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Peds Exam 5 > Integumentary > Flashcards

Integumentary Flashcards

1
Q

Difference in Skin Between Children and Adults

A
  • Infant’s epidermis is thinner and blood vessels are closer to the surface.
  • Infant’s skin contains more water.
  • Infant’s skin is less pigmented,
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2
Q

Infant’s epidermis is thinner and blood vessels are closer to the surface so that means..

A

Infant loses heat more readily through skin surface.
Allows substances to be absorbed through skin quicker
Dehydrate quicker

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3
Q

Infant’s skin contains more water, which means..

A

Epidermis is loosely bound to the dermis.
Friction may easily cause separation of layers, resulting in blistering or skin breakdown.

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4
Q

Infant’s skin is less pigmented, which means…

A

at risk for UV damage.

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5
Q

Age-Related Skin Manifestations

A
  • Infants: Birthmarks; diaper dermatitis (Mongolian spots mistaken as bruising)
  • Early childhood: Atopic dermatitis; viral illness
  • School-age children: Ringworm
  • Adolescents: Acne; contact dermatitis
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6
Q

Atopic Dermatitis (Eczema)

A

Frequently seen in infants/kids with asthma
Incidences decrease with age
Allergy response- foods, detergents, soaps, shampoo, fabrics

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7
Q

Atopic Dermatitis (Eczema) s/s

A

dematous, Pruritic(itchy), weep and crust
Mostly seen on cheeks, distal surfaces arms and legs
Scratching cause skin break down leading to infection – scratching creates huge portal of entry for infection

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8
Q

Treatment for Eczema

A
  • avoid dressing to much-too hot
  • No solid foods until 6month
  • Avoid triggers (Heat causes reaction and causes them to itch more)
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9
Q

How to introduce solid foods to babies

A

· 1 solid food over for 4-7 days to see if react to it

o if do more than 1 don’t know what reacting to

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10
Q

Preventative tx eczema

A

Oral/topical antihistamines

Benadryl

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11
Q

Flare up tx eczema

A

topical steroids, antibiotics for 2ndary infections

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12
Q

Skin hydration eczema

A

tepid baths, emollients afterwards, soft cotton clothing

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13
Q

Nursing Dx Eczema

A

Impaired skin integrity, Pain, risk for infection, Knowledge deficit

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14
Q

Diaper Dermatitis

A
  • Usually from irritation of urine and feces
  • Detergents inadequately rinsed from clothing
  • Chemical irritation (especially from diaper wipes)
  • Folds or creases in the groin are usually unaffected
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15
Q

most chemicals put on baby from…

A

Wipes, Take wipes, wash out with water then put on baby

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16
Q

Nursing considerations for diaper dermatitis

A

include altering wetness, pH, and fecal irritants

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17
Q

Candidiasis of diaper area***

A

Yeast infection

_Skin folds or creases in the groin are affected
Satellite lesions are apparent_
Goes everywhere
Feed yogurt

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18
Q

Bacterial Infections of the Skin

A

Bullous and nonbullous impetigo
Folliculitis
Cellulitis
Staphylococcal scalded skin syndrome

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19
Q

Impetigo

A

Most common in toddlers and preschoolers
Mostly during Summer, highly contagious
Staph Aureus
Vesicular, blister-like rash (Rash usually on face around bottom lip/chin)

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20
Q

Impetigo Discharge**

A

dries to a honey colored crust

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21
Q

Impetigo treatment

A

remove crusting, oral and or topical antibiotics

Take off crust so good application of antibiotics

Teach parents to wash hands!

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22
Q

Cellulitis

A

All ages
Staph Aureus, Grp A streptococci, MRSA
Enters through a puncture wound, scrathc , abraision
Begins as an inflammatory response but bacteria proliferates and migrates to sub Q layer of skin
Can also be in body already because carrier then float and land in certain area

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23
Q

Cellulitis s/s

A

redness, edema, warmth, pain, FV, malaise, lymphadenopathy

Get the hugh around the area of infection – blueberry appearance**

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24
Q

cellulitis dx

A

wound, Cx, CBC, Bld Cx.

