Coordinating Care for Patients With Skin Disorders PDF

Coordinating Care for Patients With Skin Disorders D ya n a Ga l l a n t , B S N , R N , C M S R N N U R S 1 3 6 , M o n day, Fe b r u a r y 3 , 2 0 2 5 , Re c o r d e d L e c t u r e H o ff m a n C h a pt e r 5 0 p. 1 1 6 8 - 1 1 8 9 Objectives Understanding Sk...

Coordinating Care for Patients With Skin Disorders D ya n a Ga l l a n t , B S N , R N , C M S R N N U R S 1 3 6 , M o n day, Fe b r u a r y 3 , 2 0 2 5 , Re c o r d e d L e c t u r e H o ff m a n C h a pt e r 5 0 p. 1 1 6 8 - 1 1 8 9 Objectives Understanding Skin Disorders: Discussing Interprofessional Management: the epidemiology, pathophysiology, and Diagnostic Evaluation: Describing Exploring the collaborative clinical manifestations of common skin diagnostic methods and results used management of bacterial infections, disorders, including bacterial infections, to confirm the presence of skin herpes simplex, fungal infections, herpes simplex, fungal infections, and disorders. and psoriasis, involving multiple psoriasis. healthcare disciplines. Nursing Care Planning: Developing Complications and Risk comprehensive nursing care plans Management: Identifying potential for patients with skin disorders, complications associated with skin incorporating pharmacological disorders and strategies for treatments, dietary modifications, prevention and management. and lifestyle interventions to promote optimal outcomes. Functions of the Integumentary System Protection Barrier from bacteria and viruses Insulation – Temperature Regulation Sensory perception Movement Vitamin D Metabolism Factors Infl uencing Our Skin NUTRITION HYDRATION AGE HYGIENE ENVIRONMENT MOBILITY LIFESTYLE MEDICATIONS Skin Infections: Uncomplicated vs Complicated Uncomplicated Complicated  No systemic symptoms  Systemic symptoms (tachycardia, fever, lethargy,  Localized signs disproportionate pain)  Localized warmth  Spreading of cellulitis (lymph  Mild to moderate pain nodes)  No changes in blood work  Edema, ischemia and tissue necrosis  Moderate pain  Elevated WBC & CRP Bacterial Skin Infections Epidemiology Pathophysiology Community or healthcare acquired Non-necrotizing Most skin and soft tissue infections are from Portal of entry through breach in skin integrity Staphylococcus aureus and Streptococcus Necrotizing pyogenes Spread rapidly and destroy tissue Methicillin-resistant Staphylococcus aureus (MRSA) infection after surgery affects up to 33% of patients Methicillin-RESISTANT Staphylococcus Aureus *MRSA* Resistant to many antibiotics Overcrowded living conditions Skin-skin contact Sharing contaminated objects Previous MRSA infections Hospital Professions Immunocompromise Poor hygiene Can also cause infection in healthy/younger patients  Impetigo Caused by strep, staph or combination. Typically aff ects face Honey colored crust, Red surrounding Tx: topical Rx antibiotic VERY CONTAGIOUS  Folliculitis Caused by staph Tender to touch Most common areas are scalp, beard, extremities Advise to use soaps like Hibiclens, Dial Tx: Topical antibiotic  May need systemic antibiotic if extensive, deep lesions  Cellulitis Caused by staph aureus or strep Hot, tender, red and swollen area with diff use borders May also have chills, malaise and fever Tx: Systemic antibiotics, elevation  Necrotizing Fasciitis  Potentially life threatening  Rapid spread  Fever, tachycardia, hypotension  Pain (disproportionate)  Disorientation  Edema  Loss of feeling: vascular occlusion  Sepsis Bacterial Skin Infections  Medical management—Diagnosis Laboratory data ‒ Culture and sensitivity, complete blood count (CBC), serum electrolytes, C-reactive protein (CRP) Biopsies Nasal swab  Complications Overuse and misuse of systemic antibiotics Necrotizing infection Bacteria Skin Infections  Nursing management—Assessment and analysis Clinical manifestations depend on organism, tissues involved, and comorbidities  Nursing interventions—Assessments Vital signs Wound and skin Complete blood count Culture results Nutritional status Bacterial Skin Infections  Nursing interventions—Actions Administer antibiotics based on culture results Wound care Surgical evaluation Bacterial Skin Infections  Nursing interventions—Teaching Hand washing Wound care Clinical