Diseases of the Hair, Skin and Nails

PN 111

2007

Causes of Skin Disturbances and examples

• Congenital

• Inflammation

• Obstruction

• Malignant Lesions

• Unknown Causes

• Degeneration

• Aging

• Trauma

Promotion, maintenance and Restoration

• Potential Nursing Diagnosis

• Psycosocial Responses

• Local Care

• Pharmathereapeutics

• Physicial agents

Review of Skin

Epidermis:

Function of the Skin

regulation of body temperature

protective surface

sensory structure

excretion

immunity

blood reservoir

synthesis of vitamin D

Physical Assessment

• Includes mucous membranes, scalp, hair, and nails

• Skin is a reflection of overall health

• Disorders often correspond to disease in other organ systems

General Appearance

• colour

• temperature

• moisture

• dryness

• skin texture (rough or smooth)

• lesions

• vascularity, mobility, hair, nails

Diagnostic Evaluation

• Skin Biopsy

• Immunofluorescence

• Patch Testing

• Skin Scrapings

• Tzanck Smear

• Wood Light Exam

• Clinical Photos

Congenital: angiomas

Capillary vascular malformation

Figure 66-14Senile (cherry) angiomas

Angiomas(port wine, strawberry lessions)

• Benign vascular tumors involving the skin and the subcutaneous tissues

• present at birth

• violet red patches (port wine) to raised bright red nodular lesions (strawberry)

• Strawberry-involute in first few years

• port wine persist

Inflammation: Bacterial

• Impetigo

Cellulitis of the legs

Boils

Viral: Herpes Simplex

Herpes Whitlow

Herpes Zoster

Viral: Herpes Zoster

• Shingles on the forehead

molluscum

Warts

Fungal Infections: Thrush

• Oral Candidiasis (Yeast or Thrush)

Treatment: Fungal

• Hygiene

• pharmaceutical

• prevention of re infection or spread

Tinea pedis and

tinea unguium

Athlete's Foot

Mould Infection (aspergillus)

Parasitic Infection

• Pediculosis

Pubic Lice

Pubic lice in the eye

Scabies

Cradle Cap (Seborrheic)

Dermatitis: eczema

Psoriasis

Corticosteriods

• Steroids are absorbed at different rates from different parts of the body. A steroid that works on the face may not work on the palm. Conversely, a steroid which works well on the palms may cause side effects on the face.

Topical Absorption

• For example: Forearm absorbs 1%

Armpit absorbs 4%

Face absorbs 7%

Eyelids and genitals absorb 30%

Palm absorbs 0.1%

Sole absorbs 0.05%

Long term effects of Cortical Steroid use

Skin Impairment: Obstruction

• Acne

Pressure Ulcers

• Tissue damage

• skin and underlying soft tissue compressed between bone and external surface

• Over a period of time

• Sacrum, hip, ankles, any body part

• Ischemia-infarction-necrosis

Clients At Risk

• Unable to feel

• Unable to communicate

• Limited mobility

• Can’t change position

• Friction and shear

Pressure Ulcer Prevention

Prevention

Pressure Ulcer Prevention

Prevention

Assessment

Observation

Movement

Turning

positioning

Avoid Moisture

Avoid soap

No massage

Nutrition

Friction and Shear

Mental Status

Pressure Ulcer tx &mx

TX and MX

Moist, cleanse, dressing

Diet; fluid Mattress; room humidifyer

Debridment Lift with a lift sheet

Infection prevention

Burns

• Causes: dry; moist; contact; chemical; electrical; radiation

Burns:

• Rule of 9’s

Burns: the Lund MethodAge (Years) • Area 0-1 1-4 5-9 10-15

• Head 19 17 13 10

• Neck 2 2 2 2

• Anterior trunk 13 13 13 13

• Posterior trunk 13 13 13 13

• Buttock 5 5 5 5

• Genitalia 1 1 1 1

• Arm 4 4 4 4

• Forearm 3 3 3 3

• Hand 2½ 2½ 2½ 2½

• Thigh 5½ 6½ 8½ 8½

• Leg 5 5 5½ 6

• Foot 3½ 3½ 3½ 3½

Depth of Burn

• Traditionally 1st, 2nd, 3rd

• More accurate to describe the level burned:

• Superficial

• Partial thickness

• full thickness

• subdermal

Classification

• <25% = local response

• >25% = local + systemic response

Burns:

• Rule of 9’s

How burns heal

Compensatory Respones

• Inflammatory

• Sympathetic Nervous System

Figure 68-8The physiologic actions of the sympathetic nervous system compensatory responses to burn injury (early phase)

Consequences of Burns

• Cardiac Changes

• Pulmonary Changes

• Gastrointestinal Changes

• Metabolic Changes

• Immunologic Changes

Nursing Interventions

• Impaired skin integrity

• Risk for infection

• Imbalanced nutrition

• Impaired physical mobility

• Disturbed body image

Collaborative problems

• Grieving

• Family coping

• Self-care deficits

• Sexual dysfunction

• Disturbed sleep pattern

• Social isolation

• Potential for pneumonia; septicemia