New nurse unsure what to use for contact dermatitis...

Specialties Wound

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Hi there, thanks for reading my post.

Just for context let me start by saying that I have been an RN (med/surg) for THREE WHOLE DAYS now and am looking for some opinions/advice regarding a patient I had the other night.

During my initial assessment of a male patient (who had been in the hospital for 3 days) the other evening, I discovered he had a fairly extensive case of Contact Dermatitis (CD) in the groin area, which makes me wonder about the following:

1. By the amount of body surface area affected, in addition to the fact that I did not see any signs of previous onitment being applied, would it be fair to conclude that the rash had been missed up until this point? I think what I am trying to get at is, if you catch CD early, can you stop the spread of it? While common sense tells me yes, I am looking for experienced confirmation or correction.

2. Treatment: I am thinking I should wash and dry the area first (with luke warm water) and then apply something like Critic Aid mositure barrier. Would this be the proper treatment, or am I completely off base?

3. How often are you going to retreat the area?

Thanks so much for any advice you can give!

Upon further reflection, I'm not 100% sure I've posted this under the right area, but I was thinking that if anyone knew how to properly treat the skin, it would be wound care nurses.

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Specializes in Complex pedi to LTC/SA & now a manager.

What is the physician's diagnosis and treatment orders? Irritant dermatitis is treated differently than a mycotic or other dermatitis.

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As best as I can remember, there was no physician diagnosis. I am guessing by that question that if it had not previously been identified, I should have called the doctor to advise her/him?

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Specializes in Complex pedi to LTC/SA & now a manager.

Yes call doctor it needs to be assessed and diagnosed first if no diagnosis. Fungal, infectious and allergic rashes can appear and exacerbate quickly hence the need to be evaluated and diagnosed. You don't want to exacerbate the condition. One cannot make treatment recommendations without visualizing the skin.

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Thanks for setting me straight; one more lesson learned :-)

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Specializes in Wound Care, LTC, Sub-Acute, Vents.

Was it fungal rash? If nobody inform the doctor yet, you should. The doctor will probably order Nystatin powder BID x 14 days.

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In the presentation you've described, fungus and/or yeast is the likely culprit. Criticaid barrier ointment is good for protecting tissue from excoriation, however does not help with the friction of skin on skin and the persistent moisture problem. As another poster suggested, nystatin powder is 'ok', however does not pose a solution to the moisture problem either-- and i absolutely ABHOR bathing patients and having to dig out powder balls from all crevices. Do you all use any type of textiles at your facility such as interdry AG? It can be placed in skin folds to wick moisture and combat organisms perpetuating skin breakdown. It is the same type of material that Nike uses for its dri-fit clothing or under armor uses for their fancy shirts. intersry is great, because in our hospital, it isnt considered a 'med', so the techs can replace it after helping the patient bathe/void, etc. Good for you for actually assessing your patient and seeking knowledge. Most physicians are very amenable to skin/wound advice.... so don't be afraid to make recommendations, because if this problem is allowed to go on, patients can develop ulcerations and even full thickness wounds. Sorry for the long post, hope it helped.

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Specializes in Wound Care.

This made me laugh FanniesMom....Just for context let me start by saying that I have been an RN (med/surg) for THREE WHOLE DAYS now. We have all so been there :yes:

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