Isotretinoin has many side effects. It is a known teratogen and can cause severe birth defects. A pregnancy test is required before therapy is initiated, and strict birth control measures must be used during therapy. Sun exposure, alcohol ingestion, and f
“Have you or any family members ever had skin cancer?”
“Do you drink alcoholic beverages?”
“Which method of contraception are you using?”
“Do you spend a great deal of time in the sun?”
Ketoconazole is an antifungal. Clindamycin and linezolid are antibiotics. Acyclovir is an antiviral drug.
Fungal infection – Ketoconazole (Nizoral)
Yeast infection – Linezolid (Zyvox)
Bacterial infection – Acyclovir (Zovirax)
a. Viral infection – Clindamycin (Cleocin)
The hospital nurse should provide details about the wound, including size and appearance and any special wound needs, in a hand-off report to the home health nurse. Insurance information is important to the home health agency and manager, but this is not
Recent wound assessment, including size and appearance
Complete health history and physical assessment findings
Insurance information for billing and coding purposes
Resources available to the client for wound care supplies
Clients with psoriatic lesions are often self-conscious of their skin. The nurse should first provide direct contact and touch without gloves to establish a good report with the client. Psoriasis is not an infectious disease, nor is it contagious. The nur
Shake the client’s hand and introduce self.
Assess for signs and symptoms of infections.
Don gloves and an isolation gown.
Ask the client if she might be pregnant.
A client with a Braden Scale score of 9 is at high risk for skin breakdown and requires moderate to maximum assistance to prevent further breakdown. Family members who care for clients at home may experience a disruption in family routines and added stres
“How are you coping with providing this care?”
“What are you doing to prevent pediculosis?”
“Are you sharing a bed with your husband?”
“Do you have a bedpan at home?”
The white blood cell count is not directly related to nutritional status. Albumin, prealbumin, and lymphocyte counts all give information related to nutritional status. The prealbumin count is a more specific indicator of nutritional status than is the al
Assess the client’s vital signs.
Perform a neuromuscular assessment.
Initiate Contact Precautions.
Request a dietary consult.
A client on anticoagulants is not a candidate for VAC because of the incidence of bleeding complications. The health care provider needs this information quickly to plan other therapy for the client’s wound. The nurse should contact the wound care nurse a
Contact the provider and express concerns related to the wound treatment prescribed.
Obtain a prescription for a low-fat, high-protein diet with vitamin supplements.
Assess the client’s vital signs and initiate continuous telemetry monitoring.
Consult the wound care nurse to apply the VAC device.
Necrotic tissue should be removed so that healing can take place. Whirlpool treatment can gently remove the necrosis. A wound covered with eschar most likely needs surgical débridement. Warm water would not be recommended for a client with erythema. A wet
Client with a sacral ulcer with purulent drainage – Transparent film dressing
Client with urticaria – Wet-to-dry dressing changes every 6 hours
Client with a sunburn and erythema – Soaking in warm water for 20 minutes
Client with a left heel ulcer with slight necrosis – Whirlpool treatments
Client with an eschar-covered sacral ulcer – Surgical débridement
A small pillow decreases the risk for pressure between bony prominences, a lift sheet decreases friction and shear, and heels have poor circulation and are at high risk for pressure sores, so they should be kept off hard surfaces. Head-of-the-bed elevatio
Place a small pillow between bony surfaces.
Limit fluids and proteins in the diet.
Use a rubber ring to decrease sacral pressure when up in the chair.
Re-position the client who is in a chair every 2 hours.
Elevate the head of the bed to 45 degrees.
Use a lift sheet to assist with re-positioning.
Keep the client’s heels off the bed surfaces.
Herpes zoster (shingles) is caused by reactivation of the same virus, varicella zoster, in clients who have previously had chickenpox. Anyone who has not had the disease or has not been vaccinated for it is at high risk for getting chickenpox. Herpes zost
Check the admission orders for analgesia.
Choose a roommate who also is immune suppressed.
Ensure that gloves are available in the room.
Prepare a room for reverse isolation.
Assess staff for a history of or vaccination for chickenpox.
Using a lift sheet will prevent shearing forces from tearing skin. Tape should be avoided so that the skin won’t tear. Using pressure-relieving devices for clients who are at risk for pressure ulcer formation, including older adults, is a proactive approa
Use loose dressing on all wounds.
Avoid whirlpool therapy.
Implement pressure-relieving devices.
Avoid tape when applying dressings.
Use a lift sheet when moving the client in bed.
Systemic factors, hormonal changes, psychological stress, medications, and general health factors can aggravate psoriasis. Psoriatic lesions are not triggered by chocolate, public showers, or international travel.
“Have you been out of the country recently?”
“Have you changed any medications recently?”
“Have you eaten a large amount of chocolate lately?”
“Have you recently had any other health problems?”
“Have you been under a lot of stress lately?”
“Have you recently used a public shower?”
All health care providers should follow Standard Precautions when caring for clients who have any open skin areas. This includes hand hygiene and wearing gloves when in contact with the lesions. The UAP is not qualified to assess the client’s skin. The ot
“Wear gloves when bathing the client.”
“Apply lotion to lesions while the skin is wet.”
“Use a damp cloth to scrub the lesions.”
“Wash your hands before touching the client.”
“Assess skin for breakdown during the bath.”
For a client with eczematous dermatitis, the goal of comfort measures is to decrease inflammation and help débride crusts and scales. The nurse should implement cool, moist compresses and tepid baths with additives such as cornstarch. Topical corticostero
Tepid bath with cornstarch
Back rub with baby oil
Cool, moist compresses
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