2023/8/16

By Pushpa Devkota
Medical Surgical Nursing
Table Of Content
Unit 10 nUrsing care of Patient with skin DisorDer

Unit 10.1 Anatomy and Physiology of the Skin

10.2 Etiology path physiology sign and symptoms, investigation
treatment, nursing management of patient with the following
disorder
10.3 Inflamatory Disorder
Acne Vulgaris,Herpes Simplex
Learning Objectives
• To define skin
• To List the layer of skin
• To describe function of skin
• To define Acne Vulagaris,Herpes simplex.
• To understand Etiology,patho,sign and
symptoms,diagnosis,treatement and Nursing management of Acne
Vulgaris and Herpes Simplex.
Skin
Defination
The skin is also known as cutaneous membrane ,covers the external
surface of the body. It is a sensory organ which is an largest organ of
the body in both surface area and weight. It protects the underlying
structures from injury and from invasion by microbes.
Layers of Skin

The skin consists of 3 layers:

– Epidermis
– Dermis
– Subcutaneous tissue (hypodermis)
Epidermis
• The epidermis is the thinnest layer of skin, but it’s responsible for
protecting you from the outside world, and it’s composed of five
layers of its own.It is non vascular outermost layer, continuously
dividing cells.
Layers of Epidermis
Stratum Corneum: The outermost layer of the epidermis, composed of dead
skin cells called corneocytes. It acts as a barrier to prevent water loss and
protect against external factors.

Stratum Lucidum: This layer is only present in thick skin areas, such as the
palms and soles of the feet. It consists of translucent cells that help with
additional protection.

Stratum Granulosum: In this layer, cells produce granules that contain

keratin, a protein that contributes to skin strength and water resistance.
Cont’d...
Stratum Spinosum: This layer contains cells that are responsible for
producing keratinocytes, which are eventually transformed into keratin.

Stratum Basale (or Stratum Germinativum): The deepest layer of the

epidermis where cells are actively dividing. Melanocytes, which
produce melanin (the pigment responsible for skin color), are also
found here.
Cells of Epidermis
Keratinocytes: Keratinocytes produce the protein keratin, which is the
main component of the epidermis.

Melanocytes: Melanocytes make your skin pigment, known as melanin.

Langerhans cells: Langerhans cells prevent things from getting into

your skin.
Dermis
The largest portion of the skin and provides strength and structure. It
consists of glands (sebaceous, sweat), hair follicle, blood vessels, and
nerve endings.
Layers Of Dermis
• Papillary dermis: The papillary layer is the top layer of your dermis. It
Consists of collagen fibers, fibroblast cells, fat cells, blood vessels ,
nerve fibers, touch receptors and cells that fight bacteria (phagocytes).

• Reticular dermis: The reticular layer is the bottom layer of your

dermis. It’s thick, and it contains blood vessels, glands, hair follicles,
lymphatics, nerves and fat cells.
Contents of Dermis
• Fibroblasts: These are cells responsible for producing collagen and other
structural proteins that give the skin its strength, elasticity, and support.

• Collagen and Elastin Fibers: Collagen provides the skin with its tensile
strength and is responsible for maintaining its firmness. Elastin fibers, as
the name suggests, contribute to the skin's elasticity and flexibility.

• Blood Vessels: The dermis contains a network of blood vessels that

provide nutrients and oxygen to the skin cells, helping maintain their
health and supporting the healing process.
Cont’d...

• Hair Follicles: Hair follicles are structures within the dermis that
produce hair. They consist of hair bulbs, papilla, and sebaceous glands,
all of which are involved in hair growth and maintenance.

• Sebaceous Glands: These glands produce sebum, an oily substance

that helps keep the skin moisturized and forms a protective barrier.
Cont’d...
• Sweat Glands: Sweat glands are responsible for producing sweat,
which helps regulate body temperature and eliminate waste products.

• Nerve Endings: The dermis contains various types of nerve endings,

including those for touch, temperature, and pain. These nerve
endings provide sensory information to the brain.

• Immune Cells: Immune cells within the dermis help protect the skin
from infections and other harmful agents.
Cont’d...
• Lymphatic Vessels: These vessels are part of the lymphatic system and are
involved in draining excess fluids and waste products from the skin.

• Sensory Receptors: Various sensory receptors in the dermis allow us to

perceive sensations like pressure, touch, heat, and cold.

• Connective Tissue: The dermis is primarily composed of connective tissue,

which provides structural support to the skin and anchors it to the underlying
tissues.

• Matrix Proteins: In addition to collagen and elastin, the dermis contains other
matrix proteins that contribute to the skin's overall structure and function.
Hypodermis
The hypodermis is deep to the dermis and is also called subcutaneous
fascia. It is the deepest layer of skin and contains adipose lobules along
with some skin appendages like the hair follicles, sensory neurons, and
blood vessels.
Componets Of Hypodermis
Adipose Tissue: The main component of the hypodermis is adipose
tissue, which consists of fat cells . It also plays a role in thermal
regulation.

Connective Tissue: Collagen and elastin, that anchor the skin to

underlying muscles and structures.

Nerves and Nerve Endings: Nerve endings, such as sensory receptors

for pressure and pain, extend into the hypodermis from the dermis.
Cont’d.....
• Blood Vessels: Blood vessels run through the hypodermis, supplying
oxygen and nutrients to the adipose tissue and surrounding
structures.
• Lymphatic Vessels: Lymphatic vessels within the hypodermis help
drain excess fluid and waste products from the tissues, playing a role
in maintaining fluid balance and immune response.
FUNCTIONS OF SKIN
Protection :it acts as a barrier against: invasion by
microbes ,chemicals ,physical agents, e.g. mild trauma, ultraviolet light
dehydration.

Absorption: Medicine can be administered through the skin.

Water resistance: The skin acts as a water-resistant barrier so essential

nutrients are not washed out of the body
Cont’d...
Sensation: contains a variety of nerve endings that react to heat and,
touch, pressure, vibration, and tissue injury.

Vitamin D: The skin initiates the biochemical processes involved in

Vitamin D production, which is essential for calcium absorption and
normal bone metabolism.

Regulation of Temperature: Skin participates in thermal regulation by

conserving or releasing heat and helps maintain the body’s water and
homeostatic balance.
Cont’d...
Excretion: Sweat by sweating is at most a secondary function to
temperature regulation.

Communication and Expression: Facial expressions and body language,

which are facilitated by the skin's mobility, contribute to nonverbal
communication.
Acne Vulgaris

Acne vulgaris, commonly referred to as acne, is a chronic skin disorder

characterized by the formation of various types of lesions on the skin.
These lesions include comedones (blackheads and whiteheads),
papules, pustules, nodules, and cysts. Acne typically occurs in areas
with a high concentration of sebaceous (oil) glands, such as the face,
neck, chest, back, and shoulders.
Etiology:
Acne vulgaris is a common skin condition that primarily affects
adolescents and young adults, although it can occur at any age. The
exact cause of acne is not fully understood, but several factors
contribute to its development.
Risk Factors
• Diet
• Gentetic
• Cosmetics and Skincare Products: Some cosmetics and skincare
products contain ingredients that can clog pores and contribute to
acne, especially if they are not labeled as "non-comedogenic" (won't
clog pores).
• Environmental Factors
• Stress
• Friction and Pressure
Cont’d...
Excess Sebum Production: Sebaceous glands produce an oily substance called
sebum. In individuals with acne, these glands may produce excess sebum,
contributing to clogged follicles.

