Nursing Lecture on the Integumentary System


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Nursing Lecture on the Integumentary System

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  3. 4. MEASLES <ul><li>An acute, highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough and small spots with white centers on an erythematous base on the buccal mucosa (Koplik spots) </li></ul>
  4. 5. Causative agent: <ul><li>Measles virus, a member of the genus Morbilivirus of the family Paramyxoviridae </li></ul>
  5. 6. Incidence: <ul><li>Endemic in all large cities of the world recurring in epidemic form every 2 years usually occurs during cold weather. </li></ul>
  6. 7. Mode of transmission: <ul><li>Direct contact with nasal and throat secretions </li></ul><ul><li>Droplet infection </li></ul><ul><li>Less commonly, by articles freshly soiled with nose and throat secretions </li></ul>
  7. 8. Incubation period: <ul><li>9- 20 days </li></ul><ul><li>Average: 10 days </li></ul>
  8. 9. Period of communicability: <ul><li>Ranges from 3 to 4 days before the onset of the symptoms to 5 days after the rash appearance </li></ul>
  9. 10. Stages <ul><li>1. Incubation period (average of 10 days) </li></ul><ul><li>2. Pre-eruptive stage or stage of invasion (3-6 days) </li></ul><ul><li>3. Eruptive stage </li></ul><ul><li>4. Desquamation Stage </li></ul>
  10. 11. Pre-eruptive stage or stage of invasion <ul><li>from the appearance of the first sign/symptoms to the earliest evidence of the eruption. </li></ul><ul><li>fever, severe cold </li></ul><ul><li>frequent sneezing </li></ul><ul><li>profuse nasal discharge </li></ul><ul><li>eyes are red and swollen, with mucopurulent discharge (lids stick together) </li></ul><ul><li>Stimsons sign: (puffiness of lower eyelids with definite line of congestion on the conjunctivae) </li></ul>
  11. 12. Pre-eruptive stage or stage of invasion <ul><li>redness of both ear drums </li></ul><ul><li>vomiting, drowsiness </li></ul><ul><li>hard dry cough </li></ul><ul><li>Koplik’s spot (appears on 2nd day): small, bright red macules or papules with tiny bluish-white specks on the center and can be found on the buccal cavity </li></ul><ul><li>maculopapular rashes (seen late in 4th day), occurs first on the cheeks or at the hairline </li></ul><ul><li>true measles rash: slightly elevated small red papules, dry and hot sensation to touch </li></ul>
  12. 16. Eruptive stage <ul><li>Characterized by a general intensification of all local constitutional symptoms of the pre-eruptive stages with the appearance of bronchitis and loose bowels </li></ul><ul><li>Maculo-papular rashes starting from head to feet </li></ul><ul><li>Irritability and restlessness </li></ul><ul><li>Red and swollen throat </li></ul><ul><li>Enlargement of cervical glands </li></ul><ul><li>Fever subsides </li></ul>
  13. 17. Desquamation Stage <ul><li>follows after the rashes fade, dry, and feel off </li></ul><ul><li>follows the order of distribution seen in the formation of eruption </li></ul>
  14. 18. Summary <ul><li>Cough, colds, coryza (3C’s) </li></ul><ul><li>3 rd day: Characteristic red blotchy rash appears on the 3 rd to 7 th day </li></ul><ul><li>Rash begins on the face  becomes generalized, lasts 4 – 7 days </li></ul><ul><li>Ends in desquamation </li></ul>
  15. 19. Diagnostic exam: <ul><li>No specific diagnostic exam except only for the presence of leukopenia </li></ul>
  16. 20. Prevention: <ul><li>Education of parents regarding the disease </li></ul><ul><li>Passive immunization of infants and children (gamma-globulin) </li></ul><ul><li>Active immunization (1st year of life) </li></ul>
