NURSING MANAGEMENT: INTEGUMENTARY SYSTEM

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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 .

.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. squamous cell carcinoma. Basal cell carcinoma. and malignant melanoma  Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun.

 Avoid sun between 10 AM and 3 PM  Start with short sessions  15-20 minutes  Sunscreen SPF >15 daily. strenuous exercises. 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 .

 .TANNING BEDS  Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.  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.  People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.

STOPPING THE SPREAD OF INFECTION  Gloves  Good hand washing  Safe disposal of soiled dressings  Avoid scratching of lesion  Trim nails. no fake 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.

 Management:  warm wet compresses four times a day  I & D  Antibiotics-topical and/or oral  Do not squeeze . red.FURUNCLE (BOIL)  Deep infection of the hair follicle  commonly caused by Staph Aureus  Clinical manifestations: small. elevated. painful nodule.

Strep. 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.glistening. weeping.IMPETIGO Superficial skin infection: caused by Staph.

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 . red.CELLULITIS Bacterial infection of the skin Skin is warm to touch. swollen and painful Pt has fever.

dairy.  Wear loose fitting clothing  Change damp or soiled clothing quickly  Wear cotton underwear  Keep toenails clean and short. .  Avoid eating foods high in sugar. caffeine.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 towels. and yeast – as all of these will enhance fungal growth. hats or any type of headgear. clothes. and avoid walking barefoot on areas like locker rooms and public showers. wheat.

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 . bald patches on the head.TINEA CAPITIS Ringworm of the scalp is a fungal infection of the scalp and hair shafts Usually appears as itchy. scaly.

TINEA CORPORIS Ringworm  Trunk. well defined red borders with center clearing Treatment  Wash and dry the area first. legs  Elevated ring shaped scaling. arms.  Do not use a bandage over ringworm .  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 .

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 . inner thighs and buttocks  Itching and redness in your groin. inner thighs and buttocks  Possible itching in your anal area  Burning sensation in affected areas  Flaking.TENIA CRURIS Affects the skin of your genitals. including your genitals.

Terbinafine (Lamisil). blisters. Tolnaftate (Tinactin)  Keep using the medicine for 1 . scaly patches  May contain bumps. can be on hands  Red. or scabs Treatment:  Butenafine (Lotrimin).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 .TENIA PEDIS Athlete’s Foot  Most commonly between toes and soles of the feet. Miconazole (Desenex). Clotrimazole (Lotrimin).

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. the health care provider may remove the nail . are used  In some cases.

fiery red or moist pink.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 .

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Garlic.  Diaper rash – Zinc oxide oint. Live cultured yogurt (acidophilus) .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.

detergents. Hypersensitivity to allergen 2-7 days after exposure Poison Oak or Ivy. and pruritus . nickel.CONTACT DERMATITIS Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating substance. hair dyes. edema. paint. wool. hive like papules. rubber/latex Red. insecticides. soap.

TREATMENT  Avoidance of irritant  Teach  Wash exposed skin with  Topical corticosteriods. fluid spreads the disease. . cool water asap post antihistamines. skin exposure hydration antipruritic  Within 15 minutes  Trim nails  Avoid breaking of blisters.

insect bites. exposure to heat and cold. stress. and exercise Treatment: antihistamines cold compresses  Remove of irritant source . inhalants.URTICARIA  Pruritic transient wheals of varying shapes and sizes (Hives)  Response to irritant: drugs. food.

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 .

wheat. and peanuts . red to redish-brown circumscribed lesions  Itches more at night  In children positive correlation with allergies to milk.ATOPIC DERMATITIS (ECZEMA)  Often begins in infancy  2-6 months  Scaly. eggs.

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 .

vegetative papule Treatment:  Cryosurgery  Chemical destruction (salicylic acid)  Curettage  Desiccation  Laser .VERRUCAE (WARTS)  Verruca Vulgaris  Hands  Flesh-colored or brownish gray scaling.

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.

spread by kissing.HSV-1  Grouped. oral cavity. Menes. systemic infection  Hand washing  Last 7-10 days . contact with fingers  Exacerbated:  Stress. trauma. eyes and brain  Teach:  direct contact. burning. oral genital sexual contact. sunlight. fatigue. and itching vesicles on erythematous base  Mouth.

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.

stress. immunosuppressed  Painful vesicles in a linear pattern along dermatome (spinal and cranial nerve tracts) .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.

burning. analgesia. numbness or tingling  Heals without complication  may scar Treatment:  Antiviral agent  Acyclovir. bedtime sedation  Shingles Vaccine  Zostavax .HERPES ZOSTER  Grouped vesicles on erythema base  Most commonly to the trunk  Fluid-filled blisters that break open and crust over  Pain. famiciclovir  Cool compresses.

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 .

