SKIN DISORDERS Class Presentation

7/29/2019 SKIN DISORDERS Class Presentation

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SKIN DISORDERS

Medical-Surgical Nursing


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Anatomy&Physiology Largest Organ of the body in surface

area and weight.

In Adults

skin covers an area of about 2 sq.mt.

Thickness is 0.5-4mm,depending uponthe location.

weighs 4-5kg.


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Anatomy&PhysiologyCont

Consists of 2 PrincipalParts:-

Epidermis Superficial,thinportion composed of epithelialtissue.

Dermis Deeper,thickercomposed of connective

tissue.

Deep to the dermis is asubcutaneous layer called asHYPODERMIS consists of

aerolar & adipose tissues


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FUNCTIONS OF THE SKIN

Regulation of body temperature.

Protection

Sensation Excretion

Immunity

Blood reservoir

Synthesis of Vitamin D


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SKIN LESIONS

Primary Lesions:-

MaculaFlat,circumscribed

discoloration of skin,mayhave any size or shape.

PapuleSolid,elevatedlesion,1cmwide,extended deep intodermis.

Macule

Papule

Nodule


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SKIN LESIONS- Cont.

VesicleCircumscribedelevated lesion1cm wide e.g. 2nddegreeburn.

PustuleCircumscribedraised lesion that containspus; may form as a result ofpurulent changes in avesicle.

Vesicle

Pustule


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SKIN LESIONS- Cont.

WhealElevation of the skinthat lasts 1cm e.g. psoriasis & leukoplakia. CystSoft or firm mass, filled

with semisolid or liquid materialcontained in a sac.

Wheel

Cyst
http://ilearn.senecac.on.ca/aahs/health/IHP/skina/skdesc/cyst.htmlhttp://ilearn.senecac.on.ca/aahs/health/IHP/skina/skdesc/eros.html


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SKIN LESIONS- Cont.

SECONDARY LESIONS:-

ScaleHeaped-up,horny layerof dead epidermis; may developas a result of inflammatorychanges e.g.dandruff.

CrustCovering formed by thedrying of serum,blood,or pus onthe skin.

ExcoriationLinear scratchmarks or traumatized areas of theskin e.g.visible sign of itching.

Scales Excoriation
http://ilearn.senecac.on.ca/aahs/health/IHP/skina/skdesc/exc.html


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SKIN LESIONS- Cont.

SECONDARY LESIONS:- Fissure Cracks in the

skin,usually from markeddrying & longstandinginflammation.

Ulcer Lesion formed bylocal destruction of theepidermis & by part orall of theunderlyingdermis.
http://ilearn.senecac.on.ca/aahs/health/IHP/skina/skdesc/ulcer.html


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SKIN LESIONS- Cont.

SECONDARY LESIONS:- Lichenification

Thick,leathery skin,usually

the result of constantscratching & rubbing.

Scar New formation ofconnective tissue thatreplaces the loss ofsubstance in the dermis as aresult of injury or diseasee.g.mark left skin.

Atrophy loss of skin cells

that cause thinning of theskin.

Lichenification
http://ilearn.senecac.on.ca/aahs/health/IHP/skina/skdesc/lichen.htmlhttp://ilearn.senecac.on.ca/aahs/health/IHP/skina/skdesc/lichen.html


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SHAPE OF SKIN LESIONS

Annular Ring shaped

Confluent Lesions runtogether or joinedtogether.

Grouped Clustering oflesions.

Herpetiform Groupedvesicles.

Linear In lines

Iris Ring or series of

concentric circles.


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SHAPE OF SKIN LESIONS

Solitary Single lesion

Satellite Single lesion

occurring in close proximity tobut separate from a large groupof lesions.

Zosteriform Band likedistribution,limited to one ormore dermatomes of skin.

Nummular Coin shaped


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SHAPE OF SKIN LESIONS-Cont.

Reticulated Lace like network.

Serpiginous Snake like

Telangiectasia Tiny superficial,dilatedcutaneous vessel seen as red thread orline.

Discrete Lesions remain separate. Guttate Drop like.

Multiform More than one kind of skinlesion.


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SKIN TURGOR

Gently squeeze the skinon the forearm orSternal area between

your thumb &forefinger.

