Skin, Hair,

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Skin, Hair, Nail DisordersChapter 71
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Body Ornamentation

• Ornamental
• Cosmetic
• Utilitarian reasons
• Breast reconstruction
• Eyebrows
• Permanent makeup

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Tattoos

• A tattoo is pigmentation of the dermal layer of
  skin with needles containing dye.
• Tattoo artist should at least be certified by the
  Alliance for Professional Tattooistfollow
  infection control guidelines developed in
  conjunction with the FDA.

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Tattoos

• RISKS
• Allergies
• Interfere with quality of MRI because of the
  interaction of metallic compounds within the
  pigment.
• Swelling or burning in the area
• Infection
• Transmitting bloodborne infectious diseases
  (hepatitis B and C and HIV)

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Tattoos

• RISKS
• Return the ink to the bottle for the next
  customer.
• The American Association of Blood Banks rejects
  potential blood donors who have received a tattoo
  within 1 year.

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Tattoos

• RISKS
• Granulomaan inflammatory nodular lesion, may
  form as a result of a cellular attack waged
  against the particles in the tattoo pigment,
  which the body senses as foreign.
• Darker pigmented skin tend to form keloidsan
  overgrowth of scar tissue.

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Tattoos

• Tattoo removalon your own pg. 1265

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Body Piercing

• Body piercing is the insertion of a metal ring or
  barbell, which is a straight or curved rod, into
  a body part.
• Common locations lips, ear cartilage, cheeks,
  nose, tongue, eyebrows, navel, nipples, or
  genital area.

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Body Piercing

• No certification is needed to be a piercer.

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Body Piercing

• Tissue trauma
• Swelling
• Bleeding
• Airway obstruction (tongue)
• Interfere with resuscitation efforts that require
  oral or nasal intubation
• Dental implications

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Body Piercing

• Interfere with speaking and swallowing resp.
  problems
• INFECTION (1-8 months to heal)
• Hepatitis and HIV
• Tetanus and TB with ear piercing
• Endocarditis

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Body Piercing

• Site Care and Removal on your own!!

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Dermatitis Pg 1267

• General term that refers to an inflammation of
  the skin.
• It is a common sign of many skin disorders that
  are accompanied by a red rash.
• An associate symptom is pruritus, or itching.
• Dermatitis may be localized or generalized.

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Patho TX

• Allergic contact dermatitis develops in
  individuals who are sensitive to one or more
  substances, such as drugs, fibers in clothing,
  cosmetics, plants (poison ivy) and dyes. Fig
  71-2
• Tx is to remove the substances causing the
  reaction.
• This is done by flushing he skin with cool water.
• Topic lotions, such as calamine, or systemic
  drugs, such as benadryl or periactin to relieve
  the itching.

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Acne Vulgaris pg 1268

• Tends to coincide with puberty, is an
  inflammatory disorder that affects the sebaceous
  glands and hair follicles.
• The severity of the condition varies from minimal
  to severe.
• Believe to be R/T the hormonal changes that occur
  when secondary sex characteristics are
  developing.

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ACNE

• Sebum, keratin, and bacteria accumulate and
  dilate the follice.
• The collective secretions form a comedone, or
  what most refer to as a blackhead. Fig 71-5.

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ACNE

• Severe acne, if neglected, leads to deep, pitted
  scars that leave the skin permanently pockmarked.
  
• Improves after adolescence.

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Medical Management

• Gentle facial cleaning nonprescription drying
  agents containg benzoyl peroxide.
• Drug therapy Include Topical Retin-A Or oral
  administration of Accutane.
• Erythromycin and tetracycline in low doses for
  severe cases.

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Nursing Management

• Female clients that use Isotretinoin (accutane)
  need to be counseled on the risk of birth
  defects.
• 1. Must have a negative pregnancy test 2 weeks
  before beginning therapy.
• 2. Must comply with contraceptive measures while
  taking the drug.
• Continue reliable contraception for 1 month after
  therapy is d/cd.

