1228 Integumentary System

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NURSINGMANAGEMENT:

INTEGUMENTARYSYSTEM


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Largest organ of the body. It includes skin, hair, nails,and glands

Healthy skin reflects a healthy body


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Important health

information Past health history

Medications

Surgery or othertreatments

ASSESSMENT OF THE SKIN


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Nutrition

Exercise

RestHygiene

Avoid irritants and over exposure to thesun

Quite smoking

HEALTH PROMOTION


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Skin is thinner anddryer

Be familiar with skinand assess regularly

Shower less often

Use warm ratherthan hot water

Use mild soap

Apply moisturizerimmediately aftershower while skin isstill damp

GERONTOLOGICALCONSIDERATIONS


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Sun exposure

Ultraviolet rays of the sun

Direct or indirect exposure

Degenerative changes in the dermis

Premature aging Loss of elasticity

Thinning

Wrinkles

Drying

Risk for precancerous and cancerous lesions

Actinic Keratosis, Basal cell carcinoma, squamous cellcarcinoma, and malignant melanoma

Up to 90 percent of the visible changes commonlyattributed to aging are caused by the sun.

SUN EXPOSURE AND YOUR SKIN


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Avoid sun between 10AM and 3 PM

Start with short sessions

15-20 minutes Sunscreen SPF >15

daily, all year

Reapply after swimming,strenuous exercises, or

prolonged sun bathing

Lip balm SPF >15

Protective clothing

Hat

Sunglasses

Watch out for cloudy daysand water reflection

Avoid tanning lamps ortanning booths

PROTECTING YOUR SKIN FROM

THE SUN


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Ten minutes in a sunbed matches the cancer-causing effects

of 10 minutes in the Mediterranean summer sun.

Indoor ultraviolet (UV) tanners are 74 percent more likely to

develop melanoma than those who have never tanned

indoors.

People who use tanning beds are 2.5 times more likely to

develop squamous cell carcinoma and 1.5 times more likely

to develop basal cell carcinoma.

TANNING BEDS


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Gloves

Good hand washing

Safe disposal ofsoiled dressings

Avoid scratching oflesion

Trim nails, no fakenails

STOPPING THE SPREAD OFINFECTION


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Pruritus (itching)Makes pruritus worse Heat and rubbing Dryness Restricted clothing

Makes pruritus better Cool environment Corticosteroids Cool compress Menthol, camphor, or pheno

Numbs the itch receptorsAntihistamines Benadryl

Aveeno baths

NURSING MANAGEMENT: PRURITUS


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Deep infection of the hairfollicle commonly caused by Staph

Aureus

Clinical manifestations:small, red, elevated, painfulnodule.

Management: warm wet compresses four

times a day I & D Antibiotics-topical and/or

oral Do not squeeze

FURUNCLE (BOIL)


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Superficial skin infection:caused by Staph, Strep, or

MRSA

enters through a break in theskin

Honey-colored crusts onerythematous base

Areas beneath crust- glistening,weeping, and eroded

Primarily face

Treatment: Gently remove crust with soap

and water

Topical bactericidal ointment ororal antibiotics

Usually heals without scarring

IMPETIGO
http://162.129.70.33/images/Impetigo_contagiosa_5_060721.jpg


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Bacterial infection of the skinSkin is warm to touch, red,

swollen and painfulPt has fever, malaise, chills

Treatment:Elevation of affect partAntibioticsDressing changes if open

wounds are present

Usually resolves in 2 weekswith TX

Untreated risk of gangrene

CELLULITIS
http://162.129.70.33/images/iv_drug_abuse_1_060403.jpg


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Fungal infection are transmitted person to person oranimal to person

Avoiding fungal infections

Keep your skin clean and dry

Avoid sharing comb or brushes, hats or any type ofheadgear, clothes, and towels.

Avoid eating foods high in sugar, dairy, caffeine, wheat,and yeast as all of these will enhance fungal growth.

