Medical management for clients w/ dermatitis

• remove the substances causing the reaction
• flush skin w/ cool water
• topical lotions: calamine
• diphenhydramine; cyproheptadine
• moisturizing creams w/ lanolin restore lubrication
• wet dressings w/ astringent solutions
• corticosteroids

Nursing management for clients w/ dermatitis

• wear rubber gloves when coming in contact with any substance such as soap or solvents
• put all clothes through a second rinse cycle when laundering to remove soap residue
• avoid the use of cosmetics or any topical drug or substance until etiology of dermatitis is identified

REVIEW CLIENT AND FAMILY TEACHING 65-1: REDUCING ITCHING W/ DERMATITIS

REVIEW CLIENT AND FAMILY TEACHING 65-1: REDUCING ITCHING W/ DERMATITIS

tends to coincide w/ puberty

• an inflammatory disorder that affects the sebaceous glands and hair follicles
• severity of condition varies from minimal to severe
• sebum, keratin, and bacteria accumulate and dilate hair follicles forming a comedone/blackhead

Acne vulgaris

This client presents w/:

• comedones and pustules on the face, chest and back, where the skin is excessively oily
• oiliness of the scalp often accompanies acne

Acne vulgaris

Medical management for clients w/ acne vulgaris?

• facial cleansing and nonprescription drying agents containing benzoyl peroxide
• topical application of tretinoin and oral administration of isotretinoin
• tetracycline and erythromycin

Women prescribed isotretinoin must have what while on this medication?

• have a negative pregnancy test 2 weeks before use
• practice 2 forms of birth control; adhere to contraceptive measures while taking the drug and for one month after discontinuing therapy
• check w/ primary provider about risks to an infant while breastfeeding

Surgical management for clients w/ acne vulgaris?

• dermabrasion

method for removing surface layers of scarred skin

• outermost areas are removed by sandpaper, a rotating wire brush, chemicals (chemical peels), or diamond wheel
• the client is instructed to avoid washing area until is has healed sufficiently
• client must refrain from picking and touching the area b/c contact w/ the fingers may cause infection or scarring from secondary trauma

• dermabrasion

Nursing management for clients w/ acne vulgaris?

• keep the face and hair clean and avoid cosmetics that contribute to oily skin
• manipulating the lesions worsen the condition
• in women clients, warn clients about the risk of birth defects associated w/ isotretinoin
• keep hair short and away from the face and forehead
• wash hair frequently; daily shampooing does not damage hair
• tell nurse to avoid makeup, lotions, hairsprays, and skin care products no approved by pcp

generally characterized by a rosy appearance

• incurable, but manageable and may progress in severity
• telangiectases: eventually, the facial capillaries and arterioles become chronically dilated w/ spidery appearance, appearing as linear streaks on the skin

Rosacea

this client presents w/:

• frequent, intermittent flushed appearance across the nose, forehead, cheeks, and chin
• triggers: hot beverages, spicy food, alcohol, exposure to sun, wind, or cold; bathing w/ hot water; stress; use of skin care products
• as condition progresses skin remains red, appearing like a sunburn
• inflamed tissue may sting and feel chronically irritated; solid papules and pustules may form
• face appears swollen and baggy, and large facial pores produce a texture resembling an orange
• nose becomes permanently enlarged, red, nodular, and bulbous (rhinophyma)
• eyes may appear inflamed
• client may report that they can't wear contact lens or that eyes feel as if there's a foreign body in them

Rosacea

Medical/surgical management for clients w/ rosacea?

• antibiotics: tetracycline, minocycline, erythromycin
• metronidazole
• topical retinoids
• isotretinoin (remember restrictions!)
• 2-4 laser treatments

Nursing management for clients w/ rosacea?

