Chapter 65: Caring for Clients w/ Skin, Hair, and Nail Disorders Flashcards

1

inflammation of the skin

accompanied by a red rash and pruritis

Dermatitis

2

develops in people who are sensitive to one or more substances, such as drugs, fibers in clothing, cosmetics, and plants

Allergic contact dermatitis

3

localized reaction that occurs when the skin comes in contact w/ a strong chemical such as a solvent or detergent

Primary irritant dermatitis

4

This client presents w/:

dilation of the blood vessels, causing redness and swelling, and sometimes by blister formation and oozing
itching
irritation

Dermatitis

5

Medical management for clients w/ dermatitis

remove the substances causing the reaction
flush skin w/ cool water
topical lotions: calamine
diphenhydramine; cyproheptadine
moisturizing creams w/ lanolin restore lubrication
wet dressings w/ astringent solutions
corticosteroids

6

Nursing management for clients w/ dermatitis

wear rubber gloves when coming in contact with any substance such as soap or solvents
put all clothes through a second rinse cycle when laundering to remove soap residue
avoid the use of cosmetics or any topical drug or substance until etiology of dermatitis is identified

7

REVIEW CLIENT AND FAMILY TEACHING 65-1: REDUCING ITCHING W/ DERMATITIS

8

tends to coincide w/ puberty

an inflammatory disorder that affects the sebaceous glands and hair follicles
severity of condition varies from minimal to severe
sebum, keratin, and bacteria accumulate and dilate hair follicles forming a comedone/blackhead

Acne vulgaris

9

This client presents w/:

comedones and pustules on the face, chest and back, where the skin is excessively oily
oiliness of the scalp often accompanies acne

Acne vulgaris

10

Medical management for clients w/ acne vulgaris?

facial cleansing and nonprescription drying agents containing benzoyl peroxide
topical application of tretinoin and oral administration of isotretinoin
tetracycline and erythromycin

11

Women prescribed isotretinoin must have what while on this medication?

have a negative pregnancy test 2 weeks before use
practice 2 forms of birth control; adhere to contraceptive measures while taking the drug and for one month after discontinuing therapy
check w/ primary provider about risks to an infant while breastfeeding

12

Surgical management for clients w/ acne vulgaris?

dermabrasion

13

method for removing surface layers of scarred skin

outermost areas are removed by sandpaper, a rotating wire brush, chemicals (chemical peels), or diamond wheel
the client is instructed to avoid washing area until is has healed sufficiently
client must refrain from picking and touching the area b/c contact w/ the fingers may cause infection or scarring from secondary trauma

dermabrasion

14

Nursing management for clients w/ acne vulgaris?

keep the face and hair clean and avoid cosmetics that contribute to oily skin
manipulating the lesions worsen the condition
in women clients, warn clients about the risk of birth defects associated w/ isotretinoin
keep hair short and away from the face and forehead
wash hair frequently; daily shampooing does not damage hair
tell nurse to avoid makeup, lotions, hairsprays, and skin care products no approved by pcp

15

generally characterized by a rosy appearance

incurable, but manageable and may progress in severity
telangiectases: eventually, the facial capillaries and arterioles become chronically dilated w/ spidery appearance, appearing as linear streaks on the skin

Rosacea

16

this client presents w/:

frequent, intermittent flushed appearance across the nose, forehead, cheeks, and chin
triggers: hot beverages, spicy food, alcohol, exposure to sun, wind, or cold; bathing w/ hot water; stress; use of skin care products
as condition progresses skin remains red, appearing like a sunburn
inflamed tissue may sting and feel chronically irritated; solid papules and pustules may form
face appears swollen and baggy, and large facial pores produce a texture resembling an orange
nose becomes permanently enlarged, red, nodular, and bulbous (rhinophyma)
eyes may appear inflamed
client may report that they can't wear contact lens or that eyes feel as if there's a foreign body in them

Rosacea

17

Medical/surgical management for clients w/ rosacea?

