Integumentary disorders part 2

Melanoma-appearance

irregular, circular, bordered lesion with hues of tan, black, or blue. Rapidly infiltration into tissue, highly metastatic.

Fluorouracil side effects

itching, burning, inflammation, rash, and increased sensitivity to sunlight.

Fluorouracil

A topical medication that affects DNA and RNA synthesis and causes a sequence of responses that results in healing; results usually seen in 2-6 wks but may take 1-2 months longer for complete healing.

Tacrolimus may increase risk of ?

-contracting varicella zoster infection in children -developing skin cancer and lymphoma

Erysipelas and Cellulitis Assessment

1. Pain and tenderness 2. Erythema and warmth 3. Edema 4. Fever

Erysipelas and Cellulitis Interventions

1. Promote rest of affected area. 2. Apply warm compresses as prescribed to promote circulation and to decreases discomfort. erythema, and edema 3. Apply antibacterial dressings, ointments, or gels as prescribed. 4. Administer antibiotics as prescribed for an infection; obtain a culture of the area before initiating antibiotics

topical glucocorticoids

1. antiinflammatory, antipruritic, and vasoconstrictive actions 2. preparations vary in potency and depend on the concentration and type of preparation and method of application (occlusive dressings enhance absorption, increasing the effects). 3. Systemic effects are more likely to occur with prolonged therapy and when extensive skin surfaces are treated.

Topical glucocorticoids local side and adverse effects

1. burning, dryness, irritation, itching 2. thinning of the skin, striae, purpura, telangiectasia (causes thread-like red lines on the skin) 3. skin atrophy 4. acneiform eruptions 5. hypopigmentation 6. overgrowth of bacteria, fungi, and viruses

Topical glucocorticoids systemic adverse effects ?

1. growth retardation in children 2. adrenal suppression 3. cushing's syndrome 4. ocular effects (glaucoma and cataracts)

Skin cancer Treatments

1. instruct client regarding risk factors and preventative measures. 2. Instruct client to perform monthly skin self-assessments and to monitor for lesions that do not heal or that change characteristics 3.Advise client to have moles or lesions that are subject to chronic irritation removed. 4. Advise client to avoid contact with chemical irritants. 5. Instruct client to wear layered clothing and use and reapply suncreen with an appropriate sun protection factor when outdoors. 6. Instruct client to avoid sun exposure between 10 am and 4pm. 7. Management may include surgical or nonsurgical interventions; if medication is prescribed, provide instructions about its use. 8. Assist with surgical management (cryosurgery, curettage, and electrodessication, or surgical excision of the lesion

Diclofenac Sodium

1. nonsteroidal antiinflammatory topical medication; may take up to 3 months to be effective. 2. adverse effects= dry skin, itching, redness, and rash.

Poison Ivy, Poison Oak, and Poison Sumac

A dermatitis that develops from contact with urushiol from poison ivy, oak, or sumac plants.

A client is being admitted to the hospital for treatment if acute cellulitis of the lower left leg. During the admission assessment, the nurse expects to note which finding?

A skin infection of the dermis and underlying hypodermis.

A client arriving at the emergency dept has experienced frostbit to the right hand. Which finding would the nurse note on assessment of the client's hand?

A white color to the skin, which is insensitive to touch.

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times?

At least 30 minutes before exposure to the sun

A client calls the emergency dept and tells the nurse that he came directly into contact with poison ivy shrubs. The client tells the nurse that he cannot see anything on the skin and asks the nurse what to do. The nurse should make which response?

"Take a shower immediately, lathering and rinsing several times."

Silver sulfadizaine is prescribed for a client with a partial-thickness burn, and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments?

"The medication is likely to cause stinging every time it is applied."

The nurse manager is planning the clinical assignments for the day. Which staff members cannot be assigned to care for a client with herpes zoster? SATA

The nurse who never had chickenpox. The nurse who never received the varicella-zoster vaccine.

Salicylic acid is prescribed for a client with a dx of psoriasis . The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity form this medication?

Tinnitus

Acne products

Topical Antibiotics -Benzoyl peroxide -Clindamycin & erythromycin -Clindamycin/tretinoin combination gel -Dapsone -Fixed dose cominations: Clindamycin/benzoyl peroxide and erythromycin/ benzoyl peroxide Topical Retinoids -Adapalene -Azelaic acid -Tazarotene -Tretinoin Oral Medications -Doxycycline -Erythromycin -Isotretinoin -Minocycline -Tetracycline Hormonal Medications -Oral contraceptives -Spironolactone

Medications to treat psoriasis

Topical medications -Calcipotriene -Coal tar -Glucocorticoids -Keratolytics (topical salicylic acid; sulfur) -Tazarotene Systemic medications -Acitretin -Cyclosporine -Methotrexate Systemic Biological Medications -Adalimumab -Brodalumab -Etanercept -Guselkumab -Infliximab -Ixekizumab -Ustekinumab -Secukinumab Phototherapy -Coal tar UVB irradiation -Photochemotherapy (psoralen & UVA therapy)

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?

