Shingles, or herpes zoster, is a relatively common viral infection in the UK, which is caused by a reactivation of the varicella-zoster virus after patients have had an earlier infection with chickenpox. The condition results in a painful rash and in severe cases patients can develop post herpetic neuralgia (PHN), an intense chronic pain at the affected area, despite resolution of the skin lesions. Shingles can also affect the nerves in the eyes and ears, as well as causing scarring. It is important that community nurses are aware of this condition and able to advise on supportive treatments such as topical medications, pain relief and, in appropriate cases, vaccination.
Cellulitis is an acute bacterial infection of the skin and underlying subcutaneous tissue, mostly caused by Group A Streptococci (Mortimer, 2000; Cox, 2009) and Staphylococcus aureus (Hadzovic et al, 2012) (Figure 1). It can occur anywhere on the body, but most commonly affects the lower limb in 75–90% of cases (Tsao and Johnson, 1997).
Many community nurses will have encountered atopic eczema, a widespread skin condition resulting in itchy, red, dry and cracked skin and which has a serious effect on patients’ quality of life. When atopic eczema becomes infected with Staphylococcus aureus, however, these symptoms can intensify, resulting in outbreaks of folliculitis and widespread infected eczematous lesions. These can be painful and distressing and community nurses need to be aware of the symptoms and treatments in order to deal with the problem themselves or refer on. This article looks at the background to infected atopic eczema as well as the main treatments, including oral antibiotics, antiseptics, combination topical therapies and good hygiene.
Simply trying to cope can be a challenge for the many people in the UK who have a stoma — this can include issues such as how to clean and maintain the appliance and what to do if there is a complication once they have been discharged home into the community. The community nurse is often the first point of contact when there are problems with a stoma in the patient’s home and may have to advise on how to change a stoma appliance as well as how to deal with issues such as skin stripping and leaking.
Skin reactions and insect bites associated with the spring and summer months are commonly seen in community settings. In this article, the author provides an overview of the most common skin reactions, including skin cancers, that can occur through increased exposure to the sun, as well as highlighting management techniques for community nurses faced with patients who have seasonal-associated skin complaints. With prevention being key, particularly where melanoma are concerned, this article provides a useful source of information for community nurses dealing with skin problems at this time of year.
Atopic eczema is a frustrating and complex skin condition that has no cure. However, with good support, education and the correct application of topical treatments it can be well-controlled. Community nurses can provide patients with information about their condition, how to apply their topical treatment effectively and how to manage flares and maintain a routine that will improve the eczema and the patient’s quality of life. Any information provided should be reinforced with written information and a treatment plan, with follow-up support offered as needed.
This article aims to explore the perception that treatment of sacral pressure ulcers is costly and time-consuming, especially when faced with faecally incontinent patients with loose stool. The authors’ tissue viability service used a faecal management system to prevent faeces from coming into contact with the wound bed for 12 weeks, while simultaneously allowing a conventional dressing to perform to its maximum ability. A total cost and wound-healing comparison was carried out in two community patients who were faecally incontinent and bed-bound. One patient was managed with a faecal management system and the other with incontinence pads. The authors found that although the purchase of the faecal management system was initially costly, the frequency of dressing change was reduced, the patient felt more comfortable and fewer visits from the community nurses were necessary. Also, faster healing rates were demonstrated by reductions in wound size. This technique requires further studies with a larger sample size to ascertain its true benefits, particularly around wound healing.
In order to understand lymphoedema and chronic oedema skin breakdown and thus consider the most appropriate treatment options and strategies for patient education, the normal function and structure of the skin must be understood.
This abridged version of the chapter of the same name, from the International Lymphoedema Framework document, Best Practice for the Management of Lymphoedema (2nd ed.), outlines the skin conditions commonly see in lymphoedema and chronic oedema and offers management strategies for these.
Acknowledgements:
The Editor would like to thank MEP Ltd (London), for their kind permission to reproduce the images in this article.
The Editor would also like to thank the International Lymphoedema Framework for allowing publication of this abridged chapter. The full document can be found at www.lympho.org
Mieke Flour, MD, Senior Staff Dermatology Department, University Hospital Leuven, Belgium, Head of out-patient clinics: chronic wounds, conservative phlebology, lymphoedema, compression and multidisciplinary diabetic foot clinic
Article accepted for publication: October 2012
Psoriasis can be a long-term condition, which is a significant problem for approximately 2% of the UK population. Recent NICE guidance on the treatment of psoriasis provides much-needed advice and reminds clinicians of the importance of assessment (both physical and psychological) and of talking to patients about side-effects and mode of action. Primary care nurses are in a great position to work with patients to ensure that they have the optimum treatment regimen, and that they have realistic expectations as to how it will work. An optimum regimen should always include an emollient, a topical product to treat plaques on the body along with topical products for scalp, face and flexures as necessary.
Rebecca Penzer, Community Dermatology Specialist Nurse/Clinical Lead Community Dermatology, Community Nursing and Therapy Norfolk Community Health and Care NHS Trust
Community nurses are frequently involved in the care of patients after they are discharged from hospital, including many who have undergone stoma-forming surgery. There is evidence that it takes some time to adjust to life with a stoma, with much of this adjustment occurring in the first three months following surgery. During this period, nurses can use their skills to resolve any
problems that might occur, helping patients to adapt and improve their quality of life. If community nurses cannot resolve any issues patients may have with their stomas, referral to a specialist such as the local stoma specialist nurse, might be necessary.
Jennie Burch, Enhanced Recovery Nurse, St Marks Hospital, Surgery, Harrow, Middlesex
