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Chapter 65: Caring for Clients with Skin, Hair, and Nail Disorders By: P.K. Williams, RN

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/30 Pg 1034. Chapter 65: Caring for Clients with Skin, Hair, and Nail Disorders By: P.K. Williams, RN. 28 Words to Know 02/30 Pg 1034. Acne vulgaris Alopecia Body piercing

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Chapter 65: Caring for Clients with Skin, Hair, and Nail Disorders By: P.K. Williams, RN

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  1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/30 Pg 1034 Chapter 65: Caring for Clients with Skin, Hair, and Nail Disorders By: P.K. Williams, RN

  2. 28 Words to Know 02/30 Pg 1034 • Acne vulgaris Alopecia Body piercing • Carbuncle Comedone Dermabrasion • Dermatitis Dermatone Erythema • Dermatophytoses Furuncle Furunclosis • Granuloma Herpes Zoster Nits • Onychocryptosis Pediculosis Rosacea • Onychomycosis Rhinophyma Scabies • Shingels Tattoo 02/30 Pg 1034

  3. 15 Learning Objectives • Risks associated with Tattooing & body piercing • Care following tattooing & body piercing • Define & and name two types dermatitis • Factors that lead to acne vulgaris • Describe characteristics of rosacea • Differentiate between furuncle, furunculosis & carbuncle • Appearance & cause of psoriasis • Process for eradicating a skin mite infection using a scabicidal medication • 03/30 Pg 1034

  4. 15 Learning Objectives Cont: 04/30 Pg 1034 • Identify locations where parasitic fungi known as dermatophytes most likely to infect • Characteristics of an outbreak of shingles • Factors that promote skin cancer as well as measures that help prevent it • Two conditions characterized by hair loss, & the etiology for each • The Appearance of head lice & nits & explain how to remove them • Factors that promote fungal infections of the nails • Techniques for preventing onychocryptosis (ingrown

  5. Body Ornamentation: Tattoos05/30 Pg 1035 • Pigmenting the dermal layer of skin with needles containing dye; Select certified tattooist • Tattooing Risks: Allergic reaction; Bloodborne infection; Granuloma; Keloids • Skin Care Following Tattooing: Preventing infection; Supporting tissue regeneration; Protecting skin from further trauma • Tattoo Removal: Laser treatment; Dermabrasion; Salabrasion; Scarification; Plastic surgery

  6. Question 29/30 Pg 1051 Is the following statement true or false? All tattoos must be created by certified tattooists.

  7. Answer 0/30 Pg 1035 False. Tattoos may be applied by anyone – the only regulation for tattoos is by local jurisdictions. Only those certified by the Alliance for Professional Tattooists certify compliance with following FDA infection-control guidelines during tattooing. 07/30 Pg 1035

  8. Body Ornamentation: Body Piercing • Common Locations: Lips; Ear cartilage; Cheeks; Nose; Tongue; Eyebrows; Navel; etc. • Risks: Tissue trauma; Infection; Allergies; Complications during procedure • Site Care Following Body Piercing: Oral, personal hygiene; Avoid cosmetics, skin-drying agents; Wear loose clothing • Removal of Body Piercing Jewelry: Necessary when antibiotics are ineffective against infection; Typically need special jeweler’s tools 08/30 Pg 1036

  9. Skin Disorders: Dermatitis09/30 Pg 1037 • Pathophysiology, Etiology: Different types • Allergic contact; Primary irritant • Assessment Findings: Signs and Symptoms • Blood vessel dilation; Itching; Vesiculation • Diagnostic Findings: Visual examination; Skin patch test • Medical Management: Flushing skin with cool water; Topical lotions; Corticosteroids; Wet dressings • Nursing Management: Review Older Adult & Pharmacy Considerations, 09/30 Pg 1037

  10. Dermatitis 10/30 Pg 1037

  11. Question 11/30 Pg 1037 Is the following statement true or false? There are many different etiologies for dermatitis. 11/30 Pg 1037

