integumentary_system.ppt

integumentary_system.ppt
Integumentary System
RESPONSE TO ALTERED INTEGUMENTARY FUNCTION Unit Outcomes: Upon completion of this unit of study, the student will be able to: • Safe Effective Care Environment: • 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.). • 2 . Perform thorough dermatological assessment throughout the life span. • Health Promotion and Maintenance: • 3. Identify healthy behaviors by the client and family ( screening exams, limiting risk taking behaviors). • Psychosocial Integrity: • 4. Discuss psychosocial impact of client’s altered dermatological condition ( acne, burns, rashes, tumors). • Physiologic Integrity: • 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. • 6. Develop plan of care for client with impaired skin integrity. • 7. Explain the eight parameters of assessing a lesion. • 8. Describe common lesions and rashes utilizing proper terminology. • 9. Describe pre-op and post care of clients receiving dermatological surgical procedures. • 10. Select nursing diagnoses most likely to be utilized with clients with integumentary problems. • 11. Discuss etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.
Introduction: Skin in our Culture • Defining ‘beauty’ • Language • Costs
Functions: • Protective Barrier – Injury – Microbial Invasion – Fluid & Electrolyte Balance – Temperature control • Excretion • Sensation • Vitamin D • Identity
Topics: • Assessment • Safety and preventive measures • Nursing Implications for Pharmacologic Management • Nursing Implications for Nonpharmacologic Management • Nursing Implications for Surgical Management • Nursing Management of Clients with Alterations - Integument
KP’s •Assessment • A. Parameters of General Skin Assessment • B. Lesions • C. Cultural/Ethnic variations • D. Diagnostic Testing
Thorough History • Dx & Tx – realm of practice – Difficult due to similarities in lesions and sx • Differential dx requires clues
Assessment: Subjective Data – Past Medical History • Trauma • Surgery • Prior skin disease • Jaundice • Delayed wound healing • Allergies • Sun exposure • Radiation treatments
Assessment: History Medications – Prescription – OTC – Herbals – Name – Length of usage
Assessment: History • Surgery – Cosmetic – Biopsy • Diet • Health Practices – Hygiene, products – Sunscreen, SPF – Complementary & alternative medicine • C/O symptoms • Known exposure to carcinogens, chemical irritants, allergens • Family – Alopecia (bald) – Psoriasis – Skin cancer
Assessment: History • Changes – Skin condition – Hair condition – Nail condition – Mucous membranes
• Privacy • Carefully describe: – Obvious changes in color and vascularity – Presence or absence of moisture – Edema – Skin Lesions – Skin integrity • Document properly Assessment
Parameters of General Skin Assessment • color, temperature, moisture, elasticity, turgor, texture, and odor.
Assessment: Inspection • Consider Cultural and Ethnic variations – Dark skin • rates - skin cancer • Difficult to assess flushing; cyanosis; jaundice • Rashes difficult to observe • Pseudofolliculitis • Keloids • Mongolian spots
• Inspection of hair – Distribution – Texture – Quantity • Inspection of nails • Iggy page 474-475; Wilkinson 370 – Grooves – Pitting – Ridges – Curvature – Shape Malnutrition Anorexia nervosa Anxiety Hygiene Depression Hormones Living conditions Circulatory status Chronic disease Assessment: Inspection
Lesion Description • Size – Metric • Shape – Circumscribed – Irregular – Round • Texture – Rough – smooth • Configuration – Annular • “relating to, or forming a ring” – Linear – Concentric rings – Clustered – Diffuse • Effect of pressure
