4 Dermatitis Nursing Care Plans

4 Dermatitis Nursing Care Plans

Dermatitis is a general term that describes an inflammation of the skin. There are different types of dermatitis, including seborrheic dermatitis and atopic dermatitis (eczema). Although the disorder can have many causes and occur in many forms, it usually involves swollen, reddened and itchy skin.

Nursing Care Plans

The nursing care for patients with dermatitis involves treatment for atopic lesions consisting of eliminating all allergens and avoiding irritants, extreme temperatures, and humidity changes, and other factors. Therapy also involves teaching the client on the proper application of topical medications.

Here are four (4) nursing care plans for dermatitis:

1. Impaired Skin Integrity

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Impaired Skin Integrity: Altered epidermis and/or dermis [The integumentary system is the largest multifunctional organ of the body.]

Related Factors

• - Contact with irritants or allergens

Defining Characteristics

• - Inflammation
• - Dry, flaky skin
• - Erosions, excoriations, fissures
• - Pruritus, pain, blisters

Desired Outcomes

• - Patient maintains optimal skin integrity within limits of the disease, as evidenced by intact skin.

Nursing Interventions	Rationale
Assess skin, noting color, moisture, texture, temperature; note erythema, edema, tenderness.	Specific types of dermatitis may have characteristic patterns of skin changes and lesions.
Assess the skin systematically. Look for areas of irritant and allergic contact.	Flexural areas (elbows, neck, posterior knees) are common areas affected in atopic dermatitis.
Assess skin for lesions. Note presence of excoriations, erosions, fissures, or thickening.	Open skin lesions increase the patient’s risk for infection. Thickening occurs in response to chronic scratching (lichenification).
Identify aggravating factors. Inquire about recent changes in use of products such as soaps, laundry products, cosmetics, wool or synthetic fibers, cleaning solvents, and so forth.	Patients may develop dermatitis in response to changes in their environment. Extremes of temperature, emotional stress, and fatigue may contribute to dermatitis.
Identify signs of itching and scratching.	The patient who scratches the skin to relieve intense itching may cause open skin lesions with an increased risk for infection. Characteristic patterns associated with scratching include reddened papules that run together and become confluent, widespread erythema, and scaling or lichenification
Identify any scarring that may have occurred.	Long-term scarring may result in body image disturbances.
Encourage the patient to adopt skin care routines to decrease skin irritation:	One of the first steps in the management of dermatitis is promoting healthy skin and healing of skin lesions.
- Bathe or shower using lukewarm water and mild soap or nonsoap cleansers.	Long bathing or showering in hot water causes drying of the skin and can aggravate itching through vasodilation.
- After bathing, allow the skin to air dry or gently pat the skin dry. Avoid rubbing or brisk drying.	Rubbing the skin with a towel can irritate the skin and exacerbate the itch-scratch cycle.
- Apply topical lubricants immediately after bathing.	Lubrication with fragrance-free creams or ointments serves as a barrier to prevent further drying of the skin through evaporation. Moisturizing is the cornerstone of treatment. Over-the-counter moisturizing lotions include Eucerin, Lubriderm, and Nivea. Lotions are lighter and less emollient than creams. If more moisturizing is required than a lotion can provide, a cream is recommended. These include Keri cream, Cetaphil cream, Eucerin cream, and Neutrogena Norwegian formula. Ointments are the most emollient. Vaseline Pyre Petroleum Jelly or Aquaphor Natural Healing Ointment may be beneficial.
Apply topical steroid creams or ointments.	These drugs reduce inflammation and promote healing of the skin. The patient may begin using over-the-counter hydrocortisone preparations. If these are not effective, the physician may include prescription corticosteroids for topical use. Usual application is twice daily, thinly and sparingly. Do not use with an occlusive dressing, because this potentiates the action and systemic absorption of the steroid. Usual duration of use of topical steroids is up to 14 days in adults.
Apply topical immunomodulators (TIMs): - Tacrolimus (Protopic) - Pimecrolimus (Elidel)	Tacrolimus (Protopic)has recently been approved for the treatment of atopic dermatitis. TIMs alter the reactivity of cell-surface immunological responsiveness to relieve redness and itching. In 2005, the Food and Drug Administration advised a potential cancer risk with long-term use of pimecrolimus and tacrolimus based on animal studies.
Prepare the patient for phototherapy or photochemotherapy.	This treatment modality uses ultraviolet A or B light waves to promote healing of the skin. The addition of psoralen, which increases the skin’s sensitivity to light, may benefit patients who do not respond to phototherapy alone.
Encourage the patient to avoid aggravating factors.	Some change in lifestyle may be indicated to reduce triggers.

