[Exam 4] Chapter 45 –Alteration in Tissue Integrity/Integumentary Disorder Flashcards
Differences in Skin Between Adult/Child: What to know for friction?
Infant’s skin contains much more water. Therefore, friction can easily cause separation of the layers resulting in blistering.
Differences in Skin Between Adult/Child: Dark-skinned children tend to have more prominent what?
Papules, follicular responses, and vesicular reactions
Differences in Skin Between Adult/Child: What to know about hyertrophic scarring and keloid formation?
Occurs more often in dark-skinned children
Common Medical Tx: Why is wet dressing done?
In presence of itching, crusting, or oozing, helps to remove cruts
Common Medical Tx, Health Hx: Determine child’s chief complaint, which is usually what?
Pruritus, scaling, or cosmetic disruption.
Common Medical Tx, Physical Exam: Note whether the rash is what?
Macular, papular, pustular, or vesicular
Common Medical Tx, Physical Exam: Describe lesions according to what criteria?
Linear : In a line
Shape: Are they round, oval?
Morbilliform: Rose, maculopapular rash
Target lesions: like bull’s eye
Common Medical Tx, Labs: What does POtassium Hydroxide (KOH) prep determine?
Fungfal infections
Bacterial Infections: What is Impetigo?
Readily recognizable skin rash.
Bacterial Infections: When does nonbullous impetigo occur?
Follows some type of skin trauma , or may arise seconary to a bacterial infection
Bacterial Infections: What is bullous impetigo?
Demonstrates sporadic occurence pattern and develops on intact skin, resulting from toxin production
Bacterial Infections: What is Folliculitis, and why does it occur?
Infection of hair follicle, and comes from occlusion of hair follicle. May result from poor hygiene or prolonged contact with contaiminated water.
Bacterial Infections: What is cellulitis?
Localized infection and inflammation of the skin adn subcutaneous tissues.
Bacterial Infections: When does staphyloccal scalded skin syndrome occur?
Results from infection with S. Auresu that produces a toxin, which then causes exfoliation. REsults in diffuse erythema (reddening of skin) and skin tenderness
Bacterial Infections: Where does CA-MRSA most commonly occur?
As a skin or soft tissue infection, such as cellulitis
Bacterial Infections: Risk factors for CA-MRSA?
Turf burns, towel sharing, or participation in team sports.
Bacterial Infections: Therapeutic mx of these infections?
topical or systemic antibodies and appropriate hygiene
Bacterial Infections, Nursing Assessment: Note history of skin disruption such as?
cut, scrape, or insect or spider bite.
Bacterial Infections, Nursing Assessment: Body piercings can lead to what?
Impetigo or cellulitis
Bacterial Infections, Nursing Assessment: FEver may occur with what?
Bullous impetigo or cellulitis , common with scalded skin syndrome
Bacterial Infections, Nursing Mx: What should you do for impetiginous lesions?
Soak them with cool compreses or Burrow solution to remove crusts before applying topical antibiotics
Bacterial Infections, Nursing Mx: How to prevent transmission of nosocomial MRSA?
Isolating children
Bacterial Infections, Nursing Mx: How to reduce risk of scarring with scalded skin syndrome?
minimal handling, avoiding corticosteroids and applying soothing ointments.
Bacterial Infections, Nursing Mx: How does nonbullous impetigo appear?
Papules progressing to vesicles, then painless pustules. Honey-colored exudate, and then crust after rupture
Bacterial Infections, Nursing Mx: Treatment for nonbullous impetigo?
Topically with mupirocin ointment.
Numerous lesiosn = cephalosporin
Bacterial Infections, Nursing Mx: Treatment for nonbullous impetigo, what may be needed for MRSA?
Clindamycin.
Bacterial Infections, Nursing Mx: How to remove honey-colored crust with nonbullous impetigo?
Cool compress twice daily
Bacterial Infections, Nursing Mx - Bullous Impetigo: Skin findings here?
Red macules and bullous eruptions.
Size may be from few mm to cm
Bacterial Infections, Nursing Mx - Bullous Impetigo: Treatment?
Oral cephalosporin and good hygiene
Bacterial Infections, Nursing Mx - Folliculitis: Skin findings?
Red, raised hair follicles
Bacterial Infections, Nursing Mx - Folliculitis: Treatment?
Treat with aggressive hygiene like warm compresses after washing.
Topical mupirocin, with oral anitbiotics
Bacterial Infections, Nursing Mx - Cellulitis: Skin findings
Localized reaction with erythema, pain, edema and warmth
Bacterial Infections, Nursing Mx - Cellulitis: Treatment?