Lesion Description • Distribution – Asymmetric vs. Symmetric – Confluent • “flowing or coming together; also : run together” – Diffuse – Localized – Solitary – Zosteriform • “resembling shingles” – Satellite
Assessment: Palpation – Edema – Moisture – Temperature – Turgor – Texture Fever C-V status Respiratory status Hormones Hydration Rash/ Lesion Nutritional status
Skin cancer - most common cancer! • Risk factors – Fair skin – Blue/green eyes – Blond/red hair – History chronic sun exposure – Family history – Living near the equator – Very high/low altitudes – Working outdoors – Age > 60 (damage is cumulative)
Non-melanoma Skin Cancers • Basal Cell Carcinoma – Most common type of skin cancer – Easily treated – Doesn’t metastasize – Middle age to older adults – Symptoms • Small slow growing papule • Semi translucent or “pearly” • Erosion/ulceration of center
Basal Cell Carcinoma Medical Tx • Excision • Cryosurgery • Radiation • Topical chemotherapy
Non-Melanoma Skin Cancer • Squamous cell – Less common than BCC – High cure rate with early detection – Can be aggressive, metastasize & be fatal – Common on lips, mouth, face and hands • Pipe, cigar, & cigarette smoking – Symptoms • Firm nodule • Scaling/ulceration • Opaque
Squamous cell carcinoma Medical Tx • Excision • Radiation • Moh’s surgery  (see slide #33) • 5 FU or methotrexate intralesional – (see slide #34)
Diagnostic & Surgical Therapy • Simple Excision • Excision – Moh’s micrographic surgery • Microscopically controlled removal of lesion • Removes tissue in thin layers • Can see all margins of specimen • Preserves normal tissue • Produces smallest wound
Drug Therapy: Topical Fluorouracil (5-FU) – Selective toxicity for sun damaged cells (cytotoxic) – Indications • Premalignant skin disease (esp. actinic keratosis) • Systemic absorption minimal It causes painful eroded area within 4 days and must use 1-2 times daily 2-4 weeks. Healing up to 3 weeks after med stopped Is photosensitizing - avoid sunlight during treatment Will look worse before it gets better
Non-Melanoma Skin Cancers • Actinic Keratosis (AKA Solar keratosis) – Most common precancerous lesion – Premalignant form of squamous cell carcinoma – Symptoms • Hyperkeratotoc papules/plaques on sun exposed areas • Varied appearance – Irregular shape – Flat – Indistinct borders – Overlying scale
Actinic Keratosis (AKA Solar keratosis) Medical Tx: •Cryosurgery  (see slide #37) •5 FU •Surgical removal •Retin A •Chemical peels
Cryosurgery – Subfreezing temps for surgery (liquid nitrogen) • Lesion becomes red & swollen, blisters, then scabs; falls off in 1-3 weeks • Minimal scarring – Indications • Genital warts • Seborrheic keratosis • Actinic keratosis
Malignant Melanoma • 1/3 of all melanoma occur in existing nevi or moles – Any sudden or progressive change in size, color or shape of a mole should be checked
Malignant Melanoma • Can metastasize anywhere • Most deadly of skin cancers • Causes – UV radiation – Skin sensitivity – Genetic – Hormonal – Sun exposure – Mutation of gene (B-RAF) 70%
A B C D’s of Melanoma Asymmetry Border irregular, edges ragged Color varied pigmentation • Tan, brown, black, red Diameter > 6mm
Melanoma Medical Tx Depends on site, stage, age and general health of client – Surgery – Chemotherapy – Biologic Therapy • Interferon, interleukin – Radiation therapy
Prevention/Education • Sunscreen • Limit exposure • Hat/clothes/sunglasses • Shade • Inspect skin regularly
Sunburn: Education (Protect, Protect, Protect) • Same precautions as for skin cancer. • Don’t let clouds or cool air fool you – Florida sun is damaging then too. • Get out of the sun before you turn red! • Cool skin off. Immediately! • Hydrate!