  12. Answer 12/30 Pg 1037 False. While many different allergens may result in dermatitis, dermatitis is an allergic reaction to specific substance(s). So while there may be many irritants, the etiology of dermatitis is the allergic reaction. 12/30 Pg 1037

  13. Acne Vulgaris 13/30 Pg 1039 • Pathophysiology, Etiology: Overproduction of sebum • Assessment Findings: Signs and Symptoms • Oily scalp; Comedones • Diagnostic Findings: Visual examination • Medical, Surgical Management: Gentle facial cleansing; Drying agents containing benzoyl peroxide; Topical, oral drugs; Antibiotics; Removal with instruments; Dermabrasion • Nursing Management / Review Pharmacy, 13/30 Pg 1039

  14. Acne Vulgaris 14/30 Pg 1038 Figure 65-4: Acne of (left) the face and (right) the chest

  15. Rosacea***15/30 Pg 1040 • Pathophysiology, Etiology: Helicobacter pylori; Mites (Demodex folliculorum); Telangiectases [Incurable] • Assessment Findings: Signs and Symptoms • Intermittent blushing; Papules, pustules; Facial swelling; Rhinophyma in late stages • Medical, Surgical Management: Oral antibiotics; Topical medications; Pulsed light treatment • Nursing Management Fig: 65-5 Pg 1040 [B]

  16. Furuncles, Furunculosis, Carbuncles***16/30 Pg 1040 • Physiology, Etiology: Skin infections; Diabetes mellitus • Assessment Findings: Signs and Symptoms • Painful pustule surrounded by erythema; Fever; Anorexia; Weakness; Malaise • Diagnostic Findings: C & S of exudate identifies the pathogen • Medical, Surgical Management: Hot wet soaks; Antibiotics; Surgical incision, drainage (I&D) • Nursing Management: strict asepsis 16/30 Pg 1040

  17. Question 17/30 Pg 1041 Is the following statement true or false? Furuncles, furunculosis, and carbuncles are treated with antibiotic therapy. 17/30 Pg 1041

  18. Answer 18/30 Pg 1041 True. Furuncles, furunculosis, and carbuncles are the result of skin infection or diabetes mellitus. A culture and sensitivity lab result indicates the proper antibiotic to use in treatment. 18/30 Pg 1041

  19. Psoriasis***19/30 Pg 1041 • Pathophysiology, Etiology: Likely genetic predisposition; Keratinocytes; Plaque • Assessment Findings: Signs and Symptoms • Erythema with silvery scales; Lesions • Diagnostic Findings: Visual examination; Skin biopsy [exacerbation & remission] • Medical Management: Symptomatic treatment; Drug therapy; Biologic therapy; Photochemotherapy • Nursing Management [incurable] 19 Pg 1041

  20. Figure 65-6 Psoriasis on the elbows • 1 Corticosteroids • 2 Retinoids • 3 Analogs of V D • 4 MethotrexateChemo • 5 Etretinate/ TegisonRA • 6 Vitamin A • 7 Kenacort Injections • Biologic Therapy • 1 Raptiva • 2 Remicade • Both Modify activity of • T Cells, autoimmune • Reduce inflammation & • Hyperplasia • Photochemotherapy, UV • Light & Psoralen Psoriasis***20/30 Pg 1041

  21. Scabies*** 21/30 Pg 1049 • Pathophysiology, Etiology: Itch mite; Spread by skin-to-skin contact(Group environments), daycare, military, boarding schools, College Dorms, Nursing Homes [ linens & clothing] • Assessment Findings: Signs and Symptoms • Itching; Excoriation [ webs & sides of fingers, wrists, elbows, armpits, waist, thighs, genitalia, nipples, breasts, lower buttocks ] • Diagnostic Findings: Visual examination; Ink or mineral oil test • Medical Management: Scabicide application; Thorough bathing, clean clothing, avoiding contact with those infected • Nursing Management / Older Adult Considerations, Lindane,