Mild = Cephalexin or Amoxicillin
Severe= IV Cephalosporins
Bacterial Infections, Nursing Mx - Staphlyococcal Scalded Skin Syndrome: Findings here?
Flattish bullae that rupture within hours
Red , weeping surface left, common on face, groin, neck
Bacterial Infections, Nursing Mx - Staphlyococcal Scalded Skin Syndrome: Treatment?
Mild-moderate: Oral Cephalexin or Amoxicillin
Severe = Fluid Management and IV Oxacillin or CLindamycin
Fungal Infections: What is Tinea?
Fungal disease of skin occuring on any part of body. Part of body affected determines second word in name.
Fungal Infections: Tinea Pedis location?
Fungal infection on feet
Fungal Infections: Tinea Corporis location?
Fungal infection on arms or legs
Fungal Infections: Tinea Versicolor location?
Fungal infection of trunk or extremities
Fungal Infections: Tinea Capitis location?
Fungal infection on scalp, eyebrows or eyelashes
Fungal Infections: Tinea cruris location?
Fungal infection on groin
Fungal Infections: Theraptuic management invovles?
Appropriate hygiene and admin of antifungal agent
Fungal Infections, Nursing Assess: Get history, noting exposure to what?
Person with fungal infection or exposure to a fet.
Fungal Infections, Nursing Assess: Note areas that child may have gone to including?
Barber (Tinea Capitis), and damp areas like locker room and swimming pools or use of nylon socks
Fungal Infections, Tinea Corporis (Ringworm): Skin findings?
Annular lesions with raised peripheral scaling and central clearing
Fungal Infections, Tinea Corporis (Ringworm): Treatment
Antifungal cream for 4 weeks
Fungal Infections, Tinea Capitis): Tinea capitis skin finding?
Patches of scaling in scalp with central hair loss. .
Risk of kerion development (inflamed, boggy mass filled with psutules)
Fungal Infections, Tinea Capitis: Tinea capitis treatment?
Oral griseofulvin for 4-6 weeks
Selenium sulfie shampoo to decrease contagiousness
No schhol for 1 week
Fungal Infections, Tinea Versicolor: Skin finding?
Superificial tan or hypopigmented lesions.
Mote noticeable in summer
Fungal Infections, Tinea Versicolor: Treatment?
Apply selenium sulfide shampoo all over body once a week for 4 weeks
Topical antifunals may be used too
Fungal Infections, Tinea Pedis (Athlete’s Foot): Skin finding?
Red, scaling rash on soles and between toes
Fungal Infections, Tinea Pedis (Athlete’s Foot): Treatment?
Topical antifungal cream, powder
Foot hygiene
Fungal Infections, Tinea Cruris: Skin finding?
Erythema, scaling, maceration in inguinal creases and inner thighs
Fungal Infections, Tinea Cruris: Treatment?/
Topical antifungal for 4-6 weeks
Fungal Infections, Diaper Candidiasis (Monilial Diaper Rash): Skin findings?
Fiery, red lesions, scaling in skin folds, and setellite lesions
Fungal Infections, Diaper Candidiasis (Monilial Diaper Rash): Treatment?
Topical nystatin with diaper changes.
Fungal Infections, Nursing Mx: What to know for tinea corporis?
Contangeous, but can return to schoo once treatment begins.
Fungal Infections, Nursing Mx: What to tell parents for tinea capitis?
Hair will regrow in 3-12 months and wash sheets in hot water
Fungal Infections, Nursing Mx: What to tell child with tinea versicolor?
Normal skin pigmentation may take several months.
Diaper Dermatitis: What is this?
Inflammatory reaction of the skin in the area covered by a diaper
Diaper Dermatitis, Nursing Assess: Inspect skin in the diaper area for what?
Erythema and maceration.
Diaper Dermatitis, Nursing Assess: How does this start appearance wise?
Starts as a flat red rash in the convex skin creases. May appear red and shinny and may or may not have papules.
Diaper Dermatitis, Nursing Mx: Best way to manaagment this?
Prevention.
Diaper Dermatitis, Nursing Mx: What helps provide a barrier to the skin?
Vitamins A, D, E and Zinc Oxide, or petrolatum.
Diaper Dermatitis, Nursing Mx: Prevention and management of this?
Change diapers frequently
Avoid rubber pants
Wipe area with soft cloth
If rash occurs, allow them to go diaperless for period of time each day.
Diaper Dermatitis, Nursing Mx: Why should parents not use baby pwoders?
To avoid the risk of aspiration. Inhalation of talcum containing powders may result in pneumonitis
Atopic Dermatitis: Therapeutic management of this?
