Dermatitis NCLEX Review Care Plans
Nursing Study Guide on Dermatitis
Dermatitis is a common medical condition that involves the irritation and inflammation of skin, which can be accompanied by other symptoms on the skin surface.
There are different types of dermatitis, and each may need a different medical intervention. Dermatitis can affect the patient’s comfort and body image. Contrary to common belief, dermatitis is not a contagious skin condition.
Nursing Stat Facts
Signs and Symptoms of Dermatitis
Most types of dermatitis manifest through the following signs and symptoms:
- Erythema or redness of the skin
- Swelling of the affected skin area
Types of Dermatitis
- Atopic Dermatitis. Also known as eczema, atopic dermatitis is commonly observed on areas of skin flexion, such as behind the knees, the neck area, and inside the elbows. It is characterized by an itchy rash that may be accompanied with fluid leaking from the affected skin. Crust may form on the affected area as well. Seasonal flare-ups may be seen in patients with atopic dermatitis.
- Seborrheic Dermatitis. This is a type of dermatitis wherein stubborn dandruff, skin erythema, and scaly patches are present. The condition is usually found in the body areas where oil may concentrate, such as the face, back, and upper thorax. While it is a common type of dermatitis in adults, infants may also suffer from seborrheic dermatitis called cradle cap.
- Contact Dermatitis. This type of dermatitis is caused by coming into contact with substance/s that cause irritation or allergic reaction to the skin. Aside from an itchy rash and erythema, blisters may develop. Contact dermatitis is deemed as the most common work-related skin condition in nurses and healthcare professionals around the world due to frequent hand washing or use of alcohol gel.
- Follicular Dermatitis. This type of dermatitis or eczema involves the thickening of the skin and the development of bumps in hair follicles. This condition is more common in people with dark-brown skin such as African Americans.
Causes and Risk Factors of Dermatitis
The common causes of dermatitis include:
- Skin infection (caused by staphylococcal or streptococcal bacteria)
- Dry skin
- Immune system dysfunction
- Gene mutation
- Contact allergens
- Allergy to food or dust
- Nickel-containing jewelry
- Cleaning products, perfumes, lotions, creams, and other chemical substances
- Poison ivy or other plant allergens
The risk factors for dermatitis are:
- Age – some forms of dermatitis, such as atopic dermatitis, start during infancy; other types can happen at any age
- Family history of eczema, allergy, or asthma
- Existing medical conditions such as HIV/AIDS and Parkinson’s disease increase the risk for seborrheic dermatitis
Complications of Dermatitis
- Formation of open sores through scratching
- Worse skin infections
- Low mood, disturbed self-image, or other mental health problems
Diagnosis of Dermatitis
- Patch test – this involves the application of several substances on a small area of the skin to check for the specific type of allergy that has likely caused dermatitis
- Physical exam – the skin will be inspected for the signs and symptoms to determine the specific type of dermatitis
- History taking – to assess the likely cause of the skin condition (e.g., working as a nurse, using a new face cream, having gone on a recent camping trip, etc.)
- Skin biopsy – the physician may sometimes ask for a sample of the skin to be biopsied and studied in the lab to rule out other medical conditions
Prevention of Dermatitis
The following measures are recommended to prevent dermatitis:
- Use gentle skin cleansers. Non-soap and/or unscented cleansers reduce the risk of drying the skin. Alcohol-containing skin cleansers may contribute to the dryness of the skin
- Limit showers or bath time. People at risk for dermatitis are recommended to limit their bath time to 10 minutes using warm water. The use of bath oil can help lock in the moisture in the skin.
- Pat the skin dry after bathing. Do not rub the skin when drying it and always use a soft towel.
- Moisturize the skin daily. Dermatologically tested moisturizers are safe to use in moisturizing the skin; infants with a high risk of atopic dermatitis will benefit from the application of a protective baby-safe moisturizer.
