1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin...
-
Upload
morgan-palmer -
Category
Documents
-
view
215 -
download
0
Transcript of 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin...
![Page 1: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/1.jpg)
1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Chapter 50
Skin Disorders
![Page 2: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/2.jpg)
2Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Learning Objectives
• Describe the structure and functions of the skin.• List the components of the nursing assessment of the
skin.Define terms used to describe the skin and skin lesions.
• Explain the tests and procedures used to diagnose skindisorders.
• Explain the nurse’s responsibilities regarding the testsand procedures for diagnosing skin disorders.
• Explain the therapeutic benefits and nursing considerationsfor patients who receive dressings, soaks and wet wraps, phototherapy, and drug therapy for skin problems.
• Describe the pathophysiology, signs and symptoms, diagnostictests, and medical treatment for selected skin disorders.
• Assist in developing a nursing care plan for the patientwith a skin disorder.
![Page 3: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/3.jpg)
3Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Anatomy and Physiology of the Skin
![Page 4: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/4.jpg)
4Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Definition
• The skin is an organ that covers the body surface • Two distinct layers
![Page 5: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/5.jpg)
5Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Epidermis
• Outermost layer that covers the dermis • Continually produces new cells to replace
those at the surface • Produce melanin, a dark pigment, that helps
determine the color of the skin • Strong ultraviolet light, such as in sunlight,
stimulates the production of melanin
![Page 6: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/6.jpg)
6Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Dermis
• Strong connective tissue that contains nerve endings, sweat glands, hair roots
• Well supplied with blood vessels, causing the skin to redden when surface vessels are dilated
• Subcutaneous tissue lies beneath the dermis
![Page 7: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/7.jpg)
7Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-1
![Page 8: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/8.jpg)
8Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Appendages
• Hair, nails, and sebaceous glands• Hair root located in tube in dermis called a hair
follicle • Arrector muscles located around hair follicles
contract, causing hairs to stand erect and
gooseflesh skin • Sebaceous glands secrete oily substance: sebum • Sweat glands, in most parts of the skin, secrete
through skin surface water that contains salts, ammonia, amino acids, lactic acid, ascorbic acid, uric acid, and urea
![Page 9: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/9.jpg)
9Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Functions
• Protection • Temperature regulation • Secretions• Sensation • Synthesis of vitamin D • Blood reservoir
![Page 10: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/10.jpg)
10Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Age-Related Changes
• Wrinkling a result of thinning skin layers and degeneration of elastin fibers
• Sweat glands decrease, although production changes little until advanced age
• Production of sebum decreases, becoming apparent earlier in women than in men
• Dryness and pruritus are common • Skin pales because the number of cells that
produce melanin decreases
![Page 11: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/11.jpg)
11Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Age-Related Changes
• Skin lesions are more common• Lentigines • Senile purpura• Senile angiomas • Seborrheic keratoses • Acrochordons
• By age 50, nearly half have some gray hair • Men begin to lose hair from the scalp in their
40s; by their 80s many almost bald
![Page 12: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/12.jpg)
12Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Age-Related Changes
• Scalp hair thins in women as well but usually less obvious
• Increase in facial hair in both sexes • Men may have increased hair in the nares,
eyebrows, or helix of the ear • Nails flatten; become dry, brittle, and discolored
![Page 13: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/13.jpg)
13Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-2
![Page 14: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/14.jpg)
14Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Health History
• Chief complaint and history of present illness • Discomfort, pruritus, color changes, lesions, hair
loss, or abnormal hair growth • Onset of condition/precipitating or alleviating factors
• Past medical history
• Previously diagnosed skin diseases or problems, current and recent medications, and allergies
• Diabetes mellitus, cancer, kidney failure, thyroid disease, liver disease, and anemia
![Page 15: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/15.jpg)
15Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Health History
• Review of systems • Change in skin color or pigmentation, change in a
mole, sores slow to heal, itching, dryness or scaliness, excessive bruising, rashes, lesions, hair loss, unusual hair growth, changes in nails
• Functional assessment • Past and present occupations, exposure to
chemicals or other irritants, skin care habits, sun exposure
• Recent changes in the work or living environment • Current stresses and sources of anxiety
![Page 16: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/16.jpg)
16Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Physical Assessment
• Skin color and variations in pigmentation • Document dilated blood vessels and angiomas • Nevi (moles) inspected for irregularities in
shape, pigmentation, and ulcerations or changes in surrounding skin
• If a rash, location, distribution, and characteristics. If any drainage, the color, amount, and odor are noted
![Page 17: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/17.jpg)
17Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-3
![Page 18: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/18.jpg)
18Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Physical Assessment
• Palpate skin for temperature, moisture, texture, thickness, edema, mobility, and turgor
• Mobility and turgor • Hair color, distribution, oiliness, and texture.