Sunburn • Superficial burn • Excessive exposure to ultraviolet rays injures dermis. • Dilated capillaries = red, tender, edema, blisters • Large area = nausea, fever
Sunburn • Redness & pain begin within a few Hours. • Intensity may increase before subsiding. • 3-5 days to heal • Tx: cool bath; soothing lotions; topical corticosteroids; fluids
Insects/Pests/Parasites • Spiders • Fire Ants • Lice/Scabies • Mosquitoes • Scorpions • “Sand fleas”
Infestations: Pediculosis – Head, body or pubic lice (“crabs”) – Parasite excrement and eggs on skin – Nits in hair • Waxy, don’t fall off easily • Symptoms • Tiny red points to papular wheal-like lesions • Pruritis – check hairline • Secondary excoriation
Pediculosis Medical tx • Pyrethrins (Rid), Permethrin (Nix) or if all other agents fail…Benzene hexachloride (Kwell) • Contact screening • l
Infestations: Scabies – Skin reactions due to eggs, feces, & mite parts – Transmitted by direct contact • Symptoms – Severe itching especially at HS – Usually not on face – Presence of burrows esp. interdigital webs & flexor surface of wrists – Redness, swelling, vesiculation
Scabies Medical tx – Topical Scabicide – Antibiotics for 2ndary infection – Treat those in close proximity – Clothing & linens – hot water and detergent
Drug Therapy: Antiparasitics – Pediculicides • Pyrethrins (RID) • Permethrin (NIX) – Scabicide & Pediculicide • Lindane (Kwell, Scabene) – Cream, lotion – Shampoo  nit comb – Adverse effects  Rash, rare CNS toxicity
Plants in FL that irritate skin • Poinsettia, Croton • Milky sap can cause skin irritation • Oleander – Touching the plant is not dangerous, but prolonged contact can irritate the skin. • Poison Ivy , Brazilian Pepper – Touching the leaves or oil from the plant can cause an itchy rash with blisters.
Brazilian Pepper
Poison Ivy: Virginia Creeper
Drug Therapy • Topical Corticosteroids – Anti-inflammatory, antipruritic • Low potency (hydrocortisone) – Slower acting – Can be used longer without serious side effects – Ointment most efficient – Higher potency, long term, systemic use is different tx
– Intralesional • Reservoir of med effects lasts several weeks to months • Indications – Psoriasis – Alopecia – Cystic acne – Hypertrophic scars and keloids – Systemic • Undesirable adverse effects – Lilley 6th ed. Page 869 • Short term therapy – poison ivy • Long term therapy – chronic bullous diseases Corticosteroids Triamcinolone (Kenalog)
Bases for Topical Medications • Powder – Promotes dryness – Good for antifungals • Lotion – Cooling and drying with residual powder film – Good for pruritic eruptions • Cream – Emulsion of oil and water – Lubrication and protections • Ointment – Oil with water in suspension – Lubrication – Most efficient delivery system • Paste – Mixture of powder and ointment – Drying – Moisture absorption
Nursing Management: RN as skin “symptomologist” • Dry skin – Elderly; Infants • Itchy skin • Broken skin • Prevention of secondary infections
Nursing Management: Dry skin • Manifestations • Interventions: – Elder – • Fewer total baths • Lotions & Mild soaps • Hydrate!
