Presentation on theme: "INTEGUMENTARYSYSTEM PN 124 BACTERIAL AND FUNGAL INFECTIONS."— Presentation transcript:
INTEGUMENTARYSYSTEM PN 124 BACTERIAL AND FUNGAL INFECTIONS
Objectives Discuss s/s of 8 infectious disorders of the skin; bacterial and fungal Define the nursing management of the client with infectious disorders of the skin Discuss common diagnostic tests used as diagnostic tools for integumentary disorders
CELLULITIS, Bacterial infection Etiology/Pathophysiology -infection is potentially serious. -infection is potentially serious. -not contagious -not contagious -can be spread by direct contact with an -can be spread by direct contact with an open area from a person that has an open area from a person that has an infection. infection. -causes in adults: group A streptococci -causes in adults: group A streptococci and Staphylococcus aureus. and Staphylococcus aureus.
CELLULITIS -Hemophilus influenzae type B is more common in -Hemophilus influenzae type B is more common in children. children. -increase the risk for cellulitis: -increase the risk for cellulitis: -venous insufficiency or stasis -diabetes mellitus -lymph edema -surgery -malnutrition -substance abuse -treatment with steroids or cancer chemotherapy
RISKS FOR CELLULITIS - presence of another infection - presence of another infection - compromised immune function due to - compromised immune function due to human immunodeficiency virus (HIV) human immunodeficiency virus (HIV) - autoimmune diseases, such as lupus - autoimmune diseases, such as lupus erythematosus erythematosus
CELLULITIS -Develops as an edematous, erythematous area of skin -Develops as an edematous, erythematous area of skin -hot and tender -hot and tender -bacteria enters through a break in the -bacteria enters through a break in the skin skin -can be from a cut, scratch, insect bite, etc -can be from a cut, scratch, insect bite, etc -common areas are the lower extremities. -common areas are the lower extremities. -usually is a superficial infection -usually is a superficial infection -may spread and become life-threatening -may spread and become life-threatening
CELLULITIS CLINICAL MANIFESTATIONS: -affected areas of the skin/underlying subcutaneous tissues -erythematous, tender, warm, edematous. -fever
CELLULITIS -s/s are caused by the bacteria, and the body’s attempts to stop the infection. -skin appears pitted, like an orange peel. -area of redness spreads and small red spots appear -vesicles may form and burst
CELLULITIS -nearby lymph nodes may become enlarged and tender. (lymphadenitis) -nearby lymph nodes may become enlarged and tender. (lymphadenitis) -edema secondary to the infected area occludes the lymphatic vessels in the skin. -edema secondary to the infected area occludes the lymphatic vessels in the skin. -most patients only feel mildly ill, -most patients only feel mildly ill, - but some have fever, chills, headache, - but some have fever, chills, headache, tachycardia, confusion, hypotension. tachycardia, confusion, hypotension.
ERYSIPELAS A specific acute, inflammatory disease -caused by a beta- hemolytic streptococci -characterized by hot, red, edematous and sharply defined eruptions
ASSESSMENT SUBJECTIVE: - fatigue - tenderness - pain - limited movement of the involved extremity , - feeling of general malaise.
ASSESSMENT OBJECTIVE: -Inspection of the skin - erythema - edema - areas that are warm to the touch. -Vesicles may be present. -Elevated temperature. -Tachycardia -Leukocytosis.
DIAGNOSTIC TESTS Cultures - identifies the causative bacteria -from the blood, purulent exudate, or tissue specimens -Gram stain -determines the appropriate antibiotic therapy. Complete blood count (CBC). Inspection of the area
DIAGNOSTIC TESTS -Tests done to differentiate cellulitis from deep vein thrombosis. - ( they both have similar s/s) - X-ray, ultrasound, computed tomography or magnetic resonance imaging (MRI) - determines the extent of inflammation -identifies abscess formations
MEDICAL MANAGEMENT Antibiotic treatment - effect against streptococci and staphylococci - 10 day course -can be either oral or IV depending on severity
Nursing Diagnosis Deficient knowledge, related to the cause and the spread of the disease. Pain related to edema
NURSING INTERVENTIONS -Treat s/s and to prevent the spread of the infection. -Administer the antibiotic -Assess pain; administer an analgesic if necessary -Warm, moist dressings applied to the affected area may relieve discomfort. -Monitor fluid intake and nutritional status.
NURSING INTERVENTIONS -Keep the affected part immobile -Keep the affected part immobile - helps reduce the edema - helps reduce the edema -Stress the importance of taking the entire prescription of antibiotics. -Stress the importance of taking the entire prescription of antibiotics. -Monitor for secondary diseases, such as -Monitor for secondary diseases, such as yeast infections yeast infections
PROGNOSIS Cure is possible with 7-10 days of treatment. Cellulitis may be more severe in people with chronic diseases and those who are susceptible to infection, such as the immunocompromised. Complications: sepsis, meningitis, and lymphangitis.
Bacterial Disorders of the Skin Impetigo contagiosa Etiology/pathophysiology Etiology/pathophysiology Staphylococcus aureus or streptococci, or a mixed bacterial invasion of the skin.Staphylococcus aureus or streptococci, or a mixed bacterial invasion of the skin. Common in children.Common in children.