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Furuncles, Furuncoloisis Carbuncles pg 1270

• A furuncle is a boil
• Furuncolosis refers to having multiple furuncles.
• A Carbuncle is a furuncle from which pus drains.

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S/S

• The lesion, which may appear anywhere on the
  body, but especially around the neck, axillary,
  and groin regions, appears as a raised, painful
  pustule surrounded by erythema.
• The area feels hard to the touch.
• After a few days, the lesion exudes pus and later
  a core.
• May have a fever, anorexia, weakness, and malaise.

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Medical Management

• Hot wet soaks are used to localize the infection
  and provide symptomatic relief.
• Antibiotics are used in some instances especially
  when a fever is present, or if the lesion is a
  carbuncle.
• Surgical I D may be necessary.

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Nursing Management

• Follow strict aseptic technique when applying or
  changing a dressing to prevent the spread of the
  infection to other parts of the body or to
  others, and teach the client to do so also.
• Never pick or squeeze a furuncle because drainage
  is infectious and this practice favors spread of
  the infection to surrounding tissues or even to
  the bloodstream.

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Psoriasis pg 1271

• A chronic, noninfectious inflammatory disorder of
  the skin
• Many types but most common is plague psoriasis
  (fig71-7).
• Periods of emotional stress, hormonal cycles,
  infection, and seasonal changes appear to
  aggravate the condition.

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S/S

• Psoriasis is characterized by patches of erythema
  (redness) covered with silvery scales, usually on
  the extensor surfaces of the elbows, knees,
  trunk, and scalp.
• Itching is usually absent or slight, but
  occasionally it is severe.
• The lesions are obvious and unsightly and the
  scales tend to shed.

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Medical Management

• Has no cure.
• Symptomatic treatment to control the scaling and
  itching
• Explain that treatment is usually for a lifetime
  and the plan of therapy must be followed.
• Instruct the client receiving photochemotherapy
  to avoid exposure to sunlight for 8 hours after
  treatment because it takes this length of time
  for methoxsalen to be excreted from the body.

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Photochemotherapy

• Photochemotherapy has been used for severe,
  disabling psoriasis that does not respond to
  other methods of Tx.
• The extent of exposure is base on the clients
  skin tolerance.
• Treatments are given once every other day or less
  because phototoxic reactions may appear 48 hours
  or more after light exposure.

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Scabies pg 1273

• Fairly common infectious skin disease
• Caused by infestation with the itch mite
• Anyone can acquire this infection it is
  erroneous to assume that infected individuals
  have poor personal hygiene.

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Scabies

• Outbreaks are common where large groups of people
  are confined such as nursing homes, military
  barracks, prisons, boarding schools, and child
  care centers.

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Scabies

• The mites are spread by skin-to-skin contact.
• In rare cases, scabies is acquired from handling
  clothing and linen in recent contact with an
  infected individual
• Scabies mites do not survive off the body more
  than 2 days

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Assessment

• There is intense itching especially at night.
• The areas that are commonly affected include the
  webs and sides of fingers and around the wrists,
  elbows, armpits, waist, thighs, genitalia,
  nipples, breasts, and lower buttocks.
• The itching is accompanied by excoriation from
  scratching.
• Skin burrows are caused by the female itch mite
  that invades the skin to lay her eggs.

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Diagnostic Findings

• American Academy of Dermatology recommends an
  examination using mineral oil or ink.
• After dropping sterile mineral oil on the lesion,
  the skin is scraped onto a slide and examined
  microscopically to detect the mites, their eggs,
  or feces.

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Diagnostic Findings

• The ink test is performed by applying a blue or
  black felt-tipped pen to the lesion, which
  highlights the burrows when the skin surface is
  wiped.

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Medical Management

• Scabicides, chemicals that destroy mites, such as
  lindane (cream or lotion).
• The medication is applied to the skin from the
  neck down in a thin layer, left on for 8 to 12
  hours, and then removed by washing.

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Medical Management

• Thorough bathing, clean clothing, and the
  avoidance of contact with others who have scabies
  are essential in preventing recurrence.