Abnormal Follicular Keratinization: Skin cells lining the hair follicles may not
shed properly, leading to the accumulation of dead skin cells that clog the
follicles.

Hormonal Influence: Androgens (male hormones) stimulate the sebaceous

glands to produce sebum. Fluctuations in hormone levels, such as during
puberty, menstruation, or pregnancy, can contribute to acne.
Cont’d...
Hormonal Influence: Androgens (male hormones) stimulate the
sebaceous glands to produce sebum.

Genetics: A family history of acne can increase an individual's likelihood

of developing the condition.

Diet and Lifestyle: Certain dietary factors and lifestyle choices may
exacerbate acne, although their exact role is still being studied.

Bacterial Overgrowth
Pathophysiology
Excess Sebum Production
↓
Increased Dead Skin Cells
↓
Formation of Blackheads, Whiteheads
↓
Increased bacteria (Propionibacterium)
↓
Inflammation
↓
Development of Papules
Signs and Symptoms:

•Comedones (blackheads and whiteheads)

•Papules (small, red bumps)

•Pustules (pus-filled, inflamed lesions)

•Nodules (larger, painful, solid bumps beneath the skin)

•Cysts (deep, painful, pus-filled lumps)

Cont’d....
Investigation
• History Taking
• Physical Examination
• Skin Biopsy
• Hormonal Assessment
• Laboratory Tests:
- Blood tests
-Microbial Culture
-Allergy Testing
Treatments
Topical Antibiotics: Prescription creams or gels containing antibiotics
(e.g., clindamycin, erythromycin)

Topical Retinoids: Derived from vitamin A, retinoids

Oral Antibiotics:Tetracycline, Doxycycline, Minocycline

Cont’d...
Hormonal Therapy:
• Oral Contraceptives
• Anti-Androgen Medications
• Oral Retinoids (Isotretinoin):

Procedures:
• Chemical Peels
• Laser and Light Therapy
Nursing Management
Patient Education:
• Educate about proper skincare routines.
• Emphasize the importance of not picking, squeezing, or popping
lesions to prevent infection and scarring.
• Provide information about prescribed medications, including how to
apply or take them, potential side effects, and duration of treatment.
Cont’d...
Monitoring and Follow-Up: Regularly assess the patient's response to
treatment and adjust the plan if necessary.

Document :Record the patient's progress and any changes in their

condition.

Encouraging Healthy Lifestyle: Discuss the potential impact of diet,

stress, and other lifestyle factors on acne.
Herpes simplex
Herpes simplex is a viral infection caused by the herpes simplex virus
(HSV). It leads to the development of sores or blisters on the skin or
mucous membranes.The virus remains in the body and can cause
outbreaks of sores, which can be painful and uncomfortable.
Etiology (Causes):

Herpes simplex infections are caused by the herpes simplex virus (HSV).
• Two main types: HSV-1 (oral herpes) and HSV-2 (genital herpes).
• Transmission occurs through direct contact with infected skin, mucous
membranes, or body fluids, especially during active outbreaks.
Risk Factors
• Close Contact with Infected Individuals
• Sexual Activity
• Weakened Immune System
• Gender -Women are generally more susceptible to genital herpes due
to the anatomy of the female genital tract
• Stress and Immune Suppression
Pathophysiology
HSV is transmitted through direct contact with infected skin, mucous
membranes, or bodily fluids.

Experience symptoms such as fever, pain, itching

Immune Suppress the virus

Later Trigger Factors like Stress, illness, hormonal changes lead to

outbreak.
Herpes Simplex Type

Herpes Simplex Type

Oral Herpes: HSV-1 is commonly associated with oral herpes, which

causes cold sores or fever blisters around the mouth and lips.

Genital Herpes: HSV-2 is the primary cause of genital herpes,

characterized by the presence of painful sores in the genital and anal
areas.
Sign and Symptoms
Oral Herpes (HSV-1):
• Cold Sores: Painful, fluid-filled blisters or sores appear on or around
the lips, mouth, or face.
• Fever: Some people experience fever, headache, and body aches.
• Tingling Sensation
• Itching: The affected area may become itchy and uncomfortable.
• Clustered Lesions: The blisters can appear in clusters and may burst,
ooze, and crust over before healing.
• Pain
Cont’d...
Cont’d...
Genital Herpes (HSV-2):
• Genital Lesions: Painful blisters or sores on the genital
• Itching and Discomfort
• Painful Urination
• Flu-like Symptoms: Fever, body aches, and swollen lymph nodes.
• Asymptomatic Shedding: Some individuals with genital herpes can
shed the virus even when no symptoms are present.
Investigation
• History Taking
• Physical Examination
• Viral Culture: A swab sample is taken from a fresh lesion to collect
viral material.
• Serological Tests
• Antigen Detection Tests: Rapid diagnostic tests that detect viral
antigens on swab samples are also available.
Treatement
Acyclovir (Zovirax):

• It can be taken orally, applied topically as a cream, or administered

intravenously.
• Acyclovir can also be used for suppressive therapy to reduce the frequency of
outbreaks.

Valacyclovir (Valtrex)
Cont’d...
Pain Management:Over-the-counter pain relievers such as ibuprofen or
acetaminophen can help manage pain, discomfort, and fever
associated with herpes outbreaks.

It's important to note that while these antiviral medications can help
manage herpes symptoms and reduce the frequency of outbreaks, they
do not cure the infection.
Nursing Management
1. Education:
Provide information about the nature of the infection, its transmission,
and methods to prevent spreading the virus to others.
Educate patients about the potential triggers for outbreaks and
strategies to manage and reduce these triggers.
Explain the benefits of antiviral medications, their proper use, and
potential side effects.
Cont’d...
2. Symptom Management:
Recommend over-the-counter pain relievers (as appropriate) and
proper hygiene practices to keep lesions clean and prevent secondary
infections.

3.Health Promotion:.
Advise on stress reduction techniques, a balanced diet, staying
hydrated, regular exercise, and adequate sleep.
Cont’d....
4.Preventive Measures:
• Educate patients about strategies to prevent transmitting the virus to
sexual partners or other individuals.
• Provide guidance on practicing good hygiene to reduce the risk of
self-infection or spreading the virus to other areas of the body.
Cont’d...

5.Pregnancy Considerations:
Provide guidance to pregnant patients about managing herpes
infections during pregnancy, as the virus can be transmitted to the
newborn during childbirth.

6.Regular Follow-Up
Thank you
8/21/2023

By PUshPa Devkota
MeDical sUrgical nUrsing
Unit 10 nUrsing care of Patient with skin DisorDer

10.3 Inflamatory Disorder

Dermatitis
Impetigo
Eczema
Psoriasis
Dermatitis
Dermatitis is a term used to describe a group of skin conditions
characterized by inflammation, redness, itching, and various skin
changes. The condition can affect people of all ages and can manifest in
different ways depending on the specific type of dermatitis and the
individual's susceptibility.
Etiology
• Allergens: Contact dermatitis can be caused by exposure to allergens
like plants (e.g., poison ivy), metals (e.g., nickel), cosmetics,
fragrances, or latex.

