Caring for Clients With Skin Disorders

1. 45 Caring for Clients With Skin Disorders

2. Skin Changes in Older Adults • Decrease in activity of sebaceous and sweat glands leading to reduced lubrication and moisture retention • Reduced fat in subcutaneous layers increases the risk for shearing, tearing, and pressure ulcers

3. Common Skin Disorders • Pruritis • Dry Skin • Psoriasis • Dermatitis • Acne

4. Pruritis • Itching sensation producing the urge to scratch • Small or widespread with or without a rash • Triggered by heat and prostaglandins • Increased by release of histamine and chemical mediators

5. Pruritis • Caused by anything in the internal or external environment • Stimulation or irritation of receptors in the junction between the epidermis and dermis • Itch–scratch–itch cycle

6. Dry Skin • Decreased activity of sebaceous and sweat glands reducing skin lubrication • More common in older adults • Exposure to environmental heat and low humidity, sunlight, excessive bathing, and decreased intake of liquids • Pruritis and flaking of skin

7. Psoriasis • Chronic, noninfectious skin disorder • Raised, reddened, round circumscribed plaques covered by silvery white scales • Appear anywhere in the body • Plaques shed gray scales

8. Psoriasis • Cause unknown • May be an autoimmune disorder • Sunlight, stress, hormone fluctuations, steroid withdrawal, seasonal changes, and drugs may make condition worse • Family history • Pruritis, pain, discoloration of nails

9. Dermatitis • Acute or chronic inflammation of the skin • Erythema and pain or pruritis • Vesicles, scales, and pruritis initially • Progresses to edema, serous discharge, and crusting

10. Dermatitis • Types • Contact • Atopic—eczema • Seborrheic • Exfoliative

11. Acne • Disorder of sebaceous glands • Face, scalp, scrotum • Sebum is produced in response to hormonal stimulation • Lesions are called comedones • Acne vulgaris • Acne rosacea

12. Common Skin Disorders • Most treated by self-care at home • Focus of treatment is identifying, modifying, or eliminating precipitating factors • Diagnosis • Culture • Skin scrapings • Biopsy • Ultrasound tests

13. Common Skin Disorders • Pruritis - medications and treatments • Antihistamines • Tranquilizers—stress related to pruritis • Antibiotics • Topical steroids • Therapeutic baths

14. Common Skin Disorders • Psoriasis - medications and treatments • Topical corticosteroids • Tar preparations • Retinoids to decrease inflammation • Photochemotherapy • Ultraviolet-B

15. Common Skin Disorders • Acne - medications and treatments • Based on type and severity of lesions • Retinoic acid, Retin-A • Benzoyl peroxide • Azelaic acid • OTC medications • Accutane • Surgery—dermabrasion

16. Common Skin Disorders • Complimentary therapy • Aloe • Goldenseal • Peppermint oil

17. Bacterial Infections • Arise from the hair follicle where bacteria accumulate and grow • Localized infection • Systemic if invade into deeper tissue

18. Folliculitis • Staphylococcus aureus • Skin surface and extends into hair follicle • Inflammation • Scalp and extremities, face of bearded men, legs of women who shave, eyelids (stye) • Poor hygiene, nutrition, prolonged moisture, trauma

19. Furuncle • Infection of the hair follicle • Carbuncle—group of infected hair follicles • Staphylococcus aureus • Deep red nodule that gets larger and cystic • May cause fever, chills, or malaise

20. Cellulitis • Localized infection of the dermis and subcutaneous layers • Spreads as a result of spreading factor hyaluronidase • Breakdown of fibrin network and other barriers

21. Cellulitis • Red swollen, painful • Fever, chills, malaise, headache, swollen lymph glands

22. Fungal Infections • Plantlike organisms that live in soil, on animals, on humans • Dermatotypes live on stratum corneum, hair, and nails • Superficial infections • Ringworm or tinea • Mycoses

23. Dermatophyte (Tinea) • Tinea pedis • Athlete’s foot • Tinea curis • Groin infection

24. Candidiasis • Candida albicans • Yeastlike infections on skin, vagina, gastrointestinal tact

25. Viral Infections • RNA or DNA core surrounded by a protein coat • Depend on live cells for reproduction • Increase cell growth or cause cellular death

26. Warts • Human papillomavirus • Skin and mucous membranes • Nongenital warts are benign lesions • Genital warts are precancerous • Transmitted through skin contact • Common • Plantar • Condylomata acuminate (venereal warts)

