Infant vs Adult skin 1. Epidermidis is thinner...(Consequences) 2. Skin contains more water.. (Consequences) 3. Less pigmentation... (Consequences) 4. When does skin reach adult thickness... 5. Darker skin may have these issues...

1. Loses heat quicker & substances more easily absorbed through skin 2. Friction results in skin breakdown/ blistering 3. UV damage Increased odds 4. Teenager Hypertrophic scarring/ keloids

Nonbullous impetigo Papules progressing to vesicles, then painless pustules with narrow red boarder. Treatment..... 1. Topical.... 2. Numerous lesions... 3. MRSA .. Remove honey colored crust 2x daily HONEY COLORED exudate when vesicles or pustules rupture- forming a crust / ulcer like base Bullous Impetigo Red macules & blisters filled with clear yellow fluid Size: mm - several CM Treatment.... 4. Med...

1. Topical mupirocin ointment 2. First gen cephalosporin 3. Clindamycin 4. First generation cephalosporin

Cellulitis- Purulent (fluid) SS Erythema Warmth Fever Tenderness Induration (Hardening of tissue) Possible Purulent Drainage 1. Diagnosis... 2. Why wound cultures... Treatment Incision & Drainage (I&D) 3. Meds.... (Mod / Severe) Nursing interventions 4. _____ compresses

1. US 2. To know which type of bacteria were dealing with (Staph / MRSA) 3. Mod cephalosporin, Trimethoprim/Sulfamethoxazole TMP/SMX Severe Vancomycin 4. Warm

Scarlet fever is Pyrogenic exotoxin-mediated response to Streptococcus pyogenes infection SS 1. Sandpaper, red, and blanchable rash starts where... 2. Last how long... 3. Ends with desquamation (Define).... Strawberry tongue- starts white and turns bright red Complications: Peritonsillar abcess Retropharyngeal abcess Cervical lymphadenitis Acute rheumatic fever Glomerulonephritis

1. Groin / axillary 2. 5 days 3. Peeling off of skin

Integumentary Disorders Flashcards by Jade Ring

A flat, discolored skin lesion less than 1 cm in size, without elevation or depression.

Macule

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A small, raised, solid skin lesion less than 1 cm in diameter.

Papule

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A ring-shaped skin lesion with central clearing and an active border.

Annular

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Pruritus….

Itchiness

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A small, fluid-filled blister less than 1 cm in diameter.

Vesicle

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Small, pus-filled skin lesions that may be inflamed.

Pustules

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Flaking or shedding of dead skin cells from the outermost layer.

Scaling

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Raised, flat-topped skin lesions larger than 1 cm, often formed by merging papules.

Plaques

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Infant vs Adult skin

Epidermidis is thinner…(Consequences)
Skin contains more water..
(Consequences)
Less pigmentation… (Consequences)
When does skin reach adult thickness…
Darker skin may have these issues…

Loses heat quicker & substances more easily absorbed through skin
Friction results in skin breakdown/ blistering
UV damage Increased odds
Teenager

Hypertrophic scarring/ keloids

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Impetigo is highly contagious & mostly caused by Staphylococcus aureus.

It can be divided into
Nonbullous & bullous

Red macules & blisters filled with clear yellow fluid
Size: mm - several CM

Papules progressing to vesicles, then painless pustules with narrow red boarder.

HONEY COLORED exudate when vesicles or pustules rupture- forming a crust / ulcer like base

Nonbullous impetigo
Papules progressing to vesicles, then painless pustules with narrow red boarder.

HONEY COLORED exudate when vesicles or pustules rupture- forming a crust / ulcer like base

Bullous Impetigo

Red macules & blisters filled with clear yellow fluid
Size: mm - several CM

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Nonbullous impetigo

Papules progressing to vesicles, then painless pustules with narrow red boarder.

Treatment…..

Topical….
Numerous lesions…
MRSA ..
Remove honey colored crust 2x daily

HONEY COLORED exudate when vesicles or pustules rupture- forming a crust / ulcer like base

Bullous Impetigo

Red macules & blisters filled with clear yellow fluid

Size: mm - several CM

Treatment….

Med…

Topical mupirocin ointment
First gen cephalosporin
Clindamycin
First generation cephalosporin

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Topical bactericidal ointment for impetigo…

Mupirocin/ triple antibiotics

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Oral antibiotics for Impetigo….

