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Question It is believed that the natural wound healing process should not be disrupted. Unless a wound is infected or has heavy discharge, how many days should acute wounds be left covered? A. 1 B. 2 C. 3 D. 4
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer A. 1
It is believed that the natural wound healing process
should not be disrupted. Unless the wound is infected or has heavy discharge, acute wounds should be left covered for only 1 day.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Care of Patients With Skin Conditions Objectives of therapy are to prevent additional damage, prevent secondary infection, reverse inflammatory processes, and relieve symptoms. Nursing care includes administration of topical and systemic medications, wound care and dressings, and providing for patient hygiene. Nursing care also needs to address the educational, emotional, and psychosocial needs of the patient.
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Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Impetigo
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Herpes Zoster (Shingles)
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Patient Education: Bacterial Infections Impetigo is contagious and may spread to other parts of patients body or to other persons. Patient education regarding antibiotics, hygiene, and skin and lesion care. Dont share towels, combs, and so on. Bathe daily with antibacterial soap. Furuncles, boils, or pimples should never be squeezed.
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Patient Education: Viral Infections Herpes zoster: instruction regarding prescribed antiviral medications, lesion care, dressings, and hand hygiene Herpes simplex: instruction regarding prescribed antiviral medications and prophylactic medication use, instruction regarding spread of herpes, and measures to reduce contagion of partner or of neonates born to mothers with genital herpes
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Patient Education: Fungal Infections Instruction regarding medications, use of oral and topical agents, and shampoos Instructions regarding hygiene: use clean towels and washcloths every day Do not share towels, combs, and so on. Keep skin folds and feet dry. Wear clean, dry, cotton clothing, including underwear and socks; avoid synthetic underwear, tight-fitting garments, wet bathing suits, and plastic shoes. Avoid excessive heat and humidity. Hair loss associated with tinea capitis is temporary. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Parasitic Skin Infestations Pediculosis (lice): pediculosis capitis, pediculosis corporis, Phthirus pubis Scabies (mites): Sarcoptes scabei
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Patient Education: Pediculosis Capitis Head lice may infest anyone and are not a sign of uncleanliness. Instruction in use of shampoo (lindane [Kwell] or pyrethrin [RID]) and combing of hair with fine-tooth comb dipped in vinegar to remove all nits Note lindane may have toxic effects and must be used only as directed. All articles of clothing and bedding must be disinfected, washed in hot water, or dry cleaned. Furniture and floors should be frequently vacuumed. Do not share combs, hats, and so on. All family members and close contacts must be treated. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Education: Pediculosis Corporis and Pubis Pediculosis corporis is a disease related to poor hygiene and of those who live in close quarters. Pediculosis pubis is common and spread chiefly by sexual contact. Bathe in soap and water and apply prescription scabicide or OTC permethrin (NIX). If eyelashes are involved, Vaseline may be applied twice a day for 8 days. Mechanically remove any nits. All family members and sexual contacts must be treated and instructed regarding personal hygiene. All clothing and bedding must be washed in hot water or dry cleaned. Patient and partner should also be scheduled for checkup to assess for coexisting sexually transmitted disease.
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Patient Education: Scabies Mite frequently involves fingers and hands; contact may spread infection. Health care personnel should wear gloves when providing care until infection is ruled out. Instruct patient to take a warm, soapy bath; allow skin to cool; and apply prescription scabicide lindane, crotamiton, or 5% permethrin to entire body, not including the face or scalp. Leave on for 12 to 24 hours. Wash clothing and bedding in hot water and dry in a hot dryer. Treat all contacts at the same time. Repeat the treatment in 1 week to prevent reinfestation Pruritus may continue for several weeks and does not mean retreatment is required. Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Psoriasis A chronic, noninfectious inflammatory disease of the skin in which epidermal cells are produced at an abnormally rapid rate Affects about 2% of the population, primary those of European ancestry Improves and recurs; a lifelong condition May be aggravated by stress, trauma, seasonal and hormonal changes Treatment: baths to remove scales and medications
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Psoriasis
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Nursing Process: The Care of the Patient With PsoriasisAssessment Appearance of the skin Coping of the patient with condition Note impact of the disease on patient activities and interactions
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Nursing Process: The Care of the Patient With PsoriasisDiagnoses Deficient knowledge Impaired skin integrity Disturbed body image
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Collaborative Problems and Potential Complications Infection Psoriatic arthritis
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Nursing Process: The Care of the Patient With PsoriasisPlanning Major goals may include Increased understanding of psoriasis and the treatment regimen Achievement of smoother skin with control of lesions Development of self-acceptance Absence of complications
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interventions Patient education regarding the disease, skin care, and treatment regimen Measures to prevent skin injury: avoid picking or scratching Measures to prevent skin dryness: use of emollients, avoid excessive washing, and use warm (not hot) water, pat dry Use of the therapeutic relationship for support and to aid coping
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question Is the following statement true or false?
