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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e 01/30 Pg 1034

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 103428 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


15 Learning Objectives15 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


15 Learning Objectives Cont: 04/30 Pg 103415 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


Body Ornamentation: Tattoos 05/30 Pg 1035Body Ornamentation: Tattoos 05/30 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


Question 29/30 Pg 1051 Question 29/30 Pg 1051

Is the following statement true or false?

All tattoos must be created by certified tattooists.


Answer 0/30 Pg 1035Answer 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


Body Ornamentation: Body Piercing 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


Skin Disorders: Dermatitis 09/30 Pg 1037 Skin Disorders: Dermatitis 09/30 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


Dermatitis 10/30 Pg 1037Dermatitis 10/30 Pg 1037




There are many different etiologies for dermatitis.

11/30 Pg 1037


Answer 12/30 Pg 1037Answer 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


Acne Vulgaris 13/30 Pg 1039 Acne Vulgaris 13/30 Pg 1039

• Pathophysiology, Etiology: Overproduction of sebum


– 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


Acne Vulgaris 14/30 Pg 1038Acne Vulgaris 14/30 Pg 1038

Figure 65-4: Acne of (left) the face and (right) the chest


Rosacea*** 15/30 Pg 1040 Rosacea*** 15/30 Pg 1040

• Pathophysiology, Etiology: Helicobacter pylori;

Mites (Demodex folliculorum); Telangiectases [Incurable]


– 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]


Furuncles, Furunculosis, Carbuncles*** 16/30 Pg 1040Furuncles, Furunculosis, Carbuncles*** 16/30 Pg 1040

• Physiology, Etiology: Skin infections; Diabetes mellitus


– 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 asepsis16/30 Pg 1040




Furuncles, furunculosis, and carbuncles are treated with antibiotic therapy.

17/30 Pg 1041


Answer 18/30 Pg 1041 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


Psoriasis*** 19/30 Pg 1041Psoriasis*** 19/30 Pg 1041

• Pathophysiology, Etiology: Likely genetic predisposition; Keratinocytes; Plaque


– 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


Psoriasis*** 20/30 Pg 1041Psoriasis*** 20/30 Pg 1041

Figure 65-6 Psoriasis on the elbows

1 Corticosteroids2 Retinoids3 Analogs of V D4 Methotrexate Chemo5 Etretinate/ Tegison RA6 Vitamin A7 Kenacort Injections Biologic Therapy1 Raptiva2 RemicadeBoth Modify activity of T Cells, autoimmune Reduce inflammation & HyperplasiaPhotochemotherapy, UV Light & Psoralen


Scabies*** 21/30 Pg 1049 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]


– 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,


Dermatophytoses*** 22/30 Pg 1043 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


Shingles*** 23/30 Pg 1044 Shingles*** 23/30 Pg 1044

• Pathophysiology, Etiology: Varicella-zoster virus; Inflammation in dermatome


– Fever; Headache; Vesicles; Itching

– 3rd Cranial nerve =corneal ulcers

– 8th Cranial nerve = cerebral vessels

– Vertigo, hearing loss

• Medical Management: Oral or topical acyclovir; Corticosteroids



Skin Cancer*** Skin Cancer***

• Pathophysiology, Etiology: Exposure to UV radiation; Low skin melanin[most common form of cancer in in US] [Primary lesions]


– 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



Scalp and Hair Disorders: Seborrhea, Seborrheic Dermatitis, Dandruff Scalp and Hair Disorders: Seborrhea, Seborrheic Dermatitis, Dandruff

• Pathophysiology, Etiology: Pityrosporum ovale


– 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



Alopecia*** 26/30 Pg 1048 Fig: 65-1Alopecia*** 26/30 Pg 1048 Fig: 65-1

• Pathophysiology, Etiology: Alopecia areata; Androgenetic alopecia (male pattern baldness)


– 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


Head Lice*** 27 /30 Pg 1049 Head Lice*** 27 /30 Pg 1049 • Pathophysiology, Etiology: Transmitted

through direct contact


– 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


Nail Disorders: Onychomycosis 28/30 Pg 1051 Nail Disorders: Onychomycosis 28/30 Pg 1051

• Pathophysiology, Etiology: Fungal infection


– Thick, distorted; Yellow, friable nails

• Diagnostic Findings: Visual inspection; Microscopic examination

• Medical, Surgical Management: Prolonged systemic drug therapy; Nail removal; Surgery



Nail Disorders: Onychocryptosis 29/30 Pg 1051 Nail Disorders: Onychocryptosis 29/30 Pg 1051

• Pathophysiology, Etiology: Inherited trait; ingrown toenail; Fungal nail infections


– Swelling; Pain; Purulent drainage; Odor

• Diagnostic Findings: Physical examination

• Medical, Surgical Management: Local, systemic antibiotic therapy; Surgery


29/30 Pg 1051


End of Presentation:By: P.K. Williams, RN

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