Nursing Management: Itchy skin • Control of pruritis – Keep cool – No rubbing – Moisturize – Systemic antihistamines – Wet dressing – Topical steroids – Menthol, Camphor, Phenol numb itch receptors – Oatmeal baths
Nursing Management: itch • Baths – For large body areas – Has sedating and antipruritic effect – Oilated oatmeal (Aveeno), potassium permangenate, sodium bicarb – Temp comfortable to client – Soak 15-20 mins 3-4 times daily – Pat dry, no rubbing – apply moisturizers or meds after baths
Nursing Management • Wet dressings – Indications • Skin weepy from infection/inflammation • Relieves itching • Debrides wound • Increases penetration of topical meds • Relieves discomfort • Enhances removal of scabs, crusts, and exudate
Wet dressings Procedure •Clean solution and gauze •Squeeze until not dripping •Apply to affected area, avoid normal tissue •Leave in place 10-30 minutes 2-4 times a day •Discontinue if skin macerates (“to soften”)
Nursing Management: Protect • Protect intact skin! – Turn at least q2h – Reposition frequently – Alleviate pressure – Hydration – Mechanical intervention – Rx
Nursing Management: Psychological support • Chronic skin conditions – Emotional stress – Self concept alterations – Body image changes
Nursing Interventions: Psychological support: – Support client – Allow verbalizations of frustrations – Reinforce treatment – Support groups – Help with camouflage
Diagnostic Testing Biopsy – Punch – Incisional – Excisional – Shave RN Responsibilities – Informed Consent – Prep site – Assist with procedure – Apply dressing – Post-op instructions – Properly ID specimen
Diagnostic Testing • Cultures – Diagnose fungal, bacteria, viral infections – KOH (Potassium Hydroxide) • Fungus • Sample collection – Skin scraping – Swabbing – Meticulous labeling
Diagnostic Testing • Woods Light – Organisms fluoresce • Pseudomonas • Fungus • Vitiligo • Mineral oil slides – Infestations • Patch test – Allergen testing
Dermatological Interventions • Phototherapy – UVA & UVB (UVL) – Ultraviolet wavelengths cause erythema, desquamation, and pigmentation – Enhance with psoralem (photosensitizing) • Treatment for • Psoriasis • Atopic dermatitis • Vitiligo
Phototherapy • Adverse effects – Basal or squamous cell Ca – Burns – Erythema – Teach patients to avoid further sun exposure & photosensitizing drugs – Wear eye protections as psoralem absorbed by lens of eye
Dermatological Interventions • Radiation Therapy – Indications • Cutaneous malignancies – Advantages • Produces minimal damage to surrounding tissues – Adverse effects • Permanent hair loss (alopecia) to irradiated areas • Telangiectasia • Atrophy • Hyperpigmentation / depigmentation • Ulceration • BCC and SCC y.
Dermatological Interventions • Laser Therapy (CO2, Argon) – Cuts, coagulates, & vaporizes tissue – No cumulative tissue damage • Indications – Coagulation of vascular lesions – Skin resurfacing – Removal birthmarks – BCC – Keloids – Plantar warts
Diagnostic & Surgical Therapy • Skin Scraping – Scalpel – Surface cells for microscopic inspection • Electrodesication & electrocoagulation – Electrical energy converted to heat – Destroys tissue by burning • Coagulates bleeding vessels • Curettage – Remove tissue with circular cutting edge – Small skin tumors • warts, seborrheic keratosis, BCC, SCC
Allergic Conditions • Contact Dermatitis – Delayed hypersensitivity – Lesions 2-7 days after antigen exposure • Manifestations – Red, hive-like papules and plaques – Sharply circumscribed – Vesicles – Pruritic
Contact Dermatitis Medical Tx – Topical corticosteroids – Antihistamines – Skin lubrication – Elimination of allergen – Systemic steroids if severe http://dermatology.cdlib.org/DOJvol7num1/NYUcases/contact/joe.html
Drug Therapy: Antihistamines • Compete with histamine receptor site – Oral or Topical • Cetitizine (Zyrtec) – PO tabs, syrup QD – Non-sedating • Diphenahydramine (Benadryl) – PO, IM, topical • Indications – Urticaria – Pruritis – Allergic reactions