The scalp is inspected for scaliness, infestations, and lesions
• Shape/contour of the fingernails and toenails • Color of the nail bed• Capillary refill checked by applying pressure to
the nail to cause blanching and then releasing
![Page 19: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/19.jpg)
19Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-4
![Page 20: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/20.jpg)
20Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Diagnostic Tests and Procedures
• Microscopic examination of skin specimens• Potassium hydroxide (KOH) examination • Tzanck smear • Scabies scraping
• Wood’s light examination • Patch testing for allergy• Biopsy
• Shave biopsy • Punch biopsy • Surgical excision
![Page 21: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/21.jpg)
21Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Therapeutic Measures
• Dressings• Protect wounds; retain surface moisture • Types: wet, dry, absorptive, and occlusive
• Negative pressure wound therapy• Reduce healing time of traumatic wounds, dehisced
surgical wounds, pressure and chronic ulcers
• Soaks and wet wraps• Soothe, soften, and remove crusts, debris, and
necrotic tissue
![Page 22: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/22.jpg)
22Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Therapeutic Measures
• Phototherapy• Ultraviolet light in combination with photosensitive
drugs promotes shedding of the epidermis
• Drug therapy• Topical drugs: keratolytics, antipruritics, emollients,
lubricants, sunscreens, tars, anti-infectives, glucocorticoids, antimetabolites, antihistamines, antiseborrheic agents, and vitamin A derivatives
![Page 23: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/23.jpg)
23Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Disorders of the Skin
![Page 24: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/24.jpg)
24Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Pruritus
• Etiology and risk factors • Triggered by touch, temperature changes,
emotional stress, and chemical, mechanical, and electrical stimuli
• Prominent symptom of psoriasis, dermatitis, eczema, insect bites
![Page 25: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/25.jpg)
25Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Pruritus
• Medical treatment • Stress management and avoidance of known
irritants, sudden temperature changes, and alcohol, tea, and coffee
• Lubricants in the bathwater and emollients applied after bathing also may help
• Medications include corticosteroids, antihistamines, and local anesthetics
![Page 26: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/26.jpg)
26Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Pruritus
• Assessment• Collect data about symptoms that may help
determine the cause • The history of the current illness is important
because pruritus may be just one symptom of a condition that requires attention
![Page 27: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/27.jpg)
27Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Pruritus
• Interventions• Lubricants/emollients; adding oils to bathwater• Advise to avoid bathing in very hot water • Administer medications or instruct patient in their
use • Inspect skin daily to determine effects of treatment • Explain possible causes of pruritus and encourage
the patient to avoid them
![Page 28: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/28.jpg)
28Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Atopic Dermatitis (Eczema)
• Pathophysiology• Acute stage: red, oozing, crusty rash and intense
pruritus • Subacute stage: redness, excoriations, and scaling
plaques or pustules. Fine scales may give skin a silvery appearance
• Chronic stage: the skin becomes dry, thickened, scaly, and brownish gray
![Page 29: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/29.jpg)
29Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Atopic Dermatitis (Eczema)
• Etiology and risk factors• Personal or family history of asthma, hay fever,
eczema, or food allergies • People with atopic dermatitis have an immune
dysfunction, but it is not known whether that dysfunction is a cause or an effect of the disorder
![Page 30: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/30.jpg)
30Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-6
![Page 31: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/31.jpg)
31Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Atopic Dermatitis (Eczema)
• Medical diagnosis • Health history and physical examination• Skin biopsy, serum immunoglobulin E levels, and
cultures; allergy tests
• Medical treatment • Topical corticosteroids; systemic antihistamines
![Page 32: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/32.jpg)
32Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Atopic Dermatitis (Eczema)
• Assessment• Allergies, bathing practices, and current medications
• Interventions• Impaired Skin Integrity • Risk for Infection • Disturbed Body Image
![Page 33: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/33.jpg)
33Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Seborrheic Dermatitis
• Pathophysiology• Chronic inflammatory disease of the skin • Affects scalp, eyebrows, eyelids, lips, ears, sternal
area, axillae, umbilicus, groin, gluteal crease, and under the breasts
