Class 5 Integumentary

Question 1

Inegumentary system in children: info

Answer 1

NB epidermis thinner than adults
Increased permeability to topical agents
Increased water loss thru skin
Infants/toddlers less able to regulate body temp r/t immature eccrine glands in skin (mature 2-3 years)
Fewer melanocytes than adults increases photosensitive

Question 2

Contact dermatitis: causes

Answer 2

Rubber products
Clothing dyes
Scented soap/lotions
Wool clothing
Moisture such as urine, ammonia (urine fecal contact), friction (diaper rash)

Question 3

Contact dermatitis: manifestation, diaper, allergic

Answer 3

Dry, inflamed, pruritic skin

Distribution of lesions correlates with skin surface in contact with irritating agent

Diaper: erythema in perianal region, can progress to macules, papules that form erosion’s and crusts

Allergic: blistering weeping lesions, intense itching/crusted scaly lesions

Question 4

Contact dermatitis: management

Answer 4

Stop using agent
Wash skin and apply cool compress
A&D ointment (diaper)
Topical steroid

Management of 3 factors:
Wetness
pH
Fecal irritation

Question 5

Atopic dermatitis: Eczema

Answer 5

Common chronic inflammation of skin with severe itching
Unknown cause but thought to be malfunction of immune system. Allergies to food, hay fever, family history of asthma. Tendency for dry sensitive skin, emotional stress

Question 6

Atopic dermatitis: Eczema diagnosis

Answer 6

High IgE (immunoglobulin E) and eosinophil level
Test for food allergies (mild, eggs, wheat, soy)
Family history

Question 7

Atopic Dermatitis (Eczema) manifestations

Answer 7

Oozing, weeping, crusting, cracking lesions develop cheek, forehead and extend to scalp and legs/arms

High levels of histamine in skin trigger inflammatory response

Scratch/itch/scratch/itch cycle (cut nails short)

Skin has high staph aureus

**secondary infection common: impetigo, herpes, molluscum contagiosum

Question 8

Eczema management

Answer 8

Goal:
hydrate skin
relieve pruritus
reduce flare ups or inflammation
prevent and control secondary infection

Question 9

Eczema nursing interventions

Answer 9

Keep fingernails short, clean, filed
Gloves/coverings over hands
Dress attire that reduces itching, soft no seams
Tepid bath water prevents drying skin
Apply lotion after bath and frequently
Monitor for s/s of skin infection
Humidifier in room

Question 10

Impetigo, what is it?

Answer 10

Most common bacterial skin infection of childhood
Usually occurs following infection from another skin lesion (insect bite)
Very contagious

Question 11

Impetigo, how is it spread

Answer 11

poor hygiene, sharing towels, drinking glasses
Crowded living areas, daycare centers
Hot humid conditions increases occurrences
Toddlers and preschoolers most commonly affected
Incubation period 7-10 days

Question 12

Impetigo manifestations

Answer 12

Small vesicles that progress to bullae
Initially filled with serous fluid that progress to pustular
Lesions rupture skin appears scaly/crusty
Mildly itchy
Diagnosed by exam
Culture under crust

Question 13

Impetigo treatment

Answer 13

Topical and oral antibiotics, IV if severe
Wash lesions TID, soak crust then remove
Handwashing imperative to prevent spread
Wear gloves when giving care
Advise no to attend school or daycare for 24 hours after beginning treatment

Question 14

Tinea infection, what is it?

Answer 14

Superficial infection caused by group of fungi called dermatophytes
Classified by location:
Tinea capitis-scalp
Tinea corporis (ringworm)- face, trunk, extremities
Tinea cruris- jock itch
Tinea pedis- athlete foot

Question 15

Tinea infection, capitis manifestations and treatment

Answer 15

Erythema scaling of scalp
1 or more round patches of alopecia

Oral griseofulvin q day 6 weeks (take with mild/high fat food for increase absorption)
Antifungals if griseofulvin not tolerated
Sulfide shampoo-selenium blue

Question 16

Tinea infections, corporis manifestations and treatment

Answer 16

Common trunk, face or extremities
Ring like plaques clear scaly centers red margins
Mildly itchy

Topical antifungals to lesions
PO griseofulvin (take with mild/high fat food for increase absorption)

Question 17

Tinea infections, cruris manifestations and treatment

Answer 17

Pink papules and scales inner thighs, groin, scrotum, buttocks not the penis
Pruritus present

Topical antifungals BID

Question 18

Tinea infections, pedis manifestations and treatment

Answer 18

Scaly lesions sole of fee, between toes, under nails
Peeling, fissures, macerations, pruritus, burning often present

Topical antifungals
PO griseofulvin (take with mild/high fat food for increase absorption), itraconazole

Question 19

Tinea infection treaching

Answer 19

Keep are clean and dry
Don’t share personal items
Athletes foot, cotton socks, powder to feet, keep dry
Jock itch, loose fit cotton underwear, avoid itching, avoid soap, use plain water to affected areas
Take all meds as directed
May require lengthy treatment

Question 20

Herpes Simplex Virus (HSV) how is it spread?

