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Diaper RashDiaper Rash
A case studypresented tothe Faculty of Nursing
Capitol Medical Center Colleges
In partial fulfillmentof the requirementsin NCM-102 Lecture
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I. IntroductionI. IntroductionBackground of the Study
Diaper rash or diaper dermatitis is a general term
describing any of a number of inflammatory skin conditions
that can occur in the diaper area. It is caused by over
hydration of the skin, maceration, prolonged contact with
urine and feces, retained diaper soaps, and topical
preparations
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SymptomsSymptoms
Red, itchy, scaly rash patches in the diaper area
and legs
Redness around the anus and genitalia
Bright red and tender rash and/or spots in the
folds between the thighs and abdomen
Deep red rash with yellowish scales
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Objectives of the studyObjectives of the studyGeneral Objective:
At the end of this case study, the students will be
able to accurately assess signs and symptoms of diaper
rash and will appropriately discuss reduction of risk
factors for diaper rash with other health care providers
and people who are directly taking care of the infants.
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Specific objectives:Students will be able to:
Explain indicators of risk and complications of diaper rash to
their health provider of patients.
Describe the risks of diaper rash complications, including
Intertrigo, psoriasis and the goals of management.
Discuss with patients and families the importance of good
hygiene in the prevention and management of diaper rash.
Develop treatment plans in the context of each patient's life
and environment.
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Theoretical FrameworkTheoretical FrameworkSelf-Care Deficit
Dorothea E. Orem
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Dorothea E. Orem, M.S.N.Ed., D.sc., R.N., was born in 1914 in
Baltimore, Maryland. She began her nursing education at Providence
Hospital School of Nursing in Washington DC. She earned her
Bachelor ofScience in Nursing Education in 1939 and her Master of
Science in Nursing Education in 1945 from the Catholic University of
America. She has received several honorary degrees including a
Doctor ofScience.
Defined Nursing: The act of assisting others in the provision and
management of self-care to maintain/improve human functioning at
home level of effectiveness .
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Identified 3 related concepts:Identified 3 related concepts:Self-care activities an Individual performs
independently throughout life to promote and maintain
personal well-being.
Self Care Agency aquired ability or power to
engage in self-care.Self Care Demand totality of care measures
necessary at specific at specific times
Self Care Requisites defined as the reason for
which self-care is undertaken.
Self-care deficit results when self-care agency
(Individuals ability) is not adequate to meet the known
self-care needs.
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Nursing System nursing interventions needed when Individual
is unable to perform the necessary self-care activities:
Wholly compensatory nurse provides entire self-care for
the client.
Example: care of a new born, care of client recovering from
surgery in a post-anesthesia care unit
Partial compensatory nurse and client perform care;
client can perform selected self-care activities, but also
accepts care done by the nurse for needs the client cannot
meet independently.
Example: Nurse can assist post operative client to ambulate,
Nurse can bring a meal tray for client who can feed himself
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Supportive-educative nurses actions are to help the
client develop/learn their own self-care abilities through
knowledge, support and encouragement.
Example: Nurse guides a mother how to breastfeed her baby,
nurse educates mother in prevention and treatment of diaper
rash
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Self Care
Self-CareAgency
Self-CareDemand
NursingAgency
DEFICIT
R R
R R
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II. Patients Data BaseII. Patients Data Base
Personal data
Patient Baby zelle is a 1 and 1/2
month old, female, single and living inNayon Quezon City. She was born in the
30th of January 2011. She is a Filipino
citizen and a member of Roman Catholic
Church.
