Adult Health 1: Management of Patients With Dermatologic Problems
What is Psoriasis?
A chronic, noninfectious inflammatory disease of the skin in which epidermal cells are produced at an abnormally rapid rate Improves and recurs; a lifelong condition May be aggravated by stress, trauma, seasonal and hormonal changes Treatment: baths to remove scales and medications
What is Kaposi"s Sarcoma?
A malignancy of endothelial cells that line the blood vessels: dark reddish-purple lesions of the skin, oral cavity, GI tract, and lungs
How do each types of skin cancer present?
A small papule with a dry, rough scale would be actinic keratosis, which can be a precancerous skin lesion. A firm, nodular lesion topped with crust is usually a sign of squamous cell carcinoma. A pearly papule with a central crater and a waxy border is a lesion expected with basal cell carcinoma. An irregularly shaped lesion is common with melanomas.
How should Psoriasis be assessed?
Appearance of the skin Coping of the patient with condition Note impact of the disease on patient activities and interactions
How should patient's with blistering diseases be assessed?
Appearance of the skin Monitor VS frequently and assess for signs and symptoms of infection Pain, pruritus, and discomfort Coping of the patient with condition Note impact of the disease on patient activities and interactions
What are infectious diseases of the skin?
Bacterial infections: Impetigo Folliculitis, furuncles, and carbuncles Viral infections: Herpes zoster Herpes simplex: orolabial, genital Fungal infections: tinea pedis, tinea coporis, tinea capitis, tinea cruris, tinea unguium
What is impetigo?
Bacterial skin infection Highly contagious Affects mainly infants and children Appears as red sores on face (nose and mouth) and hands and feet. Sores burst and develop honey-colored crusts Treated with Antibiotics
What are the types of skin cancer?
Basal cell carcinoma Most common type and most successfully treated because tumors remain localized Squamous cell carcinoma Prognosis depends upon presence of metastasis Treatment involves eradication of the tumor
How should Pediculosis Corporis and Pubis be managed?
Bathe in soap and water and apply prescription scabicide or OTC permethrin (NIX). If eyelashes are involved, Vaseline may be applied twice a day for 8 days. Mechanically remove any nits. All family members and sexual contacts must be treated and instructed regarding personal hygiene. All clothing and bedding must be washed in hot water or dry cleaned. Patient and partner should also be scheduled for checkup to assess for coexisting sexually transmitted disease.
What is Herpes Zoster (Shingles)?
Chickenpox and shingles Painful Band, strip or small area on one side of body Elderly and immunecompromised Shingles occur chickenpox virus reactivates Virus dormant in nerve roots Can't get shingles from someone but can possibly get chickenpox
What patient education should be provided about Pediculosis Capitis (Head Lice)?
Head lice may infest anyone and are not a sign of uncleanliness. Instruction in use of shampoo (lindane [Kwell] or pyrethrin [RID]) and combing of hair with fine-tooth comb dipped in vinegar to remove all nits Note lindane may have toxic effects and must be used only as directed. All articles of clothing and bedding must be disinfected, washed in hot water, or dry cleaned. Furniture and floors should be frequently vacuumed. Do not share combs, hats, and so on. All family members and close contacts must be treated.
What patient education should be provided about viral infections?
Herpes zoster: instruction regarding prescribed antiviral medications, lesion care, dressings, and hand hygiene Herpes simplex: instruction regarding prescribed antiviral medications and prophylactic medication use, instruction regarding spread of herpes, and measures to reduce contagion of partner or of neonates born to mothers with genital herpes
What are goals for patients with Psoriasis?
Increased understanding of psoriasis and the treatment regimen Achievement of smoother skin with control of lesions Development of self-acceptance Absence of complications
What are potential complications of facial reconstructive surgery?
Infection Bleeding and hematoma formation Compromised circulation of flap and tissue necrosis
What are complications of Psoriasis?
Infection Psoriatic arthritis
What are potential complications of blistering diseases in patients?
Infection and sepsis Fluid volume deficit and electrolyte imbalance
What interventions should be provided to a patient with Stevens-Johnson Syndrome?
Maintaining skin and mucous membrane integrity Attaining fluid balance Preventing hypothermia Relieving pain Prevent infection, consider reverse isolation Reducing anxiety Monitoring and managing potential complications Promoting home and community-based care
What are causes of Stevens-Johnson Syndrome?
Medication: Antigout medications, Nonsteroidal anti-inflammatory drugs, Penicillins and sulfonamides, Anticonvuslsants, Sertraline (Zoloft) Infectious: Herpes (simplex and zoster), Influenza, HIV, Diphtheria, Typhoid, Hepatitis
What are potential complications of melanoma?
Metastasis Infection of surgical site
What are interventions for patient's with blistering diseases?
Meticulous oral hygiene Avoid commercial mouthwashes Keep lips moist with lip balm, petroleum, or lanolin Cool mist humidified air Cool, wet dressing or baths; hygiene measures Apply powder liberally to keep skin from adhering to sheets Monitor for and prevent hypothermia Skin care may be similar to that of the patient with extensive burns Measures to prevent secondary infections Encourage adequate fluid and nutritional intake
How should a patient with facial reconstructive surgery be assessed?
