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2 Tissue Integrity And Integumentary System Flashcards

1
Q

Newborn skin

Skin vs adults
Heat
Epidermis
Absorption of topical meds
Melanin

A

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)

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2
Q

Adolescents skin

Vs infants
Epidermis
Sweat glands
Melanin

A

Thickens

Epidermis and dermis tightly bound

Sweat glands full production

Melanin is at adult level

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3
Q

Bacterial infections

A

Impetigo *
Cellulitis *
Staphylococcal scalded skin syndrome*

Folliculitis (ingrown hair)
Furuncle (boil)
Carbuncle (multiple boils)

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4
Q

Impetigo

Usually what
Manifestations 3
How it spreads

A

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

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5
Q

Impetigo

Nursing management

A

Topical abx ointment

Standard precautions (hand hygiene)

Severe: oral/IV abx

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6
Q

Cellulitis

Cause
Manifestation

A

Step, staph, H. Influenza (any open wounds)

S/s:
-firm, swollen, reddened area of skin/ subcutaneous tissue

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7
Q

Cellulitis tx

A

Po/IV abx

Rest

Immobilization of affected area

If septic may need more extensive care

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8
Q

Staphylococcal scalded skin syndrome

Cause
S/s

A

Staphylococcus aureus

S/s:
-rought textured skin w/ macular erythema

-epidermis becomes wrinkled w/ large bullae

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9
Q

Staphylococcal scalded skin syndrome

Tx

A

Systemic abx (different/ IV)

Burows solution / saline to cleanse skin gently

Use compresses of 0.25% silver nitrate

(Tx is similar to burn pts)

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10
Q

Viral infections

A

Molluscum contagiosum *
Verruca (warts)
Verruca plantaris (plantar warts)
Cold sore/fever blister
Genital herpes
Herpes zoster/shingles

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11
Q

Viral:
Molluscum contagiosum

Cause
Transmission
Incubation
Age

A

Poxvirus

Transmission:
-direct contact with lesion or clothing

Incubation: 2-7 weeks (before we get lesions)

Ages: 2-11y/o

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12
Q

Viral:
Molluscum contagiosum

S/s

A

Flesh colored, pearl-like Lesion have centralized depression (courtney disagress)

Not itchy

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13
Q

Viral:
Molluscum contagiosum

Nursing management

A

Lesions resolve spontaeously within 18 months

-cantharidin (oil)
Toxin from beetle that blisters lesions causing:
Extrusion when blister ruptures

-cryotherapy
Freezing off lesions

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14
Q

Viral:
Molluscum contagiosum

Nursing management: Education

A

-No towel sharing

-Cover if wrestling or other contact sports (it can spread)

-limit touching lesions / hand hygiene

-transmitted easier when wet

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15
Q

Fungal infections

A

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)

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16
Q

Fungal:
Candidiasis (diaper)

Cause
S/s
Secondary to

A

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

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17
Q

Fungal:
Candidiasis (diaper)

Nursing management

A

Skin clean and dry

Topical antifungal:
-miconazole
-nystatin cream

(More in diaper dermatitis)

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18
Q

Fungal:
Candidiasis (oral) thrush

Causes
Risk

A

Causes:
-newborns
-asthmatic using steroid inhalers
-abx

Risk of invasive infection if immunocompromised

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19
Q

Fungal:
Candidiasis (oral) thrush

S/s
Mistaken for what?

A

White patches on oral mucosa

Mistaken for milk (try rubbing it off)

Causes decreased appetite:
-d/t discomfort and pain

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20
Q

Fungal:
Candidiasis (oral) thrush

Tx

Nursing management

A

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

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21
Q

Skin infections

A

Scabies
Head lice

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22
Q

Scabies

Tranmission
S/s

A

Direct contact with person

Mite burrows into skin and lays eggs

S/s:
Itching
Pencil-like marks on skin

23
Q

Scabies

Nursing management

A

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

24
Q

Head lice (pediculosis capitis)

Infestation of what
Life span of adult louse
Lay eggs and hatch when

A

Infestation of hair and scalp

Life span: 1 month of adult louse

Females lay eggs at night
Hatch in 7-10days

25
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
26
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
27
Head lice (pediculosis capitis) Nursing management
Shampoos/medications Must get all nits out
28
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
29
Inflammatory conditions
Diaper dermatitis Seborrheic dermatitis Atopic dermatitis Acne
30
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
31
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)*
32
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
33
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
34
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)
35
Seborrheic dermatitis S/s
Pruritus Erythematous rash Waxy scales Yellow-red patches with “greasy” scales
36
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
37
Atopic dermatitis (eczema) Type of what Characterized by what
Type of eczema Intense itching And History of allergies (its usually due to allergies)
38
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
39
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
40
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)
41
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
42
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
43
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****
44
Burn assessment: Initial survey
ABC’s Assess airway (patent/maintainable) Respiratory effort/breath sounds Skin color HR, cap refill, pulses for strength
45
Burn assessment: Secondary survey
Burn depth Estimate brun extent by: TBSA affected Inspect child for further traumatic injuries
46
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
47
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
48
Burn tx for major burns ABCs management (primary survey)
Maintain airway/ventilation, humidifies 100% o2 CR monitor Large bor IV (fluid resuscitation)
49
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)
50
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
51
Burn tx: meds Topical Pain
Topical: Silver sulfadiaxzine Bacitracin Pain: Morphine sulfate Midazolam Fentanyl Propofol Nitrous oxide
52
Burn tx Therapeutic tx Skin covers: Biological vs permanent
Bio: -allograft (human cadavers) -xenograft (skin of animals) -synthetic skin covering Permanent: -autograft (patients skin)
53
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

N305 (17 decks)

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