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Immunization History:Immunization History:
BCG January 30, 2011
Hepa B1 January 30, 2011
DPT1 March 15, 2011
OPV1 March 15, 2011
Hepa B2 March 15, 2011
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Family HistoryFamily History::Mother Father
Allergies
(-) (-)
Hypertension
(+) (-)
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Mother Father Diabetes Mellitus
(+) (-)
Convulsion
(-) (-)
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Physical ExaminationPhysical Examination
Body Part Normal Finding Actual FindingHead Symmetrical,
normocephalic
Symmetrical,
normocephalic
Clear scalp with hair intact
Hair is black and equally
distributed
Eyes Pinkish conjunctiva
Clear sclera
Symmetrical, pinkish
conjunctiva
Anicteric sclera
Chest Shoulder is at the same
height
Nipples is symmetrically
aligned
Shoulder is at the same
height
Nipple is symmetrically
aligned
Symmetrical chest
expansion
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Body Part Normal Finding Actual Finding
Abdomen No lesions
Flat or rounded
Uniform in colour
Soft and Rounded
No lesions, rashes and no
mass
Neck No inflammation of lymph
nodes
No nodules
No inflammation of lymph
nodes
No mass
Skin Skin is uniform, whitish
pink in colour, no lesions,
moist
Skin is uniform, warm and
moist, fair white in color.
With rashes in buttocks to
genitalia
Extremities No lesion and No edema No lesion and edema
(-) cyanosis
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III. Clinical DiscussionsIII. Clinical Discussions
Anatomy and Physiology
INTEGUMENTARY SYSTEM
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Integumentary System is the organ system that
protects the body from damage, comprising the skin.The integumentary system has a variety of functions;
it may serve to waterproof, cushion, and protect the
deeper tissues, excrete wastes, and regulate
temperature, and is the attachment site for sensory
receptors to detect pain, sensation, pressure, and
temperature. In humans the integumentary system
also provides vitamin D synthesis.
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Epidermis
This is the top layer of skin made up of epithelial cells. It does not
contain blood vessels. Its main function is protection, absorption of
nutrients, and homeostasis. In structure, it consists of a keratinized
stratified squamous epithelium comprising four types of cell:
keratinocytes, melanocytes, Merkel cells, and Langerhans cell. The
major cell of the epidermis is the keratinocyte, which produces
keratin. Keratin is a fibrous protein that aids in protection. The majority of
the skin on the body is keratinized, meaning waterproofed.
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The only skin on the body that is non-
keratinized is the lining of skin on the inside of the
mouth. The epidermis also contains Langerhans
cell, which are formed in the bone marrow and
then migrate to the epidermis. They work in
conjunction with other cells to fight foreign bodies
as part of the body's immune defense system.
Melanocytes create melanin, the substance that
gives skin its colour.
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Dermis
The dermis is the middle layer of skin, composed of
dense irregular connective tissues. Its major parts are collagen
(a protein that adds strength), reticular fibers (thin protein fibers
that add support), and elastic fibers (a protein that adds
flexibility) allowing stretching and conferring flexibility, while also
resisting distortions, wrinkling, and sagging. The dermal layer
provides a site for the endings of blood vessels and nerves. The
dermis has two layers: the papillary layer, which has looseconnective tissue, and the reticular layer, which has dense
connective tissue.
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The papillary layer lies directly beneath the epidermis
and connects to it via papillae (finger-like projections).
Some papillae contain capillaries that nourish the
epidermis; others contain Meissner's corpuscles, sensory
touch receptors.
The reticular layer also contains Pacinian corpuscles,
sensory receptors for deep pressure. This layer contains
sweat glands, lymph vessels, smooth muscle, and hair
follicles and cells that aid in healing.
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Subdermis
It is composed mainly of connective and adipose
tissue. Skin produces associated structures such as
sudoriferous glands and sebaceous glands. Its
physiological functions include insulation, storage of
energy.
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Patterns of
Functioning
Before infection During infection Analysis /
Interpretation
Health
Perception-
Health
Management
Pattern
Health provider
has a good
therapeutic health
management and
seeks for healthconsultation.
Health provider
followed the
doctors order for
her childs
immediaterecovery.
Health provider
has good
management in
developing
condition.
Nutritional-
Metabolic
Pattern
Patient
breastfeeds 7-8
times
Patient still
breastfeeds 7-8
times
Patients nutrition
is still the same
and essential in
the recovery of
her condition.
Activity-
Exercise
Pattern
Patient has
limited activities.
Patient has
limited activities.
