ENGLISH IN NURSING II

INTEGUMENT SYSTEM:
Nursing Care Plan: Acne

Instructor :
Ira Suarilah, S.Kp., M.Sc
Group 5 Class A2
Presented by :
1. Siti Lusiyanti

131511133073

2. Rahmadanti Nur Fadilla

131511133074

3. Ayu Rahmawati

131511133075

4. Alfian Gafar

131511133121

5. Nopen Tri Jatmiko

131511133123

6. Dewita Pramesti

131511133125

7. Rifki Fauzi Maulida

131511133126

STUDY PROGRAM PENDIDIKAN NERS

FAKULTAS KEPERAWATAN
UNIVERSITAS AIRLANGGA
SURABAYA
November, 2016

TABLE OF CONTENT

TABLE OF CONTENT..................................................................................................ii
PREFACE...................................................................................................................... iii
CHAPTER I INTRODUCTION...................................................................................1
Issue Background................................................................................................. 1
Problem Statement................................................................................................1
Aims......................................................................................................................1
Outcome................................................................................................................2
CHAPTER II LITERATURE REVIEW......................................................................3
Definition............................................................................................................ 3
Classification........................................................................................................ 3
Etiology and Risk Factor..................................................................................... 6
Pathopysiology..................................................................................................... 6
WOC.................................................................................................................... 8
Clinical Manifestation ......................................................................................... 9
Acne Sign............................................................................................................. 9
Symptoms............................................................................................................ 9
Medical Treatment............................................................................................. 10
Management....................................................................................................... 11
Assessment......................................................................................................... 15
Nursing Diagnosis.............................................................................................. 16
Nursing Care Planing......................................................................................... 16
CHAPTER III CONCLUSION...................................................................................20
Blibliografi

PREFACE
Praise onto Allah, The Cherisher and Sustainer of the worlds, God who has been
giving His blessing and mercy to the writers to complete the paper entitled "Integument
system : Nursing Care Plan : Acne". This paper is submitted to fulfill one of the task of
English In Nursing II subject in Faculty of Nursing. Inside completing this paper, the
writer really gives their regards and thanks for people who has given guidance and help,
they are:
1. Ira Suarilah, S.Kp., M.Sc as the English lecture, who have teached us and given
detail information.
2. And all of my friends who has given support to us and help us.
In writing the paper, the writers realizes there are errors and unintended. We are
really allows all readers to give reviews their criticism and suggestion to improve the
content of its paper in order to be made as one of the good examples for the next paper.
Thank you very much for the attention.

Surabaya, 29th of November 2016

Group 5

CHAPTER I
INTRODUCTION
1.1 Issue Backround
Acne is a cutaneous pleomorphic disorder of the pilosebaceous unit involving
abnormalities in sebum production and is characterized by both inflammatory
(papules, pustules and nodules) and non inflammatory (comedones, open and
closed) lesions. Propionibacterium acnes and Staphylococcus epidermidis are
common pus-forming microbes responsible for the development of various forms
of acne vulgaris. Common therapies that are used for the treatment of acne include
topical, systemic, hormonal, herbal and combination therapy. It is the sequelae of
the disease that are the distinguishing characteristics of acne in skin of color,
namely post inflammatory hyperpigmentation and keloidal or hypertrophic
scarring. Although the medical and surgical treatment options are the same, it is
these features that should be kept in mind when designing a treatment regimen for
acne.
Acne is estimated to affect 9.4% of the global population, making it the eighth
most prevalent disease worldwide. Epidemiological studies have demonstrated that
acne is most common in post puberscent teens, with boys most frequently affected,
particularly with more severe forms of the disease. Recent general and institutional
studies from around the world have shown that the prevalence of acne is broadly
consistent globally (with the exception of specific populations, which are
discussed).
1.2 Problem Statement
How the Nursing Care for acne should be develop?
1.3 Aims
1.3.1

General Purpose
To explain the basic concepts of nursing care in patients with acne.
1.3.2 Specifik Purpose

1. To explain the concept of acne.

2. To explain the nursing assessment of acne.
3. To explain the nursing diagnostic of acne.
4. To explain the nursing care plan of acne.
1.4 Outcome
Apply the knowledge learned to be implemented in the public.

