Chapter 52-Part 3-Med/Surg

Chapter 52-Part 3-Med/Surg

2/3/21

Fungal Infections (Tinea-caused by fungus)

Pathophysiology

ØTinea pedis (athlete’s foot)

ØTinea manus (hand)

ØTinea cruris (groin)

ØTinea capitis (scalp)

ØTinea corporis (body) (Ringworm)

ØTinea barbae (beard)

ØCandidiasis: affects skin, mouth, vagina, gastrointestinal tract, and lungs

Ringworm

Fungal Infections (cont.)

Cause and risk factors

ØSpread through direct contact or by inanimate objects

ØLesions may be scaly patches with raised borders

ØPruritus common symptom

˜Medical diagnosis

ØConfirmed by microscopic examination of skin scrapings

Medical treatment

ØFungal: treated with antifungal powders and creams

ØOral candidiasis: treated with clotrimazole troches, nystatin mouthwash or lozenges, oral amphotericin B

Fungal Infections (cont.)

Assessment

ØConditions that might make a person susceptible to fungal infections

ØInspect the skin and mucous membranes for lesions

Interventions

ØDisturbed body image

ØImpaired oral mucous membrane

ØRisk for injury

Athlete's Foot

Acne

Pathophysiology

ØAffects the hair follicles and sebaceous glands

ØComedones (whiteheads, blackheads), pustules, cysts

ØOften develop on the face, neck, and upper trunk

Cause and risk factors

ØAndrogenic hormones cause increased sebum production; bacteria proliferate, causing sebaceous follicles to become blocked and inflamed

Acne (cont.)

Medical treatment

ØTopical medications: antibiotics, keratolytics such as benzoyl peroxide, topical vitamin A preparations

ØOral antibiotics given over several months

ØEstrogen to counteract effects of androgenic hormones

ØSpironolactone for antiandrogenic effects

ØNonpharmacologic treatment: comedo extraction or cryotherapy

Dermabrasion to reduce scarring

Acne (cont.)

˜Isotretinoin (Accutane)prescribed for severe cases unresponsive to other treatments

˜Oral medication; has drying effect on the skin

˜Skin appearance worsens, then improves

˜Teratogenic effect; harmful to fetus

˜Two forms of effective contraception must be used

˜Patient must have 2 negative pregnancy tests within 2 weeks of starting therapy and one negative test before each monthly refill

˜Drug should be started day 3 or 4 of next normal menstrual period

˜Patient must agree to the terms of IPledge program

Acne (cont.)

Assessment

ØDocument any treatments being used

ØInspect skin to determine extent and severity

Interventions

ØDisturbed body image

Ineffective self-health management

Herpes Simplex

Cause and risk factors

ØViral infection begins with itching and burning and progresses to vesicles that rupture and form crusts

ØNose, lips, cheeks, ears, genitalia most often affected

ØOral lesions called cold sores or fever blisters

ØInfections on the face and upper body usually caused by HSV-1; genital infections by HSV-2 

Herpes Simplex (cont.)

Medical diagnosis

ØLaboratory studies of exudate from a lesion and blood studies to detect specific antibodies

Medical treatment

ØAcyclovir (Zovirax)

ØDocosanol (Abreva) for cold sores

ØAntiviral drugs may reduce severity and frequency of outbreaks (are not curative)

ØAnalgesic agents and topical anesthetic agents may be prescribed for pain

Herpes Simplex (cont.)

Assessment

ØDescribe the development of the herpetic lesions

ØSexual contacts documented so that they can be advised of the need for medical evaluation

ØInspect the lesions

Interventions

ØAcute pain

ØIneffective coping

ØIneffective self- health management

Herpes Zoster

Cause and risk factors

ØCommonly called shingles

ØVaricella zoster virus; also causes chickenpox

ØSymptoms: pain, itching, and heightened sensitivity along a nerve pathway, followed by the formation of vesicles in the area

ØWhen the skin is affected, crusts form

ØOlder adults especially susceptible to complications

ØImmunosuppressed at greater risk for herpes zoster infections; may have serious systemic complications

Herpes Zoster (cont.)

Medical diagnosis 

ØHealth history and physical examination findings

ØTzanck smear or viral culture of material from a lesion

Medical treatment

ØAntiviral agents: acyclovir, famciclovir, valacyclovir, and foscarnet (most effective if initiated within 72 hours of the onset of the rash)

ØWet dressings soaked in Burow’s solution

ØPain may be treated with analgesics and sedatives

Herpes Zoster (cont.)

Assessment

ØConditions or treatments that might cause the patient to have a reduced immune response

ØDistribution and appearance of the lesions

Interventions

Impaired skin integrity

Acute pain

Ineffective coping

Multiple Choice

A patient who has undergone treatment for herpes simplex virus type 2 (HSV type 2) expresses relief that she is cured. What should the nurse include in her teaching?

• Daily douches of Burow solution are needed.

• HSV is permanently cured by acyclovir (Zovirax).

• Sexual partners are now safe from infection from her.

• HSV lies dormant and can be triggered without any sexual contact.

Multiple Choice

An 80-year-old patient comes to the emergency department with extreme pain and itching in the hip and leg and has herpetic vesicular lesions on the left hip. What should the nurse inquire about patient exposure to?

• HSV, type 1

• HSV, type 2

• Smallpox

• Chickenpox

Multiple Choice

A physician asks a nurse to take a smear from herpetic lesions in an older patient’s hip to diagnose the disorder. What is the most probable test that will be performed?

• Culture and sensitivity test to a bactericide

• Tzanck smear to test for viral culture

• Complete blood count to assess the white blood count for response to a pathogen

• Titration for the strength of the pathogen

Multiple Choice

A nurse organizes a nursing care plan on the nursing diagnosis of “Acute pain, related to postherpetic neuralgia.” Which is the least appropriate implementation?

• Give antiviral medication as prescribed.

• Generously administer pain medication.

• Offer guided imagery or distraction techniques.

• Have the patient ambulate several times daily.

Multiple Select

Which conditions can be improved with negative pressure therapy? (Select all that apply.)

• Pressure ulcers

• Skin grafts

• Burns

• Dehisced surgical wounds

• Eczema