Dermatologic Disorders in Adult Health for Nursing

Dermatologic Disorders Adult Health I Lecture notes

Pressure Ulcers
Causes
Pressure
Friction
Shear

Identify Risk Factors
Altered mobility
Altered mentation
Decreased sensory perception
Excess moisture
Poor nutrition

Braden Scale
Interventions for Patients at Risk
Use a scoring tool at regular intervals
Document skin condition on admission and daily
Turn and position q2h – use a turning schedule
Use lift sheets or lift devices
Moisturize dry skin
Use mild soaps and warm (not hot) water to bathe

Interventions for Patients at Risk
Heel/elbow protectors
Use moisture barrier creams
Keep linens dry and wrinkle-free
Do not massage over bony prominences
Diet rich in calories, protein, vitamin c, zinc, b vitamins
Use pillows to align properly and elevate limbs off bed
Use pressure-reducing mattress

Wound Assessment
Location
Size (length x width x depth)
Color
Exudate
Odor
Periwound condition
Tunnelling
Undermining
Presence of foreign bodies
Pain
Patient tolerance to procedure

Wound Assessment Documentation Example:
Stage IV sacral wound measuring 3cm x 2.8cm x1.7cm. 2cm tunnel at 5 o’clock. Small amount serous drainage, no odor present. Base of wound 90% granulation tissue, 10% yellow adherent slough tissue at 6 o’clock. Periwound skin intact. Wound irrigated with normal saline and wound filled with calcium alginate dressing and covered with transparent dressing. Patient denied pain, tolerated procedure without complaints. Nancy Nurse, RN.

Stage I
Redness that does not blanch
Skin intact
Stage II
Superficial break in the skin

Stage III
Extends to subcutaneous tissue but not into fascia
Crater-like appearance
Stage IV
Extends down into fascia and possibly bone
Undermining and tunnelling become more common

Transparent Dressings
Useful to prevent shearing and friction wounds or as a secondary dressing
Limited absorption

Hydrocolloid Dressings
Useful for wounds with some exudate
Can be left in place for several days
Can be used as a secondary dressing

Foam Dressings
Highly absorbent
Can be left in place for several days
Calcium Alginate Dressings
Easily applied
Requires secondary dressing
Highly absorbent
Can be left in place for few days at a time
Can be used for autolytic debridement

Hydrogel Dressings
Adds moisture to dry wounds
Can be useful to debride
Can cause maceration if not used properly
Requires secondary dressing
Hydrofiber Dressings
Easily applied and atraumatic
Requires secondary dressing
Highly absorbent
Can be left in place for few days at a time
Can be used for autolytic debridement

Gauze Dressings
Needs frequent changes
Can use with topical agents
Can use to debride
Readily available and cost effective

Wound Vac Therapy
Useful for chronic wounds and wounds preparing for flap/graft surgery

Debridement
Used to remove necrotic tissue

Flap – Graft Surgery Management

Fluidized air bed
Totally off flap surgical site
Drain care
Pain management
Assess site for viability
Monitor for infection
Prevent post-op complications

Cellulitis
Usually caused by Staph or Strep infections
Clinical Manifestations:
Erythema
Edema
Drainage
Pain

Treatment:
Antibiotics – oral or intravenous (reserved for severe cases)
PCNs, Cephalosporins, Quinolones
Herpes Zoster (Shingles)
Caused by reactivation of varicella-zoster virus

Clinical Manifestations:
Malaise
Tingling, pain in area
Unilateral rash along set of dermatomes
Raised cluster of erythematous vesicles

Treatment:
Pain management
Antiviral (ex: Valcyclovir)
Prevention: Zostivax – 60y and older

Psoriasis
Autoimmune disorder where rate of cell division is sped up and plaque formation develops
Clinical Manifestations:
Thickened red plaques with silvery white scales
Usually found bilaterally in elbows, scalp, trunk, knees, outside surfaces of limbs

Psoriasis Treatment:
Topical steroids
Topical tar
Ultraviolet light therapy
Methotrexate
Biologics
Raptiva
Enbrel

Skin Cancer
Health Prevention Strategies
Limit sun exposure between 11:00a – 3;00p
Wear sunscreen
Wear opaque clothing and sunglasses
Examine skin monthly for lesions

Seek medical advice if any of the following:

Asymmetry
Border irregularity
Color changes
Diameter >6mm
Elevation
Treatment
Nonsurgical
Topical 5-FU
Interferon
Radiation
Immunotherapy – experimental
Surgical
Cryosurgery
Excisioncurettage and electrodessication