• Irritants: Irritant contact dermatitis can result from exposure to

substances that damage or irritate the skin, such as harsh chemicals,
detergents, or solvents.
• Genetics: Some individuals are genetically predisposed to certain
forms of dermatitis, like atopic dermatitis (eczema), due to a
malfunction in the skin's protective barrier.

• Autoimmune Factors: Autoimmune disorders like psoriasis can cause

inflammation and irritation of the skin.

• Infections: Bacterial, fungal, or viral infections can contribute to

dermatitis.
Pathophysiology
• Dermatitis involves inflammation of the skin, often triggered by
immune responses to allergens, irritants, or other factors. The skin's
barrier function may be compromised, leading to increased
permeability and vulnerability to external agents.
Types of Dermatits
Atopic Dermatitis (Eczema):

• A chronic condition
characterized by dry, itchy skin
and often associated with
allergies and asthma.
• Commonly affects children and
infants but can persist into
adulthood.
Contact Dermatitis:
• Occurs when the skin comes into
contact with an irritant or
allergen.
• Allergic contact dermatitis
results from an allergic reaction
to a specific substance, while
irritant contact dermatitis is
caused by direct irritation from
substances like chemicals or
soaps.
Seborrheic Dermatitis:
• Commonly referred to as
dandruff when it affects the
scalp.
• Causes red, flaky, and oily
patches, especially in areas rich
in oil glands like the scalp, face,
and chest.
• Can be associated with yeast
overgrowth.
Signs and Symptoms:

• Redness
• Swelling
• Itching
• Rash or patches of irritated skin
• Dry or scaly skin
• Blisters or vesicles (fluid-filled bumps)
• Crusting or oozing in severe cases
Diagnois
• History taking
• Physical Examination
• Patch Testing
• Skin Biopsy
Treatement
• Moisturizers
• Topical Corticosteroids
• Topical Calcineurin Inhibitors: Non-steroidal creams that can be used
on sensitive areas or when corticosteroids are not suitable.
• Antihistamines: Oral antihistamines can help alleviate itching and
improve sleep.
• Avoidance
• Cool Compresses: Applying cool, wet compresses to the affected area
can provide relief.
• Antifungal Shampoos: For scalp involvement, medicated shampoos
containing antifungal agents (like ketoconazole) can be effective.
• Topical Steroids or Antifungals
• Avoid Harsh Products
Nursing Management
1. Patient Education:
• Explanation: Explain the type of dermatitis the patient has, its causes,
triggers, and expected course.
• Medication Usage: Educate patients about prescribed medications,
how to apply them, and potential side effects.
• Triggers: Help patients identify and avoid triggers specific to their
condition.
4. Prevention and Hygiene:

• Infection Prevention: Educate patients about the risk of infection and

encourage proper wound care and cleanliness.
• Avoid Irritants: Help patients identify and avoid irritants, allergens,
and triggers that can exacerbate their condition.
• Avoid Scratching: Provide strategies to minimize scratching, such as
keeping nails short and using distraction techniques.
5. Lifestyle Recommendations:
• Diet and Hydration: Encourage a balanced diet and adequate
hydration to support overall skin health.
• Stress Management: Discuss stress-reduction techniques, as stress
can exacerbate some forms of dermatitis.
• Clothing and Fabrics: Advise patients to wear breathable, comfortable
clothing made from natural fibers to prevent irritation.
6. Follow-Up:

• Monitoring: Regularly assess patients for symptom improvement or

worsening.
• Adaptation: Address any concerns or questions that patients may
have during follow-up visits.
• Treatment Adjustments: Collaborate with the healthcare team to
adjust treatment plans as needed based on the patient's progress.
7. Emotional Support:

• Psychological Impact: Acknowledge the emotional toll that chronic

dermatitis can have on patients and provide a supportive
environment for discussing their concerns.
• Referrals: Consider referring patients to support groups or mental
health professionals if needed.
Impetigo
Defination
Impetigo is a common bacterial skin infection characterized by the
development of red sores that quickly rupture, forming honey-colored
crusts. It is highly contagious and primarily affects the outer layers of
the skin, especially in children and infants. The infection can spread
through direct contact or through contaminated objects.
Etiology
Impetigo is primarily caused by bacteria, most commonly
Staphylococcus aureus or Streptococcus pyogenes (Group A
Streptococcus).
Risk Factors:

• Age: Children, particularly those between 2 and 5 years old, due to their less
mature immune systems
• Warm and Humid Conditions: Create an environment conducive to bacterial
growth.
• Skin Injuries: Openings in the skin, such as cuts, scrapes, or insect bites,
provide entry points for bacteria.
• Weakened Immune System: Individuals with weakened immune systems are
more vulnerable to infections, including impetigo.
• Crowded Living Conditions: Close quarters can facilitate the spread of bacteria
between individuals.
Pathophysiology:

Bacteria enter the skin through breaks or openings, such as cuts, insect
bites, or areas of irritated skin.

Bcteria multiply, leading to the development of impetigo.

The bacteria produce enzymes and toxins that contribute to tissue

damage and inflammation.
Types of Impetigo
Non-Bullous Impetigo (Impetigo Contagiosa):
This is the most common type of impetigo. It typically starts as small
red sores that quickly rupture and develop a yellowish-brown crust.

Bullous Impetigo:
Bullous impetigo is less common but still contagious. It's characterized
by the formation of larger, fluid-filled blisters that can be clear or
cloudy.
Sign and Symptoms
• Red Sores: Impetigo typically begins with the appearance of red sores
on the skin. They often occur around the nose and mouth or on the
hands and feet.
• Quick Rupture: The red sores quickly rupture, leaving behind a raw,
moist surface.
• Honey-Colored Crusts: As the ruptured sores dry out, they develop a
characteristic honey-colored or yellowish-brown crust.
• Itching: The affected area may be itchy and uncomfortable.
Cont’d...
• Blisters (Bullous Impetigo): In some cases of bullous impetigo, larger
fluid-filled blisters form. These blisters can be clear at first and then
turn cloudy or pus-filled before they burst.
• Swollen Lymph Nodes
• Pain and Discomfort: The raw, irritated skin can be painful and
uncomfortable
Investigation
• History taking

• Physical Examination

• Bacterial Culture

• Laboratory Tests
Treatement
Topical Antibiotics:
• Mupirocin (Bactroban)
• Neomycin/polymyxin B/bacitracin
Oral antibiotics
• Cephalexin
• Clindamycin
Pain and Discomfort Relief:
• Acetaminophen or ibuprofen
Nursing Management
Wound Care and Hygiene:
-Teach patients and caregivers
proper wound care techniques,
including gently cleansing the
affected area with mild soap and
water and patting it dry.
-Advise against picking or
scratching the sores to prevent
spreading the infection to other
areas.
Comfort Measures:
-Provide pain relief measures if the affected area is uncomfortable or
painful. Over-the-counter pain relievers may be recommended.

