diaper rash case pres

8/6/2019 Diaper Rash Case Pres

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Diaper RashDiaper Rash

A case studypresented tothe Faculty of Nursing

Capitol Medical Center Colleges

In partial fulfillmentof the requirementsin NCM-102 Lecture


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I. IntroductionI. IntroductionBackground of the Study

Diaper rash or diaper dermatitis is a general term

describing any of a number of inflammatory skin conditions

that can occur in the diaper area. It is caused by over

hydration of the skin, maceration, prolonged contact with

urine and feces, retained diaper soaps, and topical

preparations


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SymptomsSymptoms

Red, itchy, scaly rash patches in the diaper area

and legs

Redness around the anus and genitalia

Bright red and tender rash and/or spots in the

folds between the thighs and abdomen

Deep red rash with yellowish scales


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Objectives of the studyObjectives of the studyGeneral Objective:

At the end of this case study, the students will be

able to accurately assess signs and symptoms of diaper

rash and will appropriately discuss reduction of risk

factors for diaper rash with other health care providers

and people who are directly taking care of the infants.


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Specific objectives:Students will be able to:

Explain indicators of risk and complications of diaper rash to

their health provider of patients.

Describe the risks of diaper rash complications, including

Intertrigo, psoriasis and the goals of management.

Discuss with patients and families the importance of good

hygiene in the prevention and management of diaper rash.

Develop treatment plans in the context of each patient's life

and environment.


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Theoretical FrameworkTheoretical FrameworkSelf-Care Deficit

Dorothea E. Orem


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Dorothea E. Orem, M.S.N.Ed., D.sc., R.N., was born in 1914 in

Baltimore, Maryland. She began her nursing education at Providence

Hospital School of Nursing in Washington DC. She earned her

Bachelor ofScience in Nursing Education in 1939 and her Master of

Science in Nursing Education in 1945 from the Catholic University of

America. She has received several honorary degrees including a

Doctor ofScience.

Defined Nursing: The act of assisting others in the provision and

management of self-care to maintain/improve human functioning at

home level of effectiveness .


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Identified 3 related concepts:Identified 3 related concepts:Self-care activities an Individual performs

independently throughout life to promote and maintain

personal well-being.

Self Care Agency aquired ability or power to

engage in self-care.Self Care Demand totality of care measures

necessary at specific at specific times

Self Care Requisites defined as the reason for

which self-care is undertaken.

Self-care deficit results when self-care agency

(Individuals ability) is not adequate to meet the known

self-care needs.


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Nursing System nursing interventions needed when Individual

is unable to perform the necessary self-care activities:

Wholly compensatory nurse provides entire self-care for

the client.

Example: care of a new born, care of client recovering from

surgery in a post-anesthesia care unit

Partial compensatory nurse and client perform care;

client can perform selected self-care activities, but also

accepts care done by the nurse for needs the client cannot

meet independently.

Example: Nurse can assist post operative client to ambulate,

Nurse can bring a meal tray for client who can feed himself


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Supportive-educative nurses actions are to help the

client develop/learn their own self-care abilities through

knowledge, support and encouragement.

Example: Nurse guides a mother how to breastfeed her baby,

nurse educates mother in prevention and treatment of diaper

rash


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Self Care

Self-CareAgency

Self-CareDemand

NursingAgency

DEFICIT

R R

R R


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II. Patients Data BaseII. Patients Data Base

Personal data

Patient Baby zelle is a 1 and 1/2

month old, female, single and living inNayon Quezon City. She was born in the

30th of January 2011. She is a Filipino

citizen and a member of Roman Catholic

Church.


