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1228 Integumentary System

1228 Integumentary System

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Published by Jennifer Andrews

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Published by: Jennifer Andrews on Mar 23, 2012
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  • HSV-1
  • HSV-2
  • LICE



Largest organ of the body. It includes skin, hair, nails, and glands Healthy skin reflects a healthy body


 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

 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.




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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