• Areas affected by this condition may have fine, powdery scales, thick crusts, or oily patches
• Scales may be white, yellowish, or reddish • Pruritus is common
![Page 34: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/34.jpg)
34Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Seborrheic Dermatitis
• Etiology and risk factors • The cause is unknown • May be an inflammatory reaction to infection with
the yeast Malassezia
![Page 35: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/35.jpg)
35Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Seborrheic Dermatitis
• Medical diagnosis • Health history and physical examination
• Medical treatment • Topical ketoconazole (Nizoral), sometimes with
topical corticosteroids • Shampoos that contain selenium sulfide (Selsun),
ketoconazole, tar, zinc pyrithionate, salicylic acid, or resorcin
![Page 36: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/36.jpg)
36Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Seborrheic Dermatitis
• Assessment• Inspect and describe the affected areas
• Interventions• Explain the condition and reinforce the physician’s
instructions for treatment
![Page 37: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/37.jpg)
37Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Psoriasis
• Pathophysiology • Abnormal proliferation of skin cells • Classic sign: bright red lesions that may be covered
with silvery scales
• Etiology and risk factors • Caused by rapid proliferation of epidermal cells • Usually chronic with cycles of exacerbations and
remissions
![Page 38: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/38.jpg)
38Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Psoriasis
• Medical diagnosis • Health history and physical examination
• Medical treatment • No cure; usually treated with topical medications:
corticosteroids, tazarotene, Estar (coal tar), and vitamin D derivatives
![Page 39: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/39.jpg)
39Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-7
![Page 40: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/40.jpg)
40Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Psoriasis
• Assessment• Describe symptoms and treatments• Inspect affected areas for lesions and scales • Document joint pain or stiffness because the
condition may cause arthritis
• Interventions• Ineffective Therapeutic Regimen Management • Disturbed Body Image • Social Isolation
![Page 41: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/41.jpg)
41Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Intertrigo
• Pathophysiology • Inflammation where two skin surfaces touch: axillae,
abdominal skinfolds, and under the breasts • The affected area is usually red and “weeping” with
clear margins; may be surrounded by vesicles and pustules
• Etiology and risk factors • Results from heat, friction, and moisture between
touching surfaces
![Page 42: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/42.jpg)
42Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Intertrigo
• Medical diagnosis and treatment • Based on site/appearance of inflamed skin• If the skin not broken, wash with water twice daily;
rinse and pat dry; soft gauze used to separate layer of tissue and absorb moisture
• For severe inflammation or fungal infection: topical corticosteroid or antifungal agent
![Page 43: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/43.jpg)
43Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Intertrigo
• Assessment• Complaints of pain, irritation, or redness in body
folds • Inspect susceptible areas daily
![Page 44: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/44.jpg)
44Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Intertrigo
• Interventions• Areas where skin surfaces are in contact must be kept clean
and dry • Apply topical medications as ordered • Report increasing redness and tenderness, fever, and broken
skin to the physician • Encourage women with pendulous breasts to wear a soft,
supportive bra • If incontinence has contributed to perineal intertrigo, position
patient with legs apart to allow moisture to evaporate
![Page 45: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/45.jpg)
45Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Fungal Infections
• Pathophysiology • Tinea pedis (athlete’s foot)• Tinea manus (hand)• Tinea cruris (groin)• Tinea capitis (scalp)• Tinea corporis (body)• Tinea barbae (beard)• Candidiasis: affects skin, mouth, vagina,
gastrointestinal tract, and lungs
![Page 46: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/46.jpg)
46Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Fungal Infections
• Etiology and risk factors • Spread through direct contact or by inanimate objects • Lesions may be scaly patches with raised borders • Pruritus common symptom
• Medical diagnosis • Confirmed by microscopic examination of skin
scrapings• Medical treatment
• Fungal: treated with antifungal powders and creams • Oral candidiasis: treated with clotrimazole troches, nystatin
mouthwash or lozenges, oral amphotericin B
![Page 47: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/47.jpg)
47Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-8
![Page 48: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/48.jpg)
48Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Fungal Infections
• Assessment• Conditions that might make a person susceptible to
fungal infections• Inspect the skin and mucous membranes for lesions
• Interventions• Disturbed Body Image • Altered Oral Mucous Membrane • Risk for Injury
![Page 49: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/49.jpg)
49Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Acne
• Pathophysiology • Affects the hair follicles and sebaceous glands • Comedones (whiteheads, blackheads), pustules, cysts • Often develop on the face, neck, and upper trunk
• Etiology and risk factors • Androgenic hormones cause increased sebum production;
bacteria proliferate, causing sebaceous follicles to become blocked and inflamed
• Medical diagnosis • Health history and physical examination findings
![Page 50: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/50.jpg)
50Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Acne
• Medical treatment • Topical medications: antibiotics, keratolytics such as
benzoyl peroxide, topical vitamin A preparations• Oral antibiotics given over several months • Nonpharmacologic treatment: comedo extraction or
cryotherapy • Dermabrasion to reduce scarring
![Page 51: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/51.jpg)
51Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Acne
• Assessment• Document any treatments being used
• Inspect skin to determine extent and severity
• Interventions• Disturbed Body Image • Ineffective Therapeutic Regimen Management
![Page 52: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/52.jpg)
52Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Herpes Simplex
• Etiology and risk factors • Viral infection begins with itching and burning and progresses
to vesicles that rupture and form crusts• Nose, lips, cheeks, ears, genitalia most often affected • Oral lesions called cold sores or fever blisters• Infections on the face and upper body usually caused by HSV-
1; genital infections by HSV-2
• Medical diagnosis • Laboratory studies of exudate from a lesion and blood studies
to detect specific antibodies
![Page 53: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/53.jpg)
53Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-9
![Page 54: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/54.jpg)
54Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Herpes Simplex
• Assessment• Describe the development of the herpetic lesions • Sexual contacts documented so that they can be advised of
the need for medical evaluation • Inspect the lesions
• Interventions• Acute Pain • Ineffective Coping • Ineffective Therapeutic Regimen Management
![Page 55: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/55.jpg)
55Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Herpes Zoster
• Etiology and risk factors• Commonly called shingles • Varicella-zoster virus; also causes chickenpox • Symptoms: pain, itching, and heightened sensitivity along a
nerve pathway, followed by the formation of vesicles in the area
• When the skin is affected, crusts form • Older adults especially susceptible to complications• Immunosuppressed at greater risk for herpes zoster infections;
may have serious systemic complications
![Page 56: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/56.jpg)
56Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-10
![Page 57: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/57.jpg)
57Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Herpes Zoster
• Medical diagnosis • Health history and physical examination findings • Tzanck smear or viral culture of material from a lesion
• Medical treatment • Antiviral agents: acyclovir, famciclovir, valacyclovir, and
foscarnet • Wet dressings soaked in Burow’s solution • Pain may be treated with analgesics and sedatives
![Page 58: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/58.jpg)
58Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Herpes Zoster
• Assessment• Conditions or treatments that might cause the
patient to have a reduced immune response • Distribution and appearance of the lesions
• Interventions• Impaired Skin Integrity • Acute Pain • Ineffective Coping
![Page 59: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/59.jpg)
59Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Necrotizing Fasciitis
• Infection of deep fascial structures under the skin • Aerobic and anaerobic organisms: Streptococcus,
Staphylococcus, Peptostreptococcus, Bacteroides, and Clostridium species
• Organisms excrete enzymes that destroy blood vessels that supply the affected area
• Deprived of blood flow, tissue necrosis occurs • Treatment involves extensive débridement, intravenous
and topical antibiotics, and eventual skin grafting
![Page 60: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/60.jpg)
60Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Infestations
• Lice• Scabies
![Page 61: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/61.jpg)
61Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-12
![Page 62: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/62.jpg)
62Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Pemphigus
• Chronic autoimmune condition: bullae (blisters) develop on the face, back, chest, groin, and umbilicus
