• Medications: Corticosteroids for inflammation; antihistamines like Benadryl for itching and edema.
• Non-contagious

Dermatitis Venenata

• Allergic reaction to plants, primarily poison ivy and poison oak.
• Symptoms: Mild to severe erythema with pruritus.
• Mechanism: Initial exposure sensitizes the body. Subsequent exposure triggers a reaction involving lymphocytes releasing irritating chemicals and causing inflammation, edema, and vesiculation.
• Management:
  • Immediately wash affected area with cool water and soap if exposure occurs.
  • Corticosteroids to reduce inflammation.
  • Apply cool wet dressings.
  • Use calamine lotion to soothe itching.
  • Provide Benadryl for itching relief.

Dermatitis Medicamentosa

• Allergy to a medication.
• Symptoms: Range from mild to severe, potentially including respiratory arrest and anaphylaxis.
• Management: Identify the drug and discontinue it.
• Nursing intervention: Notify the provider.
• Note: Allergies can develop over time with any medication.

Urticaria (Hives)

• Allergic reaction manifesting as wheals or hives.
• Causes: Drugs, food, insect bites, inhalants, emotional stress, heat or cold exposure.
• Appearance: Reddish outer rim with a pale or whitish center.
• Mechanism: Histamine release from the body's antigen-antibody reaction.
• Management:
  • Administer antihistamines such as Benadryl.
  • Provide epinephrine (adrenaline) for severe reactions.
  • Identify and eliminate triggers.

Angioedema

• Form of urticaria with localized edema in subcutaneous tissue.
• Causes: Same as urticaria.
• Locations: Eyelids, hands, feet, tongue, larynx, gastrointestinal tract, genitalia, lips.
• Management:
  • Administer antihistamines (Benadryl).
  • Administer epinephrine.
  • Administer corticosteroids (Solu-Medrol IV).
  • Apply cold compresses.
• Note: Potential for respiratory distress if tongue, larynx, or lips are affected.
  • Advise using a Medic Alert bracelet.

Eczema (Atopic Dermatitis)

• Chronic inflammatory skin disorder, often commencing in infancy.
• Associations: Allergies to chocolate, eggs, wheat, or orange juice.
• Link: Strong association with asthma in children with eczema.
• Mechanism: Heredity plays a role.
• Management: Minimize allergen exposure.
• Symptoms: Papules and vesicles surrounded by erythema, rupture, exudate, crusting, and intense itching.
• Note:
  • Children may exhibit fussiness, irritability, and anorexia due to discomfort.
  • Commonly affects the scalp, forehead, cheeks, neck, and extremities.
  • The affected area is erythematous and dry.
  • Thick scales often form in dry areas.
• Key management:
  • Hydration: Soak in warm water for 15-20 minutes and gently pat dry (avoid rubbing).
  • Occlusive ointment: Apply a thick layer of ointment to moist skin (petroleum jelly, corticosteroid ointments, vegetable shortening).
  • Lotion: Employ lotions like Eucerin, Curel, or Lubriderm for maintenance.

Acne Vulgaris

• Inflammatory papulopustular skin eruption involving sebaceous (oil) glands.
• Common in adolescence, but can occur at any age.
• Risk factors:
  • Diet (debatable).
  • Stress.
  • Heredity.
  • Hormonal imbalances.
  • Grease and oil-containing cosmetics.
  • Perspiration.
  • Oil production, dead skin cells, clogged pores, and bacteria.
• Mechanism: Oil glands become occluded.
• Locations: Face, neck, upper chest, shoulders, back.
• Symptoms: Tender area, edema, and comedo (blackhead).
• Note: Comedo is not dirt; it's a reaction of oil and epithelial cells with oxygen.
• Management:
  • Topical, systemic, or intralesional medications.
  • Refer to Table 43-4 (page 1326) for common medications (retinoids, isotretinoin, antibiotics).
  • Isotretinoin is hepatotoxic. Require liver function tests and pregnancy tests. Avoid pregnancy while on this medication.
  • Medications help cleanse, dry, decrease inflammation, reduce bacteria, and decrease sebum production.

Acne Vulgaris Nursing Interventions

• Maintain skin cleanliness and dryness.
• Address any psychological concerns (e.g., low self-esteem).
• Instruct clients to avoid touching their face with hands or hair to minimize oil transfer.
• Advise wearing loose-fitting clothing to promote air circulation.
• Wash hair daily.
• Wash skin 2-3 times daily with medicated soap.
• Use water-based cosmetics.
• Note: Improvement may take 3 weeks of treatment. Low-dose oral contraceptives may be helpful.

