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Largest organ of the body. It includes skin, hair, nails, and glands Healthy skin reflects a healthy body
ASSESSMENT OF THE SKIN
Important health information
Past health history Medications Surgery or other treatments
HEALTH PROMOTION Nutrition Exercise Rest Hygiene Avoid irritants and over exposure to the sun Quite smoking .
GERONTOLOGICAL CONSIDERATIONS Skin is thinner and dryer Be familiar with skin and assess regularly Shower less often Use warm rather than hot water Use mild soap Apply moisturizer immediately after shower while skin is still damp .
and malignant melanoma Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun. squamous cell carcinoma.SUN EXPOSURE AND YOUR SKIN 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.
all year Reapply after swimming. or prolonged sun bathing Lip balm SPF >15 Protective clothing Hat Sunglasses Watch out for cloudy days and water reflection Avoid tanning lamps or tanning booths PROTECTING YOUR SKIN FROM THE SUN . Avoid sun between 10 AM and 3 PM Start with short sessions 15-20 minutes Sunscreen SPF >15 daily. strenuous exercises.
Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.5 times more likely to develop basal cell carcinoma.TANNING BEDS Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun. People who use tanning beds are 2. .5 times more likely to develop squamous cell carcinoma and 1.
no fake nails .STOPPING THE SPREAD OF INFECTION Gloves Good hand washing Safe disposal of soiled dressings Avoid scratching of lesion Trim nails.
camphor. or pheno Antihistamines .NURSING MANAGEMENT: PRURITUS Pruritus (itching) Makes pruritus worse Heat and rubbing Dryness Restricted clothing Makes pruritus better Numbs the itch receptors Aveeno baths Benadryl Cool environment Corticosteroids Cool compress Menthol.
red. elevated.FURUNCLE (BOIL) Deep infection of the hair follicle commonly caused by Staph Aureus Clinical manifestations: small. painful nodule. Management: warm wet compresses four times a day I & D Antibiotics-topical and/or oral Do not squeeze .
glistening. weeping. and eroded Primarily face Treatment: Gently remove crust with soap and water Topical bactericidal ointment or oral antibiotics Usually heals without scarring . or MRSA enters through a break in the skin Honey-colored crusts on erythematous base Areas beneath crust. Strep.IMPETIGO Superficial skin infection: caused by Staph.
red. swollen and painful Pt has fever.CELLULITIS Bacterial infection of the skin Skin is warm to touch. malaise. chills Treatment: Elevation of affect part Antibiotics Dressing changes if open wounds are present Usually resolves in 2 weeks with TX Untreated risk of gangrene .
hats or any type of headgear.FUNGAL INFECTIONS (DERMATOPHYTE) Fungal infection are transmitted person to person or animal to person Avoiding fungal infections Keep your skin clean and dry Avoid sharing comb or brushes. and avoid walking barefoot on areas like locker rooms and public showers. clothes. and yeast – as all of these will enhance fungal growth. and towels. Avoid eating foods high in sugar. . wheat. caffeine. dairy. Wear loose fitting clothing Change damp or soiled clothing quickly Wear cotton underwear Keep toenails clean and short.
Possible permanent hair loss Oral antifungal medication such as Griseofulvin or Lamisil Selenium Sulfide shampoos Topical antifungal agents Avoid using the same comb Routinely wash scarf's and hats Examine family and pets for symptoms Treatment Teaching . scaly.TINEA CAPITIS Ringworm of the scalp is a fungal infection of the scalp and hair shafts Usually appears as itchy. bald patches on the head.
arms. Apply the cream Use the cream twice a day for 7 to 10 days. Medications Griseofulvin (Grifulvin V) Fluconazole (Diflucan) Terbinafine (Lamisil) Begin applying 1 inch beyond lesion and work inward for 1-2 weeks until resolved . well defined red borders with center clearing Treatment Wash and dry the area first. legs Elevated ring shaped scaling.TINEA CORPORIS Ringworm Trunk. Do not use a bandage over ringworm .
inner thighs and buttocks 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 be soothing Keep area clean and dry Make sure your clothes fit correctly Prevention . including your genitals. inner thighs and buttocks Itching and redness in your groin.TENIA CRURIS Affects the skin of your genitals.
