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Chapter: Medical Surgical Nursing: Management of Patients With Dermatologic Problems

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Skin Care for Patients With Skin Conditions

Some skin problems are markedly aggravated by soap and water, and bathing routines are modified according to the condition.

Skin Care for Patients With Skin Conditions

Some skin problems are markedly aggravated by soap and water, and bathing routines are modified according to the condition. Denuded skin, whether the area of desquamation is large or small, is excessively prone to damage by chemicals and trauma. The friction of a towel, if applied with vigor, is sufficient to pro-duce a brisk inflammatory response that causes any existing lesion to flare up and extend.

 

Protecting the Skin

 

The essence of skin care and protection in bathing a patient with skin problems is as follows: a mild, lipid-free soap or soap substi-tute is used; the area is rinsed completely and blotted dry with a soft cloth; and deodorant soaps are avoided.

 

Special care is necessary when changing dressings. Pledgets sat-urated with oil, sterile saline, or another prescribed solution help to loosen crusts, remove exudates, or free an adherent dry dressing.

 

Preventing Secondary Infection

 

Potentially infectious skin lesions should be regarded strictly as such, and proper precautions should be observed until the di-agnosis is established. Most lesions with pus contain infectious material. The nurse and physician must adhere to standard pre-cautions and wear gloves when inspecting the skin or changing the dressing. Proper disposal of any contaminated dressing is car-ried out according to Occupational Safety and Health Adminis-tration (OSHA) regulations.

 

Reversing the Inflammatory Process

 

The type of skin lesion (eg, oozing, infected, or dry) usually de-termines the type of local medication or treatment that is pre-scribed. As a rule, if the skin is acutely inflamed (ie, hot, red, and swollen) and oozing, it is best to apply wet dressings and sooth-ing lotions. For chronic conditions in which the skin surface is dry and scaly, water-soluble emulsions, creams, ointments, and pastes are used. The therapy is modified as the responses of the skin indicate. The patient and the nurse should note whether the medication or dressings seem to irritate the skin. The success or failure of therapy usually depends on adequate instruction and motivation of the patient and the interest of and support by the health care personnel.

 

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