SYNTHESIS

Care of the Patient with an Integumentary Disorder

The topic that was assigned to us is about the care of patient with an integumentary

disorder wherein there are eight divisions that we discussed particularly viral disorder of the

skin, bacterial disorder of the skin, fungal infections of the skin, inflammatory disorder of the

skin, parasitic diseases of the skin, tumors of the skin, disorder of the appendages and burns. It

was presented in the class through reporting with a case scenario that is either a true case or a

hypothetical one that helped and facilitated our learnings.

The integumentary system is comprised of the skin and its accessory structures: hair,

nails and glands. The skin is the largest body organ, which provides protection by serving as a

barrier between the internal and external environments. Functions of the skin are many, as the

skin contains receptors for touch and sensation, helps regulate body temperature and maintains

fluid and electrolyte balance. The skin also provides cues to racial and ethnic background and

plays a major role in determining self- concept. Also normally our skin is resistant to infections

and infestations, disorders may occur as a result of a break in the skin surface, a virulent agent,

and/or decreased resistance due to a compromised immune system.

Bacterial disorder of the skin happens when a break in the skin is invaded by pathogenic

bacteria and the infection may occur, it may be a localized one or it can invade deeper tissues

and cause a systemic infection, a potentially life- threatening disorder. Various types of bacterial

infections of the skin discussed are folliculitis, furuncles or boils, carbuncles, cellulitis and

erysipelas. The mentioned infections has similar symptoms of inflammation of the skin, areas are
red, painful, itchy, burning sensation, pus and may experience fever, chills, malaise as a sign of

infection.

Fungal infections of the skin are caused by dermatophytes (tinea or ringworm) and

candidiasis (yeast) infections. Dermatophytes are fungal infections of the skin and nails caused

by several different fungi and classified by the location on the body. Dermatophytes are molds

(fungi) that need the protein keratin for nutrition. Keratin is the structural material that makes up

the outer layer of human skin. It is also the main structural material of hair and nails. To survive,

dermatophytes must live on skin, hair, or nails. The most important factor in the development of

fungal infection is the moisture.

Dermatophytes classified by the location on the body:

Ringworm on feet (Tinea pedis)- or athlete’s foot, Ringworm on Scalp ( Tinea Captis),

Ringworm of the Body ( Tinea corporis), Tinea versicolor- is a fungal infection of the upper

chest, back and sometimes the arms, Ringworm on Groin (tinea cruris) also known as jock itch

or crotch rot, Ringworm on Face (Tinea barbae) Also known a Barbers itch, Ringworm on Hands

(Tinea manuum), Ringworm on Face (tinea faciei), and Ringworm on Nails (tinea unguium). The

presenting symptoms for dermatophyte infections depend on the location, but the common

manifestations are itchy red rash that can be very sore and irritating, pain, scaling of the skin,

circular patches, hair loss that is temporary, pus, foul odor and change in color of the skin.

For Candidiasis infections they are caused by Candida albicans, fungus yeast like fungus. This

fungus is normally found on mucous membranes, on the skin, in the vagina and in the

gastrointestinal tract. Symptoms for candidiasis infections are erythematous lesions that can be

either dry or moist. Lesions have clear borders and satellite lesions are present. There is also
pain, itchiness and burning sensation with foul odor for vagina, and candidiasis infection has a

symptom of creamy white material or thrush in the mouth.

Parasitic disorder of the skin or the parasitic infestation are caused by the parasite lice

and mite that do not normally live on the skin, but infest the skin through contact with infected

person or contact with linen or objects infested with it. If fungal have dermatophytes, parasitic

infestation has pediculosis an infection with lice of three types namely: Pediculosis corporis is an

infestation with body lice, Pediculosis pubis is an infestation with pubic lice and Pediculosis

capitis is an infestation with head lice. Manifestations of pediculosis are pruritus, scratching and

erythema of the scalp and if untreated, the hair appears matted and crusted with a foul-smelling

substance. For mite infection or the scabies is an infestation of the skin with the mite Sarcoptes

scabiei. Scabies causes intensely pruritic lesions especially at night with erythematous papules

and burrows in web spaces, wrists and elbow, the axillae, the female nipple, waistline, and

genitals.

