Class 5 Integumentary Flashcards
Inegumentary system in children: info
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
Contact dermatitis: causes
Rubber products Clothing dyes Scented soap/lotions Wool clothing Moisture such as urine, ammonia (urine fecal contact), friction (diaper rash)
Contact dermatitis: manifestation, diaper, allergic
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
Contact dermatitis: management
Stop using agent
Wash skin and apply cool compress
A&D ointment (diaper)
Topical steroid
Management of 3 factors:
Wetness
pH
Fecal irritation
Atopic dermatitis: Eczema
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
Atopic dermatitis: Eczema diagnosis
High IgE (immunoglobulin E) and eosinophil level
Test for food allergies (mild, eggs, wheat, soy)
Family history
Atopic Dermatitis (Eczema) manifestations
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
Eczema management
Goal: hydrate skin relieve pruritus reduce flare ups or inflammation prevent and control secondary infection
Eczema nursing interventions
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
Impetigo, what is it?
Most common bacterial skin infection of childhood
Usually occurs following infection from another skin lesion (insect bite)
Very contagious
Impetigo, how is it spread
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
Impetigo manifestations
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
Impetigo treatment
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
Tinea infection, what is it?
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
Tinea infection, capitis manifestations and treatment
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
Tinea infections, corporis manifestations and treatment
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)
Tinea infections, cruris manifestations and treatment
Pink papules and scales inner thighs, groin, scrotum, buttocks not the penis
Pruritus present
Topical antifungals BID
Tinea infections, pedis manifestations and treatment
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
Tinea infection treaching
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
Herpes Simplex Virus (HSV) how is it spread?
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
Two types of Herpes Simplex Virus
HSV 1= affected areas above waist, cold sore
HSV 2= affected areas below waist, genitals
What is Herpes Labialis? s/s? appearance?
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
What is Herpes gingivostomatitis? appearance? s/s?
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
What is Herpes ocular?
Results from rubbing eyes with contaminated fingers
Herpes Simples Virus nursing care
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
HSV treatment
Topical or oral Acyclovir
Antibiotic ointment may be used to prevent secondary infection
Oral or rectal acetaminophen
Mouth rinse: Benadryl, kaopectate lidocaine viscus
Pediculosis (lice), what is it? transmission?
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
Pediculosis, 3 types
Pediculosis capitis: head lice
Pediculosis corporis: body lice
Pediculosis pubis: pubic lice, crab lice
Pediculosis manifestations
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
Pediculosis managment
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
Scabies, what is it?
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
Scabies manifestations
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
Scabies treatment
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
Acne Vulgaris what is it? influenced by?
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
Acne Vulgaris manifestations
Consists of closed whiteheads, blackheads, papules, pustules, nodules, cysts
Treatment based on type
Affects face, neck, back, shoulder, upper chest
Acne Vulgaris medication
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
Pinworm, transmission, manifestations, diagnosis?
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
Pinworm teaching
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
