1. INTEGUMENTARY SYSTEM PN 124 BACTERIAL AND FUNGAL INFECTIONS

2. 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

3. CELLULITIS, Bacterial infection
Etiology/Pathophysiology
-infection is potentially serious.
-not contagious
-can be spread by direct contact with an
open area from a person that has an
infection.
-causes in adults: group A streptococci
and Staphylococcus aureus.

4. CELLULITIS -Hemophilus influenzae type B is more common in children.
-increase the risk for cellulitis:
-venous insufficiency or stasis
-diabetes mellitus
-lymph edema
-surgery
-malnutrition
-substance abuse
-treatment with steroids or cancer chemotherapy

5. RISKS FOR CELLULITIS - presence of another infection
- compromised immune function due to
human immunodeficiency virus (HIV)
- autoimmune diseases, such as lupus
erythematosus

6. CELLULITIS -Develops as an edematous, erythematous area of skin
-hot and tender
-bacteria enters through a break in the
skin
-can be from a cut, scratch, insect bite, etc
-common areas are the lower extremities.
-usually is a superficial infection
-may spread and become life-threatening

8. CELLULITIS

9. CELLULITIS CLINICAL MANIFESTATIONS:
-affected areas of the skin/underlying
subcutaneous tissues
-erythematous, tender, warm,
edematous.
-fever

11. 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

12. CELLULITIS
-nearby lymph nodes may become enlarged and tender. (lymphadenitis)
-edema secondary to the infected area occludes the lymphatic vessels in the skin.
-most patients only feel mildly ill,
- but some have fever, chills, headache,
tachycardia, confusion, hypotension.

13. ERYSIPELAS A specific acute, inflammatory disease
-caused by a beta- hemolytic streptococci
-characterized by hot, red, edematous
and sharply defined eruptions

15. ASSESSMENT SUBJECTIVE: - fatigue - tenderness - pain
- limited movement of the involved
extremity
, - feeling of general malaise.

16. ASSESSMENT OBJECTIVE: -Inspection of the skin - erythema - edema
- areas that are warm to the touch.
-Vesicles may be present.
-Elevated temperature.
-Tachycardia
-Leukocytosis.

17. 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

18. 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

19. MEDICAL MANAGEMENT Antibiotic treatment
- effect against streptococci and
staphylococci
- 10 day course
-can be either oral or IV depending on
severity

20. Nursing Diagnosis
Deficient knowledge, related to the cause and the spread of the disease.
Pain related to edema

21. 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.

22. NURSING INTERVENTIONS
-Keep the affected part immobile - helps reduce the edema -Stress the importance of taking the entire prescription of antibiotics. -Monitor for secondary diseases, such as yeast infections

23. 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.

24. Bacterial Disorders of the Skin
Impetigo contagiosa
Etiology/pathophysiology
Staphylococcus aureus or streptococci, or a mixed bacterial invasion of the skin.
Common in children.

25. IMPETIGO Clinical manifestations/assessment Lesions begin as macules
- develop into pustule vesicles.
Pustules rupture
-form honey-colored exudate.
-under the exudate is smooth, red skin.
Affects exposed areas
-face, hands, arms, and legs.
Highly contagious—
-direct or indirect contact
Low-grade fever; leukocytosis t

26. 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.

27. 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.

28. Diagnostic Tests Medical management -Culture of exudate from lesions
-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

29. Folliculitis, furuncles, carbuncles, and felons
Etiology/pathophysiology
Folliculitis
Infected hair follicle (generally from Staphylococcus aureus).
Furuncle (boil)
Infection deep in hair follicle; involves surrounding tissue.
Carbuncle
Cluster of furuncles.
Felons
Infected soft tissue under and around an area.

30. Folliculitis, furuncles, carbuncles, and felons
Clinical manifestations/assessment
-Pustule
-Edema
-Erythema
-Pain
-Pruritus
-Shiny, point up
Carbuncle-the center will turn yellow.

31. Folliculitis
Furuncles

32. Carbuncle
Felon

33. ASSESSMENT SUBJECTIVE: -patient’s symptoms.
-family history of diabetes mellitus.
-wearing of improperly fitting clothes.

34. ASSESSMENT OBJECTIVE: -erythema an -edema of the involved area.
-often overweight
-may use poor body hygiene practices.

35. NURSING DIAGNOSES
Impaired skin integrity, related to exudate from wound
Pain, related to edema

36. DIAGNOSTIC TESTS Diagnostic tests Physical exam Culture of drainage
Health history

37. MEDICAL MANAGEMENT -Goal - prevent the spread of the infection.
-Patients in the hospital are isolated
- using wound and secretion precautions.