• maintain a diary, documenting lifestyle practices and triggers
• establish a cause-and-effect relationship b/t foods and beverages so client can avoid in the future
• advise client to minimize skin exposure and use sunscreen spf 15 or higher
• protect skin in cold/windy weather w/ scarf or ski mask and apply skin moisturizer
• pace physical activity to avoid overheating
• review basic skin care regimen that includes washing the face w/ lukewarm water and gentle cleanser; avoid using face cloth; blot skin dry; wait 5-10 minutes after cleansing before applying medication to reduce potential discomfort
• avoid self treatment w/ acne meds, especially those containing benzoyl peroxide b/c they can further irritate the skin
• encourage stress management

a boil

Furuncle

multiple furuncles

Furunculosis

furuncle from which pus drains

carbuncle

This client presents w/:

• lesions that appear anywhere but primarily around the neck, axillary, groin
• raised, painful pustule surrounded by erythema
• areas feel hard to the touch
• after a few days, lesion exudes pus and a core
• client may experience a fever, anorexia, weakness, and malaise

Furuncle

Medical/surgical tx for clients w/ a furuncle?

• hot, wet soaks to localize infection and provide symptomatic relief
• antibiotics
• surgical incision and drainage

Nursing management for clients w/ a furuncle?

• follow strict aseptic technique when applying or changing a dressing to prevent the spread of infection to other parts of the body or to others
• inform client to never pick or squeeze a furuncle
• client should wash hands thoroughly before and after applying topical medications, keep hands away from infected areas, and use face cloths and towels separate from those used by others
• washing clothing, towels, and face cloths in hot water and bleach separately from family laundry

chronic, noninfectious inflammatory disorder of the skin that affects both men and women

• periods of emotional stress, hormonal cycles, infection, and seasonal changes appear to aggravate the condition

• Psoriasis
• ex. plaque psoriasis

this client presents w/:

• patches of erythema covered w/ silvery scales, usually on the extensor surfaces of elbows, knees, trunk, and scalp
• itchy may be absent, slight, or severe
• lesions are obvious and unsightly
• scales tend to shed
• dx'd by visual exam or skin biopsy

• Psoriasis

Medical management for clients w/ psoriasis?

• NO CURE!
• coal tar extract
• corticosteroids
• topical corticosteroids and topical retinoids
• analogs of Vitamin D
• Methotrexate with severe disease that doesn't respond to other forms of therapy
• Photochemotherapy

caused by infestation w/ tiny mites

• anyone can acquire this
• it is erroneous to assume that infected people have poor personal hygiene
• spread by skin-to-skin contact

Scabies

This client presents w/:

• intense itching, especially at night
• commonly affected areas include webs and sides of fingers, around wrists, elbows, elbows, armpits, waist, thighs, genitalia, nipples, breasts, and lower buttocks
• excoriation from scratching accompanies the itching

Scabies

How is scabies dx'd?

• examination using mineral oil or ink
• after dropping sterile mineral oil on lesion, skin is scraped onto a slide and examined microscopically to detect mites, eggs, and feces
• ink test is performed by applying a blue or black-felt tipped pen to the lesion, which highlights the burrows when the skin surface is wiped

Medical management for clients w/ scabies?

• Permethrin cream
• medication is applied to skin in a thin layer, left on for 8-12 hours, and then removed by rinsing
• thorough bathing, clean clothing, and avoidance of contact w/ others who have scabies are essential in preventing reoccurences

Nursing management for clients w/ scabies

• advise thorough bathing
• review directions for applying scabicide medications included w/ product
• compliance is important
• instruct client, after bathing and applying medication, to don clean clothing and launder preworn clothing, towels, and bed linen in hot water asap
• client is told to vacuum furniture and other unwashable items
• EXPLAIN THAT ITCHING MAY CONTINUE FOR 2-3 WEEKS AFTER TREATMENT

Superficial fungal infections

ex. ringworm, athlete's foot, jock itch

Dermatophytoses

parasitic fungi that invade the skin, scalp and nails

• aka tinea

Dermatophytes

This client presents w/:

• rings of papules or vesicles w/a clear center in nonhairy areas of the skin
• several clusters of rings may be found in the same general location
• often itches and becomes red, scaly, cracked, and sore

Tinea corporis

This client presents w/:

• infection that begins between the toes and spreads to the soles of the feet

Tinea pedis

This client presents w/:

• infection that invades the hair shaft below the scalp, followed by breaking of the hair, usually close to the scalp
• common in children

Tinea capitis

Medical treatment for Dermatophytoses

• Tolnaftate
• Miconazole

Nursing management for clients w/ Dermatophytoses

• review directions for use of meds and explain that infected person must use separate towels, washcloths, stresses that keeping the affected areas dry to reduce the spread of infection
• thoroughly dry all areas of body after shower
• avoid excessive heat and humidity
• avoid acquiring or spreading fungal infection of the feet
• advise against sharing towels and slippers or going barefoot in locker rooms or community bathrooms
• KEEP FEET DRY, ESPECIALLY IN-BETWEEN TOES
• for clients that perspire freely, advise applying power between toes, washing and thoroughly drying feet daily
• wear different pairs of shoes daily

skin disorder that develops years after an infection w/ varicella

• more frequent in middle-aged to older adults and clients immunocompromised
• aka shingles

Herpes Zoster

In Herpes Zoster, a viral reactivation produces inflammatory symptoms in this, which is a skin area supplied by the nerve

• raised, fluid filled, and painful skin eruptions accompany the inflammaiton

Dermatome

What is the most serious complication associated w/ herpes zoster?

cerebral vasculitis

• involvement of the internal carotid arteries can result in a stroke

This client presents w/:

• area of skin along a dermatome develops red, blotchy appearance that begins to itch or feel numb
• in about 24-48 hours, vesicles appear on the skin along the nerve's pathway
• eruptions are unilateral on the trunk, neck, or head
• vesicles are extremely painful, severe itching soon follows
• vesicles rupture in a few days and crusts form
• scarring or permanent skin discoloration is possible
• pain (postherpetic neuralgia) and itching persist for months or as long as 2 years or mroe

• Herpes zoster

Medical management for clients w/ herpes zoster

• acyclovir
• corticosteroids
• analgesics
• liquid preparations w/ drying or antipruritic effect are applied to affected area once crusts have fallen off
• immunization

Recommendations regarding shingles vaccine?

• adults who are 60 years old or older should receive a 2 dose immunization of Shingrix vaccines regardless of whether they have had chickenpox or not
• the vaccine reduces the risk and severity of shingles and postherpetic neuralgia

Nursing management for clients w/ herpes zoster?

• a supervisory nurse reassigns nursing personnel who have not had chickenpox to AVOID contact w/ client who has herpes zoster
• instruct clients w/ CRUSTED LESIONS TO AVOID CONTACT W/ IMMUNOCOMPROMISED PEOPLE AND THOSE WHO HAVE NOT HAD CHICKENPOX
• advise that application of cool or warm compresses or warm showers may relieve pain and itching; may be necessary to experiment w/ both to see which one provides the best relief
• nurse recommends that client wear lose clothing and avoid scratching the area
• if oral acyclovir is ordered, the nurse reviews the dose regimen

deadliest form of skin cancer

Melanoma

What should tattooist do to avoid the spread of infection?

• sterilize equipment, including components that hold the needles
• discard ink after each use

an inflammatory nodular lesion that may form as a result of a cellular attack waged against the particles in the tattoo pigment

Granuloma

overgrowth of skin tissue

• seen especially in those w/ darkly pigmented skin

Keloids

what color tattoo ink causes the most dermatologist problems?

• what is recommended prior to obtaining a tattoo w/ this color ink?

• Red
• Patch testing

What is the priority of care following a tattoo?

• preventing infection
• supporting regeneration of tissue
• protecting the skin from concurrent

REVIEW AND FAMILY TEACHING 65-3: CARE AFTER A TATTOO

REVIEW AND FAMILY TEACHING 65-3: CARE AFTER A TATTOO

tattoos interfere w/ the quality of what? and why?