CHAPTER II
LITERATURE REVIEW
2.1 Acne
2.1.1

Definition
Acne is a skin condition that affects the hair follicles and sebaceous

glands (Linton, 2012). Acne is a condition of the skin that is caused by

excessive oil secretion of the sebaceous glands (oil glands) and the excess
production of keratin inside the hair follicles (Swalin Parija et.al, 2013). It
is characterized by comedones (whiteheads and blackheads), pustules, and
cysts. These lesions most often develop on the face, neck, and upper trunk.
Acne commonly begins in adolescence and may last into adulthood. Most
cases are mild, but serious cases with extensive inflammation can cause
permanent scarring (Linton, 2012).

2.1.2

Clasifications

Occasionally, patients with acne vulgaris may exhibit variants of the disease,
some of which require aggressive treatment. These variants are discussed
below.
1. Acne fulminans The presence of fever and arthralgias with an acute
eruption of large inflammatory nodules and friable plaques with
hemorrhagic crusts suggests the diagnosis of acne fulminans, a
systemic disorder. This rare condition affects adolescent males
primarily. Lesions usually involve the trunk, but may be present
elsewhere. Acne fulminans is associated with leukocytosis, an elevated
erythrocyte sedimentation rate, proteinuria, and osteolytic lesions.
Patients with acne fulminans can be treated with systemic
glucocorticoids (0.5 to 1 mg/kg) plus oral isotretinoin or oral
antibiotics. Treatment regimens vary, but oral glucocorticoids should

be initiated about four weeks prior to starting low-dose oral

isotretinoin to prevent a flare of the condition. Oral isotretinoin is
started at 0.5 mg/kg/day or less and can be gradually increased. After
several weeks of therapy, glucocorticoids are tapered as tolerated. In
rare cases, treatment of acne vulgaris with isotretinoin can precipitate
an acne fulminans-like eruption.
2. Acne conglobata Acne conglobata is a severe form of nodular acne
that is most commonly seen in young males. Lesions are most
prominent on the back, chest, and buttocks, but can also appear in
other sites. Large draining lesions, sinus tracts, and severe scarring
may occur. Systemic symptoms are absent. Treatments have included
systemic

antibiotics,

intralesional

glucocorticoids,

systemic

glucocorticoids, and surgical intervention. Patients can respond well to

isotretinoin, although they may experience severe flares at the start of
isotretinoin therapy. For this reason, lower doses of isotretinoin (0.5
mg/kg/day or less) plus systemic glucocorticoids before or during
isotretinoin therapy are often required. A few case reports have
documented improvement in acne conglobata during treatment with
biologic TNF-alpha inhibitors. However, further study is necessary
before treatment with these agents can be recommended.
3. SAPHO syndrome The SAPHO syndrome, synovitis, acne,
pustulosis, hyperostosis, and osteitis syndrome.
4. PAPA syndrome PAPA syndrome (sterile pyogenic arthritis,
pyoderma gangrenosum, and acne) is an autosomal dominant
inflammatory disorder that is discussed separately.
5. Gram-negative folliculitis Patients with pre-existing acne vulgaris
who have been treated with long-term systemic antibiotics (usually
tetracyclines) may develop gram-negative folliculitis. These patients
exhibit an initial response to the oral antibiotic, followed by apparent
resistance to the treatment and worsening of acne. Inflammatory
papules, pustules, and nodules typically appear on perinasal skin and

the central face. A culture of lesions will yield gram-negative

organisms, such as Enterobacter, Klebsiella, Pseudomonas, Proteus, or
Escherichia species. Patients are treated with antibiotics with gram
negative coverage. Recalcitrant cases are managed with oral
isotretinoin

for

four

to

five

months.