PSORIASIS CON’ T. 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 .  Elbows.  Erythematous plaque with sharp well defined borders and silvery white scales. knees. lumbosacral skin. scalp.

INSECT AND ANIMAL CONTACTS Scabies (Mites)  Mite infestation in the dermis to lay eggs Inflammation and itching (worse at night) Burrows between fingers. wrist. popliteal. axillary folds. and inguinal Treatment: Elimite Lotion  Apply head to toe then repeat in 1 week .

PEDICULOSIS  Lice infestation  3 types  Pediculosis Capitus  Head lice  Pediculosis Corpus  Body lice  Pediculosis Pubis  Pubic lice  crabs .

caps. or other items used on or near hair  Can invade all ages .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. scarves. slumber parties. hats. coats. shared lockers.

rinse and towel dry  Remove nits with nits comb  Lice treatment kill. RID  Apply treatment  Leave on 10 minutes. nape of the neck  Treatment  Pediculocides and manual removal of nit cases  NIX. but do not remove the nits . head.LICE  Manifestations  Visual  Itching/scratch marks  Behind ears.

brushes. and hair accessories in lice killing products for 1 hours or in boiling water for 10 minutes . stuffed animals.TEACH Machine wash all washable clothing. mattresses. car sets. and bed linens in hot water. rugs. pillows. towels. and dry in hot dryer for at least 20 minutes Thoroughly vacuum carpets. and upholstered furniture Seal non-washable items in a plastic bag for 14 days if unable to dry clean or vacuum Soak combs.

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. box springs. headboards and bed frames  Red. during the day. arms and hands Treatment:  Cortisone cream  Antihistamine  Treat pruritus .CIMICIDE Bedbugs  Feed at noc. neck. they hide in the cracks and crevices of beds.

wasps. yellow jackets. mud daubers. itching  Resolves in a few hours . erythema pain. bumblebees. and fire ants Reaction may be immediate or delayed (after 2 hours) Non-allergic reaction  Local edema. hornets.STINGS Allergic reactions account for 30 deaths each year  Honeybees.

antihistamines . Avoid breaking or squeezing Treatment Ice. elevation. shock and death 10-30 minutes post sting Epinephrine 0. 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.Severe with possible anaphylaxis reaction Generalized urticaria and pruritus. laryngeal edema.5 mL of 1:1000 sol.1-0.

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 .

irregular shaped. back of hands. slightly  Sun exposure  May progress to squamous cell CA .PREMALIGNANT LESISONS Actinic keratosis  Face. flat. neck. forearms  Rough scaly patch.

MALIGNANT NEOPLASMS
Basal Cell- most common – least
deadly

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
 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 .

6 mo.up at 3 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. and yearly for life if skin cancer is removed .

PROGRESSION OF SUSPICIOUS MOLES .

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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.

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 . moderate exercise. squeeze. well-balanced diet. or finger  Secondary infection  Avoid creams/oils  Make-up bases can aggravate acne  Adequate rest.NURSING MANAGEMENT  Do not pick.

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 .

bedclothes.PEELING AGENTS  Treatment  Retin A  Cream. or liquid  apply 20-30 minutes after washing  Burning sensation/ redness of skin  Avoid sun exposure  Sunscreen  Apply at bedtime Benzoyl Peroxide  Cream. lotion. wash  Bleaching effect on sheets. gel. gel. and towels .

mechanical and surgical face-lift. rhinoplasty. tummy tuck. eyelid lift. hair transplant. removal of double chin .PLASTIC SURGERY Elective cosmetic surgery  Main reason  To improve self-image Most common procedures  Breast enlargement. breast reduction. liposuction.

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 .

frown lines and crow's feet. pain. swelling. HA.  Paralyzing small muscles involved in facial expressions  Does not cause botulism (small doses)  Redness.BOTOX INJECTIONS  Temporarily eliminates brow furrows. and double vision for 1-2 weeks  Injections are expensive  Must be repeated every 3-6 months .

NURSING DIAGNOSIS  Social isolation  Coping  Nutrition  Anxiety .

.  C. The nursing assistant washes hands frequently and wears gloves when in the room.REVIEW  An elderly patient who is diagnosed with herpes zoster (shingles) has draining vesicles. if observed by the nurse. The patient keeps the draining vesicles covered with a dressing.  B. The licensed practical nurse wears a mask when entering the patient’s room. Which action. would require an intervention?  A.  D. The student nurse who takes prednisone requests a different patient assignment.

Which statement.“I will avoid taking hot showers.” .”Menthol can be used to numb the itch sensation.REVIEW  The nurse teaches a patient several interventions to reduce pruritus associated with dry skin. if made by the patient to the nurse.”  D. indicates further teaching is required?  A.”  B.“A wet dressing followed by a lubricating lotion will help.”  C.“I should rub my skin instead of scratching.

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