PYRAMID POINTS CHAPTER 50: INTEGUMENTARY MEDICATIONS.

PYRAMID POINTSPYRAMID POINTS

CHAPTER 50: CHAPTER 50:

INTEGUMENTARY INTEGUMENTARY MEDICATIONSMEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH: Integumentary Medications

50-2


I. Emollients and LotionsI. Emollients and Lotions EmollientsEmollients

• Used for dry, scaly, itchy inflammatory conditionsUsed for dry, scaly, itchy inflammatory conditions

Solutions and lotionsSolutions and lotions• Lotions are predominantly water, but have drying effect Lotions are predominantly water, but have drying effect

on skin when water evaporateson skin when water evaporates

• Used as wash for skin or as wet dressings on woundsUsed as wash for skin or as wet dressings on wounds

Therapeutic bathsTherapeutic baths• Cleanse, soothe the skinCleanse, soothe the skin

• Provide anti-inflammatory effects if medicatedProvide anti-inflammatory effects if medicated



50-3


II. Rubs and LinimentsII. Rubs and Liniments Temporary relief of muscular aches, rheumatism, Temporary relief of muscular aches, rheumatism,

arthritis, sprains, neuralgiaarthritis, sprains, neuralgia Over-the-counter products contain combinations of Over-the-counter products contain combinations of

antiseptics, local anesthetics, analgesics, antiseptics, local anesthetics, analgesics, counterirritantscounterirritants

Some products contain salicylates, which can Some products contain salicylates, which can cause side effects, such as tinnitus, nausea, cause side effects, such as tinnitus, nausea, vomitingvomiting

Do not use heating pad simultaneouslyDo not use heating pad simultaneously



50-4


III. Anti-infective AgentsIII. Anti-infective Agents DescriptionDescription

• Include antiseptics and antibacterial, antifungal, antiviral, Include antiseptics and antibacterial, antifungal, antiviral, antiparasitic medicationsantiparasitic medications

AntisepticsAntiseptics• Sodium hypochlorite (Dakin’s solution)Sodium hypochlorite (Dakin’s solution)

Loses potency during storageLoses potency during storage Should not come into contact with healing or normal tissueShould not come into contact with healing or normal tissue Should be rinsed off immediately following irrigationShould be rinsed off immediately following irrigation

• Chlorhexidine gluconate (Hibiclens)Chlorhexidine gluconate (Hibiclens) Used for irrigating and cleansing wounds, but not for Used for irrigating and cleansing wounds, but not for

packing woundspacking wounds



50-5


III. Anti-infective Agents (continued) III. Anti-infective Agents (continued) Antiseptics (continued)Antiseptics (continued)

• Acetic acid preparationsAcetic acid preparations Healthy skin surrounding wound must be protected with petroleum Healthy skin surrounding wound must be protected with petroleum

barrierbarrier

• Hydrogen peroxideHydrogen peroxide Used to irrigate, clean necrotic tissue, purulent drainage from open Used to irrigate, clean necrotic tissue, purulent drainage from open

woundswounds When epithelial tissue begins to form, use discontinuedWhen epithelial tissue begins to form, use discontinued

• Hexachlorophene (pHisoHex, Septisol)Hexachlorophene (pHisoHex, Septisol) Absorbed through broken skin; may cause neurotoxicityAbsorbed through broken skin; may cause neurotoxicity Should be rinsed well from skin after useShould be rinsed well from skin after use

Antifungals: May cause erythema, stinging, blistering, Antifungals: May cause erythema, stinging, blistering, peeling, pruritus, urticaria, general skin irritationpeeling, pruritus, urticaria, general skin irritation



50-6


III. Anti-infective Agents (continued)III. Anti-infective Agents (continued) AntibacterialsAntibacterials

• Mupirocin calcium (Bactroban): Effective against Mupirocin calcium (Bactroban): Effective against Staphylococcus aureusStaphylococcus aureus, beta-hemolytic streptococci, , beta-hemolytic streptococci, Streptococcus pyogenesStreptococcus pyogenes

AntiviralsAntivirals• Acyclovir (Zovirax)Acyclovir (Zovirax)

Use rubber gloves to apply ointmentUse rubber gloves to apply ointment Ointment may cause mild pain, transient burning and stingingOintment may cause mild pain, transient burning and stinging

AntiparasiticsAntiparasitics• Used to treat scabies (mites), pediculosis (lice)Used to treat scabies (mites), pediculosis (lice)• May be harmful during pregnancy and to young children; may May be harmful during pregnancy and to young children; may

irritate skin, eyes, mucous membranesirritate skin, eyes, mucous membranes



50-7


IV. AntipruriticsIV. Antipruritics Used to allay itchingUsed to allay itching Applied as wet dressings, pastes, lotions, creams, Applied as wet dressings, pastes, lotions, creams,

ointmentsointments Persons with dry skin should be instructed to Persons with dry skin should be instructed to

bathe less frequentlybathe less frequently



50-8


V. KeratolyticsV. Keratolytics DescriptionDescription

• Soften scales, loosen horny layer of skin by dissolving Soften scales, loosen horny layer of skin by dissolving keratinkeratin

