Exam 4 (skin and poisoning, etc) 25% of final Flashcards
pruritis
itching
erythema
reddened area caused by increased amounts of oxygenated blood in the dermal vasculature
ecchymoses (bruises)
localized 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
papule
palpable solid elevated less than 1cm lesion (wart/mole)
macule
nonpalpable flat and circumscribed lesion less than 1cm (freckle)
nodule
elevated solid lesion may extend into dermis, greater than 1 cm (fibroma)
wheal
localized area of edema, elevated and firm/itchy (mosquito bite)
vesicle
elevation of skin filled with clear fluid, less than 1cm (blister, herpes simplex)
pustule
elevation of skin filled with pus (acnes, impetigo)
ulcer
loss of skin layer, irregular shape, may bleed (pressure sore, chancre)
atrophy
thinning of the skin (from steroid use, aging)
types of wound healing
primary, secondary, tertiary
primary wound healing
all layers of wound are well approximated; heals with minimal scarring; ex is surgical incision; suture clean wound when even margins
secondary wound healing
when edges cannot be well approximated; healing occurs after likely debridement; heals from edges/bottom inward and upward
tertiary wound healing
suturing is delayed after injury or wound later breaks down and is sutured or re-sutured when granulation is present; increased risk for infection or abscess formation; can be due to a wound-vac
signs of wound infection
increased erythema (beyond wound margin), edema, purulent exudate, odor, pain at site or beyond, increased temp (at site and generalized)
bacterial infections of the skin
impetigo contagiosa, pyoderma, cellulitis, folliculitis and furuncle and carbuncle, staphylococcus aureus and MRSA
impetigo contagiosa
staph or strep infection; begins as reddish macule and becomes vesicular; ruptures easily leaving moist superficial erosion; spreads peripherally in sharp marginated irregular outlines; exudate dries to form heavy honey-colored crusts; pruritis common; loosen scales with burows solution; usually heals without scarring unless secondary infection; highly contagious
pyoderma
deeper extension of infection into the dermis; caused by MRSA/Strep/Staph; most common in ages 2-5; can lead to sepsis if untreated
cellulitis
inflammation of skin and subcutaneous tissues; characterized by redness, swelling, firm infiltration; can form abscesses
folliculitis, furuncle, carbuncle
folliculitis- pimple; furuncle- boil, carbuncle- multiple obils
staphylococcus aureus and MRSA
bacterial infection that require certain antibx to treat (often more painful than expected for lesion); can do gentile bleach bath for sterile skin
viral infections
verruca, verruca plantaris, herpes simplex virus, varicella zoster virus, molluscum contagiosum
verruca
warts; well circumscribed gray or brown, elevated, firm papules; local destructive therapy to remove like liquid nitrogen; common in children and tend to disappear spontaneously
verruca plantaris
plantar warts; flattened due to constant pressure; removed via caustic chemical solution or surgical removal
herpes simplex virus
grouped burning and itching vesicles in inflammatory base usually near mucosa and skin like nose lips genitalia and buttocks; vesicles dry forming crust then exfoliate and then spontaneously heal after 8-10 days; avoid secondary infection and may require antiviral like acyclovir and valtrex; type 1 can be prevented using sunscreens and protecting against UV rays
varicella zoster virus
aka herpes zoster/shingles; same virus that causes chicken pox; preceded by neuralgic pain and itching followed by vesicular pain following dermatone; contagious to anyone who has not had chickenpox or not immune against chicken pox or immunocompromised; treat with pain meds, antivirals, and shingles vaccine for >50yrs
dermatone
area of sensory nerves near the skin that are supplied by specific spinal nerve root
type 1 vs type 2 herpes simplex virus
type 1: cold sores, fevers, blisters; type 2: genital
molluscum contagiosum
pox virus; occurs in trunk, face, extrem.; common in school aged contact and spread skin to skin; well children resolve spontaneously within 18 mo; chemical treatment
molluscum
flesh colored papules with central caseous plug
fungal skin infections
tinea capitis, tinea corporis, tinea cruris (jock itch), tinea pedis (athletes foot), tinea unguium (nails); candidiasis
tinea
aka ring worm; all are itchy; transmit person to person; good hygiene is important
candidiasis
oral thrush in neonates (treat with nystatin); antifungal required based on location
miscellaneous infection of the skin
urticaria, intertrigo, psoriasis, alopecia, erythema multiforme
urticaria
aka hives; usually allergic response to drugs or infection
intertrigo
mechanical trauma/friction due to excessive heat, moisture, and sweat retention
psoriasis
cause is unknown; hereditary predisposition; may be triggered by stress
alopecia
acreata- sudden onset noninflammatory round, bald patches in hairy parts of body; traumatic- traction based (tight hair styles); trichotilliomania- compulsive hair pulling
erythema multiforme
steven johnson syndrome; associated with ingestion of some drugs and often follows upper respiratory tract infection; rare and serious disorder causing inflammation and ulcers throughout the body
lyme disease
most common tickborne disorder in the US; most cases in NE from s. maine to northern virginia; may to october
3 stages of lyme disease
localized- 3 to 30 days where erythema migrans rash can be seen; early disseminated- 3 to 10 weeks; systemic involvement- 2-12 months, cuases myocarditis and chronic pain
treatment for lyme disease
