Title: Management of Clients with Integumentary Problems
1Management of Clients with Integumentary Problems
2Brief Review of Integumentary System
- Comprised of skin, hair and nails
- First line of defense
- Barrier between internal and external environment
- Largest organ of the body
3Brief Review of Integumentary System
- Physiologic Functions
- Protection
- Water balance
- Temperature regulation
- Sensory organ
- Vitamin synthesis
- Immune Response Function
- Psychologic Function
- Psychosocial
4Aging
- Identify physiologic skin changes associated with
aging. - What are the implications for care related to the
associated changes?
5Integumentary Assessment History
- An accurate history is needed before physical
examination - Demographic data
- Personal and family history
- Medication history
- Diet history
- Socioeconomic background
- Current health problems
6Integumentary Assessment Exam
- Inspection
- Observe all areas
- Systematic assessment
- obvious changes in color or vascularity
- Presence of absence of moisture
- Edema
- Skin lesions
- Skin integrity
- Palpation
7Integumentary AssessmentPsychosocial
- Psychosocial
- Assess for altered perceptions in body image or
disturbances in self concept - Assess for social isolation
8Integumentary AssessmentDiagnostic Evaluation
- Skin Biopsy
- Immunofluorescence
- Patch testing
- Skin scrapings
- Tzanck Smear
- Woods Light Examination
- Clinical photographs
9Skin Care for Patients with Skin Conditons
- What are the three main objectives of skin care
in patients with skin conditions? - How will these objectives be achieved?
10Wound Care for Skin Conditions
- Three types of wound dressings
- Passive
- Interactive
- Active
- Compare and contrast autolytic debridement and
surgical debridement.
11Categories of Wound Dressings
- Occlusive
- Wet
- Moisture-retentive
- Hydrogels
- Hydrocolloids
- Foam dressings
- Calcium alginates
12Wound Treatment Advances
- Cytokines
- Bioengineered skin substitutes
- Oral medications
- Under investigation
13Medical Therapy
- Therapeutic baths
- Pharmacologic therapy
- Lotions, powders, creams, gels, pastes,
ointments, sprays and aerosols, corticosteroids,
intralesional therapy, and systemic medications
14Pruritis
- Itching caused by stimulation of itch-specific
nerve fibers at the dermal-epidermal junction - Scratching brings relief, but causes the
itch-scratch cycle - Associated with local (skin lesions) or systemic
(liver, venous) disorders - Care goal promote comfort and prevent
alterations in skin integrity - Therapeutic baths
- Antihistamines /or topical steroids
15Urticaria
- White or red edematous papules or plaques of
varying sizes - Usually caused by exposure to a specific noxious
stimulus which causes release of histamines - Exact cause not always identified, possible
factors - Drug -- Foods -- Infections --
Autoimmune disease - Malignancies -- Physical stimuli --
Psychogenic reactions - Treatment aimed at removal of potential stimulus
and relief of symptoms - Antihistamines
- Avoidance of overexertion, alcohol consumption,
and warm environments
16Skin Infections Assessment
- History clinical manifestations provide
direction for data collection - Physical exam many skin lesions are contagious,
precautions to prevent spread must be taken - Lab swab culture, blood culture, viral culture
17Skin Infections
- Bacterial Infections
- Usually start at the hair follicle
- Folliculitis superficial infection of upper
portion of follicle caused by staph - Furuncles infection caused by staph is deeper in
hair follicle (boil) - Cellulitis is a generalized non-follicular
infection of the deeper tissues caused by either
staph or strep - Can spread infection to other parts by scratching
18Viral Skin Infections
- Herpes Simplex
- Type I cold sore
- Type II genital lesions
- After primary infection virus remains dormant in
the nerve ganglia - Physical or psychological stressors can
reactivate the infection - Time between episodes and the severity of
individual attacks will vary
19 Viral Skin Infections
- Herpes Zoster
- Reactivation of latent varicella zoster virus
- Resides in dorsal root ganglia of the sensory
cranial and spinal nerves - Multiple lesions, segmentally distributed on skin
area innervated by infected nerve - Discomfort is experienced before eruptions and
can persist after lesions are healed
(postherpetic neuralgia) - Herpes Zoster is contagious to those who have
never had chickenpox
20Fungal Skin Infections
- Dermatophytoses (superficial)
- Term tinea plus the term for the location is used
to describe - Infection occurs when infecting organism come in
contact with impaired skin surface of a
susceptible host - Most infections spread by direct contact
- Tinea capitus and tinea corporus can be spread by
inanimate objects
21Skin Infections Interventions
- Non-surgical
- Meticulous skin care
- Antibacterial soaps or baths
- Astringent compresses
- Isolation precautions
- Minimize spread of microorganisms
- handwashing
- Drug therapy
- Topical medications (antibacterial, antifungal)
- Acyclovir for viral infections (topical or oral)
- Surgical Management
- Not indicated except for ID of furuncles or when
lesion progresses to full-thickness in
immunocompromised person
22Fungal Skin Infections
- What is the most common fungal infection?