• Blisters rupture easily, releasing a foul-smelling drainage • Potassium permanganate baths, Domeboro solution, and oatmeal
products soothe the affected areas, reduce odor, and decrease the risk of infection
• Treatments: corticosteroids, other immunosuppressants, and oral or topical antibiotics
• Patients with extensive skin loss require the same care as burn patients
![Page 63: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/63.jpg)
63Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Actinic Keratosis
• Precancerous lesions most often found on the face, neck, forearms, and backs of the hands—all areas exposed to sunlight
• May become malignant if not treated • Most common among older white adults • Appear as papules or plaques of irregular shape
• The hard scale on the lesion may shed and reappear
• Treatments include drug therapy, cryotherapy, electrodesiccation, and surgical excision
![Page 64: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/64.jpg)
64Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Nonmelanoma Skin Cancer
• Basal cell carcinoma • Painless, nodular lesions; pearly appearance • Related to sun exposure • Grow slowly and rarely metastasize • Treated with surgical excision, Mohs’ micrographic
excision, electrodesiccation and curettage, cryotherapy, radiation, or drugs that are applied topically or injected into the lesion
![Page 65: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/65.jpg)
65Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Nonmelanoma Skin Cancer
• Squamous cell carcinoma • Scaly ulcers or raised lesions • Develop on sun-exposed areas including the lips,
and in the mouth • Caused by overuse of tobacco and alcohol • Grow rapidly and metastasize • Treatment may include surgical excision,
cryotherapy, and radiation therapy
![Page 66: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/66.jpg)
66Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-13A-C
![Page 67: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/67.jpg)
67Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Melanoma
• Arises from pigment-producing cells in the skin • Most serious form of skin cancer; fatal if it
metastasizes • Found anywhere on the body • Irregular borders and uneven coloration; many are
dark, but some are light. Begin as tan macule that enlarges
• Removed surgically; a wide area around a melanoma is usually excised
• Chemotherapy and immunotherapy also may be employed
![Page 68: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/68.jpg)
68Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-13D
![Page 69: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/69.jpg)
69Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Cutaneous T-Cell Lymphoma
• Migration of malignant T cells to the skin • Mycosis fungoides and Sézary syndrome • May resemble eczema, with macular lesions appearing
on areas protected from the sun • Tumors form, enlarge, spread to distant sites • When confined to the skin, this type of lymphoma can
be cured with topical chemotherapy, systemic psoralens with UVA, and/or superficial radiotherapy
![Page 70: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/70.jpg)
70Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Kaposi’s Sarcoma
• Malignancy of the blood vessels • Red, blue, purple macules with pain, itching, swelling • Lesions appear first on the legs and then on the upper body, face,
and mouth • Enlarge to form large plaques that may drain• In patients with HIV but not confined to this group • Local lesions excised or injected with intralesional chemotherapy • Systemic lesions are treated with chemotherapy, immune therapy,
and radiotherapy
![Page 71: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/71.jpg)
71Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Disorders of the Nails
![Page 72: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/72.jpg)
72Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Infections
• Usually indicated by redness, swelling, and pain around the margin of the nail
• Treated with warm soaks and topical or systemic anti-infectives
• Incision and drainage may be necessary
![Page 73: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/73.jpg)
73Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Ingrown Toenail
• Painful inflammation at distal corner of nail • Caused by trimming nail too short at the
corners or wearing shoes that are too tight • Ingrown nail should be protected from pressure
as it grows out • Warm soaks may be soothing • Surgical excision of ingrown portion of nail
![Page 74: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/74.jpg)
74Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Care of the Patient with a Nail Disorder
• Assessment• Health history should document the diagnoses of
diabetes mellitus or peripheral vascular disease • In the physical examination, inspect the nails for
redness, swelling, or pain • Inspect extremities for lesions and abnormal color,
and palpate for warmth and peripheral pulses
![Page 75: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/75.jpg)
75Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Care of the Patient with a Nail Disorder
• Interventions• Teach patients how to trim their nails correctly and
the importance of properly fitting shoes • Toenails should be cut straight across and even
