Integumen Viral Infection

7/29/2019 Integumen Viral Infection

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ViralSkinInfection:HerpesZoster,HerpesSimplex,FungalInfection,DermatitisContact,SkinNeoplasm,Ulceration

KusmanIbrahim,Ph.D

DEPARTEMENTOFCLINICALNURSING

FACULTYOFNURSING

UNIVERSITASPADJADJARAN

logounpad


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VIRALSKININFECTION

HerpesZoster(Shingles)

.HZisacommon,predominantlydermal,andneurologicdisordercausedbythevaricella-zostervirus(VZV),avirusmorphologicallyandantigenicallyidenticaltotheviruscausingvaricella(chickenpox).Thediseaseischaracterizedbyapainfulvesiculareruptionalongtheareaofdistributionofthesensorynervesfromoneormoreposteriorganglia.Itisassumedthatherpeszosterrepresentsareactivationoflatentvaricellavirusinfectionandreflectsloweredimmunity


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VIRALSKININFECTION

IncidenceandMortality/Morbidity

.About10%ofadultsgetshinglesduringtheirlifetimes,usuallyafterage50years.Thereisanincreasedfrequencyofherpeszosterinfectionsamongpatientswithweakenedimmunesystemsandcancers,especiallyleukemiasandlymphomas(Odometal.,2000).Internationally,theincidenceofzosterhasnotbeenwellstudied,butprobablyitisinthesamerangeof2-3casesper1000personsperyear.Zosterisrarely,ifever,fatal,althoughinindividualswhoareseverelydebilitated,zostermaybeconsideredacontributingfactortodeath.


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VIRALSKININFECTION

IncidenceandMortality/Morbidity

.Morbidityusuallyisconfinedtopainwithintheaffecteddermatome,whichcanbesevereandcanpersistwellbeyondthedurationofactivedisease(postherpeticneuralgia[PHN]).Eyeinvolvement(zosterophthalmicus)cancausetemporarilyorpermanentlydecreasedvisualacuityorblindness..Almost50%ofindividualswholivebeyondage80yearscanexpecttodevelopzoster.Zosterisrareinchildrenandyoungadults,withtheexceptionofyoungerpatientswithAIDS,lymphoma,othermalignancies,andotherimmunedeficiencies,andpatientswhoarerecipientsofbonemarrowandkidneytransplants


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VIRALSKININFECTION

ClinicalManifestation

.Theeruptionisusuallyaccompaniedorprecededbypain,whichmayradiateovertheentireregionsuppliedbytheaffectednerves..Thepainmaybeburning,lancinating(ie,tearingorsharplycutting),stabbing,oraching..Itchingandtendernessmayoccuroverthearea.Malaiseandgastrointestinaldisturbancesprecedetheeruptionwhoarerecipientsofbonemarrowandkidneytransplants


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VIRALSKININFECTION

ClinicalManifestation

.Thepatchesofgroupedvesiclesappearontheredandswollenskin..Theearlyvesicles,whichcontainserum,latermaybecomepurulent,rupture,andformcrusts.Theinflammationisusuallyunilateral,involvingthethoracic,cervical,orcranialnervesinabandlikeconfiguration..Theblistersareusuallyconfinedtoanarrowregionofthefaceortrunk(Fig.56-2)..Theclinicalcoursevariesfrom1to3weeks.Ifanophthalmicnerveisinvolved,thepatientmayhaveeyepain.Inflammationandarashonthetrunkmaycausepainwiththeslightesttouch.Thehealingtimevariesfrom7to26days.