- What body areas are most often affected?
- What is the mainstay of medical management?
- Discuss key aspects of nursing management.
23Parasitic Disorders
- Pediculosis
- Lice infestation
- Transmitted by contact or sharing of combs, hats,
etc. - Pruritis- most prominent symptom
- Can result in secondary infection
- Lindane
- Wash clothing and linens
- Environment clean-up
- Scabies
- Contagious mite infestation which causes a
hypersensitivity reaction - Transmitted by close and prolonged contact
- Epidermal ridges skin between fingers, palms and
volmar aspect of wrists - Confirmed by skin scraping
- Lindane/topical sulfur
- Launder clothes and bed linens
24Contact Dermatitis
- What is it?
- Describe lesion progression.
- What are common causes?
- What are predisposing factors?
- Identify complications of repeated outbreaks.
- Describe medical management.
- What are key aspects of nursing care?
25Non-Infectious Inflammatory Dermatoses
- Psoriasis
- Chronic
- Hereditary defect
- Exfoliative Dermatitis
- Serious condition
- Profound loss of stratum corneum
- Considerable water and protein loss from skin
26Blistering Diseases
- Identify origins or skin blisters.
- Severity
- Diagnosis
- Based upon histologic examination of biopsy
specimen - Acantholysis
- Immunofluorescent studies may identify
circulating antibiodies
- Disorders
- Pemphigus
- Bullous Pemphigoid
- Dermatitis Herpetiformis
- Toxic Epidermal Necrolysis
- Stevens-Johnson Syndrome
27Toxic Epidermal Necrolysis and Stevens-Johnson
Syndrome
- Potentially fatal skin disorders
- Mucocutaneous reactions
- Triggered by reaction to medications
- Clinical manifestations
- Initially conjunctival burning or itching,
cutaneous tenderness, fever, cough, sorethroat,
headache, malaise, myalgia - Followed by rapid onset of erythema, flaccid
bullae and shedding of sheets of epidermis
28TEN and SJS Care
- What normal body functions are altered?
- What complications would you anticipate?
- What is the mainstay of care?
- The care of TEN or SJS will be similar to what
other condition?
29Skin Tumors (Benign)
- Cysts
- Seborrheic and actinic keratoses
- Keloids
- Nevi (Moles)
- Verrucae (Warts)
- Angiomas
- Dermatofibroma
- Neurofibromatosis (Von Recklinghausess Disease)
30Skin Cancers
- Actinic/solar keratosis
- Premalignant
- May progress to squamous cell
- Squamous cell
- Cancer of epidermis
- Potentially metastatic
- Basal cell
- Metastasis is rare
- Underlying tissue destruction
- Melanoma
- Originate in melanin-producing cells of epidermis
- Highly metastatic
31Mole Assessment
- A
- B
- C
- D
- What should be done if patient experiences one or
more of the above?
32Skin Cancers Interventions
- Non-surgical management
- Drug therapy
- Topical chemotherapy
- Systemic chemotherapy
- Interferon after OR for melanoma
- Radiation therapy
- Limited to older clients with large, deeply
invasive basal cell tumors or poor surgical risks - Immunotherapy
- Experimental, melanoma vaccine
33Skin Cancer Interventions
- Surgical Management
- Cryosurgery
- Local application of liquid nitrogen
- Curettage/electrodesiccation
- For small lesions with well defined borders
- Excision
- For large of poorly defined skin cancers,
recurrent tumors and deeply invasive cancers
34Post-Surgical Wound Coverage
- Skin grafts
- Flaps
- What are the key aspects of nursing care for
these?