Pathogenesis,

clinical

manifestations, and diagnosis of acne vulgaris

6. Neonatal acne and infantile acne Neonatal acne (also called
neonatal cephalic pustulosis) and infantile acne are distinct conditions.
Neonatal acne appears within the first few weeks of life. infantile acne
usually appears around three to six months of age.
7. Childhood acne Mid-childhood acne (acne that occurs in children
ages one to six years) is uncommon. Affected children usually present
with a mixture of comedones and inflammatory lesions on the face. An
endocrinology workup to evaluate for hyperandrogenism is indicated
when acne develops in a child in this age group. Unlike mid-childhood
acne, pre-adolescent acne (acne in children aged 7 to 12 years) is
common. Acne may be the initial sign of puberty. A predominance of
comedones with relatively few inflammatory lesions is typically seen
in affected children. An endocrinologic work-up usually is not
necessary for children with pre-adolescent acne in the absence of other
clinical signs of hyperandrogenism. However, the possibility of
polycystic ovarian syndrome should be considered in girls with
unusually severe acne, other signs of hyperandrogenism, or a poor
response to treatment.
8. Acne excorie des jeunes filles This scarring acne condition is
often, but not always, seen in young women. Relatively mild acne
comedones or inflammatory papules are chronically and obsessively
picked and excoriated, leading to erosions and scarring. An underlying
psychiatric disorder can be associated, and treatment may involve
antidepressants and psychotherapy.

9. Solid facial edema Solid facial edema (Morbihan's disease) is a rare

complication of acne that presents as facial soft tissue edema and
erythema. The condition may wax and wane in severity, but usually
does not spontaneously resolve without treatment. Improvement with
isotretinoin with or without ketotifen, systemic glucocorticoids, or
clofazimine has been reported.

2.1.3

Etiology and Risk Factors

Acne lesions develop when androgenic hormones cause increased

sebum production and bacteria (Propionibacterium acnes) proliferate,

causing sebaceous follicles to become blocked and inflamed. Despite
popular opinion, acne is not caused by fatty foods, chocolate, or poor
hygiene. In addition to androgenic hormones, exacerbations of acne can be
triggered by high levels of progestin in birth control pills, oil-based
cosmetics, high doses of systemic corticosteroid agents, hormonal changes
associated with the menstrual period (Linton, 2012).

2.1.4

Pathophysiology
The pathogenesis of acne vulgaris is multifactorial. The key factor is

genetics. Acne develops as a result of an interplay of the following 4

factors:
1) Follicular epidermal hyperproliferation with subsequent plugging of the
follicle.
2) Excess sebum production.
3) The presence and activity of the commensal bacteria Propionibacterium
acnes.

4) Inflammation.
Retention hyperkeratosis is the first recognized event in the
development of acne vulgaris. The exact underlying cause of this
hyperproliferation is not known. Currently, 3 leading hypotheses have been
proposed to explain why the follicular epithelium produces cells at a rapid
rate that are retained in individuals with acne. First, androgen hormones
have been implicated as the initial trigger. Comedones, the clinical lesion
that results from follicular plugging, begin to appear around adrenarche in
persons with acne in the T-zone area. Furthermore, the degree of comedonal
acne in prepubertal girls correlates with circulating levels of the adrenal
androgen

dehydroepiandrosterone

sulfate

(DHEA-S).

Additionally,

androgen hormone receptors are present in sebaceous glands; individuals

with malfunctioning androgen receptors do not develop acne.
Excess sebum is another key factor in the development of acne
vulgaris. Sebum production and excretion are regulated by a number of
different hormones and mediators. In particular, androgen hormones
promote sebum production and release. Still, most men and women with
acne have normal circulating levels of androgen hormones. An end-organ
hyper-responsiveness to androgen hormones has been hypothesized.
Androgen hormones are not the only regulators of the human sebaceous
gland. Numerous other agents, including growth hormone and insulinlike
growth factor, also regulate the sebaceous gland and may contribute to the
development of acne.
P acnes is an anaerobic organism present in acne lesions. The
presence of P acnes promotes inflammation through a variety of
mechanisms.

acnes

stimulates

inflammation

by

producing

proinflammatory mediators that diffuses through the follicle wall. Studies

have shown that P acnes activate the toll-like receptor 2 on monocytes and
neutrophils. Activation of the toll-like receptor 2 then leads to the
production of multiple proinflammatory cytokines, including interleukins
12 and 8 and tumor necrosis factor. Hypersensitivity to P acnes may also
explain why some individuals develop inflammatory acne vulgaris while
others do not.

