1. Fall 2010 C. Matthews MSN, RN Ignatiavicius references are for 6th ed.
Integumentary System
Fall 2010
C. Matthews MSN, RN
Ignatiavicius references are for 6th ed.

2. RESPONSE TO ALTERED INTEGUMENTARY FUNCTION Unit Outcomes: Upon completion of this unit of study, the student will be able to:
 Safe Effective Care Environment:
1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
2 . Perform thorough dermatological assessment throughout the life span.
Health Promotion and Maintenance:
3. Identify healthy behaviors by the client and family ( screening exams, limiting risk taking behaviors).
Psychosocial Integrity:
4. Discuss psychosocial impact of client’s altered dermatological condition ( acne, burns, rashes, tumors).
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
7. Explain the eight parameters of assessing a lesion.
8. Describe common lesions and rashes utilizing proper terminology.
9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
10. Select nursing diagnoses most likely to be utilized with clients with integumentary problems.
11. Discuss etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.

3. Introduction: Skin in our Culture
Defining ‘beauty’
Language
Costs
Every RN
4. Psychosocial Integrity: Discuss psychosocial impact of client’s altered dermatological condition.
C. Matthews MSN, RN

4. Costs: $$ - Skin care and tx
“skincare market including both mass and prestige to reach $7.2 billion by 2010”
(The US Market for Skin Care Products, 2005)
“In the U.S., 2.5 million pressure ulcers are treated each year in acute care facilities, and the cost of treating these potentially deadly wounds has been estimated at $11 billion a year.” (Groch, 2006)
4. Psychosocial Integrity: Discuss psychosocial impact of client’s altered dermatological condition.
C. Matthews MSN, RN

5. Costs:
“…quadriplegic actor Christopher Reeve died at the age of 52 from complications reportedly associated with an infected pressure ulcer. Once established, these wounds are notoriously hard to treat and are associated with adverse health outcomes and high treatment costs…” (Groch, 2006)
4. Psychosocial Integrity: Discuss psychosocial impact of client’s altered dermatological condition.
C. Matthews MSN, RN

6. Multiple layers within the integumentary system form a wall of protection
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun
exposure, environmental toxins, etc.).
C. Matthews MSN, RN

7. Anatomy review
See illustration – Iggy’s text (6th ed. - page 461 and/or Lilly text (6th ed.) page 864
FYI
C. Matthews MSN, RN

8. Skin Layers C. Matthews MSN, RN
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention
(sun exposure, environmental toxins, etc.).
C. Matthews MSN, RN

9. Functions: Protective Barrier Injury Microbial Invasion
Fluid & Electrolyte Balance
Temperature control
Excretion
Sensation
Vitamin D
Identity
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention.
Psychosocial Integrity: 4. Discuss psychosocial impact of client’s altered dermatological condition.
C. Matthews MSN, RN

10. Topics: Assessment Safety and preventive measures
Nursing Implications for Pharmacologic Management
Nursing Implications for Nonpharmacologic Management
Nursing Implications for Surgical Management
Nursing Management of Clients with Alterations - Integument
C. Matthews MSN, RN

11. KP’s Assessment A. Parameters of General Skin Assessment B. Lesions
C. Cultural/Ethnic variations
D. Diagnostic Testing
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

12. Thorough History Dx & Tx – realm of practice
Difficult due to similarities in lesions and sx
Differential dx requires clues
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

13. Assessment: Subjective Data
Past Medical History
Trauma
Surgery
Prior skin disease
Jaundice
Delayed wound healing
Allergies
Sun exposure
Radiation treatments
Chart page 466
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

14. Assessment: History Medications Prescription OTC Herbals Name
Length of usage
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

15. Assessment: History Surgery Diet Health Practices C/O symptoms
Cosmetic
Biopsy
Diet
Health Practices
Hygiene, products
Sunscreen, SPF
Complementary & alternative medicine
C/O symptoms
Known exposure to carcinogens, chemical irritants, allergens
Family
Alopecia (bald)
Psoriasis
Skin cancer
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
Health Promotion and Maintenance: 3. Identify healthy behaviors by the client and family (screening exams, limiting risk taking behaviors).
C. Matthews MSN, RN

16. Assessment: History Changes Skin condition Hair condition
Nail condition
Mucous membranes
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

17. Assessment Privacy Carefully describe: Document properly
Obvious changes in color and vascularity
Presence or absence of moisture
Edema
Skin Lesions
Skin integrity
Document properly
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

18. Parameters of General Skin Assessment
color, temperature, moisture, elasticity, turgor, texture, and odor.
Wilkinson page
Physiologic Integrity: 7. Explain the parameters of assessing a lesion.
C. Matthews MSN, RN

