Table of Contents:

1. Stevens-Johnson 3. Cellulitis
Syndrome (SJS) 4. Skin Cancer
2. Shingles (Herpes Zoster) 5. Frostbite

Acute & Concerning Skin Conditions

1. Stevens-Johnson Syndrome (SJS)

y Interventions
FIGURE 1. STEVENS-JOHNSON SYNDROME

Priority = discontinue the trigger medication.
y Administer IV fluids for dehydration.

Manage wounds similarly to burns to prevent
infection (sterile care) and promote healing
(moist dressings) (see BURNS CHEAT SHEET).
y Monitor for respiratory complications if oral
mucosa is affected.
y Administer analgesics.

2. Shingles (Herpes Zoster)

FIGURE 2. SHINGLES

Stevens-Johnson syndrome: A life-threatening skin

reaction to medications  Widespread destruction and
detachment of <30% of skin and mucous membranes
(classified as toxic epidermal necrolysis [TEN] if ≥30% of

Integumentary
body is affected)
y Common causative medications include (3 A’s):
y Antibiotics (sulfa drugs like sulfamethoxazole-
trimethoprim)
y Anticonvulsants (lamotrigine)
y Allopurinol Shingles: Reactivation of latent varicella-zoster virus
y Findings (chickenpox)  Painful, vesicular rash in a linear
y Flu-like symptoms (early) pattern along a dermatome (FIGURE 2).
y Rash: Widespread erythema  Painful blistering y Findings
and peeling (FIGURE 1) y Pain, burning, and itching
y Painful lesions in the eyes and mouth y Rash: Unilateral vesicles on erythematous
base  Crusting

 Stevens-Johnson Syndrome (SJS): The priority for managing SJS is to discontinue the trigger
medication immediately. Apply moist dressings to promote healing and administer IV fluids to
prevent dehydration.

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2. Shingles (Herpes Zoster), Continued 4. Skin Cancer
y Interventions

Initiate contact and airborne isolation FIGURE 4. SKIN LESIONS
precautions until lesions crust.
y Administer analgesics (NSAIDs, acetaminophen) or
nerve pain medications (gabapentin).

Administer antiviral medications (acyclovir,
valacyclovir) toseverity and pain.
y Skin care
y Keep lesions clean and dry.
y Avoid scratching to prevent infection.
y Apply calamine lotion.

Recommend zoster vaccine for individuals
≥50 years to prevent recurrence.

3. Cellulitis
Cellulitis: Acute bacterial
infection of skin and FIGURE 3. CELLULITIS
subcutaneous tissue
(commonly by Strep or Skin cancer: Skin malignancy caused primarily by sun
Staph, including MRSA) exposure (FIGURE 4)
(FIGURE 3). y Basal cell carcinoma (BCC): Lesion with pearly, rolled
y Findings borders and a central crater; slow-growing
y Erythema, warmth, y Squamous cell carcinoma (SCC): Firm, red lesion with
swelling, pain at a central crust
the site
Melanoma: Irregular, multicolored, highly metastatic
y Fever, chills y Actinic keratoses: Premalignant lesions with
y Interventions irregularly shaped, rough, scaly patches
y Administer oral or IV y Risk factors
antibiotics (cefazolin,
UV exposure: Sun, tanning beds, outdoor

Integumentary
amoxicillin). occupation

Elevate the affected y Fair skin or hair (blonde, red)
limb toswelling
ABCDEs of melanomas (FIGURE 5):
and improve y A: Asymmetry
circulation. y B: Border irregularity (ragged edges)

Apply warm, moist compresses to promote y C: Color variation (blue, red, white)
drainage andpain. y D: Diameter >6 mm (¼ in) (size of pencil eraser)
y Keep site clean. y E: Evolving appearance

Mark borders of redness using a marker to
monitor for spread.
y Monitor for complications like sepsis.

 Shingles: For clients with shingles, initiate contact  Skin cancer: Teach clients to limit UV exposure
and airborne precautions until lesions crust. (apply sunscreen, wear protective clothing, avoid
Recommend zoster vaccine for individuals ≥50 tanning beds) and perform regular skin checks.
years to prevent recurrence. Assess lesions with the ABCDE mnemonic
(Asymmetry, Border irregularity, Color variation,
 Cellulitis: For clients with cellulitis, elevate the
Diameter >6 mm [¼ in], Evolving appearance).
limb to reduce swelling and apply warm, moist
compresses to promote drainage and reduce pain.
Mark borders to monitor spread.