Inflammation may be a primary phenomenon or a secondary

phenomenon. Most of the evidence to date suggests a secondary
inflammatory response to P acnes. However, interleukin 1-alpha expression
has been identified in microcomedones, and it may play a role in the
development of acne.
Hormones

High doses of systemic corticosteroid agents

Heredity

Oil based cosmetic

Increased sebum secretion

Decrease immune system
Bacteria (propionibacterium acnes) proliferate

Sebaceous follicles blocked

Inflammation

Acne

2.1.5

Inflamatory reaction

WOC

Antigen-antibody reaction

Itching

Damage of body tissue

Ineffective care

Inflammatory mediator release

Disturbed body image

Pain stimulates the sensory center

Pain due to inflammation

Acute Pain

Risk for infection

2.1.6

Clinical Manifestation

Acne vulgaris typically affects those areas of the body that have the
largest, hormonally-responsive sebaceous glands, including the face, neck,
chest, upper back, and upper arms. In addition to the typical lesions of acne
vulgaris (eg, open comedones, closed comedones, and inflammatory
lesions), scarring and postinflammatory hyperpigmentation can occur,
which can

be greatly distressing for patients. Postinflammatory

hyperpigmentation is most common in patients with darker complexions,

and an individual hyperpigmented macule may take several months or more
to resolve without treatment.
Adult women may present with acne involving the lower face and
neck that is often associated with premenstrual flares. These women, in
particular, seem to benefit from hormonal therapies for acne. Premenstrual
flares of acne appear to be more common in women over the age of 33 than
in women aged 20 to 33 years.

2.1.7

Acne Signs
Many people think that acne is just pimples. But a

person who has acne can have any of these blemishes:

2.1.8

Blackheads.

Whiteheads.

Papules.

Pustules (what many people call pimples).

Cysts.

Nodules.

Symptoms

Acne can cause more than blemishes. Studies show that

people who have acne can have:

Low self-esteem: Many people who have acne say

that

their

acne

makes

them

feel

bad

about

themselves. Because of their acne, they do not want

to be with friends. They miss school and work.
Grades can slide, and absenteeism can become a
problem because of their acne.

Depression: Many people who have acne suffer

from more than low self-esteem. Acne can lead to a
medical condition called depression. The depression
can be so bad that people think about what it would
be like to commit suicide. Many studies have found
that teens who believe that they have bad acne
were likely to think about committing suicide.

Dark spots on the skin: These spots appear when

the acne heals. It can take months or years for dark
spots to disappear.

Scars (permanent): People who get acne cysts and

nodules often see scars when the acne clears. You
can

prevent

these

scars.

Be

sure

to

see

dermatologist for treatment if you get acne early

between 8 and 12 years old. If someone in your
family had acne cysts and nodules, you also should
see a dermatologist if you get acne. Treating acne
before cysts and nodules appear can prevent scars.
2.1.9

Medical Treatment

Treatment varies with the severity of the condition. Mild cases may
respond very well to topical antimicrobial agents or retinoid agents
(Vitamin A preparations). Topical antimicrobial agents include azelaic acid
(Azelex) and benzoyl peroxide; topical retinoid agents include tretinoin
(Retin-A) or tazarotene (Tazorac). If these agents do not adequately control
acne, then oral antibiotic agents (i.e., tetracycline, azithromycin,
erythromycin) may be given over a period of several months. Esterogen
also may be prescribed to counteract the effects of androgenic hormones.
Spironolactone may be used for its antiandrogenic hormones. If acne is
severe and unresponsive to all of these treatments, then isotretinoin
(accutane) may be prescribed. Nonpharmacologic treatment may include
comedone extraction or cryotherapy. Dermabrasion may be used to reduce
scarring.
2.1.10

Management

a.) Basic of acne treatment

Antibacterial

Examples: benzoyl peroxide (topical), azelaic acid

(topical), topical and oral antibiotic

Keratolytic/Comedolytic

Examples: alpha-hydroxy acid family

(glycolic acid, lactic acid), beta-hydroxy acid
family (salicylic acid), retinoids (retinoic acid)

Anti-androgens

Examples: spironolactone (aldactone, spiritone),

cyproterone acetate (androcur, climen, diane
35, Ginette 35), flutamide (eulexine) nilutamide
(anandron,

nilandron),

propecia)

