Dermatologic Disorders localized areas of cellulitis of legs and

trunk.
Cellulitis
Parenteral antibiotics may be needed
Definition: is an inflammation of the for cellulitis of the hands, face, or
subcutaneous tissue of the skin that lymphatic spread.
results from an infectious process.
Surgical drainage and debridement for
suppurative areas.
Pathophysiology and Etiology Complications:
Caused by infection with group A beta- Tissue necrosis
hemolytic streptococci, Staphylococcus
aureus, Haemophilus influenza, or other Septicemia
organisms.
Nursing Assessment
Usually results from break in skin.
Obtain the history of trauma to skin,
Infection can spread rapidly through needle stick, insect bite or wound.
lymphatic system.
Observe the expanding borders and
Clinical Manifestations: lymphatic streaking; palpate for
fluctuate of abscess formation.
Tender, warm, erythematous, and
swollen area that are demarcated. Watch for signs of antibiotic sensitivity –
shortness of breath, urticaria,
Tender, warm, erythematous streak that angioedema, maculopapular rash, or
extends proximally from the area, severe skin reaction, such as erythema
indicating lymph vessel involvement. multiforme, or toxic epidermal
Possible fluctuant abscess or purulent necrolysis.
discharge. Assess for patient and caretaker ability
Possible fever, chills, headaches, to provide care at home, keep affected
malaise. areas clean and adhere to medication
prescribed.
Diagnostic Evaluation:

Gram stain and culture drainage

Nursing Diagnoses:
Blood cultures
Risk for Impaired Skin Integrity related
Management: to infectious process

Oral antibiotics (penicillinase-resistant Alteration in Comfort: Acute Pain related

penicillins, cephalosporin, or to inflammation of the subcutaneous
quinolones) may be adequate to treat tissue
Nursing Interventions:
A. Protecting Skin Integrity
Administer, or teach patient to
administer, antibiotics as prescribed;
teach dosage schedule and side effects.
Maintain intravenous infusion or venous
access to administer intravenous
antibiotics, if administer.
antibiotics to determine adequacy of
treatment.
Teach patients with impaired circulation
or with impaired sensation proper skin
care and how to expect skin for trauma.
Outcome-Based Evaluation
Skin is normal color and temperature,
non-tender, non-swollen, and intact.

Elevate affected extremity to promote Patient actively moving extremity;

drainage from area. verbalize the pain.

Administer warm soaks to relieve

inflammation and to promote drainage.
Herpes Zoster
Prepare patient for surgical drainage
and debridement, if necessary. A. Definition: (shingles) is an
inflammatory condition in which a virus
Relieving Pain produces a painful vesicular eruption
along the distribution of the nerves from
Encourage comfortable position and one or more dorsal root ganglia. The
immobilization of affected area. prevalence increases with age.
Administer, teach patient to administer, Pathophysiology and Etiology
analgesics as prescribed; monitor side
effects. Caused by a varicella-zoster virus,
which is a member of DNA virus
Use of bed cradle to relieve pressure
from bed covers. Virus is identical to the causative agent
of varicella(chicken pox). After the
Patient Education and Health primary infection, the varicella-zoster
Maintenance virus may persist in a dormant state in
Ensure that patient understands dosage the dorsal nerve root ganglia. The virus
schedule of antibiotics and the may emerge from this site in later
importance of complying with therapy years, either spontaneously or in
to prevent complications. association with immunosuppresion, to
cause herpes zoster.
Advise patient to notify health care
provider immediately if condition Clinical Manifestation:
worsens; hospitalization may be Eruption may be accompanied or
necessary. preceded by fever, malaise, headache
Outpatient-treated cellulitis should be and pain may be burning, lancinating,
observed within 48 hours of starting stabbing, or aching.
Inflammation is usually unilateral, Antiviral drugs, such as acyclovir
involving the cranial, cervical, thoracic, (Zorivax), famcylovir (Famvir), and
or sacral nerves in a bandlike valacylovir (Valtrex), interfere with viral
configuration. replication; may be used in all cases,
but especially for treatment of
Vesicles appear in 3 to 4 days. immunosuppressed and/or debilitated
a. Characteristic patches of grouped patients.
vesicles appear on erythematous, Corticosteriods early in illness-given for
edematous skin severe herpes zoster if symptomatic
b. Early vesicles contain serum; they measure fail; given for anti-
later rupture and form crusts; scarring inflammatory effect and for relief of
usually does not occur unless the pain. Controversial.
vesicles are deep and they involve the Pain management; aspirin,
dermis. acetaminophen, NSAIDs, narcotics-
c. If ophthalmic branch of the facial useful during the acute stage, but not
nerve is involved, patient may have a generally effective for postherpetic
painful eye. neuralgia.

