INTEGUMENTARY SYSTEM PN 124 BACTERIAL AND FUNGAL INFECTIONS

INTEGUMENTARYINTEGUMENTARY

SYSTEMSYSTEM

PN 124PN 124

BACTERIAL AND BACTERIAL AND FUNGAL INFECTIONSFUNGAL INFECTIONS

Objectives Objectives

Discuss s/s of 8 infectious disorders of the Discuss s/s of 8 infectious disorders of the skin; bacterial and fungalskin; bacterial and fungal

Define the nursing management of the Define the nursing management of the client with infectious disorders of the skinclient with infectious disorders of the skin

Discuss common diagnostic tests used as Discuss common diagnostic tests used as diagnostic tools for integumentary diagnostic tools for integumentary disordersdisorders

CELLULITIS, Bacterial infectionCELLULITIS, Bacterial infection

Etiology/PathophysiologyEtiology/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 anopen 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.

CELLULITISCELLULITIS

-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-venous insufficiency or stasis -diabetes mellitus-diabetes mellitus -lymph edema-lymph edema -surgery-surgery -malnutrition-malnutrition -substance abuse-substance abuse -treatment with steroids or cancer chemotherapy-treatment with steroids or cancer chemotherapy

RISKS FOR CELLULITISRISKS 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

erythematosuserythematosus

CELLULITISCELLULITIS -Develops as an edematous, erythematous area of -Develops as an edematous, erythematous area of

skin 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



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


-s/s are caused by the bacteria, and the-s/s are caused by the bacteria, and the body’s attempts to stop the infection.body’s attempts to stop the infection. -skin appears pitted, like an orange peel.-skin appears pitted, like an orange peel. -area of redness spreads and small red-area of redness spreads and small red spots appear spots appear -vesicles may form and burst-vesicles may form and burst


-nearby lymph nodes may become -nearby lymph nodes may become enlarged and tender. (lymphadenitis)enlarged and tender. (lymphadenitis)

-edema secondary to the infected area -edema secondary to the infected area occludes the lymphatic vessels in the skin.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.

ERYSIPELASERYSIPELAS

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

ASSESSMENTASSESSMENT

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


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

DIAGNOSTIC TESTSDIAGNOSTIC TESTS

Cultures Cultures - identifies the causative bacteria - identifies the causative bacteria -from the blood, purulent exudate, or-from the blood, purulent exudate, or tissue specimens tissue specimens -Gram stain -Gram stain -determines the appropriate antibiotic-determines the appropriate antibiotic therapy.therapy. Complete blood count (CBC).Complete blood count (CBC). Inspection of the areaInspection of the area


-Tests done to differentiate cellulitis from-Tests done to differentiate cellulitis from deep vein thrombosis. deep vein thrombosis. - ( they both have similar s/s)- ( they both have similar s/s) - X-ray, ultrasound, computed tomography- X-ray, ultrasound, computed tomography or magnetic resonance imaging (MRI)or magnetic resonance imaging (MRI) - determines the extent of inflammation - determines the extent of inflammation -identifies abscess formations -identifies abscess formations

MEDICAL MANAGEMENTMEDICAL MANAGEMENT

Antibiotic treatment Antibiotic treatment - effect against streptococci and - effect against streptococci and staphylococcistaphylococci - 10 day course- 10 day course -can be either oral or IV depending on-can be either oral or IV depending on severityseverity

Nursing DiagnosisNursing Diagnosis

Deficient knowledge, related to the cause Deficient knowledge, related to the cause and the spread of the disease.and the spread of the disease.

Pain related to edemaPain related to edema

NURSING INTERVENTIONSNURSING INTERVENTIONS

-Treat s/s and to prevent the spread of the-Treat s/s and to prevent the spread of the infection.infection. -Administer the antibiotic-Administer the antibiotic -Assess pain; administer an analgesic if-Assess pain; administer an analgesic if necessarynecessary -Warm, moist dressings applied to the affected-Warm, moist dressings applied to the affected area may relieve discomfort.area may relieve discomfort. -Monitor fluid intake and nutritional status.-Monitor fluid intake and nutritional status.


-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 -Stress the importance of taking the entire prescription of antibiotics.prescription of antibiotics.

-Monitor for secondary diseases, such as -Monitor for secondary diseases, such as

yeast infectionsyeast infections

PROGNOSISPROGNOSIS

Cure is possible with 7-10 days of Cure is possible with 7-10 days of treatment. treatment.

Cellulitis may be more severe in people Cellulitis may be more severe in people with chronic diseases and those who are with chronic diseases and those who are susceptible to infection, such as the susceptible to infection, such as the immunocompromised.immunocompromised.

Complications: sepsis, meningitis, and Complications: sepsis, meningitis, and lymphangitis.lymphangitis.

