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AN305 > 2 Tissue Integrity And Integumentary System > Flashcards

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
Q

Head lice (pediculosis capitis)

Effects all
Age group
Risk factors
Transmitted

A

All SES

3-12y/o

Schools/daycares

Transmitted directly or thru contaminated :
-brushes/clothing/hats

26
Q

Head lice (pediculosis capitis)
S/s 3
Adult louse size of

A

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
Q

Head lice (pediculosis capitis)

Nursing management

A

Shampoos/medications

Must get all nits out

28
Q

Head lice (pediculosis capitis)

NM/teaching

A

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
Q

Inflammatory conditions

A

Diaper dermatitis

Seborrheic dermatitis

Atopic dermatitis

Acne

30
Q

Diaper dermatitis (diaper rash)

Most common
What is it
What ages most common

Caused by what

A

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
Q

Diaper dermatitis (diaper rash)
S/s

A

Starts flat, bright red, raw rash (scaly)
-can get puss filled

Satellite lesions

can lead to secondary infection (candida albicans)

32
Q

Diaper dermatitis (diaper rash)
Nursing management

Types of cream
If yeast

A

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
Q

Diaper dermatitis (diaper rash)

Teaching
REDS

A

-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
Q

Inflammatory skin condition:
Seborrheic dermatitis

Common in who
What plays a part
Found on areas with what/ examples

A

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
Q

Seborrheic dermatitis
S/s

A

Pruritus
Erythematous rash
Waxy scales
Yellow-red patches with “greasy” scales

36
Q

Seborrheic dermatitis

Nursing management

A

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
Q

Atopic dermatitis (eczema)

Type of what

Characterized by what

A

Type of eczema

Intense itching
And
History of allergies (its usually due to allergies)

38
Q

Atopic dermatitis (eczema)

S/s
Where we see it in different ages

A

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
Q

Atopic dermatitis (eczema)

Nursing management 4
Meds 2

A

Tepid baths (luke warm) w/ mild soap

Hydrate/ lubricate skin

Occlusive emollient after bathing

determine allergen

Meds:
-anti-histamines (Benadryl)
-topical corticosteroids

40
Q

Atopic dermatitis (eczema)
Education

A

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
Q

Acne

Where its located
Most common when (but can be at any age)

S/s

A

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
Q

Acne

Tx
And
Med education

A

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
Q

Acne meds

A

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
Q

Burn assessment:

Initial survey

A

ABC’s

Assess airway (patent/maintainable)

Respiratory effort/breath sounds

Skin color

HR, cap refill, pulses for strength

45
Q

Burn assessment:
Secondary survey

A

Burn depth

Estimate brun extent by:
TBSA affected

Inspect child for further traumatic injuries

46
Q

Home tx of burns

Intial tx
Vs
Extensive

A

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
Q

Burn tx for minor burns

A

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
Q

Burn tx for major burns

ABCs management (primary survey)

A

Maintain airway/ventilation, humidifies 100% o2

CR monitor

Large bor IV (fluid resuscitation)

49
Q

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

A

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
Q

Burn tx for major burns

Assess what things

A

DW
Signs of shock (septic/hypovolemic)
Pain
Nutritional support (protein)
Wound care
Infection prevention
Restore mobility
Psych support

51
Q

Burn tx: meds

Topical
Pain

A

Topical:
Silver sulfadiaxzine
Bacitracin

Pain:
Morphine sulfate
Midazolam
Fentanyl
Propofol
Nitrous oxide

52
Q

Burn tx
Therapeutic tx

Skin covers:
Biological vs permanent

A

Bio:
-allograft (human cadavers)

-xenograft (skin of animals)

-synthetic skin covering

Permanent:
-autograft (patients skin)

53
Q

Burn prevention

A

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

AN305 (15 decks)

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