all ages take oral doxycycline
scabies
endemic infestation caused by scabies mite; lesions created from impregnated females burrow into epidermis to lay eggs and feces; causes inflammatory response and pruritis; transmitted via prolonged personal contact; maculopapular lesions characteristically distributed in skin folds
treatment for scabies
application of scabicide; permetrin 5% cream (elimite) for > 2 months old; enough meds for everyone in the househould
headlice
aka pediculosis capitis; observation of white eggs (nits) firmly attached to the hair shaft
treatment of headlice
application of pediculicides and manual removal of nit; permethrin 1%; repeat 7-10 days to ensure cure; malthion for children >2 yo with recurrent lice; removal of nits with metal comb daily; transmitted via person to person contact/personal items
nursing care to prevent spread and recurrence of pediculosis
machine wash everything, vacuum all household furniture and accessories; seal non-washable items in plastic bag for 14 days; soak combs/brushes/hair accessories in lice killing products (1hr) or boiling water for (10min); discourage sharing of items among children; avoid physical contact with infected kids; inspect children in group setting regularly; provide education
diaper rash
diaper dermatitis is caused by prolonged and repetitive contact with an irritant; candida albicans infection (yeast)
treatment of diaper rash
keep skin dry, use superabsorbent diapers, change diapers as soon as soiled, expose healthy or slightly irritated skin to air, apply ointment like zinc oxide or petrolatum, avoid removing skin barrier cream, avoid washing with perfumed soaps or commercial wipes, may use moisturizer, wipe stool gently with soft cloth and warm water, use disposable diapers (detergent and alcohol free), apply powder
atopic dermatitis
aka eczema; chronic relapsing inflammatory skin disorder that results in itching and lesions; occurs in 20% of children; unknown cause but likely genetic and environmental causes; symptoms vary but itching is common in all; 3 types based on age and distribution of lesions3 t
3 types of eczema
infantile eczema- usually begins 2-6 months and undergoes spontaneous remission by 3 yrs; childhood- may follow infantile and occurs 2-3yrs of age and 90% of children have manifestations by age 5; preadolescent and adolescent- begins at 12yrs and may continue into early adulthood or indefinitely
atopic dermatitis/eczema management
hydrate the skin, relieve pruritis, reduce flare-ups or inflammation, prevent and control secondary infection
difference in BSA children vs adult
children have increased BSA of head and torso
key points of burns
fluid treatment for major burns (requires very high volume fluid repletion), monitor UOP; pt lose ability to regulate temp with major burns (keep room 85-100); pain management; frequent PT/OT to prevent contractures; hot water heater set to 120F;
1st degree burn
epidermis remain intact without blisters; erythema, skin blanches with pressure; painful; discomfort lasts 48-72 hrs and desquamation occurs in 3-7 days
2nd degree burn
wet, shiny, weeping surface; wound blanches with pressure; painful and sensitive to touch and air; superficial partial heals in <21 days; deep partial heals >21 days; healing depends on depth and presence of infection
3rd degree burn
color varies from deep red, white, black, brown; surface dry; thrombosed vessels visible; no blanching; insensate (decreased pinprick sensation); autografting necessary for healing
4th degree brurn
color varies; charring present in deepest areas; extremity movement limited; insensate; amputation of extremities is likely; autografting is required for healing
emergency care of poisoning
- assess victim- ABCs, mental status, trauma/illness associated; 2. terminate exposure- remove object from mouth, remove toxins from skin, remove from inhaled toxins (move to fresh air); 3. identify the poison- ask others, call poison control; 4. prevent poison absorption- prevent aspiration, side lying
caustic ingestion
can quickly cause severe esophageal and gastric erosion; all caustic ingestions are medical emergency and require 911; ED should have intubation kit ready; teach and reinforce safe storage
acetaminophen (tylenol) poisoning
most common accidental drug poisoning in children; toxicity occurs from acute ingestion
signs and symptoms of tylenol overdose
4 stages; start with GI symptoms; lead to liver failure; eventually can lead to death if untreated or undetected
antidote for acetaminophen poisoning
N-acetylcysteine (mucomyst); equally effective if oral or IV
4 stages of acetaminophen poisoning after ingestion
0-24hrs: N/V, sweating, pallor; 24-72hrs: patient improves, may have right upper quadrant abdominal pain; 72-96: pain in right upper quadrant, jaundice, vomiting, confusion, stupor, coag. abnormalities, potential renal failure, pancreatitis; more than 5 days: resolution of hepatotoxicity or progress to multiple organ failure, may be fatal
lead poisoning
most instances of acute childhood lead poisoning from lead based pain in older homes or lead-contaminated bare soil; can have long term systemic affects; need to be <5mcg/dL otherwise need treatment; lead chelation therapy needed for severe cases
child neglect
lack of intervention or providing of necessary resources
physical neglect
the deprivation of necessities such as food, clothing, shelter, supervision, medical care, and education
emotional neglect
failure to meet the childs needs for affection, attention, and emotional nurturance
child abuse