Application of scabicide immediately after bathing and
before the skin dries and cools increases percutaneous absorption of the scabicide and the potential for central nervous system abnormalities.
Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer True
Application of scabicide immediately after bathing and
before the skin dries and cools increases percutaneous absorption of the scabicide and the potential for central nervous system abnormalities.
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Nursing Process: The Care of the Patient With Blistering DiseasesAssessment Appearance of the skin Monitor VS frequently and assess for signs and symptoms of infection Pain, pruritus, and discomfort Coping of the patient with condition Note impact of the disease on patient activities and interactions
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Nursing Process: The Care of the Patient With Blistering DiseasesDiagnoses Acute pain: skin and oral cavity Impaired skin integrity Anxiety Ineffective coping Deficient knowledge
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Collaborative Problems and Potential Complications Infection and sepsis Fluid volume deficit and electrolyte imbalance
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Nursing Process: The Care of the Patient With Blistering DiseasesPlanning Major goals may include Relief of pain and discomfort for lesion Skin healing Reduced anxiety Improved coping Absence of complications
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Interventions Meticulous oral hygiene Avoid commercial mouthwashes Keep lips moist with lip balm, petroleum, or lanolin Cool mist humidified air Cool, wet dressing or baths; hygiene measures Apply powder liberally to keep skin from adhering to sheets Monitor for and prevent hypothermia Skin care may be similar to that of the patient with extensive burns Measures to prevent secondary infections Encourage adequate fluid and nutritional intake Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: The Care of the Patient With Toxic Epidermal Necrolysis and StevensJohnson SyndromeAssessment Skin inspection Oral cavity inspection Vital signs Respiratory secretions Fatigue Pain level Coping mechanism
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Nursing Process: The Care of the Patient With Toxic Epidermal Necrolysis and StevensJohnson SyndromeDiagnoses Impaired tissue integrity (i.e., oral, eye, and skin) related to epidermal shedding Deficient fluid volume and electrolyte losses related to loss of fluids from denuded skin Risk for imbalanced body temperature (i.e., hypothermia) related to heat loss secondary to skin loss Acute pain related to denuded skin, oral lesions, and possible infection Anxiety related to the physical appearance of the skin and prognosis Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Collaborative Problems and Potential Complications
Sepsis Conjunctival retraction, scars, and corneal lesions
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Interventions Maintaining skin and mucous membrane integrity Attaining fluid balance Preventing hypothermia Relieving pain Prevent infection, consider reverse isolation Reducing anxiety Monitoring and managing potential complications Promoting home and community-based care
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Skin Cancer Frequently related to sun exposureprevention: use of sunscreen and avoid sun exposure Incidence is increasing Prevention of all types of skin cancer involves protection from excessive sun exposure Basal cell carcinoma Most common type and most successfully treated because tumors remain localized Squamous cell carcinoma Prognosis depends upon presence of metastasis Treatment involves eradication of the tumor Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Basal Cell Carcinoma and Squamous Cell Carcinoma
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Kaposis Sarcoma A malignancy of endothelial cells that line the blood vessels: dark reddish-purple lesions of the skin, oral cavity, GI tract, and lungs Categories Classic KS Endemic (African) KS Immunosuppression-associated KS Occurs in transplant recipients and people with AIDS Much more aggressive form that involves multiple body organs
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Melanoma Risk factors Worldwide incidence and mortality rates are increasing Peak incidence, 20 to 45 years of age Types: superficial spreading, lentigo-maligna melanoma, nodular melanomas Treatment: surgical excision, other therapies
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Melanoma
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Nursing Process: The Care of the Patient With MelanomaAssessment Inspect skin carefully Ask specific questions about pruritus, tenderness, pain, changes in moles, or new pigmented lesions Assess knowledge level and risk factors Assess coping and anxiety Refer to Figures 61-5 and 61-6
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Nursing Process: The Care of the Patient With MelanomaDiagnoses Acute pain Anxiety Depression Deficient knowledge
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Collaborative Problems and Potential Complications Metastasis Infection of surgical site
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Nursing Process: The Care of the Patient With MelanomaPlanning Major goals may include Relief of pain and discomfort Reduced anxiety and depression Increased knowledge of early signs of melanoma Absence of complications
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Interventions Pain: provide appropriate analgesics and measures to promote comfort Provide emotional support, allow patient to express feelings, clarify misconceptions and supply information, support coping, involve family in discussion
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Question When assessing the patients skin for possible melanoma, what type of lesion would be of most concern as potential melanoma? A. A small papule with a dry, rough scale B. A firm, nodular lesion topped with crust C. A pearly papule with a central crater and a waxy border D. An irregularly shaped lesion
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Answer D. An irregularly shaped lesion
A small papule with a dry, rough scale would be actinic
keratosis, which can be a precancerous skin lesion. A firm, nodular lesion topped with crust is usually a sign of squamous cell carcinoma. A pearly papule with a central crater and a waxy border is a lesion expected with basal cell carcinoma. An irregularly shaped lesion is common with melanomas.
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