Chapter 31Dermatologic Conditions

Chapter 31Dermatologic Conditions

Types of LesionsTypes of Lesions

• Macule

• Papule

• Plaque

• Nodule

• Tumor

• Wheal

• Vesicle

• Bulla

• Pustule

• Fissure

• Ulcer

Measures to Prevent Dermatologic ProblemsMeasures 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 SurgeryPatient 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 PruritusFactors 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 PruritusMeasures 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

KeratosesKeratoses

• Definition

– Small, light gray or brown lesions on exposed areas of the skin

– Formation of a cutaneous horn due to keratin accumulation

Keratoses (cont.)Keratoses (cont.)

• Treatment

– Freezing agents and acids

– Electrodesiccation or surgical excision

– Close nursing observation for changes in keratotic lesions

Seborrheic KeratosesSeborrheic 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 KeratosesTreatment 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 MelanomasClassification 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 MelanomasDetection 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 LesionsVascular 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 UlcerNursing 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 UlcersFactors 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 UlcesrsNursing 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 UlcersStages 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 UlcersProtective 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 ConsiderationsNursing Considerations

• Promoting Normalcy

– Psychological support

– Need for normal interactions and contacts

Using Alternative Therapies 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

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).