Sebosuppresive agents

finasteride

(proscar,

Examples of oral sebosuppresive agent: oral

osotretinoin (Accutane), examples of topical
sebosuppresive agents: (zinc oxide, copper
peptide, isolutrol,topical niacinamide)

b.) Topical medications

A complete list of medications, including vitamin supplements,
should be obtained. Known causes of acne or acneiform eruptions include
glucocorticoids, phenytoin, lithium, isoniazid, epidermal growth factor
inhibitors, iodides, bromides, androgens, and other drugs. Vitamins B2, B6,
and B12 may also cause drug-induced acne.
The most common topical prescription medications for
acne are:

Retinoids. These come as creams, gels and

lotions. Retinoid drugs are derived from vitamin
A and include tretinoin (Avita, Retin-A, others),
adapalene (Differin) and tazarotene (Tazorac,
Avage). You apply this medication in the
evening, beginning with three times a week,
then daily as your skin becomes used to it. It
works by preventing plugging of the hair
follicles.

Antibiotics. These work by killing excess skin

bacteria and reducing redness. For the first few
months of treatment, you may use both a
retinoid and an antibiotic, with the antibiotic
applied in the morning and the retinoid in the
evening. The antibiotics are often combined
with benzoyl peroxide to reduce the likelihood

of developing antibiotic resistance. Examples

include

clindamycin

with

benzoyl

peroxide

(Benzaclin, Duac, Acanya) and erythromycin

with benzoyl peroxide (Benzamycin).

Dapsone (Aczone). This gel is most effective

when combined with a topical retinoid. Skin
side effects include redness and dryness.

c.) Oral Medications

1. Antibiotics. For moderate to severe acne, you may need
oral antibiotics to reduce bacteria and fight inflammation.
Choices for treating acne include tetracyclines, such as
minocycline and doxycycline.
Your doctor likely will recommend tapering off these
medications as soon as your symptoms begin to improve or
as soon as it becomes clear the drugs aren't helping
usually, within three to four months. Tapering helps prevent
antibiotic resistance by minimizing undue exposure to these
medications over a long time.
You will likely use topical medications and oral
antibiotics together. Studies have found that using topical
benzoyl peroxide along with oral antibiotics may reduce the
risk of developing antibiotic resistance.
Antibiotics may cause side effects, such as an upset
stomach and dizziness. These drugs also increase your
skin's sun sensitivity. They can cause discoloration of
developing permanent teeth and reduced bone growth in

children born to women who took tetracyclines while

pregnant.
2. Combined

oral

contraceptives. Combined

oral

contraceptives are useful in treating acne in women and

adolescent
approved

girls.
three

The

Food

products

and

that

Drug

combine

Administration
estrogen

and

progestin (Ortho Tri-Cyclen, Estrostep and Yaz).

The most common side effects of these drugs are
headache, breast tenderness, nausea, weight gain and
breakthrough bleeding. A serious potential complication is a
slightly increased risk of blood clots.
3. Anti-androgen

agent. The

drug

spironolactone

(Aldactone) may be considered for women and adolescent

girls if oral antibiotics aren't helping. It works by blocking
the effect of androgen hormones on the sebaceous glands.
Possible side effects include breast tenderness, painful
periods and the retention of potassium.
4. Isotretinoin. This medicine is reserved for people with the
most

severe

acne.

Isotretinoin

(Amnesteem,

Claravis,

Sotret) is a powerful drug for people whose acne doesn't

respond to other treatments.
Oral isotretinoin is very effective. But because of its
potential side effects, doctors need to closely monitor
anyone they treat with this drug. The most serious potential
side effects include ulcerative colitis, an increased risk of
depression and suicide, and severe birth defects.
In fact, isotretinoin carries such serious risk of side
effects that women of reproductive age must participate in a

Food and Drug Administration-approved monitoring program

to receive a prescription for the drug.

d.) Therapies
These therapies may be suggested in select cases, either
alone or in combination with medications.

Light therapy. A variety of light-based therapies have been

tried with success. But further study is needed to determine
the ideal method, light source and dose. Light therapy targets
the bacteria that cause acne inflammation. Some types of light
therapy are done in a doctor's office. Blue-light therapy can be
done at home with a hand-held device.
Possible side effects of light therapy include pain,
temporary redness and sensitivity to sunlight.

