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NURS 406 > Exam 1: Tissue Integrity > Flashcards

Exam 1: Tissue Integrity Flashcards

1
Q

Pediatric Skin Differences

A
  • 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.
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2
Q

Atopic Dermatitis (Eczema)

A
  • Chronic inflammatory disease of the skin: red and inflamed
  • Characterized by chronic severe pruritus
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3
Q

Atopic Dermatitis (Eczema) Etiology

A

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.)
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4
Q

When does atopic dermatitis (eczema) begin?

A
  • In infancy and clears by age 2-3.

- Can last through adulthood (Asians are most common in adulthood)

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5
Q

Clinical Manifestations of Atopic Dermatitis in Infancy

A
  • 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)
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6
Q

Clinical Manifestations of Atopic dermatitis (Eczema) in Children

A
  • 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
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7
Q

What are the goals of management for atopic dermatitis (eczema)?

A
  • Control itching and scratching
  • Moisturize the skin
  • Prevent secondary infections
  • Remove irritant and allergens
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8
Q

Treatment for Atopic Dermatitis (Eczema)

A
  • Oral Antihistamines
  • Proper Skin Hydration
  • Anti-inflammatory skin creams and ointments
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9
Q

Atopic dermatitis (Eczema): Proper Skin Hydration in Humid Climates

A

Bathing should be infrequent with lukewarm water and mild, non-perfumed soap and emollients like Eucerin applied after bathing to damp skin.

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10
Q

Atopic Dermatitis (Eczema): Proper Skin Hydration in Dry climates

A

Bathe frequently, use hydrophilic agents and should be moisturized with ointment or cream after (avoid products with alcohol-they dry skin)

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11
Q

Atopic Dermatitis (Eczema) Management: Proper Skin Hydration

A
  • 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.
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12
Q

Atopic Dermatitis (Eczema) Management: Anti-inflammatory skin creams and ointments

A
  • 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.
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13
Q

Atopic Dermatitis (Eczema): Interventions

A
  • 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
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14
Q

Impetigo

A
  • Occurs as a secondary infection from another skin lesion

- Highly contagious

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15
Q

Impetigo: Incubation period

A

7-10 days

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16
Q

Impetigo: When do lesions resolve?

A

Lesions resolve in 12 to 14 days with treatment: if we dont treat it, then it will keep on going

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17
Q

When does impetigo most often occur?

A

During hot, humid summer months

18
Q

What are clinical manifestations of bullous impetigo?

A

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
19
Q

What are clinical manifestations of crusted impetigo?

A
  • Vesicle/pustule that ruptures -> erosion w/ overlay of honey-colored crustà
  • Erosions bleed easily when crusts removed
20
Q

How is impetigo diagnosed?

A

Characteristic lesion

21
Q

Treatment for Impetigo

A
  • 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
22
Q

Nursing Implications for Impetigo

A
  • Child should sleep alone and should be bathed daily alone with antibacterial soap.
  • Need to bleach bathtub after.
  • Hand washing is very important
23
Q

When is a child with impetigo able to go back to school?

A

Notify school of diagnosis → Child should avoid school until on antibiotics for 24 hour

24
Q

Complications of Impetigo

A

Hand washing is important to prevent spread of infection.

25
Q

Pediculosis (Lice Infection)

A
  • Small, blood sucking insects that live only on humans (cannot jump)
  • Not a serious health problem.
26
Q

How is lice transmitted?

A

By direct contact with infected persons or indirect contact with infected objects: sharing combs and things like that.

27
Q

Head Lice

A
  • Clean hair is no deterrent to head lice.

- Don’t like really oily hair since it suffocates them. They like clean hair.

28
Q

Clinical Manifestations of Pediculosis Capitis (Head lice)

A
  • 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
29
Q

Clinical Manifestations of Pediculosis Corporis (Body lice)

A
  • 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.
30
Q

Pediculosis (Lice Infection) Management

A
  • 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
31
Q

Treatment of Pedicolosis (Lice)

A
  • 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
32
Q

Ovidices used to treat pediculosis

A

Should not be used on children less than 2 years old.

33
Q

What should the nurse teach about environmental objects touched by children with lice?

A
  • 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.
34
Q

Mite Infestation (Scabies) is caused by

A

Sarcoptes scaniei

35
Q

Mite Infestation (Scabies)

A

-Cannot live away from human skin for >3 days; prevalent in many schools.

36
Q

Mite Infestation (Scabies): Transmission

A
  • Contagious

- Transmitted by close personal contact

37
Q

Major Complications of Mite Infestation (Scabies)

A
  • Impetigo (major cause)

- Skin Infections

38
Q

What are clinical manifestations of mite infestation (scabies)?

A
  • 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.
39
Q

Management of Mite Infestation (Scabies)

A
  • 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.
40
Q

Application of Topical Agents (Permethrin 5% or lindane cream 1%) to Treat Mite Infestation

A
  • 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
41
Q

Contraindications of Lindane Cream

A

Should not be used on children under 2 years old or pregnant women because of its risk of neurotoxicity.

NURS 406 (18 decks)

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