2 Tissue Integrity And Integumentary System Flashcards
Newborn skin
Skin vs adults
Heat
Epidermis
Absorption of topical meds
Melanin
Thinner than adults
Lose heat faster
Epidermis is loosely bound to dermis
-causes friction = blister easier
Changes absorption of topical meds
Melanin is low! (No sunscreen until 6mo old)
Adolescents skin
Vs infants
Epidermis
Sweat glands
Melanin
Thickens
Epidermis and dermis tightly bound
Sweat glands full production
Melanin is at adult level
Bacterial infections
Impetigo *
Cellulitis *
Staphylococcal scalded skin syndrome*
Folliculitis (ingrown hair)
Furuncle (boil)
Carbuncle (multiple boils)
Impetigo
Usually what
Manifestations 3
How it spreads
Usually staph but can also be strep
S/s:
-reddish macules become vasicular
-moist erosion on skin (secretions dry causing honey-colored crusts
-pruritis (itchy)
-spreads peripherally by direct contact
Impetigo
Nursing management
Topical abx ointment
Standard precautions (hand hygiene)
Severe: oral/IV abx
Cellulitis
Cause
Manifestation
Step, staph, H. Influenza (any open wounds)
S/s:
-firm, swollen, reddened area of skin/ subcutaneous tissue
Cellulitis tx
Po/IV abx
Rest
Immobilization of affected area
If septic may need more extensive care
Staphylococcal scalded skin syndrome
Cause
S/s
Staphylococcus aureus
S/s:
-rought textured skin w/ macular erythema
-epidermis becomes wrinkled w/ large bullae
Staphylococcal scalded skin syndrome
Tx
Systemic abx (different/ IV)
Burows solution / saline to cleanse skin gently
Use compresses of 0.25% silver nitrate
(Tx is similar to burn pts)
Viral infections
Molluscum contagiosum *
Verruca (warts)
Verruca plantaris (plantar warts)
Cold sore/fever blister
Genital herpes
Herpes zoster/shingles
Viral:
Molluscum contagiosum
Cause
Transmission
Incubation
Age
Poxvirus
Transmission:
-direct contact with lesion or clothing
Incubation: 2-7 weeks (before we get lesions)
Ages: 2-11y/o
Viral:
Molluscum contagiosum
S/s
Flesh colored, pearl-like Lesion have centralized depression (courtney disagress)
Not itchy
Viral:
Molluscum contagiosum
Nursing management
Lesions resolve spontaeously within 18 months
-cantharidin (oil)
Toxin from beetle that blisters lesions causing:
Extrusion when blister ruptures
-cryotherapy
Freezing off lesions
Viral:
Molluscum contagiosum
Nursing management: Education
-No towel sharing
-Cover if wrestling or other contact sports (it can spread)
-limit touching lesions / hand hygiene
-transmitted easier when wet
Fungal infections
Candidiasis (diaper and oral)*
Tinea capitis (ringworm of the scalp)
Tinea corporis (ringworm of the body)
Tinea cruris (jock itch)
Tinea pedis (athlete’s foot)
Fungal:
Candidiasis (diaper)
Cause
S/s
Secondary to
Candida albicans (fungus)
S/s:
-found in moist areas of skin
-white exudate
-peeling inflammed areas (bleed easy)
-pruritic (itchy)
Most common in younger children is:
-secondary infection related to diaper dermatitis
Fungal:
Candidiasis (diaper)
Nursing management
Skin clean and dry
Topical antifungal:
-miconazole
-nystatin cream
(More in diaper dermatitis)
Fungal:
Candidiasis (oral) thrush
Causes
Risk
Causes:
-newborns
-asthmatic using steroid inhalers
-abx
Risk of invasive infection if immunocompromised
Fungal:
Candidiasis (oral) thrush
S/s
Mistaken for what?
