A skin integrity issue might mean the skin is damaged, vulnerable to injury or unable to heal normally. They may occur before, or more often, after the start of treatment. It is believed to have reached the Americas with populations migrating from Asia across the Bering Strait, whereas M. leprae travelled with colonists from the Old World. Urinary retention related to incomplete emptying of bladder. Copy edited by Gus Mitchell. Symptoms are usually mild initially and are only noticed years after exposure. Corneal ulcers or blindness can also occur if facial nerves are affected, due to loss of sensation of the cornea (outside) of the eye. Surgery is currently the only curative treatment for a cataract (Figure 3). Infection can present at any age. 2020;83(1):1-14. doi:10.1016/j.jaad.2019.12.080. Outcome: Maintenance of normal skin integrity. Mycobacterium lepromatosis was identified by genome sequencing of isolates in Mexico and has subsequently been identified in many other countries. FIG 1 Indeterminate leprosy. Patch of skin that looks lighter (or darker) and may be dry or flaky. Patient’s BMI is 37.5 and he also suffers from stage 3 kidney disease. Most endemic countries follow the WHO recommended multi-drug therapy (MDT) of antibiotics; the combination of drugs selected and duration of treatment depends on the type of leprosy. The potential differential diagnosis list for leprosy is long and depends on the type and clinical features. Maintain skin integrity/ no skin breakdowns, Demonstrates behaviors/techniques to prevent skin breakdowns, Patient understanding and demonstration of behaviors and techniques to prevent skin breakdowns, Pressure management to prevent ulceration, Check for fit of shoes, slippers and change as needed, Control edema; interstitial edema and impaired circulation slow down drug absorption and predispose to tissue breakdown/ development of infection, Alternating pressure/egg-crate mattress, pillows, sheepskin elbow/ heel, Using bed cradle or footboard to relieve pressure from bed linens. Surgery 8. Pressure Ulcers. In the initial stages, small sensory and autonomic nerve fibers in the skin of a person with leprosy are damaged. Pressure, shear, and friction from immobility put an individual at risk for altered skin integrity. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Author: Vanessa Ngan, Staff Writer, 2003. BT leprosy with type 1 reaction. Collect patient history, including risk factors and symptoms (objective and subjective data), Inspect the skin (especially bony prominences, dependent areas, and affected extremity for pallor, redness and breakdown, Presence of signs and symptoms establishes an actual diagnosis. Management of Cataract. Fit poorly, increased risk of breakdown due pressure on skin on feet, Excessive dryness or moisture as they can damage skin and hasten breakdown, Antidysrhythmic agents, Anticholinergic agents, pain medications if needed. Leprosy has very characteristic clinical features, and dermoscopy is being used more often to aid clinical diagnosis. 2017;15(8):801-27. doi:10.1111/ddg.13301. Characteristic 'Swiss cheese' appearance (black arrows), Red lesions of variable size. the nurse is caring for a client at risk for impaired skin integrity. Monitor site of skin impairment at least once a day for color changes, redness, swelling, warmth, pain, or other signs of infection. Residual disabilities may require corrective reconstructive surgery to allow day-to-day activity. Radiated skin becomes thin and friable, may have less blood supply, and is at higher risk for breakdown. Leprosy: treatment and management of complications. Kar HK, Kumar B (eds). The skin is a waterproof, flexible organ that covers the human body. In 2017, over 200,000 new cases of leprosy were registered world-wide. Leprosy, also called Hansen disease, is a disorder known since ancient times. In the United States, the National Hansen’s Disease Program External provides diagnostic services.. GOAL: Monitor the condition of skin and risk factors to ensure skin integrity Potential Interventions: Inspect skin daily with cares (done by nursing assistants) Inspect skin weekly by licensed nurse Risk assessment per protocols Documentation of skin integrity concerns (i.e., pressure ulcer) at least weekly OUTCOMES AND PLAN: a. Borderline lepromatous (BL) leprosy is characterised by: Borderline lepromatous leprosy This has a characteristic, Skin Slit Smear â a small slit is made using a sharp blade over the skin of the earlobe, forehead, or, Hypopigmented patches and macules may need to be distinguished from. Vaccines and other forms of immunotherapy are being trialled. Temperature is the first sensation lost, followed by light touch, pain, and then deep pressure. In 80% of new cases, there is a clear history of prolonged contact with an untreated person suffering from leprosy. This may precede the development of cutaneous lesions by years. 