Severe cases…..

1 / 2 gen cephalosporin

Severe: cephalexin - Keflix

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Impetigo- turns to MRSA this medication is indicated…

Clindamycin

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Cellulitis Non-Purulent

Intact skin, erythema, warmth, swelling, tender.

When to notify HCP…

Treatment…

Red streak infected area to grind (lymphangitis)

Cephalexin - IV cephalosporin severe cases

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Periorbital cellulitis bacterial infection of eyelids.

When to notify HCP…

Conjuctival redness
Change in vision
Pain w/ movements
Eye weakness
Proptosis (Bulging Eye) - think Graves disease

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Proptosis…

(Bulging Eye) Periorbital cellulitis

Also Graves disease

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Cellulitis- Purulent (fluid)

Erythema
Warmth
Fever
Tenderness
Induration (Hardening of tissue)
Possible Purulent Drainage

Diagnosis…
Why wound cultures…

Treatment

Incision & Drainage (I&D)
3. Meds…. (Mod / Severe)

Nursing interventions

_____ compresses

US
To know which type of bacteria were dealing with (Staph / MRSA)
Mod cephalosporin, Trimethoprim/Sulfamethoxazole TMP/SMX

Severe Vancomycin

Warm

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Cause of this illness

Pyrogenic exotoxin-mediated response to Streptococcus pyogenes infection

Typically Pharyngitis

Scarlet fever

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Scarlet fever is
Pyrogenic exotoxin-mediated response to Streptococcus pyogenes infection

Sandpaper, red, and blanchable rash starts where…
Last how long…
Ends with desquamation (Define)….

Strawberry tongue- starts white and turns bright red

Complications:

Peritonsillar abcess
Retropharyngeal abcess
Cervical lymphadenitis
Acute rheumatic fever
Glomerulonephritis

Groin / axillary
5 days
Peeling off of skin

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Scarlet fever caused from a Pyrogenic exotoxin-mediated response to Streptococcus pyogenes (Pharyngitis)

Diagnosis….
Treatment…
Type & length of isolation…

Diagnosis: Rapid strep test / throat culture
Penicillin V or Cephalexin
Droplet: 24 hrs after start of antibiotics & while febrile

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Serious skin infection causes by toxins released by Staphylococcus aureus

Diagnosed via skin biopsy/ culture

More common in <5yrs
Low immune system
Low renal clearance

Name disease…

Prognosis…

Staph Scalded Skin infection SSS

Good prognosis: 2 - 3 week min scarring

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Tinea (Fungal disease of the skin)

Tinea:

Capitis….

Cruris…

Pedis…

Corporis…

Versicolor…

Capitis: scalp

Cruris: groin

Pedis: feet

Corporis: affecting any other parts of the body

Versicolor: hypopigmented lesions on upper body

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Tinea capitis Patches of scaling in the scalp with central hair loss 1. Risk of kerion....(define) Treatment: 2. Oral griseofulvin for atleast _____ 3. Tyoe of special shampoo.... No school/ daycare 1 week after start of Treatment

1. Kerion: Inflammation, boggy mass that is filled with pustules 2. Oral griseofulvin for atleast 4 - 6 weeks 3. Selenium sulfide shampoo

Tinea corporis Annular lesion with raised peripheral scaling and central clearing (Looks like a Ring) Treatment....

Antifungal cream 4 weeks minimum

Scabies is a parasitic infection Lesions difference in children & infants Children.... Infants...

Child: grayish brown threadlike, mite burrows, pruritic - black dot Infants: eczematous eruption, prurtitic

Distribution for scabies in >2yrs <2yrs Where are they found...

>2yrs hands and wrists <2yrs feet and ankles

Treatment of scabies Application of scabicide: permethrin 5% cream. How often Treatments... Tyoe of isolation...

2 treatments a week apart Contact isolation

Pediculosis Capitis (Parasitic) Head louse Direct contact with head or clothes/brush (uncommon) needed. Describe hospital PPE

Hairnet Shoe covering Gown Gloves

_____ aka Diaper rash Caused by irritation & candida albican Red central erythema with satélite pustules. Not responsive to general treatment Nursing care.... Keep skin, DRY / air out Apply antifungal/ triple paste Avoid overwashing

Diaper dermatitis

Atopic dermatitis aka

Eczema

Chronic, relapsing inflammatory skin disorder. SS Dry, pruritic skin rash Erythema Vesicles Crusting Scaling Hypo/hyperpigmentation Lichenification (Thickening & Hardening of skin)

Atopic dermatitis aka Eczema

Atopic dermatitis aka eczema Avoid triggers 1. Bathe how long..... (avoid washcloths or scrubbing) Use Vaseline/ Aquapark within 3 minutes of bathing 2. Are steroids prescribed...

