Chapter 23: Concepts of Care for Patients With Skin Problems

The skin serves as the body's first line of defense against infection and environmental damage, and nurses must recognize how disruption of skin integrity through pressure, infection, inflammation, or trauma requires systematic assessment and evidence-based intervention. Pressure injuries represent a major focus, defined as localized tissue damage resulting from sustained pressure, shear forces, or friction on vulnerable areas. The Braden Scale guides risk stratification by evaluating mobility, moisture exposure, nutritional status, and sensory perception, enabling nurses to implement preventive strategies such as repositioning schedules, pressure-redistributing surfaces, and nutritional supplementation. Staging frameworks from nonblanchable erythema through full-thickness tissue loss with exposed bone guide wound assessment and guide treatment intensity. Infectious skin disorders demand careful pathogen identification and transmission control, encompassing bacterial infections like cellulitis caused by Staphylococcus aureus, viral infections including herpes simplex and herpes zoster that present as painful vesicular eruptions, and fungal infections requiring prolonged antifungal therapy and moisture management. Inflammatory and immune-mediated conditions such as atopic dermatitis, psoriasis, and contact dermatitis involve chronic itching, erythema, and skin barrier dysfunction managed through emollients, topical and systemic corticosteroids, phototherapy, and emerging biologic agents targeting specific immune pathways. Wound healing principles encompass primary intention healing for clean surgical wounds and secondary intention healing for wounds with tissue loss, requiring systematic cleansing, debridement of necrotic tissue through mechanical, enzymatic, or surgical methods, moisture balance using evidence-based dressing selections, and infection surveillance. Acute dermatologic emergencies including Stevens-Johnson syndrome and toxic epidermal necrolysis represent life-threatening drug reactions requiring intensive burn-unit level care, fluid resuscitation, infection prevention, and psychological support. Throughout all skin conditions, nursing care integrates meticulous assessment with patient education addressing hygiene practices, nutritional optimization, medication adherence, sun protection, stress management, and body image support to restore skin integrity, promote healing, prevent complications, and enhance quality of life across diverse patient populations and healthcare settings.