Miconazole (Desenex).2 weeks Prevention: Dry your feet thoroughly after bathing or swimming Wear sandals or flip-flops at a public shower or pool Change your socks often to keep your feet dry Wear shoes that are well ventilated . Clotrimazole (Lotrimin). Terbinafine (Lamisil). scaly patches May contain bumps. or scabs Treatment: Butenafine (Lotrimin). can be on hands Red. Tolnaftate (Tinactin) Keep using the medicine for 1 .TENIA PEDIS Athlete’s Foot Most commonly between toes and soles of the feet. blisters.
are used In some cases. the health care provider may remove the nail .TENIA UNGUIUM Fungal infection of the nails Brittleness Change in nail shape Crumbling of the outside edges of the nail Loosening or lifting up of the nail Loss of luster and shine Thickening of the nail White or yellow streaks on the side of the nail Treatment Topical or oral antifungals for about 2 to 3 months Fluconazole and griseofulvin.
NON-DERMATOPHYTE INFECTIONS Candidiasis Yeast Likes warm moist areas Glistening. beefy red with satellite pustules Severe itching/burning Skin folds/groin area Diaper rash (dermatitis) Oral-thrush . fiery red or moist pink.
Live cultured yogurt (acidophilus) . Diaper rash – Zinc oxide oint.TEACH PREVENTION AND MANAGEMENT Healthy diet Manage stress Keep skin clean and dry Diabetic – control blood sugar Antibiotics – eat live cultured yogurt Anti Fungal Medicine – clotrimazole (Lotrimin) or nystatin. avoid using wipes Fluconazole (Diflucan) or Nystatin swish and swallow for Oral Thrush Home Remedies – Tea Tree Oil. Garlic.
hair dyes. edema.CONTACT DERMATITIS Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating substance. rubber/latex Red. nickel. detergents. paint. and pruritus . insecticides. Hypersensitivity to allergen 2-7 days after exposure Poison Oak or Ivy. hive like papules. soap. wool.
cool water asap post antihistamines. skin exposure hydration antipruritic Within 15 minutes Trim nails Avoid breaking of blisters. . fluid spreads the disease.TREATMENT Avoidance of irritant Teach Wash exposed skin with Topical corticosteriods.
insect bites. inhalants. exposure to heat and cold. and exercise Treatment: antihistamines cold compresses Remove of irritant source . food.URTICARIA Pruritic transient wheals of varying shapes and sizes (Hives) Response to irritant: drugs. stress.
DRUG REACTION Hypersensitivity to certain drugs Red macular and papular rash Generally abrupt onset Can appear as late as 14 days post drug TX: withdrawal of drug and corticosteroids .
ATOPIC DERMATITIS (ECZEMA) Often begins in infancy 2-6 months Scaly. and peanuts . red to redish-brown circumscribed lesions Itches more at night In children positive correlation with allergies to milk. eggs. wheat.
TREATMENT Teaching Dietary restrictions in children Keep nails trimed Avoid overheating (nylon clothing) Avoid people infected with chicken pox or herpes simplex Avoid live vaccines Wear non-irritating clothing Corticosteriods Phototherapy Coal tar therapy Intralesional injections of steriods Hydration of skin Reduction of stress Stress causes flare up .
VERRUCAE (WARTS) Verruca Vulgaris Hands Flesh-colored or brownish gray scaling. vegetative papule Treatment: Cryosurgery Chemical destruction (salicylic acid) Curettage Desiccation Laser .
Valtrex .HERPES SIMPLEX (HSV) Most common virus in humans Two types HSV-1 Fever blister and cold sores HSV –2 Genital herpes Treatment: Antiviral Zovirax. Famvire.
oral genital sexual contact. oral cavity. systemic infection Hand washing Last 7-10 days . eyes and brain Teach: direct contact. sunlight. spread by kissing. contact with fingers Exacerbated: Stress. burning. and itching vesicles on erythematous base Mouth. fatigue. trauma.HSV-1 Grouped. Menes.
even if he or she has no visible sores . Symptoms include: pain. itching and sores in genital area Infected people have no signs or symptoms of genital herpes An infected person can be contagious.HSV-2 Genital herpes is a common sexually transmitted infection that affects both men and women.