19. Assessment: Inspection
Consider Cultural and Ethnic variations
Dark skin (Iggy page chart 26-3 page 476)
rates - skin cancer
wrinkles
Difficult to assess flushing; cyanosis; jaundice
Rashes difficult to observe
Pseudofolliculitis
Keloids (page 509)
Mongolian spots
Iggy - Chart 26-3 pg. 476
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

20. Assessment: Inspection
Inspection of hair
Distribution
Texture
Quantity
Inspection of nails
Iggy page ; Wilkinson 370
Grooves
Pitting
Ridges
Curvature
Shape
Malnutrition
Anorexia nervosa
Anxiety
Hygiene
Depression
Hormones
Living conditions
Circulatory status
Chronic disease
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
Physiologic Integrity: 11. Discuss etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.
C. Matthews MSN, RN

21. Lesion Description Configuration Size Annular Metric
Page
Configuration
Annular
“relating to, or forming a ring”
Linear
Concentric rings
Clustered
Diffuse
Effect of pressure
Size
Metric
Shape
Circumscribed
Irregular
Round
Texture
Rough
smooth
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span. Physiologic Integrity: 7. Explain the eight parameters of assessing a lesion. 8. Describe common lesions and rashes utilizing proper terminology
C. Matthews MSN, RN

22. Lesion Description Distribution Asymmetric vs. Symmetric Confluent
Page
Distribution
Asymmetric vs. Symmetric
Confluent
“flowing or coming together; also : run together”
Diffuse
Localized
Solitary
Zosteriform
“resembling shingles”
Satellite
Safe Effective Care Environment: 2.Perform thorough dermatological assessment throughout the life span. Physiologic Integrity: 7. Explain the eight parameters of assessing a lesion. 8. Describe common lesions and rashes utilizing proper terminology
C. Matthews MSN, RN

23. Inspection See slides 129 - 133 at the end of the slide show
See Iggy text illustrations on pages for “primary” and “secondary” lesions

24. Pause for photos
C. Matthews MSN, RN

25. Assessment: Palpation
Table 26-4, page 472
Assessment: Palpation
Edema
Moisture
Temperature
Turgor
Texture
Fever
C-V status
Respiratory status
Hormones
Hydration
Rash/ Lesion
Nutritional status
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

26. Skin problems common in Florida
Skin cancer
Sunburn
Insects
Plants
Water sports
C. Matthews MSN, RN

27. Skin cancer http://www.cdc.gov/cancer/skin/statistics/state.htm
Iggy text, page
C. Matthews MSN, RN

28. Skin cancer - most common cancer!
Risk factors
Fair skin
Blue/green eyes
Blond/red hair
History chronic sun exposure
Family history
Living near the equator
Very high/low altitudes
Working outdoors
Age > 60 (damage is cumulative)
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
Health Promotion and Maintenance: 3. Identify healthy behaviors by the client and family.
C. Matthews MSN, RN

29. Non-melanoma Skin Cancers
Basal Cell Carcinoma
Most common type of skin cancer
Easily treated
Doesn’t metastasize
Middle age to older adults
Symptoms
Small slow growing papule
Semi translucent or “pearly”
Erosion/ulceration of center
Safe Effective Care Environment: 2. Perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

30. Basal Cell Carcinoma Medical Tx Excision Cryosurgery Radiation
Topical chemotherapy
See illustration, page 510
Physiologic Integrity: 8. Describe common lesions and rashes utilizing proper terminology.
C. Matthews MSN, RN

31. Non-Melanoma Skin Cancer
Squamous cell
Less common than BCC
High cure rate with early detection
Can be aggressive, metastasize & be fatal
Common on lips, mouth, face and hands
Pipe, cigar, & cigarette smoking
Symptoms
Firm nodule
Scaling/ulceration
Opaque
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

32. Squamous cell carcinoma
Medical Tx
Excision
Radiation
Moh’s surgery
(see slide #33)
5 FU or methotrexate intralesional
(see slide #34)
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

33. Diagnostic & Surgical Therapy
Simple Excision
Excision
Moh’s micrographic surgery
Microscopically controlled removal of lesion
Removes tissue in thin layers
Can see all margins of specimen
Preserves normal tissue
Produces smallest wound
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
C. Matthews MSN, RN

34. Drug Therapy: Topical Fluorouracil (5-FU)
Selective toxicity for sun damaged cells (cytotoxic)
Indications
Premalignant skin disease (esp. actinic keratosis)
Systemic absorption minimal
It causes painful eroded area within 4 days and must use 1-2 times daily 2-4 weeks.
Healing up to 3 weeks after med stopped
Is photosensitizing - avoid sunlight during treatment
Will look worse before it gets better
Lilley 6th ed. page
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

35. Non-Melanoma Skin Cancers
Actinic Keratosis (AKA Solar keratosis)
Most common precancerous lesion
Premalignant form of squamous cell carcinoma
Symptoms
Hyperkeratotoc papules/plaques on sun exposed areas
Varied appearance
Irregular shape
Flat
Indistinct borders
Overlying scale
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