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25
Q

cellulitis tx

A
  • IV antibiotics (vanc)
  • Tylenol/motrin
  • Warm compresses, I&D
  • Pack dressing and leave in, change every 2 days
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26
Q

nursing dx cellulitis

A

Impaired skin integrity, Infection, Knowledge deficit, Pain

Knowledge deficit – how to take care of, how got, how to prevent

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27
Q

Tinea pedis:

A

fungal infection on the feet, athelete’s foot

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28
Q

Tinea corporis:

A

fungal infection on the arms or legs- ring worm

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29
Q

Tinea versicolor:

A

fungal infection on the trunk and extremities

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30
Q

Tinea capitis:

A

fungal infection on the scalp, eyebrows, or eyelashes (ringworm)

31
Q

Tinea cruris:

A

fungal infection on the groin

32
Q

fungal infection s/s

A

S/S- skin red, itchy, dry, scaly, distinct ring rash

Patches of hair may fall out where ring worm is at

33
Q

fungal infection tx

A
  • topical or oral antifungal
  • Scalp usually oral treatment- griseofulvin (PO or topically)
  • Teach hygeine
34
Q

scalp fungal infection tx**

A

griseofulvin PO

35
Q

Pediculosis

A

LICE

  • Capitis- head- lesions behind ears and on neck from scratching- nits- removed with a fine toothed comb
  • Corporis- Body
  • Pubis- pubic- sexual contact
36
Q

Most obvious sign of lice**

A

constantly scratching head

37
Q

Pediculosis tx

A

Treat everyone in the house even if no s/s
Put rid kick in hair and comb to get nits (eggs) out

38
Q

Scabies

A

Caused by scabies mite as female burrows into the epidermis to deposit eggs and feces
Inflammation occurs 30 to 60 days later
Usually around torso and around finger

39
Q

scabies s/s

A

Intense pruritus

40
Q

scabies tx

A

Elimite

41
Q

bee stings

A
  • May cause mild to moderate discomfort- apply cool compresses
  • Manage with symptomatic measures and prevention of secondary infection
  • With beestings, the stinger penetrates the skin
  • Sensitization to beestings may result in anaphylaxis
42
Q

why apply cool compress to bee sting

A

vasoconstricts to keep venom from spreading, so decrease swelling

43
Q

If stinger is left in pt then

A

Remove the stinger as soon as possible – use edge of object to scratch out, don’t use tweezers

44
Q

If Sensitization to beestings may result in anaphylaxis then tx with **

A

epipen

45
Q

Macules** -

A

flat brown, mole less than 1 cm diameter

46
Q

Vesicles -

A

bullae- elevated,circumscribed , less than 1 cm diameter, serous fluid

47
Q

Acne

A

predominantly in adolescents

Pathophysiology

  • Involves hair follicles and sebaceous glands
  • Comedogenesis (clogs pores, black heads)
48
Q

Topical Acne Medications

A

Topical – benzoyl peroxide and Retin-A

49
Q

Medication given for Acne only after not responding to other treatment**

A

Accutane

  • Sucks moisture out of skin
  • Will lose weight
  • Blood work every month
  • Terrible birth defects
  • Puts at a higher risk for fractures
50
Q

Acne nursing dx

A

body image/self esteem

51
Q

Burns

A

Toddlers: Hot water scalds
Older children: Flame-related burns
Child abuse – cig burns, curling iron burns
Child with matches or lighters accounts for 1 in 10 house fires

52
Q

Characteristics of Burn Injury

A

Extent of injury described as total body surface area (TBSA)

53
Q

depth of burn injury**

A
  • Superficial (first degree)
  • Partial thickness (second degree)
  • Full thickness (third degree)
  • Full thickness plus underlying tissue (fourth degree)
54
Q

Superficial (first degree)

A

only epidermis, feels pain, no blisters

usually heal without scarring within 4-5 days

55
Q

Partial thickness (second degree)

A

epidermis and dermis, red, blisters, not popped, very painful,

heal within 2 weeks with minimal risk of scarring

do not pop blisters

56
Q

Full thickness (third degree)