antibiotics: tetracycline, minocycline, erythromycin
metronidazole
topical retinoids
isotretinoin (remember restrictions!)
2-4 laser treatments

18

Nursing management for clients w/ rosacea?

maintain a diary, documenting lifestyle practices and triggers
establish a cause-and-effect relationship b/t foods and beverages so client can avoid in the future
advise client to minimize skin exposure and use sunscreen spf 15 or higher
protect skin in cold/windy weather w/ scarf or ski mask and apply skin moisturizer
pace physical activity to avoid overheating
review basic skin care regimen that includes washing the face w/ lukewarm water and gentle cleanser; avoid using face cloth; blot skin dry; wait 5-10 minutes after cleansing before applying medication to reduce potential discomfort
avoid self treatment w/ acne meds, especially those containing benzoyl peroxide b/c they can further irritate the skin
encourage stress management

19

a boil

Furuncle

20

multiple furuncles

Furunculosis

21

furuncle from which pus drains

carbuncle

22

This client presents w/:

lesions that appear anywhere but primarily around the neck, axillary, groin
raised, painful pustule surrounded by erythema
areas feel hard to the touch
after a few days, lesion exudes pus and a core
client may experience a fever, anorexia, weakness, and malaise

Furuncle

23

Medical/surgical tx for clients w/ a furuncle?

hot, wet soaks to localize infection and provide symptomatic relief
antibiotics
surgical incision and drainage

24

Nursing management for clients w/ a furuncle?

follow strict aseptic technique when applying or changing a dressing to prevent the spread of infection to other parts of the body or to others
inform client to never pick or squeeze a furuncle
client should wash hands thoroughly before and after applying topical medications, keep hands away from infected areas, and use face cloths and towels separate from those used by others
washing clothing, towels, and face cloths in hot water and bleach separately from family laundry

25

chronic, noninfectious inflammatory disorder of the skin that affects both men and women

periods of emotional stress, hormonal cycles, infection, and seasonal changes appear to aggravate the condition

Psoriasis
ex. plaque psoriasis

26

this client presents w/:

patches of erythema covered w/ silvery scales, usually on the extensor surfaces of elbows, knees, trunk, and scalp
itchy may be absent, slight, or severe
lesions are obvious and unsightly
scales tend to shed
dx'd by visual exam or skin biopsy

Psoriasis

27

Medical management for clients w/ psoriasis?

NO CURE!
coal tar extract
corticosteroids
topical corticosteroids and topical retinoids
analogs of Vitamin D
Methotrexate with severe disease that doesn't respond to other forms of therapy
Photochemotherapy

28

caused by infestation w/ tiny mites

anyone can acquire this
it is erroneous to assume that infected people have poor personal hygiene
spread by skin-to-skin contact

Scabies

29

This client presents w/:

intense itching, especially at night
commonly affected areas include webs and sides of fingers, around wrists, elbows, elbows, armpits, waist, thighs, genitalia, nipples, breasts, and lower buttocks
excoriation from scratching accompanies the itching

Scabies

30

How is scabies dx'd?

examination using mineral oil or ink
after dropping sterile mineral oil on lesion, skin is scraped onto a slide and examined microscopically to detect mites, eggs, and feces
ink test is performed by applying a blue or black-felt tipped pen to the lesion, which highlights the burrows when the skin surface is wiped

31

Medical management for clients w/ scabies?

Permethrin cream
medication is applied to skin in a thin layer, left on for 8-12 hours, and then removed by rinsing
thorough bathing, clean clothing, and avoidance of contact w/ others who have scabies are essential in preventing reoccurences

32

Nursing management for clients w/ scabies

advise thorough bathing
review directions for applying scabicide medications included w/ product
compliance is important
instruct client, after bathing and applying medication, to don clean clothing and launder preworn clothing, towels, and bed linen in hot water asap
client is told to vacuum furniture and other unwashable items
EXPLAIN THAT ITCHING MAY CONTINUE FOR 2-3 WEEKS AFTER TREATMENT