  17. 21. Vaccine storage: <ul><li>Freeze – dried measles vaccine is relatively stable and can be stored in a freezer or at refrigerator temperatures with safety  for a year or more </li></ul><ul><li>Reconstituted vaccine should be kept at refrigerator temperatures and discarded  after 8 hours </li></ul><ul><li>Both vaccine should be protected from prolonged exposure to ultraviloent light  which may inactivate the vaccine </li></ul>
  18. 22. Management: <ul><li>1. Drugs – Antibiotics for secondary bacterial infection) </li></ul><ul><li>2. Isolation </li></ul><ul><li>3. Meticulous skin care - warm alcohol cup to prevent pressure sores </li></ul><ul><li>4. Good oral and nasal hygiene – increase oral fluids </li></ul><ul><li>5. Proper care of the eyes - screen to avoid direct light: wear dark glasses </li></ul><ul><li>6. Ears should be cleaned after bath, bath if there discharges – patient should lie the affected ear down or towards the bed </li></ul><ul><li>7. Give ample of fluids during febrile stage </li></ul>
  19. 23. Complications: <ul><li>1. Otitis media </li></ul><ul><ul><li>death rate is highest in the 1st 2 years of life. </li></ul></ul><ul><li>2. Bronchopneumonia </li></ul><ul><ul><li>after 4 yrs. uncommon </li></ul></ul><ul><li>3. Severe bronchitis </li></ul><ul><ul><li>overall mortality rate-less than 4% </li></ul></ul>
  20. 25. GERMAN MEASLES <ul><li>An acute infectious disease characterized by mild constitutional symptoms, rose colored macular eruption which may resembles measles and enlargement and tenderness of lymph nodes </li></ul>
  21. 26. Causative agent: <ul><li>Rubella virus (family Togaviridae; genus Rubivirus) </li></ul>
  22. 27. Incidence: <ul><li>Occurs mostly in spring and seen mostly in children over 5 years of age </li></ul>
  23. 28. Mode of transmission: <ul><li>Contact with nasopharyngeal secretions of infected people </li></ul><ul><li>Droplet spread or direct contact with patients </li></ul>
  24. 29. Incubation period: <ul><li>Period of 14 – 21 days </li></ul>
  25. 30. Period of communicability: <ul><li>7 days before to 5 days after the rashes appears </li></ul><ul><li>Infants with CRS may shed virus for months after birth </li></ul>
  26. 31. Clinical manifestations: <ul><li>fever </li></ul><ul><li>loss of appetite </li></ul><ul><li>enlargement of lymph nodes </li></ul><ul><li>sweating </li></ul><ul><li>leucopenia </li></ul><ul><li>vomiting (in some cases) </li></ul><ul><li>headache, mild sore throat </li></ul><ul><li>desquamation follows the rash </li></ul>
  27. 32. Clinical manifestations: <ul><li>enanthem of uvula with tiny red spots </li></ul><ul><li>rash (cardinal symptom) accompanied with cervical adenitis </li></ul><ul><li>begins on the face including the area around the mouth </li></ul><ul><li>oval, pale rose-red papules about the size of a pinhead </li></ul><ul><li>covers the body within 24 hours and gone by the end of 4th day </li></ul>
  28. 34. Prevention: vaccination <ul><li>1. Gammaglobulin – given to pregnant women with negative history and who have been exposed in the first trimester of pregnancy. </li></ul><ul><li>2. Included in MMR given at 15 months to the baby. </li></ul>
  29. 35. Management: <ul><li>1. Isolation – (Catarrhal stage) to prevent infection to others </li></ul><ul><li>2. Bed rest for first few days </li></ul><ul><li>3. Meticulous skin care especially after the rash fades </li></ul><ul><li>4. Good oral and nasal hygiene (use petroleum jelly if lips become dry) </li></ul><ul><li>5. No special diet is necessary / increase fluid intake </li></ul>
