learning Objectives - Describe the various diseases and disorders of integumentary system and their management. Demonstrate skill in providing care to the clients with disorders of integumentry system
Hours - 5
Teaching and Learning Activities - Lecture cum discussion Explain using Charts, graphs models, films, slides
Assessment Methods - Essay type Short answers Object type Assessment of skills with check list
Content of the chapter
a) Nursing Assessment
– History
– Physical assessment
b) Etiology
c) Pathophysiology
d) Clinical manifestions
e) Nursing management of disorders of skin
and its appendages
– Lesions and abrasions
– Infection and infestations Dermititis
– Dermatoses; infectious and Non
infectious
– Inflammatory dermatoses
– Acne Vulgaris
– Allergies and Eczema
– Psoriasis
– Malignant Melanoma
– Alopecia
– Infestations
– Bacterial infections
– Pyoderma
– Impetigo
– Folliculitis
– Furuncles
– Carbuncles
– Viral infections
– Herpes zoster
– Herpes simplex
– Fungal infection
– Athlete’s foot (Tanta Pedi’s)
– Parasitic infestation
– Pediculosis
– Scabies
– Pemphigus
– Stevens – Johnson syndrome
– Skin cancer
– Special dermatological therapies
f) Burn and its management
– Burns Plastic Surgery
– Incidence, causes of burns
– Types & classification of burns
– Pathophysiology
– Calculation of the percentage
– Local & systematic effects of burns
– Immediate care
– First aid care
– Medical Management, barrier nursing
care of the burns
– Complications, Health education
g) Plastic Surgery
– Define plastic & reconstructive surgery
– Types
– Define skin graft flaps
– Possible complication
– Preparation of patient for constructive
surgery
– Post operative care
– Health Education
h) Alternate therapies
i) Drugs used in treatment of integumentary
disorders
Nursing Management of Patients with Diseases and Disorders of the Integumentary System
The integumentary system includes skin, hair, nails, and glands. Nursing care focuses on assessment, prevention, treatment, wound care, patient education, and psychosocial support.
a) Nursing Assessment
1. History
- Onset, duration, and progression of skin problem
- Associated symptoms: itching, pain, discharge, fever
- Past dermatological conditions
- Allergies, exposure to irritants, or infections
- Medication history (drug reactions)
- Family history of skin disorders
- Lifestyle factors: hygiene, occupation, exposure to chemicals or sunlight
2. Physical Assessment
- Inspection:
- Skin color, moisture, temperature, turgor, texture
- Presence of lesions: size, shape, distribution, type (macule, papule, vesicle, pustule)
- Hair and nail abnormalities
- Palpation:
- Tenderness, induration, edema
- Temperature changes, moisture levels
- Assessment of functional limitations (e.g., mobility affected by burns or rashes)
b) Etiology
- Genetic: psoriasis, eczema
- Infections: bacterial, viral, fungal, parasitic
- Allergic reactions: contact dermatitis, urticaria
- Trauma: abrasions, burns, pressure ulcers
- Neoplastic: skin cancers
- Environmental: UV exposure, chemical irritants
c) Pathophysiology
- Disruption of normal skin barrier
- Inflammatory response causing redness, swelling, pain, and itching
- Infection may cause tissue damage
- Autoimmune reactions in conditions like pemphigus, psoriasis
- Burns: coagulation, protein denaturation, vascular compromise, systemic inflammatory response
d) Clinical Manifestations
- Redness, edema, itching, pain
- Lesions: papules, pustules, vesicles, ulcers, scales, crusts
- Discharge or bleeding
- Hair and nail changes
- Systemic symptoms in severe infections or burns: fever, malaise
e) Nursing Management of Disorders of Skin and Appendages
1. Lesions and Abrasions
- Clean with mild antiseptic
- Apply dressing to prevent infection
- Monitor for signs of infection
2. Infections and Infestations
Bacterial:
- Pyoderma, impetigo, folliculitis, furuncles, carbuncles
- Nursing care: hygiene, antibiotics, wound care, patient education
Viral:
- Herpes simplex, herpes zoster
- Nursing care: antiviral therapy, pain management, isolation if necessary
Fungal:
- Athlete’s foot (Tinea pedis), ringworm
- Nursing care: antifungal agents, keep skin dry, hygiene education
Parasitic:
- Pediculosis (lice), scabies
- Nursing care: topical scabicides, lice treatment, hygiene measures
3. Dermatitis and Dermatoses
- Inflammatory dermatoses: eczema, allergies
- Nursing care: remove irritants, topical corticosteroids, moisturizers
- Psoriasis: chronic autoimmune
- Nursing care: topical therapy, phototherapy, patient education
4. Malignant Melanoma and Skin Cancer
- Early detection using ABCDE rule (Asymmetry, Border, Color, Diameter, Evolving)
- Nursing care: surgical preparation, postoperative wound care, education on sun protection
5. Special Dermatological Therapies
- Phototherapy, laser treatment, topical immunomodulators
- Nursing care: eye protection, monitoring for adverse effects
f) Burns and Their Management
1. Definition and Causes
- Burns are tissue injuries caused by heat, chemicals, electricity, or radiation
2. Types & Classification
- Superficial (1st degree): redness, pain
- Partial thickness (2nd degree): blisters, severe pain
- Full thickness (3rd degree): charred skin, may be painless
3. Pathophysiology
- Local tissue damage
- Fluid loss, electrolyte imbalance
- Inflammatory response, risk of infection
- Systemic effects: hypovolemic shock, renal failure, sepsis
4. Assessment
- Calculate Total Body Surface Area (TBSA) using rule of nines
- Monitor vital signs, pain, and airway
5. Immediate Care
- Stop burning process, remove clothing and jewelry
- Cool the burn with running water
- Cover with sterile dressing
- Assess airway in inhalation burns
6. Medical Management
- Fluid resuscitation (Parkland formula)
- Pain management
- Infection control: barrier nursing
- Nutritional support
7. Complications
- Infection, sepsis, contractures, hypovolemia, electrolyte imbalance
g) Plastic Surgery
1. Definition
- Plastic surgery: repair, reconstruction, or replacement of tissues
- Reconstructive surgery: restores function
- Cosmetic surgery: improves appearance
2. Types
- Skin grafts (split-thickness, full-thickness)
- Flap procedures
3. Nursing Management
- Preoperative: patient education, emotional support, preparation of donor and recipient sites
- Postoperative: monitor graft/flap viability, infection prevention, pain management, positioning to prevent pressure on graft
- Complications: graft rejection, infection, necrosis
h) Alternate Therapies
- Aloe vera, herbal creams for minor burns and dermatitis
- Moisturizers for eczema and psoriasis
- Meditation, relaxation for stress-related skin conditions
- Phototherapy and light therapy for psoriasis
i) Drugs Used in Treatment of Integumentary Disorders
- Topical corticosteroids: hydrocortisone, betamethasone
- Antibiotics: mupirocin, cephalexin
- Antifungals: clotrimazole, terbinafine
- Antivirals: acyclovir
- Antihistamines: diphenhydramine, cetirizine (for itching and allergies)
- Immunomodulators: tacrolimus, pimecrolimus (eczema, psoriasis)
- Pain relief: NSAIDs, opioids for severe burns
Conclusion
Nursing management of integumentary disorders emphasizes early assessment, accurate diagnosis, infection prevention, wound care, pain management, patient education, and psychosocial support. Burns and surgical interventions require specialized care, including fluid management, barrier nursing, rehabilitation, and patient counseling. Holistic care improves recovery, skin integrity, and quality of life.