Chemical peel. This procedure uses repeated applications of

a chemical solution, such as salicylic acid. It is most effective
when combined with other acne treatments, except oral
retinoids. Chemical peels aren't recommended for people
taking oral retinoids because together these treatments can
significantly irritate the skin.
Chemicals peels may cause temporary, severe redness,
scaling and blistering, and long-term discoloration of the skin.

Extraction

of

whiteheads

and

blackheads. Your

dermatologist uses special tools to gently remove whiteheads

and blackheads (comedos) that haven't cleared up with topical
medications. This technique may cause scarring.

Steroid injection. Nodular and cystic lesions can be treated

by injecting a steroid drug directly into them. This improves
their appearance without the need for extraction. The side
effects of this technique include thinning of the skin, lighter
skin and the appearance of small blood vessels on the treated
area.
e.) Treating acne scars
Procedures used to diminish scars left by acne include
the following:

Soft tissue fillers. Injecting soft tissue fillers, such as

collagen or fat, under the skin and into indented scars can
fill out or stretch the skin. This makes the scars less
noticeable. Results are temporary, so you would need to
repeat the injections periodically. Side effects include
temporary swelling, redness and bruising.

Chemical peels. High-potency acid is applied to your skin

to remove the top layer and minimize deeper scars.

Dermabrasion. This procedure is usually reserved for more

severe scarring. It involves sanding (planing) the surface
layer of skin with a rotating brush. This helps blend acne
scars into the surrounding skin.

Laser resurfacing. This is a skin resurfacing procedure

that uses a laser to improve the appearance of your skin.

Light therapy. Certain lasers, pulsed light sources and

radiofrequency devices that don't injure the epidermis can
be used to treat scars. These treatments heat the dermis
and cause new skin to form. After several treatments, acne
scars may appear less noticeable. This treatment has
shorter recovery times than some other methods. But you

may need to repeat the procedure more often and results

are subtle.
Skin surgery. Using a minor procedure called punch
excision, your doctor cuts out individual acne scars and
repairs the hole at the scar site with stitches or a skin graft.

2.2 Assessment
2.1 Identity
2.2 History of illness
a

Main complain
Itching on the face

History of current illness

Client comes to hospital because there are itching and acne vulgaris on their
face.

History of previous illness

There is no history of acne vulgaris before. It is related to integumentary
system although the other systemic disorders.

2.3 Physical examination

a. Breathing :normal
b. Blood : normal
c. Brain : normal
d. Bladder :normal
e. Bowel: normal
f. Bone :normal

2.4 Diagnoses
a

acute pain related to biological injury agent. Domain 12 Comfort, Class 1,

physical comfort (00132)

disturbed body image related to illness domain 6 self perception, Class 3

body image (00118)

risk for infection related to inflammation respond. Domain 11

Safety/Protection, Class 1 Infection (00004)

2.5 Nursing interventions

No. Nursing Asessment
NOC
1
Domain
12 1. Knowledge:

NIC
pain 1. Analgesic administration

Comfort, Class 1,

management (1843)

physical

a. cause and contributing

comfort

(00132) acute pain

related to biological
injury agent.

(2210)
1. determine pain location,

factors (5)

characteristics,

b. sign and symptoms of

and

pain (5)

severity

before

medicating patient

c. strategies to control

2. check medical order for

pain (5)
d. correct

quality,

drug, dose, and frequency

use

of

of analgesic prescribed

prescribed medication

3. check history for drugs

(5)

4.

e. Safe use of prescribed

medication (5)

route,

therapeutic effects (5)

g. Medication

side

effects (5)

the

patients

ability to participate in
selection

f. Medication

h. Medication

evaluate

of

and

analgesic,
dose,

and

involve the patient, as

appropriate.
5. teach about the use of

adverse

effects (5)

analgesics, strategies to
decrease side effect, and
expectation for involment
in decisions about pain
relief.

domain

self 1. Body Image (1200)

perception, Class 3
body image (00118)
disturbed
image
illness

related

body
to

a. Internal picture of self

(5)
b. Satisfaction with body
appearance (5)
c. Satisfaction with body
function (5)

