Romdzati, S.Kep., Ns.

, MNS
Nursing School, Faculty of Medicine and Health Sciences
Universitas Muhammadiyah Yogyakarta

 Integumentary

system: skin, hair,

nails, & glands

The largest organ 20% of bodys
weight
Primary function: protect the body
Skin layer: epidermis, dermis

Wrinkle
Moles
Age spots
Dryness
Thinning
Pigment changes in the hair and skin
The changes associated risks include
injury, infection, illness, and
temperature control.

 The
The

Thin

epidermal cells change shape

barrier function is reduced

& become more susceptible to

trauma & infection

Physical Changes

Clinical Findings

Changes in
Functional Ability

Epidermis
Decreased thickness
in epidermal layer

Increased skin
transparency &
fragility

Decreased epidermal
mitotic activity

Delayed wound
healing

Decreased epidermal
mitotic homeostasis

Skin hyperplasia,
such as
hyperkeratoses & skin
cancers

Increased epidermal
permeability

Increased
susceptibility to
irritant reactions

Decreased barrier
function

Decreased number of

Decreased cutaneous

Decreased injury

Decreased cell
replacement

Physical Changes

Clinical Findings

Decreased number of
active melanocytes

Increased sensitivity to sun

exposure

Hyperplasia of
melanocutes at the
dermal-epidermal
junction (*)

Mottled hyperpigmentation
& hypopigmentation (liver
spots, age spots)

Decreased vitamin D
production

Increased susceptibility to
osteomalacia

Flattening of the
dermal-epidermal
junction

Increased susceptibility to
shearing forces, with
resultant blisters, purpura,
skin tears, & pressurerelated skin problems

Changes in
Functional
Ability

Decreased
vitamin D
production

Physical Changes

Clinical Findings

Changes in
Functional Ability

Dermis
Decreased dermal
blood flow

Increased susceptibility
to dry skin (xerosis)

Decreased
chemical clearance

Decreased vasomotor
responsiveness

Increased
thermoregulatory
alterations
(predisposition to heat
stroke & hypothermia)

Decreased injury
vascular
responsiveness

Decreased dermal
thickness

Paper-thin, transparent
skin with an increased
susceptibility to trauma

Decreased injury
response

Degeneration of
elastic fibers

Decreased tone &

elasticity (wrinkles)

Body image
alterations

Benign proliferation of Cherry hemangiomas

capillaries

Physical Changes

Clinical Findings

Changes in
Functional
Ability

Abnormal nerve
endings

Alterations in sensory perception

Decreased
sensory
perception

Redistribution of
adipose tissue

Bags, cellulite, double chin,

abdominal apron

Body-image
alterations

Thinning of
subcutaneous fat
layer

Increased susceptibility to
Decreased
hypothermia
thermoregulation
Decreased resistance to mechanical
injury (pressure necrosis)

Subcutaneous
Layer

Hair
Decreased number
of hair follicles &

Increased hair thinning

Decreased cell
replacement

Physical Changes

Clinical Findings

Changes in
Functional
Ability

Decreased rate of
growth

Increased susceptibility to fungal

infections

Decreased cell
replacement

Decreased blood
flow beneath the
nail

Longitudinal nail ridges

Nails

Glands
Decreased sebum
production despite
sebaceous gland
hyperplasia

Increased size of pores (especially

on nose); large comedones in malar
region

Decreased eccrine
& apocrine gland
activity

Increased susceptibility to dry skin

Decreased perspiration, leading to
decreased cooling effect

Decreased sweat
production
Decreased

 Eczema
Keratosis

EKSIM (ECZEMA)

Eksim=dermatitis
Tahap:
1. Dermatitis akut: erosi ekstensif dengan
eksudat serosa atau papul dan vesikel
eritematosa sangat gatal pada dasar
eritema
2. Dermatitis subakut: papul atau plak
eritematosa, pengelupasan mengkilap
3. Dermatitis kronis: penebalan kulit, bekas
garukan