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VIRALSKININFECTION

MedicalManagement

.Thegoalsofherpeszostermanagementaretorelievethepainandtoreduceoravoidcomplications,whichincludeinfection,scarring,andpostherpeticneuralgiaandeyecomplications..Analgesics.Corticosteroids.Antiviralagentssuchasacyclovir(Zovirax),valacyclovir(Valtrex),orfamciclovir(Famvir)areadministeredwithin24hoursoftheinitial.Ophthalmicherpeszoster.ophthalmicemergency,refertoanophthalmologistimmediatelytopreventthepossiblesequelaeofkeratitis,uveitis,ulceration,andblindness


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VIRALSKININFECTION

NursingManagement

.Thenurseassessesthepatientsdiscomfortandresponsetomedicationandcollaborateswiththephysiciantomakenecessaryadjustmentstothetreatmentregimen..Thepatientistaughthowtoapplywetdressingsormedicationtothelesionsandtofollowproperhandhygienetechniquestoavoidspreadingthevirus.Diversionaryactivitiesandrelaxationtechniquesareencouragedtoensurerestfulsleepandtoalleviatediscomfort..Helpwithdressingchangesandfoodpreparationforpatientswhocannotcareforthemselvesorpreparenourishingmeals.


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Typicalzosterinthevicinityofrightpopliteal...Suspectedzosterofthehand.TypicalzosterinthevicinityofrightpoplitealfossainavertebralnerveL4distribution

Suspectedzosterofthehand

Herpeszosterophthalmicus(HZO)


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VIRALSKININFECTION

HerpesSimplex

.Twotypesofthecausativevirus,whichareidentifiedbyviraltyping..Type1(orolabial)occursonthemouthandtype2inthegenitalarea.About85%ofadultsworldwideareseropositivefor.herpestype1.Theprevalenceoftype2islower;type2usuallyappearsattheonsetofsexualactivity..Herpessimplexisclassifiedasatrueprimary(theinitialexposuretothevirus),anonprimaryinitialepisode(theinitialepisodeoftype1ortype2inapersonpreviouslyinfectedwiththeothertype),recurrentepisodes(subsequentepisodesofthesameviraltype)


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VIRALSKININFECTION

OrolabialHerpes

.=feverblistersorcoldsores,consistsoferythematous-basedclustersofgroupedvesiclesonthelips..Tinglingorburningwithpainmayprecedetheappearanceofthevesiclesbyupto24hours..Sunlightexposureorincreasedstress,maycauserecurrentepisodes..Theonsetisoftenaccompaniedbyhighfever,regionallymphadenopathy,andgeneralizedmalaise..Anothercomplicationoforolabialherpesisthedevelopmentoferythemamultiforme,anacuteinflammationoftheskinandmucousmembraneswithcharacteristiclesionsthat.havetheappearanceoftargets.


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http://blog.unila.ac.id/sunni/files/2010/05/Herpes_Simplex_tongue-XX.jpghttp://t3.gstatic.com/images?q=tbn:ANd9GcQ-Nt2SEsdSf5hNEAAzovnevj4Eg6ddM5KtmmIogToslLUn9RA&t=1&h=166&w=223&usg=__GY_UlJv2JUffmxD5s4TuuZ7HE6A=


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VIRALSKININFECTION

GenitalHerpes

.Manifestswithabroadspectrumofclinicalsigns.Minorinfectionsmayproducenosymptomsatall;severeprimaryinfectionswithtype1cancausesystemicflulikeillness..Lesionsappearasgroupedvesiclesonanerythematousbaseinitiallyinvolvingthevagina,rectum,orpenis..Newlesionscancontinuetoappearfor7to14days..Feverandflulikesymptomsarecommon.Typicalrecurrencesbeginwithaprodromeofburning,tingling,oritchingabout24hoursbeforethevesiclesappear.Asthevesiclesrupture,erosionsandulcerationsbegintoappear.Severeinfectionscancauseextensiveerosionsofthevaginaloranalcanal


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http://t3.gstatic.com/images?q=tbn:ANd9GcS59qFq2lUz6Ze2YpEEUEwjS-aOvCInRWCBwUms2mu_vnCEHLU&t=1&h=205&w=136&usg=__n1WcSUdAHh9jhWq6aDt95D8H7bE=http://t2.gstatic.com/images?q=tbn:ANd9GcSNy9MBfynFHAfnAQX5Va-P5UM89k-7zTT05Fu4dlGLuBz7jnY&t=1&usg=___OV4xIBC7iKVQnStcEWxAsyNYgI=