The similar thing with bacterial, fungal, parasitic and viral infections is that it can be

transmitted from one person to another through direct contact with the infected person or contact

with inanimate objects such as combs, pillow cases, bed linens, towels, contaminated dressings

and others. They are primarily diagnosed in outpatient settings and treated at home, but may also

occur in hospitalized people. Cleanliness in the environment and especially personal hygiene is

important as it may worsen the condition and it can help in preventing the spread and recurrence

of the infection. Contributing factors are almost the same especially for bacterial and fungal

which includes: poor personal hygiene, prolonged skin moisture, tight fitting clothes, hot/warm

and humid climate. They affect people of all social classes but are associated with crowded and

unsanitary living conditions.

 Diagnosis is primarily based on the manifested signs and symptoms, but in order to

determine the causative organism as for bacterial, fungal and parasitic laboratory tests are being

requested like wound aspirate or wound swab and sent for culture and sensitivity in order to

determine which appropriate antibiotics to be used, skin scrapings to determine fungi,

microscopic examination of parasite and other tests.

Medications for bacterial infection are an antibiotic specific to the organism, but

sometimes it can be intravenously or topically. For fungal infection an antifungal agents

depending on the specific drugs and prepared in a variety of forms: creams, powders, shampoos,

suspension, troches, vaginal suppositories an oral tablets. For parasitic infestation with lice

permethrin shampoo or permethrin cream for pubic and body lice and fine-toothed comb to comb

the dead nits off hair shaft and for scabies topical cream also.

Nursing care is focuses on preventing the spread of infection and restoring normal skin

integrity and health teaching on the patient and family.

Nursing Diagnoses and Intervention

Discomfort related to impaired skin integrity

Acute pain related to disease process

Potential risk for infection related to ineffective infection control practices by healthcare

personnel

Interventions are applicable to all the infections of the skin.

Health education for the Person and Family on the following topics:

 the importance to practice good hand washing and its importance

 preventing the spread of infection in the home by not sharing personal items, bed

linen, towels and wash clothing and linen in hot water

 the importance of cleanliness of the environment

 the importance of not squeezing or trying to open a lesion

 the importance of showering daily and to keep the skin dry especially on skin

folds as to avoid moisture in order to prevent fungi and bacteria to grow

 the importance of good nutrition

 the importance of taking the full course of prescribed antibiotics, antifungal,

antiprasitic and antiviral medications on a regular schedule until the prescribed

supply is finished

 Specific to fungal: do not wear tight fitting clothes, do not wear the same pair of

socks every day, do not wear rubber- or plastic soled- shoes in order to prevent

further infection and treat the sexual partner at the same time to avoid passing the

infection back and forth to each other

 REFLECTION

I will not forget the first day of class when mam Sophie told us the requirements and that

we are going to report, Yes: reporting is not new to me but I can say it is one of my weaknesses

because I am afraid that I may not deliver it right or if somebody questioned I will not be able to

answer and honestly speaking, on that day I thought of quitting. A lot of things came into my

mind on that day not only because of the reporting, but because I doubt myself if can I really

survive, then I realized that I should not quit and that I must try it because I am lucky that my

mother is able to send me to graduate school, unlike my other classmates that is at their own

expense and that they are working and eager to pursue and finish masters’ degree.

As I attend the class little by little I was able to cope up and absorb the world of pursuing

a higher education. I learned and realized that reading different sources is a must in order to learn

more and to share the knowledge to the class. Through the reporting it was not just a review but

also learning new things especially new trends, because way back in college not everything is

being taught.

Even though I felt some negative vibes, I was still happy and lucky because our professor

is kind, encourages us that we can, guided us and facilitated our learnings well, also my

classmates who are supportive of each other and accepts one’s capabilities and I admired them

for that.

Other realization from this subject/ course is that I was forced for my own good to make

and present a report; I believe that it is not only for this time that it is helpful to me and to others

but will be more helpful in the future as I pursue my career in the future.