Med-surg Exam 2 (Unit 3)
Alterations in tissue Integrity
Pruritus Pg-1829-1830:
Pruritus (itching) is the most common symptom of patients with dermatologic disorders
Can be:
oGeneral- all over the skin surfaces)
oConfined- specific regions of the skin surface
May be the first indication of a systemic internal disease such as:
oDiabetes
oBlood disorders
oCancer (occult malignancy of the of the breast or colon cancer)
May also accompany:
oKidney diseases
oHepatic diseases
oThyroid diseases
Causes:
oMedications- aspirin, antibiotics, hormones (estrogen, testosterone, or oral
contraceptives), opioids (morphine); may also increase sensitivity to ultraviolet
light
oIrritants (soaps & chemicals)- radiation therapy’s, miliaria (prickly heart), contact
with wool garments, laundry detergent
oDryness
oHigh temperatures
oPsychological (stress)- “psychogenic stress” excessive stress in family or work
situations
Older adult considerations:
oPruritus is a result of dry skin
oMore likely to have a systemic illness that triggers pruritus
oTaking multiple medications
Pathophysiology:
oScratching the pruritic area causes inflamed cells and nerve endings to release
histamine (resulting in more pruritus generating and itch-scratch cycle)
oScratching may alter the skin integrity resulting in excoriation, redness, wheals
(raised areas), could include rash
oInfection and changes in pigmentation may result
Treatment/Management:
, oHx and assessment to determine cause of pruritus (ex: hay fever, allergy, recent
admin. of new meds, or change in cosmetics or soap)
oGoal: to relieve the pruritus
oAvoid washing with soap and hot water
oA warm bath followed by application of a bland emollient (oils, creams,
moisturizer, lotions) to moist skin can control xerosis (abnormally dry skin)
oTepid baths
oApplying cool compresses or cooling agents that contain menthol and camphor
(constrict blood vessels)
Pharmacologic therapy:
oTopical antipruritic agents (lidocaine, prilocaine)
oCapsaicin cream
oTopical corticosteroids- effective when used to diminish pruritus that occurs
secondary to inflammatory conditions
oOral antihistamines (diphenhydramine (Benadryl), hydroxyzine)
oSelective serotonin reuptake inhibitors (fluoxetine, sertraline) may be effective
with patients with pruritus that is secondary to cholestasis or the uremia of
chronic kidney disease
Nursing management/Interventions/teaching:
oReinforces reason for the prescribed therapeutic regimen
oEducates patient about specific points of care
oRemind patient to use tepid water and to shake of excess water and blot between
body folds with a towel
oImmediately after bathing, the skin should be lubricated with an emollient to trap
moisture
oAvoid vasodilation- hot environment, ingestion of alcohol or hot foods and liquids
oUsing a humidifier- to prevent dry air
oAvoid activities that cause perspiration
oWear cotton clothing keep nail trimmed to prevent skin damage and infection
Urticaria Pg-:
Nail Disorders Pg-1809:
Inspection of the nails include:
oConfiguration
oColor
oConsistency
, Many alterations of the nail beds reflect local or systemic abnormalities in progress or
resulting from past events
Beau Lines:
oTransverse depression of the nail
oMay reflect retarded growth of the nail matrix (indicates severe/chronic illness);
more commonly local trauma
Ridged nails:
oRidging, hypertrophy and other changes may be visible
oIndicates local trauma
Paronychia:
oInflammation of the skin around the nail
oUsually accompanied by tenderness and erythema (redness)
oInflamed cuticle or nail bacterial infection
Pitted surface:
oDefinite indication of psoriasis
Spoon shaped:
oIndicates severe iron deficiency anemia
oAngle between normal nail and its base is 160 degrees
oWhen palpated the nail base is usually firm
Clubbing:
oManifested by the straightening of the normal angle (180 degrees or greater)
oSoftening of the nail base (feels spongy like when palpated)