36. Actinic Keratosis (AKA Solar keratosis)
Medical Tx:
Cryosurgery
(see slide #37)
5 FU
Surgical removal
Retin A
Chemical peels
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

37. Cryosurgery Subfreezing temps for surgery (liquid nitrogen)
Lesion becomes red & swollen, blisters, then scabs; falls off in 1-3 weeks
Minimal scarring
Indications
Genital warts
Seborrheic keratosis
Actinic keratosis
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
C. Matthews MSN, RN

38. Malignant Melanoma 1/3 of all melanoma occur in existing nevi or moles
Any sudden or progressive change in size, color or shape of a mole should be checked
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

39. Malignant Melanoma Can metastasize anywhere
Most deadly of skin cancers
Causes
UV radiation
Skin sensitivity
Genetic
Hormonal
Sun exposure
Mutation of gene (B-RAF) 70%
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
C. Matthews MSN, RN

40. Malignant Melanoma 4 Types occur different areas of body
Superficial Spreading Melanoma (SSM)
Most common type
Most curable
Frequently from preexisting moles
Lentigo Maligna Melanoma (LMM)
Acrallentiginous melanoma (ALM)
Nodular melanoma (NM)
C. Matthews MSN, RN

41. A B C D’s of Melanoma Asymmetry Border irregular, edges ragged
Color varied pigmentation
Tan, brown, black, red
Diameter > 6mm

42. Melanoma
Medical Tx
Depends on site, stage, age and general health of client
Surgery
Chemotherapy
Biologic Therapy
Interferon, interleukin
Radiation therapy
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
C. Matthews MSN, RN

43. Pause for Photos

44. Prevention/Education
Sunscreen
Limit exposure
Hat/clothes/sunglasses
Shade
Inspect skin regularly
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
Health Promotion and Maintenance: 3. Identify healthy behaviors by the client and family.
C. Matthews MSN, RN

45. Sunburn: Education (Protect, Protect, Protect)
Same precautions as for skin cancer.
Don’t let clouds or cool air fool you – Florida sun is damaging then too.
Get out of the sun before you turn red!
Cool skin off. Immediately!
Hydrate!
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
C. Matthews MSN, RN

46. Sunburn Superficial burn
Illustration page 522
Excessive exposure to ultraviolet rays injures dermis.
Dilated capillaries = red, tender, edema, blisters
Large area = h/a, nausea, fever
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

47. Sunburn Redness & pain begin within a few Hours.
Intensity may increase before subsiding.
3-5 days to heal
Tx: cool bath; soothing lotions; topical corticosteroids; fluids
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

48. Insects/Pests/Parasites
Spiders
Fire Ants
Lice/Scabies
Mosquitoes
Scorpions
“Sand fleas”
Chiggers
AKA harvest mites or red bugs
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

49. Spider bites
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

50. Infestations: Pediculosis
Head, body or pubic lice (“crabs”)
Parasite excrement and eggs on skin
Nits in hair
Waxy, don’t fall off easily
Symptoms
Tiny red points to papular wheal-like lesions
Pruritis – check hairline
Secondary excoriation
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span. 11. Identify etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.
C. Matthews MSN, RN

51. Pediculosis Medical tx
Pyrethrins (Rid), Permethrin (Nix) or if all other agents fail…Benzene hexachloride (Kwell)
Contact screening
11. Identify etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders. Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

52. Infestations: Scabies
Skin reactions due to eggs, feces, & mite parts
Transmitted by direct contact
Symptoms
Severe itching especially at HS
Usually not on face
Presence of burrows esp. interdigital webs & flexor surface of wrists
Redness, swelling, vesiculation
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span. 11. Identify etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.
C. Matthews MSN, RN

53. Scabies Medical tx Topical Scabicide Antibiotics for 2ndary infection
Treat those in close proximity
Clothing & linens – hot water and detergent
11. Identify etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.
C. Matthews MSN, RN

54. Drug Therapy: Antiparasitics
Pediculicides
Pyrethrins (RID)
Permethrin (NIX)
Scabicide & Pediculicide
Lindane (Kwell, Scabene)
Cream, lotion
Shampoo
nit comb
Adverse effects
Rash, rare CNS toxicity
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders. 11. Identify etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.
C. Matthews MSN, RN

55. Plants that irritate skin:
Poison ivy/ oak
“nettles”
Cacti
Sawgrass
Plants w/ milky sap
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

56. Plants in FL that irritate skin
Poinsettia, Croton
Milky sap can cause skin irritation
Oleander
Touching the plant is not dangerous, but prolonged contact can irritate the skin.
Poison Ivy , Brazilian Pepper
Touching the leaves or oil from the plant can cause an itchy rash with blisters.
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

