...Developing top notch CNAs, one inservice at a me. A Disease Process Module for Nurse Aides: Common Skin Conditions, from A to Z

Transcription

1 ...Developing top notch CNAs, one inservice at a me A Disease Process Module for Nurse Aides: Common Skin Conditions, from A to Z

2 Developing Top-Notch CNAs, One Inservice at a Time A Disease Process Module: Common Skin Conditions, from A to Z We hope you enjoy this inservice, prepared by registered nurses especially for nursing assistants like you! Instructions for the Learner If you are studying the inservice on your own, please do the following: Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important. If you have questions about anything you read, please ask. Take the quiz. Think about each statement and pick the best answer. Check with your supervisor for the right answers. You need 8 correct to pass! Print your name, write in the date, and then sign your name. Keep the inservice information for yourself and turn in the quiz page to no later than. Show your Inservice Club Membership Card to so that it can be initialed. In the Know at feedback@knowingmore.com with your comments and/or suggestions for improving this inservice. After finishing this inservice, you will be able to: Describe how skin is a vital organ in the human body. List at least four important functions of the skin. Identify at least 10 common skin conditions in clients. Discuss the CNA s role in caring for clients with common skin conditions. List at least five ways you can help clients maintain healthy skin. THANK YOU!

3 Developing Top-Notch CNAs, One Inservice at a Time Inside This Inservice: Anatomy of the Skin 2 Conditions: A-B 3 Conditions: C-E 4 Conditions: F-H 5 Conditions: I-M 6 A Disease Process Module: Common Skin Conditions, from A to Z WHY WE RE SO SENSITIVE ABOUT SKIN... Did you know that skin is considered an organ in the human body? In fact it s the body s largest organ... and it s the only organ that comes in contact with the rest of the world! Most people take the skin for granted. It s just skin, after all. No big deal right? But, it is a huge deal. Being the largest organ in the body, the skin has a BIG job to do. In fact it has many big jobs to do: It holds body fluids in, preventing dehydration. Conditions: N-P 7 Conditions: R-S 8 It keeps harmful germs out, preventing infections. It is the home of millions of nerve endings that help you feel things like heat, cold, and pain. Conditions: T-Y 9 Keeping Skin Healthy 10 These are just a few of the amazing things that skin can do! And aside from all the biological functions of the skin, our skin also does something for us psychologically and emotionally. It s like a suit that we can t take off. It never goes out of style, but it does change the way we see ourselves and the way we feel when we present ourselves to the world. Like a good hair day, when our skin looks good, we feel good. And, when our skin looks or feels bad, we feel bad. So, you can see that when there s a problem with the skin, it can mean big trouble for the whole body. Keep reading to learn all about 21 common skin conditions and how you can help the clients who have them. Hopefully, by the end, you ll see just how important healthy skin is and how you play an important role in keeping your client s skin in tip top condition!

4 2016 In the Know, Inc. Page 2 ANATOMY AND PHYSIOLOGY OF THE SKIN Epidermis Dermis Subcutaneous Tissue THE LAYERS OF THE SKIN The Epidermis: This is the outside layer of skin that we can see and touch. It is made up of dead cells. That doesn t sound very appealing, does it? But, those dead cells serve a very important purpose: they protect the delicate layers of skin underneath. The dead cells shed, or fall off, and are replaced by new cells that are pushed up from below. The epidermis is the layer that gives skin its color. Special cells called melanocytes produce the pigment known as melanin. Melanin protects the skin from UV light. The Dermis: The next layer of skin is called the dermis. It is thicker than the first layer and is very elastic, giving us the ability to stretch and move. The dermis contains sweat glands, hair follicles, and nerve endings. Subcutaneous Tissue: The bottom layer of the skin is known as subcutaneous tissue. It is comprised mostly of fat which helps keep the body cool in the summer and warm in the winter. Fat also cushions the body and stores extra fuel. FORM AND FUNCTION! Although skin is made up of just three thin layers, it is responsible for all of the following vital functions: 1. Protects the body from germs. 2. Makes the body waterproof. 3. Provides padding for bones and muscles. 4. Keeps the body temperature stable. 5. Makes the body feel everything it touches. 6. Circulates up to 25% of the body s blood supply. 7. Produces important hormones and enzymes. 8. Allows oxygen to enter the body while at the same time, getting rid of excess water. But, that s not all! In addition to these eight important jobs, the skin is expected to heal itself whenever it gets injured. Just think of all the bruises, bumps, scrapes, and cuts that each person s skin has to deal with throughout a lifetime! Grab your favorite highlighter! As you read this inservice, highlight five things you learn that you didn t know before. Share this new information with your co-workers!