oMost often associated with pulmonary disease
oCan be a sign of chronic hypoxia
Infectious Processes
Viral- Herpes simplex 1 Pg-1838:
Viral- Herpes simplex 2 Pg-1682:
NO CURE OR VACCINE
Recurrent, lifelong viral infection causing herpetic lesions (blisters) on the external
genitalia (BELOW THE WAIST)
Sexually transmitted (can be transmitted asexually; from wet surfaces or self-
transmission ex: touching a cold sore then touching the genitalia)
Initial infection is usually very painful, and blisters may take up to 2-4 weeks to heal (can
also be asymptomatic)
Recurrent outbreaks are less painful and self-limiting
, Transmission is possible even when a carrier does not have symptoms (subclinical
shedding)
HSV increases the risk for HIV and other STI’s
Causes:
oSexual contact
oStress
oSunburn
oDental work
oInadequate rest
oPoor nutrition
oAny situation that taxes the immune system
Pathophysiology:
oWhen viral replication diminishes, the virus ascends the peripheral sensory nerves
and remain inactive in the nerve ganglia
oAnother outbreak may occur when the host is subjected to stress
Clinical Manifestations:
oItching and pain occur as the infected area becomes red and edemaous
oInfection may begin with macules and papules and progress to vesicles and ulcers
oVesicular states appears as a blister, which later coalesces (merges), ulcerates and
encrusts
oFlu-like symptoms may occur 3-4 days after the lesions appear
oOther s/s:
Inguinal lymphademopathy (enlarged lymph nodes in the groin area)
Minor tempaterature elevation
Malaise
Headache
Myalgia (muscle aches)
Dysuria (pain when urinating)
oTouching lesions and then touching other areas may result in in spread to other
areas of the body
oPotential problems:
Aseptic meningitis
Neonatal transmission
Severe emotional stress r/t diagnosis
Treatment/management:
oGoal: no treatment = relieving symptoms
oPreventing the spread of infection
oDecreasing potential health risks
oInitiating counseling and education programs
Alterations in tissue Integrity
Pruritus Pg-1829-1830:
Pruritus (itching) is the most common symptom of patients with dermatologic disorders
Can be:
oGeneral- all over the skin surfaces)
oConfined- specific regions of the skin surface
May be the first indication of a systemic internal disease such as:
oDiabetes
oBlood disorders
oCancer (occult malignancy of the of the breast or colon cancer)
May also accompany:
oKidney diseases
oHepatic diseases
oThyroid diseases
Causes:
oMedications- aspirin, antibiotics, hormones (estrogen, testosterone, or oral
contraceptives), opioids (morphine); may also increase sensitivity to ultraviolet
light
oIrritants (soaps & chemicals)- radiation therapy’s, miliaria (prickly heart), contact
with wool garments, laundry detergent
oDryness
oHigh temperatures
oPsychological (stress)- “psychogenic stress” excessive stress in family or work
situations
Older adult considerations:
oPruritus is a result of dry skin
oMore likely to have a systemic illness that triggers pruritus
oTaking multiple medications
Pathophysiology:
oScratching the pruritic area causes inflamed cells and nerve endings to release
histamine (resulting in more pruritus generating and itch-scratch cycle)
oScratching may alter the skin integrity resulting in excoriation, redness, wheals
(raised areas), could include rash
oInfection and changes in pigmentation may result
Treatment/Management:
, oHx and assessment to determine cause of pruritus (ex: hay fever, allergy, recent
admin. of new meds, or change in cosmetics or soap)
oGoal: to relieve the pruritus
oAvoid washing with soap and hot water
oA warm bath followed by application of a bland emollient (oils, creams,
moisturizer, lotions) to moist skin can control xerosis (abnormally dry skin)
oTepid baths
oApplying cool compresses or cooling agents that contain menthol and camphor
(constrict blood vessels)
Pharmacologic therapy:
oTopical antipruritic agents (lidocaine, prilocaine)
