4. Risk for Impaired Skin Integrity - Dermatitis Nursing Care Plans
| Common Risk Factors |
- Severe pruritus
- Scratches skin frequently
- Dry skin
|
| Common Expected Outcome Patient reports increased comfort level and skin remains intact. | NOC OutcomeTissue Integrity: Skin and Mucous MembranesNIC Interventions Skin Surveillance; Skin Care: Topical Treatments |
Ongoing Assessment
| Actions/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). |
Therapeutic Interventions
| Actions/Interventions | Rationale |
| 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 |
Source: (1) (2)
Found through:
nursing care plan for skin rashes, nursing diagnosis for contact dermatitis, nursing care plan for eczema, dula script, impaired skin integrity related to scratching, impaired comfort pruritis care plan, altered comfort ncp/pruritus
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