1. <5 min 2. Yes topical- only low doses on face and crotch

Contact dermatitis is Cell Mediated response to an antigenic substance exposure. T-lymphocyte proliferation How long for symptoms to appear...

1 - 2 days

Uticaria aka hives Type 1 hypersensitivity reaction from this antibody... Vasodilation & increased vascular permeability causing redness & wheals 2. Causes...

IgE 2. Food, bees, animals, stress

Seborrhea aka cradle cap Type of infection...

Fungal

Burn classification. Epidermidis & partial dermis, red/pink blisters, shining wearing, moist appearance, heal 7 - 10 days/ min scarring, blanchable Epidermidis only, no fluid loss, heal 3 - 5 days, painful, Sunburn Extends to dermis, >50% dermis lost, white pale less painful (nerve cells destroyed), heals 2 - 3 weeks, scarring & contractures possible, maybe skin graft. Extends to hypodermis, white, Waxy, leathery, charred appearance, no bleeding or pain, high risk infection/ fluid loss, Superficial Partial thickness Deep partial thickness Full thickness

Superficie Epidermidis only, no fluid loss, heal 3 - 5 days, painful, Sunburn Partial thickness Epidermidis & partial dermis, red/pink blisters, shining wearing, moist appearance, heal 7 - 10 days/ min scarring, blanchable Deep partial thickness Extends to dermis, >50% dermis lost, white pale less painful (nerve cells destroyed), heals 2 - 3 weeks, scarring & contractures possible, maybe skin graft. Full thickness Extends to hypodermis, white, Waxy, leathery, charred appearance, no bleeding or pain, high risk infection/ fluid loss,

Referral to a burn center if Partial thickness burns greater than ____% of BSA FULL THICKNESS BURNS ANY SIZE Inhalation burn injury

10%

Burn Singed facial hair Flash burn Soot in face Hoarseness Stridor Have this concern...

Oxygenation Burn respiratory tract

IV fluids rescuatation 1st 24 hrs... Parkland formula...

4mL × TBSA × weight Divided into 2 doses 1st over 8 hrs 2nd over 16 hours

Burn victim _____ administration, decreases amount of fluid escaping into extravascular space.

Albumjn

Thermoregulation response to Burns Small burn.. Large burn....

Small: Increased body temperature Large: Decreased body temperature

Debridement uses this type of pain management...

Intranasal fentanyl Versed Ketamine

Cleansing the burn How often hydrotherapy with dressing change...

Daily

Contact isolation for burn victims >_____% of the body

Do burn victims get prophylaxis antibiotics...

NG / NJ Tube feedings for burn victims...

Yes

Acne Vulgais 1. Mild to moderate: Topical 1st line treatment... Also, Retinoids & Antibiotics are used. Severe acne. 2. Treatment...(Special instructions) 3. Risks...

1. Benzoyl peroxide 2. Oral isotretinoin (Accutane) Report use to database for Teratogenic effects 2 forms of birth control & routine preggers testing. NO AUTO REFILLS 3. Hepatotoxicity, Hyperlipidemia, bone marrow suppression

Sever mucocutaneous hypersensitivity reaction with parital to full epidermal necrosis that involves < 10 % of body surface. Name disease...

SJS Steven Johnson Syndrome

Toxic epidermal necrolysis TENS involves ___% or more of BSA.

SJS Steven Johnson Syndrome TENS Toxic Epidermal Necrolysis Are both...

Erythema multiforne reaction

SS of erythema multiforme reaction. Initially Fever & Flu Erythematous Rash Lesions turn to papules & vesicles May extend to .... MANAGEMENT I&O Calories and Protein ____ wound care, hydrogels, Vaseline, Aquaphor

Oral, occular, urethral Moist wound care

When is mottled skin a normal finding in infants...

When it's temporary due to hypothermia / transient Concerning when accompanied by Cyanosis, Lethargy, Shock symptoms,

No SPF sunblock in infants until...