Triglyceride level

Stevens-Johnson Syndrome is similar to?

Similar to toxic epidermal necrolysis (TEN). TEN-medication induced akin reaction that results in diffuse erythema, and large blister formation on the skin and mucous membranes.

A client with severe acne is seen in the clinic and the PHCP prescribes isotretinoin. The nurse reviews the client's medication record and would contact the PHCP if the client is also taking which medication?

Vitamin A

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for follow-up by the nurse?

WBC count of 3000 mm3

Basal Cell carcinoma-appearance

Waxy nodule with pearly borders. Papule, red, central crater. Metastasis rare

Stage I pressure injury

Skin intact. Area red and does not blanch with external pressure. Areas may be painful, firm, soft, warmer, or cooler compared with adjacent tissue

MRSA Assessment

a culture and sensitivity test of the skin or would confirms presence of MRSA and leads to appropriate antibiotic therapy.

The staff nurse reviews the nursing documentation in a client's chart and notes that the wound care nurse has documented that the client has stage II pressure injury in the sacral area. Which finding would the nurse expect to note on assessment of the client's sacral area?

Partial-thickness skin loss of the dermis.

Skin disorders

Psoriasis -chronic skin disease which results in scaly, often itchy areas in patches. Urticaria (hives)-rash with red itchy bumps as a result of allergic reactions of the body. Eczema (atopic dermatitis)-characterized by red, itchy rashes. Lichen planus- Characterized by lesions caused by an inflammatory condition. Acne (pimples)- condition resulting from clogged or plugged pores present under the skin. Vitiligo (leucoderma)- condition in which the melanocytes, the pigment cells of the skin, are destroyed causing affected areas to turn pale. Often seen as patches of white skin.

suspected deep tissue injury

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.

Actinic Keratoses

Caused by chronic sun exposure. Appears rough, scaly, red, or brown lesions usually on face, scalp, arms, back of hands.

Stage III pressure injury

Full-thickness skin loss extends into the dermis and subcutaneous tissues, and slough may be present. Subcutaneous tissue may be visible. Undermining and tunneling may or may not be present

Stage IV pressure injury

Full-thickness skin loss is present with exposed bone, tendon, or muscle Slough or eschar may be present. Unermining and tunneling may develop.

unstable pressure ulcer

Full-thickness tissue loss in which wound bed is covered by slough and/or eschar True depth, and stage of wound cannot be determined until slough and/or eschar is removed to visualize the wound bed

The nurse is applying a topical corticosteroid to client with eczema. The nurse understands that if is safe to apply the medication to which body areas? SATA

1. Back 4. Soles of feet 5. Palms of the hands

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid to treat acne. The nurse determines that which client complaint may be associated with use of this medication?

Itching

A client returns to the clinic for follow-up treatment after a skin biopsy of a suspicious lesion performed 1 wk ago. The biopsy report indicates that the lesion is a melanoma. The nurse understands that the melanoma has which characteristics? SATA

Lesion is highly metastatic. Lesion is a nevus that has changes in color.

Burn products

Mafenide acetate Silver sulfadiazine Bacitracin topical ointment (1st degree burns only) Povidone-iodine

Stevens-Johnson Syndrome (SJS)

Medication-induced reaction that occurs through an immunological response; common medications causing the reaction include antibiotics (especially sulfonamides), antiseizure medications, and NSAIDS.

Stevens-Johnson Syndrome manifestations

Mild-severe, may cause vesicles, erosions and crusts on the skin. If severe systemic reactions occur that involve the respiratory ststem, renal system, and eyes, resulting in blindness. can be fatal. Initial s/s- flu like symptoms, and erythema of the skin and mucous membranes. Serious systemic s/s and complications occur when ulcerations involve the larynx, bronchi, and esophagus. Most commonly occurs in clients who have impaired immune system.

Erysipelas

acute, superficial, rapidly spreading inflammation of the dermis and lymphatics caused by group A Streptococcus, which enters via abrasion, bite, trauma, or wound.

Basal Cell cancer

arises from the basal cells contained in the epidermis; metastasis is rare, nut underlying tissue destruction can progress to organ tissue.

Topical glucocorticoids contraindicated in ?

1. previous sensitivity to corticosteroids 2. current systemic fungal, viral, or bacterial infections 3. current complications r/t glucocorticoid therapy.