Wear loose fitting clothing

Change damp or soiled clothing quickly

Wear cotton underwear

Keep toenails clean and short; and avoid walkingbarefoot on areas like locker rooms and public showers.

FUNGAL INFECTIONS(DERMATOPHYTE)


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Ringworm of the scalp is afungal infection of the scalpand hair shaftsUsually appears as itchy,

scaly, bald patches on the

head. Possible permanent hairloss

TreatmentOral antifungal medication

such as Griseofulvin or LamisilSelenium Sulfide shampoos

Topical antifungal agentsTeaching

Avoid using the same comb

Routinely wash scarf's andhats

Examine family and pets forsymptoms

TINEA CAPITIS


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Ringworm

Trunk, arms, legs

Elevated ring shaped scaling, well definedred borders with center clearing

Treatment

Wash and dry the area first. Apply the cream

Use the cream twice a day for 7 to 10days.

Do not use a bandage over ringworm.

Medications

Griseofulvin (Grifulvin V)

Fluconazole (Diflucan)

Terbinafine (Lamisil)

Begin applying 1 inch beyond lesion andwork inward for 1-2 weeks until resolved

TINEA CORPORIS


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Affects the skin of your genitals, innerthighs and buttocks

Itching and redness in your groin,including your genitals, inner thighs andbuttocks

Possible itching in your anal area

Burning sensation in affected areas Flaking, peeling or cracking skin in your

groin

Treatment Allylamines such as terbinafine

(Lamisil AT) Azoles including clotrimazole (Lotrimin

AF)

Wet compresses or sitz baths may besoothing

Prevention Keep area clean and dry Make sure your clothes fit correctly

TENIA CRURIS
http://162.129.70.33/images/Tinea_cruris_1_040522.jpg


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Athletes Foot

Most commonly between toes and soles of thefeet, can be on hands

Red, scaly patches

May contain bumps, blisters, or scabs

Treatment: Butenafine (Lotrimin), Clotrimazole (Lotrimin),

Miconazole (Desenex), Terbinafine (Lamisi l),Tolnaftate (Tinactin)

Keep using the medicine for 1 - 2 weeks

Prevention:

Dry your feet thoroughly after bathing orswimming

Wear sandals or flip-flops at a public shower orpool

Change your socks often to keep your feet dry

Wear shoes that are well ventilated

TENIA PEDIS


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Fungal infection of the nails

Brittleness

Change in nail shape

Crumbling of the outside edges ofthe nail

Loosening or lifting up of the nail Loss of luster and shine

Thickening of the nail

White or yellow streaks on theside of the nail

Treatment Topical or oral antifungals fo r

about 2 to 3 months

Fluconazole and griseofulvin, areused

In some cases, the health care

provider may remove the nail

TENIA UNGUIUM


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Candidiasis

Yeast

Likes warm moist areas

Glistening, fiery red or moist

pink, beefy red with satellitepustules

Severe itching/burning

Skin folds/groin area

Diaper rash (dermatitis)

Oral-thrush

NON-DERMATOPHYTE INFECTIONS


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http://162.129.70.33/images/Thrush_1_041024.jpghttp://162.129.70.33/images/Candidiasis_1_031219.jpg


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Healthy diet

Manage stress

Keep skin clean anddry

Diabetic controlblood sugar

Antibiotics eat livecultured yogurt

Anti Fungal Medicine clotrimazole (Lotrimin) ornystatin.

Diaper rash Zinc oxide oint,avoid using wipes

Fluconazole (Diflucan) orNystatin swish and swallow forOral Thrush

Home Remedies Tea Tree Oil,Garlic, Live cultured yogurt(acidophilus)

TEACH PREVENTION ANDMANAGEMENT


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Contact dermatitis is aninflammation of the skin caused bydirect contact with an irritating

substance.Hypersensitivity to allergen 2-7

days after exposure

Poison Oak or Ivy, nickel, wool,detergents, soap, hair dyes, paint,insecticides, rubber/latex

Red, hive like papules, edema,and pruritus

CONTACT DERMATITIS
http://162.129.70.33/images/poison_ivy_1_060728.jpghttp://162.129.70.33/images/contact_dermatitis_1_061030.jpg


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Avoidance of irritant

Teach

Wash exposed skin with

cool water asap postexposure

Within 15 minutes

Trim nails

Avoid breaking of

blisters, fluid spreads thedisease.