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Immunization History:Immunization History:

BCG January 30, 2011

Hepa B1 January 30, 2011

DPT1 March 15, 2011

OPV1 March 15, 2011

Hepa B2 March 15, 2011


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Family HistoryFamily History::Mother Father

Allergies

(-) (-)

Hypertension

(+) (-)


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Mother Father Diabetes Mellitus

(+) (-)

Convulsion

(-) (-)


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Physical ExaminationPhysical Examination

Body Part Normal Finding Actual FindingHead Symmetrical,

normocephalic

Symmetrical,

normocephalic

Clear scalp with hair intact

Hair is black and equally

distributed

Eyes Pinkish conjunctiva

Clear sclera

Symmetrical, pinkish

conjunctiva

Anicteric sclera

Chest Shoulder is at the same

height

Nipples is symmetrically

aligned

Shoulder is at the same

height

Nipple is symmetrically

aligned

Symmetrical chest

expansion


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Body Part Normal Finding Actual Finding

Abdomen No lesions

Flat or rounded

Uniform in colour

Soft and Rounded

No lesions, rashes and no

mass

Neck No inflammation of lymph

nodes

No nodules

No inflammation of lymph

nodes

No mass

Skin Skin is uniform, whitish

pink in colour, no lesions,

moist

Skin is uniform, warm and

moist, fair white in color.

With rashes in buttocks to

genitalia

Extremities No lesion and No edema No lesion and edema

(-) cyanosis


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III. Clinical DiscussionsIII. Clinical Discussions

Anatomy and Physiology

INTEGUMENTARY SYSTEM


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Integumentary System is the organ system that

protects the body from damage, comprising the skin.The integumentary system has a variety of functions;

it may serve to waterproof, cushion, and protect the

deeper tissues, excrete wastes, and regulate

temperature, and is the attachment site for sensory

receptors to detect pain, sensation, pressure, and

temperature. In humans the integumentary system

also provides vitamin D synthesis.


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Epidermis

This is the top layer of skin made up of epithelial cells. It does not

contain blood vessels. Its main function is protection, absorption of

nutrients, and homeostasis. In structure, it consists of a keratinized

stratified squamous epithelium comprising four types of cell:

keratinocytes, melanocytes, Merkel cells, and Langerhans cell. The

major cell of the epidermis is the keratinocyte, which produces

keratin. Keratin is a fibrous protein that aids in protection. The majority of

the skin on the body is keratinized, meaning waterproofed.


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The only skin on the body that is non-

keratinized is the lining of skin on the inside of the

mouth. The epidermis also contains Langerhans

cell, which are formed in the bone marrow and

then migrate to the epidermis. They work in

conjunction with other cells to fight foreign bodies

as part of the body's immune defense system.

Melanocytes create melanin, the substance that

gives skin its colour.


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Dermis

The dermis is the middle layer of skin, composed of

dense irregular connective tissues. Its major parts are collagen

(a protein that adds strength), reticular fibers (thin protein fibers

that add support), and elastic fibers (a protein that adds

flexibility) allowing stretching and conferring flexibility, while also

resisting distortions, wrinkling, and sagging. The dermal layer

provides a site for the endings of blood vessels and nerves. The

dermis has two layers: the papillary layer, which has looseconnective tissue, and the reticular layer, which has dense

connective tissue.


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The papillary layer lies directly beneath the epidermis

and connects to it via papillae (finger-like projections).

Some papillae contain capillaries that nourish the

epidermis; others contain Meissner's corpuscles, sensory

touch receptors.

The reticular layer also contains Pacinian corpuscles,

sensory receptors for deep pressure. This layer contains

sweat glands, lymph vessels, smooth muscle, and hair

follicles and cells that aid in healing.


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Subdermis

It is composed mainly of connective and adipose

tissue. Skin produces associated structures such as

sudoriferous glands and sebaceous glands. Its

physiological functions include insulation, storage of

energy.


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Patterns of

Functioning

Before infection During infection Analysis /

Interpretation

Health

Perception-

Health

Management

Pattern

Health provider

has a good

therapeutic health

management and

seeks for healthconsultation.

Health provider

followed the

doctors order for

her childs

immediaterecovery.

Health provider

has good

management in

developing

condition.

Nutritional-

Metabolic

Pattern

Patient

breastfeeds 7-8

times

Patient still

breastfeeds 7-8

times

Patients nutrition

is still the same

and essential in

the recovery of

her condition.