Drug Therapy: Antihistamines • Adverse effects – Anticholinergic – Sedation (Benadryl) – Use with caution in older adults • Indications – Urticaria – Pruritis – Allergic reactions • Adverse effects – Anticholinergic – Sedation (Benadryl) – Use with caution in older adults
Allergic Conditions: Drug Reaction • Manifestations – Rash of any morphology – Red, macular, papular – Generalized rash with sudden onset – Pruritic – Can occur as late as 14 days after drug is stopped
Drug Reaction Medical Treatment – Discontinue drug – Antihistamines, local or systemic – Corticosteroids if needed
Allergic Conditions: Atopic Dermatitis – Cause unknown – Begins in infancy and declines with age • Manifestations – Scaly, red to re-brown, circumscribed lesions – Pruritic – Symmetric eruptions
Atopic Dermatitis – Topical corticosteroids – Phototherapy – Coal tar corticosteroids – Lubrication of dry skin – Antibiotics for secondary infections Medical Treatment
Dysplastic Nevus Syndrome • Abnormal mole pattern • Increased risk for melanoma – Doubles with dysplastic nevi • Atypical moles larger than usual (>5mm) • Irregular borders, possibly notched • Various variegated colors • Most common on back
Infections of the skin • Risk factors – Imbalance between host and microorganism – Broken or damaged skin; Trauma – Systemic disease such as Diabetes – Moisture – Obesity – Systemic corticosteroids, antibiotics • Prevention – Proper hygiene – Good health
Infections: Herpes Simplex Virus, Type I (AKA “cold sores/fever blisters”) • Contagious • Dormant – Exacerbation • Triggers • Symptoms -- 1st episode 3-7 days after exposure – Painful local reaction – Vesicles on erythematous base – Fever, malaise
Herpes Simplex Virus, Type I Medical Tx – Symptom management – Moist compresses – Petrolatum to lesions – Antiviral agents (Zovirax, Famvir, Valtrex) www.treatmentsforhealth.com/.../cold-sores/
Infections: Herpes Simplex Virus, Type II – Genital “Most genital herpes is caused by HSV-2.” (n.l.m.-n.i.h./ Medline plus) – Recurrence more common than oral • Does not mean re-infection • Symptoms – Same as Type I • Treatment – Same as Type I Iggy page 1742-1743
Infections: Herpes Varicella Virus (chicken pox) ** Highly contagious • No chicken pox or vaccination • Keep those w/active lesions separated until crusted • Symptoms – Vesicular lesions in successive crops • Face , scalp, spreading to trunk and extremities  Protect eyes  Do not squeeze pustules or crusts • Vesicles > pustules > crusts > scars • Postherpetic neuralgia • Self limiting in children
Herpes Varicella Virus Medical Tx – Antivirals – Symptomatic relief
Infections: Herpes Zoster (shingles) – Activation of varicella zoster virus – Frequent occurrence in immunocompromised – Potentially contagious to immunocompromised • Symptoms – Linear patches along dermatome – Grouped vesicles on erythematous base – Unilateral on trunk – Burning pain and neuralgia
Herpes Zoster Medical Tx – Symptomatic • Wet compresses • White petrolatum to lesions – Antiviral agents
Drug Therapy: Antivirals – Acyclovir (Zovirax) • Suppresses chicken pox, herpes simplex 1 & 2, shingles • Po, IV, topical – Valacyclovir (Valtrex) • Herpes zoster (shingles) & genital herpes – Vaccines • Varivax – Prevention of chicken pox – Given to children > 12 mo. • Zostivax – HZU vaccine for adults > 60 y/o
Infections: Verruca Vulgaris – Human papillomavirus – Mildly contagious • Symptoms – Circumscribed hypertrophic flesh colored papule • Treatment – Scoop removal – Liquid nitrogen therapy – Keratolytic agents – CO2 laser therapy
Infections: Plantar Warts (Human papillomavirus) • Symptoms – Wart on “Plantar” surface (bottom) of foot – – Cone shaped with black dots (“seeds”)
Plantar Warts Medical Tx – Liquid nitrogen – Frequent paring with chemical patches – Duct tape??????
