What are petechiae and purpura?
Purple or red colored spots on the skin that occur when a small blood vessel bursts.
What is ecchymosis?
Bruising of the skin.
What is a spider angioma?
Small broken blood vessels on the surface of the skin.
They occur in the elderly and are not a concern. It also occurs with clients who have liver disease.
What are Steven’s Johnson syndrome and Toxic epidermal necrolysis?
(Immediate complication)
Really bad adverse reactions of many meds that cause a severe rash all over the body.
Always let the HCP know if you notice a rash, especially after the client starts a new med.
What is the general teaching to prevent a skin disorder from getting worse?
- not scratch the rash or damaged skin
- keep nails short
- not pick sores or lesions
- wear loose clothing
What is the client at risk for when there is an open wound or rash?
Infection, due to a break in the skin.
How often are clients turned to prevent pressure ulcers?
At least every 2 hours.
What is pruritus?
Itchy skin.
It is common for clients to receive diphenhydramine to decrease itching.
What is serous wound drainage?
Clear or straw-colored.
It is a normal finding.
What is purulent wound drainage?
Thick, yellow, green, brown or tan.
It indicates an infection.
What is serosanguinous wound drainage?
Pale red and watery.
It is a normal finding.
What is sanguineous wound drainage?
Bright red.
It indicates active bleeding.
What are the 3 main layers of the skin?
- epidermis: top layer
- dermis: includes blood vessels, nerves, sweat glands
- hypodermis: subcutaneous fat
What are the steps to getting a skin or wound culture?
- clean area first with normal saline going from close to the wound to away from the wound
- debride if needed
- use a sterile applicator or nasal swab to get a sample
- put in container
- send to lab
When are antibiotics started: before or after collecting the culture?
AFTER the culture is collected.
Describe:
Candida albicans
An infectious fungal disease of the skin.
It is also called a yeast infection, thrush, or oral candidiasis.
Risk factors:
Candida albicans
Frequently due to a decreased immune system from:
- chemotherapy
- steroids
- immunosuppressed
- long term antibiotics
On what areas of the body is candida albicans frequently found?
In warm, moist places where fungus likes to grow such as:
- skin folds
- mouth
- vagina
- under breasts
Interventions:
Candida albicans
- keep skin folds dry
- antifungal such as fluconazole or nystatin powder or suspension
Describe:
Cellulitis
An infection of the skin caused by Streptococcus or Staphylococcus. It frequently causes one leg to be red and edematous.
The client is treated with antibiotics, and warm compresses.
Describe:
Acne vulgaris
A chronic skin disorder that occurs more often in teenagers due to hormone changes.
What are acne lesions called?
- “zits”
- blackheads (closed comedones)
- whiteheads (open comedones)
Prevention and treatment:
Acne vulgaris
- don’t pick at face
- gently wash the face using prescribed topical agents
- benzoyl peroxide or antibiotics may be prescribed
- wear sunscreen
- keep hands off face
Describe:
Psoriasis
A chronic non-infectious inflammatory skin disorder.
The cause is not known.
What do psoriasis lesions look like?
Silvery-white scales on a raised, reddened, round plaque.
It normally affects the scalp, knees, elbows.
Medications:
Psoriasis
Focus on decreasing the inflammation. The most common meds are:
- steroids
- salicylic acid to soften the plaque
Describe:
Eczema (atopic dermatitis)
An allergic skin reaction that is itchy. There are small blisters and redness.
The cause is unknown but there is a higher risk if other allergies are present.
Teaching:
Eczema
- use warm water to bathe, not hot water
- don’t bathe every day
- use mild soap
- apply non-scented lotions
Medications:
Eczema
Topical steroids are applied to the rash.
Who is most at risk for skin cancer?
- older clients
- light-skinned clients
How often should clients do a thorough skin cancer check?
Once a month.
What is a skin cancer assessment?
- A: asymmetry
- B: border irregularity
- C: color that is not uniform
- D: diameter > 1/4 inch (6mm)
- E: evolving (changing) size, shape or color
Notify HCP of these changes.
At what times during the day should a client stay out of the sun?
Between 10 a.m. and 4 p.m.
What SPF factor of sunscreen should be used?
At least 15 SPF or higher.
Apply 30 minutes before going outside.
Describe:
Melanoma
A highly metastatic skin cancer.
It is typically a red, dark blue, black or even a white color.
Describe:
Basal cell carcinoma
A type of skin cancer that rarely metastasizes.
It is described as having a “waxy nodule with pearly borders”.
Describe:
Squamous cell carcinoma
A type of skin cancer that looks like an oozing, bleeding and crusting lesion.