IMPETIGO Clinical manifestations/assessment Clinical manifestations/assessment Lesions begin as maculesLesions begin as macules - develop into pustule vesicles. - develop into pustule vesicles. Pustules rupturePustules rupture -form honey-colored exudate.-form honey-colored exudate. -under the exudate is smooth, red skin.-under the exudate is smooth, red skin. Affects exposed areasAffects exposed areas -face, hands, arms, and legs.-face, hands, arms, and legs. Highly contagious—Highly contagious— -direct or indirect contact-direct or indirect contact Low-grade fever; leukocytosisLow-grade fever; leukocytosis t
Nursing assessment SUBJECTIVE DATA: -Ask about pruritis. -Ask about pain and malaise. -Ask about the spreading of the disease to different body parts -Ask about other diseases present.
IMPETIGO OBJECTIVE DATA: -Focal erythema. -Pruritic areas. -Honey-colored crust over dried lesions. -Smooth, red skin under the crust. -Low-grade fever. -Leukocytosis. -Positive culture for streptococcus or staphylococcus aureus. -Purulent exudate.
Diagnostic Tests -Culture of exudate from lesions Medical management -Antiseptic soap (Betadine of Hibiclens) to remove crusted exudate and clean area -Topical cream, ointment or lotion -Antibiotics, oral or IV (Penicillin) -Keep area clean and dry
Folliculitis, furuncles, carbuncles, and felons Folliculitis, furuncles, carbuncles, and felons Etiology/pathophysiology Etiology/pathophysiology FolliculitisFolliculitis Infected hair follicle (generally from Staphylococcus aureus). Infected hair follicle (generally from Staphylococcus aureus). Furuncle (boil)Furuncle (boil) Infection deep in hair follicle; involves surrounding tissue. Infection deep in hair follicle; involves surrounding tissue. CarbuncleCarbuncle Cluster of furuncles. Cluster of furuncles. FelonsFelons Infected soft tissue under and around an area. Infected soft tissue under and around an area.
Folliculitis, furuncles, carbuncles, and felons Clinical manifestations/assessment Clinical manifestations/assessment -Pustule-Pustule -Edema-Edema -Erythema-Erythema -Pain-Pain -Pruritus-Pruritus -Shiny, point up-Shiny, point up Carbuncle-the center will turn yellow.Carbuncle-the center will turn yellow.
ASSESSMENT SUBJECTIVE: -patient’s symptoms. -family history of diabetes mellitus. -wearing of improperly fitting clothes.
ASSESSMENT OBJECTIVE: -erythema an -edema of the involved area. -often overweight -may use poor body hygiene practices.
NURSING DIAGNOSES Impaired skin integrity, related to exudate from wound Pain, related to edema
DIAGNOSTIC TESTS Diagnostic tests Physical examPhysical exam Culture of drainageCulture of drainage Health historyHealth history
MEDICAL MANAGEMENT -Goal - prevent the spread of the infection. -Patients in the hospital are isolated - using wound and secretion precautions.
Folliculitis, furuncles carbuncles and felons Medical management/nursing interventions Medical management/nursing interventions -Warm soaks 2-3 times per day -promote suppuration -promote suppuration -Once the lesion ruptures, -Once the lesion ruptures, -hot soaks are discontinued -hot soaks are discontinued -prevents damage to the surrounding skin -prevents damage to the surrounding skin and the spread of infection. and the spread of infection.
-medical asepsis. -medical asepsis. -topical antibiotic cream or ointment -topical antibiotic cream or ointment -surgical incision and drainage -surgical incision and drainage -immobilize affected area to prevent pain -elevate affected area to decrease the -elevate affected area to decrease the edema. edema.
PATIENT TEACHING -Patient should not touch the exudate. -Meticulous hand washing -BEFORE and AFTER contact with the lesions. -Hygiene practices should be -Hygiene practices should be demonstrated and return demonstrations demonstrated and return demonstrations done by the family and the patient. done by the family and the patient.
-Whole family needs individual toilet items and bath linens -bacteriostatic soap and shampoo. -Demonstrate proper disposal of contaminated articles. contaminated articles.
FUNGAL INFECTIONS OF THE SKIN
FUNGAL INFECTIONS -Dermatophytoses -Superficial infections of the skin. -Common types are: -tinea capitis -tinea corporis -tinea cruris -tinea pedis
TINEA CORPORIS -Ringworm of the body. -Body parts that have little or no hair.
TINEA CRURIS -Jock itch. -Found in the groin area.
TINEA PEDIS -Most common of all fungal infections. -Athlete’s foot. -Between the toes of -Between the toes of people whose feet people whose feet perspire heavily. perspire heavily. -Contaminated swimming pools and public bathroom facilities
SIGNS AND SYMPTOMS TINEA CAPITIS: -erythematous. -round lesion with pustules around the edges -temporary alopecia -infected hairs will turn blue-green under a Wood’s light.
