Romdzati, S.Kep., Ns., MNSNursing School, Faculty of Medicine and Health SciencesUniversitas Muhammadiyah Yogyakarta

Integumentary system: skin, hair, nails, & glandsThe largest organ 20% of bodys weightPrimary function: protect the bodySkin layer: epidermis, dermis

Wrinkle MolesAge spotsDrynessThinning Pigment changes in the hair and skinThe changes associated risks include injury, infection, illness, and temperature control.

The epidermal cells change shapeThe barrier function is reduced

Thin & become more susceptible to trauma & infection

Physical ChangesClinical FindingsChanges in Functional AbilityEpidermisDecreased thickness in epidermal layerIncreased skin transparency & fragilityDecreased epidermal mitotic activityDelayed wound healingDecreased cell replacementDecreased epidermal mitotic homeostasisSkin hyperplasia, such as hyperkeratoses & skin cancers Increased epidermal permeabilityIncreased susceptibility to irritant reactionsDecreased barrier functionDecreased number of Langerhans cellsDecreased cutaneous inflammatory responseDecreased injury response

Physical ChangesClinical FindingsChanges in Functional AbilityDecreased number of active melanocytesIncreased sensitivity to sun exposureHyperplasia of melanocutes at the dermal-epidermal junction (*)Mottled hyperpigmentation & hypopigmentation (liver spots, age spots)Decreased vitamin D productionIncreased susceptibility to osteomalaciaDecreased vitamin D productionFlattening of the dermal-epidermal junctionIncreased susceptibility to shearing forces, with resultant blisters, purpura, skin tears, & pressure-related skin problems

Physical ChangesClinical FindingsChanges in Functional AbilityDermis Decreased dermal blood flowIncreased susceptibility to dry skin (xerosis)Decreased chemical clearanceDecreased vasomotor responsivenessIncreased thermoregulatory alterations (predisposition to heat stroke & hypothermia)Decreased injury vascular responsivenessDecreased dermal thicknessPaper-thin, transparent skin with an increased susceptibility to traumaDecreased injury responseDegeneration of elastic fibersDecreased tone & elasticity (wrinkles)Body image alterationsBenign proliferation of capillariesCherry hemangiomas

Physical ChangesClinical FindingsChanges in Functional AbilityAbnormal nerve endingsAlterations in sensory perceptionDecreased sensory perceptionSubcutaneous LayerRedistribution of adipose tissueBags, cellulite, double chin, abdominal apronBody-image alterationsThinning of subcutaneous fat layerIncreased susceptibility to hypothermiaDecreased resistance to mechanical injury (pressure necrosis)Decreased thermoregulationHairDecreased number of hair follicles & rate of growIncreased hair thinningDecreased cell replacementDecreased number of active melanocytes in follicleGradual loss of hair color (graying)Body image alterations

Physical ChangesClinical FindingsChanges in Functional AbilityNails Decreased rate of growthIncreased susceptibility to fungal infectionsDecreased cell replacementDecreased blood flow beneath the nailLongitudinal nail ridgesGlandsDecreased sebum production despite sebaceous gland hyperplasiaIncreased size of pores (especially on nose); large comedones in malar regionDecreased eccrine & apocrine gland activityIncreased susceptibility to dry skinDecreased perspiration, leading to decreased cooling effectDecreased need for antiperspirantsDecreased sweat productionDecreased thermoregulation

EczemaKeratosis

EKSIM (ECZEMA)

Eksim=dermatitisTahap:Dermatitis akut: erosi ekstensif dengan eksudat serosa atau papul dan vesikel eritematosa sangat gatal pada dasar eritemaDermatitis subakut: papul atau plak eritematosa, pengelupasan mengkilapDermatitis kronis: penebalan kulit, bekas garukan

Eksim umum, kronis, sering kambuh, gatal dimulai pd masa kanak-kanakAlergi thd serbuk bunga, asma, kulit sensitif, riwayat pd keluarga

Etiologi:GenetikLingkungan: negara industri, beriklim sedang, polusi, penurunan pemberian ASI

Pada lansia sering disebabkan oleh insufisiensi vena, alergen, iritan atau keganasan (leukemia, limfoma), interaksi obat

Onset akutRuam merahBasahTerdapat krustaKronis: kulit kering menebal, warna abu-abu kecoklatan, bersisikPruritusSering muncul infeksi kulit viral (Herpes), bakterial, jamur

Infeksi bakteri (contoh: Staphylococcus aureus): krusta berwarna seperti madu, perembesan cairan serosa, folikulitis, pioderma, furunkulosis

MedisHidrasi kulitHilangkan alergenKurangi inflamasi: antibiotik, antihistamin, kortikosteroid (jarang digunakan)KeperawatanTingkatkan kebersihan kulitKaji kebiasaan mandi, penggunaan pelembap, medikasi, paparan terhadap alergen, lingkungan, riwayat erupsi kulit

Umum pada lansia Kulit eritematosa, berisik, pecah-pecah secara halusXerosis berat: kulit kencang, gatal, & nyeri

Faktor yang memperparah:SabunDesinfektanJarang menggunakan pelembab

Penatalaksanaan:HidrasiMelembabkan kulitMenghindari fakor iritan

Jenis:Dermatitis kontak iritan: paparan terhadap zat apapun yang menyebabkan respon iritan kimiawi/fisik paling umumDermatitis kontak alergi: hipersensitivitas terhadap alergenManifestasi klinisGatal, rasa menyengat, eritema, edema, eritema

Muncul setelah 1 jam kontak atau 7-14 hari setelah kontakEritema ringan, vesikel, atau ulserasi

Penatalaksanaan:Identifikasi alergenObat topikal (gatal, nyeri)Obat antihistamin, kortikosteroid