Education:
-Educate patients and caregivers about the nature of impetigo, its
causes, and methods of transmission.
-Stress the importance of good hygiene practices to prevent further
spread and recurrence.
Assessment and Monitoring:
-Regularly assess the patient's skin lesions for improvement or
worsening of symptoms.
-Monitor for signs of complications, such as spreading infection or
secondary skin infections.

Preventive Measures:
-Teach patients about infection prevention techniques, such as proper
hand hygiene and avoiding sharing personal items, to prevent re-
infection or transmission to others.
Follow-Up
Patient and Family Support
Documentation
Eczema
Eczema, also known as atopic dermatitis, is a chronic inflammatory skin
condition characterized by dry, itchy, red, and inflamed skin.It can affect
individuals of all ages but is particularly common in children. The
condition can be triggered or worsened by various factors, including
allergens, irritants, stress, climate, and certain foods.
Etiology

• Genetics: If a person has a family history of eczema, asthma, hay fever,

or other allergic conditions.

• Skin Barrier Dysfunction: A weak skin barrier can allow allergens and
microbes

• Pain and Discomfort: Immune response that is overly sensitive or

reacts abnormally to certain triggers, leading to inflammation.
• Temperature and Humidity: Extreme temperatures, low humidity, and
excessive sweating

• Environmental Factors :Allergens , Irritants: Harsh soaps, fragrances

• Microbial Infections: Bacterial, viral, or fungal infections

• Lifestyle Factors: Stress and emotional factors

• Food Sensitivities: certain foods can trigger or exacerbate eczema
symptoms in some individuals, especially in infants and children.

• Hormonal Changes: Hormonal changes, such as those that occur

during pregnancy or menstruation
Pathophysiology
Casative factors weaken the skin's barrier function.

Allergen/Irritant Entry and Inflammatoion

Itching and Scratching causing Damaged skin which allows infections to occur
more easily.

Chronic scratching leads to thickened, leathery skin.

The cycle repeats, causing recurring flare-ups.

Sign and Symptoms

• Itchy Skin

• Redness (Erythema)

• Inflammation

• Dryness: Eczema-prone skin tends to

be dry and may appear scaly or flaky.

• Rash: Eczema can cause raised,

bumpy, or patchy rashes on the skin.
• Skin Discoloration: changes in skin
color, such as darkening or
lightening.
• Pain or Discomfort
• Secondary Infections: Scratching
can break the skin, making it
more susceptible to bacterial,
fungal, or viral infections.
• Irritability and Disturbed Sleep
Investigation

• History Taking
• Physical Examination
• Skin Biopsy
• Microbial Cultures
• Blood Tests: to assess the levels of immunoglobulin E (IgE)
• Food Allergy Testing:
Treatement
• Topical Corticosteroids:
• Topical Calcineurin
Inhibitors:Tacrolimus and
Pimecrolimus, non-steroidal
anti-inflammatory creams.
• Oral Antihistamines
• Oral Immunosuppressants
• Phototherapy
Nursing Management
• Advise patients to take short, lukewarm baths or showers using mild,
fragrance-free cleansers. Long or hot baths can worsen eczema.
• Emphasize the importance of frequent moisturization using fragrance-
free, hypoallergenic moisturizers.
• Instruct patients on the proper application of prescribed topical
medications, such as corticosteroids and/or calcineurin inhibitors.
• Nutrition and Hydration
• Stress Management
• Recommend keeping nails short to minimize skin damage from
scratching.
• Monitor the patient's progress and response to treatment, and
communicate any concerns to the healthcare team.
• Support and Emotional Well-being
• Acknowledge the emotional toll that eczema can have on patients
and their families.
2023/22/8

By PUshPa Devkota
MeDical sUrgical nUrsing
Psoriasis
Psoriasis is a chronic autoimmune skin disorder characterized by the
rapid buildup of skin cells, leading to the formation of thick, red, scaly
patches or plaques on the skin's surface. This condition is caused by an
overactive immune system that mistakenly triggers inflammation,
causing skin cells to multiply rapidly. As a result, these excess skin cells
accumulate on the surface of the skin, forming raised patches that can
be itchy, painful, and unsightly.
Etiology
The exact cause of psoriasis is not fully understood, but it is believed to
be a result of a complex interaction between different factors.
§ Genetics
§ Immune System Dysfunction: Psoriasis is considered an autoimmune
disorder, where the immune system mistakenly targets the body's
own tissues.
§ Stress: Emotional stress can lead to flare-ups or worsen existing
symptoms.
§ Infections: Streptococcal infections
§ Injuries to the Skin: Injuries, cuts, scrapes, sunburns, or even tattoos
§ Lifestyle Factors: Smoking, excessive alcohol consumption, obesity,
and a poor diet may contribute to worsening symptoms.
§ Hormonal Changes
§ Medications: Certain medications, such as beta-blockers, lithium
§ Cold Weather and Dry Skin
Pathophysiology
Genetic Predisposition and other factors

immune system mistakenly targets the body's own tissues( T cells)

Inflammation and increased blood vessel formation

Skin cells multiply and move to the surface of the skin much faster than in
healthy individuals.

Formation of Plaques on Skin Surface

Types of Psoriasis
Plaque Psoriasis (Psoriasis
Vulgaris):
§ Plaque psoriasis is the most
common.
§ Plaques often appear on the
scalp, knees, elbows, lower back,
and other areas.
Guttate Psoriasis:
§ Guttate psoriasis is more
common in children and young
adults.
§ Often triggered by streptococcal
infections (like a throat
infection).
Inverse Psoriasis:
§ Inverse psoriasis affects skin
folds, such as under the breasts,
armpits, groin, and buttocks.
§ It can be aggravated by friction
and sweating.
Sign and Symptoms
• Raised, red areas of skin are a hallmark of psoriasis. These patches
can be well-defined and may have sharp edges.
• Silvery Scales
• The red patches are often covered with thick, silvery-white scales that
can be easily scraped off.
• Itching and Irritation
• Psoriasis plaques can be intensely itchy and cause discomfort.
• Dryness and Cracking:
• Psoriasis can affect the nails,
discoloration, and separation
from the nail bed.
• Psoriatic arthritis can accompany
psoriasis, causing joint pain,
stiffness, and swelling.
Diagnosis

Skin Biopsy (if necessary): Under a microscope assess the characteristic

changes associated with psoriasis.
Koebner Phenomenon:Refers to the development of new psoriasis
plaques at the site of skin injury or trauma.
Rule Out Other Conditions:
The dermatologist will also consider other skin conditions that might
mimic psoriasis, such as eczema, fungal infections, and certain forms of
dermatitis.
Treatement
Topical Treatments:
§ Corticosteroids
§ Topical Vitamin D Analogues: These medications help regulate skin
cell growth and reduce inflammation.
§ Topical Calcineurin Inhibitors: Non-steroidal creams that control
inflammation and can be used in sensitive areas like the face and
genitals.
Systemic Treatments:
§ Oral Medications: Methotrexate, acitretin, or cyclosporine which uppress the
immune system and reduce inflammation.
§ Biologics: Biologics like TNF inhibitors, IL-17 inhibitors, and IL-23 inhibitors.