Bacterial Disorders of the SkinBacterial Disorders of the Skin

Impetigo contagiosaImpetigo contagiosa Etiology/pathophysiologyEtiology/pathophysiology

• Staphylococcus aureusStaphylococcus aureus or streptococci, or a mixed or streptococci, or a mixed bacterial invasion of the skin.bacterial invasion of the skin.

• Common in children.Common in children.

IMPETIGOIMPETIGO Clinical manifestations/assessmentClinical manifestations/assessment

• Lesions begin as macules Lesions begin as macules • - develop into pustule vesicles.- develop into pustule vesicles.• Pustules rupturePustules rupture• -form-form honey-colored exudate 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

• tt

Nursing assessmentNursing assessment

SUBJECTIVE DATA:SUBJECTIVE DATA: -Ask about pruritis.-Ask about pruritis. -Ask about pain and malaise.-Ask about pain and malaise. -Ask about the spreading of the-Ask about the spreading of the disease to different body partsdisease to different body parts -Ask about other diseases present.-Ask about other diseases present.

IMPETIGOIMPETIGO OBJECTIVE DATA:OBJECTIVE DATA: -Focal erythema.-Focal erythema. -Pruritic areas.-Pruritic areas. -Honey-colored crust over dried lesions.-Honey-colored crust over dried lesions. -Smooth, red skin under the crust.-Smooth, red skin under the crust. -Low-grade fever.-Low-grade fever. -Leukocytosis.-Leukocytosis. -Positive culture for streptococcus or-Positive culture for streptococcus or staphylococcus aureus.staphylococcus aureus. -Purulent exudate.-Purulent exudate.

Diagnostic TestsDiagnostic Tests -Culture of exudate from lesions-Culture of exudate from lesions Medical managementMedical management -Antiseptic soap (Betadine of Hibiclens) -Antiseptic soap (Betadine of Hibiclens) to remove crusted exudate and cleanto remove crusted exudate and clean area area -Topical cream, ointment or lotion-Topical cream, ointment or lotion -Antibiotics, oral or IV (Penicillin)-Antibiotics, oral or IV (Penicillin) -Keep area clean and dry-Keep area clean and dry

Folliculitis, furuncles, carbuncles, and felonsFolliculitis, furuncles, carbuncles, and felons

Etiology/pathophysiologyEtiology/pathophysiology• FolliculitisFolliculitis

Infected hair follicle (generally from Staphylococcus Infected hair follicle (generally from Staphylococcus aureus).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, Folliculitis, furuncles, carbuncles, and felons carbuncles, and felons

Clinical manifestations/assessmentClinical 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.

FolliculitisFolliculitis FurunclesFuruncles

CarbuncleCarbuncle FelonFelon


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


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

NURSING DIAGNOSESNURSING DIAGNOSES

Impaired skin integrity, related to exudate Impaired skin integrity, related to exudate from woundfrom wound

Pain, related to edemaPain, related to edema


Diagnostic testsDiagnostic tests

• Physical examPhysical exam

• Culture of drainageCulture of drainage

• Health historyHealth history


-Goal-Goal - prevent the spread of the infection.- prevent the spread of the infection.

-Patients in the hospital are isolated -Patients in the hospital are isolated - using wound and secretion precautions.- using wound and secretion precautions.

Folliculitis, furuncles carbuncles Folliculitis, furuncles carbuncles and felonsand felons

Medical management/nursing interventionsMedical management/nursing interventions

-Warm soaks 2-3 times per day -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-immobilize affected area to prevent pain

-elevate affected area to decrease the-elevate affected area to decrease the

edema.edema.

PATIENT TEACHINGPATIENT TEACHING

-Patient should not touch the exudate.-Patient should not touch the exudate. -Meticulous hand washing -Meticulous hand washing -BEFORE and AFTER contact with the-BEFORE and AFTER contact with the lesions.lesions.

-Hygiene practices should be -Hygiene practices should be

demonstrated and return demonstrationsdemonstrated and return demonstrations

done by the family and the patient.done by the family and the patient.

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

contaminated articles.contaminated articles.

YEAST INFECTIONSYEAST INFECTIONS

FUNGAL INFECTIONS FUNGAL INFECTIONS OF THE SKINOF THE SKIN

FUNGAL INFECTIONSFUNGAL INFECTIONS

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

TINEA CAPITISTINEA CAPITIS

TINEA CORPORISTINEA CORPORIS

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

TINEA CORPORISTINEA CORPORIS

TINEA CRURISTINEA CRURIS

-Jock itch.-Jock itch. -Found in the groin area.-Found in the groin area.

TINEA PEDISTINEA PEDIS

-Most common of all-Most common of all fungal infections.fungal infections. -Athlete’s foot.-Athlete’s foot.

-Between the toes of-Between the toes of

people whose feetpeople whose feet

perspire heavily.perspire heavily. -Contaminated swimming -Contaminated swimming pools and publicpools and public bathroom facilitiesbathroom facilities

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

TINEA CAPITIS: TINEA CAPITIS: -erythematous.-erythematous. -round lesion with pustules around the-round lesion with pustules around the edgesedges -temporary alopecia -temporary alopecia -infected hairs will turn blue-green under a-infected hairs will turn blue-green under a Wood’s light.Wood’s light.