5 2016 In the Know, Inc. Page 3 ACNE Pimples are not just for teenagers! Adults and the elderly get them too. A pimple occurs when oils and bacteria become trapped under dead skin cells. One pimple here and there is usually no big deal, but if you begin to notice clusters of them or larger cysts on your client, you may be looking at a more serious condition called acne vulgaris. When acne or pimples start in the senior years, it s usually related to certain medications, such as steroids or hormonal treatments. ATHLETE S FOOT You don't need to be an athlete to develop this skin condition! It s caused by a fungus that thrives in warm, dark, moist areas, like showers, pools, and even inside shoes. If your client has redness, blisters, peeling, and itching (especially between the toes), you may be looking at athlete s foot. When caught and reported early, this condition is usually easy to treat. If left untreated, serious complications can occur. Prevent breakouts by cleaning the face, neck, and back areas with a mild (perfume and dye free) cleanser and warm water once a day. Too much cleaning and/or using harsh soaps can make the problem worse. Report right away if your client has more frequent or larger cysts. It may be time for a change in medication or antibiotics. Never attempt to pop or squeeze a pimple on your client. This could lead to a more serious infection. Carefully inspect your clients feet during routine foot care every day. Wash the feet daily and dry completely, particularly between the toes. Always place clean, dry socks on the feet before putting on shoes. Have your client wear shower shoes when using shared bathroom facilities. In the home, keep the bathroom clean and allow surfaces to dry completely between showers. BED SORES (PRESSURE INJURIES) Pressure injuries are damaged areas caused by unrelieved pressure. They are most common in people who are immobile, lack accurate perception of pain, or who have other health issues such as poor nutrition, diabetes, dementia, or fragile skin. At first, the area becomes whitish and cold and may tingle or itch. If the pressure is not relieved, it will turn red, then a blister may form. Without treatment, the skin will begin to die and the pressure ulcer will rapidly progress to an open wound. All immobile or bedbound clients should be turned and re-positioned at least every two hours. Keep bed linens clean, dry, and free from wrinkles. When bathing a client, pat the skin dry with a towel instead of rubbing it. Use pillows and pads to minimize pressure on bony parts of the body. Encourage wheelchair bound clients to shift positions every 15 minutes if able. Keep incontinent clients as dry and clean as possible.

6 2016 In the Know, Inc. Page 4 CELLULITIS Cellulitis is a skin infection caused by a bacteria. It happens when the germ enters the body through a cut, sore, insect bite, or even a vaccine injection site. Older adults and people who have diabetes or a weak immune system are more likely to develop dangerous problems from cellulitis. The first sign of infection will be warm, red, swollen, and tender area on the skin. As the infection spreads, you may see fever, chills, and swollen glands. Cellulitis can occur anywhere on the body. In adults, it often occurs on the legs, face, or arms. DIAPER RASH Diaper rash is the term for skin irritation that develops in the diaper-covered region. It s most common in infants and incontinent adults who use adult briefs or pull-ups. The rash can be caused by moisture, harsh chemicals in stool and urine, or just by the friction of the diaper rubbing on the sensitive area. Allergic reactions to the diaper itself can also cause a diaper rash. Mild cases will go away within 24 hours. In more severe cases, the skin may blister or peel, leaving raw areas that may bleed or ooze fluid. Fungal or bacterial infections may be the cause of a severe diaper rash. ECZEMA Eczema is a skin condition that causes skin to become itchy, red, and dry. Chronic sufferers will have patches of itchy, dry, thickened skin, usually on the hands, neck, face, and legs, but it can occur anywhere. If scratched, dry patches of skin and open sores with crusts may develop and become infected. It s not clear what causes eczema. Doctors believe it is caused by a combination of factors, including genetics, immune system problems, and the environment. An eczema flare can be triggered by certain foods, stress, the weather, lotions or perfumes, or even as a result of having a cold. Report any signs of infection right away. Antibiotics will need to be started as soon as possible. If left untreated, the bacteria can spread quickly through the body which can be deadly. If your client is on antibiotics for cellulitis, remind him to take all his medication as ordered. Stopping too soon can make the infection much worse. Change incontinent clients as soon as they are soiled or wet. Diaper rash caused by leaving a client in a soiled diaper for too long is considered neglect. Use a barrier cream with zinc oxide (unless your client is allergic) to keep moisture off the skin. Sprinkle powder between folds of skin and in the creases of the thighs to minimize friction. If your client suffers from eczema, find out what triggers it and help your client avoid those things. Use mild (perfume and dye free) soaps and lotions. Encourage your client to take short, warm showers. Hot water or long showers can dry out the skin. Help your client reduce stress. Regular exercise and setting aside time to relax may help.