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Nursing Management

• After bathing and applying the medication,
  instruct the client to don clean clothing and
  launder preworn clothing. Towels, and bed linen
  in hot water as soon as possible.
• Tell the client to vacuum furniture and other
  unwashable items.
• Explain that itching may continue for 2 to 3
  weeks after treatment

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Dermatophytoses (Tinea) Pg. 1273

• Superficial fungal infections.
• Common terms ringworm ( a misnomer because the
  infection is not caused by a worm) athletes
  foot, jock itch.
• Dermatophytes (also called tinea) are parasitic
  fungi that invade the skin, scalp and nails
  (Mainly the feet, head, body, and groin)

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S/S

• Tinea corporis appears as rings of papules or
  vesicles with a clear center in nonhairy areas of
  the skin (fig 71-8).
• There may be several clusters of rings in the
  same general location
• The affected skin often itches and becomes red,
  scaly, cracked, and sore.

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S/S

• Tinea pedis , the infection begins in the skin
  between the toes and spreads to the soles of the
  feet.

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S/S

• Tinea capitis, which is more common in children,
  invades the hair shaft below the scalp followed
  by breaking of the hair, usually close to the
  scalp.

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Medical Management

• Treatment includes the topical use of antifungal
  agents which may be required for many weeks to
  eradicate the infection.

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Nursing Management

• Explain that the infected person must use
  separate towels, washcloths, grooming articles,
  and clothing because the disorder is contagious.
• Stress that keeping the affected areas dry
  reduces its spread.

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Shingles pg. 1274

• Also known as herpes zoster, a skin disorder that
  occurs years after a chickenpox (varicella)
  infection.
• Herpes zoster is an acute reactivation of the
  varicella-zoster virus

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Shingles

• The virus lies dormant in a nerve root.
• When the immune system becomes suppressed from
  aging, cancer, drugs, or AIDS, the virus migrates
  along one or more crainal or spinal nerve routes.
  

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Shingles

• Viral reactivation produces inflammatory symptoms
  in the drmatome, a skin area supplied by the
  nerve (fig 71-9).
• The inflammation is accompanied by raised,
  fluid-filled skin eruptions that are painful.

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Shingles

• If the ophthalmic branch of the trigeminal nerve
  is affected, corneal (eye) ulcerations may occur.

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Shingles

• Involvement of the vestibulococlear nerve can
  lead to vertigo and permanent hearing loss.
• Cerebral vasculitis (inflammation of cerebral
  vessels) is the most serious complication because
  involvement of the internal carotid arteries can
  result in a stroke.
• Rarely, the virus spreads to the brain, resulting
  in encephalitis

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Shingles

• Chickenpox can be acquired by susceptible
  individuals who are exposed to someone in the
  early stages of herpes infection.
• The virus is contagious until the crusts from
  ruptured lesions have dried and fallen off the
  skin.
• Herpes zoster infection can recur.

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Assessment

• Initial symptoms include a low-grade fever,
  headache, and malaise
• An area of skin along a dermatome develops a red,
  blotchy appearance that begins to itch or feel
  numb.
• In about 24 to 48 hours, vesicles appear on the
  skin along the nerves pathway.
• Usually the eruptions are unilateral (one side)
  on the trunk, neck, or head.
• The eruptions become severely painful.

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Assessment

• The intense pain is soon followed by severe
  itching.
• Like chickenpox lesions, the vesicles rupture in
  a few days and crusts form.
• Scarring or permanent skin discoloration can
  occur.
• Pain (postherpetic neuralga) and itching may
  persist for months or as long as 2 years or more.
  

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Medical Management

• Oral acyclovir (Zovirax) when taken within 48
  hours of the appearance of symptoms, reduces the
  severity of symptoms and prevents the development
  of additional lesions.
• Corticosteroid therapy reduces pain
• Treatment by ophthalmologist
• Analgesics and often narcotic analgesics such as
  codeine is often necessary during the first few
  days to weeks.