-TINEA CORPORIS:-TINEA CORPORIS:

-flat lesions that are clear in the center -flat lesions that are clear in the center with erythematous borders.with erythematous borders.

-scaliness -scaliness

-pruritis is severe.-pruritis is severe.


3. TINEA CRURIS:3. TINEA CRURIS: Has brownish-red lesions that migrate Has brownish-red lesions that migrate

out from the groin area.out from the groin area. Pruritis is a symptom.Pruritis is a symptom. Scratching is done to relieve the itching. Scratching is done to relieve the itching.

As a result, skin excoriation is present. As a result, skin excoriation is present.


4.4. TINEA PEDIS:TINEA PEDIS: This fungal infection produces more This fungal infection produces more

skin maceration than the others.skin maceration than the others. Fissures and vesicles are commonly Fissures and vesicles are commonly

seen around and below the toes, with seen around and below the toes, with occasional discoloration of the infected occasional discoloration of the infected area.area.

ASSESSMENTASSESSMENT SUBJECTIVE DATA:SUBJECTIVE DATA: -extreme itching -extreme itching -tenderness from excoriation of the area -tenderness from excoriation of the area


OBJECTIVE DATA: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 areaalopecia to the surrounding area

ASSESSMENTASSESSMENT OBJECTIVE DATA: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.


TINEA CRURIS: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:TINEA PEDIS:

-fissures between the toes and soft skin.-fissures between the toes and soft skin.

-vesicular lesions-vesicular lesions

-thick toenails. -thick toenails.


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


-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

bulbbulb

-antifungal soaps and shampoos -antifungal soaps and shampoos

Antifungal agents-Tinactin, Lotrimin, or Antifungal agents-Tinactin, Lotrimin, or Desenex Desenex

-2-6 weeks.-2-6 weeks. See AHN p. 77. for a list of drugs that are See AHN p. 77. for a list of drugs that are

used.used.

NURSING DIAGNOSESNURSING DIAGNOSES

Impaired skin integrity, related to Impaired skin integrity, related to increased moisture and pruritisincreased moisture and pruritis


-Protect the involved area from trauma and -Protect the involved area from trauma and irritationirritation

-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.


-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 -Footwear needs to be of an absorbent materialmaterial

-socks, stockings, etc. -socks, stockings, etc.

-Wear loose-fitting clothing.-Wear loose-fitting clothing.

TEACHINGTEACHING

1. Teach proper skin care and comfort 1. Teach proper skin care and comfort measures to relieve itching.measures to relieve itching.

2. The nurse needs to review the meds. and 2. The nurse needs to review the meds. and procedures to be done at home by the pt.procedures to be done at home by the pt.

3. The nurse should remind the pt. that it may 3. The nurse should remind the pt. that it may take months for fungal disorders to be cured.take months for fungal disorders to be cured.

4. Clarify any misconceptions about athlete’s 4. Clarify any misconceptions about athlete’s foot.foot.

5. Teach the pt. the process of this disease.5. Teach the pt. the process of this disease.

FOOT CAREFOOT CARE

FOOT CAREFOOT CARE

PARASITIC DISEASES OF PARASITIC DISEASES OF THE SKINTHE SKIN

PediculosisPediculosis Etiology/pathophysiologyEtiology/pathophysiology

-Lice infestation-Lice infestation

PediculosisPediculosisThree types of liceThree 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 pinchersLooks like a crab with pinchers

--Found in pubic areasFound in pubic areas

PediculosisPediculosis

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

PediculosisPediculosis

Medical management/nursing interventionMedical management/nursing intervention -Lindane (Kwell); Pyrethrins (RID)-Lindane (Kwell); Pyrethrins (RID) -Cool compresses -Cool compresses -Corticosteroid ointment-Corticosteroid ointment -Assess all contacts-Assess all contacts -Wash linens and clothes in hot water-Wash linens and clothes in hot water -Properly clean furniture or non-washable -Properly clean furniture or non-washable materialsmaterials

ScabiesScabies

ScabiesScabies

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

ScabiesScabies

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

ScabiesScabies

Diagnostic testsDiagnostic tests -Microscopic examination of infected skin-Microscopic examination of infected skin -Scratch test-Scratch test Medical management/nursing interventionsMedical management/nursing interventions -Lindane (Kwell), Pyrethrins (RID), Crotamiton-Lindane (Kwell), Pyrethrins (RID), Crotamiton (Eurax), 4-8% solution of sulfur in petrolatum(Eurax), 4-8% solution of sulfur in petrolatum -Treat all family members-Treat all family members -Wash linens and clothing in hot water-Wash linens and clothing in hot water

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INTEGUMENTARY SYSTEM PN 124 BACTERIAL AND FUNGAL INFECTIONS