Topical corticosteriods,

antihistamines, skinhydration antipruritic

TREATMENT


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Pruritic transient wheals ofvarying shapes and sizes(Hives)

Response to irritant:drugs, food, insect bites,inhalants, stress, exposureto heat and cold, andexercise

Treatment:

antihistaminescold compresses

Remove of irritant source

URTICARIA
http://162.129.70.33/images/acute_urticaria_1_061010.jpg


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Hypersensitivity to certaindrugs

Red macular and papularrash

Generally abrupt onset

Can appear as late as 14days post drug

TX: withdrawal of drug andcorticosteroids

DRUG REACTION
http://162.129.70.33/images/remicade_rash_1_050908.jpg


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ATOPIC DERMATITIS (ECZEMA)

Often begins in infancy

2-6 months

Scaly, red to redish-brown

circumscribed lesions

Itches more at night

In children positivecorrelation with allergies tomilk, eggs, wheat, andpeanuts


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CorticosteriodsPhototherapyCoal tar therapy

Intralesional injections ofsteriodsHydration of skinReduction of stress

Stress causes flare up

Teaching

Dietary restrictions inchildren

Keep nails trimed

Avoid overheating (nylonclothing)

Avoid people infected withchicken pox or herpessimplex

Avoid live vaccines

Wear non-irritatingclothing

TREATMENT


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Verruca Vulgar is

Hands

Flesh-colored orbrownish gray scaling,vegetative papule

Treatment:

Cryosurgery

Chemical destruction

(salicylic acid) Curettage

Desiccation

Laser

VERRUCAE (WARTS)


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Most common virus in humans

Two types

HSV-1

Fever blister and cold sores

HSV 2

Genital herpes

Treatment:

Antiviral Zovirax, Famvire, Valtrex

HERPES SIMPLEX (HSV)


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Grouped, burning, and itchingvesicles on erythematous base

Mouth, oral cavity, eyes andbrain

Teach: direct contact, spread by

kissing, oral genital sexualcontact, contact with fingers

Exacerbated:

Stress, trauma, Menes,sunlight, fatigue, systemicinfection

Hand washing

Last 7-10 days

HSV-1


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Genital herpes is a common sexually transmittedinfection that affects both men and women.

Symptoms include:

pain, itching and sores in genital area

Infected people have no signs or symptoms of genitalherpes

An infected person can be contagious, even if he orshe has no visible sores

HSV-2


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Shingles is a viral infection

that causes a painful rash

Related to chicken pox virus

Potentially contagious to

anyone who has not had

varicella or who is

immunosuppressed

Aging, stress,

immunosuppressed Painful vesicles in a linear

pattern along dermatome

(spinal and cranial nerve

tracts)

HERPES ZOSTER


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Grouped vesicles onerythema base Most commonly to the trunk

Fluid-filled blisters that breakopen and crust over

Pain, burning, numbness ortingling Heals without complication

may scarTreatment:

Antiviral agent

Acyclovir, famiciclovir Cool compresses, analgesia,

bedtime sedation Shingles Vaccine

Zostavax

HERPES ZOSTER


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Unknown cause

Genetically influenced

Precipitated by an event Illness or crisis

Complete absence ofmelanocytes

Non-contagious

VITILIGO


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Complete loss of pigment,macular, variation in sizeand location

May be permanent

Topical steroids for smallareas

PUVA

Light treatment andpsoralens

Cosmetics and stains

VITILIGO


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Chronic hereditarydisorder

Light-skinned race Environmental factors

that trigger

Skin injury InfectionsHormone changesStressDrugsAlcoholSmoking obesity

PSORIASIS


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Erythematous plaque with

sharp well defined borders

and silvery white scales.