57. Brazilian Pepper
C. Matthews MSN, RN

58. 5 little fingers Ø 3 little leaves
Virginia Creeper
Poison Ivy:
5 little fingers Ø 3 little leaves
C. Matthews MSN, RN

59. Drug Therapy Topical Corticosteroids Anti-inflammatory, antipruritic
Low potency (hydrocortisone)
Slower acting
Can be used longer without serious side effects
Ointment most efficient
Higher potency, long term, systemic use is different tx
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

60. Corticosteroids Triamcinolone (Kenalog)
Intralesional
Reservoir of med effects lasts several weeks to months
Indications
Psoriasis
Alopecia
Cystic acne
Hypertrophic scars and keloids
Systemic
Undesirable adverse effects – Lilley 6th ed. Page 869
Short term therapy – poison ivy
Long term therapy – chronic bullous diseases
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

61. Bases for Topical Medications
Powder
Promotes dryness
Good for antifungals
Lotion
Cooling and drying with residual powder film
Good for pruritic eruptions
Cream
Emulsion of oil and water
Lubrication and protections
Ointment
Oil with water in suspension
Lubrication
Most efficient delivery system
Paste
Mixture of powder and ointment
Drying
Moisture absorption
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

62. Water sports ‘Swimmer’s ear’ Red tide (algal bloom)
Red tide (algal bloom)
Sting rays/jelly fish
Amoeba in lake water
Naegleria fowleri
Enters via nasal tissue
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

63. KP Protect Pause for Photos C. Matthews MSN, RN
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
C. Matthews MSN, RN

64. Nursing Management: RN as skin “symptomologist”
Dry skin
Elderly; Infants
Itchy skin
Broken skin
Prevention of secondary infections
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

65. Nursing Management: Dry skin
Chart Page 480
Manifestations
Interventions:
Elder –
Fewer total baths
Lotions & Mild soaps
Hydrate!
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

66. Everyday skin care of infant from Yale- New Haven Children’s Hospital
Care of Diaper rash from Mayo Clinic Staff
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

67. Nursing Management: Itchy skin
Control of pruritis
Keep cool
No rubbing
Moisturize
Systemic antihistamines
Wet dressing
Topical steroids
Menthol, Camphor, Phenol numb itch receptors
Oatmeal baths
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

68. Nursing Management: itch
Baths
For large body areas
Has sedating and antipruritic effect
Oilated oatmeal (Aveeno), potassium permangenate, sodium bicarb
Temp comfortable to client
Soak mins 3-4 times daily
Pat dry, no rubbing
apply moisturizers or meds after baths
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

69. Nursing Management Wet dressings Indications
Skin weepy from infection/inflammation
Relieves itching
Debrides wound
Increases penetration of topical meds
Relieves discomfort
Enhances removal of scabs, crusts, and exudate
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

70. Wet dressings Procedure Clean solution and gauze
Squeeze until not dripping
Apply to affected area, avoid normal tissue
Leave in place minutes 2-4 times a day
Discontinue if skin macerates (“to soften”)
Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

71. Nursing Management: Protect
Protect intact skin!
OOB
Turn at least q2h
Reposition frequently
Alleviate pressure
Hydration
Mechanical intervention Rx
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.). Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

72. Nursing Management: Psychological support
Chronic skin conditions
Emotional stress
Self concept alterations
Body image changes
Psychosocial Integrity: 4. Discuss psychosocial impact of client’s altered dermatological condition Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

73. Nursing Interventions: Psychological support:
Support client
Allow verbalizations of frustrations
Reinforce treatment
Support groups
Help with camouflage
Psychosocial Integrity: 4. Discuss psychosocial impact of client’s altered dermatological condition Physiologic Integrity: 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

74. Diagnostic Testing Biopsy RN Responsibilities Informed Consent
(Iggy, page 477)
Informed Consent
Prep site
Assist with procedure
Apply dressing
Post-op instructions
Properly ID specimen
Punch
Incisional
Excisional
Shave
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
C. Matthews MSN, RN

75. Diagnostic Testing (Iggy, page 476-477)
Cultures
Diagnose fungal, bacteria, viral infections
KOH (Potassium Hydroxide)
Fungus
Sample collection
Skin scraping
Swabbing
Meticulous labeling
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures
C. Matthews MSN, RN

76. Diagnostic Testing (Iggy, page 476-477)
Woods Light
Organisms fluoresce
Pseudomonas
Fungus
Vitiligo
Mineral oil slides
Infestations
Patch test
Allergen testing
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures
C. Matthews MSN, RN

77. Dermatological Interventions
Phototherapy
UVA & UVB (UVL)
Ultraviolet wavelengths cause erythema, desquamation, and pigmentation
Enhance with psoralem (photosensitizing)
Treatment for
Psoriasis
Atopic dermatitis
Vitiligo
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures
C. Matthews MSN, RN

78. Phototherapy Adverse effects Basal or squamous cell Ca Burns Erythema
Teach patients to avoid further sun exposure & photosensitizing drugs
Wear eye protections as psoralem absorbed by lens of eye
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders. Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures
C. Matthews MSN, RN

79. Dermatological Interventions
Radiation Therapy
Indications
Cutaneous malignancies
Advantages
Produces minimal damage to surrounding tissues
Adverse effects
Permanent hair loss (alopecia) to irradiated areas
Telangiectasia
Atrophy
Hyperpigmentation / depigmentation
Ulceration
BCC and SCC
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.

