Nursing Management of Patients with Dermatologic Problems

Objectives

• Describe the manifestations and management of abnormal skin conditions.

Key Concepts

• Therapy Goals: Control disorder, allow skin to repair.
• Risk Factors: Loss of skin barrier increases infection risk.
• Contagious Conditions: Require isolation.
• Nursing Diagnoses: Impaired skin integrity, disturbed body image.

Conditions and Management

Contact Dermatitis

• Cause: Reaction to physical, chemical, or biological agents (e.g., soaps, detergents).
• Symptoms: Itching, burning, erythema, edema, vesicles.
• Treatment: Remove irritant, cool compresses, unscented lotions, corticosteroids.

Seborrheic Dermatitis

• Location: Sebaceous gland areas (e.g., face, scalp).
• Forms: Oily (greasy, yellow-red), Dry (powdery scales).
• Treatment: Glucocorticoid cream, UV therapy, antiscorporic shampoos.

Viral Skin Infections (Herpes Zoster/Shingles)

• Cause: Reactivation of Varicella-zoster virus.
• Symptoms: Painful vesicular eruption along nerves.
• Treatment: Antivirals (acyclovir), corticosteroids for complications.

Tinea (Ringworm)

• Location: Body, groin, feet, nails.
• Symptoms: Red ring-like macules, scaling.
• Treatment: Topical antifungals, soaking in vinegar solution.

Scabies

• Cause: Infestation by itch mite.
• Symptoms: Severe itching, burrows.
• Treatment: Scabicide after bath, treating all contacts.

Psoriasis

• Cause: Hereditary defect, overproduction of keratin.
• Triggers: Stress, infection, hormonal changes.
• Symptoms: Red patches with silvery scales.
• Treatment: Baths, UV therapy, corticosteroids.

Exfoliative Dermatitis

• Symptoms: Generalized erythema, scaling, fever.
• Management: Balance fluid/electrolytes, prevent infection.

Blistering Disorders (Pemphigus, Bullous Pemphigoid)

• Cause: Autoimmune conditions.
• Symptoms: Painful blisters, lesions.
• Treatment: Corticosteroids, immunosuppressives, plasmapheresis.

Toxic Epidermal Necrolysis/Steven-Johnson Syndrome

• Trigger: Medication reaction.
• Symptoms: Erythema, ulcers, epidermal shedding.
• Treatment: Stop medication, manage pain, prevent infection.

Skin Cancer

Risk Factors

• Light skin, chronic sun exposure, chemical exposure.

Prevention

• Avoid sun, use sunscreen (SPF 15+), protective clothing.
• Perform self-examinations (ABCD of moles).

Types of Skin Cancer

• Basal Cell Carcinoma: Waxy nodules, pearly borders.
• Squamous Cell Carcinoma: Scaly tumor, potential metastasis.

Treatments

• Surgical: Mohs micrographic surgery, electrosurgery, cryosurgery.
• Radiation: Reserved for elderly, vital areas.

Nursing Management

• Self-care education, wound care, prevention focus.

Medications

Corticosteroids

• Use: Anti-inflammatory, antipyretic effects.
• Application: Sparingly, thoroughly.
• Side Effects: Skin thinning, hyperglycemia, immunosuppression.

Body Jewelry

• Risk of impaired skin integrity, infection.
• Can interfere with medical imaging.

Review Questions

1. Basal Cell Carcinoma Treatment: Mohs micrographic surgery (precise for eye areas).
2. Topical Corticosteroid Side Effects: Skin atrophy and thinning.
3. Shingles Medication: Antivirals like acyclovir.

Conclusion

• Complete matching activity on Canvas for next class discussion.