Infections: Candidiasis (moniliasis) – Candida albicans (Fungus) – 50% are symptom free carriers – Immunocompromised >> pathogenic – Likes warm moist areas • Mouth, vagina, skin An opportunistic infection
Infections: Candidiasis – Symptoms • Mouth – White, cheesy plaque (milk curds) • Vagina – Vaginitis – Red edematous painful vaginal wall – White patches – Vaginal discharge – Pruritis – Painful urination & intercourse • Skin – Diffuse papular erythematous rash – Pinpoint satellite lesions around edges Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
Candidiasis Medical Tx: Anti-fungals • Nystatin – Vaginal suppository – Oral lozenge • Mycostatin powder, cream • Keep skin clean dry • Diagnosis culture Microscopic exam (KOH)
Infections: Fungal • Tinea Corporis – AKA ringworm – Symptoms • Annular • well defined margins • erythematous
Tinea Corporis AKA ringworm Medical Tx •Cool compresses •Topical antifungals – Miconazole, clotrimazole, butenafine
Infections: Fungal • Tinea Cruris – AKA jock itch – Symptoms • Self-defined border • In groin – Treatment topical antifungal cream or solution
Infections: Fungal • Tinea Pedis – AKA athletes foot – Symptoms • Interdigital scaling • Erythema • Blistering • Pruritis • Pain
Medical Tx • Topical antifungals • Keep dry Tinea Pedis AKA athletes foot
Infections: Fungal • Tinea Unguium – Symptoms • Brittle thickened nails • White/yellow discoloration
Tinea Unguium Medical Tx • Topical antifungal cream or solutions • Griseofulvin (fingernails) • Lamisil • Debride toenails
Drug Therapy: Antifungals – Clotrimazole (Mycelex, Lotrimin) • Lozenges- thrush • Cream, solution, lotion- athletes foot • Intravaginal creams, tablets – Miconazole (Monistat, Micotin) • Athletes foot • Jock itch • Ringworm • Yeast infections
Drug Therapy: Antifungals – Fluconazole (Diflucan) • PO & IV • Excellent bioavailability • Vaginal or systemic candidiasis – Ketaconazole (Nizoral) – Nystatin (Mycostatin) – Tervinafine (Lamisil) for onychomycosis – Tolnaftate (Tinactin)
Infections, Bacterial • Impetigo – Group A beta hemolytic strept or staph – Associated with poor hygiene and low socioeconomic status • Symptoms – Vesiculopustular lesions – Thick honey colored crust – Surrounded by erythema – Pruritic – Contagious • Treatment – Systemic antibiotics – Saline or aluminum acetate soaks – Soap & water – Removal of crusts – Topical antibiotic cream • Strept can cause glonerulonephritis if untreated
Infections: Bacterial • Cellulitis – Staph aureus or strept – Can be primary or secondary infection – Symptoms • Hot • Tender • Erythematous • Edematous • Diffuse borders maybe malaise and fever – Treatment • Moist heat • Immobilization • Elevation • Systemic antibiotics • Hospitalize if severe – Can progress to gangrene if untreated
Drug Therapy: Antibiotics – Topical - apply lightly • OTC – bacitracin – Polymixin B • Prescription – Mupirocin (staph) – gentamycin (staph), – erythromycin (staph & strept) – clindamycin (Cleocin) (acne) – Systemic - culture & sensitivity guides selection • Penicillin • Erythromycin • Tetracycline
Benign Skin Conditions: Acne Inflammatory disorder of sebaceous glands • Symptoms comedones, inflammatory lesions, papules, pustules face, neck, upper back • Treatment – Comedo extraction – Topical Benzoyl Peroxide – Peeling and irritating agents (retinoic acid) – Antibiotic therapy - long term – Phototherapy – Sun exposure – If severe - isotretinoin (Accutane) CAUTION! Teratogenic
Drug Therapy: Acne Preparations – Benzoyl peroxide (Benzac, Desquam-X, PanOxyl, etc) • Apply 1-4x day • Effects seen 4-6 weeks • Adverse effects – Erythema, tenderness, dryness, pruritis, burning – Erythromycin (Eryderm, T-Stat, Erygel) • Macrolide antibiotic • Adverse effects – Erythema, tenderness, pruritis, burning