Emotional responses Coping mechanisms and support Patient knowledge and understanding Assess family, coping, knowledge, and support Ineffective airway clearance (most important nursing diagnosis)
How can skin cancer be prevented?
Frequently related to sun exposure—prevention: use of sunscreen and avoid sun exposure Incidence is increasing Prevention of all types of skin cancer involves protection from excessive sun exposure
What patient education should be provided about bacterial infections?
Impetigo is contagious and may spread to other parts of patient's body or to other persons. Patient education regarding antibiotics, hygiene, and skin and lesion care. Don't share towels, combs, and so on. Bathe daily with antibacterial soap. Furuncles, boils, or pimples should never be squeezed.
How should a patient with melanoma be assessed?
Inspect skin carefully Ask specific questions about pruritus, tenderness, pain, changes in moles, or new pigmented lesions Assess knowledge level and risk factors Assess coping and anxiety Remember ABCDE
What patient education should be provided about fungal infections?
Instruction regarding medications, use of oral and topical agents, and shampoos Instructions regarding hygiene: use clean towels and washcloths every day Do not share towels, combs, and so on. Keep skin folds and feet dry. Wear clean, dry, cotton clothing, including underwear and socks; avoid synthetic underwear, tight-fitting garments, wet bathing suits, and plastic shoes. Avoid excessive heat and humidity. Hair loss associated with tinea capitis is temporary.
What patient education should be provided about scabies?
Itch Mite causing itching small red raised spots Mite frequently involves fingers and hands; contact may spread infection. Health care personnel should wear gloves when providing care until infection is ruled out. Instruct patient to take a warm, soapy bath; allow skin to cool; and apply prescription scabicide lindane, crotamiton, or 5% permethrin to entire body, not including the face or scalp. Leave on for 12 to 24 hours. Wash clothing and bedding in hot water and dry in a hot dryer. Treat all contacts at the same time. Repeat the treatment in 1 week to prevent reinfestation Pruritus may continue for several weeks and does not mean retreatment is required.
What is the goal of nursing care for patients with skin disorders?
Objectives of therapy are to prevent additional damage, prevent secondary infection, reverse inflammatory processes, and relieve symptoms. Nursing care includes administration of topical and systemic medications, wound care and dressings, and providing for patient hygiene. Nursing care also needs to address the educational, emotional, and psychosocial needs of the patient.
What interventions are used in patient's with melanoma?
Pain: provide appropriate analgesics and measures to promote comfort Provide emotional support, allow patient to express feelings, clarify misconceptions and supply information, support coping, involve family in discussion
What interventions should be provided for facial reconstructive surgery?
Patient and family education and support Monitor airway and for signs of hypoxia Keep head slightly elevated to minimize edema Provide analgesics as prescribed Maintain aseptic technique Provide frequent, gentle oral hygiene Monitor nutritional status: I&O, weight, serum protein, and electrolyte levels. Provide individualized nutritional care. Address communication needs preoperatively; use pencil and paper, pictograph board, or other methods as needed; referral to speech therapy. Provide emotional reassurance and support. Encourage socialization as appropriate.
What are interventions for patients with Psoriasis?
Patient education regarding the disease, skin care, and treatment regimen Measures to prevent skin injury: avoid picking or scratching Measures to prevent skin dryness: use of emollients, avoid excessive washing, and use warm (not hot) water, pat dry Use of the therapeutic relationship for support and to aid coping
What is Melanoma?
Peak incidence: 20 to 45 years of age Types: superficial spreading, lentigo-maligna melanoma, nodular melanomas Treatment: surgical excision, other therapies
What are parasitic skin infections?
Pediculosis (lice): pediculosis capitis, pediculosis corporis, Phthirus pubis Scabies (mites): Sarcoptes scabei
What patient education should be provided about Pediculosis Corporis and Pubis?
Pediculosis corporis is a disease related to poor hygiene and of those who live in close quarters. Cutaneous condition caused by body lice (lay eggs in seams of clothing) Pediculosis pubis is common and spread chiefly by sexual contact. Pthirus pubis infecting pubic hair
What is Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis?
Rare, serioous, hypersensitivity reaction to medication or infection Can be mild or affect numerous body areas Oral, nasal, eye, vagina, urethral, GI, lower respiratory tract, mucus membranes
What are goals for a patient with melanoma?
Relief of pain and discomfort Reduced anxiety and depression Increased knowledge of early signs of melanoma Absence of complications
What are goals for patient's with blistering diseases?
Relief of pain and discomfort for lesion Skin healing Reduced anxiety Improved coping Absence of complications
What are potential complications of Stevens-Johnson Syndrome?
Sepsis Conjunctival retraction, scars, and corneal lesions
How should a patient with Stevens-Johnson Syndrome be assessed?
Skin inspection Oral cavity inspection Vital signs Respiratory secretions Fatigue Pain level Coping mechanism