Psoriasis

• Non-infectious, hereditary, chronic, proliferative skin disorder.
• Mechanism: Epidermis produces cells rapidly (faster than normal 28-day cycle).
• Locations: Scalp, elbows, chin, trunk.
• Symptoms:
  • Papules that develop into plaques.
  • Red skin patches covered with silver scales.
• Severity: Mild, moderate, or severe.
• Note: Report any psychosocial issues (depression, loneliness, self-consciousness) occurring due to this condition.

Psoriasis Management

• Medications:
  • Topical corticosteroids (hydrocortisone, betamethasone) for inflammation.
  • Keratolytic agents (tar preps, salicylic acid) to decrease shedding of the outer skin.
  • Photochemotherapy with methoxsalen orally and UV light.
  • Methotrexate (for severe cases).
  • Vitamin D to decrease epidermal proliferation.
  • Cyclosporine.
  • Acitretin.
  • Infliximab (biological for severe plaque disease).

Discoid Lupus

• Inflammatory skin condition with the potential to progress to systemic lupus erythematosus.
• Symptoms: Red, inflamed patches showing scaling and encrusting.
• Locations: Face, ears, scalp, and other body parts.
• Note: Protect exposed skin from sun.

Systemic Lupus Erythematosus (SLE)

• Chronic, incurable, multi-system autoimmune disorder.

• Mechanism: Body produces antibodies against its own tissues.

• Locations: Skin, joints, kidneys, serous membranes.

• Triggers: Genetic, hormonal, and environmental factors.

• Prevalence: More common in women of childbearing age.

• Genetics: Genetic predisposition.

• Sex difference: Three times higher rate in African Americans.

• Survival rates: Increasing, with longer survival times (over 15 years) after diagnosis.

• Clinical Manifestations: Skin, joint, kidney, and serous membrane issues (not all listed).

Lupus

• Lupus is an autoimmune disorder where the body's immune system attacks its own tissues and organs.
• Anemia is a common complication of Lupus.
• Coagulopathy is a blood clotting defect, increasing risk for bleeding and clotting disorders.
• Diagnosis requires multiple tests and at least three specific criteria.
• Lupus treatment aims to relieve symptoms, induce remission, and prevent complications.
• Medications used include NSAIDs, aspirin, antimalarials (like Plaquenil), corticosteroids, anti-neoplastic drugs, and anti-infective agents.
• Annual eye exams are necessary for those using antimalarial drugs.
• Tapering high-dose corticosteroids is crucial to prevent complications.
• Moderate to severe kidney damage may necessitate peritoneal or hemodialysis.
• Therapy also includes analgesics, diuretics, and stress reduction techniques.

Pediculosis (Lice)

• Pediculosis is a parasitic skin disorder, often linked to poor hygiene and living conditions, but can affect anyone.
• Transmission via intimate contact and contaminated items like hats, clothing, and grooming supplies.
• Lice ingest blood from their host.
• Adult lice perish after a day without a blood source.
• Lice lay eggs (nits) on hair shafts or skin.
• Types include head lice (pediculosis capitis), body lice (pediculosis corporis), and pubic lice (pediculosis pubis).
• Head lice attach to hair, lay ~10 eggs daily, and survive for up to 30 days.
• Nits are commonly observed at the back of the neck and behind the ears.
• Body lice cluster around the neck, waist, and thighs; they can be found within seams of clothing.
• Pubic lice, similar to crabs, use pincers to attach to pubic hair; transmission happens via sexual contact or affected linens.
• Treatment options include over-the-counter medications (e.g., Quellada [lindane], RID [pyrethin]) and prescription medications (e.g., benzyl alcohol, malathion).
• Multiple treatments may be needed.
• Management also involves cool compresses, corticosteroid ointments, and thorough cleaning of furniture, linens, stuffed animals, and clothing.
• For children under two years old and pregnant women, petroleum jelly can be used instead of medications.

Scabies

• Scabies arises from a female itch mite that burrows into skin and lays eggs.
• Transmission is through extended contact with an infected person or their belongings (e.g., bedding, clothing).
• Commonly present in crowded or impoverished living conditions, but occurs across socio-economic groups.
• The mite burrows create light brown, thread-like lines on the skin.
• Scabies causes intense itching, especially at night, and predisposes individuals to secondary infections.
• Common locations include hands, arms, body folds, and genitalia.
• Diagnosis depends on symptoms and confirmed by skin scraping and laboratory testing.
• Treatment aligns with pediculosis protocols.
• Thorough cleaning of the house and items is vital to halt re-infection.