manifestations of infection  Nursing management—Evaluating care outcomes Recovery of infection Herpes Simplex Virus  Epidemiology HSV-1 ‒ 60% to 95% of adults ‒ Cause of 71.2% cases of genital herpes HSV-2 ‒ 16.2% of people aged 14 to 49 Herpes Simplex Virus  Pathophysiology Primary infection—Occurs through direct contact with an individual with HSV Secondary infection—Occurs following an exogenous or endogenous trigger that reactivates the dormant virus ‒ Triggers: Ultraviolet (UV) light exposure, febrile illness, stress Herpes Simplex Virus  Clinical manifestations Fever Malaise Myalgia Anorexia Irritability Cervical or inguinal lymphadenopathy Lesions on lip, face, mucous membranes Herpes Simplex Virus  Medical management—Diagnosis Clinical presentation Virological testing Serological type-specific glycoprotein  Medical management—Treatment Systemic antiviral therapy Episodic or suppressive therapy Herpes Simplex Virus  Complications Psychosocial stress Risk factor for HIV acquisition Disseminated neonatal herpes (passed on during pregnancy) Herpes Simplex Virus  Nursing management—Assessment and analysis HSV infection may be asymptomatic  Nursing interventions—Assessments Pain and fever Oral cavity lesions Genital lesions Sexual history Skin and mucous membranes Knowledge of HSV transmission Test for pregnancy Ability to cope with diagnosis Herpes Simplex Virus  Nursing interventions—Actions Laboratory testing Administer medications as ordered Collaborate with interprofessional team Herpes Simplex Virus  Nursing interventions—Teaching Actions of antiviral medications Safe sex practices Considerations of HSV infection in pregnancy  Nursing management—Evaluating care outcomes Engages in safe sexual practices Cope with feelings of isolation and depression  Herpes Simplex Virus (HSV) Most common viral infection Two types 1.HSV 1 (cold sores) 2.HSV 2 (genital) Lifelong virus Within 2 weeks of transmission Fever Malaise Cervical/Inguinal lymph node enlargement Facial or genital lesions  Chicken Pox & Shingles varicella zoster virus Immunizations – Varicella Vaccine! Signs & Symptoms – Skin Lesions, Fever, Itching If acquired, supportive care – antivirals, antihistamines, pain  Molluscum Contagiosum poxvirus Raised, “fluid-filled” bumps Pain and Itch No antiviral treatment  Viral Skin Infections: Nursing Management Administration of Side Eff ects of antiviral medications are often antiVIRals (acyclovir, unpleasant for most patients: valacyclovir) -Severe nausea -Fatigue Assessment -Irritability “fl u-like- symptoms” Vital signs -Body aches Pain management Strict adherence to regimen, Emotional support patient compliance Education Supportive care will be needed. Fungal Infections  Epidemiology 4 million healthcare visits per year  Pathophysiology Yeasts Dermatophytes Fungal Infections  Medical management—Diagnosis History and physical Potassium hydroxide microscopy  Medical management—Treatment Antifungal agents Fungal Infections  Complications Critically ill and immunocompromised patient ‒ High mortality of invasive candida Fungal Infections  Nursing management—Assessment and analysis Careful assessment of high risk patients  Nursing interventions—Assessments Assess skin Pruritus Current and recent infections Liver function Health history Fungal Infections  Nursing interventions—Actions Meticulous hand washing Perform cultures as needed Administer antifungal medications as prescribed Cleanse incontinent episodes ASAP Separate skin folds with gauze or dressings to keep dry Fungal Infections  Nursing interventions—Teaching Avoid tight fitting clothes Clinical manifestations of fungal infections Complete antifungal infection medications as prescribed  Nursing management—Evaluating care outcomes Knowledge of clinical manifestations Avoidance of complications ‒ Bloodstream infection Tinea Capitis Location: SCALP Clinical Manifestations: 1. Scaly scalp 2. Alopecia 3. Broken hair Treatment: 4. Oral antifungals (Fluconazole) 5. Topical antifungals (Lamisil) Tinea Corporis Loc a t i on: BODY Cl i ni c a l M a ni fe sta t i ons: 1. Pa t c he s/ Pl a que s 2. Ra i se d borde rs 3. Ce ntra l c l e a ri ng Trea tm e nt : 4. Topi c a l a nt i funga l s Tinea Cruris Locat ion: GROIN (Jock itch) Clinical Manifest