7 2016 In the Know, Inc. Page 5 FUNGAL NAIL INFECTIONS A fungal nail infection occurs when a fungus attacks a fingernail or toenail through small cuts in the skin around the nail or through the opening between the nail and nail bed. A nail with a fungal infection may turn yellow or white, get thicker, or even crumble and fall off. Yeasts, molds, and different kinds of fungi can cause fungal nail infections. Most are caused by the same type of fungus that causes athlete's foot. People most at risk for a nail infection are those that are older than 60, have diabetes or a weak immune system, or those that live in hot humid places. GRANULOMA ANNULARE The name sounds much more serious than it is! Granuloma annulare is a chronic skin condition that causes raised, reddish or skin-colored bumps (lesions) that form ring patterns, usually on the hands and feet. In most cases, granuloma annulare isn't itchy or painful, so no treatment is necessary. The lesions usually disappear on their own. HIVES Hives is a skin reaction that causes raised, red, itchy welts that can appear anywhere on the body. It's not always possible to know the exact cause, but many times, hives is an allergic reaction. Here are some common culprits: Foods Shellfish, fish, peanuts, tree nuts, eggs. Medications Penicillin, Motrin, blood pressure meds. Weather Heat, cold, sunlight. Other Pollen, latex, insect stings, stress. Fungal nail infections are usually not serious, but can be difficult to treat. Help prevent nail infections by following the same guidelines for preventing athlete s foot. In addition: Give feet plenty of open-to-air time when your client is sitting or resting. Never share nail files, clippers, socks, towels, or other personal items between clients. Reassure your client that the condition is not serious and will go away on it s own. Report right away if your client s skin develops reddish bumps (lesions) in ring patterns that don't go away within a few weeks. Watch for and report and signs of infection (redness, swelling, warmth, pain, etc.). Report anytime you notice hives on your client. Mild cases usually clear up on their own, but treatment with an antihistamine can help relieve itching or other serious discomfort. Try to identify the food, medication, or other trigger that caused the hives so you can help your client avoid it in the future. A cool bath with a sprinkle of baking soda can be soothing. Dress your client in light, loose clothing to avoid further irritation.

