Dermatitis Nursing Diagnosis & Care Plan

Dermatitis is a general term that describes inflammation of the skin. It’s a common condition that can manifest in various forms, each with unique characteristics and triggers. Dermatitis nursing diagnosis encompasses a range of skin problems that require careful assessment and management to promote patient comfort and skin integrity.

Causes (Related to)

Dermatitis can result from various factors that irritate the skin or trigger an immune response. Common causes include:

• Allergic reactions to substances like latex, metals, or cosmetics
• Exposure to irritants such as harsh soaps, detergents, or chemicals
• Genetic predisposition to skin sensitivity
• Environmental factors like extreme temperatures or humidity
• Stress or emotional factors
• Certain medications
• Underlying health conditions (autoimmune disorders)
• Poor hygiene practices
• Nutritional deficiencies

Signs and Symptoms (As evidenced by)

Dermatitis can present with a variety of signs and symptoms. During a physical assessment, a patient with dermatitis may exhibit:

Subjective: (Patient reports)

• Itching (pruritus)
• Burning or stinging sensation
• Pain or discomfort in affected areas
• Sensitivity to touch

Objective: (Nurse assesses)

• Redness (erythema)
• Swelling (edema)
• Dry, scaly, or flaky skin
• Blisters or vesicles
• Oozing or crusting
• Thickened or leathery skin texture
• Changes in skin pigmentation
• Warm skin in affected areas
• Presence of rash or skin lesions

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for dermatitis:

• The patient will report reduced itching and discomfort within 24-48 hours of treatment initiation.
• The patient’s skin will show visible signs of improvement (reduced redness, swelling, and scaling) within 3-5 days.
• The patient will demonstrate proper skin care techniques and avoid known triggers by the end of the education session.
• The patient will maintain skin integrity without signs of infection throughout the treatment period.
• The patient will verbalize understanding of the chronic nature of their condition and the importance of long-term management by discharge.

Nursing Assessment

The nursing assessment is crucial in developing an effective care plan for dermatitis. Here are key steps in assessing a patient with dermatitis:

1. Obtain a comprehensive health history.
   Gather information about the onset, duration, and progression of symptoms. Inquire about potential triggers, allergies, and previous treatments.
2. Perform a thorough skin assessment.
   Examine the affected areas, noting the lesions’ location, extent, and characteristics. Use the ABCDE method: Appearance, Body location, Characteristics, Distribution, and Extent.
3. Assess the patient’s level of discomfort.
   Use a pain scale to quantify the patient’s itching, burning, or pain level.
4. Evaluate the impact on daily activities.
   Determine how the condition affects the patient’s sleep, work, and social interactions.
5. Check for signs of infection.
   Look for increased redness, warmth, swelling, or purulent discharge that might indicate secondary infection.
6. Assess the patient’s current skincare routine.
   Inquire about the products and methods the patient uses for cleansing and moisturizing.
7. Identify potential environmental triggers.
   Discuss the patient’s home and work environments to identify possible irritants or allergens.
8. Review medication history.
   Note any current medications that might be causing or exacerbating the dermatitis.
9. Assess psychological impact.
   Evaluate the patient’s emotional state and body image concerns related to the skin condition.
10. Perform patch testing if indicated.
    Coordinate with the healthcare provider for allergen patch testing to identify specific triggers.

Nursing Interventions

Effective nursing interventions are crucial in managing dermatitis and promoting skin healing. Here are the interventions:

1. Implement a gentle skin care regimen.
   Teach the patient to use mild, fragrance-free cleansers and lukewarm water for bathing. Pat the skin dry gently instead of rubbing.
2. Apply prescribed topical medications.
   Administer topical corticosteroids, calcineurin inhibitors, or other prescribed treatments as ordered, teaching the patient proper application techniques.
3. Moisturize the skin regularly.
   Encourage using emollients or prescribed moisturizers immediately after bathing to lock in hydration.
4. Manage itching.
   To relieve itching, implement both pharmacological (e.g., antihistamines) and non-pharmacological measures (e.g., cool compresses).
5. Prevent scratching.
   Trim the patient’s nails short and consider using cotton gloves at night to minimize damage from scratching.
6. Identify and avoid triggers.
   Help the patient identify and eliminate or minimize exposure to known irritants or allergens.
7. Promote optimal nutrition.
   Encourage a balanced diet rich in essential fatty acids, vitamins, and minerals that support skin health.
8. Educate on proper clothing choices.
   Recommend loose-fitting, breathable fabrics like cotton and advise against wool or synthetic materials that may irritate the skin.
9. Manage stress.
   Teach stress-reduction techniques, as stress can exacerbate dermatitis symptoms.
10. Monitor for signs of infection.
    Regularly assess the skin for signs of secondary infection and promptly report any concerns to the healthcare provider.
11. Provide emotional support.
    Offer empathy and encouragement, and refer to support groups or counseling if needed.
12. Educate on long-term management.
    Teach the patient about the chronic nature of many forms of dermatitis and the importance of ongoing care and follow-up.