33

Superficial fungal infections

ex. ringworm, athlete's foot, jock itch

Dermatophytoses

34

parasitic fungi that invade the skin, scalp and nails

aka tinea

Dermatophytes

35

This client presents w/:

rings of papules or vesicles w/a clear center in nonhairy areas of the skin
several clusters of rings may be found in the same general location
often itches and becomes red, scaly, cracked, and sore

Tinea corporis

36

This client presents w/:

infection that begins between the toes and spreads to the soles of the feet

Tinea pedis

37

This client presents w/:

infection that invades the hair shaft below the scalp, followed by breaking of the hair, usually close to the scalp
common in children

Tinea capitis

38

Medical treatment for Dermatophytoses

Tolnaftate
Miconazole

39

Nursing management for clients w/ Dermatophytoses

review directions for use of meds and explain that infected person must use separate towels, washcloths, stresses that keeping the affected areas dry to reduce the spread of infection
thoroughly dry all areas of body after shower
avoid excessive heat and humidity
avoid acquiring or spreading fungal infection of the feet
advise against sharing towels and slippers or going barefoot in locker rooms or community bathrooms
KEEP FEET DRY, ESPECIALLY IN-BETWEEN TOES
for clients that perspire freely, advise applying power between toes, washing and thoroughly drying feet daily
wear different pairs of shoes daily

40

skin disorder that develops years after an infection w/ varicella

more frequent in middle-aged to older adults and clients immunocompromised
aka shingles

Herpes Zoster

41

In Herpes Zoster, a viral reactivation produces inflammatory symptoms in this, which is a skin area supplied by the nerve

raised, fluid filled, and painful skin eruptions accompany the inflammaiton

Dermatome

42

What is the most serious complication associated w/ herpes zoster?

cerebral vasculitis

involvement of the internal carotid arteries can result in a stroke

43

This client presents w/:

area of skin along a dermatome develops red, blotchy appearance that begins to itch or feel numb
in about 24-48 hours, vesicles appear on the skin along the nerve's pathway
eruptions are unilateral on the trunk, neck, or head
vesicles are extremely painful, severe itching soon follows
vesicles rupture in a few days and crusts form
scarring or permanent skin discoloration is possible
pain (postherpetic neuralgia) and itching persist for months or as long as 2 years or mroe

Herpes zoster

44

Medical management for clients w/ herpes zoster

acyclovir
corticosteroids
analgesics
liquid preparations w/ drying or antipruritic effect are applied to affected area once crusts have fallen off
immunization

45

Recommendations regarding shingles vaccine?

adults who are 60 years old or older should receive a 2 dose immunization of Shingrix vaccines regardless of whether they have had chickenpox or not
the vaccine reduces the risk and severity of shingles and postherpetic neuralgia

46

Nursing management for clients w/ herpes zoster?

a supervisory nurse reassigns nursing personnel who have not had chickenpox to AVOID contact w/ client who has herpes zoster
instruct clients w/ CRUSTED LESIONS TO AVOID CONTACT W/ IMMUNOCOMPROMISED PEOPLE AND THOSE WHO HAVE NOT HAD CHICKENPOX
advise that application of cool or warm compresses or warm showers may relieve pain and itching; may be necessary to experiment w/ both to see which one provides the best relief
nurse recommends that client wear lose clothing and avoid scratching the area
if oral acyclovir is ordered, the nurse reviews the dose regimen

47

deadliest form of skin cancer

Melanoma

48

What should tattooist do to avoid the spread of infection?

sterilize equipment, including components that hold the needles
discard ink after each use

49

an inflammatory nodular lesion that may form as a result of a cellular attack waged against the particles in the tattoo pigment

Granuloma

50

overgrowth of skin tissue

seen especially in those w/ darkly pigmented skin

Keloids

51

what color tattoo ink causes the most dermatologist problems?

what is recommended prior to obtaining a tattoo w/ this color ink?

