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Nursing Care of Patients with Skin Disorders: Pressure Ulcers, Dermatitis, Psoriasis, Herpes, Fungal Infections

This chapter provides an overview of the nursing care for patients with various skin disorders including pressure ulcers, dermatitis, psoriasis, herpes, and fungal infections. It covers the pathophysiology, risk factors, prevention strategies, diagnostic methods, and therapeutic interventions for each condition.

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Nursing Care of Patients with Skin Disorders: Pressure Ulcers, Dermatitis, Psoriasis, Herpes, Fungal Infections

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  1. Chapter 54 Nursing Care of Patients with Skin Disorders

  2. Pressure Ulcers • Pathophysiology • Pressure Against Skin • Tissue Anoxia • Etiology • Pressure • Friction • Shear

  3. Risk Factors • Immobility • Impaired Circulation • Impaired Sensory Perception • Elderly • Very Thin or Obese

  4. Prevention • Assess Daily • Cleanse and Dry Daily and PRN • Lubricate Daily • Clean Incontinence Promptly • Use Moisture Barrier PRN • Do Not Massage Reddened Areas • Shift every Weight every 15 min

  5. Prevention (cont’d) • Turn/Reposition at Least every 2 hr • Keep Heels Off Bed • Pad/Protect Bony Prominences • Use Pressure-Reducing Mattress • Use Lift Sheet to Move • Provide Nutrition and Hydration

  6. Braden Scale • Sensory PerceptionMoisture • Activity • Mobility • Nutrition • Friction and Shear

  7. Signs and Symptoms • Pain • Open Ulcerated Area • Color Tip • Black: Necroses • Yellow: Infection • Red: Healing

  8. Diagnosis • Physical Examination • Culture and Sensitivity • Blood Supply Studies • Wound Biopsy

  9. Therapeutic Interventions • Remove All Pressure • Debride • Mechanical • Enzymatic • Autolytic • Surgical • Cleanse • 4 – 15 PSI

  10. Dressings • Types • Hydrogel • Polyurethane Film • Hydrocolloid Wafer • Biological • Alginate • Gauze • Moist Environment • Caution with Tape

  11. Negative Pressure Wound Therapy

  12. Stages • Deep Tissue Injury • I – Skin Intact, Red, Does Not Blanch • II – Partial Thickness Skin Loss • III – Full Thickness Skin Loss, May Have Eschar • IV – Damage to Muscle, Bone, or Support Structures • Unstageable

  13. Stages (cont’d)

  14. Nursing Diagnoses • Impaired Skin Integrity • Risk for Infection • Pain

  15. Dermatitis • Pathophysiology • Inflammation of the Skin • Etiology • Allergens • Irritants • Heredity • Stress

  16. Types of Dermatitis • Contact • Irritant • Allergic • Atopic • Seborrheic

  17. Signs and Symptoms • Rash, Itching • Lesions • Scales • Crusts • Fissures • Macules • Papules • Pustules

  18. Complications • Infection • Sepsis

  19. Diagnosis • History and Physical • Culture and Sensitivity

  20. Therapeutic Interventions • Antihistamines • Analgesics • Antipruritics • Steroids • Colloidal Oatmeal Baths • Wet Dressings

  21. Nursing Diagnoses • Impaired Skin Integrity • Disturbed Body Image • Deficient Knowledge

  22. Psoriasis • Pathophysiology • Inflammatory Disorder • Proliferation of Epidermal Cells • Scaling

  23. Aggravating Factors • Stress • Strep Pharyngitis • Hormone Changes • Cold Weather • Skin Trauma • Some Drugs

  24. Signs and Symptoms • Papules, Plaques • Silvery Scales • Itching

  25. Complications • Infection, Fever, Chills • Arthritis • Nail Changes • Lymphadenopathy

  26. Diagnosis • Physical Assessment • Rule Out Infection

  27. Therapeutic Interventions • Tub Baths • Corticosteroids • Salicylic Acid • Keratolytics • Vitamin D Creams • Retinoids • Coal Tar, Anthralin • UV Light • Chemotherapy • Occlusive Dressings • Fish Oil Supplements

  28. Herpes Simplex • Pathophysiology • Viral Infection • HSV1 – Above Waist • HSV2 – Below Waist

  29. Herpes Simplex (cont’d) • Primary Infection • Direct Contact • Respiratory Droplet • Fluid Exposure • Lies Dormant • Recurs with Stress

  30. Signs and Symptoms • Prodromal Phase • Burning, Tingling • Vesicles and Pustules • Burning, Itching, Pain • Contagious Until Scabs Form

  31. Diagnosis • History and Physical • Culture

  32. Therapeutic Interventions • Antiviral Agents (Acyclovir/Zovirax) • Topical • Oral • Antibiotics for Secondary Infection • Avoid Triggers of Recurrence

  33. Herpes Zoster (Shingles) • Pathophysiology • Acute Inflammation/Infection • Painful Vesicules • Follows Nerve Distribution • Usually One-sided

  34. Etiology • Reactivation of Varicella Zoster Virus (Chickenpox Virus) • Occurs with Reduced Immune Function • Elderly • AIDS • Immunosuppressed

  35. Prevention • Avoidance of Infected Persons • Varicella Vaccine (Varivax) • Zostavax

  36. Signs and Symptoms • Vesicles, Plaques • Irritation • Itching • Fever • Malaise • Pain

  37. Complications • Postherpetic Neuralgia • Persistent Dermatomal Pain • Hyperesthesia • Opthalmic Herpes Zoster • Sepsis

  38. Diagnosis • History and Physical • Culture

  39. Therapeutic Interventions • Acyclovir • IV, Oral, Topical • Analgesics • Anticonvulsants/Antidepressants • Antihistamines • Corticosteroids • Antibiotics for Secondary Bacterial Infection

  40. Fungal Infections • Pathophysiology/Etiology • Direct Contact with Fungus • Overgrowth with Antibiotic Therapy • Grows in Warm Moist Environment

  41. Types • Tinea Pedis • Tinea Capitas • Tinea Corporis • Tinia Cruris • Candidiasis

  42. Therapeutic Interventions • Keep Skin Clean and Dry • Topical Antifungals • Oral Antifungals • Corticosteroids • Teach to Avoid Spread

  43. Cellulitis • Pathophysiology • Inflammation of Skin/Connective Tissue • Infection • Staphylococcus/MRSA • Streptococcus • Etiology • Open Wound/Trauma • May be Unknown

  44. Signs and Symptoms • Warmth • Redness • Edema • Pain, Tenderness • Fever • Lymphadenopathy

  45. Diagnosis • Culture and Sensitivity • Blood Cultures

  46. Therapeutic Interventions • Antibiotics • Topical • Systemic • Debridement

  47. Acne Vulgaris • Increased Sebum Production • Obstruction of Pilosebaceous Ducts

  48. Acne Vulgaris (cont’d) • Signs and Symptoms • Comedones • Open • Closed • Therapeutic Interventions • Benzoyl Peroxide • Vitamin A Acid • Antibiotics • Estrogen Therapy

  49. Nursing Diagnoses: Skin Infections • Risk for Spread of Infection • Acute Pain

  50. Pediculosis • Pathophysiology/Etiology • Infestation by Lice • Transmission by Direct Contact

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