Salicylic acidSalicylic acid• Can be absorbed systemicallyCan be absorbed systemically

• Not applied to large surface areas or open woundsNot applied to large surface areas or open wounds

MasoprocolMasoprocol• Used to treat keratosisUsed to treat keratosis

• Occlusive dressings should not be usedOcclusive dressings should not be used



50-9


VI. Stimulants and IrritantsVI. Stimulants and Irritants DescriptionDescription

• Produce mild irritation to skin surface; cause hyperemia Produce mild irritation to skin surface; cause hyperemia and inflammation, promotes healing processand inflammation, promotes healing process

Coal tarCoal tar• Used to treat psoriasis, seborrheic dermatitis, atopic Used to treat psoriasis, seborrheic dermatitis, atopic

dermatitisdermatitis• Has unpleasant odor, can stain skin and hair; can cause Has unpleasant odor, can stain skin and hair; can cause

phototoxicityphototoxicity Benzoin compoundBenzoin compound

• Protects skin when client has sore, cracked nipples or Protects skin when client has sore, cracked nipples or fissuresfissures



50-10


VII. ProtectivesVII. Protectives DescriptionDescription

• Preparations that provide film on skin to protect from Preparations that provide film on skin to protect from irritants such as light, moisture, air, dustirritants such as light, moisture, air, dust

• Promote natural healing without formation of crust over Promote natural healing without formation of crust over woundwound

SunscreensSunscreens• Most effective when applied 30 to 60 minutes before Most effective when applied 30 to 60 minutes before

exposure to sun; reapplied every 2 to 3 hours after exposure to sun; reapplied every 2 to 3 hours after swimming or sweatingswimming or sweating

Nonadherent dressingsNonadherent dressings• Woven or nonwoven dressings may be impregnated with Woven or nonwoven dressings may be impregnated with

saline, petrolatum, antimicrobialssaline, petrolatum, antimicrobials



50-11


VIII. EnzymesVIII. Enzymes DescriptionDescription

• Used to promote healing of wounds, débride skin ulcersUsed to promote healing of wounds, débride skin ulcers Enzymes used to débride, remove exudatesEnzymes used to débride, remove exudates

• Sutilains used to remove nonviable, necrotic tissue, or Sutilains used to remove nonviable, necrotic tissue, or purulent enzymes from burns, ulcers, traumatic injury purulent enzymes from burns, ulcers, traumatic injury sites, peripheral vascular disease woundssites, peripheral vascular disease wounds

• Collagenase (Santyl) used as topical débriding agentCollagenase (Santyl) used as topical débriding agent Discontinued when necrotic tissue goneDiscontinued when necrotic tissue gone

• Fibrinolysin and desoxyribonuclease used to débride Fibrinolysin and desoxyribonuclease used to débride wounds.wounds.

• Dextranomer (Debrisan) used as cleaning agentDextranomer (Debrisan) used as cleaning agent



50-12


IX. CorticosteroidsIX. Corticosteroids Topical forms have anti-inflammatory, antipruritic, Topical forms have anti-inflammatory, antipruritic,

vasoconstrictive actionsvasoconstrictive actions ContraindicationsContraindications

• Previous sensitivity to corticosteroids Previous sensitivity to corticosteroids • Clients with current systemic fungal, viral, bacterial Clients with current systemic fungal, viral, bacterial

infections infections • Clients with current complications related to Clients with current complications related to

corticosteroid therapycorticosteroid therapy Local adverse effectsLocal adverse effects

• Hypopigmentation; contact dermatitis; burning, dryness, Hypopigmentation; contact dermatitis; burning, dryness, irritation, pruritus of skin; overgrowth of bacteria, fungi, irritation, pruritus of skin; overgrowth of bacteria, fungi, virusesviruses



50-13


IX. Corticosteroids (continued)IX. Corticosteroids (continued) Systemic adverse effectsSystemic adverse effects

• Rare occurrence, but include adrenal suppression, Rare occurrence, but include adrenal suppression, Cushing’s syndromeCushing’s syndrome

InterventionsInterventions• Wash area prior to administration; increases absorption Wash area prior to administration; increases absorption

• Apply sparingly in light film, rubbing gently Apply sparingly in light film, rubbing gently

• May apply to skin alone or with dry occlusive dressing as May apply to skin alone or with dry occlusive dressing as prescribedprescribed



