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
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 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
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• 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)