Good skin hydration, application of topical corticosteroids or immune modulator, oral antihistamines for sedative effects and antibiotics
Atopic Dermatitis - Patho: What is this?
Characterized by exteme itching and inflamed, reddened and swollen skin.
Atopic Dermatitis - Patho: Why does this skin reaction occur?
In response to specific allergens, usually food or environmental triggers
Atopic Dermatitis - Patho: What happens once child encounters a triggering antigen?
Skin begins to fell pruritic and child starts to scratch. Rash comes later due to scratching.
Atopic Dermatitis - Health Hx: Common signs and symptoms of this?
Wiggling or scratching, dry skin, scratch marks, distrubed sleep and irritability
Atopic Dermatitis - Health Hx: Risk factors for this?
Family hx of atopic detamatitis
Child’s history of asthma
Food or enviroemental allergies
Atopic Dermatitis - Inspection/Observation: Where may this appear?
< 2 = Face, scalp, wrists, and extensor surfaces of arms/legs
Older = Anywhere on skin
Atopic Dermatitis - Inspection/Observation: What may erythema or warmth indicate?
Secondary bacterial infection
Atopic Dermatitis - Labs: What labs may be performed?
Serum IgE levels may be elevated
Skin prick allergy testing determines allergen
Atopic Dermatitis - Nursing Mx, Promoting Skin Hydration: What should be avoided?
Hot water or any skin/hair product containing perfumes, dyes or fragrance.
Atopic Dermatitis - Nursing Mx, Promoting Skin Hydration: How can this be promoted?
Bathe child twice in warm water. Use mild soap or cleansing agents such as dove or oil of clay
Atopic Dermatitis - Nursing Mx, Promoting Skin Hydration: What should be done after bath?
Slightly pat and leave the child mooist. Apply ointment over the area
Atopic Dermatitis - Nursing Mx, Promoting Skin Hydration: Recommended moisturizers?
Eucerin
Aquaphor
Vaseline
Crisco
Atopic Dermatitis - Nursing Mx, Maintaining Skin Integrity/Preventing Infection: How can skin integrity be maintained?
Cut fingernails short and keep clean
Avoid tight clothing.
Keep skin well moisturized.
Atopic Dermatitis - Nursing Mx, Maintaining Skin Integrity/Preventing Infection: What can help prevent itching at night?
Antihistamines to sedate child
Atopic Dermatitis - Nursing Mx, Maintaining Skin Integrity/Preventing Infection: What should parents document for 1 week?
Keep a diary of childs scratching. Helps them determine specific strategies that may raise child’s awareness or scratching
Atopic Dermatitis - Nursing Mx, Maintaining Skin Integrity/Preventing Infection: What could be done to get child to not scratch?
Use diversion, imagination and play.
Contact Dermatitis: Why does this occur?
Due to cell-mediated response to an antigenic susbtance exposure.
Contact Dermatitis: First exposure is in which phase?
Sensitization. Attaches to cell that migrate to regional lymph nodes and recogntion of antigen occurs
Contact Dermatitis: What occurs int he second stage?
Elicitation, contact with antigen results in prolfieration and release of inflammatory mediators. Allergic response occurs within 24-48 houors.
Contact Dermatitis: May result as a allergy to what?
Nickel or cobalt found in clothing.
Contact Dermatitis: More common causes in children is from what?
Poison ivy, eastern poison oak, western poison oak and poison sumac
Contact Dermatitis: How long may rash last?
2-4 weeks, with lesions continuing to appear during illness
Contact Dermatitis: Complications of this?
Secondary bacterial infection or hyperpigmentation
Contact Dermatitis: Theraptuci mx is geared toward what?
management of itching and use of topical corticosteroids. Moderate-potency topical glucocorticoid cream or ointment is used
Contact Dermatitis, Nursing Mx: When condition does occur, this focuses on what?
Relieving the discomoft associated with rash. Administer topical or systemic corticosteroids.
Seborrhea: What is this?
Chronic inflammatory dermatitis that may occur on skin or scalp.
Seborrhea: What is this referred to in infants?
Cradle cap as it occurs most often in infants.
Seborrhea: When does this resolve?
Over a period of weeks ot months
Seborrhea: Adolescents may manifest this wher
scalp (dandruff) and on the eyebrows and eyelashes, behidn the ears, and between shoulder blades
Seborrhea: Thought that this is caused by what?
Fungus pityrosporum ovale and worsed by sebaceous invovle
Seborrhea: Theraptuic management?
treating skin lesiosn with corticosteori creams or lotions. Also antidandruff shampoos containing selenium sulfide or tar
Seborrhea, Nursing Assess: Assess infants scalp and forehead for what?