HERPES ZOSTER 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. immunosuppressed Painful vesicles in a linear pattern along dermatome (spinal and cranial nerve tracts) . stress.
famiciclovir Cool compresses. burning. bedtime sedation Shingles Vaccine Zostavax . numbness or tingling Heals without complication may scar Treatment: Antiviral agent Acyclovir.HERPES ZOSTER Grouped vesicles on erythema base Most commonly to the trunk Fluid-filled blisters that break open and crust over Pain. analgesia.
VITILIGO Unknown cause Genetically influenced Precipitated by an event Illness or crisis Complete absence of melanocytes Non-contagious .
VITILIGO Complete loss of pigment. macular. variation in size and location May be permanent Topical steroids for small areas PUVA Light treatment and psoralens Cosmetics and stains .
PSORIASIS Chronic hereditary disorder Light-skinned race Environmental factors that trigger Skin injury Infections Hormone changes Stress Drugs Alcohol Smoking obesity .
knees.PSORIASIS CON’ T. Elbows. scalp. 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 . Erythematous plaque with sharp well defined borders and silvery white scales. lumbosacral skin.
popliteal. and inguinal Treatment: Elimite Lotion Apply head to toe then repeat in 1 week . wrist. axillary folds.INSECT AND ANIMAL CONTACTS Scabies (Mites) Mite infestation in the dermis to lay eggs Inflammation and itching (worse at night) Burrows between fingers.
PEDICULOSIS Lice infestation 3 types Pediculosis Capitus Head lice Pediculosis Corpus Body lice Pediculosis Pubis Pubic lice crabs .
scarves. shared lockers. caps. slumber parties. or other items used on or near hair Can invade all ages . coats.PEDICULOSIS CAPITIS Head lice School-age children Lives 48 hours Female lays eggs (nits) on the hair shaft Hatch in 7-10 days Does not live on animals Head lice can only survive on humans Easily transmitted person to person Does not jump or fly Sharing: combs. hats.
RID Apply treatment Leave on 10 minutes. head.LICE Manifestations Visual Itching/scratch marks Behind ears. nape of the neck Treatment Pediculocides and manual removal of nit cases NIX. rinse and towel dry Remove nits with nits comb Lice treatment kill. but do not remove the nits .
towels. mattresses. rugs. and hair accessories in lice killing products for 1 hours or in boiling water for 10 minutes . and dry in hot dryer for at least 20 minutes Thoroughly vacuum carpets. brushes. stuffed animals. and bed linens in hot water. car sets. and upholstered furniture Seal non-washable items in a plastic bag for 14 days if unable to dry clean or vacuum Soak combs.TEACH Machine wash all washable clothing. pillows.
during the day.CIMICIDE Bedbugs Feed at noc. neck. often with a darker red spot in the middle Itchy Arranged in a rough line or in a cluster of 3 Located on the face. they hide in the cracks and crevices of beds. arms and hands Treatment: Cortisone cream Antihistamine Treat pruritus . headboards and bed frames Red. box springs.
yellow jackets. wasps.STINGS Allergic reactions account for 30 deaths each year Honeybees. mud daubers. bumblebees. erythema pain. itching Resolves in a few hours . and fire ants Reaction may be immediate or delayed (after 2 hours) Non-allergic reaction Local edema. hornets.
laryngeal edema.Severe with possible anaphylaxis reaction Generalized urticaria and pruritus. may repeat 15-15 minutes until symptoms resolve Stinger removal Honeybees only leave stingers Clean area Remove by scraping a flat item over stinger against the entry. bronchospasms. antihistamines . Avoid breaking or squeezing Treatment Ice.1-0. elevation. shock and death 10-30 minutes post sting Epinephrine 0.5 mL of 1:1000 sol.
CANCER OF THE SKIN Risk factors Fair skin type Over exposure to sunlight Family history of skin cancers Environmental factors include Outdoor occupation frequent participation in outdoor activities Behavioral factors include .
flat. forearms Rough scaly patch. neck.PREMALIGNANT LESISONS Actinic keratosis Face. slightly Sun exposure May progress to squamous cell CA . back of hands. irregular shaped.