The patient is
asleep most of
the time.
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Patterns of
Functioning
Before infection During infection Analysis /
Interpretation
Elimination
Pattern
Patient has three
to four times of
bowel movements
per day
Patient still voids
and eliminates
bowel regularly.
Patients
elimination
pattern was not
affected by his
condition.
Sleep- Rest
Pattern
Patient is asleep
for 12 hours in a
day with three
naps and at nightpatient can go
back to sleep
when she wake
up periodically
Patient sleeps
less than 12
hours and she
could not sleepwell because
she feels
irritated by the
discomfort of
her condition..
Patient is unable
to get enough
sleep in a day
due to discomfort.
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Patterns of
Functioning
Before infection During infection Analysis /
Interpretation
Cognitive-
Perceptual
Pattern
She is attracted
to anything with
color and music
Patient is awake
and attracted to
music
Patients
sensorimotor
becomes more
functional
Self-
Perception
Pattern
She only cries
when she is
hungry or if she
feels sleepy and
uncomfortable.
Her cries and
grimaces show
that she feels
uncomfortable
due to her diaper
rash
Her cries and
grimaces show that
she feels
uncomfortable due
to her diaper rash
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Patterns of
Functioning
Before infection During infection Analysis /
Interpretation
Role-
Relationship
Pattern
Patient has a
good relationship
towards people
and his
significant others.
Patients
relationship to
people around
her was not
affected by her
condition.
Patient maintained
close relationship to
the people around
her.
Values-Belief
Pattern
Patient and her
family attends
mass every
Sunday morning
Patient and her
family still attends
mass every
Sunday morning
Patients family kept
their faith to God
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Pathophysiology
Precipitating: Predisposing:
Environment AgeIrritants
Overhydration of Stratum corneum
And increase skin pH
Disruption of lipid bilayer
Damage of Stratum corneum
Microorganism/Irritants penetrates
And reach Langerhans cells and Epidermis
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Fecal enzymes degrade Stratum corneum
Proteins and disrupt ingetrity
Penetrants interact with the keratinocytes
And fibroblasts
Penetrants stimulate cytokine release
By keratinocytes
Cytokines act on the vasculature of the
Dermis resulting in inflammation
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Drug StudyDrug Study
Generic Name: Zinc OxideBrand Name: Calmoseptine
Classification: Skin protectantDosage: Every change of diaperAction: Skin protectant, soothes irritatingskin
Indication:Protects skin, soothesirritating skin. It works by temporarily
relieving itching and pain. It alsodecreases moisture in the affected skin
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Drug StudyDrug Study
Contraindication:Contraindicated to patient withhypersensitive to drugContraindicated to treat a deep wound orpunctured woundAdverse reaction:Skin: rashes, hives, itching
Nursing Responsibilities:Dont apply to deep woundsRinse at once with cool water if medicationgot into the eyes, nose or mouth.
A Di i Pl i I l i E l i
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Assessment Diagnosis Planning Implementation Evaluation
O:
y Disruptio
n and
rednessof skin
area
y With
rashes
on the
buttocksto
genitalia
Impaired
skin integrity
related to
humidity asevidenced
by rashes on
the buttocks
to genitalia
Short term:
After 8hours of
nursing intervention
health provider willbe able to:
Demonstrate
preventive
measures
verbalize feelings
and ability tomanage situation
Long term:
After 1day of
nursing intervertion
health provider will
be able to:
maintain optimal
nutrition needed for
wound healing and
skin repair
display timely
healing of skin
lesions
y Assess the
etiology
y Periodically
remeasure wound& observe for
complication
y Keep the area
clean and dry to
prevent infection
y
Inspect skin on adaily basis,
describing wound
characteristics
and changes
y Use appropriate
barrier dressing,
skin protective
agent
y Administer
medication as
prescribed
After 8hours of
nursing
intervention
health providerwas able to
demonstrate
preventive
measures and
verbalized
feelings andability to
manage
situation
After 1day of
nursing
intervention
health provider
was able to
maintain
optimal
nutrition and
displayed