 Eksim

umum, kronis, sering kambuh,

gatal dimulai pd masa kanak-kanak
Alergi thd serbuk bunga, asma, kulit
sensitif, riwayat pd keluarga
Etiologi:
Genetik
Lingkungan: negara industri, beriklim
sedang, polusi, penurunan pemberian
ASI

 Pada

lansia sering disebabkan oleh

insufisiensi vena, alergen, iritan atau
keganasan (leukemia, limfoma),
interaksi obat

 Onset akut
Ruam merah
Basah
Terdapat krusta
Kronis: kulit kering

menebal, warna
abu-abu kecoklatan, bersisik
Pruritus
Sering muncul infeksi kulit viral
(Herpes), bakterial, jamur

 Infeksi

bakteri (contoh:
Staphylococcus aureus): krusta
berwarna seperti madu, perembesan
cairan serosa, folikulitis, pioderma,
furunkulosis

Medis
Hidrasi kulit
Hilangkan alergen
Kurangi inflamasi: antibiotik,
antihistamin, kortikosteroid (jarang
digunakan)
Keperawatan
Tingkatkan kebersihan kulit
Kaji kebiasaan mandi, penggunaan
pelembap, medikasi, paparan terhadap
alergen, lingkungan, riwayat erupsi kulit

 Umum pada lansia

Kulit eritematosa, berisik,

pecah-pecah

secara halus
Xerosis berat: kulit kencang, gatal, &
nyeri
Faktor yang memperparah:
Sabun
Desinfektan
Jarang menggunakan pelembab

Penatalaksanaan:
Hidrasi
Melembabkan kulit
Menghindari fakor iritan

Jenis:
Dermatitis kontak iritan: paparan
terhadap zat apapun yang
menyebabkan respon iritan
kimiawi/fisik paling umum
Dermatitis kontak alergi:
hipersensitivitas terhadap alergen
Manifestasi klinis
Gatal, rasa menyengat, eritema,
edema, eritema

 Muncul

setelah 1 jam kontak atau 7-14

hari setelah kontak
Eritema ringan, vesikel, atau ulserasi
Penatalaksanaan:
Identifikasi alergen
Obat topikal (gatal, nyeri)
Obat antihistamin, kortikosteroid
Uji Patch (tempel): untuk menentukan
agen spesifik

 Area

intertrignosa: di antara lipatanlipatan kulit (paha, leher, aksila, fosa

antekubital, perineum, sela-sela jari
tangan & kaki, abdomen, bawah
payudara)
Infeksi sekunder: Pseudomonas,
Staphylococcus, Candida albicans
Etiologi:
Kontaminasi cairan tubuh

 Penatalaksanaan:
Keringkan area tubuh
pakaian dari bahan katun
Hindari pakaian ketat
Jika perlu, gunakan perban
Kortikosteroid topikal (inflamasi)
Kombinasi agen steroid-antibiotik-

antifungal

 Area

kulit sangat kering, gelap,

kadang disertai ulkus dangkal pada
tungkai bawah
Etiologi: insufisiensi vena
Penatalaksanaan:
Pelembab
Antihistamin
antifungal

Faktor risiko:
Sering terpapar urine atau feses
diare
Penggunaan popok
Infeksi

kulit sekunder: jamur

Urine terserap oleh keratinosit bau
amonia, membengkak

 Penatalaksanaan:
Tentukan penyebab
Jaga kebersihan kulit
Bersihkan dengan segera,

inkontinensia

klien

KERATOSIS

 Keratosis

merupakan pertumbuhan
jaringan keratin pada permukaan
kulit
Jenis:
Keratosis aktinik
Keratosis hidrokarbon
Keratosis pilaris
Keratosis seborea

 Lesi

prakanker epitel, terutama

disebabkan oleh paparan matahari
Wajah, bagian atas telinga, leher bagian
belakang, lengan bawah, punggung
tangan, dada
Berisiko terjadi malignansi & metastasis
pada lesi yang dibiarkan
Lesi: makula, papula, iregular, rata,
sedikit eritematosa dg tepi tidak tegas,
sisik tanduk/keratotik yg keras