If the skin quicklyreturns to its originalshape - normal skin

turgor. If the skin doesnt

return to its originalshape within 30 sec.orif it maintains a tentedposition - poor turgor.


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ASSESSMENT FINDINGS

History:

Change in skin color,texture,& temp.

Perspiration or dryness. Itching

Brittle,thick,Soft nails

Fever Hair loss

Rash


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ASSESSMENT FINDINGS

Physical Examination:-

Pattern of pigmentation & hair distribution.

Skin texture,turgor,color & temp. Peripheral Edema.

Skin lesions

Pruritis Erythema

Petechiae & ecchymosis.


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DIAGNOSTIC TESTS &

PROCEDURESSkin Biopsy:-Removal of apiece of skin by scalpel

to detect malignancy orother skin disorders.

Types of Biopsy:-

Shave Biopsy Punch Biopsy

Excisional Biopsy


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DIAGNOSTIC TESTS &

PROCEDURESSkin Scrapings:-

Procedure calling for cells scraped by a

scalpel and covered with potassiumhydroxide

Purpose:- Microscopic examination of

scales,nails and hair. Nsg.Intervention:- Check the scrapping

site for bleeding & infection.


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DIAGNOSTIC TESTS &

PROCEDURESWoods Light:- Used to detect

bacterial or fungal

infections. Performed in dark

room with the help ofUV rays.

Infected area willfluorescence or shineunder UV rays.
http://www.hkcfp.org.hk/article/2003/09/image/p432f07b.jpg


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DIAGNOSTIC TESTS & PROCEDURES

PATCH TESTING:- Done to find out the different

types of allergies.

Materials are applied in patchesto the skin & checked for reaction48 hours after application &possibly again later.

Erythema,swelling,papules and

vesicles indicate an allergiccontact dermatitis rather than anirritant contact dermatitis.


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GENERAL PROCEDURES

BATHS:-

A therapeutic bath is used to applymedications to the entire skin surfaceand is useful in treating widespread

eruptions and general Pruritis


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GENERAL PROCEDURES

Indications of Therapeutic Baths:-

Vesicular,bullous and ulcerativedisorders.

Acute inflammatory conditions. Erosions and exudative, crusted

surfaces


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TYPES OF THERAPEUTIC

BATHSBath Solution Desired EffectWater Remove crusts,relieve

inflammation

Saline Relieve inflammation

Colloidal e.g.oatmeal Antipruritic,soothingeffect,lubricates,soften

Sodium bicarbonate Cooling effect,relieves skinirritation.

Starch e.g.Corn starch Soothing effect

Tar baths E.g.for Pruritis,eczema

Bath Oils E.g.Eczematous eruptions


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THERAPEUTIC BATHSNsg.Care:-

Prepare a warm bath at 32 to 38 degree

centigrade(90-100 deg.F) with the tub halffilled.

Add prescribed quantity of medication & mixwell.

Do not rub the skin. Soaking for at least 15 min.will promote

removal of loosened scales.

Keep the room & water at comfortable temp.


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THERAPEUTIC BATHSNsg.Care:-

Limit bathing to 20 to 30 min.

The bath area should be well ventilated if tarsare used,because they are volatile.

Tell the patient to use a bath mat inside thetub & to use a rug outside the tub when

bathing at home. Blot skin dry with a towel & apply emollient or

topical medication to moist skin, if prescribed.


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GENERAL PROCEDURES

Wet Dressings:- Wet dressings & soaks

are damp compresses

that contain water,normalsaline,aluminiumacetate, magnesiumsulfate solution.

They may be sterile orclean,or warm orcool,depending on skincondition and the areato which they areapplied.


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GENERAL PROCEDURESOpen Wet Dressings:-

Indications:

Bacterial infections that requiredrainage.

Inflammatory and pruritis conditions.

Oozing and crusting conditions


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GENERAL PROCEDURES Open Wet Dressings:-Related Nsg.Care:

Apply dressing to the affected area & keep

moisten to the point of slight dripping. Remoisten as necessary.

Use ice cubes for cooling effect & warm tapwater for warm effect.

Rewarm or recool every 5 min. Apply for 15 min.-3 to 4 times a day.

Do not treat one third of body area at a time.

Prevent burns & chills.


