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INTEGUMENTARY DISORDERS By: JOHN MARK B.

POCSIDIO,RN, MSN SKIN BIOPSY  A skin biopsy is the removal of a piece of skin for the purpose of further examination in the laboratory using a microscope.  Skin biopsies are performed to diagnose a number of conditions.   Skin biopsy is most frequently done to diagnose a skin growth such as a mole, or a skin condition such as a rash. A skin biopsy can also be used to diagnose a cancer of the skin.

 A skin biopsy is also sometimes used to diagnose infections of the skin. SKIN BIOPSY Methods include: punch excisional shave Pre-procedure:  Obtain informed consent  Cleanse site as prescribed  Inform client that local anesthetic can cause burning & stinging sensation SKIN BIOPSY Post procedure:  Place specimen, when obtained by physician, in the appropriate container and send to pathology laboratory for analysis  Use surgically aseptic technique for biopsy site dressings  Assess the biopsy site for bleeding and infection  Instruct the client to keep dressing in place for at least 8 hours  Clean the site daily  Use antibiotic as prescribed  Sutures removed 7-10 days after surgery Wood’s Lamp Examination Skin is viewed under UV light through a special glass (wood’s glass) to identify superficial infection’s of the skin Wood’s Lamp Examination Normal Result Normally your skin will not shine, or fluoresce, under the ultraviolet light. Abnormal results mean Skin shine & fluoresce Under UV light Wood’s Lamp Examination Special considerations  Do not wash before the test, because that may cause a false-negative result. A room that is not dark enough may also alter results. Other materials may also glow. For example, some deodorants, make-ups, soaps, may be visible with the Wood's lamp.  Darken room prior to the examination  Assist the client during adjustment from the darkened room

rubber compounds SIGNS & SYMPTOMS:  Pruritus and discomfort  Hive. itching. polyester  Cosmetics  Household products such as detergents.wool. PRE-PROCEDURE  Discontinue systemic corticosteroids or antihistamine therapy 48 hours before the test  Obtain informed consent  Bring resuscitation equipment available POSTPROCEDURE  Instruct the client to keep the skin-testing patch area dry  Avoid activities that may produce sweating  Record the site.  MODERATELY POSITIVE: Fine blisters.Patch Testing  A patch test is a method used to determine if a specific substance causes inflammation of the skin. They are kept in place with special hypoallergenic adhesive tape. insecticides . papules. date and time of the test  Initial reading is after 2 days  Inspect the site for results/ reactions like: RESULTS:  WEAK POSITIVE: Redness. The patches stay in place undisturbed for at least 48 hours.  It is often used to test for allergens. plaques  Edema  Sharply circumbscribed area and crust and ooze Diagnostic test  Skin test ( to determine specific allergen) TREATMENT: Medical  Topical steroids oral steroids . Patch Testing PROCESS:  The first appointment will take about half an hour. ulceration Skin Culture Used for microbial study Use sterile applicator & appropriate culture tube Viral culture is immediately placed on ice Obtain prior to antibiotic administration     INTEGUMENTARY DISORDERS Contact Dermatitis  Inflammatory skin reaction which results because the skin has come in contact with a specific irritant) or allergen. soap  Hair dyes  Industrial substances. severe itching  STRONG POSITIVE: Blister. CAUSES:  Poison ivy and poison oak  Fabric. pain.like papules.paints. vesicles. fine bumps. Tiny quantities of 25 to 150 materials (allergens) in individual square plastic or round aluminium chambers are applied to the upper back.

wet compress  Elevate affected area  Maintain a cool environment  Administer antihistamine and topical corticosteroids or antibiotics  Administer burrow’s solution for 20 mins  Prevent or minimize scratching. cont. Cyclosporin. steroids. Hydroxyurea)  Photochemotherapy (PUVA)  Provide client teaching and discharge  Feeling about change in appearance of skin. Plus coal tar  Assists the client to remove scales  Drugs  tar preparation. psoriasis or severe acne. salicylic acid.  Obesity  Poor immune system  Circulatory problems . such as eczema.  Eliminate conditions that increases itching like heat. knees.  Apply occlusive dressing  Systemic therapy (methotrexate. elbows QUESTION? Is there a cure? NURSING INTERVENTIONS  Goal: slow the rapid turnover of epidermis. use of mittens or socks  Burow’s solution Nursing int. wool. To promote resolution of the psoriatic lesion.  Skin disorders. wet compresses. keep nails short.  REMEMBER: there is no known cure  Precipitating factors should be removed  Limit stress  Daily soaks and tepid. : Causes:  Trauma to the skin  Poorly controlled diabetes.  Shedding. such as sunburned area or scratch. stuff toys  Wash cloth in mild soap and rinse thoroughly  Monitor lesions for signs of infections Psoriasis  Koebner’s phenomenon  Development of psoriatic lesions at the site of injury. silvery white scales on a raised reddened round plaques  Affect scalp.. (encourage to cover arms and legs with clothing if sensitive about appearance)  Importance of adhering to treatment and avoid commercial products Acute cellulitis  Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and soft tissues (the subcutaneous tissues) that lie underneath the skin.  Antihistamines and antipruritic agent Aveeno ( oatmeal) baths and topical soaks Nursing interventions Avoid exposure to skin irritants  Apply cool.

