Exam 1: Tissue Integrity Flashcards
Pediatric Skin Differences
- Newborn’s epidermis is thinner than adults
- Increased permeability to topical agents
- Increased water loss via skin
- Skin surface area to body volume is greater
- Greater absorption thru skin
- Eccrine glands to not reach maturity until 2-3 years of age
- Less able to regulate body temperature
- Fewer melanocytes
- Increases photosensitivity: need to be careful with steroid creams, not a lot of transdermal patches in this age until teenage age.
- Careful to make sure we apply sunscreen since they get sunburned a lot faster.
Atopic Dermatitis (Eczema)
- Chronic inflammatory disease of the skin: red and inflamed
- Characterized by chronic severe pruritus
Atopic Dermatitis (Eczema) Etiology
Cause is unknown but contributing factors are:
- Inherited tendency for dry, sensitive skin; allergies/allergic rhinitis; emotional stress
- TRIAD: allergies, eczema and asthma (More severe if you have all three of this triad.)
When does atopic dermatitis (eczema) begin?
- In infancy and clears by age 2-3.
- Can last through adulthood (Asians are most common in adulthood)
Clinical Manifestations of Atopic Dermatitis in Infancy
- Erythematous areas of oozing and crusting
- Papulovesicular rash and scaly, red plaques.
- Area becomes excoriated and lichenified (cheeks and then forehead, scalp extensor surfaces or arms and legs)
Clinical Manifestations of Atopic dermatitis (Eczema) in Children
- Rash in the flexor surfaces/where they bend/sweat (wrist, ankles, knees, and elbows).
- Rash on neck crease, eyelids and dorsal surfaces of hands and feet
- Excessive itching from sweating and contact w/ irritating fabrics
- Chronic lichenification
What are the goals of management for atopic dermatitis (eczema)?
- Control itching and scratching
- Moisturize the skin
- Prevent secondary infections
- Remove irritant and allergens
Treatment for Atopic Dermatitis (Eczema)
- Oral Antihistamines
- Proper Skin Hydration
- Anti-inflammatory skin creams and ointments
Atopic dermatitis (Eczema): Proper Skin Hydration in Humid Climates
Bathing should be infrequent with lukewarm water and mild, non-perfumed soap and emollients like Eucerin applied after bathing to damp skin.
Atopic Dermatitis (Eczema): Proper Skin Hydration in Dry climates
Bathe frequently, use hydrophilic agents and should be moisturized with ointment or cream after (avoid products with alcohol-they dry skin)
Atopic Dermatitis (Eczema) Management: Proper Skin Hydration
- Do not rub with the towel after shower, pat dry and put on lotion
- Reduce the secondary infections
- Creams stick better
- Put cream on then ointment on top of it. We want a barrier and ointments are like a barrier for that.
Atopic Dermatitis (Eczema) Management: Anti-inflammatory skin creams and ointments
- Don’t use all the time; only use when getting worse
- Avoid putting on skin because it thins the skin
- Ointment works as a barrier: ointments are like Vaseline. (Steroid creams first, then lotion)
- Try to avoid PO steroids (systemic). Choose more towards topical.
Atopic Dermatitis (Eczema): Interventions
- Keep child skin hydrated to relieve itching, apply moistening cream like Eucerin several times a day
- Soak and cool, wet compresses to smooth and remove crusts, reduced inflammation and dry weeping areas
- Teach about clothing- soft cotton or cotton-polyester tolerated best
- Advise to keep child’s fingernails clean and short
- Keep skin clean to minimize infection (avoid using soap) use bath oil or emulsifying ointment
- Apply moisturizer before swimming and exiting the pool
Impetigo
- Occurs as a secondary infection from another skin lesion
- Highly contagious
Impetigo: Incubation period
7-10 days
Impetigo: When do lesions resolve?
Lesions resolve in 12 to 14 days with treatment: if we dont treat it, then it will keep on going
When does impetigo most often occur?
During hot, humid summer months
What are clinical manifestations of bullous impetigo?
Small vesicle that progress to bullae lesions:
- Are initially filled with serous fluid and later become pustular
- Bullae rapidly rupture, leaving shiny, lacquered-appearing lesion with scaly rim
What are clinical manifestations of crusted impetigo?