80. Dermatological Interventions
Laser Therapy (CO2, Argon)
Cuts, coagulates, & vaporizes tissue
No cumulative tissue damage
Indications
Coagulation of vascular lesions
Skin resurfacing
Removal birthmarks
BCC
Keloids
Plantar warts
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

81. Diagnostic & Surgical Therapy
Skin Scraping
Scalpel
Surface cells for microscopic inspection
Electrodesication & electrocoagulation
Electrical energy converted to heat
Destroys tissue by burning
Coagulates bleeding vessels
Curettage
Remove tissue with circular cutting edge
Small skin tumors
warts, seborrheic keratosis, BCC, SCC
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.

82. Allergic Conditions Contact Dermatitis Manifestations
Delayed hypersensitivity
Lesions 2-7 days after antigen exposure
Manifestations
Red, hive-like papules and plaques
Sharply circumscribed
Vesicles
Pruritic
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

83. Contact Dermatitis Medical Tx Topical corticosteroids Antihistamines
Skin lubrication
Elimination of allergen
Systemic steroids if severe
Physiologic Integrity:
5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders.
6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

84. Drug Therapy: Antihistamines
Compete with histamine receptor site
Oral or Topical
Cetitizine (Zyrtec)
PO tabs, syrup QD
Non-sedating
Diphenahydramine (Benadryl)
PO, IM, topical
Indications
Urticaria
Pruritis
Allergic reactions
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

85. Drug Therapy: Antihistamines
Adverse effects
Anticholinergic
Sedation (Benadryl)
Use with caution in older adults
Indications
Urticaria
Pruritis
Allergic reactions
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

86. Allergic Conditions: Drug Reaction
Manifestations
Rash of any morphology
Red, macular, papular
Generalized rash with sudden onset
Pruritic
Can occur as late as 14 days after drug is stopped
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

87. Drug Reaction Medical Treatment Discontinue drug
Antihistamines, local or systemic
Corticosteroids if needed
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

88. Allergic Conditions: Atopic Dermatitis
Cause unknown
Begins in infancy and declines with age
Manifestations
Scaly, red to re-brown, circumscribed lesions
Pruritic
Symmetric eruptions
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

89. Atopic Dermatitis Medical Treatment Topical corticosteroids
Phototherapy
Coal tar
Intralesional corticosteroids
Lubrication of dry skin
Antibiotics for secondary infections
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

90. Pause for Photos

91. Dysplastic Nevus Syndrome
Abnormal mole pattern
Increased risk for melanoma
Doubles with dysplastic nevi
Atypical moles larger than usual (>5mm)
Irregular borders, possibly notched
Various variegated colors
Most common on back
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

92. Infections of the skin Risk factors Prevention
Imbalance between host and microorganism
Broken or damaged skin; Trauma
Systemic disease such as Diabetes
Moisture
Obesity
Systemic corticosteroids, antibiotics
Prevention
Proper hygiene
Good health
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
C. Matthews MSN, RN

93. Infections: Herpes Simplex Virus, Type I (AKA “cold sores/fever blisters”)
Contagious
Dormant – Exacerbation
Triggers
Symptoms -- 1st episode 3-7 days after exposure
Painful local reaction
Vesicles on erythematous base
Fever, malaise
11. Identify etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders.
C. Matthews MSN, RN

94. Herpes Simplex Virus, Type I
Medical Tx
Symptom management
Moist compresses
Petrolatum to lesions
Antiviral agents (Zovirax, Famvir, Valtrex)
11. Identify etiology, clinical manifestations, and interventions for viral, bacterial, fungal, and parasitic skin disorders
C. Matthews MSN, RN

95. Infections: Herpes Simplex Virus, Type II
Genital
“Most genital herpes is caused by HSV-2.” (n.l.m.-n.i.h./ Medline plus)
Recurrence more common than oral
Does not mean re-infection
Symptoms
Same as Type I
Treatment
Iggy page
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

96. Infections: Herpes Varicella Virus (chicken pox)
** Highly contagious
No chicken pox or vaccination
Keep those w/active lesions separated until crusted
Symptoms
Vesicular lesions in successive crops
Face , scalp, spreading to trunk and extremities
Protect eyes
Do not squeeze pustules or crusts
Vesicles > pustules > crusts > scars
Postherpetic neuralgia
Self limiting in children
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

