Chapter 43: Adult Integumentary Problems

The integumentary system serves as the body's primary defense mechanism against infection, regulates temperature, and synthesizes essential nutrients, making skin health critical to overall wellness. Understanding the normal phases of wound healing—inflammatory, fibroblastic, and maturation stages—is essential for recognizing pathological healing patterns and drainage characteristics that indicate infection or complications. Diagnostic approaches such as wound cultures, Wood's light examination, and diascopy help identify the underlying etiology of skin manifestations before treatment initiation. The chapter covers infectious conditions including herpes zoster, which requires isolation precautions and antiviral therapy; methicillin-resistant Staphylococcus aureus presenting as painful folliculitis; fungal infections like Candida albicans; and bacterial infections such as cellulitis and erysipelas that demand antibiotic intervention and supportive care. Environmental injuries receive detailed attention, from contact dermatitis management through immediate oil removal to bite and sting protocols varying by organism type, with specific guidance on venom management and tissue preservation in frostbite cases. Severe drug reactions like Stevens-Johnson syndrome demand immediate medication discontinuation and emergency care due to systemic complications. The chapter also addresses chronic conditions and malignancies, including various skin cancer types distinguished by appearance and metastatic potential, with melanoma requiring heightened surveillance due to rapid progression and high mortality risk. Chronic inflammatory conditions like psoriasis and acne vulgaris require long-term management strategies emphasizing skin care, psychological support, and prevention of complications. Throughout all conditions, the chapter emphasizes the significant psychosocial impact of integumentary disorders on body image, self-esteem, and social functioning, requiring holistic nursing care that addresses both physical healing and emotional well-being.