Integumentary Disorders Flashcards
Differences in Anatomy and Physiology of the
Skin of a Pediatric Patient vs an Adult Patient
- Infant’s blood vessels lie closer to the surface
- Pediatric patient with decreased subcutaneous fat
- Infant loses heat easier than an older child/adult
- Substances are absorbed more readily in an infant
- Bacteria can gain easier access via skin
- Infants skin less pigmented – UV rays more damage
- Infants skin has higher water content – blisters easier
- Skin thickness and characteristics reach adult level by teenage years
Skin Differences, cont.
Dark–skinned children
More pronounced cutaneous reactions
* Hypo- or hyper-pigmentation in affected area more prominent
* More prominent papules, follicular responses, lichenification,
and vesicular or bullous reactions
* More frequent hypertrohic scarring and keloid formation
Skin Differences, cont.
Sebaceous and Sweat glands
- Sebaceous glands immature / increase in tween years
- Eccrine glands fully functional in tween years
- Appocrine sweat glands mature during puberty – produce odor
Assessment – Pediatric
Integumentary/Tissue Disorders Health Hx
onset, location, other sxs, relieving factors
discharge from lesions?
pruritis?
change in environment or food intake?
new soaps, detergents?
anyone else at home with similar sxs?
pets? Pets go outdoors?
Sun exposure?
play in woods or fields?
ASSESSMENT – PEDIATRIC
INTEGUMENTARY/TISSUE DISORDERS,
CONT.
Physical Exam:
Good lighting to examine skin
MM for lesions
Examine all surfaces of skin and scalp
Temperature, moisture, texture, and fragility
Lesions/rashes – detailed explanation
drainage
Common Nursing Diagnosis
- Impaired skin integrity
- Risk for infection
- Risk for volume deficit
- Altered nutrition
- Disturbed body image
- Alt in comfort/pain
- Risk for caregiver role strain
Bacterial Infections of Integumentary
- Bullous impetigo
- Nonbullous impetigo
- Folliculitis
- Cellulitis
- Staph scalded skin syndrome
Bacterial Infections of Integumentary, cont. - Bullous (blisters) impetigo
More common in infants
* Sporadic occurrence
* Intact skin
* S.aureus
Bacterial Infections of Integumentary, cont. - Non-bullous impetigo
70% of cases, 2-5 y. most common
* S. aureus - most common cause
* After skin trauma or secondary bacterial infection* Contagious
* Honey colored/crusted lesions
* Prevent spread; single towel, etc.
* Antibiotic ointment vs oral antibiotic (Keflex)
Bacterial Infections of Integumentary, cont. - Folliculitis
- infection of hair follicle
- occlusion of hair follicle
- May result: poor hygiene, contaminated water, maceration, moist environment, use of occlusive emollient products
Bacterial Infections of Integumentary, cont.
(Cellulitis)
- Localized infection and inflammation of skin and subcutaneous tissues
- Usually preceded by skin trauma
- Periorbital cellulitis – bacterial infection eyelids and surrounding tissues
- Entry: bug bite, laceration, abrasion, FB or impetiginous lesion
- Bacteria produce an enzyme or endotoxic that initiate inflammatory response
- Results in: Erythema, edema and infiltration of the skin
Bacterial Infections of Integumentary, cont. (Staphylococcal scalded skin syndrome)
- S. aureus invades and produces a toxin that causes exfoliation
- Abrupt onset – diffuse erythema and tenderness
- Most common: infants, rare >5yo
Bacterial Infections of Integumentary,
cont. - Methicillin Resistant Staph Aureus (MRSA)
- community acquired
- presents as abscess or cellulitis
- RFs: sharing items ie towels, team sports, day care, camps
- Culture for MRSA
Fungal Conditions
Tinea pedis
Tinea corporis (ringworm)
Tinea versicolor
Diaper candidiasis
Tinea capitis
Table 23.2
Fungal conditions, cont. (Nursing Management)
Return to school or daycare once treatment initiated (corporis)
* wash linen in hot water
* do not reuse linen, clothes
* keep areas clean and dry
* white socks cotton
* flip flops in swimming pools/locker rooms
* pigmentation return in several mos (versicolor)
Inflammatory Skin Conditions (Diaper Dermatitis)
- inflammatory reaction of skin
- response to skin irritant
- teaching guidelines in book
Atopic Dermatitis (eczema)
- 2.5-20% of children affected
- often assoc with food allergies, allergic rhinitis, asthma
- chronic itchig causes physicological distress
- self image
difficulty sleeping
irritability
parental stress over condition
Complications: scarring, hypopigmenation, lichenification, secondary
bacterial infection
Treatment: skin hydration, topical corticosteroids, topical immune modulators, oral antihistamines
Inflammatory Skin Conditions, cont.
