4-2-08 Sue Renfrow
Skin Disorders
Acne Vulgaris
• Disorder affecting skin follicles
• Begins at puberty
• Most cases are between 12-35 years of age affects males and females
equally
• Sign and symptoms
o Closed comedones (whiteheads)
o Open comedones (black heads)
o Papules, pustules, nodules, and cysts
• Acne Treatment
o Mild cases-may just need to wash twice daily with cleansing soap.
o Topical
Benzoyl peroxide preparations
Vitamin A (tretinoin) topical
Antibiotics (tetracycline, clindamycin, erythromycin)
o PO Medications
Antibiotics (tetracycline, doxycycline, minocycline)
Oral retinoids
Accutane (isotretinoin) synthetic vitamin A compound
• Nursing Consideration
o The healthcare provider may under estimate the relative importance of
the disease to the adolescent.
o They may not be motivated to follow the treatment plan
o Families need to be involved in the treatment for encouragement
o Educate about factors that aggravate and damage the skin
Bacterial Disorders-Pyodermas
• Impetigo
o Contagious to others or other parts of skin
o Common in children, may be seen in adults
o Signs and symptoms
Small, red macule then vesicle then rupture than exudates then
crust (honeycomb-yellow and crusty)
Matted hair if on scalp
Itching, burning
May have swelling of their lymph nodes
• Treatment
o Teach good hand washing so that it doesn’t spread
o Keep fingernails cut so that it doesn’t get under fingernails
o Wash bed sheets in hot water
o Use bacterial soap to bathe them
o Wear gloves while applying antibiotic to area
o Put them in cool water to prevent itching
o Pat them dry
o Use separate towels, bathe daily, cut fingernails, and avoid contact
o Topical antibiotics
Area must be soaked, crust removed and cleaned with
antibacterial soap before applying topical
o Systemica antibiotics-treat deep infectionand prevents acute
glomerulonephritis
Penicillin or erythromycin
Folliculitis
4-2-08 Sue Renfrow
• Infection that arises within the hair follicles (beard bumps) women sometimes
get it on their legs
• Deep in one or more hair follicles and spreading into the surrounding areas
• Signs and symptoms
o Red, painful
• Once it gets infected it is called Furuncles or (“boil” or “risen”) basically an
abscess
• Carbuncle=Extension of a furuncle that has invaded several follicles and is
large and deep seated
o Signs and symptoms
Pain, Cellulitis, fever, leukocytosis, and possible spread into the
blood stream
• Treatment: folliculitis, furuncles, and Carbuncles
o Don’t mash or squeeze them
o Warm soaks increase vasculariztion and hasten suppuration
o Isolate drainage
o May require I&D carbuncles
o Culture and sensitivity
o May be put on antibiotics
Mycotic (Fungal) Infections
• Tinea
o Tinea Pedis-atheletes foot
o Tinea corporis-body (ringworm) apply shampoo every two weeks (cants
and dogs)
o Tinea capitus- head
o Groin- jock itch
o Under nails-hard yellow nails
• Fungus in general
o Candidia (yeast infection) or thrush
o Treatment
Nystatin
Oral antifungal (rifatin B)
o Change socks regularly
o Keep feet dry
Parasitic skin disorders
• Pediculosis
o Lice infestation on the outside of the host’s body
o Pediculosis capitus-hardest to get rid of
o Pediculosis corporis
o Pediculosis pubis (crabs)
o Signs and symptoms
Itching visible infestation
o Treatment
Skin must be dry before you apply OTC shampoos
Wash linens
Wash everything in house with hot water
Shampoo your rugs
Vacuum drapes
Treat entire family
• Scabies
o Clinical manifestation usually starts about 4 weeks
o Infestation of the skin by the itch mite, frequently found in unsanitary
living conditions
4-2-08 Sue Renfrow
o Signs and symptoms
Severe itching (especially at night), redness, burrows in skin
Usually found in webs of fingers and toes
Female crawls underneath your skin, laying eggs
o Treatment
Same as lice
• Skin Neoplasms
o Basal cell carcinoma
Most common type of skin cancer
Usually on sun exposed parts of the body
Begins as a small, waxy nodule with rolled translucent borders-
may have small vessels visible in it
May be shiny, gray, flat, or yellowish
Rarely metastasizes but recurrence is common