Phototherapy (Light Therapy):

§ UVB light slows down skin cell growth and reduces inflammation.

Combination Therapies:
§ Topical medications along with phototherapy or systemic medications, to
achieve better results.
Nursing Management
Education:
§ Provide thorough education about psoriasis, including its causes, triggers, and
potential complications.
§ Explain different treatment options, their benefits, and potential side effects.
§ Educate patients about the chronic nature of psoriasis and the importance of
adherence to treatment plans.
Skin Care:
§ Instruct patients on proper skin care practices, including gentle cleansing with
mild, fragrance-free products and moisturizing to prevent dryness and scaling.
§ Emphasize the importance of avoiding harsh soaps, hot water, and excessive
scrubbing.
Skin Care:
§ Instruct patients on proper skin care practices, including gentle
cleansing with mild, fragrance-free products and moisturizing to
prevent dryness and scaling.
§ Emphasize the importance of avoiding harsh soaps, hot water, and
excessive scrubbing.
Wound Care and Infection Prevention:
§ Teach patients how to care for any skin lesions, prevent scratching,
and avoid infection.
§ Stress Management:
§ Discuss stress-reduction techniques such as mindfulness, relaxation
exercises, and hobbies to help manage stress, which can trigger flare-
ups.
Lifestyle Modifications:
§ Encourage maintaining a healthy lifestyle with balanced nutrition,
regular exercise, and adequate sleep.
§ Discuss the impact of smoking and alcohol on psoriasis symptoms and
encourage healthy choices.
Support and Emotional Well-being:
§ Help patients cope with body image concerns and self-esteem issues.
§ Follow-Up and Monitoring
Leprosy
Leprosy, also known as Hansen's disease, is a chronic infectious disease
caused by the bacterium Mycobacterium leprae. It primarily affects the
skin and peripheral nerves but can also involve other organs. Leprosy
has been known throughout history and is characterized by its potential
to cause skin lesions, nerve damage, and disfigurement if left untreated.
Etiology
It’s is caused by the bacterium
Mycobacterium leprae. It is
primarily transmitted through
prolonged and close contact with
respiratory droplets from an
infected person, although the
exact mode of transmission is not
fully understood.
Risk factors

• Close and Prolonged Contact: Being in close and prolonged contact

with an untreated person with leprosy increases the risk of
transmission.
• Weak Immune Response
• Genetic Susceptibility: Some people are more genetically predisposed
to contracting leprosy.
• Living Conditions: Poor living conditions, inadequate sanitation, and
limited access to healthcare.
• Endemic Regions: Prevalent in certain regions with higher rates of
transmission, such as parts of Asia and Africa.
• Unidentified Reservoirs: The bacteria can survive in certain animals,
and the possibility of transmission from animals to humans.
Pathophysiology
Infection with Mycobacterium leprae and other factors
⬇ ️
Immune Respone and inflamation
⬇ ️
Bacteria Target and multiplies in the peripheral nerves
⬇ ️
Nerve Damage ,Loss of Sensation ,skin lesions
⬇ ️
Risk of Complications like Deformities,
The pathophysiology of leprosy involves complex interactions between
the bacteria and the immune system, leading to various clinical
presentations and outcomes.
Sign and Symptoms
• Earliest signs is the appearance of pale, discolored, or reddish skin
patches that may have decreased sensation.

• Lesions can be flat, raised, or nodular in nature.

• Muscle weakness, particularly in the extremities.

• Sensations of numbness, tingling, and pins and needles.

• Leprosy can affect the eyes, causing dryness, irritation, and potential vision
problems.

• Nerves near skin lesions may become thickened and palpable.

• loss of eyebrows and eyelashes can occur.

• Due to loss of sensation, wounds and ulcers can develop on the skin.

• Deformities
Investigation
• History taking
• Physical Examination
• Skin Biopsy
• Slit Skin Smear Test (SSS)
• Nerve Biopsy
• Nerve conduction studies
• Blood Tests
Treatment
• Medication:Rifampicin,Clofazimine and Dapsone
• Physiotherapy
• Surgery, and other interventions may be recommended to address
any deformities or disabilities caused by the disease.
Nursing Management
• Assessment and Diagnosis:
Nurses play a vital role in identifying and assessing the signs and
symptoms of leprosy. This includes observing skin lesions, assessing
nerve function, and determining the type and severity of the disease.
Early detection and accurate diagnosis are crucial for initiating timely
treatment.
• Education and Counseling:
Providing information about leprosy, its treatment, and potential
complications is essential. Nurses can educate patients about the
importance of adhering to the treatment regimen and completing the
full course of antibiotics. Counseling can help alleviate fears, dispel
myths, and address any stigma associated with the disease.
• Wound Care and Prevention of Infections:
Nurses assist with wound care for any existing skin lesions, promoting
proper hygiene and cleanliness to prevent secondary infections. Educating
patients about wound care practices at home is also crucial.

• Support for Deformities and Disabilities:

If patients experience deformities or disabilities as a result of nerve
damage, nurses can provide support and education on adaptive
techniques and assistive devices to enhance mobility and independence.
• Psychosocial Support:
Coping with a chronic illness like leprosy can be emotionally challenging.
Nurses can offer emotional support, provide opportunities for patients
to express their feelings, and connect them with support groups or
counseling services if needed.
• Promoting Social Reintegration:
For patients who have experienced social isolation or stigma due to
leprosy, nurses can help facilitate their reintegration into their
communities by providing education to dispel misconceptions and
promoting acceptance.
Scabies
• Scabies is a highly contagious skin infestation caused by a microscopic
mite known as Sarcoptes scabiei. These tiny mites burrow into the
outer layer of human skin, where they lay eggs and trigger an allergic
reaction that leads to intense itching and a rash. This is transmitted
through close skin-to-skin contact and through shared personal items
like clothing and bedding.
Etiology
Mite Infestation: Sarcoptes scabiei mites on the skin which burrow into
the upper layer of the skin, where they lay eggs and trigger an immune
response.

Transmission: Scabies is highly contagious and spreads from person to

person through direct contact and indirectly through shared clothing,
bedding, and other personal items that have come into contact with an
infested person.
Risk Factors: Crowded living conditions, close contact with infected
individuals, and compromised immune systems can increase the risk of
scabies infestations. Scabies is common in areas with poor sanitation
and among populations such as nursing home residents and individuals
with weakened immune systems.
Pathophysiology
Person-to-person contact or contact with infested clothing, bedding, or personal items.

Sarcoptes scabiei burrow into the upper layer of the skin, creating tunnels and lay eggs.

Egg Hatching and larvae that grows and causes Allergic Reaction due to waste production.