3. In New Zealand, there were 38 reported cases in the decade 2004-2013 with the majority of cases having lived in the Western Pacific region or Southeast Asia: most cases came from Samoa. An ill-defined erythematous patch over the face. Skin integrity refers to skin health. Impaired Skin Integrity related to the effects of surgery; immobilization. It divides very slowly and takes years to reach a number sufficient to show signs of infection. Infection 5. Temperature extremes 9. Evidence of zoonotic leprosy in Pará, Brazilian Amazon, and risks associated with human contact or consumption of armadillos. DermNet NZ does not provide an online consultation service. JAYPEE Brothers Medical Publication, 2010. Notice of damage or slowing healing. Its three main purposes are: (1) to protect the body, (2) to regulate temperature, and (3) to provide sensation. Such reactions are responsible for most of the nerve damage, deformity, and disability. Sensory loss is unusual in indeterminate leprosy. Assess the skin of the side effects of cancer therapy. doi:10.1371/journal.pntd.0006532. These are sudden responses resulting from the release of immunologically active bacilli or its products leading to localised or systemic symptoms and signs. J Dtsch Dermatol Ges. Impaired Skin Integrity Diagnosis and Interventions NCLEX Review . 5 Nursing Care Plans for Impaired Skin Integrity. Pressure ulcer, pressure sore, decubitus ulcer, and bedsore are terms used to describe impaired skin integrity related to unrelieved, prolonged pressure. Diagnosis should be confirmed by one of the following investigations. Leprosy is a bacterial disease of the skin and nerves 2. Antibiotics used during the treatment will kill the bacteria that cause leprosy. Impaired skin integrity related to radiation therapy. Damage and destruction to the affected tissue (cornea, integumentary subcutaneous, cornea) Localized pain. Leprosy is completely curable 3. The urea in urine turns into ammonia within minutes, and is caustic to the skin. Kelley LS, Mobily PR. In time, they can damage nerves and other parts of your body. M. leprae grows best at cool temperatures, explaining its predilection to affect skin and peripheral superficial nerves. » Impaired skin integrity nursing diagnosis and early recognition allows for prompt intervention. Maymone MBC, Laughter M, Venkatesh S, et al. Guidelines for the diagnosis, treatment and prevention of leprosy. Pure neural leprosy Leprosy is nearly always caused by M. leprae, an intracellular acid-fast bacillus related to Mycobacterium tuberculosis and Mycobacterium ulcerans. Home If skin has lost its elasticity for any reason, then a comprehensive nursing care plan for impaired skin integrity is needed as soon as possible to guarantee that no further damage is going to happen. Use these statements below for your “related to” in your diagnostic statement. With your help, we can update and expand the website. 2019;ciz1121. A. Leprosy, also called Hansen disease, is a chronic bacterial infection primarily affecting the skin and peripheral nerves usually caused by Mycobacterium leprae. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Yu R, Jarrett P, Holland D, Sherwood J, Pikholz C. Leprosy in New Zealand: an epidemiological update. 1. Patient mentions he is experiencing warmness and pain in the lower back. Altered circulation 2. doi:10.1093/cid/ciz1121. Several genes have been identified which increase the susceptibility to infection with M. leprae. The most current terminology is pressure ulcer (), which is consistent with the recommendations of the pressure ulcer guidelines written by the Wound, Ostomy and Continence Nurses Society (WOCN, 2010). Potential for impaired skin integrity related to edema secondary to renal cysts. Tendency by the person to protect the area. It is believed to be spread by breathing airborne droplets from affected individuals when they sneeze or cough. There are two age peaks; 10â14 years of age, and 35â44 years. Otherwise, scroll down to view this completed care plan. Leprosy can affect people of all races anywhere in the world. Skin stretched tautly over edematous tissue is at risk for impairment. Diagnose the impaired tissue integrity and monitor the characteristics of the lesion such as size, … IAL Textbook of Leprosy. Report of the literature review. Radiation 7. Chronic bacterial infection with Mycobacterium leprae. Asymmetrical distribution of erythematous infiltrated plaques in skin of colour, Asymmetrical distribution of erythematous infiltrated plaques in skin of colour. Physical immobility, prolonged bed rest, alterations in nutritional status often result in impaired peripheral circulation, compromising the tissue nutrient delivery and skin integrity. September 2020. Risk for infection related to abscess formation of bone, skin damage. Leprosy also known as Hansen’s disease, is a chronic infectious disease caused by slow-growing bacteria called Mycobacterium leprae, which has a preference for the skin and peripheral nerves 1). Fluid imbalances 4. Impaired physical mobility related to specific client condition. Fischer M. Leprosy â an overview of clinical features, diagnosis, and treatment. Impaired skin integrity related to physical immobilization. Lepromatous (LL) leprosy is the multibacillary form defined by: Lepromatous leprosy Invert / change positions often. So to treat impaired skin integrity, the nurse should be aware of all aspects to tackle the risky conditions.