97. Herpes Varicella Virus
Medical Tx
Antivirals
Symptomatic relief
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

98. Infections: Herpes Zoster (shingles)
Activation of varicella zoster virus
Frequent occurrence in immunocompromised
Potentially contagious to immunocompromised
Symptoms
Linear patches along dermatome
Grouped vesicles on erythematous base
Unilateral on trunk
Burning pain and neuralgia
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

99. Herpes Zoster Medical Tx Symptomatic Antiviral agents Wet compresses
White petrolatum to lesions
Antiviral agents
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

100. Drug Therapy: Antivirals
Acyclovir (Zovirax)
Suppresses chicken pox, herpes simplex 1 & 2, shingles
Po, IV, topical
Valacyclovir (Valtrex)
Herpes zoster (shingles) & genital herpes
Vaccines
Varivax
Prevention of chicken pox
Given to children > 12 mo.
Zostivax
HZU vaccine for adults > 60 y/o
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

101. Infections: Verruca Vulgaris
Human papillomavirus
Mildly contagious
Symptoms
Circumscribed hypertrophic flesh colored papule
Treatment
Scoop removal
Liquid nitrogen therapy
Keratolytic agents
CO2 laser therapy
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

102. Infections: Plantar Warts
(Human papillomavirus)
Symptoms
Wart on “Plantar” surface (bottom) of foot –
Cone shaped with black dots (“seeds”)
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

103. Plantar Warts Medical Tx Liquid nitrogen
Frequent paring with chemical patches
Duct tape??????
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

104. Infections: Candidiasis (moniliasis)
Candida albicans (Fungus)
50% are symptom free carriers
Immunocompromised >> pathogenic
Likes warm moist areas
Mouth, vagina, skin
An opportunistic infection
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
C. Matthews MSN, RN

105. Infections: Candidiasis
Symptoms
Mouth
White, cheesy plaque (milk curds)
Vagina
Vaginitis
Red edematous painful vaginal wall
White patches
Vaginal discharge
Pruritis
Painful urination & intercourse
Skin
Diffuse papular erythematous rash
Pinpoint satellite lesions around edges
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.

106. Candidiasis Diagnosis Medical Tx: Anti-fungals Nystatin
Vaginal suppository
Oral lozenge
Mycostatin powder, cream
Keep skin clean dry
Diagnosis
culture
Microscopic exam (KOH)
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

107. Infections: Fungal Tinea Corporis Symptoms Annular
AKA ringworm
Symptoms
Annular
well defined margins
erythematous
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

108. Tinea Corporis AKA ringworm
Medical Tx
Cool compresses
Topical antifungals
Miconazole, clotrimazole, butenafine
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

109. Infections: Fungal Tinea Cruris AKA jock itch Symptoms
Self-defined border
In groin
Treatment topical antifungal cream or solution
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

110. Infections: Fungal Tinea Pedis Symptoms Interdigital scaling Erythema
AKA athletes foot
Symptoms
Interdigital scaling
Erythema
Blistering
Pruritis
Pain
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

111. Tinea Pedis AKA athletes foot Medical Tx Topical antifungals Keep dry
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity.
C. Matthews MSN, RN

112. Infections: Fungal Tinea Unguium Symptoms Brittle thickened nails
White/yellow discoloration
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

113. Tinea Unguium Medical Tx Topical antifungal cream or solutions
Griseofulvin (fingernails)
Lamisil
Debride toenails
Physiologic Integrity: 5. Discuss nursing implications for medications prescribed for clients with dermatologic disorders. 6. Develop plan of care for client with impaired skin integrity
C. Matthews MSN, RN

114. Drug Therapy: Antifungals
Clotrimazole (Mycelex, Lotrimin)
Lozenges- thrush
Cream, solution, lotion- athletes foot
Intravaginal creams, tablets
Miconazole (Monistat, Micotin)
Athletes foot
Jock itch
Ringworm
Yeast infections
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

115. Drug Therapy: Antifungals
Fluconazole (Diflucan)
PO & IV
Excellent bioavailability
Vaginal or systemic candidiasis
Ketaconazole (Nizoral)
Nystatin (Mycostatin)
Tervinafine (Lamisil) for onychomycosis
Tolnaftate (Tinactin)
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

116. Pause for Photos
C. Matthews MSN, RN

117. Infections, Bacterial Impetigo Symptoms Treatment
Group A beta hemolytic strept or staph
Associated with poor hygiene and low socioeconomic status
Symptoms
Vesiculopustular lesions
Thick honey colored crust
Surrounded by erythema
Pruritic
Contagious
Treatment
Systemic antibiotics
Saline or aluminum acetate soaks
Soap & water
Removal of crusts
Topical antibiotic cream
Strept can cause glonerulonephritis if untreated