Penatalaksanaan medis:
Obat topikal fluorouracil
antineoplastik topikal
Cara pemberian: dioleskan 2x sehari
selama 2-4 minggu
Side effect: nyeri
Penyembuhan bisa 1-2 bulan
Krioterapi (pembekuan menggunakan
nitrogen cair), tanpa anestesi

 Elektrodesikasi

& kuretase: anestesi

lokal, pengikisan, area luka dijaga
lembab dg salep antibiotik
Eksisi laser: energi cahaya untuk
menguapkan lesi
Biopsi punch/eksisional9

 Keratosis

hidrokarbon=pitch
keratosis: keratosis yang terjadi
setelah terpapar hidrokarbon
Keratosis pilaris=follicular keratosis
Keratosis seborea=seborrheic
verruca : berbentuk oval atau bulat;
penatalaksanaan dengan
electrocautery, curettage, shave
excixion, cryosurgery

 Assessment
Diagnose
Outcome
Intervention
Implementation

 Impaired skin integrity

Disturbed body image
Risk for infection
Risk for impaired skin integrity

 Common

related factor: contact with

irritant
Defining characteristics:
Inflammation
Dry, flaky skin
Erosion, excoriations, fissures
Pruritus, pain, blisters
Expected outcome: patient maintains
optimal skin integrity within limits of the
disease, as evidenced by intact skin

Intervention

Rationale

Encourage the patient to adopt

skin care routines to decrease
skin irritation

One of the first steps in the

management of dermatitis is
promoting healthy skin & healing
of skin lesions

Bathe or shower using lukewarm

water, mild soap or non soap
cleanser

Long bathing or showering in hot

water causes drying of the skin &
can aggravate itching through
vasodilatation

After bathing, allow the skin to air Rubbing the skin with a tower can
dry or gently pat the skin dry.
irritate the skin & exacerbate the
Avoid to rubb or brisk drying.
itch-scratch cycle
Apply topical steroid creams or
ointments

Reduce inflammation & promote

healing of skin

Defining Characteristics
Visible skin lesions
Common Related Factor
Verbalizes feelings about change in body
appearance
Verbalizes negative feelings about the skin
condition
Fear of rejection or reactions of others
Expected Outcome
Patient verbalizes feeling about lesions and
continues daily activities and social
interactions.

Intervention

Rationale

Assist the patient in articulating

responses to questions from
others regarding lesions.

Patients may need guidance in

determining what to say to
people who comment about the
appearance of their skin.
Dermatitis is not a contagious
skin condition.

Allow patients to verbalize

feelings regarding their skin
condition.

Through talking, the patient can

be guided to separate physical
appearance from feelings of
personal worth.

Assist patients in identifying ways Clothing, cosmetics, and

to enhance their appearance.
accessories may direct attention
away from the skin lesions. The
patient may need help in
selecting methods that do not
aggravate the skin lesions.

 Risk Factors
Impaired skin integrity
Severe inflammation
Excoriation
Desired Outcome
Patient remains free of

infection.

secondary

Intervention

Rationale

Apply topical antibiotics.

Topical antibiotics may be

used to treat infections that
occur with dermatitis.

Administer oral antibiotics.

Oral antibiotics may be more

effective in treating infections
on the skin.

Encourage the patient to use

appropriate hygiene methods.

Keeping the skin clean, dry,

and well lubricated reduces
skin trauma and risk of
infection.

 Risk Factors
Severe pruritus
Scratches skin frequently
Dry skin
Desired Outcome
Patient reports increased comfort

level and skin remains intact.

Intervention

Rationale

Encourage the patient to avoid

triggering factors.

Contact with factors that

stimulate histamine release will
increase itching

Maintain hydration of stratum

corneum.

Moist skin is less likely to

experience pruritus

Use cool compresses on pruritic

areas of the skin.

Cool, moist compresses help

relieve pruritus and itching

Administer antihistamine drugs.

It will help relieve itching and

promote comfort

Apply topical steroid creams if

indicated.
Administer oral steroids.

 Ketika

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melakukanwukuf di Arofah, tiba-tiba
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alaihi wa sallam
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Aurat berlaku bagi yang masih hidup
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