White patches on oral mucosa
Mistaken for milk (try rubbing it off)
Causes decreased appetite:
-d/t discomfort and pain
Fungal:
Candidiasis (oral) thrush
Tx
Nursing management
Oral nystatin
IV/PO fluconazole (severe cases/ immunocompromised pts)
Proper nystating administration
-infants wont swish in mouth so need to use a swab
-children need to swish it around
-do it after eating so you dont wash it away
Breastfeeding moms need tx too bc they probably gave it to the baby
Proper technique with inhaler
Skin infections
Scabies
Head lice
Scabies
Tranmission
S/s
Direct contact with person
Mite burrows into skin and lays eggs
S/s:
Itching
Pencil-like marks on skin
Scabies
Nursing management
Antiparasitic topicalmed applied:
-Neck down
-left on for 8 hours at a time
Oral meds
All linen’s and clothing must be laundered in HOT water
Head lice (pediculosis capitis)
Infestation of what
Life span of adult louse
Lay eggs and hatch when
Infestation of hair and scalp
Life span: 1 month of adult louse
Females lay eggs at night
Hatch in 7-10days
Head lice (pediculosis capitis)
Effects all
Age group
Risk factors
Transmitted
All SES
3-12y/o
Schools/daycares
Transmitted directly or thru contaminated :
-brushes/clothing/hats
Head lice (pediculosis capitis)
S/s 3
Adult louse size of
Itching
Dandruff
Nits attach close to scalp found:
-behind ears
-nape of neck near scalp
Adult lice difficult to see: size of sesame seeds
Head lice (pediculosis capitis)
Nursing management
Shampoos/medications
Must get all nits out
Head lice (pediculosis capitis)
NM/teaching
Bag items that cannot be laundered into tightly sealed bag for 14DAYS
Wash laundry in HOT water
Bedding/linens/towels must be changed DAILY
Boil combs, brushes, hair accessories
Watch from psychosocial of kid and scrating complications
Inflammatory conditions
Diaper dermatitis
Seborrheic dermatitis
Atopic dermatitis
Acne
Diaper dermatitis (diaper rash)
Most common
What is it
What ages most common
Caused by what
Most common contact dermatitis in children
Inflammatory hypersensitive reaction of the skin
Common in 9-12month olds
Caused by:
-detergents, soaps & chemicals
-prolonged exposure to urine/feces
Diaper dermatitis (diaper rash)
S/s
Starts flat, bright red, raw rash (scaly)
-can get puss filled
Satellite lesions
can lead to secondary infection (candida albicans)
Diaper dermatitis (diaper rash)
Nursing management
Types of cream
If yeast
Freq diaper changes
Wash with no irrtating cleanser/ expose to air if can
Water impermeable barriers with every diaper change (diaper rash creams):
-aquaphor
-desitin
-“Magic Barrier Cream” (zinc oxide, petroleum jelly)
If yeast, daily application until 3 days after cleared
-nystatin powder or cream
Diaper dermatitis (diaper rash)
Teaching
REDS
-Instruct family to change diaper q2hrs or when wet/soiled
-topical barriers: magic barrier cream
-open to air as much as possible
- warm wash cloths or mineral oil to clean skin
REDS:
Avoid baby wipes w/ alcohol
-watch for signs of infection
-powder is NOT recommened
-prevention is the key
Inflammatory skin condition:
Seborrheic dermatitis
Common in who
What plays a part
Found on areas with what/ examples
Common in infants and adolescents
Hormones play a part
(Maternal for infants)
(Androgens in adolescents)
Areas with alot of sebaceous glands:
-scalp (cradle cap)
-forehead
-postauricular (behind ear)
-periorbital (around eye)
Seborrheic dermatitis
S/s
Pruritus
Erythematous rash
Waxy scales
Yellow-red patches with “greasy” scales
Seborrheic dermatitis
Nursing management
Gently scrubbing to remove scales
-use fine comb to remove crusts
Lubricant/emollient (softens scales)
-olive oil, baby oil, petroleum jelly
In adolescents:
-use anti-dandruff shampoo
Must have (selenium sulfide) in it
-steroids (topical) must be recommended by doctor
Atopic dermatitis (eczema)
Type of what
