Management of Patients with Skin Disorders PDF

Presented by Keron Jones-Fraser; RN, BScN, Cert. Nsg. Ed. MScN, PhD Candidate Developed by Mrs Keron Jones-Fraser & Mrs Sylvia Morgan Following Socratic Give an overview of the Questionin...

Presented by Keron Jones-Fraser; RN, BScN, Cert. Nsg. Ed. MScN, PhD Candidate Developed by Mrs Keron Jones-Fraser & Mrs Sylvia Morgan Following Socratic Give an overview of the Questioning Integumentary System with 99% students will be accuracy able to: Following Large Overview of information can be group Discussion garnered from a health history of students will be the various conditions with 95% able to: accuracy  After small group discussion and use of worksheet able to: ◦ Explain the major condition of the Integumentary System 98% accuracy  After group collaboration students should be able to: ◦ Discuss the nursing management of clients with conditions of the integumetary system with 95% accuracy  Largest organ of the body  Provide protection to internal organs and tissue  Composed of two layers/ Regions ◦ Epidermis  Stratum Corneum  Stratum lucidum  Stratum granulosum  Stratum spinosum  Stratum basale ◦ Dermis  Superficial Fascia  Glands Protects tissue from physical, chemical and biologic damage prevent water loss stores melanin convert cholesterol to vitamin D exposure to sun contains phagocytes Regulates body Dilating and temperature constricting capillaries Nerve ending to central Transmits messages Nervous System ◦ Activity 1: ◦ WHAT ARE SOME QUESTIONS YOU WOULD ASK IN TAKING THE HEALTH HISTORY?  COMMON ◦ Pruritus ◦ Xerosis (dry Skin)  Xeroderma – Dry rough Skin  Ichthyosis _ inherited, dry, fissured, fish scales appearance Skin Infections and Infestations  Viral  Bacterial  Fungal  Paracitic Inflammatory Disorders  Dermatitis ◦ Contact ◦ Atopic ◦ Seborrheic Inflammatory Disorders  Acne ◦ Vulgaris ◦ Rosecea ◦ Conglobata  Pemphigus Vulgaris  Lichen Planus  Toxic Epidermal Necrolysis ( Stevens-Johnson syndrome) Benign Skin Tumours Cyst Seborrheic and Actinic Keratoses Verrucae: Warts Angioma Pigmented Nevi: Moles Keloids Dermatofribroma Neuofibromatosis Malignant Skin Tumours Basal cell and Squamous cell Carcinomas Malignant Melanoma Metastatic Skin Tumours Kaposi Sarcoma  Viral ◦ Herpes simplex ◦ Herpes zoster Herpes simplex (Fever or cold Herpes Zoster (Shingles sores): Viral infection of skin Dermatome section of and Mucus membranes Types: the skin. Orolabial-Hsv1 Cause Varicella virus Genital HSV 2 (Chickenpox  Tzanck Smear :  Culture of the vesicles  Antibody test Pharmacological Management Antiviral Analgesia Narcotic Non-narcotic Antihistamines  Student Activity  Work in groups to identify the possible diagnosis and interventions for these conditions Possible Nursing Diagnoses: Acute Pain Altered Comfort Impaired Skins/tissue integrity Deficient knowledge Anxiety Risk for infection Arises from hair follicle or open wounds Types Folliculitis Cellulitis Furuncles and Carbuncles Methicillin-resistant Staphylococcus aureus (MRSA) Bacterial infection of hair follicle; pustule surrounded by areas of erythema Localize infection of the dermis and subcutaneous tissue Cause : Staphylococcus aureus (S.Aureus Furuncles (Boils) deep firm, red, painful nodule. Carbuncles group of Infected hair follicle infection spread deep into dermis boils.  Dermatophytoses (Tinea) : Superficial fungal infection of the skin.  Types ◦ Tinea Capitis (Head) ◦ Tinea Corporis (body) ◦ Tinea Cruris ( groin) ◦ Tinea Pedis (foot) Tinea Capitis (Head) Tinea Corporis (body) Tinea Cruris (groin) Tinea pedis (foot) Pediculosis: Infestations of the skin by parasites Types Pediculosis Corporis (By Body Lice) Pedicolosis Pubis ( By pubic lice-crabs) Scabies Cause by mites (Scarcoptes scabiei) Inflammatory skin disorders:  covers a broad category  ranging in severity, from mild itching to grave medical health complications.   Characterized by irritation and inflammation of the skin. Dermatitis: an inflammation of the skin characterized by erythema and pain, or pruritus may be acute or chronic. Types  Contact  Atopic  Seborrheic  Exfoliative  Atopic (eczema) cause Contact: hypersensitivity unknown related to increase response to chemical histamine sensitivity; elevated IgE levels; depressed cell- irritation. Causes soap, mediated immunity. Have a perfume, dyes, latex, plant. family history of dry skin, etc allergic rhinitis, asthma. Patient may also have food allergy Seborrheic : Chronic inflammatory Exfoliative Dermatitis disorder involves the scalp, eyebrow, characterized by excessive eyelids, ear canals, nasolabial fold, peeling or shedding of the trunk and axillae. skin may be as a result of the Cause is unknown other types of dermatitis  What sign and symptoms patient would present with.  