Chapter 30: Caring for the Child with an Integumentary Condition Flashcards
The Skin
- largest organ in the body
- purpose is to protect the deeper tissues from injury and from foreign matter invasion
- protects the body from exposure to a variety of environmental, pest, tactile, and chemical irritants on a daily basis that can disrupt the effectiveness of the skin as a protective barrier
- synthesis of vitamin D from ultraviolet light
- aiding in water retention
- ridding the body of toxins
- helps regulate temperature
- initiates the sensations of touch, pain, heat, and cold in the body
The Skin has Three Layers
The epidermis, the dermis, and the subcutaneous fatty layer
-these layers act to provide the body with a barrier against external invaders
-each layer contains specific properties
>Epidermis: outlet for the sweat glands, and the hair follicles protrude through this layer
>Dermis: contains the nerves, muscles, connective tissue, sebaceous and sweat glands, blood vessels, and lymph channels
>Subcutaneous fatty layer: separates the skin from the underlying tissue as well
The Accessory Structures of the Skin At Birth
while all the accessory structures of the skin (the hair, nails, sebaceous glands, exocrine glands, and apocrine glands) are present at birth, most are immature and cannot function to their full potential until middle childhood
>children are at higher risk for certain skin conditions based on their body surface area and still maturing immune system
Infant Skin and Temperature
infants skin is thin and contains very little subcutaneous fat
- temperature regulation becomes an important issue b/c the infant tends to loose heat rapidly
- take care not to leave an infant uncovered and exposed for a prolonged time
- b/c of their immature neurological system and large body surface area, infants have more difficulty in regulating their body temperature
Growth and Development
child with an integumentary condition may experience increased emotional insecurity b/c of decreased self-esteem and disturbances in self-image r/t alterations in appearance from acne, scars, or burns
- nursing care focused on promoting a positive self-esteem
- learning and mastering tasks can increase confidence
- encourage participation in activities that promote learning, self-confidence, and acceptance
- activities and stimulation should be individualized to each child’s developmental age and situation
- assess for signs of avoidance and social isolation
- encourage the child to interact with others normally to encourage social and cognitive development
- provide an environment to openness that fosters a sense of well-being to the child
- provide education to the child about the disease process and treatment expectations in a nonjudgmental manner that fosters open communication and trust
- encourage parental involvement to better ease the child’s discomfort and acceptance of the disease process
Skin Lesions
a circumscribed area of altered tissue
>Two Types:
-Primary: macules, papules, patches, nodules, tumors, vesicles, pustules, bullae, and wheals (macules, papules, and nodules are found in children and adolescence with acne; vesicles and pustules are seen with chickenpox and impetigo; wheals often seen in allergic reactions)
-Secondary: those happened as a result of changes from the primary lesions; crusts, scales, lichenification, scars, keloids, fissures, erosions, and ulcers (lichenification [thickening of the skin with hyperpigmentation] is found with atopic dermatitis, ulcers may be associated with cancer; scars are the result of a wound; keloids result from hypertrophy of the scar tissue that extends beyond the wound edges)
When Assessing a Skin Lesion
note the size, shape, color, and texture
Primary Skin Lesions
macules, papules, patches, nodules, tumors, vesicles, pustules, bullae, and wheals
- macules, papules, and nodules are found in children and adolescence with acne
- vesicles and pustules are seen with chickenpox and impetigo
- wheals often seen in allergic reactions
Secondary Skin Lesions
those happened as a result of changes from the primary lesions
- crusts, scales, lichenification, scars, keloids, fissures, erosions, and ulcers
- lichenification [thickening of the skin with hyperpigmentation] is found with atopic dermatitis
- ulcers may be associated with cancer
- scars are the result of a wound
- keloids result from hypertrophy of the scar tissue that extends beyond the wound edges
Integumentary System: Infant
- skin is thin
- friction can cause blistering easily
- eccrine sweat glands are functional
- apocrine sweat glands are not functional
- color is lighter than normal for race and ethnicity
- newborns and infants should AVOID direct exposure to the sun
Integumentary System: Child
- skin thickens with age
- friction and shear are not as destructive to the child’s skin, but skin is still developing the bond between epidermis and dermis
- eccrine sweat glands are functional
- apocrine sweat glands grow larger preparing for pubescence
- color is normal for race and ethnicity
- skin is easily sunburned, especially in fair-haired, fair-skinned children
Integumentary System: Adolescent
- skin reaches adult thickness
- epidermis and dermis are bound together and firm
- eccrine sweat glands are fully functional
- testosterone increases sweating in the male
- apocrine sweat glands are mature at puberty
- color is normal for race and ethnicity, functional at adult levels
- melanin is normal and provides some UV protection; protection from direct sun is still important
Wounds and Wound Healing
- Typical wounds: cuts, scrapes, and burns
- 3 phases to skin healing: inflammation, proliferation, and remodeling
Wound Healing: Inflammation Phase
First stage of wound healing
- reflects the skin’s initial healing response
- lasts 2 to 5 days
- preparatory stage for repair
- the wound seals itself with blood coagulation, followed by vasodilation that allows the leukocytes to ingest the bacteria and debris at the site of injury
Wound Healing: Proliferation Phase
Secondary stage of wound healing
- the blood flow is reestablished to the site, and natural debridement occurs
- lasts 2 to 3 weeks
- the wound contracts and a fine layer of epithelial cells cover the site of new collagen
