Impaired Skin Integrity disturbances.

cream, Cetaphil
cream, Eucerin cream,
Ongoing Assessment and Neutrogena
Therapeutic Actions
Norwegian formula.
Ointments are the
Actions/Interventions Rationale Actions/Interventions Rationale most emollient.
Assess skin, noting color, Specific types of Encourage the patient to adopt One of the first steps Vaseline Pyre
moisture, texture, temperature; dermatitis may have skin care routines to decrease skin in the management of Petroleum Jelly or
note erythema, edema, characteristic patterns of irritation: dermatitis is promoting Aquaphor Natural
tenderness. skin changes and lesions. healthy skin and Healing Ointment may
Assess the skin systematically. Flexural areas (elbows, healing of skin lesions. be beneficial.
Look for areas of irritant and neck, posterior knees)  Bathe or shower using Long bathing or Apply topical steroid creams or These drugs reduce
allergic contact. are common areas lukewarm water and showering in hot water ointments. inflammation and
affected in atopic mild soap or nonsoap causes drying of the promote healing of the
dermatitis. cleansers. skin and can skin. The patient may
Assess skin for lesions. Note Open skin lesions aggravate itching begin using over-the-
presence of excoriations, increase the patient’s risk through vasodilation. counter
erosions, fissures, or for infection. Thickening  After bathing, allow the Rubbing the skin with hydrocortisone
thickening. occurs in response to skin to air dry or gently a towel can irritate the preparations. If these
chronic scratching pat the skin dry. Avoid skin and exacerbate are not effective, the
(lichenification). rubbing or brisk drying. the itch-scratch cycle. physician may include
Identify aggravating factors. Patients may develop prescription
Inquire about recent changes in dermatitis in response to corticosteroids for
use of products such as soaps, changes in their  Apply topical lubricants Lubrication with topical use. Usual
laundry products, cosmetics, environment. Extremes of immediately after fragrance-free creams application is twice
wool or synthetic fibers, temperature, emotional bathing. or ointments serves as daily, thinly and
cleaning solvents, and so forth. stress, and fatigue may a barrier to prevent sparingly. Do not use
contribute to dermatitis. further drying of the with an occlusive
skin through dressing, because this
Identify signs of itching and The patient who
scratching. scratches the skin to evaporation. potentiates the action
Moisturizing is the and systemic
relieve intense itching
may cause open skin cornerstone of absorption of the
treatment. Over-the- steroid. Usual duration
lesions with an increased
risk for infection. counter moisturizing of use of topical
lotions include steroids is up to 14
Characteristic patterns
associated with Eucerin, Lubriderm, days in adults.
and Nivea. Lotions are Apply topical immunomodulators Tacrolimus (Protopic)
scratching include
reddened papules that lighter and less (TIMs): has recently been
emollient than creams. approved for the
run together and become
confluent, widespread If more moisturizing is treatment of atopic
required than a lotion  Tacrolimus (Protopic)
erythema, and scaling or dermatitis. TIMs alter
can provide, a cream  Pimecrolimus (Elidel)
lichenification the reactivity of cell-
is recommended. surface immunological
Identify any scarring that may Long-term scarring may These include Keri
have occurred. result in body image responsiveness to
 relieve redness and Actions/Interventions Rationale experience pruritus.
itching. In 2005, the Assess severity of pruritus. Patients with dermatitis Use cool compresses on Cool, moist compresses
Food and Drug may develop an itch- pruritic areas of the skin. help relieve pruritus and
Administration advised scratch cycle. The itching. Additionally, cool
a potential cancer risk extreme itchiness of the baths with colloidal
with long-term use of skin causes the person to oatmeal (e.g., Aveeno)
pimecrolimus and scratch, which in turn can provide relief.
tacrolimus based on worsens the itching. Many Encourage the patient to keep Long fingernails used for
animal studies. patients report the itching fingernails trimmed short. scratching are more likely
Prepare the patient for This treatment to be worse at night, thus to cause skin trauma and
phototherapy or modality uses disrupting their sleep. aggravate itching.
photochemotherapy. ultraviolet A or B light Assess skin for excoriations Scratching and rubbing Administer antihistamine Antihistamines such as
waves to promote and lichenification. the skin in response to the drugs. hydroxyzine will help
healing of the skin. itching increases the relieve itching and
The addition of irritation of the skin. When promote comfort. These
psoralen, which papules are scratched, drugs can be taken at
increases the skin’s they may break open, bedtime. Their sedative
sensitivity to light, may causing excoriations that effect may also help
benefit patients who become crusty and promote sleep. During the
do not respond to infected. Over time, daytime, nonsedating
phototherapy alone. constant rubbing and antihistamines may
Encourage the patient to avoid Some change in scratching cause the skin increase the efficacy of
aggravating factors. lifestyle may be to become thick and pruritus control.
indicated to reduce leathery (lichenification). Loratadine is an over-the-
triggers. counter medication.
Therapeutic Interventions Apply topical antipruritic These may be used alone
4. Risk for Impaired Skin Integrity agents if indicated. or combined with oral
antihistamines. Over-the-
Actions/Interventions Rationale counter products include
Common Risk Factors Encourage the patient to avoid Contact with factors that Sarna lotion, Prax lotion,
 Severe pruritus triggering factors. stimulate histamine and Itch-X gel.
 Scratches skin frequently release will increase Prescription Cetaphil with
 Dry skin itching. Because irritants menthol may also help.
vary from one patient to Apply topical steroid creams if Do not apply on the face.
another, each patient indicated. Use thinly and sparingly,
Common Expected NOC Outcome Tissue needs to determine
Outcome Patient reports Integrity: Skin and Mucous up to a maximum of 14
substances and situations days. Do not use with
increased comfort level Membranes that aggravate the
and skin remains intact. occlusive dressings.
dermatitis.
Administer oral steroids. Short-term low-dose oral
NIC Interventions Skin Maintain hydration of stratum Application of lubricating steroids may be ordered
Surveillance; Skin Care: corneum. creams and ointments for severe cases. Oral
Topical Treatments serve as a barrier to water steroids are not indicated
evaporation from the skin.  for long-term use despite
Ongoing Assessment Moist skin is less likely to their efficacy