Drug Therapy: Acne Preparations – Isotretinoin (Accutane) • Pregnancy Category X – Proven teratogen – 2 contraceptive methods – Tretinoin (Retinoic acid, Vitamin A acid, Retin-A) • Stimulates epidermal cell turnover -> skin peeling • Adverse effects – Red edematous blisters, crusted skin, altered skin pigmentation • Avoid sun, use sunscreen • Apply to dry skin
Benign Skin Conditions: Moles Grouping of normal cells • Manifestations – Hyperpigmented areas – Varying form and color • Treatment – None necessary – Cosmetic – Biopsy for diagnosis
Benign Skin Conditions • Psoriasis – Chronic dermatitis due to rapid turnover of epidermal cells – Family predisposition – Manifestations – Sharply demarcated scaling plaques of • Scalp • Elbows • Knees • Palms, soles, and fingernails possible • Treatment – Retard growth of epidermal cells – Topical corticosteroids – Tar – Anthralin topical – Sunlight, UV light – Alefacept (Amevive) injection – Antimetabolites (methotrexate) or systemic retinoids for difficult cases
Benign Skin Conditions • Seborrheic Keratoses – Irregularly shaped flat topped papules or plaques – Warty surface – Appearance of being stuck on – Increase in pigmentation – No association with sun exposure – Treatment • Removal – Curettage – cryosurgery
Benign Skin Conditions: Lipoma Encapsulated tumor of adipose tissue Most common 40-60 years of age • Manifestations – Rubbery, compressible, round mass – Variable in size – Most common on trunk, back of neck, forearms • Treatment – Biopsy – Excision if indicated
Benign Skin Conditions: Vitiligo – Unknown cause – Genetic connection – Complete absence of melanocytes – Non-contagious • Manifestations – Complete loss of pigment – Variation in size an location – Symmetric and permanent • Treatment – Exposure to UVA and psoralens – Depigmentation of pigmented skin in extensive disease – Cosmetics and stains
Benign Skin Conditions: Lentigo • (see fig. 26-7, Iggy page 465) – AKA liver spots – Increased number of melanocytes – Related to aging and sun exposure • Manifestations – Hyperpigmented brown to black flat lesion – Usually in sun exposed areas • Treatment – Liquid nitrogen • Possible reoccurrence in 1-2 years – Cosmetics
Primary Lesions • Macule (freckles, petecchia, measles) – Flat – Change in color – < 1cm • Papule (wart, mole) – elevated, – Solid – <1cm • Vesicle (chicken pox, herpes zoster, 2nd burns) – Elevated – Fluid filled – <1cm
Primary Lesions • Bulla – > 1cm – Elevated – Serous fluid filled • Plaque (psoriasis, keratosis) – Elevated – Solid lesion – >1cm
Primary Lesions • Wheal (insect bite) – Firm – Edematous – Irregular shape – Diameter variable • Pustule (acne, impetigo) – Elevated – Purulent fluid – Varied size
Secondary Lesions • Fissure (athletes foot) – Linear crack from epidermis to dermis • Scale (excess dead & flaking of skin) – Drug eruption – Scarlet fever • Scar – Increased connective tissue – Surgical incision – Healed wound
Secondary Lesions • Ulcer – Crater – Loss of epidermis, dermis – Pressure ulcers, chancre • Atrophy – Thinning of epidermis/dermis – Ages skin, striae • Excoriation – Missing epidermis – Scabies, abrasion, scratch
References: • Chickenpox in Pregnancy. (2009). March of Dimes Foundation. Retrieved 9/25/09 from http://www.marchofdimes.com/professionals/14332_1185.asp • Common Poisonous Plants of Florida (Florida Poison Information Center/Tampa) @ http://www.poisoncentertampa.org/poisonous-plants.aspx • Culbert, D. (April 14, 2005). Florida scorpions. UF/IFAS Okeechobee County Extension Service. Retrieved 6/17/09 from http://okeechobee.ifas.ufl.edu/News%20columns/Florida.Scorpions.htm • Groch, J. (August 23, 2006). Guidelines for Preventing Pressure Ulcers Seen as Suboptimal. MedPage Today. Retrieved 6/12/09 from http://www.medpagetoday.com/Dermatology/GeneralDermatology/3982