Magnetic Resonance Imaging (MRI) b/c of the interaction of metallic compounds w/i the pigment

• some people have experienced swelling or burning in the area of the tattoo when undergoing an MRI

Techniques for Tattoo Removal

• Laser treatments: only tend to lighten tattoos (often take 5-12 sessions, with a month in between each tx
• Dermabrasion: mechanically abrades the skin layers w/ a sanding disc or wire brush, sometimes leave a scar
• Salabrasion: uses a salt solution solution
• Scarification: skin w/ an acid solution
• Plastic surgery: the surgeon inserts fluid-filled balloons under the skin to stretch it so they can remove the tattooed skin, approximate the wound edges, and retattoo the skin to camouflage the existing tattoo

What are the safest metals for piercings?

• surgical stainless steel
• niobium
• titanium
• solid 14k gold

Site care for oral piercings of the tongue or lip

• keep the mouth clean as possible and should use a soft-bristle toothbrush to avoid additional oral injury
• rinse mouth for 30-60 seconds w/ an antibacterial, alcohol-free mouthwash after eating food until the piercing heals
• substitute an antifungal mouthwash or salt water if a superinfection of candiasis develops from the antibacterial mouthwash

CLIENT AND FAMILY TEACHING 65-4: CARE AFTER A BODY PIERCING

CLIENT AND FAMILY TEACHING 65-4: CARE AFTER A BODY PIERCING

dermatologic condition associated w/ excessive production of secretions from the sebaceous glands

Seborrhea

presents as red areas covered by yellowish, greasy-appearing scales

Seborrheic dermatitis

loose, scaley dead, keratinized epithelium shed from the scalp in clients who may or may not have seborrheic dermatitis

Dandruff

This client presents w/:

• hair is unusually oily
• red or scaly patches on the scalp
• white flakes fall from the hair and become more obvious when they collect on the shoulders of dark clothing
• inflamed areas may itch

Seborrhea, Seborrheic dermatitis, Dandruff

Medical management for clients w/:

Seborrhea, Seborrheic dermatitis, Dandruff

• frequent shampooing w/ or w/o medication to reduce oil in scalp and hair
• effected medicated shampoos contain, tar, zinc pyrithione, selenium sulfide, sulfur, or salicylic acid
• corticosteroids

Nursing management for clients w/:

Seborrhea, Seborrheic dermatitis, Dandruff

• explain underlying cause and review directions and frequency for using medications
• inform clients that disease may recur and that persistent treatment is necessary to control the condition

refers to "baldness"

• affects the hair follicles and results in partial or total hair loss
• client may experience self-consciousness and lose self-confidence

Alopecia

genetically acquired condition

• "male pattern baldness"
• can also affect women to a milder degree
• pattern: loss of hair in lateral frontal areas or over the vertex of the head

Androgenetic alopecia

This client presents w/:

• hair that's thinning and falling out in patches in several areas of the scalp
• fhx of androgenetic baldness
• not associated w/ any other physical health problems

Alopecia

Medical/surgical management for clients w/ Alopecia

• the etiology usually restores hair growth
• minoxidil
• finasteride
• hair grafting

Why is finasteride contraindicated for women?

• it is an androgenic inhibitor

Nursing management for clients w/ Alopecia?

• reassure client that they can cope w/ hair loss
• suggest client consult w/ cosmetologist
• women are advised to opt for loose styling rather than ponytails or braids
• recommend using a conditioner or detangler after shampooing to avoid pulling hair from the head and wide-toothed comb or brush w/ smooth tips

infestation w/ lice

• can infest any hairy parts of the body
• transmitted through direct contact
• cannot survive longer than 24 hours w/o blood
• lice move away quickly from light

Pediculosis

This client presents w/:

• itching of the scalp
• nits cling to hairs close to 1/20 to 1/4 in from the scalp
• dx made by scalp and hair inspection
• removed w/ tweezers or adhesive side of tape

Pediculosis

Medical management for clients w/ pediculosis?