8 2016 In the Know, Inc. Page 6 IMPETIGO (COLD SORE) Impetigo (im-puh-tie-go) is a highly contagious skin infection that appears as red sores on the face, especially around the nose and mouth. The sores burst and develop honey-colored crusts. Impetigo is most common in children, but anyone can get it. It s common in warmer months and in crowded living conditions. Older adults and people with diabetes or a compromised immune system are more likely to develop ecthyma, a more serious form of impetigo. LICHEN SIMPLEX CHRONICUS This skin condition starts with a patch of itchy skin, but scratching it makes the area even itchier until the person begins to scratch simply out of habit. The chronic itching and scratching can cause the affected skin to become thick and leathery. Lichen simplex chronicus isn't serious, but breaking the itchscratch cycle can be a challenge. The exact cause is unknown, but in some cases, it s associated with dry skin, eczema, or psoriasis. Stress and anxiety can trigger itching, too. Report any sores right away so steps can be taken to isolate and treat the infection. An antibiotic cream will help with small sores. Oral antibiotics may be needed for more severe cases. Remember, impetigo is highly contagious, so wash your hands and encourage your client to wash his or her hands frequently. Minimize contact with others by covering the sores with a bandage. Be sure to remove the bandage as a soon as possible to keep the sore open to air. In severe cases, medication may be needed to stop the itching. If the problem is related to anxiety, therapy may help. A cool bath with a sprinkle of baking soda or uncooked oatmeal can be soothing. Keep your clients nails trimmed short to prevent scratching open the skin. Provide mild soaps without dyes or perfumes. Be sure to rinse off the soap completely. And after washing, apply an unscented moisturizer to protect the skin. MELANOMA Melanoma is the most serious type of skin cancer. It can develop anywhere, but occur most often in areas that have had exposure to the sun, such as your back, legs, arms, and face. The first sign of melanoma is often a change in an existing mole. It can also show us as a new unusual-looking growth on the skin The best treatment for melanoma includes early detection. To help you identify characteristics of unusual moles that may indicate melanomas or other skin cancers, think of the letters A-B-C-D-E. A is for Asymmetrical. Look for moles with irregular shapes, such as two very differentlooking halves. B is for irregular Border. Look for moles with irregular, notched, or scalloped borders. C is for Color. Look for growths that have many colors or an uneven distribution of color. D is for Diameter. Look for new growth in a mole larger than 1/4 inch (about 6 millimeters). E is for Evolving. Look for changes over time, such as a mole that grows in size or that changes color or shape.

9 2016 In the Know, Inc. Page 7 NECROTIZING FASCITIS A condition that seems to jump right out of a science fiction novel, this flesh eating bacteria infects nearly 12,000 Americans yearly and kills 1,800. This bacteria (the same one that causes strep throat) can destroy skin, fat, and the tissue covering the muscles within a very short time. The symptoms start suddenly after an injury. The person may have normal pain that suddenly gets much worse than what is normal for the wound or injury. There may also be other signs of infection, such as red, swollen, and hot skin and fever and chills. PRURITIS Pruritis is just a fancy medical term that means itchy skin. Itchy skin seems harmless, right? Well, it can be, if it s from dry skin or an easily identifiable rash. But it also may be a sign something serious, like liver disease or kidney failure. With this skin condition, the skin may appear normal, or you may see redness, rough skin, bumps, or blisters. Finding and treating the underlying cause of itchy skin is important for long-term relief. Unrelieved pruritis can lead to the condition, lichen simplex chronicus, which is described on page 6 of this module. PSORIASIS Psoriasis is a chronic skin (long term) skin condition that causes skin cells to grow too quickly. Normally, skin cells grow slowly and flake off about every four weeks. New skin cells grow to replace the outer layers of the skin as they shed. But with psoriasis, new skin cells move rapidly to the surface of the skin where they build up and form thick patches called plaques. It is believed the be caused by an immune response. It can also be genetic, as it seems to run in families. Common triggers of flare-ups include smoking, stress, changes in weather. Necrotizing Fascitis is a medical emergency. If you think your client is showing signs GET HELP IMMEDIATELY! Pay attention to your clients reports of pain. Remember, the first sign may be a report of pain that seems out of proportion to an injury. In one case, a woman had what seemed like an ingrown hair on her leg, but she reported excruciating pain. A few days later, her skin was eaten down to the bone. Be sure to report any long term itching, particularly if there seems to be no reason for the itching. To reduce itching and soothe skin, apply a highquality moisturizer once or twice daily. Examples include Vanicream, Cetaphil, Eucerin, and CeraVe. Help your clients stay cool and dry. Dress them in cool, light, loose clothing to minimize irritation. There is no cure for psoriasis. The most important part of treatment is helping each individual identify and avoid the triggers that cause the flare-ups. Help clients gently remove plaques after softened by bathing. This will help any lotions or medications absorb better. UV rays from sunlight can help decrease symptoms. You client may have orders to spend time in the sun on a regular basis. Follow the schedule to help your client get sunlight.

