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.
Risk for Impaired Skin Integrity
- Risk for Impaired Skin Integrity
- Severe pruritus
- Scratches skin frequently
- Dry skin
- Patient reports increased comfort level and skin remains intact.
|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|
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