1. Body

Image

Enhancement (5220)
a. Determine
body

patients
image

expectations based on
developmental stage
b. Use

anticipatory

d. Adjustment

to

guidance to prepare

changes in physical

patient for predictable

appearance (5)

changes in body image

e. Adjustment
changes

in

to

c. Determine if a recent

health

physical change has

status (5)

been incorporated into

patients body image
d. Assist

patient

to

discuss changes caused

by

puberty,

as

appropriate
e. Assist

patient

to

discuss changes caused

by

aging,

as

appropriate
f. Teach the patient the
normal changes in the
body associated with
various

stages

of

aging, as appropriate
g. Determine

patients

and

familys

perceptions

of

alteration

in

the
body

image versus reality

h. Identify

coping

strategies

used

by

parents in response to
changes
3

Safety/Protection,
(00004).

childs

appearance
11 1. Risk Control : Infectious 1. Control infection (6545)

Domain
Class 1

in

Process

Infection
Risk

for

a. Seeks
information

1. damp dust flat surfaces and

current
about 2.

light in operating room

monitor

and

maintain

infection related to
inflammation
respond.

infection control

laminar airflow

b. Identifies risk factors 3. use universal precautions

for infection

4. verify integrity of sterile

c. Acknowledges

packaging

behaviors associated 5. monitor sterile field for

with risk for infection
d. Identifies

infection

risk in daily activities

e. Monitors

personal

behaviors for factors

associated

with

infection risk
f. Maintains

clean

environment
g. Develops

effective

infection

control

strategies
h. Practices
sanitization

hand

break-in

sterility

and

correct breaks, as indicated

CHAPTER III
CONCLUSION

Acne is a condition of the skin that is caused by excessive oil secretion of the sebaceous
glands (oil glands) and the excess production of keratin inside the hair follicles . Acne
lesions develop when androgenic hormones cause increased sebum production and
bacteria (Propionibacterium acnes) proliferate, causing sebaceous follicles to become
blocked and inflamed. In addition to androgenic hormones, exacerbations of acne can be
triggered by high levels of progestin in birth control pills, oil-based cosmetics, high doses
of systemic corticosteroid agents, hormonal changes associated with the menstrual period.
Excess sebum is another key factor in the development of acne vulgaris. Sebum production
and excretion are regulated by a number of different hormones and mediators.Treatment
varies with the severity of the condition. Mild cases may respond very well to topical
antimicrobial agents or retinoid agents (Vitamin A preparations). The physical examination
should focus upon the skin and in women, evidence of hyperandrogenism. The type and
location of lesions, scarring, and post inflammatory pigmentary changes should be noted.
The skin examination is essential for determining the best treatment course for an
individual patient. Basic of acne treatment such as giving antibacterial,
keratolytic/comedolytic, anti-androgens and sebosuppresive agents also
given to treat acne. Along with oral medication, therapies also given to
patients with acne to decrease the severity of the condition.

BIBLIOGRAPHY
Pride HB, et al. What's new in pediatric dermatology?: Part II.
Treatment. Journal of the American Academy of Dermatology. 2013;68:899.
Titus S, et al. Diagnosis and treatment of acne. American Family Physician.
2012;86:734.
Linton, Adrianne Dill. 2012. Introduction to Medical-Surgical Nursing. Canada:
Elsevier Saunders.
Clark, Christine. 2009. Acne causes and clinical features Vol 1. Available at:
http://www.pharmaceutical-journal.com/files/rps-pjonline/pdf/cp200904_163.pdf.
Ray, Chanda. 2013. Acne and its Treatment Lines 3(1): 1-16. Available at:
https://urpjournals.com/tocjnls/40_13v3i1_1.pdf.
Parija, Swalin et.al. 2013. A Review on Alternative Therapy for Acne Vol-2(1) 2013
[267-273].

Available

at:

http://www.ijrpp.com/File_Folder/A%20review%20on

%20alternative%20therapy%20for%20Acne%20_%20ijrpp.pdf
Applegate, Edith MS. 2011. The Anatomy and Physiology Learning System,4th
edition. USA:Sounders Elsevier
Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for
the diagnosis and treatment of pediatric acne. Pediatrics 2013; 131 Suppl 3:S163
Sand FL, Thomsen SF. Adalimumab for the treatment of refractory acne conglobata.
JAMA Dermatol 2013; 149:1306.