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GENERAL PROCEDURESOcclusive Dressings:-

It is an airtight plastic orvinyl film applied overmedicated areas of skin(usually withcorticosteroids)to enhanceabsorption of medication &to promote moistureretention.

Indication:-Psoriasis


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GENERAL PROCEDURES

Occlusive Dressings:-Related Nsg.Care: Wash area and pat dry.

Apply medication while skin is still moist.

Cover with plastic wrap.

Seal edges with paper tape or other dressingto hold in place.

Dont apply on ulcerated skin.

Remove within 12 to 24 hours. Dont use occlusive dressings excessively as it

leads to skinatrophy,Telangiectasia,erythema,no healing

ulceration


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ASTHETIC PROCEDURES Aesthetic procedures are a type of

reconstructive (plastic) surgery

performed to reconstruct or to alter

congenital or acquired defects or to

restore or improve the bodys

appearance.


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ASTHETIC PROCEDURES

Types of procedures:- Rhytidectomy- Face lift

Blepharoplasty- Toremove excess skin or

fat from the upper &lower eyelids.

Rhytidectomy

blepharoplasty


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ASTHETIC PROCEDURES Dermabrasion- To

removescars,nevi,tattoo.

Liposuction/BodyContouring-Reduces localizeddeposits of fat fromface,neck,breasts,abdomen,flanks,hips,buttocks&extremities.


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BENIGN TUMORS Benign Tumors are

common skin growths.

Characteristics:- Seborrheic Keratoses:-

Benign wart like lesions of

varying size andcolor,ranging from light tanto black.Common in middle

age and older age people.


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BENIGN TUMORSCont. Actinic (Solar)

Keratoses:-Premalignant

skin lesions appearing asrough,scaly patches withunderlyingerythema,which develop

as a result of prolongedexposure to ultravioletrays and graduallytransform into squamous

cell carcinoma.


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BENIGN TUMORSCont. Verrucae (Warts):-A circumscribed

elevation of skin tends to disappearspontaneously.

Angiomas (Birthmarks):- Benignvascular tumors involving the skin andsubcutaneous tissue.May occur asflat,violet-red patches(port-wineangiomas) or as raised,bright-red nodular

lesions(Strawberry angiomas).Strawberryangiomas may involute spontaneously,whereas port-wine angiomas usuallypersist indefinitely.

Warts


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BENIGN TUMORSCont. PigmentedNevi(Moles):-Flat,macular

lesions,elevatedpapules,or nodules thatoccasionally containhair ranging fromyellowish to brown to

black. Keloids:-Benign

overgrowth ofconnective tissue atsite of scar or trauma.


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DERMATITIS Dermatitis:- Refers to a group of

inflammatory skin disorders thatvary in cause,morphology &

distribution.They are oftenhighly pruritic.

Types:-

Acute:WET,erythematous,edematous, oozing.

Chronic:-DRY,scaling,crusting,powdery.
http://www.rrze.uni-erlangen.de/docs/fau/fakultaet/med/kli/derma/bilddb/


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CONTACT DERMATITISDef.:-Inflammatory response of the skin aftercontact with a specific antigen.

Causes:- Mechanical,biological,& chemical irritants.

Cosmetics and hair dyes.

Detergents,cleaning agents,& soaps.

Insecticides.

Poison Ivy

Wool


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CONTACT DERMATITISPathophysiology:-

Contact with an

antigen triggers alocalized inflammatoryresponse.

Inflammatoryresponse producesskin changes.


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CONTACT DERMATITISAssessment Findings:-

Pruritis &Burning

Erythema at point of contact. Localized edema

Vesicles and papules

Lichenification Thick,leathery skin. Pigmentation changes

Eczema

Scaling


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CONTACT DERMATITISDiagnostic test findings:- Patch testing

Visual Examination

Medical Management:- Position: Elevation of extremity.

Activity: as tolerated

Monitor V/S & neurovascular checks.

Apply cool,wet dressings with aluminum acetatesolution (Burrow's solution).

Antibiotic: Ampicillin

Antipruritic/Antihistamine: (benadryl)

Corticosteroids: Hydrocortisone.


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CONTACT DERMATITISNursing Interventions:-

Assess & record neurovascular status.

Maintain elevation of affected extremity.

Monitor & record vital signs. Administer medications.

Provide tepid baths,bed cradle,&cool,wet

dressings Avoid soaps,heating pads or blankets.

