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 3rd semester