Impetigo

Impetigo is a contagious superficial pyoderma, caused by Staphylococcus aureus and/or group A streptococci, that begins with a superficial flaccid vesicle that ruptures and forms a thick yellowish crust, most commonly occurring in children.

The most common sites of infection are the face, around the mouth, the hands, the neck, and the extremities. The lesions begin as vesicles or pustules surrounded by edema and redness and progresses to an exudative and crusting stage. And after crusting, the initially serous vesicular fluid becomes cloudy and ruptures. It makes a honey-colored crust covering an ulcerated base.

Persons with impetigo will have specific signs:

1. Pruritus
2. Lesions
3. Burning
4. Lymph node involvement

How to care person with impetigo?

Here are the guidelines:

• Use standard precautions and implement agency specific isolation procedures in relation with impetigo.
• Let lesions to dry by air exposure.
• Daily bathing with antibacterial soap such as pHisoHex.
• Warm compresses to lesions 2 or 3 times per day to remove crusts and healing.
• Oral antibiotic for impetigo as prescribed.
• Use emollients to prevent skin cracking.
• Frequent hand washing when caring person with impetigo, to prevent the spread of infection.
• Use separate towels, linens, and dishes.
• All linens and clothing should be washed separately with detergent in hot water.

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Paronychia

Paronychia is a suppurative inflammation of the nail fold surrounding the nail plate; may be due to bacteria or fungi, most commonly staphylococci and streptococci. It most commonly occurs in middle-aged women and in the client with diabetes mellitus.

Person who has paronychia will have painful, redness and swelling around the nailbed, and soreness at nailbed. There may be pus-filled blisters, especially with a bacterial infection. Because of paronychia, the nail may look detached, abnormally shaped, or have an unusual color.



There are three types of paronychia :

1. Bacterial paronychia that is caused by bacteria.
2. Candidal paronychia that is caused by a specific type of yeast.
3. Fungal paronychia that is caused by a fungus other than Candida.

Nursing Intervention for paronychia:

• Monitor temperature
• Monitor for infection around the nails
• Monitor for cellulitis in the affected area
• Soaking the nail in hot water 2 or 3 times a day helps reduce inflammation and pain
• Incision and drainage of infected area if prescribed
• Antibiotic and fungicidal ointments as prescribed

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Kaposi’s Sarcoma

Kaposi’s Sarcoma is a multifocal malignant neoplasm that occur primarily in individuals with a compromised immune system such as AIDS. It is clinically manifested by cutaneous lesions consisting of reddish-purple to dark-blue macules, plaques, or nodules, that seen most commonly in men over 60 years of age.

Kaposi’s sarcoma may first appear on the feet or ankles, thighs, arms, hands, or face. Organ involvement includes the lymph nodes, airways or lungs, or any part of the gastrointestinal tract from the mouth to anus. So person has Kaposi’s Sarcoma may also has bleeding from gastrointestinal lesions, shortness of breath from lesion in the lung, and bloody sputum from lesions in the lung. Refer to images (end of this article)

Treatment of Kaposi’s sarcoma will depend on the extent and location of the lesions, person’s symptoms, and degree of immunosuppression. Radiation therapy, cryotherapy or chemotherapy also may be used for lesions in certain areas.

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Psoriasis

Psoriasis is a chronic noninfectious skin inflammation involving keratin synthesis that results in psoriatic patches, characterized by the eruption of circumscribed, discrete and confluent, reddish, silvery-scaled maculopapules. The lesions occur predominantly on the elbows, knees, scalp, and trunk.

Psoriasis most commonly begins between ages 15 and 35 and it can appear suddenly or slowly.

Type of Psoriasis
There are five main types of psoriasis.

1. Erythrodermic: The skin is redness and covers a large area.
2. Guttate: The skin appears small, pink-red spots.
3. Inverse: Skin redness and irritation occurs in the armpits, groin, and in between overlapping skin.
4. Plaque: Thick, red patches of skin are covered by flaky, silver-white scales. This is the most common type of psoriasis.
5. Pustular: White blisters are surrounded by red, irritated skin.

Symptoms:

• Pruritus
• Shedding, silvery, white scales on a raised, reddened, round plaque that mostly affects the scalp, knees, elbows, extensor surface of arms and legs, and sacral regions.
• A yellow discoloration, pitting, and a thickening of nails if they are affected.
• Joint inflammation with psoriatic arthritis.

Please see images on the end of this post/article!

Nursing Intervention:

• Administer daily soaks and tepid, wet compresses to the affected areas to remove scales.
• Assist the client to remove the scales during the soak.
• Occlusive dressing may be applied following application of corticosteroid to increase its effectiveness
• Plastic wrap or bags can be used as occlusive dressing.
• Instruct the client not to scratch the affected areas and to keep the skin lubricated to minimize itching
• Encourage client to wear light cotton clothing over affected areas.
• Instruct the client to be consistent regarding prescribed treatment and avoid over the counter medications.

click image to enlarge

Treatment for psoriasis can be intralesional therapy (injection of triamcinolone acetonide, aristocort, kenlog-10, trymex), systemic therapy (methotrexate, hydroxyurea, and cyclosporine A), and photochemotherapy.

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LYME DISEASE

Lyme disease is a subacute inflammatory disorder caused by infection with Borrelia burgdorferi, a nonpyogenic spirochete transmitted by Ixodes scapularis (see image the end of this article), the deer tick bite, in the eastern U.S. and I. pacificus, the western black-legged tick, in the western U.S. Ticks live in wooded area and survive by attaching to a host. And tick nymphs are thought to be responsible for about 90% of transmission to human beings.

Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. Variations in clinical features or severity from one patient to another may be due to inborn variations in immune response, perhaps linked to the human lymphocytic antigen system. The specific symptoms are depend on stages.

First Stage : Early localized infection

• Symptoms occur several days to month following the bite.
• Flulike symptoms
• Small red pimple that becomes ring-shaped rash (see image on the end of this article), and it can be large or small

Second Stage: Early disseminated infection

• Symptoms occurs several week following the bite.
• Neurological complication
• Joint pain
• Cardiac complication

Third Stage: Late persistent infection

• Large joints becomes involved
• Arthritis progresses

CARE INTERVENTIONS:

1. Remove the tick with tweezers gently, wash skin with antiseptic.
2. Take a blood test for 4 – 6 weeks following a bite to detect the presence of lyme disease.
3. Antibiotics as prescribed if the lyme disease is confirmed.
4. Avoid area that contain ticks (wood area, grassy area) especially in summer.
5. Wear long-sleeved tops long pants, close shoes and hat while outside
6. It is recommended to spray the body with tick repellent before going outside.

Images are here :


ring-shaped rash



Ixodes scapularis, the primary vector of Lyme disease in eastern North America




Nymphal and adult deer ticks can be carriers of Lyme disease.

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POISON IVY, OAK AND SUMAC

This is a dermatitis that develops from contact with uroshiol from poison ivy, oak, or sumac plant. Poison ivy, oak and sumac are most common allergy in the country claiming half the population and sensitivity to uroshiol can develop at any time. And a person who contacts with ivy, oak or sumac appears to react slightly different to all the remedies.

Assessment :

• Papulovesicular lesions
• Severe itching

How is the nursing intervention?

When a person is suspected contact with poison ivy, oak or sumac, do these steps:

• Cleanse the skin of the plant oils
• Apply cool, wet dressing with Burow’s solution to relieve itching
• Apply lotion or topical corticosteroid as prescribed, and
• Oral corticosteroid for severe reaction as prescribed

Pictures of Ivy :



Pictures of Oak :


Pictures of Sumac :

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