d. If healthy host, lesion resolve in 2 to Complications:

3 weeks. Chronic pain syndrome (postherpetic
A susceptible person can acquire neuralgia), characterized by constant
chicken pox if he or she comes in aching and burning pain or by
contact with the infective vesicular fluid intermittent lancinating pain or
of a zoster patient. A person with a hyperesthenia of affected skin after it
history of chicken pox is immune and has healed.
thus is not at risk from infection after Opthalmic complications with
exposure to zoster patients. involvement of ophthalmic branch of
Diagnostic Evaluation trigeminal nerver with kertitis, uveitis,
corneal ulceration, and possible
Usually diagnosed by clinical blindness.
presentation
Facial and auditory involvement,
Culture of varicella-zoster virus from resulting in hearing deficits, vertigo and
lesions or detection by fluorescent facial weakness.
antibody techniques, including viral
detection that uses monoclonal Visceral dissemination-pneumonitis,
antibodies (Micro Trak), may be done to esophagitis, enterocolitis, myocarditis
confirm diagnosis. and pancreatitis.

Management Nursing Diagnoses:

Alteration in Comfort: Pain related to Advise patient not to open the blisters,
inflammation of cutaneous nerve to avoid secondary infection and
endings. scarring.

Impaired Skin Integrity related to Reassure that shingles is a viral

rupture of vesicles.
Nursing Intervention:
Controlling Pain:
Assess patient’s level of discomfort and
medicate as prescribed monitor for side
effects of pain medications.
infection of the nerves, nervousness
does not cause shingles.
A caregiver may be required to assist
with dressing and meals. In older
persons the pain is more pronounced
and incapacitating. Dysesthesia and
skin hypersensitivity are increasing.

Teach patient to apply wet dressing for

soothing effect. Outcome-Based Evaluation
Encourage distraction techniques, such Patient verbalized decreased pain
as music therapy.
Reepithelialization skin without scarring
Teach relaxation techniques and
imagery, to help control pain

Improving skin integrity PEMPHIGUS

Apply wet dressing to cool and dry A. Definition: Is a serious autoimmune

inflamed areas by means of disease of the skin and of the mucous
evaporation. membranes, characterized by the
appearance of blisters (bullae) of
Adminster antiviral medication in various sizes on apparently normal skin
dosage prescribed (usually high dose); and mucous membranes (mouth,
warn the patient of side effects, such as conjunctiva, vagina, esophagus).
nausea. Familial benign chronic pemphigus
Apply antibacterial ointments (after (Hailey-Hailey disease) is a familial type
acute stage) as prescribed, to soften of pemphigus that appears in adults,
and separate adherent crusts and affecting particularly the axillae and
prevent secondary infection. groin.

Patient Education and Health Pathophysiology and Etiology

Maintenance The cause is unknown
Teach patient to use proper Certain drugs, other autoimmune
handwashing technique, to avoid disease, and genetics, may play a role
spreading of herpes zoster virus. in its development.

Many variants of pemphigus exist.

Clinical Manifestations

Initial lesions may appear in oral cavity;

flaccid blisters (bullae) may arise or
normal or erythematous skin.

A. The bullae enlarge and rupture,

forming painful, raw and denuded areas
that eventually become crusted.

B. The eroded skin heals slowly;

eventually, widespread