Basal Cell- most common – least
Reoccurring Does not metastasize
superficial and doesn't extend very far into the skin occurs most often on areas of the skin exposed to the sun Face and neck Pearly, translucent rounded border with dilated blood vessels
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
SQUAMOUS CELL CARCINOMA
Risk factors prolonged exposure to sunlight or 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
MALIGNANT MELANOMA E -evolving over time .
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 affects areas with greatest exposure to the sun .
DIAGNOSIS Excisional biopsy Punch biopsy .
TREATMENT 4 Treatment options Surgery Chemotherapy Radiation Immunotherapy .
and yearly for life if skin cancer is removed . 6 mo.PREVENTION Avoid unnecessary exposure to sunlight Includes tanning beds Use sunscreen Apply often Wear protective clothing Hat. sunglasses Know your skin Inspect moles Report any changes Report development of any new lesions Self examination of the skin Check skin monthly Professional check.up at 3 mo.
PROGRESSION OF SUSPICIOUS MOLES .
neck.ACNE VULGARIS Involves the hair follicle and sebaceous glands of the face. and upper back Few comedones (blackheads) to severe inflammatory reaction Cystic acne Cause Hormone Products that contain oily components Increased comedones Fast food chains No dietary link . chest.
squeeze. reduction of stress Gentle cleansing with mild cleanser once or twice a day (dove) Forehead acne may improve by keeping hair off the forehead Do not leave make-up on over night Expect improvement in 46 weeks Acne may appear worse in the beginning .NURSING MANAGEMENT Do not pick. well-balanced diet. or finger Secondary infection Avoid creams/oils Make-up bases can aggravate acne Adequate rest. moderate exercise.
TREATMENT OF ACNE Antibiotics tetracycline OCP Oral contraceptive pill .Yasmin Accutane Cystic acne Significant side effect Causes birth defects Contraindicated with pregnancy Pregnancy test Effective contraceptive method during treatment and for 6 months after treatment Elevates triglyceride and cholesterol Monitor levels .
wash Bleaching effect on sheets. lotion. and towels . gel. gel.PEELING AGENTS Treatment Retin A Cream. bedclothes. or liquid apply 20-30 minutes after washing Burning sensation/ redness of skin Avoid sun exposure Sunscreen Apply at bedtime Benzoyl Peroxide Cream.
eyelid lift. mechanical and surgical face-lift.PLASTIC SURGERY Elective cosmetic surgery Main reason To improve self-image Most common procedures Breast enlargement. hair transplant. tummy tuck. liposuction. breast reduction. rhinoplasty. removal of double chin .
CHEMICAL FACE-LIFT/PEEL Chemical burn Moderate swelling and crusting for 1 week Within 7-8 days new skin will appear Healing is complete in 10 days Redness for 6-8 weeks Pink tone for several months Complete sun block(reduction in melanin) .
DERMABRASION Removal of epidermis Prevent drying Emollients and wet soaks Sunscreen .
BOTOX INJECTIONS Temporarily eliminates brow furrows. and double vision for 1-2 weeks Injections are expensive Must be repeated every 3-6 months . frown lines and crow's feet. HA. pain. Paralyzing small muscles involved in facial expressions Does not cause botulism (small doses) Redness. swelling.
NURSING DIAGNOSIS Social isolation Coping Nutrition Anxiety .
Which action. D. if observed by the nurse. B. The patient keeps the draining vesicles covered with a dressing. C.REVIEW An elderly patient who is diagnosed with herpes zoster (shingles) has draining vesicles. The nursing assistant washes hands frequently and wears gloves when in the room. would require an intervention? A. The student nurse who takes prednisone requests a different patient assignment. . The licensed practical nurse wears a mask when entering the patient’s room.
” D.” . Which statement.” B.REVIEW The nurse teaches a patient several interventions to reduce pruritus associated with dry skin. indicates further teaching is required? A.“A wet dressing followed by a lubricating lotion will help.” C.”Menthol can be used to numb the itch sensation.“I should rub my skin instead of scratching.“I will avoid taking hot showers. if made by the patient to the nurse.
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