Usually good prognosis
o Squamous Cell Carcinoma
Malignant proliferation arising from epidermis
Usually on sun damaged skin-but not always
May arise from normal skin or pre-existing lesions
Rough , thickened, scaly tumor may be asymptomatic or bleed
Metastasis via blood or lymphatic system
Prognosis depends on metastasis
o Malignant Melanoma
Cancerous neoplasm in which atypical melanocytes are present
in the epidermis and the dermis
Lesion may be circular with irregular borders, it may be flat, or
elevated and palpable, may be a combination of colors-brow,
tan, black, and mixed with other colors
Prognosis depends on size and if lymph nodes are involved
Frequently metastasized to bone, lung, liver
Cause unknown
If greater than 1.5 ml in thickness life expectancy less than five
years
KNOW CHART IN BOOK ON PREVENTION
Incidence-doubled in last 30 years
Diagnosis-punch biopsy
TNM
• Tumor thickness
• Node involvement
• Metastasis
Classification and staging
• Clark and Breslow classifications
• Levels 1-5
o Screening for skin cancer
A asymmetry
B irregular border
C variegated color
D diameter
o Treatment
Remove the tumor and any involved tissue and nodes
Chemotherapy may be used for metastatic melanoma but
generally with poor results
4-2-08 Sue Renfrow
Regional perfusion with chemotherapeutic agent if malignant
melanoma in an extremity is being tried
Immunotherapy used with varied success
Pain management when needed
Teaching
Allergies
• Occurs when the body is invaded by a an antigen
• Antigens are usually proteins
• The body thinks that the antigen is a foreign invader and sends lymphocytes
to the rescue, when they respond then antibodies are produced to interact
with the antigen and protect the body for the foreign invader
• The antibodies are immunoglobulins
o Include IgA, IgE, IgD, IgG, and IgM
o They are found in lymph nodes, tonsils, appendix, Peyer’s patches, of
intestinal tract and blood and lymph circulation
o Each type has its own functions
o IgE is the one we will be talking about
o IgE is located in respiratory and oral mucosa
• Hypersensitivity Reaction
o An abnormal heightened reaction to any type of stimuli
o Usually does not occur with first exposure
o Four types of hypersensitivity reactions
Anaphylactic (type 1)
• Immediate reaction beginning within minutes of exposure
to an antigen
• May be local or systemic response
• Mediated by IgE antibodies
• Requires previous exposure to the antigen
• Characterized by vasodilation increase causes increase in
mucous secretions
Cytotoxic- type 2 –blood reaction
Immune complex- type 3
Delayed type-type 4
• Also known as cellular hypersensitivity
• Occurs 24-72 hours after exposure to allergen
• Mediated by sensitized T cells and macrophages
• Examples; contact dermatitis, reaction to PPD (TB skin
test), poison Ivy
Diagnostic Tests
• CBC-usually normal
• Serum IgE level
• Skin tests
• Scratch
• Prick
• Intradermal
• RAST test
o Anaphylaxis
Clinical response to an (type 1 hypersenstivity reaction, IgE
mediated) immunologic reaction between a specific antigen and
an antibody
Triggered by exposure via inhalation, injection, ingestion, or skin
contact
4-2-08 Sue Renfrow
Life threatening
Happens within seconds to minutes from exposure to antigen
Give Epinephrine, then oxygen, then IV in them, then give
Benadryl IV, give solumedrol, sometimes epinephrine drip and
go to ICU
Characterized
• Mild
o Peripheral tingling, fullness in mouth and throat,
nasal congestion, sneezing, tearing
o O2 sat and watch them
• Moderate
o Flushing, warmth, anxiety, bronchospasm, edema
of airway, cough, wheezing and itching is added
o Give Benadryl IV
• Severe
o Same symptoms as moderate, but abrupt onset,
can have abdominal cramping, vomiting, and
diarrhea, and advance to cardiac arrest
o Epinephrine, oxygen, may have to intubate
• Local
o s/s appear at site of allergen-antibody interaction
o includes hay fever, hives, allergic gastroenteritis
• Systemic
o Peripheral vasodilation, bronchospasm, laryngeal
edema, dyspnea, cyanosis, respiratory, skin and GI
systems involved
o Life threatening
o Treatment
Prevention-limit contact with the allergen