10 2016 In the Know, Inc. Page 8 ROSACEA Rosacea is a common skin condition that causes redness, swelling, and small, red, pus-filled bumps across the face. The cause of rosacea is unknown, but it s likely a combination of hereditary and environmental triggers. Common rosacea triggers include: hot foods or beverages, spicy foods, alcohol, sunlight, and stress. Although anyone can develop rosacea, those at highest risk are women with fair skin between the ages of 30 and 60, or those who have a family history of rosacea. SHINGLES You may already know that shingles and chicken pox are related. Both conditions are caused by the same bug the varicella zoster virus. After a bout of chickenpox, the virus hides out in the body. It can remain hidden for life or it can wake up. If that happens, even years or decades later, the virus can come back down the nerve pathway and cause shingles to develop. You can t catch shingles from someone else, but people who have not had chickenpox can get chickenpox from someone with shingles. SKIN TAGS These flesh-colored growths protrude from the skin, on a stalk. They can be anywhere on the body, but are most often found on the neck or in the armpits. Skin tags are usually benign, which means they are not cancerous. They don t cause symptoms, unless they are repeatedly rubbed, scratched, or nicked when shaving. Very large skin tags may burst under pressure. Since these are harmless, treatment is not necessary. However, if the tag is large, cause discomfort or is located on the face, a doctor can surgically remove it. Medications can be helpful, but the best treatment often requires a combination of prescription treatments and certain lifestyle changes. Important lifestyle changes you can help your client make include: Applying sunscreen when outdoors. Protecting the face in the winter with a scarf. Washing face with a gentle cleanser like Dove or Cetaphil. If your client has shingles, report if she continues to develop new blisters, or the current ones become more swollen. Apply a cool compress to ease pain. Encourage rest in bed until the fever is gone. Make sure visitors know that if they have not had chickenpox or are pregnant, they should stay away until the blisters have dried up and any risk of transmission has passed. Report any issues that seem to bother your client about the skin tag, such as pain or irritation, bleeding, or embarrassment. Never try to remove a client s skin tag on your own. It will bleed and could become infected. Take extra care if the tag is in an area that is shaved, like the neck for men or underarms for women. Report right away if the tag is nicked while shaving.

11 2016 In the Know, Inc. Page 9 TINEA CORPORIS Tinea corporis is a fungal skin infection. You may know it more commonly as ringworm. Ringworm is highly contagious. It can be spread by direct contact or by touching items, such as clothing or surfaces that have the fungi on them. Fungi love warm, moist areas and are more like to infect people who have wet skin for a long time (such as from sweating), do not bathe or wash hair often, or those who come in close contact with other people (such as in a long term care living situation). The classic rash is ring-shaped, with a red-colored, raised border and a clearer center. WARTS Warts are small, grainy skin growths that occur most often on fingers or hands. They may feel rough to the touch and often have a few tiny black dots, which are really just small, clotted blood vessels. Warts are caused by a virus and are spread by touch. Children and young adults are more likely to develop them, but people who have weakened immune systems are also at risk. Warts usually disappear on their own, but some people choose to have them removed because they find them bothersome or embarrassing. Report any sign of ringworm right away so treatment can be started. Prevent the infection from spreading by: Washing all towels in warm, soapy water and then drying them. Use a new towel and washcloth every time you bathe your client. Cleaning sinks, bathtubs, and bathroom floors well after using. Reassure your client, that although it can take up to two years, most warts go away on their own. Don't brush, clip, comb or shave areas that have warts. If you touch a wart, wash your hands carefully afterwards. Help your client prevent spreading or making warts worse by: Keeping the hands dry. Reminding them not to pick at warts. YEAST RASH Yeast is a fungus that is normally found in small amounts in the human body. But certain medicines and health problems can cause it to multiply leading to uncomfortable and even dangerous symptoms. Yeast rashes can be oral (aka thrush); genital; they can occur in folds of skin, like under breasts; and yeast can even be the cause of the diaper rash described on page 4. Anyone can get a yeast rash, but people most at risk are those who take long term antibiotics or steroids, people with weak immune systems and diabetics. Routinely check you client s skin, mouth and genital areas and report any new rashes right away. Keep your client s skin dry and exposed to air. Applying drying powder in the folds of skin (particularly for obese clients) may help prevent rashes from developing. Encourage clients on antibiotics to eat yogurt with live active cultures every day. Help diabetic clients keep blood sugar controlled with diet and exercise.

