D2 Flashcards
Differences in pediatric skin
- Children’s Epidermal Layer Less Bound To Dermal layer
- Poor Adherence Results In Separation Of layers
- Much Higher Risk Of Separation In Preterm infants
- Increased Exposure To Iatrogenic Risk Factors
- Increased exposure to body fluids
- Limited/no ability to self care or self report
- Higher risk of accidental injury
- Higher Risk Of Inflammatory Conditions
factors that influence skin healing
promotes? Delays?
Promotes
- moist clean environment
- good nutrition
Delaying Healing:
- Immunocompromised
- Impaired Circulation
- Stress
- infection,antiseptics, medication
- foreign bodies, mechanical friction
- co-existing diseases/ morbidities
Skin condition assesment
- Location/distribution
- Extent
- Colour
- Type
- Pruritus?
- Pain/tenderness/ other Bleeding?
- Swelling
- Infected?
more
- Age of onset
- Allergies
- Exposure to irritants
- History in the family
- Asthma/Hay fever
Erythema, ecchymosis, petichea, primary and seconday lesions
Erythema
- A reddened area caused by increased amounts of oxygenated blood in the dermal vasculature
Ecchymoses (bruises)
- Localised red or purple discolorations caused by extravasation of blood into dermis and subcutaneous tissues
Petechiae
- Pinpoint, tiny, and sharp circumscribed spots in the superficial layers of the epidermis
Primary lesions
- Skin changes produced by a causative factor;
- primary lesions in paediatric: macules, papules, vesicles, patches, bullae, plaque, wheals, nodules, pustules, and cysts
Secondary lesions
- Changes that result from alteration in the primary lesions, such as those caused by rubbing, scratching, medication, or involution and healing
Managent of Iacotengic risks: Reduce and promote
Reduce:
- Pressure, especially over bony prominences
- Friction And Shear
- Epidermal stripping
- Contact with irritants (urine and faeces,ostomy fluids,IVfluids)
Promote:
- Optimal Oxygenation
- Hydration And Nutrition
- Circulation
- Movement
managment of ostomies
- tracheostomy, gastrostomy, ileostomy, nephrostomy, urostomy, jejunostomy, colostomy
Care priorities
- Maintain position and patency of tubes * - Protect surrounding skin
- Prevent/reduce skin exposure to fluids
- Keep as clean and dry as possible
- Use barriers – creams, protective and/or absorbent wound products, ostomy wafers
diaper dermatitis
what? Diaper wetness produces?
prolonged and repetitive contact with irritant (e.g., urine, faeces, soaps, detergents, ointments, friction)
diaper wetness produces:
- higher friction
- greater abrasion damage
- Increase In pH from the breakdown of urea in the presence of faecal urease
- Possibly from detergents or soaps from inadequately rinsed cloth diapers or the chemicals in disposable wipes
Candida albicans infection and interventions
Candida albicans infection
- perineal inflammation and a maculopapular rash with satellite lesions that may cross the inguinal fold
Nursing Interventions
- Reduce contact with irritant
- Changing diapers often
- Don’t Use Perfumed Products/wipes
- Keep skin dry
- Use barrier creams– Re-apply each change (Zinc oxide – remove with mineral oil)
- Minimise Friction
- Avoid Frequent Washing/firm rubbing
- Monitor For Secondary Infection And Treat Accordingly
AD eczema
daignosis and managment
Descriptive diagnosis
- Intense pruritus- inflammatory chronic skin disease
- Associated with asthma and allergies (family hx)
- dermatological manifestations appear subsequent to scratching, lesions disappear if scratching is stopped
- Improvement in humid environments
interventions
Managment
- Bathe in tepid water with mild or no soap
- Apply hydrating moisturisers
- Apply topical medications as required
- Dress in warm moist dressings/clothes, with dry outer layer
- Cool wet compresses/dressings Evaluate for secondary infections
- Address Itch, scratching, pain, stress, fatigue, sleep disturbance
Burns
what? contributing factors to severity?
Young children at high risk of hot fluid burn injuries
- Scalds = 50% of all burn injuries
- Children under 5 highest risk
- Severity, therapy, prognosis related to amount of tissue destroyed: total body surface and depth
- Infant skin thin and more easily burned
Contributing factors:
- Location
- Causative agent
- Age of child
- Respiratory involvement
- General health
burns classification and common rule
- Depth of injury (used to be classified as “degree”)
- Superficial (first degree)
- Partial-thickness (second degree)
- Full-thickness (third degree)
- Full-thickness + underlying tissue (fourth degree)
Commonly used rule
- child’s palm, including fingers = 1% of body surface area.
- For children, a burn of 10% of TBSA can be life threatening if not treated appropriately.
patho thermal injury
- A major burn (greater than 30% TBSA)
- edema and severe capillary damage
- an increase in capillary permeability, allowing plasma, proteins, fluids, and electrolytes to be lost
- Anaemia –> caused by direct heat destruction of red blood cells(RBCs), injured RBCs, and trapping of RBCs in the microvascular thrombi of damaged cells
- increased blood flow
- Increase in metabolism to maintain body heat,providing for the body’s increased energy needs.
managment of burns
- Stop Burning Process (run cool water over burn; wet clothes, only remove clothes if they come off easily – otherwise, soak the area)
- Keep the child warm – do not cool large burns
- Assess Child’s Condition
- ABC: Always Give Oxygen For Moderate–severe burns
- Cover burn to Prevent Contamination
- Transport Child To Appropriate Level Of Care
- Pain management
- Fluid Replacement Therapy: critical in first 24 hours
BURNS correctionon of fluis electrolyte balance
- High Risk Of Hypovolemia And Sodium Losses
Maintain Tissue Perfusion: - Normal Saline or Ringer’s lactate
- Depending on Total Body Surface Area (TBSA) (>15-20%) IV infusion immediately to maintain urine output at ~1-2 mL/kg (under 30 kg) or ~ 30-50 mL/hr (>30 kg).
managment of burns
complications, minor burns, and ideal wound dressing
Reduce Complications:
- Airway Compromise
- Infection (local,pneumonia,systemic)
- Contractures
- Scarring
Care of Minor Burns
- Wound cleansing
- Debridement – with or without removal of blisters
- promote healing + puritis mngmt
Ideal burn dressing:
- Reduce risk of infection (broad spectrum antimicrobial)
- Require infrequent changing with minimal discomfort
- Promote re-epithelialization
- Cover wounds with antimicrobial ointment OR use occlusive dressings OR both