Prevent scratching & rubbing.

Maintain cool environment.

Provide diversional activity.


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PSORIASIS

Definition:- Chronic,noninfectious skininflammation that occurs in patchescharacterized by frequent remission &reoccurrence.

Age Group:- Late childhood or youngadulthood.

Body parts involved:-Scalp,Elbows,knees,chest,back,arms,nails,folds between the buttocks


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PSORIASIS

Causes:- Stress

Epidermal Trauma

Streptococcal Infection Changes in Climate

Genetics

Anxiety

Alcoholism Rheumatoid Arthritis

DrugInduced:Lithium,Prapranolol,Betablockers


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PSORIASIS

Pathophysiology:-

Loss of normal regulatory mechanisms ofcell division leads to rapid multiplication ofepidermal cells that interfere withformation of normal protective layer ofskin.

Epidermal turnover occurs 6 to 9 timesfaster than normal.

Papules coalesce to form plaques.


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PSORIASISClinical Manifestations:- Erythematous,raised,

patches with silveryscales.

SymmetricInvolvement

Pruritic & painful

Pitting of

nails,yellowishdiscoloration

Arthritis in app.10%of patients(PsoriaticArthritis)


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PSORIASIS

Clinical Manifestations:-

Shedding,scaling plaques

Erythema Papules on sacrum,palms

Plaques, on visual examination.

Diagnostic test findings:-

Skin Biopsy: Positive

Serum Uric acid level: Increased


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PSORIASIS

Medical Management:-

Monitor V/S & neurovascular checks.

Treatments: Give daily soaks,usetepid,wet compresses & bed cradle.

Corticosteroids: Triamcinolone &

betamethasone used for occlusivedressing.

Antipsoriatics: Anthralin,coal tar,followed

by exposure to UV light.


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PSORIASIS

Medical Management:-

Antimetabolite: Methotrexate

Photo chemotherapy(PUVA therapy):Methoxsalen(Photosensitizer) followed byexposure to ultraviolet rays.

Keratolytics(Antiacne): Benzoyl peroxide,salicylic

acid Antimicrobial: Sulfasalazine

Diet: high protein,high calorie,frequent feedings.


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PSORIASIS Nursing Interventions:-

Assess & record neurovascular status.

Monitor and record V/S.

Administer medications. Administer UV light & PUVA therapy.

Apply occlusive dressings.

Prevent scratching. Maintain the patients diet.

Help the patient to remove scales during soaks.

Wear light cotton clothing over affected areas.


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HERPES ZOSTER(SHINGLES)

Definition:-

Acute viral infection of nerve structurecaused by varicella zoster(DNA virus).

Causes:-

Cytotoxic drug induced immunosuppression.

Hodgkins Lymphoma

Exposure to varicella zoster

Debilitating Disease.


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Pathophysiology:-

Activation of dormant varicella zoster virus

causes an inflammatory reaction. Produces painful vesicles along the

distribution of nerves.

Affected areas spinal & cranial sensoryganglia and posterior gray matter of thespinal cord.


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Assessment Findings:-

Neuralgia

Malaise

Pruritis & burning sensation

Clustered skin vesicles on trunk,thorax,face.

Erythema

Fever & headache

Paresthesia

Edematous skin


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Diagnostic tests:- By clinical presentation

Skin cultures & stains

Medical management:-

Antibacterial ointmentAnalgesics: Acetaminophen,Oxycodone

Antianxiety drugs:Diazepam,Hydroxyzine

Antipruritic:DiphenhydramineCorticosteroids:Hydrocortisone,Triamcinolone

Nerve block agent:Lidocaine

Antiviral Agents:Acyclovir,Interferon


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Nursing Interventions:- Assess Pain & Allay patients anxiety.

Monitor & record vital signs & neurologicalstatus.

Administer medications. Provide acetic acid compresses,tepid baths,bed

cradle & air mattress.

Prevent scratching and rubbing of affectedareas.

Recognize the signs & symptoms of hearingloss.

Avoid wool and synthetic clothing.


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Medical complications:-

Infection

Chronic pain syndromeOphthalmic herpes zoster

Facial paralysis

Vertigo

Tinnitus

Hearing loss

Visceral dissemination


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PARONYCHIA

Definition:- Inflammation of the skin folds

surrounding the finger nail.