  30. 36. Complications: <ul><li>1. Otitis media </li></ul><ul><li>2. Encephalitis </li></ul><ul><li>3. Congenital defects for babies whose mother were exposed in early pregnancy </li></ul>
  31. 38. VARICELLA <ul><li>A very contagious acute disease usually occurring in small children, characterized by the appearance of vesicles, frequently preceded by papules , occasionally followed by pustules but ending in crusting </li></ul>
  32. 39. Causative agent: <ul><li>Varicella zoster virus </li></ul>
  33. 40. Incidence: <ul><li>Occurs before the 6th year especially in winter </li></ul>
  34. 41. Mode of transmission: <ul><li>From person to person by direct contact </li></ul><ul><li>Droplet or airborne spread of vesicle fluid or secretions of the respiratory tract </li></ul><ul><li>Indirectly through articles freshly soiled by discharges from vesicles and mucous membranes of infected people </li></ul>
  35. 42. Incubation period: <ul><li>2 – 3 weeks </li></ul><ul><li>Commonly 14 – 16 days </li></ul>
  36. 43. Period of communicability: <ul><li>Highly contagious from 2 days prior to rash to 6 days after rash erupts </li></ul><ul><li>Patient remain contagious until the lesion have crusted completely </li></ul>
  37. 44. Clinical Manifestations: <ul><li>Slight fever: first to appear </li></ul><ul><li>Body malaise, muscle pain </li></ul><ul><li>Eruption (maculopapular) then progresses to vesicle (3-4 days) </li></ul><ul><ul><li> begins on trunk and spreads to extremities and face (even on the scalp, throat and mucus membranes) </li></ul></ul><ul><li>Intense pruritus </li></ul><ul><li>Vesicles ended as a granular scab </li></ul><ul><li>Irritability </li></ul>
  38. 46. Prevention: <ul><ul><li>0.5 mL SC varicella vaccine </li></ul></ul><ul><ul><li>And for immunization of children up to 12 years of age who have not had varicella </li></ul></ul>
  39. 47. Management: <ul><li>1. Drugs </li></ul><ul><ul><ul><li>Penicillin: can be used when the crusts are severe or infected to prevent scarring or secondary invasion </li></ul></ul></ul><ul><ul><ul><li>Acyclovir, Immunosin – anti virus </li></ul></ul></ul><ul><ul><ul><li>Hydrocortisone lotion 1% for itching </li></ul></ul></ul><ul><li>2. Isolation in a room by itself </li></ul><ul><li>3. Provide a well-ventilated, warm room to the patient </li></ul><ul><li>4. Warm bath should be given daily to relieve itching (may use baking soda) </li></ul><ul><li>5. Avoid injuring the lesions by using soft absorbent towel and the patient should be potted dry instead of rubbed dry </li></ul><ul><li>6. Maintain good oral hygiene. If lesions are found in the mouth or nasal passages, antiseptic prep may be used </li></ul>
  40. 48. Complications: <ul><li>1. Pneumonia </li></ul><ul><li>2. Nephritis </li></ul><ul><li>3. Encephalitis </li></ul><ul><li>4. Impetigo </li></ul><ul><li>5. Pitting or scarring of the skin </li></ul>
  41. 50. HERPES ZOSTER <ul><li>Acute viral infection of the peripheral nervous system due to reactivation of varicella zoster virus. </li></ul><ul><li>The consequence of a reactivation of latent VZV from the dorsal root ganglia. </li></ul><ul><li>Contagious to anyone who has not had varicella or who is immunosuppressed. </li></ul>
