Download Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 21

Chapter 56
Management of Patients With
Dermatologic Problems
Primary Skin Lesions
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Macule, Patch: Flat, nonpalpable skin color change
(color may be brown, white, tan, purple, red)
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Macule: <1 cm, circumscribed border
Patch: >1 cm, may have irregular border
Papule, Plaque: Elevated, palpable, solid mass
Circumscribed border
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Papule: <0.5 cm
Plaque: >0.5 cm
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Nodule, Tumor: Elevated, palpable, solid
mass. Extends deeper into the dermis
than a papule
Nodule: 0.5–2 cm; circumscribed
 Tumor: >1–2 cm; tumors do not always have
sharp borders
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Vesicle, Bulla: Circumscribed, elevated,
palpable mass containing serous fluid
Vesicle: <0.5 cm
 Bulla: >0.5 cm
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Pustule: Pus-filled vesicle or bulla
Bacterial Skin Infections/Impetigo
caused by staphylococci, streptococci, or
multiple bacteria.
 face, hands, neck, and extremities are
most frequently involved
 It is contagious and may spread to other
parts of the patient's skin or to other
members of the family who touch the
patient or use towels or combs that are
soiled with the exudate of the lesions.
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Starts as red macules, changed to thinwalled vesicles that rupture and become
covered with a loosely adherent honeyyellow crust
 Management: Antibiotics
 Complications: Acute glomerulonephritis
 Nsg: good hygiene to prevent spread of
infection to others.
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Cellulitis
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Deep infection of the skin and subcutaneous tissue
caused by Group A Strep or S Aureus
Bacteria enters through a break in the skin, then
Inflammation spreads horizontally
Warm, red, swollen and painful
Fever, malaise, chills, leukocytosis, elevated
Sedimintation Rate
Bed rest, elevation of affect part, antibiotics
Resolves in 2 weeks with TX
Folliculitis & furuncle
Folliculitis is an infection of bacterial or
fungal origin that arises within the hair
follicles.
 A furuncle (boil) is an acute inflammation
arising deep in one or more hair follicles
and spreading into the surrounding
dermis. It is a deep form of folliculitis.
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Carbuncle
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An abscess of the skin and subcutaneous tissue
that represents an extension of a furuncle that has
invaded several follicles and is large and deepseated.
Caused by a staphylococcal infection.
Appear in areas where the skin is thick and
inelastic; the back of the neck and the buttocks
are common sites.
Purulent secretions, high fever, pain, leukocytosis,
and even extension of the infection to the
bloodstream.
Herpes Zoster
Caused by the varicella-zoster virus
 Usually, patients have a history of
chickenpox. The virus becomes dormant
and lies inside nerve cells near the brain
and spinal cord
 The viruses become latent, until immunity
decrease, then it will become active. They
travel by way of the peripheral nerves to
the skin.
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Herpes Zoster
S & S: painful vesicular eruption (usually
on face, neck & thorax). Vesicles contain
serum, then become purulent.
 Treatment:
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Antiviral agents such as acyclovir (Zovirax)
 Pain is controlled with analgesics
 ? Corticosteroids
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Herpes Simplex
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Orolabial Herpes (fever blisters or cold sores)
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clusters of grouped vesicles on the lips.
The onset is often accompanied by high fever,
regional lymphadenopathy, and generalized malaise.
Genital Herpes
Minor infections may produce no symptoms
 Severe infections can cause systemic flulike
illness. Lesions appear as grouped vesicles
on the vagina, rectum, or penis.
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Fungal (Mycotic) Infections
Tinea Capitis
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Person to person transmission
Commonly known as ringworm
Affect the Scalp
Scaling area with broken hair shafts, plaques, pustules
Possible permanent hair loss
Treatment
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Oral Griseofulvin
Selenium Sulfide shampoos
Topical antifungal agents
Tinea Corporis (Body)
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Appears on face, neck,
trunk, and extremities.
From infected pets
Elevated scalilng,
erythematous, very pruritic
May spread to the hair,
scalp, or nails.
Oral Griseofulvin
Cool compresses
Antifungal cream applied 1
inch beyond lesion for 1-2
weeks until resolved
Tenia Cruris (Groin)
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Begins with small, red scaling patches, which
spread to form circular elevated plaques, very
pruritic
Clusters of pustules may be seen around
borders.