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Nursing Management

• Reassign nursing personnel who have not had
  chickenpox so as to avoid contact with a client
  with herpes zoster.
• Avoid contact with immunocompromised people and
  those who have not had chickenpox.

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Vaccine

• Vaccine is now available.

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Skin Cancer pg 1275

• Skin cancer is the most common type of cancer in
  the US 1 in 7 acquires some form of skin cancer
  each year.
• In can involve anyone of three types of cells in
  the epidermis
• 1. Squamous cells that are flat and scaly
• 2. Basal cells that are round
• 3. Melanocytes, cells that contain color pigment.

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Patho

• Increased exposure to ultraviolet (UV) radiation,
  especially UVB and UVC, harmful components in the
  spectrum of sunlight, predisposes to malignant
  skin changes and other health risks including
  cataracts and premature aging of the skin.
• Fair-skinned individuals are more susceptible

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Patho

• Malignant growths of the skin (Table 71-2) are
  usually primary lesions, that is, they originate
  in the skin.
• Their spread to other parts of the body or the
  tissues is prevented by prompt removal of the
  malignant tissue.

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Assessment

• Symptoms vary, but usually the new appearance of
  a growth or a change in color of the skin is the
  first symptom the client notices.
• The lesion can be smooth or rough, flat or
  elevated, feel itchy or tender, and even bleed.

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Nursing Management

• Examine and measure abnormal-appearing skin
  lesions,especially those in sun-exposed areas
  such as the face, nose, lips, and hands.
• Determine facts about the lesion, including when
  the lesion first was noticed, whether the lesion
  has undergone any recent changes, and, if so,
  what kind of changes.
• Give emotional support to those having
  disfiguring surgery.

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Client and Family Teaching

• Always use a sunscreen with a sun protection
  factor (SPF) of at least 15 higher SPFs are
  beneficial for individuals who sunburn easily
• Reapply sunscreen at least every 2 hours or more
  often if swimming or perspiring
• Use a lip balm with sunscreen
• Wear a hat with a wide brim and cover the back of
  the neck
• Stay in the shade when outdoors

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Client Teaching

• Avoid prolonged sun exposure between 1000 AM and
  400 PM
• Avoid artificial tanning

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Head Lice pg 1280

• An infestation with lice is called pediculosis.
• Although lice can infest hairy parts of the body
  such as the pubic area, they are more likely to
  be found on and in the hair on the head.
• Lice are crawling brown insects about the size of
  sesame seeds, they do not fly or jump (Fig 71-13)

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Lice

• Nymphs look like moving dandruff, but they may
  appear red after feeding.
• Adult lice nymph creep over the skin and feed
  on human blood.
• The bites result in itching.

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Lice

• Eggs, or nits, laid by adult females are tightly
  cemented to the side of hair shafts.
• They appear like small yellowish white ovals.

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Lice

• Nits hatch in 7 to 10 days have a lifespan of
  approx 30 days during which time one female can
  lay 100 to 400 nits.
• Researchers believe that lice are developing
  strains that resist chemical extermination.
• Lice are transmitted from person to person
  through direct contact.
• They cannot survive longer than about 24 hours
  without blood.

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Lice

• Sharing clothing, combs, and brushes promotes
  transmission Anyone can acquire lice, but
  infestations among school children tend to be
  difficult to arrest.
• Many schools have a zero tolerance policy for
  lice infestation that is, an infected child is
  barred from attending school until the hair and
  scalp are free of lice and nits.

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Medical Management

• Nonprescription shampoos, gels, and liquids
  containing pediculocides are effective.
• One example is Nix, which kills adult forms of
  lice.
• Kwell (lindane) is neurotoxic
• Those that contain benzene, is carcinogenic
  especially to children

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Medical Managment

• Pediculocides are contraindicated for pregnant
  and nursing women, children under 2 years of age,
  and those who have health conditions such as open
  wounds, epilepsy, or asthma.
• Nits and live lice are removed mechanically with
  a fine-tooth combing tool such as one called the
  LiceMeister

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Nursing Management

• Review on your Own!!