  42. 51. HERPES ZOSTER <ul><li>Occurs at all ages, but its incidence is highest among individuals in the 6 th through the 8 th decades of life </li></ul><ul><li>Approximately 2 % of patients with herpes zoster will develop a second episode of infection </li></ul><ul><li>Factors responsible for the reactivation of VZV are not known </li></ul>
  43. 52. Clinical manifestations <ul><li>Neuralgic pain </li></ul><ul><li>Malaise </li></ul><ul><li>Burning sensation </li></ul><ul><li>Fever </li></ul><ul><li>Cluster of skin vesicles along course of peripheral sensory nerves ( unilateral and found in trunk, thorax or face): appears 3-4 days. </li></ul>
  45. 54. Management: <ul><li>1. Drugs </li></ul><ul><ul><li>Analgesics </li></ul></ul><ul><ul><li>Corticosteroids </li></ul></ul><ul><ul><li>Anti virals (acyclovir, famcyclovir, valacyclovir) </li></ul></ul><ul><li>2. Isolate client </li></ul><ul><li>3. Apply drying lotions (calamine) </li></ul><ul><li>4. Administer medications as ordered </li></ul><ul><li>5. Instruct client on preventive measures </li></ul>
  46. 59. SCABIES <ul><li>A parasitic infection of the skin caused by a mite </li></ul><ul><li>Penetration is visible as papules, vesicles or tiny linear burrows containing the mites or their eggs </li></ul><ul><li>Lesions are prominent around finger webs, anterior surfaces of wrists and elbows, anterior axillary folds, belt portion of the buttocks </li></ul>
  47. 61. SCABIES <ul><li>In infants, the head, neck, palms, and soles may be involved; these areas are usually spared in older individuals </li></ul><ul><li>Common in individuals living in areas of poverty where cleanliness is lacking </li></ul>
  48. 62. Causative Agent: <ul><li>Sarcoptes scabiei, a mite </li></ul>
  49. 63. Mode of transmission: <ul><li>Direct contact with infested skin and can be acquired during sexual contact </li></ul><ul><li>Transfer from undergarments and bedclothes occurs only if these have been contaminated by infested people immediately beforehand </li></ul>
  50. 64. Clinical Manifestations: <ul><li>Intense itchiness especially at night, but complications are limited to lesions secondarily infected by scratching </li></ul><ul><li>Sites: </li></ul><ul><ul><li>Interdigital areas </li></ul></ul><ul><ul><li>Flexors surface of the wrist and palms </li></ul></ul><ul><ul><li>Nipples </li></ul></ul><ul><ul><li>Umbilicus </li></ul></ul><ul><ul><li>Axillary folds </li></ul></ul><ul><ul><li>Groin or gluteal folds </li></ul></ul><ul><ul><li>Penis and scrotum </li></ul></ul>
  51. 65. Diagnostic Examination: <ul><li>Presence on skin of female mites and ova upon skin biopsy or scraping </li></ul>
  52. 66. Medical Management: <ul><li>Lindane solution (Kwell) </li></ul><ul><li>Crotamiton (Eurax) </li></ul><ul><li>Anti-histamines – to reduce itchiness. </li></ul>
  53. 67. Nursing Interventions: <ul><li>Boiling of linens and clothes </li></ul><ul><li>Encourage to change clothing and linen frequently </li></ul><ul><li>Warm shower bath to remove scaling debris or crusts </li></ul><ul><li>Putting on a gown and gloves for health care provider </li></ul>
  54. 69. LEPROSY (Hansen’s Disease) <ul><li>Chronic bacterial infection characterized by the appearance of nodules in the skin or mucous membrane, and by changes in the nerves leading to anesthesia or paralysis </li></ul>
  55. 70. Causative agent: <ul><li>Mycobacterium leprae (acid fast bacilli) </li></ul><ul><li>The organism has not been grown in bacteriologic media or cell cultures </li></ul><ul><li>It can be grown in mouse foot pads </li></ul>
  56. 71. Incubation Period: <ul><li>Ranges from 9 months to 20 years </li></ul><ul><li>The average is probably 4 years for tuberculoid leprosy and twice that for lepromatous leprosy </li></ul>