A

pale white, no hair, don’t feel pain-numb,

take longer to heal, changes in hair, nail, and sebaceous glands,

extend through epidermis, dermis, and hypodermis,

extensive scaring

deep tissue damage

57
Q

Full thickness plus underlying tissue (fourth degree)

A

if underlying tendons and/or bone damanged

58
Q

Assessment of burns

A

Primary survey-ABCs- measure end tidal CO2, carboxyhemoglobin (carbon monoxide)can cause a false high O2 sat.have cherry red lips

Secondary- type of burn, pattern, blistering, eschar, MOI (chem burn/flash burn), depth

59
Q

severity of burn injury

A

Major burn injury is treated in a specialized burn center
Moderate burn injury is treated in a hospital with expertise in burn treatment
Minor burn injury is treated in an outpatient setting
If walk into hospital then your responsibility

60
Q

Inhalation Injury

A

Trauma after inhalation of heated gases and toxic chemicals produced during combustion
Upper airway obstruction may require endotracheal intubation

If see cinged eyebrows/burn on skin, get ready to intabate because airway will swell

61
Q

Inhalation Injury s/s**

A

sut nose, mouth, cinged facial hair, eyebrows, nose hair

62
Q

Pathophysiology of Thermal Injuries

A
  • Systemic response involving increased capillary permeability leading to vasodilatation
  • Edema-H2O, electrolytes, protein leak from vasculature into tissue as a result of the increased hyodrostatic pressure
  • Hypovolemia- fluid loss occurs at 5-10 more in burned skin
  • Initially a decreased cardiac output occurs but then changes to a hypermetabolic state that can lead to insulin resistance and increased protein catbolism
63
Q

because pts are in a hypermetabolic state, what type of diet?

A

high protein and high carb

64
Q

Complications of Burn Injuries ***

A

Immediate threat of airway compromise
Profound shock- most immediate threat to life
Infection (local and systemic sepsis)- after the acute phase
Inhalation injuries, aspiration, pulmonary edema, pulmonary embolus

65
Q

at risk for infection after what phase of burn**

A

acute phase

66
Q

Burns: Therapeutic Management

A
  • First priority is airway maintenance
  • Fluid replacement therapy is critical in the first 24 hours - So 1st secure airway, then flood with fluids so no shock
  • Prevent infection
  • Restore function
  • Skin doesn’t have elasticity anymore – can’t move – have to go to burn unit to get function of joint
  • Nutrition for enhanced metabolic demands - High protein – low carbs
67
Q

what can lead to a false O2 sat reading in burn pt

A

high levels of carboxyhemoglobin

68
Q

care of major burns

A
  • Primary excision – removing dead skin
  • Débridement- whirl pool, premedicate - Washes off dead skin​
    • Typically give morphine before
  • Topical antimicrobial agents – Silvaderx, vasotracin – keep moist and wrap it
  • Biologic skin coverings
    • Allograft (human cadaver skin)
    • Xenograft (porcine skin)
    • Synthetic skin substitutes
    • Split-thickness skin grafts (sheet or mesh grafts)
69
Q

Care of minor burns

A
  • Wound cleansing – run under cool water, don’t pop blister, clean with little antimicrobial soap, put basic tracin or silvadin on
  • Débridement - To pop the blister or not to pop the blister
  • Dressings - Controversy regarding whether to cover the wound with antimicrobial ointment or occlusive dressings
    • Typically silvade
70
Q

rehabilitation after major burns

A

Begins once wound coverage has been achieved
Prevention or management of contractures
Physical and occupational therapy
Multidisciplinary team
Facilitate adaptation of the child and family

71
Q

depth of burns pic

A
72
Q

Common skin injury in children due to ultraviolet exposure

A

sunburn

73
Q

Nursing Implications - Sunburns

A

EDUCATION:

  • Importance of protection with sunscreen application above 6 months of age \
    • Can’t put sunscreen on before 6 months, so baby should not be out in sun
    • If younger know shade and clothes
  • Clothing
  • Limiting risk of injury or exposure- stay in shade or inside

Peds Exam 5 (5 decks)

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