at ions: 1. Red/ brown plaques 2. Cent ral clear ing 3. Vesicles or pust ules to borders 4. Pr ur it is 5. Scrot um spared Treatment: 6. Topical Ant if ungals Tinea Pedis Location: Feet Clinical Manifestations 1. Maceration between toes 2. Dry scaling of soles of feet Treatment: 3. Keep feet dry/ventilated 4. Topical antifungal 5. PO antifungal  Oral Candidiasis “Oral Thrush” Location: Mouth Clinical Manifestations: 1. Creamy, white plaques 2. Thick white coating often on tongue Treatment: 3. PO antifungal swish & swallow (Nystatin) 4. PO tablet (Fluconazole)  Vaginal Yeast Infection Vulvovaginal candidiasis Location: Vagina and Vulva Clinical Manifestations: 1. Thick discharge 2. Pruritis Treatments: 3. Topical antifungals 4. Intravaginal antifungals (miconazole) 5. PO antifungals (fl uconazole)  Intertrigo Lo c a t i o n : S k i n f o l d s ( a rm p i t s , u n d e r b re a s t s / a b d o m e n ) Clinical Manifestations: 1. Maceration & Erythema 2. I t c h i n g & B u rn i n g Tre a t m e n t : 3. Eliminate causative factors 4. Separate skin folds (InterDry) 5. Ke e p s k i n d r y 6. To p i c a l A n t i f u n g a l p o w d e r s ( N y s t a t i n )  Onychomycosis Location: Nails Clinical Manifestations: 1. Ye l l o w n a i l s 2. Brittle/thick nails 3. S u b u n g u a l h y p e r ke r a t o s i s Tr e a t m e n t : 4. To p i c a l / P O a n t i f u n g a l s 5. Nail lacquer solutions 6. Laser treatments 7. Nail removal Antifungal Medications Antifungal Medications Nursing Considerations Minimal side eff ects Many antifungals are over-the-counter (OTC) available for people Antifungals can inhibit healthy bacteria growth and result in a secondary bacterial infection needing antibiotics Skin issues should always be looked at by a physician/dermatologist – fungal versus bacterial plays an important role in the treatment Psoriasis  Epidemiology 7.5 million people 2% of population  Pathophysiology Cause unknown Epidermal thickness with increased vascularity and inflammation Psoriasis  Medical management—Diagnosis No laboratory tests Clinical manifestations  Medical management—Treatment Reduce clinical manifestations Topical creams UV light therapy Systemic medications Psoriasis  Complications High risk of other diseases ‒ Cancer, cardiovascular disease, Crohn’s disease, metabolic syndrome, uveitis, liver disease Depression, anxiety Psoriasis  Nursing management—Assessment and analysis Assessment of full health history, family history, and quality of life are imperative  Nursing interventions—Assessments Vital signs Pain Skin Mood Psoriasis  Nursing interventions—Actions Administer ordered medications Monitor for side effects of treatments Topical preparations Provide emotional support Referral to counseling Psoriasis  Nursing interventions—Teaching Proper hand washing Clinical manifestations Signs of skin infection Limit sunlight exposure  Nursing management—Evaluating care outcomes Emotional support and referrals and family education will help enhance patient’s quality of life  AUTOIMMUNE – Skin Disease Psoriasis  No cure  Exacerbation & Remission  Genes, Immune system and Environment  Two types 1. Plaque psoriasis 2. Erythroderma  Can lead to psoriatic arthritis  Nursing Management  Skin assessments  Reduce symptoms  UV light therapy  Topical steroid creams  Systemic medications  Education *Dry patches can lead to open sores = risk for infection  Emotional support  Refer ral to counseling/support groups  General Skin Notes  You are the physician’s eyes  Become informed with organization’s policy on skin assessment  4-Eyed Skin Assessment  Implement orders as written  If there is a dressing, there should be an order  Assist patient in turning/repositioning  Assist patient in hygiene practices  Skin Breakdown Prevention Utilize pressure mattresses and Use pillows for arms, knees if surfaces. appropriate If possible keep HOB elevated at Moisture barriers for incontinence (IE: zinc- oxide an appropriate degree for their ointment). condition. Moisturize dry skin. If patients sits in chair a lot, use Avoid tape. Use gauze wrap if waffl e cushions or other possible. approved cushions. Focus on your Braden Scale If signifi cant bony prominences Score for Skin Breakdown use approved padded dressings RISK.