Chapter:

Case Study, Chapter 61, Management of Patients With Dermatologic Problems 1. Mark Penn, a 25-year-old patient, is diagnosed with psoriasis. He presents with multiple lesions of red, raised patches of skin covered with silver scales on the back, elbows, and legs. He has flaky skin lesions of the scalp, and large chunks of skin with hair are flaked off while skin with hair lies beneath the surface of the flaking lesions. There are several small lesions on the forehead and cheeks. The fingernail beds are discolored a brownish-yellow, pitted, and the edges are separating and breaking off the nail plate. The patient reports that it is embarrassing to wear shorts because people stare, talk among themselves, and avoid him. He states that he wants to wear a sign that states, I have a face; you can talk to me. The patient states that the lesions are itchy and he scratches them at times, making the lesions bleed so he ends up with blood spots on his sheets or clothing. The physician orders the patient to use Dermarest Psoriasis Medicated Shampoo Plus Conditioner, which contains 3% salicylic acid, daily and keep the hair short so the sun may penetrate the scalp. The patient is instructed to soak daily in the bathtub using Aveeno Oilated Oatmeal Bath, scrub lightly with a soft bath brush, and pat the skin dry. After the bath, the patient should apply Lac-Hydrin lotion to the skin to help soften the thick scales. At nighttime, the patient should apply calcipotriene (Dovonex) lightly to the affected areas and rub it into the skin; then he should wash his hands with soap and water. The patient should keep his nails trimmed and soak in a bowl of warm water with three capfuls of tar bath oil for 20 minutes. After soaking, pat the hands dry, apply a tar moisturizer into each nail, and apply cotton gloves that should be kept on during sleep. The patient is instructed not to use the calcipotriene to the facial lesions. Instead, the patient should use the Lac-Hydrin lotion. The patient is encouraged to use sun exposure to the affected areas and observe for burning. If the skin becomes pink, apply a sunscreen with a SPF of 15 or higher to prevent sunburn. (Learning Objective 3) a. What is the rationale of the treatments ordered?

b. What nursing care should be provided for the patient?2. Edna Jones, a 56-year-old patient, is admitted to the burn unit with the diagnosis of toxic epidermal necrolysis. The patient developed the rapid onset of skin erythema and mucous membranes with large sheets of epidermis being shed, leaving the dermis exposed and painful. There are several painful lesions in her mouth. Her fingernails and toenails fell off as the skin sloughed. The patient had received a sulfonamide and had this reaction. The sulfonamide has been discontinued. (Learning Objective 4)a. What assessment should the nurse conduct?

b. What nursing interventions should the nurse provide?