Clinical Manifestations:-

Acute Paronychia starts as ared,warm,painful swelling of the skin aroundthe nail.May progress to the formation of pusthat separates the skin from the nail.

In Chronic Paronychia,the redness &tenderness are less noticeable.The skinaround the nail can get boggy.Nail maybecome green because of pseudomonasinfection


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PARONYCHIA

Causes:- Trauma to the skin

e.g.ingrown nail,nail biting

The bacteria responsible forparonychia isStaphylococcusaureus,Streptococcus &Pseudomonas

Chronic infection occurs dueto repeated exposure todetergents & water.It canbe caused by Candidaalbicans & other fungi.


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PARONYCHIA

Treatment:-

Antibiotics: cephalexin

Topical Antibacterial ointments do noteffectively treat paronychia.

Incision & Drainage if pus formation isthere.

Antifungal medication such asKetoconazole cream can be used astopical agent.


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PARONYCHIA

Nursing Management:-

Encouraging soaking in warm water for

10-15 min.3-4 times a day while acutelyinflamed to relieve pain & promotedrainage.

Recommend use of rubber gloves overthin cotton gloves when working aroundmoisture.


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PARONYCHIA

Prevention of paronychia:-

Do not bite nails or cuticles.

Do not suck fingers.

Try to avoid soaking hands in waterwithout wearing waterproof gloves.


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Frost bite is damage to the bodytissue caused by the tissue

freezing,which may bepermanently affected.

Frost bite causes a loss of feelingand a white or pale appearancein extremities such asfingers,toes,ear lobes or the tipof the nose.

Frost Bite


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People at risk:-

People who have circulatory diseases

deep vein thrombosis. People taking beta blockers to lower the

blood pressure.

If deep tissues are damaged,gangrenemay result

Frostbite

Pathophysiology


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The fluids in the body tissues & cellularspaces freeze & crystallize.

This can cause damage to the bloodvessels & result in blood clotting & lackof oxygen to the affected area.

It can be very serious condition that itcan lead to amputation.

Pathophysiology


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Length of time a person is exposed to thecold.

Temperature outside.

Force of the wind.

Humidity in the air.

Wetness of clothing, shoes, & body

coverings. Ingestion of alcohol and other drugs & high

altitudes.

Causes of FrostBite

Si & t f F tbit


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Mild frostbite(frostnip) affects the outer skin layers& appears as a blanching or whitening of the skin.Usually, these symptoms disappear as warmingoccurs, but the skin may appear red for severalhours.

In severe cases, the frostbitten skin will appearwaxy looking with a white, grayish-yellow orgrayish-blue color.The affected parts will have nofeeling(numbness) & blisters may be present. Thetissue feel frozen or wooden.This indicates a veryserious condition.

Other symptoms that indicate frostbite are swelling,

itching, burning & deep pain as the area is warmed.

Sign & symptoms of Frostbite


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Proper clothing for winter weather.Wear severallayers of light, loose clothing that will trap air, yetprovide adequate ventilation.

Covering for the neck & head are important. Hats,hoods, scarves, earmuffs & facemasks are goodprotection.

Protect feet & toes. Wear 2 pairs of socks-wool isbest, or cotton socks with a pair of wool on top.Wear well fitted boots that are high enough tocover the ankles.

Prevention ofFrostbite


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Hand covering are vital. Mittens are warmerthan gloves, but may limit what you can dowith your fingers.Wear light weight glovesunder mittens so you will still have protection

if you need to take off your mittens. Be sure your clothing & boots are not tight. A

decrease in blood flow makes it harder to keepthe body parts warm & increases the risk offrostbite.

When in frostbite-causing conditions, dressappropriately, stay near adequate shelter,avoid alcohol & tobacco, & avoid remaining inthe same position for long periods.

Prevention ofFrost Bite


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Dont allow your injury to thaw thenrefreeze.This is very dangerous & can causeserious or permanent injury.It is better to delay

warming. Dont use dry heat (sunlamp,radiator, heating

pad, etc.)to thaw the injured area.

Dont thaw the injury in melted ice.

Dont rub the area with snow. Dont use alcohol, nicotine or other drugs that

may affect blood flow.

Don'ts

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SKIN DISORDERS Class Presentation