Nursing Care Plans

Care Plan #1

Nursing Diagnosis Statement:
Impaired Skin Integrity related to inflammation and pruritus secondary to atopic dermatitis as evidenced by dry, scaly patches on arms and legs, and reports of intense itching.

Related factors/causes:

• Chronic inflammatory skin condition
• Genetic predisposition
• Environmental triggers (allergens, irritants)
• Compromised skin barrier function

Nursing Interventions and Rationales:

1. Assess skin condition daily, noting characteristics of lesions and extent of involvement.
   Rationale: Regular assessment allows for early detection of changes or complications.
2. Implement a gentle skincare regimen using lukewarm water and mild, fragrance-free cleansers.
   Rationale: Gentle cleansing maintains skin hygiene without further irritating sensitive skin.
3. Apply prescribed topical corticosteroids or other medications as ordered.
   Rationale: Proper application of prescribed treatments helps reduce inflammation and itching.
4. Educate the patient on proper moisturizing techniques, emphasizing the importance of applying emollients immediately after bathing.
   Rationale: Regular moisturizing helps maintain skin hydration and improve barrier function.
5. Teach patient methods to reduce scratching, such as keeping nails short and using cool compresses for itch relief.
   Rationale: Minimizing scratching prevents further skin damage and reduces the risk of infection.

Desired Outcomes:

• The patient will demonstrate improvement in skin condition, with reduced redness and scaling within seven days.
• The patient will report decreased itching and discomfort within 48 hours of intervention implementation.
• The patient will demonstrate proper skin care techniques independently by discharge.

Care Plan #2

Nursing Diagnosis Statement:
Acute Pain related to skin inflammation and pruritus secondary to contact dermatitis as evidenced by the patient’s report of a burning sensation and observed scratching behavior.

Related factors/causes:

• Exposure to irritants or allergens
• Inflammatory response of the skin
• Compromised skin barrier

Nursing Interventions and Rationales:

1. Assess pain level using a standardized pain scale at regular intervals.
   Rationale: Consistent pain assessment helps evaluate the effectiveness of interventions.
2. Apply cool compresses to affected areas for 15-20 minutes every 2-3 hours.
   Rationale: Cool compresses can provide relief from burning sensations and reduce inflammation.
3. Administer prescribed oral antihistamines or topical anesthetics as ordered.
   Rationale: These medications can help alleviate itching and discomfort.
4. Teach distraction techniques and relaxation methods to cope with discomfort.
   Rationale: Non-pharmacological pain management strategies can complement medical treatments.
5. Identify and remove the causative agent if known.
   Rationale: Eliminating the source of irritation is crucial for symptom relief and prevention of recurrence.

Desired Outcomes:

• The patient will report a pain and burning sensation decrease to 3/10 or less on the pain scale within 24 hours.
• The patient will demonstrate the use of non-pharmacological pain management techniques by the end of the education session.
• The patient will verbalize understanding of avoiding identified irritants or allergens by discharge.

Care Plan #3

Nursing Diagnosis Statement:
Risk for Infection related to compromised skin barrier secondary to seborrheic dermatitis as evidenced by scaling and erythema on the scalp and face.

Related factors/causes:

• Disrupted skin integrity
• Presence of Malassezia yeast
• Potential for scratching due to pruritus

Nursing Interventions and Rationales:

1. Assess affected areas daily for signs of infection (increased redness, warmth, swelling, or purulent discharge).
   Rationale: Early detection of infection allows for prompt treatment.
2. Teach proper hand hygiene and the importance of avoiding touching or scratching affected areas.
   Rationale: Good hand hygiene reduces the risk of introducing pathogens to compromised skin.
3. Demonstrate and assist with proper cleansing techniques using prescribed medicated shampoos or cleansers.
   Rationale: Proper use of antifungal or anti-inflammatory products helps control the overgrowth of yeast and reduces inflammation.
4. Educate on the importance of keeping nails short and clean.
   Rationale: Short, clean nails minimize skin damage if scratching occurs and reduce the risk of bacterial introduction.
5. Monitor skin temperature and assess for systemic signs of infection (fever, malaise).
   Rationale: Systemic symptoms may indicate a more serious infection requiring medical intervention.