50-14


X. Acne ProductsX. Acne Products DescriptionDescription

• Come in variety of forms, including bar soapsCome in variety of forms, including bar soaps

liquid cleansers, creamsliquid cleansers, creams

• All products should be kept away from eyes, inside of All products should be kept away from eyes, inside of nose, mucous membranes, hairnose, mucous membranes, hair

Benzoyl peroxide is keratolytic agentBenzoyl peroxide is keratolytic agent Tretinoin and Adapalene acids of vitamin ATretinoin and Adapalene acids of vitamin A



50-15


X. Acne Products (continued)X. Acne Products (continued) Tretinoin (Retin-A)Tretinoin (Retin-A)

• Therapeutic results should be seen after Therapeutic results should be seen after

2 to 3 weeks, with optimal results after 6 weeks2 to 3 weeks, with optimal results after 6 weeks

• Teach client to apply liberally to skin, wash hands Teach client to apply liberally to skin, wash hands thoroughly after applyingthoroughly after applying

Isotretinoin (Accutane)Isotretinoin (Accutane)• Used to treat severe acne; eliminate alcohol Used to treat severe acne; eliminate alcohol

consumption during therapy; avoid vitamin A; decrease consumption during therapy; avoid vitamin A; decrease sun exposuresun exposure



50-16


continued …continued …

Local antibioticsLocal antibiotics• Include clindamycin (Cleocin T), tetracyclineInclude clindamycin (Cleocin T), tetracycline

May cause contact dermatitis; burning, stinging of skinMay cause contact dermatitis; burning, stinging of skin



50-17


XI. Poison Ivy TreatmentXI. Poison Ivy Treatment Treatment includes calamine lotion, aluminum Treatment includes calamine lotion, aluminum

acetate (Burow solution) compresses, colloidal acetate (Burow solution) compresses, colloidal oatmeal (Aveeno) bathsoatmeal (Aveeno) baths

Topical corticosteroids; prevent or relieve Topical corticosteroids; prevent or relieve inflammationinflammation

Oral corticosteroids for severe reactionsOral corticosteroids for severe reactions



50-18


XII. Burn ProductsXII. Burn Products Nitrofurazone (Furacin)Nitrofurazone (Furacin)

• Broad-spectrum topical antibioticBroad-spectrum topical antibiotic

• Applied as 1/16-inch film to areaApplied as 1/16-inch film to area

Mafenide acetate (Sulfamylon)Mafenide acetate (Sulfamylon)• Water-soluble creamWater-soluble cream

• Bacteriostatic for gram-negative, gram-positive Bacteriostatic for gram-negative, gram-positive organisms organisms

• Applied as 1/16-inch film directly to burnApplied as 1/16-inch film directly to burn



50-19


XII. Burn Products (continued)XII. Burn Products (continued) Silver sulfadiazine (Silvadene)Silver sulfadiazine (Silvadene)

• Broad-spectrum bactericidal Broad-spectrum bactericidal • Active against gram-negative, gram-positive bacteria, yeastActive against gram-negative, gram-positive bacteria, yeast• May cause localized side effects, such as rash, itching, and May cause localized side effects, such as rash, itching, and

systemic side effects, such as leukopenia, interstitial nephritissystemic side effects, such as leukopenia, interstitial nephritis• Apply 1/16-inch film; burn always kept covered Apply 1/16-inch film; burn always kept covered

Silver nitrateSilver nitrate• Antiseptic solution active against gram-negative bacteria Antiseptic solution active against gram-negative bacteria • Dressings applied to burn, then kept moist with silver nitrate Dressings applied to burn, then kept moist with silver nitrate • Do not apply directly to burn areaDo not apply directly to burn area



50-20

An adolescent client with severe cystic acne has been An adolescent client with severe cystic acne has been prescribed isotretinoin (Accutane). The nurse would correct the prescribed isotretinoin (Accutane). The nurse would correct the client’s misunderstanding of the medication if the client made client’s misunderstanding of the medication if the client made which of the following statements?which of the following statements?

1. “I need to be sure to take my vitamin A supplement so that the 1. “I need to be sure to take my vitamin A supplement so that the treatment will work.”treatment will work.”

2. “I will return to the clinic for blood tests.”2. “I will return to the clinic for blood tests.”

3. “If my lips begin to burn, it is probably because of the 3. “If my lips begin to burn, it is probably because of the medication.”medication.”

4. “My eyes may become dry and burn as a result of the 4. “My eyes may become dry and burn as a result of the medication.”medication.”

PYRAMID POINTS CHAPTER 50: INTEGUMENTARY MEDICATIONS.

Documents

Transcript of PYRAMID POINTS CHAPTER 50: INTEGUMENTARY MEDICATIONS.