SKIN CARE for PATIENTS with SKIN CONDITIONS

Protecting the skin

1. 2.

3.

A mild-lipid free soap substitute is use. The area is rinsed completely and blotted dry with a soft cloth Deodorant soaps are avoided

Preventing Secondary Infection

1.Observe standard precautions 2.Wear gloves when inspecting the skin or dressing is carried out. 3. Proper disposal of any contaminated dressing

Reversing the Inflammatory Process

If the skin is acutely inflamed and oozing -wet dressings and soothing lotions

For chronic skin conditions in which the skin surface is dry and scalywater soluble emulsions, creams, ointments and pastes are used.

PROCESS OF WOUND HEALING

THREE TYPES of WOUND DRESSINGS

1.

Passive Dressings - it only have a protective function and maintain a moist environment for natural healing
- they include those that just cover the area and may remain in place for several days.

2. Interactive - capable of absorbing wound exudates while: 1. maintain a moist environment in the area of the wound 2. Allowing the surrounding skin to remain dry - It is thought that it modifies the physiology of wound environment by modulating and stimulating cellular activity and by releasing growth factor

3. Active improve the healing process and decrease healing time. - it includes skin graft s and biologic skin substitutes.
* Both interactive and active dressing create a moist environment at the interface of the wound with the dressing

Five Rules of Wound Care: 1. Categorization 2. Selection 3. Change 4. Evolution 5. Practice

** It is believed that the natural wound healing process should not be disrupted. Unless the wound is infected or has a heavy discharge, it is common covered for 48-72 hours

AUTOLYTIC DEBRIDEMENT -A process that uses the bodys own digestive enzymes to break down necrotic tissue. -The wound is kept moist with occlusive dressings. -Eschar and necrotic debris are softened, liquefied and separated from the bed of the wound

1.

Occlusive Dressing

Cover topical medication that applied to skin

lesion Areas is kept airtight by using plastic film (plastic wrap)

2. Wet Dressing
Wet compresses applied to the skin. Traditionally used for acute, weeping and

inflammatory lesions

3. Moisture-Retentive Dressing
Commercially prepared can performed the

same a functions a wet dressing but efficient in removing exudates, improved fibrinolysis, reduced pain, fewer infection and decreased frequency of dressing changes.

Medical Management:
Therapeutic Bath (Balneotherapy)
useful when large areas of skin are

affected. Bath remove crust, scales and old medications Relieve inflammation and pruritus that accompany acute dermatoses.

Type of Therapeutic Baths

Bath Solution Water Saline Effects and Uses same effects as wet dressings used for widely disseminated lesions antipruritic, soothing

Colloidal (aveeno, oatmeal) Sodiun Bicarbonate cooling (baking soda) Starch soothing Medicated tars psoriasis and chronic eczema Bath oils antipruritic and emollient action, acute and subacute generalized eczema eruptions

Nursing Interventions
1. 2. 3. 4. 5. 6.

7.
8.

Fill the tub half full Keep the water at a comfortable temperature Do not allow the water to cool excessively. Use a bath mat, because medications added to the bath tub can cause the tub to be slippery. Apply an emollient cream to damp skin after the bath if lubrication is desired. Because tars are volatile, the bath area should be well ventilated. Maintain a constant room temperature without drafts. Encourage the patient to wear light, loose clothing after bath.

Pharmacologic Therapy
1. Lotions
Used to replenish lost skin oils or to relieve pruritus.

Applied every 3-4 hours for sustained therapeutic effect

2 types of lotions: 1. Suspension consist of powder in water, requiring

shaking before application and clear solutions, containing completely dissolved active ingredients. Ex. Calamine lotion 2. Liniments lotions with oil added to prevent crusting. Because lotions are easy to use, therapeutic compliance is generally high.

2. Powders
dusted on the skin with a shaker or with

cotton sponges. Ex. Talc, zinc oxide, bentonite corn starch base Acts as hygroscopic agents that absorb and retain moisture from the air and reduce friction between skin surface and clothing or bedding.

3. Creams
May be suspension of oil in water or emulsions of water in oil, with additional ingredients to prevent

bacterial and fungal growth. Oil-in-water creams are easily applied and usually are most cosmetically acceptable to the patient. Water-in-oil emulsions are greasier and are preferred for drying and flaking dermatoses. Creams are usually are rubbed into the skin by hand They are used for their moisturizing and emollient effects.

4. Gels
Semisolid emulsions that become liquid when applied to

the skin or scalp Greaseless and non staining Useful for acute dermatitis.

5. Pastes
Mixtures of powders and ointments used in inflammatory

blistering conditions. They adhere to the skin and may be difficult to remove without using an oil. Applied with a wooden tongue or gloved hand.

6. Ointment- retard water loss and lubricate and

protect the skin - They are preferred vehicle for delivering medications to chronic and localized dry skin conditions such as eczema and psoriasis

7. Sprays and aerosols

- They evaporate on contact and are used infrequently

8. Corticosteroids
Action: 1. anti- inflammatory 2. antipruritic 3. vasoconstrictive effect

- Absorption is enhanced if the skin is well-hydrated or

the affected area is covered by an occlusive or moisture retentive dressing - Side effects: - A. Local side effects: 1. skin atrophy and thinning 2. striae ( bandlike streaks) 3. telangiectasia
- B. Systemic side effects:

1. hyperglycemia 2. symptoms of cushing syndrome

- CAUTION:

- this is required when applying around the eye Glaucoma or cataract Anti-inflammatory effect may mask existing viral and fungal infection

9. Intralesional therapy
- Consist of injecting a sterile suspension of medication

into or just below a lesion. - Local atrophy may result if the medication is injected into subcutaneous fat.

10.Systemic medications
Ex. Antibiotics, antifungal, antihistamine

Nursing Management: Goals: 1. Maintenance of skin integrity 2. Relief of discomfort 3. Promotion of restful sleep 4. Self-acceptance 5. Knowledge about skin care 6. Avoidance of complications

1. 2. 3. 4.

5.

Assessment Teach the patient how to wash the affected area and pat it dry Apply medication to the lesion while the skin is moist Cover the area with plastic if recommended and cover it with elastic bandage or paper tape to seal the edges Dressings that contain or cover a topical corticosteroids should be removed for 12 of every 24 hours.