Inflammation and Itching (immune response)

Transmission to others and repeats the cycle

Sign and Symptoms
• Intense Itching: The itching is a result of the body's allergic reaction
worse at night.
• Rash: Small red bumps, blisters, and raised or wavy lines on the skin,
• Burrows: Thin, thread-like lines on the skin that represent the tunnels
created by the mites which may appear as tiny raised lines.
• Skin Inflammation
• Blisters: Small, fluid-filled blisters
that might ooze and crust over
due to scratching.
• Secondary Infections: Scratching
the affected areas can lead to
open sores, which can become
infected with bacteria.
• Sleep Disturbances
• General Discomfort
Diagnosis
• History Taking
• Physical Examination
• Burrow Ink Test
• Skin Scraping: Scraping the surface of the affected skin with a scalpel.
• Skin biopsy
• Family and close contact assesement
Treatement
• Ivermectin:Ivermectin is an antiparasitic medication that can be used
to treat scabies.
• Permethrin Cream:Applied to the entire body (from the neck down)
and left on for a specified period before being washed off.
• Crotamiton Cream:Relieve itching and discomfort associated with
scabies.
• Topical Steroids
• Antihistamines
Nursing Management

• Conduct a thorough assessment of the patient's skin, noting any

characteristic signs of scabies such as burrows, rash, blisters, and
itching.
• Collect information about the patient's medical history, recent
contacts, and exposure to potential sources of infestation.
• Administer prescribed medications as directed by the healthcare
provider. Ensure patients understand the proper application or
ingestion of medications.
• Explain the nature of scabies, its transmission, and the importance of
adhering to the treatment regimen.
• Educate patients about the necessity of treating all close contacts to
prevent reinfestation.
• Offer guidance on ways to manage stress related to the condition,
such as through relaxation techniques.
• Schedule follow-up appointments.
• Monitor patient compliance with the treatment plan.
2023/8/25
By Pushpa Devkota
Medical Surgical Nursing
10.4 Injuries of the Skin
Burn
Gas Gangreen
Gas Gangreen
Gas gangrene, also known as clostridial myonecrosis, is a severe and
life-threatening bacterial infection that affects the muscles and
surrounding tissue. It is mostly caused by Clostridium perfringens.
These bacteria are anaerobic. (thrive in environments with little to no
oxygen)
Etiology
• Clostridium Bacteria: These bacteria are often found in the
environment, such as soil, dust, and the intestines of animals and
humans.

• Surgical Procedures: Surgical wounds, especially those involving

removal of necrotic tissue or exposure to contaminated environments

• Immunosuppression
• Severe Burns: Extensive burns can damage skin and underlying tissues,
providing an entry point for bacteria to invade the body.

• Delayed Wound Care: Can lead to the proliferation of bacteria and

increase the likelihood of infection.

• Poor Blood Supply

• Drug Abus
Pathophysiology
Clostridium perfringens bacteria enter deep tissue through wounds or
injuries.

The bacteria multiply, produce toxins, and destroy tissue (in low O2)

Toxins disrupt blood flow, causing rapid tissue death where Bacterial
metabolism produces gas.

Pain, swelling, skin discoloration, and a crackling sensation.

Sign and Symptoms
• Severe Pain and Swelling: Sudden, intense pain in the affected area

• Skin Discoloration: Turn pale, grayish, dark purple, or black

• Crepitus: A crackling or popping sensation

• Foul Odor: Emit a foul-smelling odor due to the release of toxins.

• Skin Blisters

• Fever and Chills

• Systemic symptoms like confusion, altered mental state, and

weakness can develop due to toxins spreading through the
bloodstream.

• Systemic toxicity can lead to gastrointestinal symptoms like nausea

and vomiting.
Diagnosis
• History Taking
• Physical exam
• Tissue and fluid cultures
• Blood cultures
• Tissue Gram stain to determine the type of bacteria causing the
infection
• X-ray of the affected region
• CT or MRI scans of the affected region
Treatement
• Surgical Debridement:This involves the removal of dead and infected
tissue, which helps eliminate the source of the infection and prevents
its spread.

• Antibiotic Therapy:Commonly used antibiotics include penicillin,

clindamycin, metronidazole, and a combination of broad-spectrum
antibiotics.

• Hyperbaric Oxygen Therapy (HBOT):Increases the amount of oxygen

dissolved in the bloodstream and tissues.
Nursing Management
Risk for Infection related to tissue necrosis and bacterial invasion
Interventions
• Monitor vital signs frequently to detect any signs of worsening
infection.
• Ensure strict aseptic technique during wound care and dressing
changes.
• Educate the patient and caregivers about signs of infection and the
importance of early reporting.
Acute Pain related to tissue damage and infection
Interventions:
• Administer prescribed pain medications promptly and assess their
effectiveness.
• Use non-pharmacological pain relief techniques, such as positioning,
relaxation techniques, and distraction.
• Provide emotional support and reassurance to the patient.
Impaired Skin Integrity related to tissue necrosis and surgical
interventions:
• Perform careful and gentle wound care using sterile techniques.
• Keep the wound clean and dry to prevent secondary infections.
• Monitor the wound for signs of healing, infection, or complications
Risk for Altered Peripheral Tissue Perfusion related to compromised
blood flow:
Interventions:
• Assess peripheral pulses and capillary refill to monitor blood
circulation.
• Keep the patient's extremities elevated as appropriate to promote
blood flow.
• Educate the patient about the importance of mobility and avoiding
prolonged immobility.
Anxiety related to disease severity, treatment procedures, and
potential complications:
Interventions:
• Provide clear and honest explanations about the condition, treatment
plan, and procedures.
• Offer psychological support, including active listening and emotional
reassurance.
• Teach relaxation techniques and coping strategies to manage anxiety.
Deficient Knowledge related to the disease process and self-care post-
discharge:
Interventions:
• Educate the patient and family about the underlying disease,
treatment options, and expected outcomes.
• Provide instructions on wound care, medication administration, and
signs of infection.
• Schedule follow-up appointments and ensure the patient understands
the importance of ongoing care
Burn
• It is damage to the skin’s integrity from some type of energy source.
Etiology
• Heat (thermal): this can be hot
liquid, steam, fire etc. that
comes into contact with the
skin…most common type.
• Electrical: an electric current
passes through the body and
damages tissues.
• Chemical: toxic substances come
into contact with the skin
(powders, gases, or certain
foods…no heat needed).
• Cold: coldness comes into contact with the skin too long….example:
frostbite

• Radiation: sun, treatments for cancer

• Friction: force abrasion to the skin….car accident…road rash, rope

burn
Pathophysiology of Burn
Heat Source: Burns result from contact with hot objects, liquids, flames, or
steam.
Tissue Damage: High temperatures cause protein damage and cell death in
the affected area.
Inflammation: The body's immune response triggers swelling, redness, and
pain.
Fluid Loss: Burned skin loses its barrier function, leading to dehydration and
electrolyte imbalance.
Infection Risk
Healing Process: Burned areas regenerate through cell division, scar tissue
formation
Degrees of Burns (depth of burn damage)
Sign and Symptoms according to Degree of
Burn
• 1st Degree (superficial): affects the top layer of the skin “epidermis”
least severe of all the types
• heals usually within 7 days
• skin is very red or pink, painful, warm to touch, no blisters or usually
no scar left behind
• the faster the capillary refill, the more superficial the burn is
• 2nd degree (partial-thickness) can be superficial or deep partial-
thickness affecting various areas of the dermis
• involves the epidermis and dermis
• severity varies throughout…if severe (deep partial-thickness this burn
can easily turn into 3rd degree)
• very painful…nerve sensation still present
• blister present
• redness that will blanch, swelling, shiny red/pink and moist in area
• may need skin grafting if severe
• 3rd degree: “full-thickness”: all skin layers are damaged along with
the hair follicles, sweat glands, nerves.
• not painful or the pain is dramatically decreased because damage to
the sensation receptors
• skin can NOT heal…will need skin grafting
• months to heal
• can look black, yellow or red and hard and matte/dry
• can feel hard in areas or leathery
• 4th degree “deep full-thickness” : worst of all…all the layers are
destroyed but it extends to the muscles, bone, ligaments….all
sensation of pain is gone.