oCapsaicin cream
oTopical corticosteroids- effective when used to diminish pruritus that occurs
secondary to inflammatory conditions
oOral antihistamines (diphenhydramine (Benadryl), hydroxyzine)
oSelective serotonin reuptake inhibitors (fluoxetine, sertraline) may be effective
with patients with pruritus that is secondary to cholestasis or the uremia of
chronic kidney disease
Nursing management/Interventions/teaching:
oReinforces reason for the prescribed therapeutic regimen
oEducates patient about specific points of care
oRemind patient to use tepid water and to shake of excess water and blot between
body folds with a towel
oImmediately after bathing, the skin should be lubricated with an emollient to trap
moisture
oAvoid vasodilation- hot environment, ingestion of alcohol or hot foods and liquids
oUsing a humidifier- to prevent dry air
oAvoid activities that cause perspiration
oWear cotton clothing keep nail trimmed to prevent skin damage and infection
Urticaria Pg-:
Nail Disorders Pg-1809:
Inspection of the nails include:
oConfiguration
oColor
oConsistency
, Many alterations of the nail beds reflect local or systemic abnormalities in progress or
resulting from past events
Beau Lines:
oTransverse depression of the nail
oMay reflect retarded growth of the nail matrix (indicates severe/chronic illness);
more commonly local trauma
Ridged nails:
oRidging, hypertrophy and other changes may be visible
oIndicates local trauma
Paronychia:
oInflammation of the skin around the nail
oUsually accompanied by tenderness and erythema (redness)
oInflamed cuticle or nail bacterial infection
Pitted surface:
oDefinite indication of psoriasis
Spoon shaped:
oIndicates severe iron deficiency anemia
oAngle between normal nail and its base is 160 degrees
oWhen palpated the nail base is usually firm
Clubbing:
oManifested by the straightening of the normal angle (180 degrees or greater)
oSoftening of the nail base (feels spongy like when palpated)
oMost often associated with pulmonary disease
oCan be a sign of chronic hypoxia
Infectious Processes
Viral- Herpes simplex 1 Pg-1838:
Viral- Herpes simplex 2 Pg-1682:
NO CURE OR VACCINE
Recurrent, lifelong viral infection causing herpetic lesions (blisters) on the external
genitalia (BELOW THE WAIST)
Sexually transmitted (can be transmitted asexually; from wet surfaces or self-
transmission ex: touching a cold sore then touching the genitalia)
Initial infection is usually very painful, and blisters may take up to 2-4 weeks to heal (can
also be asymptomatic)
Recurrent outbreaks are less painful and self-limiting
, Transmission is possible even when a carrier does not have symptoms (subclinical
shedding)
HSV increases the risk for HIV and other STI’s
Causes:
oSexual contact
oStress
oSunburn
oDental work
oInadequate rest
oPoor nutrition
oAny situation that taxes the immune system
Pathophysiology:
oWhen viral replication diminishes, the virus ascends the peripheral sensory nerves
and remain inactive in the nerve ganglia
oAnother outbreak may occur when the host is subjected to stress
Clinical Manifestations:
oItching and pain occur as the infected area becomes red and edemaous
oInfection may begin with macules and papules and progress to vesicles and ulcers
oVesicular states appears as a blister, which later coalesces (merges), ulcerates and
encrusts
oFlu-like symptoms may occur 3-4 days after the lesions appear
oOther s/s:
Inguinal lymphademopathy (enlarged lymph nodes in the groin area)
Minor tempaterature elevation
Malaise
Headache
Myalgia (muscle aches)
Dysuria (pain when urinating)
oTouching lesions and then touching other areas may result in in spread to other
areas of the body
oPotential problems:
Aseptic meningitis
Neonatal transmission
Severe emotional stress r/t diagnosis
Treatment/management:
oGoal: no treatment = relieving symptoms
oPreventing the spread of infection
oDecreasing potential health risks
oInitiating counseling and education programs