References: • Hembree, D. (July 21, 2008) 10 Poisonous Plants in Florida and Safety Precautions @ http://www.associatedcontent.com/article/875395/10_poisonous_pla nts_in_florida_and_pg2.html?cat=11 • “Herpes simplex” (May, 2009). Medline Plus Medical Encyclopedia. Retrieved 6/15/09 from http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/001324.htm • Lilly, L.L., Harrington, S, & Snyder, J. (2005) Pharmacology and the Nursing Process. (4th ed.) Mosby Elsevier. St. Louis, MS. • Medical Dictionary (2009) Merrium – Webster Inc. Retrieved 6/15/09 from http://www.nlm.nih.gov/medlineplus/mplusdictionary.html
References: • The Medical News. Brain eating amoeba in lake kills sixth victim. (October 2007). Retrieved 6/16/09 from http://www.news- medical.net/news/2007/10/07/30863.aspx • The US Market for Skin Care Products. (May, 2005). Retrieved 6/12/09 from http://www.mindbranch.com/Skincare-Products-R567- 0199/ • Scorpion Sting Treatments. (2008). Orkin. Retrieved 6/17/09 from http://www.orkin.com/other/scorpions/scorpion-sting-treatments
Burns • Thermal burns – Flame, flash, scald • Chemical burns – Necrotizing substances • Acids • Alkali – Cleaning agents, drain cleaners, lye • Electrical burns – Intense heat from electrical current The Following Content – Burns – will be covered in future classes! Save this information for future use.
Classification: Depth of Burn See page 522 in Iggy text • ABA by depth of destruction – Partial thickness burn • Epidermis and dermis involved – Full thickness burn • “burns reach through the entire dermis and sometimes into the subcutaneous fat.” (Iggy, page 522) • Possibly involves muscles, tendons, and bones • *Skin cannot heal on its own.
Classification: Extent of Burn • Total Body Surface Area (TBSF) – (Iggy page 531) • Berkow method – http://www.umobile.edu/main/notes/Burn.pdf • Rule of 9’s – (Iggy page 531)
Classification: Location of Burns • Severity related to location • Complication risks related to location • Face, neck, chest – Respiratory complications • Hands, feet, joints, and eyes – Compromise ADLs • Circumferential burns of extremities – Circulatory compromise
Emergent Care • A,B,C’s • Fluid Therapy • Wound Care • Pain management • Prevention of infection
Burns What happens….
Complications of Emergent Phase • Cardiovascular – Arrhythmias – Hypovolemic shock – Impaired circulation • Respiratory – Upper airway burns – Inhalation injuries • Urinary – Acute tubular necrosis
Acute Phase • Fluid therapy – Lactated Ringers per Parkland (Baxter) formula • Wound care – Topical silvadene, sulfamylon, bacitracin, or bactroban – PREVENT INFECTION • Excision and grafting – Remove necrotic tissue – Apply split thickness auto graft skin • Porcine skin, cadaver skin, clients own skin, skin culture • Nutritional therapy – Increased fluids, proteins, vitamins A, C, E. – Zinc, iron, folate • Physical therapy – Prevent contractures • Physical and psychological comfort
Drug Therapy: Antibiotics • Silver Sulfadiazine (Slivadene) – Burn treatment – QD or BID – “frosting” – Adverse effects • Pain • Itching • Burning
Rehabilitation Phase • Prevent and minimize contractures and scarring! • Cosmetic / reconstructive therapy • Psychological support if needed

Check these out next

integumentary_system.ppt

Recommandé

Contenu connexe

Similaire à integumentary_system.ppt(20)

Plus de N3LUMBO(6)

Dernier(20)

integumentary_system.ppt