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SKIN CARE for PATIENTS with SKIN

CONDITIONS

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Protecting

the skin

1. A mild-lipid free soapsubstitute is use.

2. The area is rinsedcompletely andblotted dry with a softcloth

3. Deodorant soaps areavoided

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PreventingSecondaryInfection

1.Observe standardprecautions

2.Wear gloves wheninspecting the skinor dressing iscarried out.

3. Proper disposalof anycontaminateddressing

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Reversing the

Inflammatory

Process

If the skin isacutely inflamedand oozing -wetdressings andsoothing lotions

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For chronicskin conditions

in which theskin surface isdry and scaly-

water solubleemulsions,creams,

ointments andpastes areused.

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PROCESS OF WOUND HEALING

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THREE TYPES of WOUND DRESSINGS1. Passive Dressings

- it only have a protectivefunction and maintain a

moist environment fornatural healing

- they include those that justcover the area and mayremain in place for severaldays.

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2. Interactive

- capable of absorbingwound exudates while:

1. maintain a moistenvironment in the areaof the wound

2. Allowing the

surrounding skin toremain dry

- It is thought that itmodifies the physiologyof wound environment

by modulating andstimulating cellularactivity and by releasinggrowth factor

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3.Active improve thehealing process and

decrease healing time.- it includes skin graft sand biologic skinsubstitutes.

* Both interactive andactive dressing create a

moist environment atthe interface of the

wound with the dressing

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Five Rules of Wound Care:

1. Categorization

2. Selection

3. Change

4. Evolution

5. Practice

** It is believed that the natural wound healing processshould not be disrupted. Unless the wound is infectedor has a heavy discharge, it is common covered for48-72 hours

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AUTOLYTICDEBRIDEMENT

-A process thatuses the bodys owndigestive enzymesto break downnecrotic tissue.

-The wound is keptmoist withocclusive dressings.

-Eschar and

necrotic debris aresoftened, liquefiedand separated fromthe bed of thewound

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1. Occlusive Dressing Cover topical medication that applied to skin

lesion

Areas is kept airtight by using plastic film(plastic wrap)

2. Wet Dressing Wet compresses applied to the skin.

Traditionally used for acute, weeping andinflammatory lesions

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3. Moisture-Retentive DressingCommercially prepared can performed the

same a functions a wet dressing but efficientin removing exudates, improved fibrinolysis,reduced pain, fewer infection and decreasedfrequency of dressing changes.

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Medical Management:

Therapeutic Bath (Balneotherapy)useful when large areas of skin are

affected.

Bath remove crust, scales and oldmedications

Relieve inflammation and pruritus thataccompany acute dermatoses.

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Type of Therapeutic BathsBath Solution Effects and Uses

Water - same effects as wet dressingsSaline - used for widely disseminated

lesions

Colloidal (aveeno, - antipruritic, soothing

oatmeal)

Sodiun Bicarbonate - cooling

(baking soda)

Starch - soothingMedicated tars - psoriasis and chronic eczema

Bath oils - antipruritic and emollient action,acute and subacute generalized eczema eruptions

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Nursing Interventions1. Fill the tub half full

2. Keep the water at a comfortable temperature3. Do not allow the water to cool excessively.

4. Use a bath mat, because medications added to the bathtub can cause the tub to be slippery.

5. Apply an emollient cream to damp skin after the bath iflubrication is desired.

6. Because tars are volatile, the bath area should be well

ventilated.7. Maintain a constant room temperature without drafts.

8. Encourage the patient to wear light, loose clothing afterbath.

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Pharmacologic Therapy

1. Lotions Used to replenish lost skin oils or to relieve pruritus.

Applied every 3-4 hours for sustained therapeutic effect

2 types of lotions:

1. Suspension

consist of powder in water, requiringshaking before application and clear solutions,containing completely dissolved active ingredients.

Ex. Calamine lotion

2. Liniments lotions with oil added to preventcrusting.

Because lotions are easy to use, therapeutic compliance

is generally high.

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2. Powders

dusted on the skin with a shaker or withcotton sponges.

Ex. Talc, zinc oxide, bentonite corn starch

baseActs as hygroscopic agents that absorb and

retain moisture from the air and reduce

friction between skin surface and clothingor bedding.

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3. CreamsMay be suspension of oil in water or emulsions of

water in oil, with additional ingredients to preventbacterial and fungal growth.

Oil-in-water creams are easily applied andusually are most cosmetically acceptable to thepatient.Water-in-oil emulsions are greasier and are

preferred for drying and f laking dermatoses.

Creams

are usually are rubbed into the skin byhand

They are used for their moisturizing and emollienteffects.

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4. GelsSemisolid emulsions that become liquid when applied to

the skin or scalpGreaseless and non staining

Useful for acute dermatitis.

5. PastesMixtures of powders and ointments used in inf lammatory

blistering conditions.They adhere to the skin and may be difficult to remove

without using an oil.

Applied with a wooden tongue or gloved hand.

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6. Ointment- retard water loss and lubricate andprotect the skin

- They are preferred vehicle for delivering medications tochronic and localized dry skin conditions such as eczemaand psoriasis

7. Sprays and aerosols- They evaporate on contact and are used infrequently

8. CorticosteroidsAction: 1. anti- inflammatory2. antipruritic

3. vasoconstrictive effect

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- Absorption is enhanced if the skin is well-hydrated orthe affected area is covered by an occlusive or moisture

retentive dressing- Side effects:

- A. Local side effects:

1. skin atrophy and thinning

2. striae ( bandlike streaks)

3. telangiectasia

- B. Systemic side effects:1. hyperglycemia

2. symptoms of cushing syndrome

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- CAUTION:

- this is required when applying around the eye

Glaucoma or cataract Anti-inflammatory effect may mask existing viral and

fungal infection

9. Intralesional therapy- Consist of injecting a sterile suspension of medication

into or just below a lesion.- Local atrophy may result if the medication is injectedinto subcutaneous fat.

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10.Systemic medicationsEx. Antibiotics, antifungal, antihistamine

Nursing Management:

Goals:

1. Maintenance of skin integrity2. Relief of discomfort

3. Promotion of restful sleep

4. Self-acceptance

5. Knowledge about skin care

6. Avoidance of complications

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1. Assessment

2. Teach the patient how to wash the affected area andpat it dry

3. Apply medication to the lesion while the skin ismoist

4. Cover the area with plastic if recommended andcover it with elastic bandage or paper tape to seal theedges

5. Dressings that contain or cover a topicalcorticosteroids should be removed for 12 of every 24hours.