Uji Patch (tempel): untuk menentukan agen spesifik

Area intertrignosa: di antara lipatan-lipatan kulit (paha, leher, aksila, fosa antekubital, perineum, sela-sela jari tangan & kaki, abdomen, bawah payudara)Infeksi sekunder: Pseudomonas, Staphylococcus, Candida albicansEtiologi:Kontaminasi cairan tubuh

Penatalaksanaan:Keringkan area tubuhpakaian dari bahan katunHindari pakaian ketatJika perlu, gunakan perbanKortikosteroid topikal (inflamasi)Kombinasi agen steroid-antibiotik-antifungal

Area kulit sangat kering, gelap, kadang disertai ulkus dangkal pada tungkai bawahEtiologi: insufisiensi vena

Penatalaksanaan:PelembabAntihistaminantifungal

Faktor risiko:Sering terpapar urine atau feses diarePenggunaan popok

Infeksi kulit sekunder: jamurUrine terserap oleh keratinosit bau amonia, membengkak

Penatalaksanaan:Tentukan penyebabJaga kebersihan kulitBersihkan dengan segera, klien inkontinensia

KERATOSIS

Keratosis merupakan pertumbuhan jaringan keratin pada permukaan kulitJenis:Keratosis aktinikKeratosis hidrokarbonKeratosis pilarisKeratosis seborea

Lesi prakanker epitel, terutama disebabkan oleh paparan matahariWajah, bagian atas telinga, leher bagian belakang, lengan bawah, punggung tangan, dadaBerisiko terjadi malignansi & metastasis pada lesi yang dibiarkanLesi: makula, papula, iregular, rata, sedikit eritematosa dg tepi tidak tegas, sisik tanduk/keratotik yg keras

Penatalaksanaan medis:Obat topikal fluorouracil antineoplastik topikalCara pemberian: dioleskan 2x sehari selama 2-4 mingguSide effect: nyeriPenyembuhan bisa 1-2 bulanKrioterapi (pembekuan menggunakan nitrogen cair), tanpa anestesi

Elektrodesikasi & kuretase: anestesi lokal, pengikisan, area luka dijaga lembab dg salep antibiotikEksisi laser: energi cahaya untuk menguapkan lesiBiopsi punch/eksisional9

Keratosis hidrokarbon=pitch keratosis: keratosis yang terjadi setelah terpapar hidrokarbonKeratosis pilaris=follicular keratosisKeratosis seborea=seborrheic verruca : berbentuk oval atau bulat; penatalaksanaan dengan electrocautery, curettage, shave excixion, cryosurgery

AssessmentDiagnoseOutcomeInterventionImplementation

Impaired skin integrityDisturbed body imageRisk for infectionRisk for impaired skin integrity

Common related factor: contact with irritantDefining characteristics:InflammationDry, flaky skinErosion, excoriations, fissuresPruritus, pain, blistersExpected outcome: patient maintains optimal skin integrity within limits of the disease, as evidenced by intact skin

InterventionRationale Encourage the patient to adopt skin care routines to decrease skin irritationOne of the first steps in the management of dermatitis is promoting healthy skin & healing of skin lesionsBathe or shower using lukewarm water, mild soap or non soap cleanserLong bathing or showering in hot water causes drying of the skin & can aggravate itching through vasodilatationAfter bathing, allow the skin to air dry or gently pat the skin dry. Avoid to rubb or brisk drying.Rubbing the skin with a tower can irritate the skin & exacerbate the itch-scratch cycleApply topical steroid creams or ointmentsReduce inflammation & promote healing of skin

Defining CharacteristicsVisible skin lesionsCommon Related FactorVerbalizes feelings about change in body appearanceVerbalizes negative feelings about the skin conditionFear of rejection or reactions of othersExpected OutcomePatient verbalizes feeling about lesions and continues daily activities and social interactions.

InterventionRationaleAssist the patient in articulating responses to questions from others regarding lesions.Patients may need guidance in determining what to say to people who comment about the appearance of their skin. Dermatitis is not a contagious skin condition.Allow patients to verbalize feelings regarding their skin condition.Through talking, the patient can be guided to separate physical appearance from feelings of personal worth.Assist patients in identifying ways to enhance their appearance.Clothing, cosmetics, and accessories may direct attention away from the skin lesions. The patient may need help in selecting methods that do not aggravate the skin lesions.

Risk FactorsImpaired skin integritySevere inflammationExcoriationDesired OutcomePatient remains free of secondary infection.

InterventionRationaleApply topical antibiotics.Topical antibiotics may be used to treat infections that occur with dermatitis.Administer oral antibiotics.Oral antibiotics may be more effective in treating infections on the skin.Encourage the patient to use appropriate hygiene methods.Keeping the skin clean, dry, and well lubricated reduces skin trauma and risk of infection.

Risk FactorsSevere pruritusScratches skin frequentlyDry skinDesired OutcomePatient reports increased comfort level and skin remains intact.

InterventionRationaleEncourage the patient to avoid triggering factors.Contact with factors that stimulate histamine release will increase itchingMaintain hydration of stratum corneum.Moist skin is less likely to experience pruritusUse cool compresses on pruritic areas of the skin.Cool, moist compresses help relieve pruritus and itchingAdminister antihistamine drugs.It will help relieve itching and promote comfortApply topical steroid creams if indicated.Administer oral steroids.

Ketika seseorang tengah melakukanwukuf di Arofah, tiba-tiba dia terjatuh dari hewan tunggangannya dan patahlehernya sehingga meninggal. Maka Nabi shollallohu alaihi wa sallam berkata:Mandikanlah ia dengan air campur sidr (bidara) (HRBukhori)Aurat berlaku bagi yang masih hidup maupun untuk jenazah.