• Appears black, charred with eschar

• >months to heal and needs skin grafting
Burn Location
What areas on the body, if burned, will cause respiratory compromise?
• Face (this structure is where inhaling and exhaling starts and ends)
• Neck (contains structures that allow air to flow down into the lungs)
• Trunk (accessory muscles and structures to help you breathe)
What areas will have trouble healing because of poor blood supply
(made of cartilage)? In addition to disfigurement, infection, and
experience very slow healing?
• Ears and nose
What areas, if burned, will cause the most disability?
• Eyes, hands, feet, and joints
What areas are at most risk for infection?
• Areas used for elimination…..perineum and bottom
Treatment
1.Emergent: (lasts 24-48 hours)
2.Acute:(starts 48-72 hours until wound heals)
3.Rehabilitative
1. EMERGENT PERIOD
• Maintain patent airway
• Oxygen Continue
• Tracheostomy may be needed
• intubation for inhalation is often required
Fluid Therapy
• Crystalloid Solutions : NS, LR , D5%/NS
• Colloid Solutions :Albumin ,Dextran
Rule of Nines for Burns in an Adult
It’s a calculation used to calculate the total body surface area burned.
The percentage will determine treatment like fluid replacement.
The body is broken down in areas and nines are assigned to each area.
Rule of Nines for Burns in an Adult
Start at the top and work downward (Remember THE FRONT AND THE BACK
OF EACH AREA and there are two arm and two legs):
Adult:
• Head and Neck: 9% (4.5% anterior and posterior)
• Right Arm: 9% (4.5% anterior and posterior)
• Left Arm: 9% (4.5% anterior and posterior)
• Trunk: 36% (18% anterior and posterior)
• Perineum: 1%
• Right Leg: 18% (9% anterior and posterior)
• Left Leg: 18% (9% anterior and posterior)
Practice problem:

A 35 year old female patient has deep partial thickness burns on the front
and back of both arms, anterior trunk, back of left leg, anterior and posterior
sides of the right leg, posterior head and neck, and perineum. What is the
total body surface area percentage that is burned?
• FRONT and BACK of both arms: 18%
• ANTERIOR trunk: 18%
• BACK of left leg: 9%
• Anterior and Posterior of right leg: 18%
• POSTERIOR head and neck: 4.5%
• Perineum: 1%
Total: 68.5%
Formulas to Calculate Fluid
• Fluid treatment is essential for major burns….the Parkland’s Burn
Formula may be used to calculate the amount of fluids needed over
the next 24 hours.
• The formula calculates the amount of fluid (lactated ringers…LR)
needed 24 hours after a burn.
• Intravenous fluid resuscitation is needed for adults when a total body
surface area of least 15% or more is burned for adults, and in 10% in
children. (Diver, 2008).
• To calculate the amount of LR needed 24 hours after a burn using the
Parkland’s Burn Formula:….
Volume of Fluid needed (LR) = 4 mL x percentage of BSA x patient
weight kilograms
ACUTE PERIOD

• Pain Control
• Dietary intake, motor ability, I&O, weight
• Care of wounds and prevention of complications
• Clean & debride the area of necrotic tissue
• Skin Grafting
• Flap Surgery: Flap surgery involves moving a piece of healthy tissue,
along with its blood supply, from one area of the body to the burned
area.
REHABILITATION PERIOD

• Care of healing skin - wash daily, cover with cocoa butter or other
barrier
• Promote mobility
• Rehab period can last for months to even years
Nursing Management Of Burn
First-Degree Burns:

• Applying cold water or cold compresses to alleviate pain.

• Administering over-the-counter pain medications, if prescribed by the
healthcare provider.
• Educating the patient on wound care and emphasizing the
importance of sun protection.
Second-Degree Burns (Partial-Thickness Burns):

• Cleaning the wound gently with mild soap and water, and applying a
sterile dressing.
• Administering prescribed pain medications.
• Monitoring for signs of infection and providing appropriate wound
care.
• Assisting with wound debridement (if necessary) under medical
supervision.
Third-Degree Burns (Full-Thickness Burns):

• Ensuring a clear airway and administering oxygen if needed.

• Administering intravenous fluids and nutrition to prevent dehydration
and promote healing.
• Monitoring for signs of infection and providing wound care, often
involving regular dressing changes.
• Collaborating with the healthcare team for possible surgical
interventions like skin grafting.
• Providing emotional support to the patient and their family
Fourth-Degree Burns:
• Pain Management: Administering prescribed pain medications and
utilizing non-pharmacological methods such as distraction, relaxation
techniques, and positioning for comfort.
• Wound Care: Cleaning and dressing the wounds according to
healthcare provider instructions, to prevent infection and promote
healing.
• Fluid and Nutrition Management: Monitoring fluid balance and
providing adequate nutrition to support wound healing and prevent
malnutrition.
• Infection Prevention
• Psychosocial Support
• Mobility and Rehabilitation
• Education
10.5 Neoplasam Of Skin
Basal Cell Carcinoma
Melanoma
Cancer
Cancer is a group of diseases characterized by the uncontrolled growth
and spread of abnormal cells within the body.

Benign Tumors:Benign tumors are non-cancerous growths of cells that

do not invade nearby tissues or spread to other parts of the body.

Malignant Tumors (Cancer):Malignant tumors are cancerous growths

that have the ability to invade nearby tissues and potentially spread to
other parts of the body through a process called metastasis.
Basal Cell Carcinoma
Basal cell carcinoma (BCC) is a type of skin cancer that originates in the
basal cells, which are found in the lowest layer of the epidermis (the
outermost layer of the skin). It is the most common form of skin cancer
and typically develops in areas of the body that are exposed to the sun,
such as the face, neck, scalp, and shoulders. BCC usually grows slowly
and tends to be locally invasive, meaning it can damage nearby tissues,
but it rarely metastasizes (spreads to distant parts of the body)
Etiology

• Ultraviolet (UV) Radiation Exposure: Chronic and cumulative exposure

to UV radiation over many years increases the risk of DNA mutations
and cellular changes.

• Sun Exposure: Sunburns, especially during childhood and adolescence,

are particularly concerning.

• Fair Skin and Light Eye/Hair Color: People with fair skin, light-colored
eyes (blue or green), and blond or red hair have less natural
protection against UV radiation.
• Personal and Family History: A personal history of skin cancer,
including BCC, or a family history of skin cancer can increase the risk
of developing the disease.