118. Infections: Bacterial
Cellulitis
Staph aureus or strept
Can be primary or secondary infection
Symptoms
Hot
Tender
Erythematous
Edematous
Diffuse borders maybe malaise and fever
Treatment
Moist heat
Immobilization
Elevation
Systemic antibiotics
Hospitalize if severe
Can progress to gangrene if untreated

119. Drug Therapy: Antibiotics
Topical - apply lightly
OTC
bacitracin
Polymixin B
Prescription
Mupirocin (staph)
gentamycin (staph),
erythromycin (staph & strept)
clindamycin (Cleocin) (acne)
Systemic - culture & sensitivity guides selection
Penicillin
Erythromycin
Tetracycline
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

120. Benign Skin Conditions: Acne
Inflammatory disorder of sebaceous glands
Symptoms
comedones, inflammatory lesions, papules, pustules face, neck, upper back
Treatment
Comedo extraction
Topical Benzoyl Peroxide
Peeling and irritating agents (retinoic acid)
Antibiotic therapy - long term
Phototherapy
Sun exposure
If severe - isotretinoin (Accutane) CAUTION! Teratogenic
C. Matthews MSN, RN

121. Drug Therapy: Acne Preparations
Benzoyl peroxide (Benzac, Desquam-X, PanOxyl, etc)
Apply 1-4x day
Effects seen 4-6 weeks
Adverse effects
Erythema, tenderness, dryness, pruritis, burning
Erythromycin (Eryderm, T-Stat, Erygel)
Macrolide antibiotic
Erythema, tenderness, pruritis, burning
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

122. Drug Therapy: Acne Preparations
Isotretinoin (Accutane)
Pregnancy Category X
Proven teratogen
2 contraceptive methods
Tretinoin (Retinoic acid, Vitamin A acid, Retin-A)
Stimulates epidermal cell turnover -> skin peeling
Adverse effects
Red edematous blisters, crusted skin, altered skin pigmentation
Avoid sun, use sunscreen
Apply to dry skin
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

123. Benign Skin Conditions: Moles
Grouping of normal cells
Manifestations
Hyperpigmented areas
Varying form and color
Treatment
None necessary
Cosmetic
Biopsy for diagnosis
C. Matthews MSN, RN

124. Benign Skin Conditions
Psoriasis
Chronic dermatitis due to rapid turnover of epidermal cells
Family predisposition
Manifestations
Sharply demarcated scaling plaques of
Scalp
Elbows
Knees
Palms, soles, and fingernails possible
Treatment
Retard growth of epidermal cells
Topical corticosteroids
Tar
Anthralin topical
Sunlight, UV light
Alefacept (Amevive) injection
Antimetabolites (methotrexate) or systemic retinoids for difficult cases
C. Matthews MSN, RN

125. Benign Skin Conditions
Seborrheic Keratoses
Irregularly shaped flat topped papules or plaques
Warty surface
Appearance of being stuck on
Increase in pigmentation
No association with sun exposure
Treatment
Removal
Curettage
cryosurgery
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
C. Matthews MSN, RN

126. Benign Skin Conditions: Lipoma
Encapsulated tumor of adipose tissue
Most common years of age
Manifestations
Rubbery, compressible, round mass
Variable in size
Most common on trunk, back of neck, forearms
Treatment
Biopsy
Excision if indicated
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

127. Benign Skin Conditions: Vitiligo
Unknown cause
Genetic connection
Complete absence of melanocytes
Non-contagious
Manifestations
Complete loss of pigment
Variation in size an location
Symmetric and permanent
Treatment
Exposure to UVA and psoralens
Depigmentation of pigmented skin in extensive disease
Cosmetics and stains

128. Benign Skin Conditions: Lentigo
(see fig. 26-7, Iggy page 465)
AKA liver spots
Increased number of melanocytes
Related to aging and sun exposure
Manifestations
Hyperpigmented brown to black flat lesion
Usually in sun exposed areas
Treatment
Liquid nitrogen
Possible reoccurrence in 1-2 years
Cosmetics
C. Matthews MSN, RN

129. Primary Lesions Macule (freckles, petecchia, measles)
Flat
Change in color
< 1cm
Papule (wart, mole)
elevated,
Solid
<1cm
Vesicle (chicken pox, herpes zoster, 2nd burns)
Elevated
Fluid filled
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

130. Primary Lesions Bulla Plaque (psoriasis, keratosis) > 1cm Elevated
Serous fluid filled
Plaque (psoriasis, keratosis)
Solid lesion
>1cm
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

131. Primary Lesions Pustule (acne, impetigo) Wheal (insect bite) Elevated
Firm
Edematous
Irregular shape
Diameter variable
Pustule (acne, impetigo)
Elevated
Purulent fluid
Varied size
Safe Effective Care Environment: 2. perform thorough dermatological assessment throughout the life span.
C. Matthews MSN, RN