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VIRALSKININFECTION

Diagnostics

.Viralculturesandrapidassays

.Inallcases,itisimperativetoobtainenoughviralcellsfortesting,andcarefulcollectionmethodsarethereforeimportant.Allcrustsshouldbegentlyremovedorvesiclesgentlyunroofed.Asterilecottonswabpremoistenedinviralculturepreservativeisusedtoswabthebaseofthevesicletoobtainaspecimenforanalysis


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VIRALSKININFECTION

Complication

.Eczemaherpeticum

.Thesametypeofspreadofherpescanoccurinsevereseborrhea,scabies,andotherchronicskinconditions..HerpesWhitlowisaninfectionofthepulpofafingertipwithherpestype1or2..Mostcasesofneonatalinfectionwithherpesoccurduringdeliverybycontactoftheinfantwiththemothersactiveulcerations..Rarely,inmotherswhohaveprimaryinfectionsduringpregnancy,intrauterineneonatalinfectionsoccur.Fetalanomaliesincludeskinlesions,microcephaly,encephalitis,andintracerebralcalcifications.


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VIRALSKININFECTION

MedicalandNursingManagement

.Useasunscreenliberallyonthelipsandface

.Topicaltreatmentwithdryingagentsmayacceleratehealing..Acyclovir.Treatmentofgenitalherpesdependsontheseverity,thefrequency,andthepsychologicalimpactofrecurrencesandontheinfectiousstatusofthesexualpartner.Patientswhohavemorethansixrecurrencesperyearmay.benefitfromsuppressivetherapy.Useofacyclovir,alacyclovir,orfamciclovirsuppresses85%ofrecurrences,and20%ofpatientsarefreeofrecurrencesduringsuppressivetherapy


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FUNGAL(MYCOTIC)INFECTIONS

Tinea

.=ringwormbecauseofitscharacteristicappearanceofringorroundedtunnelundertheskin..Tineainfectionsaffectthehead,body,groin,feet,andnails.Tineapedis(ie,athletesfoot)isthemostcommonfungalinfection.Itisespeciallyprevalentinthosewhousecommunalshowersorswimmingpools.Tineacorporis(ie,ringwormofthebody),thetypicalringedlesionappearsontheface,neck,trunk,andextremities.Tineacapitis:ringwormofthescalpisacontagiousfungalinfectionofthehairshaftsandacommoncauseofhairlossinchildren


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Tinea

.Tineacruris(ie,jockitch)isringworminfectionofthegroin,whichmayextendtotheinnerthighsandbuttockarea.Itoccursmostfrequentlyinyoungjoggers,obesepeople,andthosewhoweartightunderclothing.Theincidenceoftineacrurisisincreasedamongpeoplewithdiabetes.Tineaunguium(ie,ringwormofthenails)isachronicfungalinfectionofthetoenailsor,lesscommonly,thefingernails.ItisusuallycausedbyTrichophytonspecies(T.rubrum,T.mentagrophytes)orCandidaalbicans.Itisusuallyassociatedwithlong-standingfungalinfectionofthefeet.Thenailsbecomethickened,friable(ie,easilycrumbled),andlusterless.Intime,debrisaccumulatesunderthefreeedgeofthenail.Ultimately,thenailplateseparate


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Management

.Duringtheacute,vesicularphase,soaksofBurowssolutionorpotassiumpermanganatesolutionsareusedtoremovethecrusts,scales,anddebrisandtoreducetheinflammation..Topicalantifungalagents(eg,miconazole,clotrimazole)areappliedtotheinfectedareas.Topicaltherapyiscontinuedforseveralweeksbecauseofthehighrateofrecurrence.Oralantifungalagentsareusedonlyinextensivecases.Sideeffectsoforalantifungalagentsincludehotosensitivity,skinrashes,headache,andnausea.Personalandenviromentalhygiene


