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Nursing Care of Clients with Common Skin Disorders Chapter 45 The Client with Psoriasis Definition – chronic – non-infective – raised reddened round plaques covered by silvery white scales – most common on scalp, arms, legs Diagnosed – skin biopsy Psoriasis The Client with Psoriasis Treatment – topical corticosteriods to decrease inflammation – phototherapy • exposure to ultraviolet light • decreases the growth rate of epidermal cells Nursing Care – Impaired skin integrity – Body Image Disturbance Infections and Infestations Bacterial Skin Infection – causative agent gram+ staph aureus – and beta-hemolytic streptococci Furuncle – boils, inflammation of hair follicle Carbuncles – group of infected hair follicles Cellulitis - localized infection of dermis Infections and Infestations Diagnosis – assessment – culture and sensitivity Treatment – antibiotics Fungal Foot Infection Fungal Infections of the Skin Tinea pedis - athlete’s foot Tinea capitis - scalp - ringworm Tinea corporis - body Candidiasis Infections – yeast like fungus, pustules, red rash – skin folds, mouth, peri areas – treatment - antifungal - nystatin, diflucan Ring Worm Inflammatory Disorders Dermatitis – inflammation of the skin characterized by erythema, pain and pruritus Contact Dermatitis – caused by hypersensitivity response or chemical irritation Treatment – topical oints and therapeutic baths Toxic Epidermal Necrolysis (TEN) Rare, life threatening disease in which the skin peels off leaves large areas of denuded skin can also occur internally to mucose membranes Treatment – ICU, Burn Unit Toxic Epidermal Necrolysis (TEN Surgery – skin graphing Fluid replacement – IV therapy, TPN Medications – Antibiotics -treat sepsis – Anelgesics - pain management Neoplastic Skin Disorders Benign lesions - moles, cysts, keloids, skin tags keratoses Malignant lesions - skin cancers – over time damage from ultraviolet radiation and chemicals – basal cell carcinoma, squamous cell and melanoma Risk Factors Environmental – ultraviolet radiation – pollution, chemicals viruses, trauma Host Factors – skin pigmentation – life style Skin Changes Normal Skin Aged Skin Sun Damaged Skin Basal Cell Carcinoma Tumor that originates from basal layer Most common but least aggressive Tend to recur but rarely metastasize Basal Cell Carcinoma Squamous Cell Carinoma Arises from squamous epithelium Occurs on exposed areas of skin More aggressive, faster growth rate Harden nodule may ulcerate and bleed Skin Cancer Model Interdisciplinary Care Labs and Diagnostics – biopsy Treatment – surgical excision – curettage and electrodesiccation – cryosurgery – radiation therapy Malignant Melanoma Arises from melanocytes is life threatening precursor lesions – atypical moles (dysplastic nevi) – congenital nevi - present at birth – lentigo freckle - tan or black mole, usually on the side of the face, slow growing Interdisciplinary Care Assessment – A = asymmetry – B = border irregularity – C = color variation – D = diameter >6mm – E = elevation Labs and Diagnostics – biopsy Interdisciplinary Care CT Scan, MRI, CXR, Bone Scan Blood work - CBC, Liver function Surgery – wide excision of lesion – regional lymph node dissection Chemotherapy and Radiation Therapy Interdisciplinary Care Nursing Care – Impaired skin Integrity – Hopelessness – Anxiety – Teaching for Home Care • wound care • avoid exposure • follow up appointments Skin Trauma Pressure Ulcer – ischemic lesions of the skin and underlying tissue caused by external pressure that impairs blood and lymph flow – ischemia causes tissue necrosis then ulcerations Causes – External pressure – Shearing Pressure areas on bed bound client Pressure Ulcers Staging – Stage 1 • intact skin • non-blanchable erythema – Stage 2 • open, partial layer skin loss • ulcer, abrasion, blister, shallow crater Pressure Ulcers Stage 3 – full-thickness, damage or necrosis to subcutaneous tissue – deep crater Stage 4 – full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, can have sinus tracts Pressure Ulcers Eschar – black, leathery necrotic skin – when is present, unable to accurately stage ulcer – needs to be debrided - surgical, wet-to-dry normal saline drsg changes. Pressure Ulcer Staging Stage ? Stage 2 Pressure Ulcer Stage ? On coccyx Stage ? On coccyx Heel Ulcer Stasis Ulcer --Venous Insufficiency Nursing Care Assessment - Identify those at risk Assessment of skin – systematic once a day Clean the skin – keep hydrated - use lotion Avoid massage over bony prominences Nursing Care Minimize exposure to moisture Avoid friction and shearing Ensure adequate nutritional intake Maintain activity level – What can you do for a client on bedrest? Measuring Pressure Ulcers Documentation Site Size Stage Appearance – color – drainage – odor Turn me Help me keep my skin intact Pressure relieving devices Hair and Nail Disorders Hirsutism – excessive body hair Alopecia – loss of hair or baldness Nail Disorders – discolored, malformed, infected or separated from underlying tissue Fungal Infection of the Toe Nail Burns – get ready for rd 3 semester