Answer 20

Transmitted by infected body fluids and secretions that come in contact with breaks in skin
Kids with burns, eczema, immunocompromised more susceptible
Nurse with poor hand hygiene can transmit virus

Question 21

Two types of Herpes Simplex Virus

Answer 21

HSV 1= affected areas above waist, cold sore

HSV 2= affected areas below waist, genitals

Question 22

What is Herpes Labialis? s/s? appearance?

Answer 22

Cold sore or fever blister

Burning, itching, tingling
Occurs several days before lesions

Fluid filled vesicles that ulcerate, dry and crust
Pruritus and pain present

Question 23

What is Herpes gingivostomatitis? appearance? s/s?

Answer 23

Severe oral infection

Affects children <5 years
Vesicles and ulcerations and edematous throat

Enlarged, painful cervical lymph nodes
Fever, chills, malaise, bad breath, drooling

**assess hydration

Question 24

What is Herpes ocular?

Answer 24

Results from rubbing eyes with contaminated fingers

Question 25

Herpes Simples Virus nursing care

Answer 25

Monitor pain and dehydration
Contact precautions
Offer fluids: popsicles, non-citrus juices, milk, noncarbonated
Small frequent feedings

Teach:
Contagious until scabs from visible lesions have fallen off
If lesions on mucus membranes contagious until completely healed because scabs do not form

Question 26

HSV treatment

Answer 26

Topical or oral Acyclovir
Antibiotic ointment may be used to prevent secondary infection
Oral or rectal acetaminophen
Mouth rinse: Benadryl, kaopectate lidocaine viscus

Question 27

Pediculosis (lice), what is it? transmission?

Answer 27

Live only on humans to feed
Survive 48 hours off host
Transmitted by direct and indirect contact with infested objects/person
Rarely occurs in African Americans
Girls more than boys
Adult lice difficult to see small size and crawl fast to avoid light

Question 28

Pediculosis, 3 types

Answer 28

Pediculosis capitis: head lice
Pediculosis corporis: body lice
Pediculosis pubis: pubic lice, crab lice

Question 29

Pediculosis manifestations

Answer 29

Nits (eggs) visible attached firmly to hair shaft at scalp
Tiny silver/grey/white specks look like dandruff but difficult to remove
Scattered lesions behind scalp, ears, back of neck cause intense itching

Question 30

Pediculosis managment

Answer 30

OTC pedicullicide: 1% permaethrin (Nix or Rid) one treatment
Lice often become resistant to treatments so new modalities are always evolving
Daily removal of nits from hair with metal nit comb at least 2-3 days after treatment. Back combing method
Wash clothes, bedding, objects hot water and dryer
Notify school

Question 31

Scabies, what is it?

Answer 31

Contagious
Transmitted by close contact
Mite can’t survive >3 days away from human skin
Transmission by bedding or clothing is infrequent
All socioeconomic groups affected

Question 32

Scabies manifestations

Answer 32

Intense itching especially at night
Papules, vesicles, nodules seen on wrist, finger web, elbows, umbilicus, axillae, groin, buttocks
Burrows, wavy fine, greyish, threadlike lines
Diagnosed microscopic exam of scraped lesions
Infants: head, palms, soles of feet may be affected

Question 33

Scabies treatment

Answer 33

Topical 5% permethrin, 1% lindane crème
Lindane risk for neurotoxicity, do not use <2 yr or pregnant
Applied to body and head, avoid eyes/mouth
Treat all family members even if asymptomatic
Wash items in hot water, dryer
Usually cured with one treatment

Question 34

Acne Vulgaris what is it? influenced by?

Answer 34

Disorder of sebaceous hair follicles

Overgrowth of normal bacteria
Hereditary
Hormonal influences, emotional stress
Foods do not appear to cause or increase severity
Not r/t general cleanliness of skin

Question 35

Acne Vulgaris manifestations

Answer 35

Consists of closed whiteheads, blackheads, papules, pustules, nodules, cysts
Treatment based on type
Affects face, neck, back, shoulder, upper chest

Question 36

Acne Vulgaris medication

Answer 36

Isotretinoin (Accutane):
-teach teratogenic effects on fetus
-pregnancy tests, contraception
-suicide risk in adolescents
-sun sensitivity, dry lips use sunscreen, lip balm
Retin A
Benzoyl peroxide
Antibiotics

Question 37

Pinworm, transmission, manifestations, diagnosis?

Answer 37

Transmission:
Ingestion or inhalation of eggs
Hand to mouth transfer

Manifestations: nocturnal anal itching

Treatment: anti-parasitic meds (Pyrantel pamoate, Mebendazole)

Diagnoses:
Tape test
Cellophane tape pressed to child’s anus during the night
Sample observed microscopically

Question 38

Pinworm teaching

Answer 38

Handwashing, under fingernails
Clean toilets/bathrooms with bleach
No scratching anal area bare handed
Wash fruits and veggies before eating
Change diapers frequently
Avoid swimming facilities that allow diapered children
Bottled water camping/traveling
Keep dogs/cats away from paly areas/sandbox