38. Folliculitis, furuncles carbuncles and felons
Medical management/nursing interventions
-Warm soaks 2-3 times per day
-promote suppuration
-Once the lesion ruptures,
-hot soaks are discontinued
-prevents damage to the surrounding skin
and the spread of infection.

39. -medical asepsis.
-topical antibiotic cream or ointment
-surgical incision and drainage
-immobilize affected area to prevent pain
-elevate affected area to decrease the
edema.

40. PATIENT TEACHING -Patient should not touch the exudate.
-Meticulous hand washing
-BEFORE and AFTER contact with the
lesions.
-Hygiene practices should be
demonstrated and return demonstrations
done by the family and the patient.

41. -Whole family needs individual toilet
items and bath linens
-bacteriostatic soap and shampoo.
-Demonstrate proper disposal of
contaminated articles.

42. YEAST INFECTIONS

43. FUNGAL INFECTIONS OF THE SKIN

44. FUNGAL INFECTIONS -Dermatophytoses
-Superficial infections of the skin.
-Common types are:
-tinea capitis
-tinea corporis
-tinea cruris
-tinea pedis

45. TINEA CAPITIS

46. TINEA CORPORIS -Ringworm of the body.
-Body parts that have little or no hair.

47. TINEA CORPORIS

48. TINEA CRURIS
-Jock itch.
-Found in the groin area.

49. TINEA PEDIS -Most common of all fungal infections. -Athlete’s foot.
-Between the toes of
people whose feet
perspire heavily.
-Contaminated swimming
pools and public
bathroom facilities

50. 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.

51. SIGNS AND SYMPTOMS -TINEA CORPORIS:
-flat lesions that are clear in the center with erythematous borders.
-scaliness
-pruritis is severe.

52. 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.

53. SIGNS AND SYMPTOMS 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.

54. ASSESSMENT SUBJECTIVE DATA: -extreme itching
-tenderness from excoriation of the area

55. ASSESSMENT OBJECTIVE DATA: -TINEA CAPITIS: -inspection
-round, scaled lesion
-purulent vesicles around the edges of
the scalp.
-erythema
alopecia to the surrounding area

56. ASSESSMENT OBJECTIVE DATA: -TINEA CORPORIS:
-flat lesions with clear centers and red borders
on non-hairy body parts.

57. ASSESSMENT TINEA CRURIS:
-groin-brown to red lesions that spread outward.
-skin excoriation from scratching.
TINEA PEDIS:
-fissures between the toes and soft skin.
-vesicular lesions
-thick toenails.

58. DIAGNOSTIC TESTS -visual inspection.
-Wood’s lamp-diagnose tinea capitis.
-thorough health history

59. MEDICAL MANAGEMENT
-topical or oral antifungal agents.
-Griseofulvin (oral)
-topical drugs do not penetrate the hair
bulb
-antifungal soaps and shampoos

60. Antifungal agents-Tinactin, Lotrimin, or Desenex
-2-6 weeks.
See AHN p. 77. for a list of drugs that are used.

61. NURSING DIAGNOSES
Impaired skin integrity, related to increased moisture and pruritis

62. NURSING INTERVENTIONS
-Protect the involved area from trauma and irritation
-keep the area clean and dry.
-Apply medications
-warm compresses
-Tinea pedis
-warm soaks (usually Burrow’s solution)
-topical antifungal agents.

63. NURSING INTERVENTIONS
-Clean and dry the feet thoroughly
-completely dry the toes
-Wear sandal-like shoes/go barefoot
-prevents moisture in the toes
-Footwear needs to be of an absorbent material
-socks, stockings, etc.
-Wear loose-fitting clothing.

64. 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.

65. FOOT CARE

66. FOOT CARE

67. PARASITIC DISEASES OF THE SKIN
Pediculosis
Etiology/pathophysiology
-Lice infestation

68. Pediculosis Three types of lice -Head lice (capitis)
-Attaches to the hair shaft and lays eggs
-Body lice (corpis)
-Found around the neck, waist, and thighs
-Found in seams of clothing
-Pubic lice (crabs)
-Looks like a crab with pinchers
-Found in pubic areas

69. Pediculosis Clinical manifestations/assessment Diagnostic tests
-Nits and/or lice on involved area
-Pinpoint raised, red macules
-Pinpoint hemorrhages
-Severe pruritis
-Excoriation
Diagnostic tests
-Physical exam

70. 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

71. Scabies

72. Scabies Etiology/Pathophysiology -Sarcoptes scabiei (itch mite)
-Mites lay eggs under the skin
-Transmitted by prolonged contact with
infected area

73. Scabies Clinical manifestations/assessment
-Wavy, brown, threadlike lines on the
body
-Pruritis
-Excoriation

74. 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