Integumentary System – Skin is the largest organ of our body. It acts as a barrier between our internal organs and outside sources, plays role in temperature regulation and have sensory nerve endings. Lets discuss some common skin problems and treatment options.
1. Identify if the skin diseases or disorders that are autoimmune, infectious (define the infectious agent as bacterial, viral, etc), parasitic or other.
A. Furuncle – staphylococcal bacterial infection
B. Herpes simplex & zoster – viral infection
C. Urticaria – allergic reaction to agents such as medications, foods, spores, pollens, or powder.
D. Pediculosis – parasitic infection
E. Atopic dermatitis – associated with heredity, allergy, and emotional stress. Also a possibility of an autoimmune component. May develop viral, bacterial, or fungal skin infections.
F. Impetigo – streptococcal or staphylococcal bacterial infection
G. Decubitus – pressure on bony prominences
H. Seborrhea – hormones and stress. A yeast-like organism makes it worse
I. Malignant Melanoma – virulent skin cancer
J. Candidiasis – fungal infections, mycosis
2. Briefly describe the appearance of each skin problems or disorder listed above.
A. Furuncle: staphylococcal infection of folliculitis leads to furuncle, or boil. It starts as a firm, red, tender nodule. Then after few days, it may drain pus and exudate at the core, which is a dead tissue.
B. Herpes Simplex & zoster: appears as fluid filled blisters, red sores on genitals and inner thighs.
C. Urticaria: sudden appearance of edematous elevated pink areas. Wheals may itch and burn.
D. Pediculosis: lice and nits feeding on head, body and pubic scalps.
E. Atopic Dermatitis: red, small vesicles. It may burst and ooze, forming crusts.
F. Impetigo: vesicles that ooze a clear exudate, and develops a golden-yellow crust.
G. Decubitus: appears red in the beginning, it turns purple and darker as it gets worse.
H. Seborrhea: large scales or cheese-like plugs on the skin.
I. Malignant Melanoma: darkly pigmented.
J. Candidiasis: a whitish or whitish-gray or cottage cheese-like discharge, often with a curd-like appearance
3. List treatment modalities usually ordered for these skin conditions (include medications for the skin problems)
A. Furuncle: wear clean gloves, apply warm wet dressings or soaks to localize it. May be incised and drained, and after that only antibiotic topical agent needs to be applied.
B. Herpes Simplex & zoster: antiviral medications include Acyclovir (Zovirax), Famciclovir (Famvir) and Valacyclovir (Valtrex). There are also topical antiviral cream Penciclovir (Denavir) and an over-the-counter cream, docosanol (Abreva).
C. Urticaria: treat mild reactions with cold compress, tepid colloidal-oatmeal or baking soda baths. Antipruritic lotion is calamine. In severe cases, epinephrine might need to be administered.
D. Pediculosis: best treated with over the counter preparations such as permethrin and pyrethrins (RID). Apply them for 5 to 10 minutes and then rise them off with water. Then remove nits by combing the hair.
E. Atopic Dermatitis: apply moisturizing creams, corticosteroid ointments, tar solutions, or wet dressings to inflamed skin or using starch baths.
F. Impetigo: treated with systemic antibiotics such as dicloxacillin. Daily bathing with antibacterial soap or chlorhexadine may help remove the crusts.
G. Decubitus: relieve the pressure and debridement of necrotic tissue.
H. Seborrhea: frequent shampooing that contain selenium sulfide is the main treatment. Others may include zinc pyrithione, coal tar, salicylic acid and sulfar.
I. Malignant Melanoma: wide excision of the primary lesion. Dacarbazine (DTIC) as a chemotherapeutic drug.
J. Candidiasis: swishing of an antifungal agent nystatin around in the mouth can treat thrush. Over the counter remedies include miconazole, tioconazole, and clotrimazole.
4. List common nursing interventions (does not include the treatment modalities listed already)
A. Furuncle: Advice patient to take special precaution with furuncle on the face as it can drain directly into the cranial venous sinuses.
B. Herpes Simplex & zoster: wear cotton undergarment and avoid tight fitting clothes because restricting the air circulation can slow the healing of lesions.
C. Urticaria: observe for life-threatening angioedema signs such as extreme swelling of the lips, swelling around the eyes and dyspnea.
D. Pediculosis: treat everyone in the family and close contacts at the same time. Wash clothes and lines in hot laundry water.
E. Atopic Dermatitis: avoid contact with wools and use lanolin-free lotions.
F. Impetigo: teach patient to avoid touching the crusts and exudate to prevent infection transmission.
G. Decubitus: diet should be rich in protein and the patient may need to be turned and reposition every two hour if bedridden.
H. Seborrhea: low-fat diet, exercises, sunlight and stress reduction needs to be encouraged.
I. Malignant Melanoma: patient should avoid bright sunlight, especially midday or topical sun, during 10am to 3pm. Use SPF of at least 15.
J. Candidiasis: All objects put into a child’s mouth should be sterilized after each use. Women who are breastfeeding should be evaluated for Candida of the breast.
Ehrlich, S. D. (2009, September 30). Herpes simplex virus. University of Maryland Medical Center. Retrieved July 19, 2010, from http://www.umm.edu/altmed/articles/herpes-simplex-000079.htm
Rosdahl, C. B., & Kowalski, M. T. (2008). Textbook of Basic Nursing (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Seborrhea: Health Topics: University of Iowa Health Care. (2005). University of Iowa: Health Care Home. Retrieved July 19, 2010, from http://www.uihealthcare.com/topics/skinhealth/skin4977.html
Stoppler, M. C. (2010, July 15). Candidiasis (Yeast Infection) Symptoms, Signs, and Treatment by eMedicineHealth.com. EMedicineHealth. Retrieved July 20, 2010, from http://www.emedicinehealth.com/candidiasis_yeast_infection/article_em.htm