27. Herpes Simplex • Herpes virus I and II • Fever blister or cold sore • HSV I—lips, face, and mouth • HSV I or II—genital herpes, sexually transmitted • Begins with a tingling sensation followed by erythema, vesicle formation, and pain • Lasts 10–14 days

28. Herpes Zoster • Varicella zoster • Reactivation of dormant virus • Painful vesicles on the face, trunk, and thorax • Prevalent in people who are immunocompromised • Recovery 4–6 weeks • Postherpetic neuralgia

29. Parasitic Infestations • Skin invaded by parasites or insects • Most common parasites are mites and lice

30. Pediculosis • Infestation of lice • First stage is an unhatched egg (nit) • Three types live on humans • Pediculosis corporis—body lice • Pediculosis capitus—head lice • Pediculosis pubis—pubic lice (crabs)

31. Scabies • Female mite • Infestation between fingers and inner surfaces of wrist, elbow, axillae, nipple, penis, belt line, and gluteal crease • Occur up to 4 weeks after contact • Small red mite burrows into skin

32. Infections/Infestations • Treatment focused on identifying causative agent • Administer medication to kill bacteria or eradicate the organism • Prevent secondary infection • Environmental surveillance and control

33. Infections/Infestations • Diagnosis • Culture and sensitivity • Scrapings and microscopic examination • Ultraviolet light inspection • Lab studies

34. Infections/Infestations - Treatment • Bacterial infections • Antiobiotics—topically or systemically • Fungal infections • Antifungal agents—topically or systemically • Viral infections • Antiviral agents • Medications to relieve pain and pruritis

35. Infections/Infestations • Parasitic infestations • Topical agents to kill the parasite • Complementary therapy • Tea tree oil

36. Skin Cancer • Most common of all cancers • Result of long-term exposure to the sun or environment • Exposure to chemicals, ultraviolet light • Skin pigmentation • The more melanin, the more you are protected

37. Nonmelanoma Skin Cancer • Basal cell carcinoma • Epidermis • Sun-exposed areas of the head and neck • Slow growing and rarely metastasize

38. Nonmelanoma Skin Cancer • Squamous cell carcinoma • Squamous epithelium of the skin or mucous membranes • UV ray exposure • Forehead, helix of ear, top of nose, lower lip, back of hands • Firm flesh-colored or erythematous papule • Can be recurring and invasive increasing risk of metastasis

39. Melanoma • Cutaneous or malignant • Arises from the melanocytes that produce melanin • Lesions can be benign until they infiltrate the dermis and mingle with blood and lymph • Increases the risk of metastasis

40. Melanoma • Precursor lesion is a dysplastic nevi (mole) • Change in the color or size of a nevus occurs in 70% of people diagnosed with melanoma • A asymmetry • B border irregularity • C color variation • D diameter greater than 6 mm

41. Skin Cancer • Treatment focuses on removal of malignant tissue • Surgery • Chemotherapy • Immunotherapy • Radiation therapy • Biological therapies

42. Skin Cancer • Diagnosis • Microscopic exam and tissue biopsies • Liver function tests • Chest x-rays • Microstaging

43. Skin Cancer • Assessment • Present health status • Change in mole, wart, birthmark, scar • Exposure • Other • Past medical history • Skin cancer or family history • Geographic residence • Serious sunburn

44. Pressure Ulcers • High risk for the older adult • Limited mobility with aging • Illnesses that result in paralysis

45. Skin Breakdown • Altered nutrition less than body requirements • Incontinence • Chronic illness

46. Pressure Ulcers • Pressure develops over bony prominences • Shearing forces, friction, external pressure cause damage • Impairment of flow of blood and lymph causing ischemia from distortion of capillaries • If pressure continues, platelets clump and form microthrombi

47. Pressure Ulcers • Microthrombi impede blood flow, resulting in ischemia and hypoxia • Cells and tissue die and become necrotic • Superficial • Red or blister • Deep • Deeper structures where tissue becomes necrotic and dies

48. Pressure Ulcer • Shearing forces • Result when one tissue layer slides over another • Stretching and bending of blood vessels • Head of bed elevated and torso slides down toward foot of bed • Pulling client up in bed • Increased risk with immobility

49. Pressure Ulcers • Goal is prevention • Laboratory tests to determine infection • Topical and systemic antibiotics • Surgical debridement • Specialty dressings and beds

50. Common Skin Disorders – Nursing Care Assessment Present health status Past medical history Inspection of the entire skin for color and lesions Palpate skin for temperature, texture, moisture, and turgor