Characterized by what
Type of eczema
Intense itching
And
History of allergies (its usually due to allergies)
Atopic dermatitis (eczema)
S/s
Where we see it in different ages
Erythematous lesions with:
Exudates, crusts, and pruritus
Excoriation from scratching
Leaves darker thicker skin
-look at photo to see where people get it
Infants/younger children: differences is face/scalp/feet
Olderchildren/adults: neck/chest/groin
Atopic dermatitis (eczema)
Nursing management 4
Meds 2
Tepid baths (luke warm) w/ mild soap
Hydrate/ lubricate skin
Occlusive emollient after bathing
determine allergen
Meds:
-anti-histamines (Benadryl)
-topical corticosteroids
Atopic dermatitis (eczema)
Education
Bathe/clean skin once a day
Pat water off
No lotion containing alcohol
Proper med administration:
Steroid only to affected areas, followed by emollient
Allergy education
Monitor for infection (scratch can cause it)
Acne
Where its located
Most common when (but can be at any age)
S/s
Chromic inflammatory disorder of:
Hair follicles/sebaceous glands on face/neck/trunk
Most common skin condition beginning at puberty
S/s:
-closed and open comedones initially without inflammation
-comedones can become infected w/ bacteria
-scars result from extensive rupture/inflammation
Acne
Tx
And
Med education
Preventing infection and scars
Washing fave regularly/ avoid harsh scrubbing
Support persons psychsocial impact
Hand washing
Skin/hair care
Meds:
-Daily med tx for 4-8 weeks
-Improvement with meds happens about 6-12 months
Acne meds
Oral/topical abx (not long term)
-topical: clindamycin
-oral: tetracycline, doxycycline, erythromycin
Oral contraceptives
Benzoyl peroxide (clean face)
Retinoids (promote cell turnover)
-topical: tretinoin
-oral: isotretinoin (accutane) no if preg***
Burn assessment:
Initial survey
ABC’s
Assess airway (patent/maintainable)
Respiratory effort/breath sounds
Skin color
HR, cap refill, pulses for strength
Burn assessment:
Secondary survey
Burn depth
Estimate brun extent by:
TBSA affected
Inspect child for further traumatic injuries
Home tx of burns
Intial tx
Vs
Extensive
Cool water over burn
No ice
No ointment or creams
Do not cover w/ dry or adhesive gauze
Extensive:
-ABC’s/911 (shock management)
-Only remove clothing if smoke/flame present or clothing is easy to remove
-Do not pull clothing off skin if adhered
Burn tx for minor burns
Stop burning process
Cover burn w/ damp, clean cloth
Cleanse w/ tepid water and basic soap
Antimicobial ointment/ dressing (non-adherent/hydrocolloid)
Pain control
Assure immunizations up to date
Burn tx for major burns
ABCs management (primary survey)
Maintain airway/ventilation, humidifies 100% o2
CR monitor
Large bor IV (fluid resuscitation)
Major burn tx
Fluid resuscitation cruial in what time base on what
What fluid is used 1st 24 hrs (then add what)
Urine output wanted
Monitor what
Fluid resus crucial in 1st 24hrs- based on BSA burn %
LR in 1st 24hrs
Then albumin or plasma (colloids may be used at 24-48hrs post burn
Urine:
0.5-1ml/kg/hr (children less than 30kg)
30ml/hr (children more than 30kg)
Montor fluid balance and electrolyte: isotonic fluids (LR/NS)
Burn tx for major burns
Assess what things
DW
Signs of shock (septic/hypovolemic)
Pain
Nutritional support (protein)
Wound care
Infection prevention
Restore mobility
Psych support
Burn tx: meds
Topical
Pain
Topical:
Silver sulfadiaxzine
Bacitracin
Pain:
Morphine sulfate
Midazolam
Fentanyl
Propofol
Nitrous oxide
Burn tx
Therapeutic tx
Skin covers:
Biological vs permanent
Bio:
-allograft (human cadavers)
-xenograft (skin of animals)
-synthetic skin covering
Permanent:
-autograft (patients skin)
Burn prevention
Sunscreen/ clothing
Water temps lower then 120degrees
Test bath water for child
Keep kids away from hot stuff
Cook w/ pots toward inside back of stove
Fire escape plan/fire drills
Stop/drop/roll