Larger tumors are associated with higher risk of metastasis.
How are skin cancers diagnosed and treated?
A biopsy is performed and then surgery to remove the tumor.
What is a stage 1 pressure ulcer?
Skin is intact, red, non-blanching, warm and painful.
Non-blanching means that when you press your finger on it, it stays red.
What is a stage 2 pressure ulcer?
The first or second layer of skin has come off and it looks like a shallow, pink wound or blister.
What is a stage 3 pressure ulcer?
There is full-thickness skin loss into the dermis and subcutaneous tissue.
What is a stage 4 pressure ulcer?
There is exposed bone, tendon or muscle.
What is an unstageable pressure ulcer?
When the ulcer is covered with slough or eschar.
- Slough is dead white blood cells and skin debris.
- Eschar is dead tissue and is black in color.
On what areas are pressure ulcers more common?
On bony and thin skin areas such as:
- back of head and ears
- shoulder
- elbows
- hips
- coccyx
- heels
Risk factors:
Pressure ulcers
- moist skin
- immobility
- poor nutrition
- skin being pulled on when moving up or down in bed - called “friction and shear”
How are pressure ulcers prevented?
- keep skin dry
- don’t massage bony areas - can cause capillary damage and necrosis
- turn every 2 hours
- apply skin lotion or cream
- Keep HOB at 30 degrees or less
Why do burns have a high risk of airway problems?
(Immediate complication)
Smoke inhalation.
Always assess airway first and give oxygen.
What is the best indicator of fluid intake and output in a burn client?
Urine output.
It needs to be at least >30 mL/hour for an adult.
What is the Parkland formula?
Used to calculate how much fluids a burn client needs in 24 hours.
Give Lactated Ringer’s = 4 mL X kg X % of body burned
Example: 4 mL X 75 kg X 40% = 6000 mL
How are the fluids divided up when calculating the 24-hour amount of fluids needed (using the Parkland formula)?
Divide fluids up:
- give 1/2 of the amount in the first 8 hours
- give the remaining amount in the next 16 hours
Example: If 6000 mL is to be given total
- give 3000 mL (375 mL/hr) for the first 8 hours
- give 3000 mL more (or 187.5 mL/hr) for the next 16 hours
Why is there ↑ potassium in a burn client?
The burn destroys the cells and the potassium is released into the vascular space increasing the amount in the blood.
Why is the hematocrit ↑ in a burn client?
There is fluid loss, causing the hematocrit to become concentrated.
What type of room does a burn client need to be placed in?
In a private room and placed on protective isolation (neutropenic precautions) to prevent them from getting an infection:
- wear gown and gloves
- sterile procedures
What type of injections should a burn client NOT get?
Do not give IM or subcutaneous injections in a burned client since the client will be unable to absorb the medicine.
How will the burn client receive pain meds?
Through IV.
What is the room temperature kept at for a burn client?
Keep the room warm since the client has heat loss due to skin loss.
What is the “Rule of 9’s”?
Assesses the percentage of the burned area on a client.
What is a stage 1 burn?
It is also called a superficial burn.
When the epidermis (first layer) is damaged.
It is red without blisters.
What is a stage 2 burn?
It is also called a superficial partial-thickness burn.
When the epidermis and dermis are damaged.
There is edema with blisters that are yellow.
What is a stage 3 burn?
It is also called a deep partial-thickness burn.
When all the layers of the skin are damaged.
The area is stiff, red or white and dry.
What is a stage 4 burn?
It is also called a full-thickness burn.
When the burn has gone through all the layers of the skin and reached the muscle, tendon or bone.
It is a black color.
What surgery will be needed if the burn is not healing on its own?
Skin grafts.
How should the burned area be positioned in order for skin grafts to heal?
Immobilize the area to promote the adhering of the graft to the skin.
Describe:
Tinea corporis
A fungal infection on the skin. It is also known as ringworm.
Medications:
Tinea corporis
Antifungals
Antifungals end in -azole.
Describe:
Herpes zoster (shingles)
A viral infection that causes a rash on the skin. In children it is known as chicken pox or varicella zoster.
What are the characteristic signs and symptos of herpes zoster/shingles?
Painful and itchy rash along the nerves on back or face. The vesicles can be filled with fluid.
Diagnostic test:
Herpes zoster/shingles
- culture skin and send to lab or
- direct florescent antibody test
Interventions:
Herpes zoster/shingles
- airborne and contact precautions
- antiviral medications
- prevent by getting vaccine starting at age 50
What are the 4 types of burns?
- chemical
- thermal
- electrical
- radiation