- Vesicle/pustule that ruptures -> erosion w/ overlay of honey-colored crustà
- Erosions bleed easily when crusts removed
How is impetigo diagnosed?
Characteristic lesion
Treatment for Impetigo
- Topical and oral antibiotics (speed things up)
- Topical ointment like mupirocin or bacitracin applied**
- Wash lesions 3x/day in warm, soapy water
- Gently remove crusts
Nursing Implications for Impetigo
- Child should sleep alone and should be bathed daily alone with antibacterial soap.
- Need to bleach bathtub after.
- Hand washing is very important
When is a child with impetigo able to go back to school?
Notify school of diagnosis → Child should avoid school until on antibiotics for 24 hour
Complications of Impetigo
Hand washing is important to prevent spread of infection.
Pediculosis (Lice Infection)
- Small, blood sucking insects that live only on humans (cannot jump)
- Not a serious health problem.
How is lice transmitted?
By direct contact with infected persons or indirect contact with infected objects: sharing combs and things like that.
Head Lice
- Clean hair is no deterrent to head lice.
- Don’t like really oily hair since it suffocates them. They like clean hair.
Clinical Manifestations of Pediculosis Capitis (Head lice)
- Nits are visibly attached to hair shafts
- Attached firmly to hair shaft near scalp
- Tingly, silvery or grayish white specks resembling and dandruff but more difficult to remove
- Commonly found behind ears and nape of neck
- Lesion due to intense pruritus
Clinical Manifestations of Pediculosis Corporis (Body lice)
- Popular, rose-colored dermatitis, causing intense pruritus that appears on skin in areas under tight clothing
- Attached firmly to seams of child’s clothing or bed.
- Look at belt area because thats where you will see them attached to
- Tell the families to look in the grooves of the mattress because thats where they like to hang out.
Pediculosis (Lice Infection) Management
- Examine family members and other who might be in closed contact with infested child
- Prevent spread and reoccurence
- Child should be rechecked for infestation in 7-10 days.
- Nurses cannot cut hair or fingernails
Treatment of Pedicolosis (Lice)
- Over-the counter lice creams and shampoos.
- Resistant strains are common: so then they will need ABT
- Lindane (a hexachlorocyclohexane) nominated for elimination b/c persist as poison in environment and can be neurotic if absorbed
- Pesticide malathios (ovide) approved for treatment of lice in children greater than 6 years, but requires prolonged contact to be effective
Ovidices used to treat pediculosis
Should not be used on children less than 2 years old.
What should the nurse teach about environmental objects touched by children with lice?
- Wash sheets in hot water/dry for 20 min on hot setting.
- If unable to wash, place in air tight container for 24-48 hours
- Meticulous vacuuming.
Mite Infestation (Scabies) is caused by
Sarcoptes scaniei
Mite Infestation (Scabies)
-Cannot live away from human skin for >3 days; prevalent in many schools.
Mite Infestation (Scabies): Transmission
- Contagious
- Transmitted by close personal contact
Major Complications of Mite Infestation (Scabies)
- Impetigo (major cause)
- Skin Infections
What are clinical manifestations of mite infestation (scabies)?
- Intense pruritus, especially at night (caused by mites, eggs and excrement that is burrowed into the epidermis)
- In infants, crankiness, sleep, fitfully rub hands and feet together (head, palms and soles can be affected)
- Excoriation and inflammation of burrows
- May be difficult to see d/t inflammation from scratching
- Papuans, vesicles or nodules are common.
Management of Mite Infestation (Scabies)
- Anyone who is in the house also needs to take medication
- Topical Application: Permethrin 5% or lindane cream 1%**
- Treatment for pruritus: oral antihistamines and corticosteroid cream
- Wash bedding/clothing in hot water.
Application of Topical Agents (Permethrin 5% or lindane cream 1%) to Treat Mite Infestation
- Applied to the body and head (neck to toes)
- Apply 30min after bathing and apply only to cool, dry skin.
- Must remain on the skin for 8-14 hours
- Recommended to apply at bedtime and wash off in the morning
- Retreatment in 1 week
Contraindications of Lindane Cream
Should not be used on children under 2 years old or pregnant women because of its risk of neurotoxicity.