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4. Skin Cancer, Continued 5. Frostbite
y Interventions
y Teach client to prevent and monitor. FIGURE 6. FROSTBITE

Avoid midday sun exposure (from
10 a.m.-2 p.m.).

Avoid tanning beds.

Wear protective clothing (hats, sunglasses).

Apply sunscreen to unprotected areas
and reapply frequently (every 2 hr, after
sweating or swimming).

Perform monthly skin checks and report any
“ABCDE” findings.
y Assist with biopsy of any suspicious lesions (e.g.,
new or changing moles).
y Assist with removal.
y Cryotherapy: Freezing lesions to destroy
abnormal cells.
y Surgical excision, such as Mohs surgery,
where skin is removed in microscopic layers.
y Chemotherapy, radiation
y Topical treatments, like fluorouracil or
imiquimod creams, treat actinic keratoses. Frostbite: Freezing of skin and underlying tissues from
prolonged cold exposure  Tissue damage (FIGURE 6)
FIGURE 5. ABCD OF MELANOMA y Findings
y Cold, pale skin
y Tingling, numbness
y Blisters and blackened tissue (necrosis)
when severe
y Interventions
y Remove clothing and jewelry that can constrict

Integumentary
the extremity.
y Rewarm client and assess for hypothermia.

Thaw the frozen part using a warm water bath.

Do not attempt to rewarm the affected area
using massage or dry heat, which can further
damage tissues.
y Administer analgesics (rewarming is painful).
y Elevate the extremity after thawing to
reduce edema.

Avoid friction and weight (rubbing, heavy
blankets) to prevent further tissue damage.
y Administer tetanus vaccine for prophylaxis for
tetanus-prone wounds.
y Monitor for complications (gangrene, infection,
compartment syndrome).

 Frostbite: Clients with frostbite should rewarm the affected area using a warm water bath.
Avoid massage, which can cause further tissue damage.

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  The priority in managing SJS is to _____ the  For clients with cellulitis, _____ the limb to
trigger medication immediately. Apply _____ reduce swelling and apply _____ compresses
dressings to promote healing and administer to promote drainage. Monitor the spread of
_____ to prevent dehydration. infection by _____.

 To manage shingles, initiate _____ and ______  What are three ways to limit UV exposure?
precautions until lesions crust. Recommend the What is the ABCDE mnemonic for lesion
zoster vaccine for clients ≥ ____ years to prevent assessment?
recurrence.
 Clients with frostbite should rewarm the
affected area using _____ (massage or a warm
water bath?).

clothing, no tanning beds; ABCDE: Asymmetry, Border irregularity, Color variation, Diameter >6mm (¼ in), Evolving appearance. 5. warm water bath
Answers: 1. discontinue; moist, IV fluids 2. airborne and contact precautions; 50 3. elevate, warm; marking the borders 4. Use sunscreen, wear protective

Integumentary
References:

American Academy of Dermatology. (n.d.). How to apply sunscreen. Tyerman, J., Cobbett, S., Harding, M. M., Kwong, J., Roberts, D.,
American Academy of Dermatology Association. Retrieved Hagler, D., Reinisch, C. (Eds.). (2023). Lewis’s medical-
February 2, 2025, from https://www.aad.org/public/ surgical nursing in Canada: Assessment and management
everyday-care/sun-protection/shade-clothing-sunscreen/ of clinical problems (5th ed.).
how-to-apply-sunscreen.

Berman, A. B., Snyder, S. J., & Frandsen, G. (2021). Kozier & Erb’s Attributions:
fundamentals of nursing: Concepts, process, and practice
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(11th ed.). Pearson. melanoma-red-and-brown-lesion-2-d650a6, https://picryl.com/media/
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Medical-surgical nursing: Concepts for clinical judgment
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Jarvis, C., & Eckhardt, A. (Eds.). (2020). Physical examination & y SJS: Jay2Base, CC BY-SA 4.0, via Wikimedia Commons and
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McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). y Skin Lesions: Modified from Future FamDoc, CC BY-SA 4.0 via
Pathophysiology: The biologic basis for disease in adults Wikimedia Commons and BruceBlaus, CC BY-SA 4.0, Public domain,
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