Shingles results from reactivation of the chicken-pox virus that remained in your body since you had chicken pox--perhaps many years ago. but helps to heal the rash. It is not a cure. SYMPTOMS  Unilateral clustered skin vesicles along peripheral sensory nerves  Fever  Burning neuralgia  Pruritus ( but more on pain)  paresthesia Diagnostic test  Tzanck’s smear test Treatment:  Acyclovir helps to control the skin eruption.  Athletes foot Infection due to surgery SYMPTOMS  Fever  Redness and inflammation of the skin  Pain  Swelling  Red streaking of the skin  The affected area spreading and getting bigger  Warmness to the touch  Drainage of pus from the skin  Swollen glands near the infected area NURSING INTERVENTIONS  Administer prescribed antibiotics  Rest the affected area  Elevate the extremity  Provide meticulous skin & wound care with contact precaution  Apply moist pack to the site  Provide adequate nutrition Herpes Zoster (Shingles)  is a nerve infection caused by the chicken-pox virus. provided treatment is started early. Acyclovir is taken by mouth.  Tylenol or mild painkiller as prescribed  cortisone NURSING INTERVENTIONS  Isolate the client ( contact precaution)  Assess neurovascular status and 7th cranial nerve function  Assess signs and symptoms of infection  Reassign nurse personnel who have not been exposed to chicken pox  Inform the client not to scratch the lesion  Keep weeping lesion covered  Apply cool & warm compresses ( relieve pain &itchiness) Impetigo .

 Impetigo is contagious. self limiting.  Impetigo Assessment:  Fever  Swollen lymph nodes  papule---pustule---vesicles---crust  Characteristic honey colored crust. draining lesions  Cover draining lesion  CBQ. fatty foods or cosmetics affect acne Cystic Acne (ACNE VULGARIS)  Etiology:  Propiniobacterium acne           Assessment: Papule Pustule nodule NURSING INTERVENTIONS Administration of topical or oral antibiotics Administer isotretinoin (accutane) Instruct the client to avoid sun exposure (Isotretinoin) No to pregnant ( Isotretinoin) Stop taking vitamin A during isotretinoin treatment .  Skin culture. NURSING INTERVENTIONS  Place the client on isolation precaution to limit spread of infection  Monitor patient for any signs of increase infection  Teach the patient & family members about good hand washing & skin care  Always wear gloves and mask when handling. WHEN TO RETURN TO SCHOOL????? Cystic      Acne (ACNE VULGARIS) Common. nodules Cause: unknown but may include androgenic influence on sebaceous glands. and proliferation of Propionibacterium acnes No evidence that chocolate.  Impetigo is more common in children than in adults. multifactorial disorder Requires active treatment for control until it spontaneously resolves Types of lesions: comedones. papules. caused by staphylococcus ("staph") and streptococcus ("strep") bacteria. pustules. increased sebum production. to remove crusts and drainage.CBQ  Diagnostic test  Diagnosis is based mainly on the appearance of the skin lesion. Treatment:  Topical antibiotics  Oral antibiotics  Wash the skin several times a day.Impetigo is an infection of the surface of the skin. mostly from direct contact with someone who has it. preferably with an antibacterial soap. nuts.

Assessment  “Hallmark sign???”– intense itching. crusts. worse at night  Erythematous papules and pustules  Threadlike. healing occurs in about 3-7 days      First-degree burns Superficial partial thickness burn red and painful affect the epidermis only (e. prick the facial lesion  Do not over wash the face  Use water based cosmetics. squeeze.g.   BURN PATIENT Types of Burns  Thermal – dry flames.  Secondary lesions consist of vesicles. cont  Instruct the client that improvement may not be apparent for 4-6 weeks  Instruct not to scrub.Nursing int. and excoriations. causes neurotoxicity and seizures  Apply thinly from the neck down and leave for 12-14hrs then rins  Apply to dry skin.  Intense pruritus that worsens at night. Diagnostic test  Biopsies / scraping of lesion NURSING INTERVENTIONS  Administer anti-scabies creams( LINDANE KWELL). reddish brown nodules. linear burrows up to 1 cm long. avoid contact with excessively oil-based products Scabies  Scabies is an itchy skin condition caused by an infestation by the itch mite Sarcoptes scabiei. moist skin increases absorption  All family members and close contacts  Beddings and clothings should be washed in very hot water and dried on hot dryer Cont. Administer antihistamine & topical steroids to relieve itching. (PERMITHRIN). brownish. moist and heat  Mechanical – friction or abrasion  Chemical – acid or alkali  Electrical – most fatal  Radiation – sunlight Classification of Burns  Partial Thickness Burns  1st degree burns superficial o Epidermis o Common cause is thermal burn o (+) erythema o (-) blisters o Discomfort lasts about 48 hrs. Classification of Burns Partial Thickness Burns .  Lindane (kwell) not used in <2 years old. sunburn).