Thick or flaky greasy yellow scales
Seborrhea, Nursing Mx: What should be done for treatment for adolescents
Wash or shampoo with mild soap.
Apply anti-inflammatory cream to lesions.
Seborrhea, Nursing Mx: What should also be done for infants in treatment?
Apply mineral oil and massage well, then shampoo 10-15 mintues. and then use brush to gently lift the crusts.
Burns: Who would be referred to specialized burn unit?
Partial thickness greater than 10% of body
Burns of face, hands, feet
Chemical burns
Burn injury in children
Burns: How are burns described now?
Superficial, partial thickness, deep partial thickness, and full thickness.
Burns: What does superficial burn involve?
Only epidermal injury and usulally heal without scarring or other sequelae within 4-5 days.
Burns: What occurs in a partial thickness burn?
Injury occurs not only to the epidermis but also to poritons of the dermis . Heal within 2 weeks and minimal risk for scar formation
Burns: What occurs in deep partial-thickness burns?
Take longer to heal, may scar, and result in changes in nail and hair appearance. May require surgical intervetions
Burns: What occurs in full-thickness burns?
Significant tissue damage and extend down to hypodermis. Extensive scarring and sweat glands destroyed. Skin-grafting necessary.
Burns - Patho: Why does edema occur?
Blood vessels have increased permeability, resulting in vasodilation.
Increased hydrostatic pressure in capillaries, causing water, electrolytes and protein to leak out after burn
Burns - Patho: When does capillary permeability return to normal?
Between 48-72 hours.
Burns - Therapeutic Mx: This focuses onw hat?
Fluid resuscitation, wound care, prevention of infection and restoration of function.
Burns - Therapeutic Mx: How are they treated
With antibiotics specific to the causative organism
Burns - Health Hx: If this is not life-threatening, what information should be collected?
How burn occured, noting date, time, and cause. DEtermine if smoke inhalation occured.
Burns - Health Hx: How do spatter-type burns appear?
Nonuniform, asymmetric distribution of injury
Burns - Physical Exam: Primary survey of child includes what?
Evaluation of childs airway, breathing, and circulation.
Burns - Physical Exam: Secondary survey focuses on what?
Evaluation of burns and other injuries
Burns - Physical Exam: How do superificla burns appear?
Red, dry and possibly edematous. Painful
Burns - Physical Exam: How do partial thickness and deep partial thickness burns appear?
Are very painful and edematous and have a wet appearance or blisters.
Burns - Physical Exam: How will full-thicknes burns appear?
Red, edematous, leathery, dry or wacy and may display peeling or charrred skin
Burns - Labs: What is measured after a burn?
Electrolytes and CBC to measure fluid and electrolyte balance.
With infection, culture of drainage determined.
PCO2 will also be monitored.
Burns - Labs: What is used to evaluate inhalation injury?
Fiberoptic bronchoscopy and xenon ventilation.
Burns - Labs: Why is ECG monitoring important?
For those who suffered electrical burn to identify cardiac arrhythmias, which can appear 72 hours later
Burns, Nursing Mx: First focus?
Stabilizing the child. Place on cardiac/apnea monitor, measure with broselow tape, monitor pulse ox, and apply an end-tidal CO2 monitor.
Burns, Nursing Mx - Promoting Oxygenation/Ventilation: WHy is monitoring respiratory status important?
Airway edema can occur secondary to a burn and may not be evident until 2 days after injury.
Burns, Nursing Mx - Promoting Oxygenation/Ventilation: How to administer oxygen for those with severe burns?
Administer via nonrebreather mask or bag-valve-mask ventilation
Burns, Nursing Mx - Promoting Oxygenation/Ventilation: High levels of carboxyheoglobin as a result of smoke inhalation may result in what?
Falsely high pulse oximetry readings
Burns, Nursing Mx - Restoring/Maintaining Fluid Volume: How is fluid calculation determined?
Based on body surface area burned
Burns, Nursing Mx - Restoring/Maintaining Fluid Volume: Monitor urine output, which should be at what?
1 mL/kg/hr
Burns, Nursing Mx - Restoring/Maintaining Fluid Volume: What to know for weights?
Obtained at same time each day
Burns, Nursing Mx - Preventing Hypothermia: What to do to prevent this?
WArm IV fluids before administration. And maintain neutral thermal environment
Burns, Nursing Mx - Cleansing Burn: How to stop the burning?
Remove charred clothing. Wash/rinse burn with mild soap and never apply ice.
Burns, Nursing Mx - Cleansing Burn: How to remove tar?
With cool water and mineral oil.
Burns, Nursing Mx - Cleansing Burn: Wounds that are open require debridegement, which involves what?