Treatment for Dermatitis
The treatment for dermatitis may vary depending on the specific type of dermatitis affecting the patient. In general, the following treatment methods are utilized in managing most types of dermatitis:
- Medications. The doctor may prescribe topical medications that contain corticosteroids in the form of gels, creams, or ointments. Severe forms of dermatitis may benefit from oral corticosteroids. Calcineurin inhibitors, which play a role in the immune system, may also be given. Over-the-counter anti-inflammatory and anti-itch medications such as antihistamines and hydrocortisone creams can help in the temporary relief of itchiness and redness of the affected skin.
- Phototherapy. The affected area of the skin may benefit from exposure to a controlled amount of light, either natural or artificial.
- Lifestyle changes. Over-the-counter medicated shampoos for seborrheic dermatitis and/or dandruff can be used. It is also important to moisturize the skin often using a dermatologically tested, gentle moisturizer. Cool wet cloth can be applied to soothe the itching and redness of the affected skin.
- Referral to dermatology service. The patient with severe forms of dermatitis may need to be seen by a dermatologist.
Nursing Care Plans for Dermatitis
Nursing Care Plan 1
Nursing Diagnosis: Impaired Skin Integrity related to inflammation of the skin secondary to atopic dermatitis, as evidenced by erythema or redness of the skin, swelling of the affected skin area, rash, and itchiness
Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for dermatitis.
|Assess the patient’s skin on his/her whole body.||To determine the severity of dermatitis and any affected areas that require special attention or wound care.|
|Administer the prescribed medications. Advise the patient and/or caregiver on how to perform self-application and when to take each of them.||The doctor may prescribe topical medications that contain corticosteroids in the form of gels, creams, or ointments. Over-the-counter anti-inflammatory and anti-itch medications such as antihistamines and hydrocortisone creams can help in the temporary relief of itchiness and redness of the affected skin.|
|Educate the patient and caregiver about proper hand hygiene, as well as skin cleansing techniques such as washing it with gentle soap and water, limiting bath time, and patting the skin dry with a soft towel instead of rubbing it.||It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. Although it is good to have daily bath or showers, it is recommended to limit bath time to a maximum of 10 minutes using lukewarm water. The use of bath oil can help lock in the moisture in the skin. Patting the skin dry after bathing reduces the risk of irritating the skin and removing moisture from it.|
|Inform the patient about the need to frequently moisturize the skin.||It is important to moisturize the skin often using a dermatologically tested, gentle moisturizer to resolve dryness and reduce irritation and itchiness.|
|Advise the patient and caregiver to prevent scratching the affected areas. Apply cool wet cloth on the itchy skin regions.||Dermatitis can be very itchy, but it is advisable to prevent the patient from scratching the affected areas to prevent worsening of the inflammation and irritation of skin. Cool wet cloth can be applied to soothe the itching and redness of the affected skin.|
|Refer the patient to dermatology service as required.||Patients with severe forms of dermatitis may need to be seen by a dermatologist.|
|Re-assure the patient that there is no need for isolation.||Dermatitis is not contagious.|
Nursing Care Plan 2
Risk for Infection
Desired Outcome: The patient will prevent more serious bacterial skin infections to occur by following treatment regimen for dermatitis.
|Assess any compromise in the patient’s skin integrity.||To determine the severity of dermatitis and any affected areas that require special attention or wound care for open sores that may be entry points for infectious pathogens.|
|Assess for signs of infection.||Dermatitis patients are at high risk of having skin infections caused by various bacteria, the most common one being S. aureus. The signs of infection include purulent discharge from the skin lesions caused by scratching areas that are affected by dermatitis. Other signs of infection are fever, erythema, and pain.|
|Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician.||Topical antibiotics are usually prescribed for patients who develop skin infection as a complication of dermatitis. However, oral antibiotics may be considered especially if the infection is severe, or the topical treatment is deemed ineffective. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.|
|Educate the patient and caregiver about proper skin hygiene through washing it with soap and water.||It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The sores may cause itching, but it is advisable to prevent the patient from scratching the affected areas to prevent worsening and spread of the infection.|
|Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas.||Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will allow the skin to break, forming open sores that can make the patient more susceptible to other bacterial skin infections.|
Other possible nursing diagnoses:
- Disturbed Body Image
- Knowledge Deficit
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.