Elbows, knees, scalp,

lumbosacral skin, can occur

anywhere

Teach reducing pruritus

Avoid scratching

Room humidifier

Warm not hot bathing

Avoid strong soaps

Lubricate skin

antihistamines

Management

Topical treatment

Coal tar treatment

Anthralin corticosteriods

Photo-therapy

PUVA

Psoralin

Ultra violet A light

PSORIASIS CONT.


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Scabies (Mites)

Mite infestation in thedermis to lay eggs

Inflammation and itching

(worse at night)Burrows between fingers,

wrist, axillary folds,popliteal, and inguinal

Treatment:Elimite Lotion

Apply head to toe thenrepeat in 1 week

INSECT AND ANIMAL CONTACTS


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Lice infestation

3 types

Pediculosis Capitus

Head lice

Pediculosis Corpus

Body lice

Pediculosis Pubis

Pubic lice

crabs

PEDICULOSIS


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Head liceSchool-age childrenLives 48 hoursFemale lays eggs (nits) on the hair shaft

Hatch in 7-10 daysDoes not live on animals

Head lice can only survive on humansEasily transmitted person to person

Does not jump or fly

Sharing: combs, hats, caps, scarves, coats, sharedlockers, slumber parties, or other items used on ornear hair

Can invade all ages

PEDICULOSIS CAPITIS


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Manifestations

Visual

Itching/scratch marks

Behind ears, head, nape of the neck

Treatment Pediculocides and manual removal of nit cases

NIX, RID

Apply treatment

Leave on 10 minutes, rinse and towel dry

Remove nits with nits comb Lice treatment kill, but do not remove the nits

LICE


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Machine wash all washable clothing, towels, and bedlinens in hot water, and dry in hot dryer for at least20 minutes

Thoroughly vacuum carpets, car sets, pillows, stuffed

animals, rugs, mattresses, and upholstered furniture

Seal non-washable items in a plastic bag for 14 daysif unable to dry clean or vacuum

Soak combs, brushes, and hair accessories in lice-

killing products for 1 hours or in boiling water for 10minutes

TEACH


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Bedbugs

Feed at noc, during the day, they hide in thecracks and crevices of beds, box springs,headboards and bed frames

Red, often with a darker red spot in themiddle

Itchy

Arranged in a rough line or in a cluster of 3

Located on the face, neck, arms and hands

Treatment:

Cortisone cream

Antihistamine

Treat pruritus

CIMICIDE


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Allergic reactions account for30 deaths each year

Honeybees, bumblebees,wasps, hornets, yellow

jackets, mud daubers, andfire ants

Reaction may be immediate ordelayed (after 2 hours)

Non-allergic reaction

Local edema, erythema pain,itching

Resolves in a few hours

STINGS


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Severe with possible anaphylaxis reactionGeneralized urticaria and pruritus,bronchospasms, laryngeal edema, shock and

death10-30 minutes post stingEpinephrine 0.1-0.5 mL of 1:1000 sol, mayrepeat 15-15 minutes until symptoms resolve

Stinger removal

Honeybees only leave stingersClean areaRemove by scraping a flat item over stingeragainst the entry.

Avoid breaking or squeezing

TreatmentIce, elevation, antihistamines


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Risk factors

Fair skin type

Over exposure to sunlight

Family history of skin cancersEnvironmental factors include

Outdoor occupation

frequent participation in outdoor activities

Behavioral factors include

CANCER OF THE SKIN


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Actinic keratosis

Face, neck, back of hands,forearms

Rough scaly patch,irregular shaped, flat,slightly

Sun exposure

May progress to squamouscell CA

PREMALIGNANT LESISONS


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Treatment

Mohs Micrographic Surgery

Electrodessication and curettage

Excision

Cryosurgery

Radiation therapy Photodynamic Therapy (PDT)

