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Skin Alterations

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by

Tangela Hales

on 1 October 2015

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Transcript of Skin Alterations

NUTRITIONAL-METABOLIC FUNCTIONAL HEALTH PATTERNS
Contact Dermatitis
Herpes Virus and Common Diseases
Varicella zoster: chickenpox
Everybody knows chickenpox and likely you experienced the disease as a child, can be dangerous when exposed to it in adulthood.
Another common ailment is lip and mouth “cold sores”
Genital Herpes lesions caused by HSV, sexually transmitted
HSV-1 cold sores (mild but annoying diseases)
HSV-2 genital herpes
However the Herpes family is huge, over 100 members
Psoriasis
Psoriasis is a chronic non-contagious autoimmune disease that affects the skin and the joints.
It causes rapid skin cell reproduction resulting in red, dry patches of thickened skin.

Medical Management
Assessments
An inflammatory reaction of the skin to physical, chemical, or biologic agents.
Common causes: soaps, detergents, scouring, compounds, and industrial chemicals.
Eruption begins when the causative agent contacts the skin.
Wounds
Pressure Ulcers
Stages of Pressure Ulcers
Nursing Process
Prevent pressure ulcers-early identification of those that are at risk. (Braden Scale) or other prevention protocols by agency.
Change positions (Turn client every two hours)
Perform routine hygiene or skin care.
Use support surfaces (pillows, wedges, etc.)
Provide nutritional support
Prevent friction and shear.
Educate client and family member how to prevent and treat.
Medical Treatment
Topical steroids
Systemic steroids
Wet compresses

Herpes
Chicken Pox
Herpes Zoster (Shingles)
Any break or disruption in the normal integrity of the skin and tissues.
Types of wounds:
Intentional or unintentional
Open or closed
Acute or chronic
Pressure ulcers
Factors Affecting Wound Healing
Age- (Children and healthy adults heal more rapidly).
Circulation and oxygenation- adequate blood flow is essential.
Nutritional status- healing requires adequate nutrition.
Stage I
Intact skin, non-blanchable erythema (redness).
The area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue.
Stage III
Full-thickness skin loss involving damage or necrosis to subcutaneous tissue.
Stage I Treatment
Off load pressure
Transparent film dressing
Moisture barrier
Stage II
Partial- thickness skin loss involving the epidermis and/ or dermis.
Presents as an abrasion, blister, or a shallow open ulcer.
Stage IV
Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structure (tendons, joints).
Depth of wound varies by anatomical location.
Exposed bone or tendon is visible or directly palpable.
Unstageable Wounds
Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan,brown, or black in the wound bed.
The true depth of the owund cannot be determined until the slough or eschar is removed; therefore, the state cannot be determined.
Braden-Scale
Identify the at-risk population.
Braden Scale-most uses clinically; it includes 6 subscales (sensory perception, moisture, activity, mobility, nutrition, friction and shear.
Labs
Pre-albumin and Albumin levels
Topical/Systemic Treatments
Creams
Medications
Depends on what the physician or wound care orders.
Mechanical
Wound Vac
Wound Cultures
Wound Irrigation
Albumin level<3.2mg/dl (Normal, 3.5-5mg/dl.
Prealbumin level<19mg/dl (normal 16-40mg/dl).
Inspect the wound.
Drains, Dressings, Documentation
Jackson Pratt
Closed-Drainage System
Allows accurate measurement of drainage.
Prevents microorganisms from entering the wound from saturated dressings.
Hemovac
Penrose Drain
Dry dressings
Sterile
Non-sterile
Wet-to-Dry Dressings
Packing
Dressings
Open drainage system
Soft and flexible
No collection device
Binders
Used to secure dressings, apply pressure, and support the wound.
Make sure not too tight
Documenting Wound Care
Clear and accurate documentation
Location, site
Type of wound
Drainage (Amount, color, consistency)
Wound edges
How client tolerted
Closed drainage system
Full transcript