Chapter 31 Dermatologic Conditions Types of Lesions Macule

Chapter 31 Dermatologic Conditions

Types of Lesions • Macule • Vesicle • Papule • Bulla • Plaque • Pustule • Nodule • Fissure • Tumor • Ulcer • Wheal

Measures to Prevent Dermatologic Problems • Avoid drying agents, rough clothing, highly starched linens; other irritants. • Promote activity. • Use bath oils, lotions, and massages. • Avoid excessive bathing. • Promote early treatment of pruritus and skin lesions. • Avoid exposure to UV rays.

Patient Teaching Regarding Cosmetic Surgery • Encourage all persons to look their best. • Emphasize fact that no cream, lotion, or miracle drug will remove wrinkles and lines. • Encourage the use of cosmetics. • Be informed of the various types of surgical interventions. • Explore patients’ reasons for seeking cosmetic surgery.

Factors Contributing to Pruritus • Excessive bathing and dry heat • Certain Diseases – Diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia • Certain psychiatric problems

Measures to Relieve Pruritus • Bath oils, moisturizing lotions, and massage • Vitamin supplements and a high-quality, vitamin-rich diet • The topical application of zinc oxide • Antihistamines and topical steroids

Keratoses • Definition – Small, light gray or brown lesions on exposed areas of the skin – Formation of a cutaneous horn due to keratin accumulation

Keratoses (cont. ) • Treatment – Freezing agents and acids – Electrodesiccation or surgical excision – Close nursing observation for changes in keratotic lesions

Seborrheic Keratoses • Dark, wartlike projections on various parts of the body – May be as small as a pinhead or as large as a quarter. – Tend to increase in size and number with age.

Treatment of Seborrheic Keratoses • Small Seborrheic Keratoses – Abrasive activity with a gauze pad containing oil may remove them. • Larger, Raised Lesions – Can be removed by freezing agents or by a curettage and cauterization procedure.

Classification of Melanomas • Lentigo Maligna Melanoma: black, brown, white, or red pigmented flat lesion on sun-exposed areas of the body. • Superficial Spreading Melanoma: appears as variablepigmented plaque with an irregular border. • Nodular Melanoma: found on any body surface; a darkly pigmented papule that increases in size over time.

Detection and Treatment of Melanomas • Detection – Self inspection – Early detection improves the prognosis. – Evaluate and biopsy suspicious lesions. • Treatment – Usually excised with removal of some of the surrounding tissue and subcutaneous fat. – Some physicians recommend removal of all palpably enlarged lymph nodes.

Vascular Lesions • Cause – Age-related changes weaken the walls of the veins. – Weakened vessel walls cause varicose veins. • Edema of the lower extremities • Poor tissue nutrition • Legs gain a pigmented, cracked, and exudative appearance.

Nursing Measures for Stasis Ulcer • Control of infection • Good nutrition • Assistance with weight reduction • Elevation of legs • Prevention of interferences to circulation

Factors Affecting Older Adult’s Risk for Pressure Ulcers • Skin that is fragile and damages easily • A poor nutritional state • Reduced sensation of pressure and pain • Affected by immobile and edematous conditions contributing to skin breakdown

Nursing Measures to Prevent Pressure Ulcesrs • Avoid unrelieved pressure. • Encourage activity or turning of the dependent patient. • Avoid shearing forces. • Recommend a high-protein, vitamin-rich diet. • Promote good skin care.

Stages of Pressure Ulcers • Stage 1: a persistent area of skin redness (without a break in the skin); does not disappear when pressure is relieved. • Stage 2: a partial thickness loss of skin layers involving the epidermis; presents clinically as an abrasion, blister or shallow crater. • Stage 3: a full thickness of skin is lost extending through the dermis and exposing the subcutaneous tissues. • Stage 4: a full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone, or both.

Protective Measures for Various Stages of Pressure Ulcers • Hyperemia: protect the skin with a product such as Duoderm (Squibb) or Tegasorb (3 M) before applying the adhesive. • Ischemia: protect with Vigilon, which contains water and is soothing to the area. • Necrosis: requires a transparent dressing that protects from bacteria but is permeable to oxygen and water vapor; irrigation is essential during dressing changes. • Ulceration: debridement is essential.

Nursing Considerations • Promoting Normalcy – Psychological support – Need for normal interactions and contacts

Using Alternative Therapies • Aloe vera for minor cuts and burns • Witch hazel for bruises and swelling • Homeopathic remedies • Acupuncture • Biofeedback • Guided imagery • Relaxation exercises • Nutritional supplements

Source • Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed. ). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0 -7817 -4428 -8).