For small lesions

Topical chemotherapy

5-Fluorouracil (5-FU)

For superficial lesions Post procedure

Keep wound moist and covered

Clean with NS

Antibiotic ointment

Yearly exam for life

TREATMENT


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Risk factors

prolonged exposure to sunlightor from tanning beds, fair skin,age-most common >45,genetic, smoking

flat lesion with a scaly crust Slowly enlarges

Treatment:

Surgical excision

Mohs surgery

Laser Chemo

Radiation

May metastasize

Smoking increases the risk of

SCC to mouth or lips

SQUAMOUS CELL CARCINOMA


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MALIGNANT MELANOMA

E -evolving over time


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RISK FACTORS

Fair skin hair and eyes

Hx of sunburns

Excessive exposure to sun and tanning beds

Many or unusual moles

Family hx of melanoma

Typically af fects areas with greatest

exposure to the sun


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Punch biopsy

DIAGNOSIS

Excisional biopsy


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TREATMENT

4 Treatment options

Surgery

Chemotherapy

RadiationImmunotherapy


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Avoid unnecessaryexposure to sunlight

Includes tanning beds

Use sunscreen

Apply often

Wear protective clothing

Hat, sunglasses

Know your skin

Inspect moles Report any changes

Report development ofany new lesions

Self examination of theskin

Check skin monthly

Professional check- upat 3 mo, 6 mo, andyearly for life if skincancer is removed

PREVENTION


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PROGRESSION OF SUSPICIOUSMOLES


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Involves the hair follicle andsebaceous glands of the face,neck, chest, and upper back

Few comedones (blackheads)to severe inflammatoryreaction

Cystic acne

Cause

Hormone

Products that contain oilycomponents

Increased comedones

Fast food chains

No dietary link

ACNE VULGARIS


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TREATMENT OF ACNE


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Antibiotics tetracycline

OCPOral contraceptive pill - Yasmin

AccutaneCystic acneSignificant side effect

Causes birth defectsContraindicated with pregnancy

Pregnancy test

Effective contraceptive method duringtreatment and for 6 months after treatment

Elevates triglyceride and cholesterolMonitor levels

TREATMENT OF ACNE


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Treatment

Retin A

Cream, gel, or liquid

apply 20-30 minutes

after washing Burning sensation/

redness of skin

Avoid sun exposure

Sunscreen

Apply at bedtime

Benzoyl PeroxideCream, lotion, gel,

washBleaching effect onsheets, bedclothes,and towels

PEELING AGENTS


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Elective cosmetic surgery

Main reason

To improve self-image

Most common procedures

Breast enlargement, breast reduction,rhinoplasty, tummy tuck, liposuction,mechanical and surgical face-lift, eyelid lift,hair transplant, removal of double chin

PLASTIC SURGERY


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Chemical burn

Moderate swelling andcrusting for 1 week

Within 7-8 days new skin willappear

Healing is complete in 10days

Redness for 6-8 weeks

Pink tone for several months Complete sunblock(reduction in melanin)

CHEMICAL FACE-LIFT/PEEL


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Removal ofepidermis

Prevent dryingEmollients andwet soaks

Sunscreen

DERMABRASION


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Temporarily eliminates browfurrows, frown lines andcrow's feet.

Paralyzing small musclesinvolved in facialexpressions

Does not cause botulism(small doses)

Redness, pain, swelling, HA,

and double vision for 1-2weeks

Injections are expensive

Must be repeated every 3-6months

BOTOX INJECTIONS


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Social isolation

Coping

Nutrition

Anxiety

NURSING DIAGNOSIS


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The nurse teaches a patient several interventionsto reduce pruritus associated with dry skin.Which statement, if made by the patient to thenurse, indicates further teaching is required?

A.I will avoid taking hot showers.

B.I should rub my skin instead of scratching.

C.A wet dressing followed by a lubricating lotion willhelp.

D.Menthol can be used to numb the itch sensation.

REVIEW


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1228 Integumentary System

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