Desired Outcomes:

• The patient will maintain skin integrity without signs of infection throughout the treatment period.
• The patient will independently demonstrate proper scalp and face hygiene techniques by day 3 of hospitalization.
• The patient will verbalize understanding of infection prevention strategies by discharge.

Care Plan #4

Nursing Diagnosis Statement:
Disturbed Body Image related to visible skin changes secondary to psoriasis as evidenced by patient’s expressed reluctance to engage in social activities and negative self-statements about appearance.

Related factors/causes:

• Chronic nature of the condition
• Visible plaques and scaling on exposed skin areas
• Social stigma associated with skin conditions

Nursing Interventions and Rationales:

1. Assess the patient’s perception of their body image and the impact of psoriasis on their daily life.
   Rationale: Understanding the patient’s perspective helps tailor interventions to their specific needs.
2. Provide education about psoriasis, emphasizing that it is manageable and not contagious.
   Rationale: Accurate information can help alleviate fears and misconceptions.
3. Teach camouflage techniques using medical-grade cosmetics if desired by the patient.
   Rationale: Temporary cosmetic solutions can boost confidence in social situations.
4. Refer to a support group or counseling services for additional emotional support.
   Rationale: Peer support and professional counseling can help patients cope with the psychological impact of chronic skin conditions.
5. Encourage participation in activities that promote self-esteem and are not hindered by skin appearance.
   Rationale: Focusing on abilities rather than appearance can improve overall self-image.

Desired Outcomes:

• The patient will express improved self-acceptance and body image within 2 weeks of intervention initiation.
• The patient will engage in at least one social activity without expressing anxiety about an appearance by discharge.
• The patient will verbalize at least two positive statements about self by the end of the counseling session.

Care Plan #5

Nursing Diagnosis Statement:
Deficient Knowledge related to management of newly diagnosed dyshidrotic eczema as evidenced by patient’s questions about treatment and verbalized uncertainty about self-care measures.

Related factors/causes:

• Lack of exposure to information about the condition
• Complexity of treatment regimen
• Misconceptions about eczema management

Nursing Interventions and Rationales:

1. Assess the patient’s current understanding of dyshidrotic eczema and its management.
   Rationale: Identifying knowledge gaps allows for targeted education.
2. Provide comprehensive education about the nature of dyshidrotic eczema, its triggers, and treatment options.
   Rationale: Understanding the condition empowers the patient to participate in their care actively.
3. Demonstrate proper application techniques for prescribed topical medications.
   Rationale: Correct application ensures optimal effectiveness of treatments.
4. Teach strategies for managing flare-ups, including proper hand care and avoidance of irritants.
   Rationale: Equipping the patient with practical management skills promotes self-efficacy.
5. Provide written materials and recommend reliable online resources for ongoing education.
   Rationale: Multiple forms of information reinforce learning and serve as future references.

Desired Outcomes:

• The patient will verbalize an understanding of dyshidrotic eczema and its management by the end of the education session.
• The patient will correctly demonstrate the application of topical medications before discharge.
• The patient will identify at least three strategies for preventing and managing flare-ups by the follow-up appointment.

References

1. Eichenfield, L. F., Tom, W. L., Chamlin, S. L., Feldman, S. R., Hanifin, J. M., Simpson, E. L., … & Sidbury, R. (2014). Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American Academy of Dermatology, 70(2), 338-351.
2. Wollenberg, A., Barbarot, S., Bieber, T., Christen-Zaech, S., Deleuran, M., Fink-Wagner, A., … & Czarnecka-Operacz, M. (2018). Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. Journal of the European Academy of Dermatology and Venereology, 32(5), 657-682.
3. Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme.
4. LeBovidge, J. S., Elverson, W., Timmons, K. G., Hawryluk, E. B., Rea, C., Lee, M., & Schneider, L. C. (2016). Multidisciplinary interventions in the management of atopic dermatitis. Journal of Allergy and Clinical Immunology, 138(2), 325-334.
5. Silverberg, J. I., Gelfand, J. M., Margolis, D. J., Boguniewicz, M., Fonacier, L., Grayson, M. H., … & Fuxench, Z. C. C. (2019). Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Annals of Allergy, Asthma & Immunology, 123(2), 213-219.
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