SIGNS AND SYMPTOMS -TINEA CORPORIS: -TINEA CORPORIS: -flat lesions that are clear in the center with erythematous borders. -flat lesions that are clear in the center with erythematous borders. -scaliness -scaliness -pruritis is severe. -pruritis is severe.
SIGNS AND SYMPTOMS 3. TINEA CRURIS: Has brownish-red lesions that migrate out from the groin area. Pruritis is a symptom. Scratching is done to relieve the itching. As a result, skin excoriation is present.
SIGNS AND SYMPTOMS 4. TINEA PEDIS: This fungal infection produces more skin maceration than the others. Fissures and vesicles are commonly seen around and below the toes, with occasional discoloration of the infected area.
ASSESSMENT SUBJECTIVE DATA: -extreme itching -extreme itching -tenderness from excoriation of the area -tenderness from excoriation of the area
ASSESSMENT OBJECTIVE DATA: -TINEA CAPITIS: -TINEA CAPITIS: -inspection -inspection -round, scaled lesion -round, scaled lesion -purulent vesicles around the edges of -purulent vesicles around the edges of the scalp. the scalp. -erythema -erythema alopecia to the surrounding area alopecia to the surrounding area
ASSESSMENT OBJECTIVE DATA: -TINEA CORPORIS: -TINEA CORPORIS: -flat lesions with clear centers and red borders -flat lesions with clear centers and red borders on non-hairy body parts. on non-hairy body parts.
ASSESSMENT TINEA CRURIS: -groin-brown to red lesions that spread outward. -groin-brown to red lesions that spread outward. -skin excoriation from scratching. -skin excoriation from scratching. TINEA PEDIS: -fissures between the toes and soft skin. -fissures between the toes and soft skin. -vesicular lesions -vesicular lesions -thick toenails. -thick toenails.
DIAGNOSTIC TESTS -visual inspection. -Wood’s lamp-diagnose tinea capitis. -thorough health history
MEDICAL MANAGEMENT -topical or oral antifungal agents. -topical or oral antifungal agents. -Griseofulvin (oral) -Griseofulvin (oral) -topical drugs do not penetrate the hair -topical drugs do not penetrate the hair bulb bulb -antifungal soaps and shampoos -antifungal soaps and shampoos
Antifungal agents-Tinactin, Lotrimin, or Desenex -2-6 weeks. See AHN p. 77. for a list of drugs that are used.
NURSING DIAGNOSES Impaired skin integrity, related to increased moisture and pruritis
NURSING INTERVENTIONS -Protect the involved area from trauma and irritation -Protect the involved area from trauma and irritation -keep the area clean and dry. -keep the area clean and dry. -Apply medications -Apply medications -warm compresses -warm compresses -Tinea pedis -Tinea pedis -warm soaks (usually Burrow’s solution) -warm soaks (usually Burrow’s solution) -topical antifungal agents. -topical antifungal agents.
NURSING INTERVENTIONS -Clean and dry the feet thoroughly -Clean and dry the feet thoroughly -completely dry the toes -completely dry the toes -Wear sandal-like shoes/go barefoot -Wear sandal-like shoes/go barefoot -prevents moisture in the toes -prevents moisture in the toes -Footwear needs to be of an absorbent material -Footwear needs to be of an absorbent material -socks, stockings, etc. -socks, stockings, etc. -Wear loose-fitting clothing. -Wear loose-fitting clothing.
TEACHING 1. Teach proper skin care and comfort measures to relieve itching. 2. The nurse needs to review the meds. and procedures to be done at home by the pt. 3. The nurse should remind the pt. that it may take months for fungal disorders to be cured. 4. Clarify any misconceptions about athlete’s foot. 5. Teach the pt. the process of this disease.
PARASITIC DISEASES OF THE SKIN Pediculosis Etiology/pathophysiology Etiology/pathophysiology -Lice infestation -Lice infestation
Pediculosis Three types of lice -Head lice (capitis) -Head lice (capitis) -Attaches to the hair shaft and lays eggs -Attaches to the hair shaft and lays eggs -Body lice (corpis) -Body lice (corpis) -Found around the neck, waist, and thighs -Found around the neck, waist, and thighs -Found in seams of clothing -Found in seams of clothing -Pubic lice (crabs) -Pubic lice (crabs) - Looks like a crab with pinchers - Looks like a crab with pinchers - Found in pubic areas - Found in pubic areas
Pediculosis Medical management/nursing intervention -Lindane (Kwell); Pyrethrins (RID) -Cool compresses -Corticosteroid ointment -Assess all contacts -Wash linens and clothes in hot water -Properly clean furniture or non-washable materials
Scabies Etiology/Pathophysiology -Sarcoptes scabiei -Sarcoptes scabiei (itch mite) -Mites lay eggs under the skin -Transmitted by prolonged contact with infected area
Scabies Clinical manifestations/assessment -Wavy, brown, threadlike lines on the body -Pruritis -Excoriation
Scabies Diagnostic tests -Microscopic examination of infected skin -Scratch test Medical management/nursing interventions -Lindane (Kwell), Pyrethrins (RID), Crotamiton (Eurax), 4-8% solution of sulfur in petrolatum -Treat all family members -Wash linens and clothing in hot water