Skin Problems Flashcards
Skin Condition?
Nursing interventions?
Xerosis (dryness): A common problem among older patients
Fine flaking of the stratum corneum
Generalized pruritus(itching)
Plan to promote comfort and prevent disruption of skin tissue integrity from vigourous scratching.
- Scratching may result in: secondary skin lesions, excoriations, infection, and lichenification (thick leathery skin, epidermis becomes hypertrophied)
What are some preventions for Dry Skin?
- Use a room humidifier during the winter months or whenever the furnace is in use.
- Take a complete bath or shower only every other day (wash face, axillae, perineum, and any soiled areas with soap daily).
- Use tepid water.
- Use a superfatted, nonalkaline soap instead of deodorant soap.
- Rinse the soap thoroughly from your skin.
- If you like bath oil, add the oil to the water at the end of the bath.
- Take care to avoid falls; oil makes the tub slippery.
- Pat rather than rub skin surfaces dry.
- Avoid clothing that continuously rubs the skin, such as tight belts, nylon stockings, or pantyhose.
- Maintain a daily fluid intake of 3000 mL unless contraindicated for another medical condition.
- Do not apply rubbing alcohol, astringents, or other drying agents to the skin.
- Avoid caffeine and alcohol ingestion.
(Ignatavicius 433)
Nursing Interventions
Cause?
Urticaria (Hives)
- Presence of white or red edematous papules or plaques of varying sizes
- Result of histamine release (allegen cause)
- causes: drugs, temperature, INFECTIONS, diseases, cancer, insect bites, FOODS
- Treat by removing triggering substances
- ØMost common foods– nuts, chocolate, fish, tomatoes, eggs, fresh berries, and milk.
ØAntihistamines
ØAvoid anything that will further cause blood vessels to dilate( hot showers, alcohol, exercise)and worsen symptoms
Nursing interventions
What is it?
Eschar
- Leave it alone—keep pressure off
ØExtnsive necrosis and thick eschar require surgical or chemical removals before debridiment with dressings can be effective.
ØMaggot therapy—once eschar has softened
What stage?
What kind of dressing would be used to treat?
Stage 2
Pressure ulcers: loss of tissue integrity caused when skin and underlying soft tissue are compressed between a bony prominence and an external surface for a period of time
- Braden Scale: Sensory perception, Moisture, Activity, Mobility, Nutrition, Friction and Sheer
Hydrophobic: (non-absorbent, waterproof) material is useful when the wound has little drainage and needs to be protected from external contamination
Hydrophilic: (absorbent) material draws excessive drainage away from the ulcer surface, preventing maceration
Nursing Interventions?
What is it?
Cellulitis:Generalized infection with either staphylococcus or streptococcus and involves the deeper connective tissue. Inflammation of the skin and subcutaneous tissue.
Nursing interventions:
ØDocument findings
ØAssess vital signs
ØCall MD
What is it?
Nursing Interventions?
Tinea Corporis
Tinea (medical name for ringworm): general term refers to group of fungal skin diseases caused by dermatophytes (type of fungus that affects skin)
Second word added indicates where the fungus is located
e.g. tinea manus (hands), tinea cruris (groin), tinea capitis (head)
What is it?
Nursing interventions?
Onychomycosis:Fungal infection affecting fingernails or toenails, and may be due to dermatophyte, yeast (Candida) or mold.
ØTinea unguium is the term used when a dermatophyte has been identified on culture.
Ø Topical antifungal preparations
ØOral antifungal medication may be required if the condition is severe.
Tinea capitis (scalp) —treated with oral antifungal medication
Nursing Interventions?
What is it?
Folliculitis: Occurs when hair follicles become infected , often with staphylococcus aureus or other types of bacteria
Usually goes away on its own (may need topical or PO antibiotics)
Teach Patients:
Reduce friction from clothing
Avoid shaving area
Warm, moist washcloth/ compress several times a day
Oatmeal lotion/ OTC hydrocortisone cream
Gently wash infected skin 2x/ day with antibacterial soap (hibiclens)/ apply OTC antibiotic ointment.
- Use clean washcloth/ towel to dry off each time.
- Don’t share towels / washcloths–launder hot, soapy water after every use.
What is it?
Nursing Interventions?
Furuncles may heal on their own after initial period of itching/ mild pain
Infections are much deeper in hair follicles.
Often– increase in discomfort as pus collects→ finally burst, drain, and heal.
- Warm moist compresses
- Deep/ large lesions may drained surgically
- Teach–never squeeze boil or cut it open
- Meticulous hygiene important.
- Draining lesions –cleaned frequently.
- Wash hands after touching a furuncle.
- Do not re-use or share washcloths or towels.
- Clothing, linens, other items that contact infected areas
- Dressings should be changed frequently
What is it?
Nursing Interventions?
Herpes Zosters
Also known as Shingles
ØIn people who have previously had chickenpox(varicella-zoster) or rarely the vaccine
ØShingles occur after the virus becomes active again in these nerves years later.
