Moisture-associated skin damage (MASD) results from an extended period of exposure to various types of moisture, commonly urine or faeces, sweat, and wound exudate1. It can result in extensive skin breakdown through erythema, maceration and eventually moisture lesions, with the most common presentations being incontinenceassociated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis1. MASD is not caused by moisture alone — other factors including friction, hygiene products, or microorganisms are usually involved1. MASD can be painful and effect the patient’s quality of life2, potentially resulting in moisture lesions if not properly managed.
This article will highlight some common skin lesions present in the older population. Skin lesions of this type may be frequently seen by community nurses and can be categorised as benign lesions, non-melanoma and melanoma skin cancers. The article contains a description of the lesions along with a guide to the correct terminology used to establish an accurate diagnosis. The prevalence and causes of these lesions along with an explanation of varying treatment options is also included.
This article provides an overview of the common eczematous conditions that patients may present with in the community. With early diagnosis and treatment, including patient education and effective care planning, eczema can be managed succesfully by community nurses, not only releving pain, itch and irritation, but also improving patients’ quality of life. When formulating a comprehensive management plan, community nurses will need to be able to recognise, diagnose and treat the different presentations of eczema as well as understanding the main therapies, including emollient and topical steroid therapy.
Leg ulcers present a common clinical problem for community nurses. The need for assessment and maintenance can take up a lot of nursing time and issues such as pain, exudate and compression bandaging have a significant effect on the quality of life of patients. This article describes an evaluation of two new compression devices, one for people with venous insufficiency resulting in leg ulcers who need compression therapy (Juxta CURES; medi UK); another for those with leg ulcers, venous insufficiency and lymphoedema (Juxta-Fit; medi UK). This evaluation involved 16 patients and demonstrated the impact of quality of life and the potential for savings in a community nursing team, both financially and in terms of reduced nursing time.
Among the challenges facing community nurses in their day-to-day practice is one that impacts greatly on patients, relatives and healthcare providers — the management of exudating skin conditions and wounds. This article looks at eosin solution, a popular treatment option for exudative dermatoses on mainland Europe, to the extent of being commercially available to the general public, but one which has dwindled in popularity in the UK. This article provides an introduction to this versatile nontoxic dye and outlines its potential application in the community setting by comparing it with the much more widely used alternative potassium permanganate.
Amputation surgery can be traumatic and life-changing for patients and many struggle to come to terms with the loss of a limb. Wounds that fail to heal following surgery can have an impact on each individual’s rehabilitation process. It is important to provide the correct management for these wounds to facilitate healing and enable the patient to work towards mobilisation. Equipping community nurses with the knowledge and skills to assist patients in managing their residual limbs can improve the time from amputation to ambulation. Similarly, overcoming problems with patients' skin; achieving properly filling prosthesis; and managing the ‘wear and tear’ of prosthetic limbs are all challenging aspects in the management of this patient group.
Shingles is a condition caused by reactivation of the herpes virus that is responsible for varicella (chickenpox). It results in a painful, vesicular rash that can have a devastating effect on patients. It can also have long-lasting effects such as pain and increased risk of vascular conditions such as stroke for patients under the age of 40. Being that shingles is not a notifiable disease, most of the information available on its incidence is inaccurate and based mostly on estimate studies. The health prevention of this virus is of extreme importance as a vaccination programme is made available to eligible individuals. Patients that develop shingles under the age of 40 can also be assessed for the risks of developing vascular conditions.
If left untreated, leg ulcers can descend into a cycle of tissue breakdown and healing, resulting in chronic venous leg ulcers, which are associated with considerable morbidity and impaired quality of life. Compression therapy is widely held up as the ‘gold standard’ for management of venous leg ulcers, and the provision of safe and effective compression is one of the vital skills of the community nurse. However, to provide this level of treatment it is essential that the bandage system used provides the correct amount of sub-bandage pressure, as too little will be ineffective; whereas too great a pressure may cause constriction and patient discomfort (Moffatt, 2005; Milic et al, 2010). This article highlights a study that investigated the efficacy of a two-layer bandaging system (HERO H-2®, H&R Healthcare), which was tested by a group of clinicians for its ability to provide optimum compression alongside ease of application and patient comfort.
Welcome to JCN’s learning zone. By reading the article in each issue, you can learn all about the key principles of subjects that are vital to your role as a community nurse. Once you have read the article, visit www.jcn.co.uk/learning-zone/ to evaluate your knowledge on this topic by answering the 10 questions in the e-learning unit; all answers can be found in the article. If you answer the questions correctly, you can download your certificate, which can be used in your continuing professional development (CPD) portfolio as evidence of your continued learning.
As community nurses increasingly visit patients in their own homes to perform wound care, continence care or other common community nursing tasks, they may notice various skin conditions in the course of examining or treating patients. In order to provide holistic care, it is important that community nurses have a working knowledge of the variety of infections and infestations that can affect an individual's skin. This article takes a look at some of the more common skin infections/infestations — impetigo, fungal infections, viral warts, and scabies — and provides information on presentation, assessment and treatment.