white. appears deep red. muscle and bones o Common cause is electrical burns o Not painfull o Dry. reach through the epidermis to parts of the dermis (e. thick. leathery texture. blood vessels. black. The destruction of nerve endings is the reason why severe burns are not painful. including appendages.  Third stage: recovery stage  Healing phase BURN MANAGEMENT  Emergency Room  ABCDE assessment ( how??)  Airway and fluid resuscitation (priority)  Check for arrythmia ( check ECG)  Check for kidney function  Give Tetanus vaccine  Prophylactic antibiotic  Sterile dressing for wound ABCDE . minor burns from fires) Classification of Burn Full Thickness Burns 3rd-4th degree burns o Affect all layers of skin.    2nd degree burns deep o Common cause is chemical o (+) Erythema o (+) blisters o (+) very painful o heals in 3 – 6 wks Second-degree burns Deep partial thickness burn characterized by blisters and pain. and nerve endings. yellow or brown o healing takes weeks to months Third-degree Burns full thickness burn damage all layers of the skin.g. hematocrit  Metabolic acidosis  Hyperkalemia  2nd 48 hours ( fluid remobilization phase)  s/sx:  Hypervolemia  Diuresis  Dec. hematocrit  hypokalemia  Cont.        Stages of burns  1st 48 hours ( fluid accumulation phase)  s/sx:  Generalized dehydration  Hypovolemia  Oliguria  Inc.

 It can occur at any age. To check other injuries Determine TBSA Rule of Nines “Berker Formula” Parkland Formula (4ml x TBSA x BWkg) 1st 8H give ½. 2nd 8H give ¼ and for the 3rd 8H give the last part Repeat ABCDE assessment RULE OF NINE Management of Burns  First-degree burns  Keeping the skin clean and dry  Second-degree burns  Removal of blisters. The use of a louse comb is the most effective way to detect living lice.  Antibiotic ointment application ( silver sulfadiazine) or ( mafenide) then dressing.  debridement  Third-degree burns  Excision of the eschar and split-thickness skin grafting  REMEMBER: Practice asepsis!!! Protect the patient from infection Pediculosis Capitis  Pediculosis capitis is a common infestation of the scalp. the entire scalp should be combed thoroughly with a louse comb and the teeth of the comb should be examined for the presence of living lice after each time the comb passes through the hair.A-irway .  Careful examination of the hairs will reveal the lice (they often look like moving dandruff) and their egg cases called nits  Pruritus and severe itchng (intensifies 3-4 wks after initial infestation)  Secondary infection Diagnostic test? Diagnosis and symptoms  To diagnose infestation.  All family members and close contacts must be treated  Avoid sharing of personal belongings . or mercuric oxide ointment. malathion. lindane. but it is more frequently seen in children. hats. face and neck (priority) singed and sooty hair of the nose B-reathing – rise and fall of chest C-irculation . clothing and linen Signs & symptoms  Typically it appears as red itchy bumps on the back of the neck and scalp. TREATMENT  Pediculicides: These include permethrin.if there is no breathing and circulation start CPR D-isability check and manage accordingly E-xpose to determine extent of injury ETT Insertion Cont.  Pediculosis capitis is very contagious.  "head lice". You get lice by close contact with objects that are easily infested like combs.check nose.

Absorbine Footcare.red.nails TINEA CAPITIS Tinea Cruris. maceration.(“jock itch”). Tinactin. Lotrimin. Antifungal Drugs (Topical) Drugs alter the cell wall of the fungus and disrupt enzyme activity. Tinactin for Jock Itch) NURSING INTERVENTIONS:  Keep area clean and dry  Do not scratch  Proper hygiene  avoid using the same comb  scarves and hats should be washed thoroughly and not be shared  use loose fitting cotton underwear's  change socks daily  Cut off nails or trim nails (onychomycosis) . Lotrimin 1%) VI.and pruritus.(athlete’s foot).fungal infection of scalp corporis.scaling. Micatin. Prescription Strength Desenex. Antifungal Drugs (Topical) Econazole (Spectazole) Haloprogin (Halotex) Ketoconazole (Nizoral. and shampoo forms.usually found between the toes Tinea Diagnosis Woods light exam KOH smear ( sputum) Treatment: Topical/oral antifungals ( giseofulvin) (amphotericin B) VI. ointment. Drugs are manufactured in cream. lotion. Desenex.fungal infection of the inguinal area pedis.erythema.foot inguinum.fungal infection of the body cruris. scaly patches in the groin area Tinea pedis. Aftate for Jock Itch. Penlac nail lacquer) Clioquinol Clotrimazole (Cruex. Lamisil DermGel) Tolnaftate (Absorbine Athlete's Foot Cream. Nizoral A-D) Miconazole (Lotrimin AF 2%. resulting in cell death. Monistat-Derm.small. yeasts      Tinea Tinea Tinea Tinea Tinea capitis. Butenafine (Mentax) Ciclopirox (Loprox.blistering. Ting) Naftifine (Naftin) Oxiconazole (Oxistat) Sulconazole (Exelderm) Terbinafine (Lamisil AT. Aftate for Athlete's Foot.Tinea  Etiology:  Dermatophytes.