Removal of loose skin adn eschar. Performed with sterile scissors and pair of forceps with a gauze.
Burns, Nursing Mx - Cleansing Burn: What to do when child comes in for eval of a wound?
Remove dressing by soaking the dressing in lukewarm tap water to ease removal of gauze, which may be stuck to wound.
Burns, Nursing Mx - Preventing Infection: What to do if immunizations status unknown?
Administer tetanus vaccine, along with 250 units tetanus human immunoglobulin
Burns, Nursing Mx - Preventing Infection: What is applied with burn dressing changes?
Antibiotic ointment.
Burns, Nursing Mx - Preventing Infection: What is an alternative to topical antibiotics?
Membrane dressings such as biosynthetic, hydrocolloid, and antibiotic impregnated foam dressing.
Burns, Nursing Mx - Managing Pain: What is commonly used?
Local anesthesia, sedatives, and systemic analgesics
Burns, Nursing Mx - Managing Pain: What pain management will be given to children with less severe burns managed at home?
oral meds such as acetaminophen with codeine 30-45 before dress change
Burns, Nursing Mx - Managing Pain: What will be given for someone with severe burns?
IV morphine sulfatw ith Midazolam (sedative) used with this
Burns, Nursing Mx - Txing Infected Burns: What occurs in burn wound cellulitis?
Area around the burn becomes red, swollen, and painful early in burn management
Burns, Nursing Mx - Txing Infected Burns: What happens in invasive burn cellulitis?
Burn develops a dark brown, black or purplish color. with discharge and foul odor.
Burns, Nursing Mx - Txing Infected Burns: What doees burn impetigo cause?
Causes abscesses which causes destruction of skin-grafted areas.
Burns, Nursing Mx - Txing Infected Burns: Treatment for infection?
Antibiotics
Burns, Nursing Mx - Providing Burn Rehab: Extensive burns may also result in need for pressure garments, which are what?
Not comfortable and they must be worn for 1 year straight, maybe 2. Effective in reducing hypertrophic scarring
Burns, Nursing Mx - Preventing Burns / CO Poisoning: What temp should water be kept at?
120 degrees or lower
Burns, Nursing Mx - Preventing Burns / CO Poisoning: What happens if water at 150 degrees?
Can receive third degree burn within 2 seconds
Burns, Nursing Mx - Preventing Burns / CO Poisoning: What happens if water is 140 degreees?
Takes 6 seconds to cause significant burn
Burns, Nursing Mx - Preventing Burns / CO Poisoning: What happen s if water 130 degrees?
CHild can be burned significantly in only 30 seconds
Burns, Nursing Mx - Preventing Burns / CO Poisoning: How long to get burned at 120 degrees?
Takes as long as 5 minutes.
Burns, Nursing Mx - Preventing Burns / CO Poisoning: Signs of CO poisoning?
Headaches, dizziness, disorientation and nausea
Burns, Nursing Mx - Preventing Burns / CO Poisoning: When to seek medical care for burns?
When they have 2nd/3rd degree burn
Burn results from fire, electrical socket.
Burn appears to be infected.
The nurse is teaching about skin care for atopic dermatitis. Which statement by the parent indicates that further teaching may be necessary?
“I will use Vaseline or Crisco to moisturize my child’s skin.” “A hot bath will soothe my child’s itching when it is severe.” “I will buy cotton rather than wool or synthetic clothing for my child.” “I will apply a small amount of the prescribed cream after the bath.”
“A hot bath will soothe my child’s itching when it is severe.”
The nurse is caring for a child who has received significant partial-thickness burns to the lower body. What is the priority assessment in the first 24 hours after injury?
fluid balance wound infection respiratory arrest separation anxiety
fluid balance`
The nurse is caring for a child in the emergency department who was bitten by the family dog, who is fully immunized. What is the priority nursing action?
Administer rabies immunoglobulin. Refer the child to a counselor. Assess the depth and extent of the wound. Administer a tetanus booster.
Assess the depth and extent of the wound.
The nurse is caring for an infant on the pediatric unit who has a very red rash in the diaper area, with red lesions scattered on the abdomen and thighs. What is the priority nursing intervention?
Administer griseofulvin with a fatty meal. Institute contact isolation precautions. Apply topical antibiotic cream. Apply topical antifungal cream.
Apply topical antifungal cream.
A varsity high-school wrestler presents with a “rug burn” type of rash on his shoulder that is not healing as expected, despite use of triple antibiotic cream. Two other wrestlers on his team have a similar abrasion. What infection should the nurse be most concerned about, based on the history?
tinea cruris MRSA impetigo tinea versicolor
MRSA