12 2016 In the Know, Inc. Page 10 KEEPING SKIN HEALTHY Now that you know all about the common skin conditions your clients may have, here are the top nine ways you can help keep your client s skin healthy! 1. Monitor your client s skin from head to toe at least once a day. Look for changes in color, texture, temperature, and for any new breaks in the skin. Report any changes right away. 2. Streamline skin cleansing practices. All clients should avoid cleaning with water that is too hot, harsh soaps, and extreme friction or rubbing. Instead use warm water, mild (perfume and dye free soaps), and wash skin gently to avoid tearing or burning. 3. Limit full baths. For older clients with frail skin, full baths should be limited to two or three per week and should be alternated with partial baths. Apply a moisturizing lotion after each full and partial bath to prevent drying. 4. Carefully watch for incontinence. Change any briefs or pads as soon as they are soiled or wet. Check the groin and buttocks area frequently. Use a barrier cream to help keep moisture off the skin. 5. Keep a turn schedule. Clients that are immobile need to be shifted, repositioned or moved at least once every two hours. Use a turn clock or other device to stay on schedule. 6. Catch pressure ulcers early. Monitor skin over bony areas (base of the spine, heels, hips and knees) for any early warning signs of a pressure ulcer. Report any skin that is first white, then red. It may be cool or warm to the touch. Never massage this area, it will make the damage worse. 7. Watch food and fluid intake for healthy skin. Hydrated skin is healthy skin. Make sure your client eats a healthy diet and drinks as much water as the care plan allows. 8. Teach! If your client is being discharged to home or is a home health client, take time to teach him or her and the family about healthy skin care practices. Make sure they know what products to use and how to use them. 9. It takes teamwork! If a skin condition (such as those you learned about in this module) is diagnosed, be sure to read and follow the care plan carefully. Check with the nurse if you aren t sure what to do. Be sure to talk to the wound nurse (if one is assigned) for further advice or instructions. Keep the lines of communication open because any changes (good or bad) can mean a change in the treatment plan! Now that you ve read this inservice on common skin conditions, jot down a couple of things you learned that you didn t know before.

13 Developing Top-Notch CNAs, One Inservice at a Time EMPLOYEE NAME (Please print): _ DATE: I understand the information presented in this inservice. I have completed this inservice and answered at least eight of the test questions correctly. EMPLOYEE SIGNATURE: _ SUPERVISOR SIGNATURE: _ A Disease Process Module: Common Skin Conditions, from A to Z Are you in the know about common skin conditions? Circle the best choice or fill in your answer. Then check your answers with your supervisor! 1. Which of the following is a function of the skin? A. Maintains temperature. C. Produces hormones. B. Circulates blood. D. All of the above. 2. Your client has intense itching between her toes. You report she may have: A. Ring worm. C. Athlete s foot. B. Eczema. D. Psoriasis. 3. Mrs. H received a flu vaccine. It was given as a shot in her upper left arm. The next day, the area is red, swollen and warm to the touch. You should: A. Let her know it s a normal reaction to the vaccine. B. Administer Tylenol and apply a cool compress for pain. C. Wash the area thoroughly and apply a bandage to keep it clean. D. Report your observations to the nurse because it could be cellulitis. 4. After petting a therapy dog, your client develops raised, red, itchy welts all over her arms. You suspect she is allergic to dogs, because she now has: A. Hives. C. Shingles. B. Warts. D. Pruritis. Inservice Credit: Self Study Group Study 1 hour 1 hour 5. True or False A client with eczema should take long, hot showers every day. 6. True or False A client with psoriasis may have an order to spend time in the sun. 7. True or False Ring worm is only spread through direct contact with the rash. 8. True or False Wheelchair bound clients should be encouraged to shift positions every hour to prevent pressure ulcers. File completed test in employee s personnel file. 9. True or False Nutrition and hydration are needed for a healthy body but have little effect on the health of the skin. 10. True or False The outer layer of the skin is the thickest part. It s called the dermis.