with the end of the toe • If patient cannot care for the feet adequately, refer
to a podiatrist
![Page 76: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/76.jpg)
76Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Burns
![Page 77: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/77.jpg)
77Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Definition of Burns
• Tissue injuries caused by heat • Depending on source of injury, burn is
described as thermal (flame, flash, scalding liquids, hot objects), chemical, electrical, radiation, or inhalation
• Leading cause of accidental death despite improved survival rates attributed to advances in the care of burn patients
![Page 78: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/78.jpg)
78Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Classification
• Burn size • Rule of nines• Lund and Browder method
• Burn depth • Superficial burn (first degree)
• Affect only the epidermis
• Superficial or deep partial-thickness burn (second degree)• Affects the epidermis and the dermis
• Full-thickness burns (third degree, fourth degree)• Extend into even deeper tissue layers
![Page 79: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/79.jpg)
79Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-15
![Page 80: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/80.jpg)
80Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-16
![Page 81: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/81.jpg)
81Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-17
![Page 82: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/82.jpg)
82Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Burn Severity
• American Burn Association criteria• Burn size: 25% or more body surface area for
people younger than 40 years; 20% or more body surface area for older than 40 years
• Disfiguring or disabling injuries to the face, eyes, ears, hands, feet, or perineum
• High-voltage electrical burn injury• Inhalation injury• Major trauma in addition to the burn
![Page 83: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/83.jpg)
83Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Pathophysiology of Burn Injury
• Local effects • Tissue releases chemicals that cause increased capillary
permeability, which permits plasma to leak into the tissues • Injury to cell membranes permits excess sodium to enter cell and
potassium to escape into the extracellular compartment • These shifts cause local edema and decrease in cardiac output • Fluid evaporates through the wound surface, further contributing to
the declining blood volume • 18 to 36 hours after a burn injury, capillary permeability begins to
normalize and reabsorption of edema fluid begins • Cardiac output returns to normal and then increases to meet
increased metabolic demands
![Page 84: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/84.jpg)
84Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Pathophysiology of Burn Injury
• Systemic effects
• Fluid balance • Gastrointestinal function • Immune system • Respiratory system • Myocardial depression • Psychological effects
![Page 85: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/85.jpg)
85Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Stages of Burn Injury
• Emergent: begins with the injury and ends when fluid shifts have stabilized
• Acute: begins with fluid stabilization and ends when all but 10% of burn wounds are closed or when all wounds are closed
• Rehabilitation: lasts as long as efforts continue to promote improvement
![Page 86: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/86.jpg)
86Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Medical Treatment: Emergent Stage
• Assess airway, breathing, and circulation and then determine whether the patient has injuries in addition to the burn
• If inhalation injury, oxygen therapy is started • May require intubation if airway is compromised • IV lines established to begin fluid resuscitation and to
provide emergency vascular access
![Page 87: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/87.jpg)
87Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Medical Treatment: Emergent Stage
• Indwelling urinary catheter and a nasogastric tube usually inserted
• Blood drawn for baseline lab studies• Tetanus prophylaxis may be administered • Pain assessed and analgesics are ordered• Wound is cleaned, débrided, and inspected
![Page 88: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/88.jpg)
88Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Medical Treatment: Emergent Stage
• Patient with serious burns is transferred to a burn specialty care unit or a critical care unit
• IV essential during the first few days of burn treatment • Volume based on patient’s weight and extent of injury • First 24 hours, IV fluids may consist of various combinations of
electrolyte, colloid, and dextrose solutions • Second 24 hours, volume decreased based on urine output• Fluids then different combinations of electrolyte, colloid, and dextrose
solutions • Some formulas omit electrolyte solutions in the second 24 hours
• Antibiotic therapy and surgical procedures
![Page 89: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/89.jpg)
89Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Wound Care
• Open method: topical antimicrobials but no dressings