(Contact Dermatitis)
- Irritant (detergent, soap, sweat, rough fabric)*
- Allergic (poison ivy/oak/sumac, jewelry, detergent, creams/lotions, dyes)
- Nickel – materials containing nickel (buttons, buckles)
- Diaper –
- Complications:
- Secondary infection
- Lichenification of the skin
- Change in pigmentation
Inflammatory Skin Conditions, cont.
(Erythema Multiforme)
- Acute hypersensitivity
- Uncommon in children
- Viral infections – adenovirus or EBV, mycoplasma
- Drug (esp sulfa, PCN, immunizations)
- Food reaction
- Most severe: Stevens-Johnson syndrome (SJS) & toxic epidermal necrolysis (TEN)
- Abrupt onset: fever, malaise, myalgias, pruritis and burning
- Erythematous macules to papules to placques to vesicles and target lesions over a period of days
- Supportive care – analgesics, fluids, antihistamines
Inflammatory Skin Conditions, cont. (Urticaria)
- hives
- type 1 hypersensitivity reaction
- antigen-antibody response of histamine from mast cells
- vasodilation and increased vascular permeability result in erythema and wheals
- disappear few days to mos
- common causes: foods, animal stings, infections, environmental stimuli (cold, heat, sun), stress, UK
- identify and remove cause
Inflammatory Skin Conditions, cont. (Urticaria) - Nursing Assessment
- hx: new foods, medications, recent infection, environment changes, stress
- exam: hives are raised, edematous, erythematous, blanchable, migrate,
- pruritic, angioedema presents as subcutaneous edema and warmth –extremities, face,
- genitalia Always assess airways and breathing
- management: avoid triggers, antihistamine, corticosteroids, antipruritics
- Epinephrine if airway compromised
INFLAMMATORY SKIN CONDITIONS,
CONT.
(Seborrhea)
- Chronic inflammatory dermatitis skin or scalp
- Infants (cradle cap) also nose, eyebrows, behind ears, diaper area
- Adolescents scalp (dandruff), eyebrows, eyelashes, behind ears and between shoulder blades
- Inflammatory reaction to fungus worsened by sebaceous involvement
- Treatment: corticosteroid creams, antidandruff shampoos
INFLAMMATORY SKIN CONDITIONS,
CONT.
(Seborrhea)
- Chronic inflammatory dermatitis skin or scalp
- Infants (cradle cap) also nose, eyebrows, behind ears, diaper area
- Adolescents scalp (dandruff), eyebrows, eyelashes, behind ears and between shoulder blades
- Inflammatory reaction to fungus worsened by sebaceous involvement
- Treatment: corticosteroid creams, antidandruff shampoos
Inflammatory Skin Conditions, cont.
(Acne neonatorum)
- response to maternal androgens or transient androgen production in newborn
- present at birth or 2-4 weeks of age
- no treatment
- resolves spontaneously several mos to a year
Inflammatory Skin Conditions, cont.
(Acne Vulgaris)
- 85% of adolescents
- begin as early as, 7-10years old
- androgens play a role
- face, chest, back
- RF’s preadolescence/adolescence, male, oily complexion
- Patho: sebaceous glands produce sebum
- bacterial overgrowth – inflammation as follicular wall perforates contents leaks into nearby tissue
- Therapeutic Management:
- decrease sebum production, normalize skin shedding and eliminating inflammation
- cleanse BID
- Med therapy: combo of benzoyl peroxide, salicylic acid, retinoids, and topical and/or oral antibiotics, OCPs (decrease effects of androgens on sebaceous glands)
- severe cases: Isotretinoin
Skin Injuries
(Sunburn)
- Damage to epidermis
- Erythema, blisters
- Pain, fever, chills, nausea, headache
- Comfort; Fluid resuscitation
- Sunscreen, sunglasses
- Increased risk: malignant melanoma
Skin Injuries, cont.
(Burns)
- Most common: scald (fire, hot liquid or surface) & chemical (cleaning agents)
- Damage depends on type/location of injury, temperature, depth into tissues* Rule of 9s* Facial/esophageal? Respiratory distress?* > 30 % body surface area (BSA) can be at risk for hypovolemia & shock* Decreased blood volume, decreased cardiac output, decreased urine output, decreased perfusion to extremities* Inflammatory response, causes increased capillary permeability (leak), fluid/lytes, proteins leak into interstitial space resulting in EDEMA* Inflammatory mediators: increased metabolic rate & glucose metabolism, increased protein/loss of muscle mass* Increased demand on heart, risk for renal failure (blood flow to kidneys)* Immunosuppression (no barrier, infections)* Does injury match mechanism of injury? ?Abuse? * Fluid resuscitation depends on BSA & depth (fluid loss is 5-10x greater from
SKIN INJURIES, CONT. - Burns (Nursing Management)
- Oxygenation / ventilation
- restoring and maintaining fluid volume
- prevent hypothermia
- preventing infection
- managing pain
- rehabilitation