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Tineacorporis(ringworm)oftheface

http://t0.gstatic.com/images?q=tbn:ANd9GcQEFG15vbbDbFrVVzalTUMmFQo39pSOKRNFGkfNem65yVFM0Dk&t=1&usg=__4wvgbivrjnxXTmH8EFuXb-WLs5c=Tineapedis

http://t0.gstatic.com/images?q=tbn:ANd9GcRtNH0ByuX9nLCLJUzJ_aub9bTIvLeK1ifTEH0ltwpEwAvZ9lw&t=1&usg=__IetxTeOqNDmArkCFL1T7VdAiE68=http://t2.gstatic.com/images?q=tbn:ANd9GcQ6BK8TC-RXnIEYUUCXBJtVDVtTA5OP5dVqMApX5-wqKmo4NYs&t=1&h=155&w=240&usg=__85DCtp0qrIwFq1tzY8M_L0GDyZg=Tineaunguium


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DERMATITISKONTAKPeradanganpdkulit,merupakanreaksiimunologisyaituhipersensitifitastipelambatakibatkontakdenganbahanyangmerangsangresponimunpdkulitPenyebab:Zatiritan(mekanik,kimia,biologis,asam,alkali)Alergen(tumbuhan,kosmetik,nikel,dll)TandadanGejala:Erytema,edemalokal,vesikel,kulitmengeras,bersisik,gatalTerapi:Basah.kompresPK1:10.000Kering.steroidtopikalAntibiotik,antihistamin,kortikosteroid


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contactallergicdermatitiscontactdermatitisContactdermatitisduetocosmeticsensitivity(left)andplants(right)


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contactdermatitiscontactdermatitisHanddermatitisfromstickingplaster(left)andshoes(right).


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Intervensikeperawatan.Bantukliendalammelakukanperawatanluka.kompres,gantibalutan,terapitopikal.Beripenjelasantentangterapioral/topikaltsbuntukmengurangirasagatal,ikutisesuaiprogrampengobatanPendidikanKesehatan:.Hindarikulitterlalukering(tdkmenggunakansabunyangkeras/deterjen,berendamdlmair,menggunakankremsteroidlangsungsetelahmandi).Menggunakansarungtanganketikamenyentuhbendairitasatauallergen.Hindarikainwool,nylon,bulubinatang.untukkulitygsensitif.Hindaripengobatansendiriygbisamemperburukkeadaan.Bantukliendalammemecahkanmasalah,berikankesempatanklienuntukmengekspresikanperasaannya


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TUMORKULIT(SKINNEOPLASM)KISTASuatunodulygberisicairanataumaterialsemisolit,berbatastegas,tubuhdanmenempelpadajaringandibawahnya,sebagiankistaterletakpdepidermal,tumbuhspontandanasymptomatik,lokasipertumbuhanbisadimanasaja(seluruhtubuh).kepala&badan,terapi;excisi(jarang)KELOIDPertumbuhanygberlebihandariscar(jaringansikatrik)akibatpenumpukankollagendanjaringanygmasihhidupsetelahtrauma.terapi;kombinasipembedahan+injeksisteroidataudosisrendahradiotherapiNEVUSSel-selpigmenygmembentukneoplasmajinak,dptkongenitalataudidapat(usia1-35th).nevusnormalberbentukteratur,batastegas,warnaseragam.50%nevusbisaberubahmelanomamaligna


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KANKERKULIT(SKINCANCER)PENYEBAB:Faktorinstrinsik.dariselFaktorextrinsik.pengaruhlingkunganthdsel(sinarmataharidgpjgel290-320nm,radiasisinarx,gamma,kimiaarsen,hidrokarbon,traumajar.baruygseringteriritasi)


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KARSINOMASELBASAL

PREDISPOSISI:

-PAPARANSINARMATAHARIYGBERLEBIHAN

-SINARRONTGEN/RADIOAKTIF

-JARINGANPARUT

-BAHAN-BAHANKIMIA

-PERADANGANKRONIS

-KELAINANGENETIK

-IMUNOSUPRESIF

TANDA:PAPUL/NODULSEPERTILILIN,BAGIANTENGAHCEKUNGATAUTIMBULULKUS(ULKUSRODENS)BERBATASTEGAS,DASARIRREGULER,MERUSAKSUBKUTIS,FASCIA,OTOTDANTULANG,JARANGDANTDK

BERMETASTASE

TERAPI;EXCISITOTAL,KRIOSURGERY,ELEKTRODESICCATION,ELEKTROCOAGULASI

ExampleofBasalCellCarcinomamssvbcc2massivbcc


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KARSINOMASELSKUAMOSA

TERJADIPDKULIT/MUKOSABEREPITELGEPENG,DAPATBERMETASTASEKEKGBDANORGANLAIN

PENYEBAB;IRITASIKRONISSINARMATAHARI,BAHAN-BAHANKIMIA,SINARX,GAMMA,JAR.PARUTKRONIS

TANDA;ULKUSLAMATDKSEMBUH,MAKINMELUAS,PERABUANKERAS,MUDAHBERDARAH,MENONJOLDIATASPERM.KULIT,PERM.TDKRATA,SEPERTIKEMBANGKOL.

TERAPI;PEMBEDAHAN+KEMOTERAPI(SITOSTATIKA)

ExampleofSquamousCellCarcinoma


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MELANOMAMALIGNAPALINGBERBAHAYA.CEPATBERMETASTASEDANFATAL,DAPATTIMBULBEGITUSAJAPDKULITNORMALATAUTAHILALATYGMENGALAMIDEGENERASI&KEGANASANATANDA:BERCAKATAUBINTILHITAMYGCEPATMEMBESAR,WARNAMENJADILEBIHHITANDANTDKMERATA,TIMBULULKUSYGMUDAHBERDARAH,METASTASECEPATTERAPI;-PEMBEDAHANDGEKSISILUAS(PEMERIKSAANHISTOPATOLOGIK)-KEMOTERAPI.PROGNOSABURUK

sm_mel_abcdsm_mel_nodsm_nmel_acrll


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Ulcerations

.Superficiallossofsurfacetissueasaresultofdeathofthecells..Asimpleulcer,suchasthekindfoundinasmall,superficial,partial-thicknessburn,tendstohealbygranulation(ie,newtissuegranules)ifkeptcleanandprotectedfrominjury.Ifitisexposedtotheair,theserumthatescapeswilldryandformascab,underwhichtheepithelialcellswillgrowandcoverthesurfacecompletely.Certaindiseasescausecharacteristiculcers;tuberculousulcersandsyphiliticulcers


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Ulcerations

.Ulcersrelatedtoproblemswitharterialcirculationareseeninpatientswithperipheralvasculardisease,arteriosclerosis,treatmentoftheulcersisconcurrentwithtreatmentofthearterialdisease.Nursingmanagementincludestheuseofthedressings.Ifnursinginterventionsareinstitutedearlyintheprogressionofanulcer,theconditioncanoftenbeeffectivelyimproved..Surgicalamputationofanaffectedlimbisalastresort..Pressureulcersinvolvebreakdownoftheskinduetoprolongedpressureandinsufficientbloodsupply,usuallyatbonyprominence


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http://t0.gstatic.com/images?q=tbn:ANd9GcQIN4HLaR4VC5P4UrLg1ekSgiMRlANvm59AYqCGG5PQy_zHNaw&t=1&usg=__ow61n3W_-NVcFA3l9ErXuOwzJgY=http://t1.gstatic.com/images?q=tbn:ANd9GcTOo-I4R74UbaeqnURNw4qREPU9Zp5Ivfonne3q5NkJ01OKROY&t=1&usg=__SahbIEzVD3z73U4ARDa3yUM9EdU=Ulceration


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