• Closed care: topical medications covered by dressings
• Topical medications: silver sulfadiazine (Silvadene) and mafenide acetate (Sulfamylon)
• Tetanus booster given if patient has not been immunized within the past 5 years
![Page 90: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/90.jpg)
90Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Wound Care
• For clean partial-thickness wounds that will heal without grafting, temporary wound coverings• Amniotic membranes, grafts from cadavers or pigs,
and a number of synthetic materials
• Graft sites also treated with negative pressure wound therapy
• Donor sites treated with fine-mesh gauze and synthetic and biosynthetic products
![Page 91: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/91.jpg)
91Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Wound Care
• Débridement• Removal of debris and necrotic tissue from a wound • By scissors, forceps, surgical excision, or enzymes
• Skin grafting • Autograft: the patient’s own skin • Split-thickness or a full-thickness graft
• Scarring • Can be reduced with pressure dressings in the early stages of
care, followed by custom-fitted garments that apply continuous pressure
![Page 92: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/92.jpg)
92Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 50-18
![Page 93: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/93.jpg)
93Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Care of the Patient with Burn Injury
• Health history• Circumstances surrounding the burn injury • Chronic diseases, surgeries, or hospitalizations • Medications and allergies • Family history even though not specific to burn injuries; it may
alert the staff to other problems • Review of systems detects current problems • Habits and lifestyle, roles and responsibilities, stressors, and
coping strategies
![Page 94: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/94.jpg)
94Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Care of the Patient with Burn Injury
• Physical examination • Vital signs• Inspect for burn wounds and other lesions • Wound color and the presence of eschar • Palpate intact skin for temperature and turgor • Chest expansion observed, and the lungs auscultated for
wheezing, stridor, or atelectasis • Apical pulse be auscultated for rate and rhythm • Abdomen assessed: active bowel sounds/distention • Extremities are inspected for injury and deformity • ROM assessment is delayed if extremity immobilized
![Page 95: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/95.jpg)
95Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Care of the Patient with Burn Injury
• Interventions• Decreased Cardiac Output • Fluid Volume Excess • Acute Pain• Risk for Infection • Hypothermia • Risk for Imbalanced Nutrition: Less Than Body Requirements • Impaired Physical Mobility • Ineffective Coping • Ineffective Family Coping
![Page 96: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/96.jpg)
96Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Conditions Treated with Plastic Surgery
![Page 97: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/97.jpg)
97Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Aesthetic Surgery
• Alters a body feature that is structurally normal but perceived by the patient as unattractive
• Examples: rhytidectomy, blepharoplasty, chin implants, rhinoplasty, abdominoplasty, breast augmentation, and breast reduction
![Page 98: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/98.jpg)
98Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Reconstructive Surgery
• Repair disfiguring scars, restore body contours after radical surgery like mastectomy, eliminate benign lesions such as birthmarks, restore features damaged by trauma or disease, and correct developmental defects
![Page 99: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/99.jpg)
99Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Preoperative Nursing Care
• Assessment: health history• Patient’s description of plastic surgery and what he or she
expects the procedure to accomplish. Past medical history may elicit conditions that might affect wound healing
• Review of systems: surgical area receives special attention
• Functional assessment: patient’s lifestyle and usual activities
• Interventions• Anxiety • Deficient Knowledge
![Page 100: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/100.jpg)
100Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Postoperative Nursing Care
• Assessment• Vital signs and level of consciousness • Inspect dressings for drainage or bleeding, but do
not remove them without specific orders • Observe flaps and grafts for color and evidence of
fluid accumulation, and palpate for warmth • Inspect and measure drain contents each shift • Fluid should lighten from sanguineous (red) to
serosanguineous (pink) to serous (pale yellow)• Patient’s comfort level
![Page 101: 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 50 Skin Disorders.](https://reader034.fdocuments.in/reader034/viewer/2022042623/5514590a5503462d4e8b54e9/html5/thumbnails/101.jpg)
101Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Postoperative Nursing Care
• Acute Pain • Risk for Infection • Risk for Injury • Risk for Deficient Fluid Volume • Disturbed Body Image • Ineffective Therapeutic Regimen Management