132. Secondary Lesions Fissure (athletes foot)
Linear crack from epidermis to dermis
Scale (excess dead & flaking of skin)
Drug eruption
Scarlet fever
Scar
Increased connective tissue
Surgical incision
Healed wound
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures.
C. Matthews MSN, RN

133. Secondary Lesions Ulcer Atrophy Excoriation Crater
Loss of epidermis, dermis
Pressure ulcers, chancre
Atrophy
Thinning of epidermis/dermis
Ages skin, striae
Excoriation
Missing epidermis
Scabies, abrasion, scratch
Physiologic Integrity: 9. Describe pre-op and post care of clients receiving dermatological surgical procedures
C. Matthews MSN, RN

134. References:
Chickenpox in Pregnancy. (2009). March of Dimes Foundation. Retrieved 9/25/09 from
Common Poisonous Plants of Florida (Florida Poison Information
Culbert, D. (April 14, 2005). Florida scorpions. UF/IFAS Okeechobee County Extension Service. Retrieved 6/17/09 from
Groch, J. (August 23, 2006). Guidelines for Preventing Pressure Ulcers Seen as Suboptimal. MedPage Today. Retrieved 6/12/09 from

135. References:
Hembree, D. (July 21, 2008) 10 Poisonous Plants in Florida and Safety
“Herpes simplex” (May, 2009). Medline Plus Medical Encyclopedia. Retrieved 6/15/09 from
Lilly, L.L., Harrington, S, & Snyder, J. (2005) Pharmacology and the Nursing Process. (4th ed.) Mosby Elsevier. St. Louis, MS.
Medical Dictionary (2009) Merrium – Webster Inc. Retrieved 6/15/09 from
C. Matthews MSN, RN

136. References:
The Medical News. Brain eating amoeba in lake kills sixth victim. (October 2007). Retrieved 6/16/09 from
The US Market for Skin Care Products. (May, 2005). Retrieved 6/12/09 from
Scorpion Sting Treatments. (2008). Orkin. Retrieved 6/17/09 from
C. Matthews MSN, RN

137. Burns Thermal burns Chemical burns Electrical burns
The Following Content –
Burns –
will be covered in future classes!
Save this information for future use.
Thermal burns
Flame, flash, scald
Chemical burns
Necrotizing substances
Acids
Alkali
Cleaning agents, drain cleaners, lye
Electrical burns
Intense heat from electrical current
Safe Effective Care Environment: 1. Identify factors that influence injury and disease prevention ( sun exposure, environmental toxins, etc.).
C. Matthews MSN, RN

138. Classification: Depth of Burn
See page 522 in Iggy text
ABA by depth of destruction
Partial thickness burn
Epidermis and dermis involved
Full thickness burn
“burns reach through the entire dermis and sometimes into the subcutaneous fat.” (Iggy, page 522)
Possibly involves muscles, tendons, and bones
*Skin cannot heal on its own.
C. Matthews MSN, RN

139. Classification: Extent of Burn
Total Body Surface Area (TBSF)
(Iggy page 531)
Berkow method
Rule of 9’s
C. Matthews MSN, RN

140. Classification: Location of Burns
Severity related to location
Complication risks related to location
Face, neck, chest
Respiratory complications
Hands, feet, joints, and eyes
Compromise ADLs
Circumferential burns of extremities
Circulatory compromise
C. Matthews MSN, RN

141. Emergent Care A,B,C’s Fluid Therapy Wound Care Pain management
Prevention of infection
C. Matthews MSN, RN

142. Burns
What happens….
C. Matthews MSN, RN

143. Complications of Emergent Phase
Cardiovascular
Arrhythmias
Hypovolemic shock
Impaired circulation
Respiratory
Upper airway burns
Inhalation injuries
Urinary
Acute tubular necrosis
C. Matthews MSN, RN

144. Acute Phase Fluid therapy Wound care Excision and grafting
Lactated Ringers per Parkland (Baxter) formula
Wound care
Topical silvadene, sulfamylon, bacitracin, or bactroban
PREVENT INFECTION
Excision and grafting
Remove necrotic tissue
Apply split thickness auto graft skin
Porcine skin, cadaver skin, clients own skin, skin culture
Nutritional therapy
Increased fluids, proteins, vitamins A, C, E.
Zinc, iron, folate
Physical therapy
Prevent contractures
Physical and psychological comfort
C. Matthews MSN, RN

145. Drug Therapy: Antibiotics
Silver Sulfadiazine (Slivadene)
Burn treatment
QD or BID
“frosting”
Adverse effects
Pain
Itching
Burning
Physiologic Integrity: 5. Describe nursing implications for medications prescribed for clients with dermatologic disorders.
C. Matthews MSN, RN

146. Rehabilitation Phase Prevent and minimize contractures and scarring!
Cosmetic / reconstructive therapy
Psychological support if needed
Psychosocial Integrity: 4. Discuss psychosocial impact of client’s altered dermatological condition
C. Matthews MSN, RN