Fungal Skin Disease Nursing Management

Definition and Risk factors
Tinea pedis
  • Is a fungal infection of feet known as athlete’s foot, especially in those who use communal showers or swimming pools.
Tinea corporis
  • Is a fungal infection that affects the face, neck, trunk, and extremities. Anima varieties (nonhuman varieties) cause an intense inflammatory reaction; these may be transmitted through contact with pets or pet objects.

Fungal Infection Nursing Management

Tinea capitis
  • Is ringworm of the scalp and is a contagious fungal infection of the hair shafts and a common cause of hair loss.
Tinea cruris
  • Is fungal infection of the groin, which may extend to the inner thighs and buttocks area, also known as “jock itch”. It most frequenly occurs in young joggers, obese people, and those who wear tight underclothing.
Tinea unguium (i.e. onychomycosis)
  • Is a chronic fungal infection of the toenails and less commonly of the fingernails. Usually caused by Trichophyton species or Candida albicans, it may represent lifetime fungal infection of the feet.
Pathophysiology
  • The fungal infections are caused by fungi, tiny representatives of the plant kingdom that feed on organic matter. They affect only the skin and its appendages to these skin disorders.
Assessment/Clinical Manifestations/Signs and Symptoms

Clinical manifestations depend on the specific infection.

Tinea pedis
  • May appear as an acute (i.e. inflamed vesicles) or chronic (i.e. scaly, dusky, or red rash) infection on the soles of the feet or between the toes with client complaints of pruritus.
Tinea corporis
  • Begins with erythematous macules advancing to rings of vesicles with central clearing; the lesions are found in clusters on the scalp, hair or nails.
Tinea capitis
  • Characteristically results in red, scaling patches in the scalp; small pustules or papules may be seen at the edges of the patches. Hair becomes brittle and breaks easily at the scalp.
Tinea cruris
  • Manifests with small, red, scaly patches extending to circular plaques with elevated scaly or vesicular borders; clients complain of itching.
Tinea unguium
  • The nails become thickened, friable (i.e. easily crumbled), and lusterless. Debris accumulates under the free edge of the nail, and ultimately the nail plate separates. The entire nail may be destroyed.
Laboratory and diagnostic study findings
  • Skin culture and sensitivity testing identify the causative organism
  • Under Wood’s light, the infected hair appears fluorescent, which aids in diagnosing tinea capitis.
Medical Management
Tinea capitis
  • Griseofulvin for 6 weeks
  • Shampoo hair 2 or 3 times with Nizoral or selenium sulfide shampoo
Tinea corporis (body)
  • Mild conditions: topical antifungal creams
  • Severe conditions; griseofulvin or terbinafine
Tinea cruris (groin area; “jock itch”0
  • Mild conditions: topical antifungal creams
  • Severe conditions; griseofulvin or terbinafine
Tinea pedis (foot; “athelete’s foot”)
  • Soak feet in vinegar and water solution
  • Resistant infections: griseofulvin or tervinafine
  • Terbinafine (Lamisil) daily for 3 months
Tinea unguium (toenails)
  • Itraconazole (Sporanox) in pulses of 1 week a months for 3 months
Nursing Diagnosis
  • Impaired skin integrity
  • Deficient knowledge
  • Disturbed body image
  • Acute pain
  • Imbalanced nutrition: less than body requirements
  • Risk for infection
Nursing Management
  1. Providing general nursing care for fungal skin diseases, which focuses on enhancing skin integrity, providing pain relief, preventing infection, and providing client and family teaching.
  2. Provide nursing care for the client with tinea pedis.
  3. Administer fungal foot sprays
  4. Teach the client to keep his feet as dry as possible, including the area between the toes.
    • Small pieces of cotton can be placed between the toes at night to absorb moisture.
    • Socks should be made of absorbent white cotton because synthetic material does not absorb perspiration.
    • Instruct the client to apply talcum powder or antifungal powder twice daily.
    • Instruct the client to alternate shoes so they can dry completely before being worn again.
  5. Provide nursing care for the client with tinea corporis.
    • Administer prescribed medications, which may include topical antifungal medication.
    • Instruct the client to use a clean towel and washcloth daily.
    • Instruct the client to thoroughly dry all skin areas and skin folds that retain moisture.
    • Encourage the client to wear clean cotton clothing next to the skin.
    • Instruct the client to be careful around pets and pet objects.
  6. Provide nursing care for the client with tinea capitis.
    • Administer prescribed medications, including griseofulvin, an antifungal agent. Topical agents do not provide an effective cure because the infection occurs within the hair shaft and below the surface of the scalp.
    • Instruct the client and his family to use separate combs and brushes and to avoid exchanging hats and other headgear.
    • Encourage the client that all family members and household pets must be examined, because familial infections are relatively common.
  7. Provide nursing care for the client with tinea cruris.
    • Administer prescribed medications, which may include topical antifungal medication.
    • Instruct the client to avoid excessive heat and humidity as much as possible, including avoiding wearing nylon underwear, tight-fitting clothes, and wet bathing suits.
    • Instruct the client to clean, dry and dust the groin area with a topical antifungal agent.
  8. Provide nursing care for the client with tinea unguium.
    • Administer prescribed medications, including griseofulvin, an antifungal, orally for up to 1 year.
    • Advise the client that response to medication is poor at best; frequently when the treatment is stopped, the infection returns.
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