Red
Patch testing

52

What is the priority of care following a tattoo?

preventing infection
supporting regeneration of tissue
protecting the skin from concurrent

53

REVIEW AND FAMILY TEACHING 65-3: CARE AFTER A TATTOO

54

tattoos interfere w/ the quality of what? and why?

Magnetic Resonance Imaging (MRI) b/c of the interaction of metallic compounds w/i the pigment

some people have experienced swelling or burning in the area of the tattoo when undergoing an MRI

55

Techniques for Tattoo Removal

Laser treatments: only tend to lighten tattoos (often take 5-12 sessions, with a month in between each tx
Dermabrasion: mechanically abrades the skin layers w/ a sanding disc or wire brush, sometimes leave a scar
Salabrasion: uses a salt solution solution
Scarification: skin w/ an acid solution
Plastic surgery: the surgeon inserts fluid-filled balloons under the skin to stretch it so they can remove the tattooed skin, approximate the wound edges, and retattoo the skin to camouflage the existing tattoo

56

What are the safest metals for piercings?

surgical stainless steel
niobium
titanium
solid 14k gold

57

Site care for oral piercings of the tongue or lip

keep the mouth clean as possible and should use a soft-bristle toothbrush to avoid additional oral injury
rinse mouth for 30-60 seconds w/ an antibacterial, alcohol-free mouthwash after eating food until the piercing heals
substitute an antifungal mouthwash or salt water if a superinfection of candiasis develops from the antibacterial mouthwash

58

CLIENT AND FAMILY TEACHING 65-4: CARE AFTER A BODY PIERCING

59

dermatologic condition associated w/ excessive production of secretions from the sebaceous glands

Seborrhea

60

presents as red areas covered by yellowish, greasy-appearing scales

Seborrheic dermatitis

61

loose, scaley dead, keratinized epithelium shed from the scalp in clients who may or may not have seborrheic dermatitis

Dandruff

62

This client presents w/:

hair is unusually oily
red or scaly patches on the scalp
white flakes fall from the hair and become more obvious when they collect on the shoulders of dark clothing
inflamed areas may itch

Seborrhea, Seborrheic dermatitis, Dandruff

63

Medical management for clients w/:

Seborrhea, Seborrheic dermatitis, Dandruff

frequent shampooing w/ or w/o medication to reduce oil in scalp and hair
effected medicated shampoos contain, tar, zinc pyrithione, selenium sulfide, sulfur, or salicylic acid
corticosteroids

64

Nursing management for clients w/:

Seborrhea, Seborrheic dermatitis, Dandruff

explain underlying cause and review directions and frequency for using medications
inform clients that disease may recur and that persistent treatment is necessary to control the condition

65

refers to "baldness"

affects the hair follicles and results in partial or total hair loss
client may experience self-consciousness and lose self-confidence

Alopecia

66

genetically acquired condition

"male pattern baldness"
can also affect women to a milder degree
pattern: loss of hair in lateral frontal areas or over the vertex of the head

Androgenetic alopecia

67

This client presents w/:

hair that's thinning and falling out in patches in several areas of the scalp
fhx of androgenetic baldness
not associated w/ any other physical health problems

Alopecia

68

Medical/surgical management for clients w/ Alopecia

the etiology usually restores hair growth
minoxidil
finasteride
hair grafting

69

Why is finasteride contraindicated for women?

it is an androgenic inhibitor

70

Nursing management for clients w/ Alopecia?

reassure client that they can cope w/ hair loss
suggest client consult w/ cosmetologist
women are advised to opt for loose styling rather than ponytails or braids
recommend using a conditioner or detangler after shampooing to avoid pulling hair from the head and wide-toothed comb or brush w/ smooth tips

71

infestation w/ lice

can infest any hairy parts of the body
transmitted through direct contact
cannot survive longer than 24 hours w/o blood
lice move away quickly from light

Pediculosis

72

This client presents w/:

itching of the scalp
nits cling to hairs close to 1/20 to 1/4 in from the scalp
dx made by scalp and hair inspection
removed w/ tweezers or adhesive side of tape

