Nursing Management: Integumentary System

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Nursing Management Integumentary System

• George Ann Daniels MS, RN
• Rogers State University

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Nursing Management Dermatologic Problems

• Pruritus
• Makes pruritus worse
• Heat and rubbing
• Dryness
• Restricted clothing
• Cool environment, corticosteriods
• Menthol, camphor, or pheno
• Numbs the itch receptors
• Antihistimines
• Benadryl
• Aveeno baths

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• Spread of infection
• Gloves
• good handwashing
• Safe disposal of soiled dressings
• Avoid scratching of lesion
• Trim nails
• Post procedure
• Keep wound moist and covered
• Clean with NS
• Antibiotic ointment
• Stitches
• Removed in 4-10 days

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Furuncle (Boil)

• Deep infection of the hair follicle caused by
  Staph Aureus
• Clinical manifestations small, red, elevated,
  tender nodule.
• Management warm wet compresses QID, I D, Do
  not squeeze, Antibiotics-topical and/or oral

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Impetigo

• Honey-colored crusts on erythematous base
• Areas beneath crust- glistening, weeping, and
  eroded
• Primarily face
• Antibiotics-7-10 d
• Gently remove crust with 120 Burrow solution
• Topical bactericidal ointment
• Heals without scarring

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Cellulitis

• Warm, red, swollen and painful
• Fever, malaise, chills, leukocytosis with left
  shift, elevated Sed. Rate
• Bedrest, elevation of affect part, antibiotics
• Resolves in 2 weeks with TX

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Fungal Infections (Dermatophyte)

• Fungus infection
• Tinea Capitis
• Scalp
• Scaling area with broken hair shafts, plaques,
  pustules
• Possible permanent hair loss
• Oral Griseofulvin
• Selenium Sulfide shampoos
• Topical antifungal agents

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Tinea Corporis

• Body, arms, legs
• Elevated scalilng, erythematous, serpiginous
  borders with center clearing
• Oral Griseofulvin
• Cool compresses
• Antifungal cream applied 1 inch beyond lesion for
  1-2 weeks until resolved
• Monistat, Lotrimin

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Tenia Cruris

• Groin
• Sharply demarcated area with elevated, scaling
• Jock Itch
• Local application of Tolnaftate liquid
• Wet compresses or sitz baths may be soothing
• Teaching r/t personal hygiene

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Tenia Pedis

• Feet
• Athletes Foot
• Between toes and soles of the feet
• Maceration and fissuring between toes
• May have pinhead vesicles
• Oral Griseofulvin
• Antifungal powder
• Teach

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Tenia Unguium

• Nails
• Fingernails and toenails
• Separation from the nail bed with debris under
  nail
• Thick, yellow nails

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Nondermatophyte Infections

• Candidiasis
• Glistening, fiery red or moist pink, beefy red
  with satellite pustules
• Severe itching/burning
• Skin folds/groin area
• Oral-thrush
• Diaper rash (dermatitis)
• Teach prevention and management

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Verrucae (Warts)

• Verruca Vulgaris
• Hands
• Flesh-colored or brownish gray scaling,
  vegetative papule
• Cryosurgery, chemical destruction(salicyclic
  acid), curretage and desiccation, laser

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Condyloma Acuminatum

• Soft vegetative
• Mucocutaneous skin in anogential area
• Cryosurgery, Podophyllin 25 in benzoin tincture

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Herpes Simplex (HSV)

• Most common virus in humans
• Two types
• HSV-1
• Fever blister and cold sores
• Sunlight, trauma, stress, menses
• Antiviral
• Zovirax, Famvire, Valtrex
• Mouth, oral cavity, eyes and brain
• HSV 2
• Genital herpes

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HSV-1

• Grouped, burning, and itching vesicules
• Lips, nose, mouth, oral mucosa
• Teach spread by kissing, oragenital sexual
  contact, contact with fingers
• Handwashing
• Last 7-10 days

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Herpes Zoster

• Linear patches along dermatome
• Grouped vesicles on erythema base
• trunk
• Burning pain
• Heals without complication, May scar
• Antiviral agent
• Acyclovir, famiciclovir
• Cool compresses, analgesia, bedtime sedation

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Psoriasis

• Chronic hereditary disorder
• Light-skinned race
• Environmental factors that trigger
• Skin injury
• Infections
• Hormone changes
• Stress
• Drugs
• Alcohol
• Smoking
• obesity

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Psoriasis Cont.

