Post on 11-Jan-2016
Chapter 31Dermatologic Conditions
Chapter 31Dermatologic Conditions
Types of LesionsTypes of Lesions
• Macule
• Papule
• Plaque
• Nodule
• Tumor
• Wheal
• Vesicle
• Bulla
• Pustule
• Fissure
• Ulcer
Measures to Prevent Dermatologic ProblemsMeasures to Prevent Dermatologic Problems
• Avoid drying agents, rough clothing, highly starched linens; other irritants.
• Promote activity.
• Use bath oils, lotions, and massages.
• Avoid excessive bathing.
• Promote early treatment of pruritus and skin lesions.
• Avoid exposure to UV rays.
Patient Teaching Regarding Cosmetic SurgeryPatient Teaching Regarding Cosmetic Surgery
• Encourage all persons to look their best.
• Emphasize fact that no cream, lotion, or miracle drug will remove wrinkles and lines.
• Encourage the use of cosmetics.
• Be informed of the various types of surgical interventions.
• Explore patients’ reasons for seeking cosmetic surgery.
Factors Contributing to PruritusFactors Contributing to Pruritus
• Excessive bathing and dry heat
• Certain Diseases
– Diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia
• Certain psychiatric problems
Measures to Relieve PruritusMeasures to Relieve Pruritus
• Bath oils, moisturizing lotions, and massage
• Vitamin supplements and a high-quality, vitamin-rich diet
• The topical application of zinc oxide
• Antihistamines and topical steroids
KeratosesKeratoses
• Definition
– Small, light gray or brown lesions on exposed areas of the skin
– Formation of a cutaneous horn due to keratin accumulation
Keratoses (cont.)Keratoses (cont.)
• Treatment
– Freezing agents and acids
– Electrodesiccation or surgical excision
– Close nursing observation for changes in keratotic lesions
Seborrheic KeratosesSeborrheic Keratoses
• Dark, wartlike projections on various parts of the body
– May be as small as a pinhead or as large as a quarter.
– Tend to increase in size and number with age.
Treatment of Seborrheic KeratosesTreatment of Seborrheic Keratoses
• Small Seborrheic Keratoses
– Abrasive activity with a gauze pad containing oil may remove them.
• Larger, Raised Lesions
– Can be removed by freezing agents or by a curettage and cauterization procedure.
Classification of MelanomasClassification of Melanomas
• Lentigo Maligna Melanoma: black, brown, white, or red pigmented flat lesion on sun-exposed areas of the body.
• Superficial Spreading Melanoma: appears as variable-pigmented plaque with an irregular border.
• Nodular Melanoma: found on any body surface; a darkly pigmented papule that increases in size over time.
Detection and Treatment of MelanomasDetection and Treatment of Melanomas
• Detection
– Self inspection
– Early detection improves the prognosis.
– Evaluate and biopsy suspicious lesions.
• Treatment
– Usually excised with removal of some of the surrounding tissue and subcutaneous fat.
– Some physicians recommend removal of all palpably enlarged lymph nodes.
Vascular LesionsVascular Lesions
• Cause
– Age-related changes weaken the walls of the veins.
– Weakened vessel walls cause varicose veins.
• Edema of the lower extremities
• Poor tissue nutrition
• Legs gain a pigmented, cracked, and exudative appearance.
Nursing Measures for Stasis UlcerNursing Measures for Stasis Ulcer
• Control of infection
• Good nutrition
• Assistance with weight reduction
• Elevation of legs
• Prevention of interferences to circulation
Factors Affecting Older Adult’s Risk for Pressure UlcersFactors Affecting Older Adult’s Risk for Pressure Ulcers
• Skin that is fragile and damages easily
• A poor nutritional state
• Reduced sensation of pressure and pain
• Affected by immobile and edematous conditions contributing to skin breakdown
Nursing Measures to Prevent Pressure UlcesrsNursing Measures to Prevent Pressure Ulcesrs
• Avoid unrelieved pressure.
• Encourage activity or turning of the dependent patient.
• Avoid shearing forces.
• Recommend a high-protein, vitamin-rich diet.
• Promote good skin care.
Stages of Pressure UlcersStages of Pressure Ulcers
• Stage 1: a persistent area of skin redness (without a break in the skin); does not disappear when pressure is relieved.
• Stage 2: a partial thickness loss of skin layers involving the epidermis; presents clinically as an abrasion, blister or shallow crater.
• Stage 3: a full thickness of skin is lost extending through the dermis and exposing the subcutaneous tissues.
• Stage 4: a full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone, or both.
Protective Measures for Various Stages of Pressure UlcersProtective Measures for Various Stages of Pressure Ulcers
• Hyperemia: protect the skin with a product such as Duoderm (Squibb) or Tegasorb (3M) before applying the adhesive.
• Ischemia: protect with Vigilon, which contains water and is soothing to the area.
• Necrosis: requires a transparent dressing that protects from bacteria but is permeable to oxygen and water vapor; irrigation is essential during dressing changes.
• Ulceration: debridement is essential.
Nursing ConsiderationsNursing Considerations
• Promoting Normalcy
– Psychological support
– Need for normal interactions and contacts
Using Alternative Therapies Using Alternative Therapies
• Aloe vera for minor cuts and burns
• Witch hazel for bruises and swelling
• Homeopathic remedies
• Acupuncture
• Biofeedback
• Guided imagery
• Relaxation exercises
• Nutritional supplements
SourceSource
• Eliopoulos, C. (2005). Gerontological Nursing, (6th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).