Pediculosis

73

Medical management for clients w/ pediculosis?

nonprescription shampoos, gels, and liquids containing pediculicides
PERMETHRIN
Nits and live lice are removed mechanically w/ a fine-toothed combing tool such as a LiceMeister

74

REVIEW CLIENT AND FAMILY TEACHING 65-5: REMOVING NITS AND LICE

75

Nursing management for clients w/ Pediculosis?

teach school volunteers and parents how to detect and recognize nits and ants
instruct client/family not to shampoo or rinse w/ conditioner before applying pediculicide
instruct client to follow label instructions on the pediculicide; leaving the chemical on for longer than 10 minutes or covering the head w/ a shower cap does not increase effectiveness and may increase the potential for toxicity
do not use pediculicides in women who are pregnant or nursing; are also contraindicated in children younger than 2 years of age and in clients who have conditions such as an open wound, epilepsy, or asthma
do not use pediculicide or eyebrows, eyelashes, or pets

76

fungal dermatophyte infection of the fingernails or toenails

tiny, plantlike parasite that thrives in warm, dark, moist environments
fungi can spread unchecked from one nail to another

Onychomycosis

77

This client presents w/:

nails that appear grossly different than normal
nails are much thicker, causing them to be elevated and distorted
yellowed and friable
may be long and jagged b/c they are difficult to trim
pressure and friction from thickened toenails can lead to pain b/c shoes do not fit comfortably and socks may wear through

Onychomycosis

78

Medical management for clients w/ onychomycosis?

Itraconazole
terbinafine
client takes the meds daily for 2 weeks for fingernail infections and 3 weeks for toenail infections
removal of toenails

79

Nursing management for clients w/ Onychomycosis

reinforce condition is chronic and to remain compliant w/ drug therapy for the duration of tx
explain dosing regimen, side effects that may develop
instruct clients:

- alternate shoes daily

- purchase leather shoes that promote evaporation

- never go barefoot

- wear footwear at communal pools or when showering in gyms or fitness centers

- avoid any damage to the skin around the nail

80

ingrown toenail

Onychocryptosis

81

This client presents w/:

local pressure from the abnormal nail growth
redness, swelling, pain that occurs where the nail pierces the adjacent tissue
corner of the upper nail is embedded in tissue
purulent drainage and odor
compensatory gait and postural changes in an effort to relieve pain
dx'd by physical examination

Onychocryptosis

82

Medical/surgical management for clients w/ Onychocryptosis

antibiotic therapy
hydrogen peroxide
soak foot in warm water and epsom salt, be sure to dry feet thoroughly
wedge of cotton may be inserted to lift the corner of the nail
diabetics and clients w/ pvd are referred to a podiatrist
for recurrent ingrown nails, surgery may be indicated

83

Nursing management for clients w/ Onychocryptosis

explain how to perform foot-soaking regimens and techniques to relieve the pressure around the ingrown nail
if surgery is performed, the nurse instructs the client on how to change the dressing, the frequency of dressing changes, and signs of infection or compromised circulation to report immediately to pcp
wear wide shoes and loose socks w/ sufficient room for toes
use toe nail clippers rather than scissors to trim toenails; nails are trimmed slightly longer than the end of the toes
keep feet dry and clean
avoid physical activities that involved sudden stops (basketball), which jams toes into the front of the shoe
obtain regular foot and nail care from podiatrist if there is a hx of DM2, diminished vision, vascular problems

84

UV light that detects fungal and bacterial infections

Wood light

85

examines the cells and fluids that are scraped and put on a glass slide w/ stain for herpes zoster & varicella

Tzanck Smear

86

diagnostic test for scabies obtained by shaving the top of the lesion placing under microscope w/ immersion oil

Scabies shaving

Timby's Introductory Medical-Surgical Nursing: Chapter 65: Caring for Clients w/ Skin, Hair, and Nail Disorders Flashcards