The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? SATA

2. Use sunscreen when participating in outdoor activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. 5. Examine your body monthly for any lesions that may be suspicious.

Why do you NOT massage a reddened skin area (pressure injury)?

can damage capillary beds and cause tissue necrosis.

Furuncles

caused by Staphylococcus and occurs deep in the follicle, presenting as very painful large, raised bumps that may or may not have a pustule.

SJS treatment

immediate dc of medication causing the syndrome; antibiotics, corticosteroids, and supportive therapy may be necessary.

Cellutlitis

infection of the dermis and underlying hypodermis; the causative organism is usually group A Streptococcus or Staphylococcus aureus.

Actinic Keratoses lesions

lesions considered premalignant, risk for slow progression to squamous cell carcinoma.

Skin Cancer

malignant lesion of the skin that may or may not mesastisize

Melanoma

may occur any place on the body, especially where birthmarks or new moles are apparent; it is highly metastatic to the brain, lungs, bone, and liver, with survival depending on early diagnosis and treatment.

Actinic keratoses treatment

medications, excision, cryotherapy, curettage, and laser therapy

Preferred treatment for dermatitis

moisturizer and topical glucocorticoids

Squamous cell carcinoma-appearance

oozing, bleeding, crusting lesion. Potentially metastatic. Larger tumors associated with higher risk for metastasis.

Skin Cancer causes

over exposure of the sun-primary cause. Other causes and conditions that place individual at risk include chronic skin damage from repeated injury and irritation (tanning, tanning bed use, genetic predisposition, ionizing radiation, light-skinned race, older than 60 years of age, outdoor occupation, and exposure to chemical carcinogens.

Oral corticosteroids may be prescribed for severe reactions, and an antihistamine (DIPENHYDRAMINE) may be prescribed for what?

poison ivy

Topical immunosuppressants (Tacrolimus & Pimecrolimus creams) ADVERSE EFFECTS

redness, burning, and itching; causes sensitization of the skin to sunlight. Treated areas should be protected from direct sunlight.

MRSA CONTAGIOUS

spread by contact with infected skin or infected articles

Folliculitis

superficial infection of the follicle caused by Staphylococcus and presents as a raised red rash and pustules

Squamous cell cancer

tumor of the epidermal keratinocytes and can infiltrate surrounding structures and metastasize to lymph nodes.

Poison Ivy, Oak, and Sumac Assessment & Interventions

Assessment 1. Papulovesicular lesions 2. Severe pruritus Interventions 1. Cleanse skin of the plant oils immediately. 2. Apply cool, wet compresses to relieve itching. 3. Apply topical products to relieve itching and discomfort.

Skin cancer types

Basal cell, Squamous cell, Melanoma

Poison Ivy Treatment (meds)

Bentoquatam- preventative use Calamine lotion Hydrocortisone Zinc acetate; isopropanol Zinc acetate; isopropanol; benzyl alcohol

Methicillin-resistant Staphylococcus aureus (MRSA)

Description 1. Skin or wound becomes infected with MRSA. Community acquired (sports [skin-to-skin] contact and sharing equipment) or hospital acquired (surgical site infection [SSI]). 2. MRSA screening-nasal swab. Positive clients isolated. 3. mild-severe. can present as folliculitis or furuncles. 4. if MRSA infects the blood, sepsis, organ damage, and death can occur.

Medications to treat actinic keratosis

Diclofenac sodium 3% gel Fluorouracil Imiquimod 5% cream Ingenol mebutate

A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client knowing which finding indicates that a systemic effect has occurred?

Hyperventilation

The clinic nurse notes that the HCP has documented a dx of herpes zoster (shingles) in the client's chart. Based on an understanding of the cause of the disorder, the nurse determines that this definitive dx was made by which dx test?

Positive culture results

Stage II pressure injury

Skin not intact. Partial-thickness skin loss of the dermis occurs. Presents as a shallow open ulceration with a red-pink wound bed or as intact or open/ruptured serum-filled blister.

Medications to treat dermatitis

Systemic Immunosuppressants -Azathioprine -Cyclosporine -Methotrexate -Oral glucocorticoids Topical Immunosuppressants -Pimecrolimus 1% cream -Tacrolimus

The clinic nurse assesses the skin of a client with psoriasis after the client has used a new topical treatment for 2 months. The nurse identifies which characteristics as improvement in the manifestations of psoriasis? SATA

Thinner and decrease in number of reddish papules Scarce amount of silvery-white scaly patches on the arms.

MRSA interventions

1. Maintain standard precautions and contact precautions as appropriate to prevent spread of infection 2. Monitor client closely for signs of further infection, which may result in systemic illness or organ damage. 3. Administer antibiotic therapy as prescribed.