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Chapter 31
Dermatologic Conditions
Types of Lesions
• Macule
• Vesicle
• Papule
• Bulla
• Plaque
• Pustule
• Nodule
• Fissure
• Tumor
• Ulcer
• Wheal
Measures to Prevent Dermatologic
Problems
• Avoid drying agents, rough clothing, highly starched
linens; other irritants.
• Promote activity.
• Use bath oils, lotions, and massages.
• Avoid excessive bathing.
• Promote early treatment of pruritus and skin lesions.
• Avoid exposure to UV rays.
Patient Teaching Regarding Cosmetic
Surgery
• Encourage all persons to look their best.
• Emphasize fact that no cream, lotion, or miracle drug will
remove wrinkles and lines.
• Encourage the use of cosmetics.
• Be informed of the various types of surgical
interventions.
• Explore patients’ reasons for seeking cosmetic surgery.
Factors Contributing to Pruritus
• Excessive bathing and dry heat
• Certain Diseases
– Diabetes, arteriosclerosis, hyperthyroidism, uremia,
liver disease, cancer, pernicious anemia
• Certain psychiatric problems
Measures to Relieve Pruritus
• Bath oils, moisturizing lotions, and massage
• Vitamin supplements and a high-quality, vitamin-rich diet
• The topical application of zinc oxide
• Antihistamines and topical steroids
Keratoses
• Definition
– Small, light gray or brown lesions on exposed areas
of the skin
– Formation of a cutaneous horn due to keratin
accumulation
Keratoses (cont.)
• Treatment
– Freezing agents and acids
– Electrodesiccation or surgical excision
– Close nursing observation for changes in keratotic
lesions
Seborrheic Keratoses
• Dark, wartlike projections on various parts of the body
– May be as small as a pinhead or as large as a
quarter.
– Tend to increase in size and number with age.
Treatment of Seborrheic Keratoses
• Small Seborrheic Keratoses
– Abrasive activity with a gauze pad containing oil may
remove them.
• Larger, Raised Lesions
– Can be removed by freezing agents or by a curettage
and cauterization procedure.
Classification of Melanomas
• Lentigo Maligna Melanoma: black, brown, white, or
red pigmented flat lesion on sun-exposed areas of the
body.
• Superficial Spreading Melanoma: appears as
variable-pigmented plaque with an irregular border.
• Nodular Melanoma: found on any body surface; a
darkly pigmented papule that increases in size over time.
Detection and Treatment of Melanomas
• Detection
– Self inspection
– Early detection improves the prognosis.
– Evaluate and biopsy suspicious lesions.
• Treatment
– Usually excised with removal of some of the
surrounding tissue and subcutaneous fat.
– Some physicians recommend removal of all palpably
enlarged lymph nodes.
Vascular Lesions
• Cause
– Age-related changes weaken the walls of the veins.
– Weakened vessel walls cause varicose veins.
• Edema of the lower extremities
• Poor tissue nutrition
• Legs gain a pigmented, cracked, and exudative
appearance.
Nursing Measures for Stasis Ulcer
• Control of infection
• Good nutrition
• Assistance with weight reduction
• Elevation of legs
• Prevention of interferences to circulation
Factors Affecting Older Adult’s Risk for
Pressure Ulcers
• Skin that is fragile and damages easily
• A poor nutritional state
• Reduced sensation of pressure and pain
• Affected by immobile and edematous conditions
contributing to skin breakdown
Nursing Measures to Prevent Pressure
Ulcesrs
• Avoid unrelieved pressure.
• Encourage activity or turning of the dependent patient.
• Avoid shearing forces.
• Recommend a high-protein, vitamin-rich diet.
• Promote good skin care.
Stages of Pressure Ulcers
• Stage 1: a persistent area of skin redness (without a
break in the skin); does not disappear when pressure is
relieved.
• Stage 2: a partial thickness loss of skin layers involving
the epidermis; presents clinically as an abrasion, blister
or shallow crater.
• Stage 3: a full thickness of skin is lost extending through
the dermis and exposing the subcutaneous tissues.
• Stage 4: a full thickness of skin and subcutaneous tissue
is lost, exposing muscle, bone, or both.
Protective Measures for Various Stages of
Pressure Ulcers
• Hyperemia: protect the skin with a product such as
Duoderm (Squibb) or Tegasorb (3M) before applying the
adhesive.
• Ischemia: protect with Vigilon, which contains water
and is soothing to the area.
• Necrosis: requires a transparent dressing that protects
from bacteria but is permeable to oxygen and water
vapor; irrigation is essential during dressing changes.
• Ulceration: debridement is essential.
Nursing Considerations
• Promoting Normalcy
– Psychological support
– Need for normal interactions and contacts
Using Alternative Therapies
• Aloe vera for minor cuts and burns
• Witch hazel for bruises and swelling
• Homeopathic remedies
• Acupuncture
• Biofeedback
• Guided imagery
• Relaxation exercises
• Nutritional supplements
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).