  22. Dermatophytoses*** 22/30 Pg 1043 • Pathophysiology, Etiology: Tinea: Parasitic fungi; Invade skin, scalp, and nails • Ringworm; Athlete’s foot; Jock itch [No worm] • Assessment Findings: Rings of papules or vesicles; Sore skin • Medical Management: Oral, topical antifungal agents • Nursing Management 22/30 Pg 1043

  23. Shingles*** 23/30 Pg 1044 • Pathophysiology, Etiology: Varicella-zoster virus; Inflammation in dermatome • Assessment Findings: Signs and Symptoms • Fever; Headache; Vesicles; Itching • 3rd Cranial nerve =corneal ulcers • 8th Cranial nerve = cerebral vessels • Vertigo, hearing loss • Medical Management: Oral or topical acyclovir; Corticosteroids • Nursing Management 23/30 Pg 1044

  24. Skin Cancer*** • Pathophysiology, Etiology: Exposure to UV radiation; Low skin melanin[most common form of cancer in in US] [Primary lesions] • Assessment Findings: Signs and Symptoms • New appearance of growth; Change in skin color; Skin lesion; Table 65-2, pg 1046 • Diagnostic Findings: Visual inspection; Biopsy • Medical, Surgical Management: Electrodesiccation; Surgical excision; Cryosurgery; Radiation therapy • Nursing Management 24/30 Pg 1045

  25. Scalp and Hair Disorders: Seborrhea, Seborrheic Dermatitis, Dandruff • Pathophysiology, Etiology: Pityrosporum ovale • Assessment Findings: Signs and Symptoms • Oily hair; Red or scaly patches on scalp; White flakes from hair; Itching • Diagnostic Findings: Laboratory blood work; Skin biopsy • Medical Management: Medicated shampoos; Corticosteroids • Nursing Management 25/30 Pg 1047

  26. Alopecia***26/30 Pg 1048 Fig: 65-1 • Pathophysiology, Etiology: Alopecia areata; Androgenetic alopecia (male pattern baldness) • Assessment Findings: Signs and Symptoms • Thinning hair • Diagnostic Findings: Determined by suspected physical disorder • Medical, Surgical Management: Treating the underlying medical disorder; Drug therapy; Hair replacement surgery; Hair grafting; Scalp reduction; Skin flap transfer • Nursing Management 26/30 Pg 1048 Fig: 65-11

  27. Head Lice*** 27 /30 Pg 1049 • Pathophysiology, Etiology: Transmitted through direct contact • Assessment Findings: Signs and Symptoms • Itching of scalp; Small, yellowish-white ovals (nits) attached to hair shafts; Small grey nymphs; Silvery eggs (nits) attached to hair shafts • Diagnostic Findings: Scalp, hair inspection • Medical Management: Pediculicides; Mechanical removal • Nursing Management • 27 /30 Pg 1049

  28. Nail Disorders: Onychomycosis28/30 Pg 1051 • Pathophysiology, Etiology: Fungal infection • Assessment Findings: Signs and Symptoms • Thick, distorted; Yellow, friable nails • Diagnostic Findings: Visual inspection; Microscopic examination • Medical, Surgical Management: Prolonged systemic drug therapy; Nail removal; Surgery • Nursing Management

  29. Nail Disorders: Onychocryptosis 29/30 Pg 1051 • Pathophysiology, Etiology: Inherited trait; ingrown toenail; Fungal nail infections • Assessment Findings: Signs and Symptoms • Swelling; Pain; Purulent drainage; Odor • Diagnostic Findings: Physical examination • Medical, Surgical Management: Local, systemic antibiotic therapy; Surgery • Nursing Management 29/30 Pg 1051

  30. End of Presentation: By: P.K. Williams, RN pkwilliams@DNI.edu Now!NCLEX 30/30

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