• Exposure to Certain Chemicals

• Weakened Immune System

Pathophysiology

UV Radiation Exposure
↓
DNA Damage,Genetic Mutations and Uncontrolled Cell Growth
↓
Tumor Formation (Basal Cell Carcinoma)
↓
Tissue Invasion
↓
Characteristic Features and Clinical Presentation
Sign and Symptoms
• Pearly or Translucent Bump where center of the bump may have a
depression or ulceration.

• Pink, Flesh-Colored, or Brown Lesion often blend in with the

surrounding skin.

• Visible Blood Vessels giving it a slightly vascular or "spider-like"

appearance.
• Ulceration and Crusting develop an open sore and crust.

• Slow Growth

• Red, Scaly Patch that can mimic eczema

Diagnosis
• History Taking
• Physical Examination
• Dermoscopy:It magnifies the skin lesion, allowing to observe its
internal structures and patterns.
• Biopsy
• Histopathological Examination
• In rare cases, if there is suspicion of deep invasion ultrasound, CT scan,
or MRI is perform.
Treatement
Surgery:
• Mohs surgery: Examining each layer under a microscope until no
cancer cells remain.
• Curettage and electrodesiccation: The tumor is scraped away and the
area is then treated with an electric current to destroy any remaining
cancer cells.
• Cryotherapy: Liquid nitrogen is applied to freeze and destroy the
cancer cells.
• Radiation therapy: High-energy rays are directed at the cancer to kill
the cancer cells.

• Topical treatments: 5-fluorouracil can be applied directly to the skin

• Targeted therapies: Drugs that target specific molecular pathways

Nursing Diagnosis
• Risk for Impaired Skin Integrity related to BCC lesions and treatment.
• Acute Pain related to BCC lesions and treatment.
• Anxiety related to diagnosis and treatment of BCC.
• Deficient Knowledge related to BCC and its management.
• Body Image Disturbance related to appearance changes.
• Risk for Infection related to BCC lesions and treatment interventions.
• Fear related to prognosis and potential recurrence.
Nursing Management
Patient Education
• Educate patients about the nature of BCC, its causes, risk factors, and
potential complications.
• Emphasize the importance of early detection and regular skin self-
exams.
• Educate patients about sun protection measures, such as using
sunscreen, wearing protective clothing, and avoiding peak sun hours.
Pain Management:
• Assess and manage pain associated with wound care, surgical
procedures, or other treatments.
• Administer prescribed pain medications as needed and evaluate their
effectiveness.
Emotional Support:
• Address patient anxiety, fears, and concerns related to the diagnosis
and treatment of BCC.
• Offer emotional support, active listening, and encourage patients to
express their feelings.
• Provide resources for counseling or support groups if necessary.
Psychosocial Care:

• Help patients cope with potential body image changes and scarring
resulting from surgical interventions.
• Encourage open communication about emotional well-being and any
impact on their self-esteem.
Melanoma
Melanoma is a type of skin cancer that develops from melanocytes, the
pigment-producing cells in the skin. It is one of the most dangerous
forms of skin cancer due to its potential to spread (metastasize) to
other parts of the body if not detected and treated early. Melanoma
typically presents as an abnormal growth or lesion on the skin, often
exhibiting uneven borders, irregular coloration, and changes in size and
shape.
Etiology

• Ultraviolet (UV) Radiation Exposure: UV radiation damages the DNA in

skin cells, increasing the risk of mutations that can lead to the
development of melanoma.

• Fair Skin, Light Hair, and Light Eye Color

• Family History and Genetics: Individuals with a family history of

melanoma have a higher risk of developing the disease.
• Age: The majority of melanoma cases are diagnosed in individuals
over the age of 50.
• Certain Moles or Birthmarks: Some types of moles or birthmarks may
be at a higher risk of developing into melanoma.
• Gender: Melanoma affects both men and women, but it is more
commonly diagnosed in men.
Sign and Symptoms
• Changes in Moles: Look for moles that change in size, shape, color, or
elevation over time.

• Asymmetry: Check if one half of the mole or lesion does not match
the other half.

• Irregular Borders: Melanomas often have irregular, uneven, or poorly

defined borders rather than smooth and even edges.
• Varied Color: Melanomas can display a mix of colors within the same
lesion, including shades of black, brown, tan, red, blue, or white.

• Evolving: Watch for moles or lesions that are changing in appearance,

such as becoming more elevated, itching, bleeding, or exhibiting
other noticeable changes.

• Spread to Lymph Nodes: As melanoma progresses, it may cause the

nearby lymph nodes to enlarge, which can be felt as lumps under the
skin.
• Ulceration: Melanomas may
develop sores that do not heal,
or they might bleed and form
scabs.

It's important to note that not all

melanomas will display all these
signs, and some melanomas may
have atypical features.
Pathophysiology
UV Radiation Exposure

DNA Damage and Mutation

Uncontrolled Growth and Localized Melanoma

Invasion of Nearby Tissues

Diagnosis
• History taking
• Physical Examination
• Dermoscopy
• Biopsy
• Histopathological Examination
• Ultrasound
• CT
• MRI
Treatement
• Immunotherapies:
Interferon Therapy: Interferons are proteins that stimulate the immune
system to fight cancer cells.
Cytokine Therapy: High-dose interleukin-2 (IL-2) is a type of
immunotherapy that can stimulate the immune system to attack cancer
cells.
• Chemotherapy: Dacarbazine
• Radiation Therapy
• Surgery: Early-stage melanomas are typically treated with surgical
excision, where the tumor is removed along with a margin of healthy
tissue.
Nursing Management
Assessment and Monitoring:
• Regularly assess the patient's skin and any melanoma lesions for changes in
size, color, shape, or texture.
• Monitor for signs of infection, wound healing complications, or other post-
surgical issues.
• Assess the patient's pain level, emotional state, and overall well-being.
Education:
• Provide detailed information about melanoma, its causes, risk
factors, and treatment options.
• Educate patients about the importance of early detection through
regular skin self-exams and the ABCDE rule (Asymmetry, Border,
Color, Diameter, Evolving).
• Explain the different stages of melanoma and their implications for
treatment and prognosis.
• Teach patients about sun protection measures, including wearing
sunscreen, protective clothing, and avoiding peak sun exposure
hours.
Wound Care and Hygiene:
• Instruct patients on how to care for surgical wounds and incisions to promote
proper healing and reduce the risk of infection.
• Provide guidance on cleansing the wound, changing dressings, and
recognizing signs of wound complications.
Pain Management:
• Assess the patient's pain level and provide appropriate pain relief
measures as prescribed.
• Teach patients about pain management strategies, including
medication administration and non-pharmacological techniques
like relaxation and distraction.
Psychosocial Support:
• Offer emotional support and a listening ear to address the patient's fears,
anxieties, and concerns related to their diagnosis and treatment.
• Connect patients with support groups, counseling services, or resources for
additional psychological support.
Body Image and Self-Esteem:
• Acknowledge and address any concerns the patient may have
about changes in their appearance due to melanoma or its
treatment.
• Provide encouragement, validate the patient's feelings, and offer
strategies to improve body image and self-esteem.
Thank you