Local application of Tolnaftate liquid
Wet compresses or sitz baths may be soothing
Tenia Pedis (athlete's foot)
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Between toes and soles of the feet
Maceration and fissuring between toes
May have pinhead vesicles
Oral Griseofulvin
Antifungal powder
Eliminate heat and perspiration by clean light socks,
well ventilated shoes, avoidance of occlusive shoes
Soak feet in vinegar and water solution.
Nondermatophyte Infections
Candidiasis
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Yeast fungal infection
Glistening, fiery red or moist pink, beefy red with
satellite pustules, severe itching/burning
Sites: skin folds/groin area, oral-thrush, diaper rash
Teach prevention and management
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Disposable diapers or cloth diapers without rubber pants,
Change as soon as soiled
Exposure to open air, apply ointments (zinc oxide), avoid over
washing, caution with perfumed soaps
Psoriasis
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Chronic hereditary
disorder
Light-skinned race
Environmental factors
that trigger
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Skin injury
Infections
Hormone changes
Stress
Drugs
Alcohol
Smoking
obesity
Psoriasis Con’t.
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Erythematous
plaque with sharp
well defined borders
and silvery white
scales.
Elbows, knees,
scalp, lumbosacral
skin, can occur
anywhere
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Management
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Topical treatment
Photo-therapy
Teach reducing
pruritus
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Avoid scratching
Room humidifier
Warm not hot
bathing
Avoid strong soaps
Lubricate skin
antihistamines
Neoplasms: Malignant
Skin cancer is one of the most common
malignant neoplasms in the United States
and one of the most preventable.
 Three most common types are:
 Basal Cell Carcinoma.
 Squamous Cell Carcinoma.
 Malignant Melanoma.
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Risk factors
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Fair-skinned, fair-haired, blue-eyed people.
People who sustain sunburn
Chronic sun exposure (i.e. farmers)
Exposure to chemical pollutants
Sun-damaged skin (elderly people)
History of x-ray therapy
Scars from severe burns
Chronic skin irritations
Immunosuppression
Genetic factors
Basal Cell Carcinoma
Most frequent type of skin cancer, arises
from epidermis.
 Prolonged sun exposure, poor tanning
ability, and previous therapy with x-rays
for facial acne are associated
with it.
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Squamous Cell Carcinoma
Appears as a nodular lesion within the
epidermis.
 Risk factors include prolonged sun
exposure and exposure to gamma
radiation and x-rays.
 Without treatment, it can
metastasize and cause death.
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Malignant Melanoma
Moles have irregular shape and color.
 Malignant melanoma can metastasize to
every organ in the body through the
bloodstream and lymph system.
 Responsible for 3% of all cancer-related
deaths.
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Preventing Skin Cancer
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Avoid sun between 10
AM and 3 PM
Sunscreen cream
Reapply after
swimming, strenuous
exercises, or prolonged
sun bathing
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Lip balm
Protective clothing
Inspect skin
regularly
Nonmalignant
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Benign tumor of the skin include:
 Warts
 Lipomas (benign fatty tumors).
 Keloids (abnormal growth of scar
tissue).
 Sebaceous cysts.
 Nevi (moles).
 Angiomas (birthmarks).
Inflammatory Disorders of the Skin:
Dermatitis/Eczema
In current usage, eczema has almost
become synonymous with dermatitis,
although eczema tends to be used most
often to refer to chronic forms of
dermatitis.
 Eczema is an atopic dermatitis often
associated with rhinitis and asthma. It is a
chronic superficial inflammation that
evolves into pruritic, red, weeping, crusted
lesions.
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Contact Dermatitis
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Skin reacts to external irritants like:
 allergens (e.g. poison ivy or cosmetics).
 harsh chemical substances (detergents,
insecticides).
 metals such as nickel.
 mechanical irritations from wool or
glass fibers.
 body substances like urine or feces.
Strategies for Avoiding Contact Dermatitis
Avoid contact with causative materials.
 Avoid heat, soap, and rubbing.
 Choose bath soaps, detergents, and
cosmetics that do not contain fragrance.
 Avoid topical medications, lotions, or
ointments, except those specifically
prescribed for your condition.
 Wash your skin thoroughly immediately
after exposure to possible irritants.
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