• nonprescription shampoos, gels, and liquids containing pediculicides
• PERMETHRIN
• Nits and live lice are removed mechanically w/ a fine-toothed combing tool such as a LiceMeister

REVIEW CLIENT AND FAMILY TEACHING 65-5: REMOVING NITS AND LICE

REVIEW CLIENT AND FAMILY TEACHING 65-5: REMOVING NITS AND LICE

Nursing management for clients w/ Pediculosis?

• teach school volunteers and parents how to detect and recognize nits and ants
• instruct client/family not to shampoo or rinse w/ conditioner before applying pediculicide
• instruct client to follow label instructions on the pediculicide; leaving the chemical on for longer than 10 minutes or covering the head w/ a shower cap does not increase effectiveness and may increase the potential for toxicity
• do not use pediculicides in women who are pregnant or nursing; are also contraindicated in children younger than 2 years of age and in clients who have conditions such as an open wound, epilepsy, or asthma
• do not use pediculicide or eyebrows, eyelashes, or pets

fungal dermatophyte infection of the fingernails or toenails

• tiny, plantlike parasite that thrives in warm, dark, moist environments
• fungi can spread unchecked from one nail to another

Onychomycosis

This client presents w/:

• nails that appear grossly different than normal
• nails are much thicker, causing them to be elevated and distorted
• yellowed and friable
• may be long and jagged b/c they are difficult to trim
• pressure and friction from thickened toenails can lead to pain b/c shoes do not fit comfortably and socks may wear through

Onychomycosis

Medical management for clients w/ onychomycosis?

• Itraconazole
• terbinafine
• client takes the meds daily for 2 weeks for fingernail infections and 3 weeks for toenail infections
• removal of toenails

Nursing management for clients w/ Onychomycosis

• reinforce condition is chronic and to remain compliant w/ drug therapy for the duration of tx
• explain dosing regimen, side effects that may develop
• instruct clients:

- alternate shoes daily

- purchase leather shoes that promote evaporation

- never go barefoot

- wear footwear at communal pools or when showering in gyms or fitness centers

- avoid any damage to the skin around the nail

ingrown toenail

Onychocryptosis

This client presents w/:

• local pressure from the abnormal nail growth
• redness, swelling, pain that occurs where the nail pierces the adjacent tissue
• corner of the upper nail is embedded in tissue
• purulent drainage and odor
• compensatory gait and postural changes in an effort to relieve pain
• dx'd by physical examination

Onychocryptosis

Medical/surgical management for clients w/ Onychocryptosis

• antibiotic therapy
• hydrogen peroxide
• soak foot in warm water and epsom salt, be sure to dry feet thoroughly
• wedge of cotton may be inserted to lift the corner of the nail
• diabetics and clients w/ pvd are referred to a podiatrist
• for recurrent ingrown nails, surgery may be indicated

Nursing management for clients w/ Onychocryptosis

• explain how to perform foot-soaking regimens and techniques to relieve the pressure around the ingrown nail
• if surgery is performed, the nurse instructs the client on how to change the dressing, the frequency of dressing changes, and signs of infection or compromised circulation to report immediately to pcp
• wear wide shoes and loose socks w/ sufficient room for toes
• use toe nail clippers rather than scissors to trim toenails; nails are trimmed slightly longer than the end of the toes
• keep feet dry and clean
• avoid physical activities that involved sudden stops (basketball), which jams toes into the front of the shoe
• obtain regular foot and nail care from podiatrist if there is a hx of DM2, diminished vision, vascular problems

UV light that detects fungal and bacterial infections

Wood light

examines the cells and fluids that are scraped and put on a glass slide w/ stain for herpes zoster & varicella

Tzanck Smear

diagnostic test for scabies obtained by shaving the top of the lesion placing under microscope w/ immersion oil

Scabies shaving