2. Disturbed Body Image

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Disturbed Body Image: Confusion in mental picture of one’s physical self.

Related Factors

• - Visible skin lesions

Defining Characteristics

• - Verbalizes feelings about change in body appearance
• - Verbalizes negative feelings about skin condition
• - Fear of rejection or reactions of others

Desired Outcome

• - Patient verbalizes feeling about lesions and continues daily activities and social interactions.

Nursing Interventions	Rationale
Assess the patient’s perception of changed appearance.	The nurse needs to understand the patient’s attitude about visible changes in the appearance of the skin that occur with dermatitis.
Assess the patient’s behavior related to appearance.	Patients with body image issues may try to hide or camouflage their lesions. Their socialization may decrease based on anxiety or fear about the reactions of others.
Assist the patient in articulating responses to questions from others regarding lesions and contagion.	Patients may need guidance in determining what to say to people who comment about the appearance of their skin. Dermatitis is not a contagious skin condition.
Allow patients to verbalize feelings regarding their skin condition.	Through talking, the patient can be guided to separate physical appearance from feelings of personal worth.
Assist patients in identifying ways to enhance their appearance.	Clothing, cosmetics, and accessories may direct attention away from the skin lesions. The patient may need help in selecting methods that do not aggravate the skin lesions.

3. Risk for Infection

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Risk for Infection: At increased risk for being invaded by pathogenic organisms.

Risk Factors

• - Impaired skin integrity
• - Severe inflammation
• - Excoriation

Desired Outcome

• - Patient remains free of secondary infection.

Nursing Interventions	Rationale
Assess skin for severity of skin integrity compromise.	The skin is the body’s first line of defense against infection. Disruption of the integrity of skin increases the patient’s risk of developing an infection or of scarring.
Assess for signs of infection.	Patients with dermatitis are at highest risk for developing skin infections caused byStaphylococcus aureus. Purulent drainage from skin lesions indicates infection. With severe infections, the patient may have an elevated temperature.
Apply topical antibiotics.	Topical antibiotics may be used to treat infections that occur with dermatitis.
Administer oral antibiotics.	Oral antibiotics may be more effective in treating infections on the skin.
Encourage the patient to use appropriate hygiene methods.	Keeping the skin clean, dry, and well lubricated reduces skin trauma and risk of infection.

4. Risk for Impaired Skin Integrity

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Risk for Impaired Skin Integrity: At risk for altered epidermis and/or dermis.

Risk Factors

• - Severe pruritus
• - Scratches skin frequently
• - Dry skin

Desired Outcome

• - Patient reports increased comfort level and skin remains intact.

Nursing Interventions	Rationale
Assess severity of pruritus.	Patients with dermatitis may develop an itch-scratch cycle. The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itching. Many patients report the itching to be worse at night, thus disrupting their sleep.
Assess skin for excoriations and lichenification.	Scratching and rubbing the skin in response to the itching increases the irritation of the skin. When papules are scratched, they may break open, causing excoriations that become crusty and infected. Over time, constant rubbing and scratching cause the skin to become thick and leathery (lichenification).
Encourage the patient to avoid triggering factors.	Contact with factors that stimulate histamine release will increase itching. Because irritants vary from one patient to another, each patient needs to determine substances and situations that aggravate the dermatitis.
Maintain hydration of stratum corneum.	Application of lubricating creams and ointments serve as a barrier to water evaporation from the skin. Moist skin is less likely to experience pruritus.
Use cool compresses on pruritic areas of the skin.	Cool, moist compresses help relieve pruritus and itching. Additionally, cool baths with colloidal oatmeal (e.g., Aveeno) can provide relief.
Encourage the patient to keep fingernails trimmed short.	Long fingernails used for scratching are more likely to cause skin trauma and aggravate itching.
Administer antihistamine drugs.	Antihistamines such as hydroxyzine will help relieve itching and promote comfort. These drugs can be taken at bedtime. Their sedative effect may also help promote sleep. During the daytime, nonsedating antihistamines may increase the efficacy of pruritus control. Loratadine is an over-the-counter medication.
Apply topical antipruritic agents if indicated.	These may be used alone or combined with oral antihistamines. Over-the-counter products include Sarna lotion, Prax lotion, and Itch-X gel. Prescription Cetaphil with menthol may also help.
Apply topical steroid creams if indicated.	Do not apply on the face. Use thinly and sparingly, up to a maximum of 14 days. Do not use with occlusive dressings.
Administer oral steroids.	Short-term low-dose oral steroids may be ordered for severe cases. Oral steroids are not indicated for long-term use despite their efficacy

References and Sources : nurseslabs.com