Ø Often only one attack occurs.
ØCan be contagious if person has not had chickenpox or vaccine.
ØPain can last for months or years: postherpetic neuralgia
Nursing Care:
Collaborate with MD
Extremely painful
Antivirals: Acyclovir, famciclovir, and valacyclovir may be used.
Cool wet compresses can be used to reduce pain.
Bed rest until fever goes down is recommended.
Skin should be kept clean
Person may need to be isolated while lesions are oozing to prevent infection of others – especially pregnant women.
Nursing Interventions?
What is it?
Herpes Whitlow
- Herpetic whitlow—a form of herpes simplex infection occurring on the fingertips of medical personnel who have come in contact with viral secretions
- Usually develops in an area where skin is broken ( often torn cuticle at base of fingernail)
- HSV-1 causes 60% of herpetic whitlow and HSV-2 causes remaining 40%
What is it?
Nursing Interventions?
Scabies
ØContagious skin disease caused by mite infestation: Sarcoptes scabiei.
ØTransmitted by close and prolonged contact or infested bedding.
Examine skin between fingers and on palms.
Confirmed by examination of scraping of lesion under a microscope.
Mite-killer like permethrin: (Elimite).
- Creams applied from neck down, left on overnight, then washed off.
- Usually repeated in seven days.
- Needs to be in isolation
- Antihistamines
What is it?
Nursing Intervetions?
Psoriasis
ØIs a persistent, long-lasting (chronic) disease—autoimmune reaction affecting the skin
ØNo cure exists—exacerbations and remissions
ØFor some- psoriasis is just a nuisance.— others—disabling—can be associated with arthritis
Nursing Care:
- Take daily baths.
- Use moisturizer.
- Expose skin to small amounts of sunlight (light therapy).
- Apply medicated cream or ointment.
- Avoid triggers.
- Avoid drinking alcohol.
What is it?
Nursing Interventions?
Candidiasis; Skin infected with candida fungi—usually candida albicans.
ØCommon–can involve almost any skin on body-Most often in warm, moist, creased areas
ØParticularly common in diabetics and people who are obese.
Ø_Antibiotics_ and oral contraceptives increase risk
Oral thrush–usually associated with taking antibiotics.
Candida – most frequent cause of vaginal yeast infections – extremely common– associated with antibiotics use.
Treatment: General hygiene: Keeping skin dry/exposed to air, Topical antifungal medications may be used to treat infection of skin, mouth, or vagina. May need oral antifungal medications
What is it?
Nursing Interventions?
Seborrheic Keratosis
ØOne of most common types of noncancerous skin growths in older adults
ØUsually occur over age 50—not sure of cause—tends to run in families
ØNormally painless and require no treatment–may have them removed if they become irritated by clothing or for cosmetic reasons.
Nursing Care:
Teach about treatment options
- Freezing with liquid nitrogen (cryosurgery).
- Scraping the skin’s surface with a special instrument (curettage)
- Burning with an electric current (electrocautery).
What is it?
What’s a common type of Dermatitis?
Dermatitis: Broad term meaning inflammation of skin
There are different types of dermatitis,
Can have many causes and occur in many forms→ usually involves swollen, reddened, itchy skin.
Eczema
- Atopic eczema–due to hypersensitivity reaction (similar to an allergy ) in skin→ leads to long-term inflammation.
- People with eczema often have family history of allergic conditions such as asthma, hay fever, or eczema.
Moisture everyday, wear cotton or soft fabrics. Take lukewarm baths and showers.
What is it?
Nursing Interventions?
Stevens Johnson syndrome: Thought to be a hypersensitivity complex affecting skin and mucous membranes
Causes:
ØDrug reactions (NSAIDS, antibiotics (Penicillin’s and sulfa), anticonvulsants, barbiturates, Allopurinol, cocaine)
ØViruses(herpes simplex virus (HSV), AIDS, coxsackie viral infections, influenza, hepatitis, mumps and others)
ØBacterial infections
TREATMENT:
- Skin lesions are treated as burns.
- Topical anesthetics–useful in reducing pain and helping pt. to take in fluids.
- Areas of denuded (sloughed) skin must be covered with compresses of saline or Burow solution.
- Stop cause—Underlying diseases, secondary infections, offending drugs
What is it?
Nursing Interventions?
Common Warts: Warts are small, usually painless growths on the skin caused by a virus called human papillomavirus (HPV).
Generally harmless–can be disfiguring and embarrassing– occasionally itch or hurt (particularly on the feet).
The different types of warts include:
- Common warts usually appear on the hands, but can appear anywhere.
- Flat warts are generally found on the face and forehead. They are common in children, less common in teens, and rare in adults.
- Genital warts (condyloma) are usually found on the genitals, in the pubic area, and in the area between the thighs, but they can also appear inside the vagina and anal canal.
- Plantar warts are found on the soles of the feet
- Subungual and periungual warts appear under and around the fingernails or toenails.