Activity-

Exercise

Pattern

Patient has

limited activities.

Patient has

limited activities.

The patient is

asleep most of

the time.


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Patterns of

Functioning


Interpretation

Elimination

Pattern

Patient has three

to four times of

bowel movements

per day

Patient still voids

and eliminates

bowel regularly.

Patients

elimination

pattern was not

affected by his

condition.

Sleep- Rest

Pattern

Patient is asleep

for 12 hours in a

day with three

naps and at nightpatient can go

back to sleep

when she wake

up periodically

Patient sleeps

less than 12

hours and she

could not sleepwell because

she feels

irritated by the

discomfort of

her condition..

Patient is unable

to get enough

sleep in a day

due to discomfort.


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Patterns of

Functioning


Interpretation

Cognitive-

Perceptual

Pattern

She is attracted

to anything with

color and music

Patient is awake

and attracted to

music

Patients

sensorimotor

becomes more

functional

Self-

Perception

Pattern

She only cries

when she is

hungry or if she

feels sleepy and

uncomfortable.

Her cries and

grimaces show

that she feels

uncomfortable

due to her diaper

rash

Her cries and

grimaces show that

she feels

uncomfortable due

to her diaper rash


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Patterns of

Functioning


Interpretation

Role-

Relationship

Pattern

Patient has a

good relationship

towards people

and his

significant others.

Patients

relationship to

people around

her was not

affected by her

condition.

Patient maintained

close relationship to

the people around

her.

Values-Belief

Pattern

Patient and her

family attends

mass every

Sunday morning

Patient and her

family still attends

mass every

Sunday morning

Patients family kept

their faith to God


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Pathophysiology

Precipitating: Predisposing:

Environment AgeIrritants

Overhydration of Stratum corneum

And increase skin pH

Disruption of lipid bilayer

Damage of Stratum corneum

Microorganism/Irritants penetrates

And reach Langerhans cells and Epidermis


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Fecal enzymes degrade Stratum corneum

Proteins and disrupt ingetrity

Penetrants interact with the keratinocytes

And fibroblasts

Penetrants stimulate cytokine release

By keratinocytes

Cytokines act on the vasculature of the

Dermis resulting in inflammation


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Drug StudyDrug Study

Generic Name: Zinc OxideBrand Name: Calmoseptine

Classification: Skin protectantDosage: Every change of diaperAction: Skin protectant, soothes irritatingskin

Indication:Protects skin, soothesirritating skin. It works by temporarily

relieving itching and pain. It alsodecreases moisture in the affected skin


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Drug StudyDrug Study

Contraindication:Contraindicated to patient withhypersensitive to drugContraindicated to treat a deep wound orpunctured woundAdverse reaction:Skin: rashes, hives, itching

Nursing Responsibilities:Dont apply to deep woundsRinse at once with cool water if medicationgot into the eyes, nose or mouth.

A Di i Pl i I l i E l i


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Assessment Diagnosis Planning Implementation Evaluation

O:

y Disruptio

n and

rednessof skin

area

y With

rashes

on the

buttocksto

genitalia

Impaired

skin integrity

related to

humidity asevidenced

by rashes on

the buttocks

to genitalia

Short term:

After 8hours of

nursing intervention

health provider willbe able to:

Demonstrate

preventive

measures

verbalize feelings

and ability tomanage situation

Long term:

After 1day of

nursing intervertion

health provider will

be able to:

maintain optimal

nutrition needed for

wound healing and

skin repair

display timely

healing of skin

lesions

y Assess the

etiology

y Periodically

remeasure wound& observe for

complication

y Keep the area

clean and dry to

prevent infection

y

Inspect skin on adaily basis,

describing wound

characteristics

and changes

y Use appropriate

barrier dressing,

skin protective

agent

y Administer

medication as

prescribed

After 8hours of

nursing

intervention

health providerwas able to

demonstrate

preventive

measures and

verbalized

feelings andability to

manage

situation

After 1day of

nursing

intervention

health provider

was able to

maintain

optimal

nutrition and

displayed

diaper rash case pres

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