• Erythematous plaque with sharp well defined
  borders and silvery white scales.
• Elbows, knees, scalp, lumbosacral skin, can occur
  anywhere

• Management
• Topical treatment
• Photo-therapy
• Teach reducing pruritus
• Avoid scratching
• Room humidifier
• Warm not hot bathing
• Avoid strong soaps
• Lubricate skin
• antihistamines

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Insect and animal contacts

• Scabies (Mites)
• Mite infestation in the dermis to lay eggs
• Inflammation and itching( worse at night)
• Interdigital, axillary, popliteal, ingunial
• Kwell Lotion

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Pediculosis Capitis

• Head lice (cooties)
• School-age children
• Lives 48 hours
• Female lays eggs (nits) on the hair shaft
• Hatch in 7-10 days
• Easily transmitted person to person
• Does not jump or fly
• Sharing combs, hats, caps, scarves, coats,
  shared lockers, slumber parties, or other items
  used on or near hair
• Can invade all ages

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• Manifestations
• Visual
• Itching/scratch marks
• Treatment
• Pediculocides and manual removal of nit cases
• NIX, RID

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Teach

• Machine wash all washable clothing, towels, and
  bed linens in hot water, and dry in hot dryer for
  at least 20 minutes
• Thoroughly vacuum carpets, car sets, pillows,
  stuffed animals, rugs, mattresses, and
  upholstered furniture
• Seal non-washable items in a plastic bag for 14
  days if unable to dry clean or vacuum
• Soak combs, brushes, and hair accessories in
  lice-killing products for 1 hours or in boiling
  water for 10 minutes

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Stings

• Allergic reactions account for 30 deaths each
  year
• Honeybees, bumblebees, wasps, hornets, yellow
  jackets, mud daubers, and fire ants
• Reaction may be immediate or delayed ( after 2
  hours)
• Non-allergic reaction
• Local edema, erythema pain, itching
• Resolves in a few hours

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• Severe with possible anaphylaxis reaction
• Generalized urticaria and pruritus,
  bronchospasms, laryngeal edema, shock and death
• 10-30 minutes post sting
• Epinephrine 0.1-0.5 mL of 11000 sol, may repeat
  15-15 minutes until symptoms resolve
• Stinger removal
• Honeybees only leave stingers
• Clean area
• Remove by scraping a flat item over stinger
  against the entry.
• Avoid breaking or squeezing
• Treatment
• Ice, elevation, antihistamines

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Neoplasm

• Benign/Malignant
• Epidermal
• Dermal
• Subcutaneous
• Pigmented

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Epidermal

• Skin tags
• Seborrheic keratosis
• Age spots
• Corns
• Epidernmal cyst

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Dermal/subcutaneous

• Cherry Hemangioma
• Keloid
• Xanthoma
• Neurofibroma
• Dermatofibroma
• Lipoma

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Pigmented Lesions

• Freckles
• Lentigo
• Melasma
• Pigmented Nevi
• moles

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Premalignant Lesisons

• Actinic keratosis Sun exposure
• Cutaneous Horn

                                                  
                      

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Malignant Neoplasms

• Basal Cell
• Pearly, translucent rounded border with dilated
  blood vessels
• Reoccurring
• Biopsy
• Curettage and desiccation

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Squamous Cell Carcinoma

• Indurated lesion
• Early-thickened area
• Slowly enlarges
• Central crust
• Surgical incision

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Cutaneous Malignant melanoma

• Fatal unless treated early
• Sunburn, sun exposure
• Variegated color, irregular border, irregular
  surface
• Surgical excision with a 2-4 mm margin
• Stage I-localized
• Stage II- regional node
• Stage III- disseminated

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Prevention

• Self examination of the skin
• Check skin monthly
• Professional check- up at 3 mo, 6 mo, and yearly
  for life if skin cancer is removed
• Report any changes
• Report development of any new lesions

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Progression of Suspicious Moles
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Preventing Skin Cancer

• Avoid sun between 10 AM and 3 PM
• Start with short sessions
• 15-20 minutes
• Sunscreen SPF gt15 daily, all year
• Reapply after swimming, strenuous exercises, or
  prolonged sun bathing

• Lip balm SPF gt15
• Protective clothing
• Watch out for cloudy days and water reflection
• Avoid tanning lamps or tanning booths

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THE END