purposefully inflicting harm; other children within the home are at risk and should be evaluated; children <1 y/o are at highest risk for physical abuse
sexual abuse common abuser
tends to be male
mandated reporter
staff members of medical or other public or private institutions, schools or facilities; usually submitted by social worker ED but can be submitted by anyone
mandated reporters must…
immediately make oral report to DCF, when in professional capacity, they have reasonable cause to believe child under age of 18 years is suffering from abuse and or neglect; must submit written report within 48 hours
down syndrome
most common chromosomal abnormality of a generalized syndrome; maternal age is known risk factor; degree of cognitive and physical impairment depends on percentage of cells with abnormal chromosome makeup; can be diagnosed with manifestations but should be confirmed with chromosome analysis
clinical manifestations of down syndrome
oblique palprebal fissures (upward, outward slant), small nose, depressed nasal bridge (saddle nose), high arched narrow palate, neck skin excess and laxity, congenital defect, wide space between big and 2nd toes, plantar crease between big and 2nd toe, hyperflex ability and muscle weakness
fragile x syndrome
most common inherited cause of cognitive impairment and second most common genetic cause of cognitive impairment or intellectual disability after down syndrome; caused by abnormal gene on lower end of the long arm of x chromosome
fragile x clinical manifestations
increased head circumference, long wide or protruding ears, long narrow face with prominent jaw, strabismus, mitral valve prolapse, aortic root dilation, hypotonia, enlarged testicles, behavior features, mild to severe cognitive impairment, speech delay (may be rapid with stuttering and repetition), short attention span/hyperactivity, hypersensitivity to tastes sounds and touch, intolerance to routine change, autistic like behaviors (gaze and social anxiety), possible aggressive behavior
hearing impaired children
should have hearing screen (AABR) prior to discharge; may be caused by prenatal and postnatal conditions
hearing aid behaviors in infants
lack of startle reflex for sounds, failure to awake from loud sounds, failure to localize source of sound by 6 mo, absence of babble or voice inflections by 7 mo, general indifference to sound, lack of response to spoken word, failure to follow verbal directions, response to loud noises as opposed to voice
safety teaching for hearing aid batteries
store where children cannot reach; do no allow children to change batteries themselves
visually impaired children
consists of myopia, hyperopia, amblyopia, strabismus
myopia
nearsightedness- ability to see objects clearly at close range but not at distance; correct with biconcave lenses that focus rays on retina; may be corrected with laser surgery
hyperopia
farsightedness- ability to see objects at a distance but not close range; correct with convex lenses when required that focus rays on retina; may be corrected with laser surgery
amblyopia
lazy eye- reduced visual acuity in one eye; poor vision in affected eye; preventable treatment of primary visual defect before 6 years old
strabismus
squint or malalignment of eyes; esotropia- inward deviation of eye; exotropia- outward deviation of eye; need to treat underlying cause
autism spectrum disorders
complex neurodevelopmental disorders of unknown etiology; consist of difficulties in social communication, social interaction, restricted repetitive behavior interest or activities; 1 out of ever 68 US children; males 4x more likely to be dx; commonly diagnosed at younger age d/t early signs; provide support with diagnosis and therapies
chronic conditions in children
medical condition that persists for > 1 yr; affects several organ systems or critically affects one system and needs specialty expertise
nursing care considerations for chronic conditions
focus on development, family centered care, help child and family with coping mechanisms
nursing care of family and child with complex or chronic conditions
proper assessment; provide support at time of diagnosis; special considerations for congenital anomaly, cognitive impairment, physical disability, chronic illness, multiple disabilities, terminal illness
separation anxiety
age increases understanding and tolerance; regression and additional comfort needs common when child is hospitalized/has chronic illness
stages of separation anxiety in young children
stage of protest- crying, screaming, physical behavior against care givers, can last hours to days; stage of despair- withdrawing, depressed, sad, regress to earlier behaviors like bedwetting or thumb sucking; stage of detachment- usually occurs after prolonged separation, build new relationships with providers, may appear happy
palliative care of the child
once death is discussed as the outcome it is necessary to determine childs and familys preference for location of palliative care; could be hospital, home, or hospice; prioritize comfort and pt wishes
common physical symptoms of dying child
fear, anxiety, pain, decreased RR, SOB
when discussing death to child
children can be very aware with what is going on with them/around them; important to explain in child appropriate terms
unexpected childhood death
occurs from trauma, SIDS (peaks 1-4 mo, sudden death <1yr)
if childs family not present at time of death…
provide calm clear explanation of childs status, provide opportunity to see boy and repeat offer at later time if denied, warn how child may appear (tubes, lines), provide bereavement kit lik locks of hair or foot/hand print), limit providers present when family with child