  57. 72. Period of Communicability <ul><li>Clinical and laboratory evidence suggest that infectiousness is loss in most instances </li></ul><ul><ul><li>with 3 months of continuous and regular treatment with dapsone or clofazimine </li></ul></ul><ul><ul><li>or within 3 days of treatment with rifampin </li></ul></ul>
  58. 73. Mode of transmission: <ul><li>Exact mode of transmission is not clearly established </li></ul><ul><li>Prolonged intimate skin-to-skin contact and to Nasopharyngeal secretions </li></ul>
  59. 74. TYPES: <ul><li>1. Tuberculoid </li></ul><ul><li>2. Lepromatous </li></ul><ul><li>3. Intermediate </li></ul>
  60. 75. Tuberculoid Type <ul><li>Shows high resistance to Hansen’s bacilli </li></ul><ul><li>Patient can mount a cell –mediated defense against the bacilli. </li></ul><ul><li>1 – 2 skin lesions only which are well defined, elevated and hypopigmented </li></ul><ul><li>(+) Lepromin test </li></ul>
  61. 76. Lepromatous Type <ul><li>Minimal resistance to the multiplication </li></ul><ul><li>Severest form </li></ul><ul><li>Patient cannot mount a cell – mediated immune response </li></ul><ul><li>Acid fast bacilli are found everywhere </li></ul><ul><li>( - ) Lepromin test </li></ul><ul><li>Clinical manifestations include: </li></ul><ul><ul><li>Leonine facies – facial skin are thickened </li></ul></ul><ul><ul><li>Saddle nose deformity – nasal cartilage can be destroyed </li></ul></ul><ul><ul><li>Infertility – secondary to internal testicular damage </li></ul></ul>
  62. 77. Clinical Manifestations: <ul><li>Early Stage: “CLUMP” </li></ul><ul><li>C - changes in skin color (red or white) </li></ul><ul><li>L - lesion is hyposthetic and loss of sweating </li></ul><ul><li>U - ulcers that do not heal </li></ul><ul><li>M - muscle weakness or paralysis </li></ul><ul><li>P – painful and thickened nerves </li></ul>
  63. 78. Clinical Manifestations: <ul><li>Late Symptoms: “CLISM” </li></ul><ul><li>C – clawing of fingers and toes </li></ul><ul><li>L – “leonine” appearance (due to thickened skin of the forehead and face) </li></ul><ul><li>I – inability to close eyelids (lagophthalmos) </li></ul><ul><li>S – sinking of nose bridge (saddle nose) </li></ul><ul><li>M – madarosis (loss of eyebrows) </li></ul>
  64. 81. Clinical Manifestations: <ul><li>Cardinal Symptoms: “PPP” </li></ul><ul><li>P – presence of hansen’s bacilli on skin biopsy </li></ul><ul><li>P – presence of localized areas of anesthesia </li></ul><ul><li>P – peripheral nerve enlargement </li></ul>
  65. 82. Diagnostic Examinations: <ul><li>Skin biopsy </li></ul><ul><li>Skin smear test </li></ul><ul><li>Lepromin test – (+) test develops a nodule on site of inoculation (1st – 3rd week ) </li></ul><ul><li>Nerve involvement with acid – fast bacilli is pathognomonic of leprosy </li></ul>
  66. 83. Medical Management: <ul><li>Multiple drug therapy (MDT) </li></ul><ul><li>(Rifampicin, Dapsone, and Clofazimine) over 6 – 9 months period or 18 – 30 months period </li></ul>
  67. 84. Nursing Interventions: <ul><li>Full diet </li></ul><ul><li>A daily cleansing bath and change of clothing </li></ul><ul><li>Skin care </li></ul><ul><li>Self care, exercise, and physical therapy </li></ul><ul><li>TSB for fever </li></ul>
  68. 85. Prevention: <ul><li>Separate infants from lepromatous parents at birth </li></ul><ul><li>Segregate and treat patients with open lesions </li></ul><ul><li>Public health supervision </li></ul>
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