What kind of management/ treatment is the preferred choice for these conditions  What are the possible Nursing Diagnosis Signs and symptoms  Weakness, malaise,  Puritus fever, chills  Rash  Weight loss  Redness & swelling  Dehydration  Peeling of the skin  pain  Pimples/blisters  Hyper/hypopigment ation  lesion   Fluid and electrolyte  Depending on the replacement condition  Plasmapheresis  Pharmacological Possible Nursing diagnosis  Analgesic  Acute Pain  Antihistamines  Altered Comfort  Antipruritic  Impaired Skins/tissue integrity  Corticosteriods  Deficient knowledge  antibiotics  Anxiety  Risk for infection  Deficient fluid Management/ treatment Medical These kind of skin disorder are: the abnormal growth of skin cells — most often develops on skin exposed to the sun. But this common form of cancer can also occur on areas of your skin not ordinarily exposed to sunlight.  This type of malignant tumour is the  Malignancy of the endoithelial cells that line the blood vessel.  Manifested by lesions on the skin, buccal cavity and gastrointestinal tract.  Skin consist of reddish-purple lesions  dark-blue macules plaques or nodules.  Types  Classic KS ◦ Affect men of Jewish of Mediterranean ancestory  Endemic ◦ Affect people living in eastern half of Africa-near the equator  Immunosuppression-associated ◦ Transplant ◦ AIDS  Medical management is based on the type  Treatment  Based on the type and the stage  May include:  Surgery  Immunotherapy  Chemo and or radiation therapy Nursing Management  Changes in a mole  Based on assessment  Development of new data pigmented lesions  Ulceration and well Possible Nursing define borders Diagnosis  Abnormal rash  Anxiety  Nodule, waxy,  Hopelessness tranlucent  Pain  tenderness Pain  Body image  puritus disturbance  Ineffective coping  Pressure Ulcer are:  ischemic legions on the skin  occur as a result of unrelieved pressure off bony prominence (eg head, sacrum, hip, heel)  that impair the flow of blood and lymph  May appear on areas of the skin that are subject to external pressure friction of shearing forces Stage one: Skin intact, Stage 2 partial thickness ; loss of dermis, nonblanchable redness of a shallow open ulcer with a red or pink wound localized area, may be painful bed. May be a intact or open blister.   Stage 4 Full Thickness tissue loss, Full thickness skin los with subcutaneous fat may be seen exposure of bone, tendon or but not bone, tendon, muscle muscle. Slough or eschar may not be exposed. Slough (dead tissue) may be present. may be present Includes tunneling Medication  Analgesia  Antibiotics  Other medicated dressing Surgical  Debridement  Skin grafting Nursing responsibilities  Prevention  Assess clients who are at risk  Repositioning of patient 2-3hly  Use of protective devices eg egg crate mattress, heel pads etc Management of the ulcer  Wound care using aseptic technique  Administer medications  Possible Nursing Diagnosis  Acute Pain  Altered Comfort  Impaired Skins/tissue integrity  Risk for infection  Ineffective coping  Chemical : direct skin Burn is an injury heat : Thermal : dry contact with acid, resulting from the or moist alkaline agents of exposure to: organic compound Radiation: Associated Electric current with sunburn of exposure to high radiation treatment voltage or lightening of cancer bolt Classification of Burns  Determine by the depth of the burn ( layers of the underlying tissue affected).  Extent of the burn ( surface area) Superficial: Involves only Partial-thickness: involves the Epidermis and dermis; has the epidermis; pink dry; fluid fill blisters may have edema -Superficial partial thickness Partial-thickness Full-thickness: extending Deep partial-thickness to the underlying tissues. extends further into the dermis; has a pale mottled Has a waxy, white , waxy white appearance leathery , charred  Effects on the Body system:  Cardiovascular  Hypovolemic shock  Cardiac dysrhythmias  Cardiopulmonary arrest  Peripheral vascular compromise Respiratory system Inhalation injury Mild-respiratory issues to Adult Respiratory Syndrome Interstitial pulmonary edema Atelectasis Complete airway obstruction Ulceration mucosal lining Gastrointestinal Gastric distention, nausea, vomiting Hematemesis, decrease peristalsis Stress ulcer (Curlings Ulcer) Bacterial Translocation –systemic sepsis and multiple organ dsyfunction syndrome Urinary System Decrease urine output Dark Brown urine Other systems  Immune  Metabolism  Emergent or Resuscitative stages  Acute Stage  Rehabilitative  NB: Read & make notes on care in each phase  Brunner & Suddarth’s Medical surgical Nursing, 12th ed. (2010). Lippincott, Williams & Wilkins  Lemone, P., Burke, K. M., & Bauldoff, G. (2014). Medical- Surgical Nursing Critical Thinking in Patient Care (5th ed., pp. 444- 499). Edinburgh Harlow: Pearson Education Limited.