Close monitoring/assessment of CV and respiratory status
100% O2
Epinephrine 1:1000 SC and/ or IV
Antihistamines and corticosteroids
Volume expanders to maintain Blood pressure
Vasopressors to bring up blood pressure
Aminophylline-only given to asthmatics when having allergic
reaction
IV glucagon
Trach or intubation may be necessary
o Teaching
Avoidance of allergens
Carry Epi Pen (0.3mg for adults and 0.01mg/kg for children)
Inject Epi-Pen at mid part of outer thigh
Medic alert bracelet worn at all times
Healthcare providers must take careful histories and be alert to
possibility of allergy at all times
Allergic Rhinitis
• Inflammation on nasal mucosa
• Most common form of respiratory allergy mediated by Type 1 immediate
reaction
• Caused by air born pollens or molds that are ingested or inhaled so it tends to
be seasonal
• Nasal stuffiness, discharge, sneezing, headache, nasal itching
• Management
o Diagnosis based on history, physical exam, and diagnostic test results
4-2-08 Sue Renfrow
o Treat with Benadryl be sure to watch them
o Goal is to provide relief of symptoms
o Avoidance therapy
o Treatment may include
o Pharmacological therapy
o Adrenergic agents
o Mast cell stabilizers
o Immunotherapy
Contact Dermititis
• Delayed hypersensitive reaction
• Itching, burning, erythema, skin lesions, peeling
• Patch test is used to diagnosed
• Treated with antihistamines, wash after exposure to allergen with soap and
water topical corticosteroids
Latex Allergy
• Allergic reaction to natural rubber proteins
• Spina bifida babies
• Be aware of high risk populations
• Cross reactions seen with kiwis, bananas, avocadoes
• s/s
o contact dermatitis
o angioedema
o laryngeal edema
o hypotension
o cardiac arrest if type 1 reaction
Epidemiology
• History
o Era 1 sanitary statistics
o Era 2 infection disease (germ theory by Robert Cook)
o Era 3 chronic disease and black box
o New Era
• Goals
o To prevent or limit the consequences of illness and disability in
humans and maximize their state of health
o Epidemiology emerged because of the need to determine the etiology
of disease conditions so that prevention and control measures could be
instituted
o Epidemiologic /Nursing
Both processes have evolved from the problem-solving process
Both are designed to provide a framework for investigating
health-related problems, obtaining new knowledge, and
planning, implementing, meeting, and evaluating specific
interventions
• Sources of Epidemiologic Data
o Traditional sources of epidemiologic data are those collected routinely
by national or state governments
• Levels of prevention
o Primary-used to prevent health care problems (teaching,
immunizations)
o Secondary-focuses on early identification, treatment, and monitoring of
existing health problems. (screening -mammograms, cholesterol
screenings, etc.)
o Tertiary prevention-is the primary focus of Health Place. (ADLs, Rehab)
Epidemiologic in Community Nursing
• Schools
• Workplace
4-2-08 Sue Renfrow
• Special population (homeless shelters, women abuse clinics)
Epidemiology in infection control
• Nosocomial infections-infections appearing in hospitalized patients that were
not present or incubating at the time of admission
• Advisory and regulatory agencies
o CDC
o JCAHO
o OSHA
o AJIC-American journal of infection control
Mortality Rates
• Death rates are common incidence rates that are calculated for public health
purposes
• Number of people 65 years and older dying from lung cancer in Boston, MA
(divided)
• Number of people 65 years and older in Boston, MA (times) based of 10
Morbidity
• Statistics from reportable diseases are population-based, but other morbidity
statistics may be based on survey data of data obtained from institutional
records
• Number of conditions or events occurring in a period of time
• KNOW THE DIFFERENCE BETWEEN THE TWO mortality/morbidity
Child birth
• World Health Organization (WHO) estimates 500,000 women die each year in
connection with pregnancy and childbirth
Role of Nursing
• Prevention
• Emerging trends
• Community intervention
• Future challenges (cloning, gene splicing)