>6 months

Impetigo is caused by this bacteria....

Staphylococcus aureus

Impetigo: Bullous vs Nonbullous Broken skin barrier On Face Honey colored exudate from broke vesicles (crust on ulcer-like base) Treatment: Mupirocin ointment Vs Intant skin Covers body Treatment: 1st gen cephalosporin

Nonbullous: On Face Honey colored exudate from broke vesicles (crust on ulcer-like base) Treatment: Mupirocin ointment Bullous: Intant skin Covers body Treatment: 1st gen cephalosporin

Which topical emollient is used for Impetigo... Why...

Auqaphor Keeps moisture inside the skin

Red streaking from an area of skin with ( Erythema, Warmth, Swelling, Tenderness, Non-purulent ) Which travles to the groin (lymphangitis) is associated with Cellulitis Non-purulent. Where is this infection traveling to...

Lymph nodes

Periorbital cellulitis (bacterial infection) is an infection of eyelids and tissue near the eye. What is the treatment....

IV antibiotics

Cellulitis- Purulent (localized abcess) Treatment: Mild/ mod.... Severe.....

Mild: incision & Drainage, Cephalosporin, Trimethoprim/ Sulfamethoxazole Severe: I&D / Vancomycin

Scarlet fever Affects 5 - 15 yr old Rash, sandpaper like, erythema, Blanchable Strawberry tongue starts with white coat and then becomes bright red. SS; Fever, chills, very red, swollen throat. Complications (5)....

Peritonsillar abscesses Retropharyngeal abcesses Cervical lymphadenitis Acute rheumatic fever Glomerulonephritis

Peritonsillar abscesses Retropharyngeal abcesses Cervical lymphadenitis Acute rheumatic fever Glomerulonephritis Are complications of which disease that mostly affects 5 - 15 year olds....

Scarlet fever

Tinea infections are which type...

Fungal aka Ring Worm "Annular" shapped

Tinea capitis is a Highly Contagious fungal infection of the scalp. Selenium Sulfide shampoo Oral Griseofulvin 4 - 6 weeks How long for child to stay out of school....

Until 1 week after the start of medication

How long for hair to grow back after tinea capitis Fungal infection....

3 months- 1 yr

Tinea pedis - Athlete foot Does water & vinegar help...

Yepppers

Body landmarks most likely to find scabbies...

Between fingers & toes Armpit Behind kneee

Pediculosis Capitis aka Head Louse How far can they hop to infect other head....

They Cannot Jump / Fly Direct contact must be made

Pediculosis Capitis aka Head Louse How does infection happen...

Scratching & breaking skin barrier. They louse is not infectious

How long can head louse Pediculosis Capitis survive without human blood...

2 days

Pediculosis Capitis aka Head Louse Nits (eggs) take this long to hatch...

8 - 9 days

Diaper Dermatitis- Diaper Rash Can be caused directly or indirectly by wearing Diapers. Diaper rash Caused by Candida Albicans (Describe Appearance)..... Treatment...

Red beefy Satellite pustules Nystatin topical cream Avoid steroids

Change diapers how often...

Q2H or PRN

Tip With diaper rash dont remove all barrier cream from skin. May cause irritation

Also Cornstarch & talcum powder

Atopic Dermatitis aka eczema Has a hereditary component List the 3 health problems common with it...

Asthma Allergic rhinitis Atopic dermatitis

Can a child "Grow-out" of atopic dermatitis....

Yes. Typically begins at 2 years old

Atopic dermatitis aka eczema Can be severe enough to require hospitalization 1. Describe dressings....

1. Wet/Dry 2QDaily

Atopic dermatitis aka eczema Use these Antihistamine Day... These Antihistamine Night...

Day: Claritin/ Allegra Night: Benedryll

2.5% hydrocortisone cream is consider a (Low / High) dose..

High Avoid use on face & crotch

Tacrolimus (Topical) immunosuppressant medication Used for....

Atopic dermatitis

Contact Dermatitis Red / Itchy Caused 1 or 2 days after contact with dyes, chemical, plants Which type of immunity causes this issue... Treatment...

Cell mediated Hydrocortisone cream

Type 1 hypersensitivity reaction from IgE mediated antibody response Causes: food, drugs, bees, animals, stress. Affects on the body: Vasodilation, vascular permeability, redness & wheals Name of problem... Treatment....

Uticaria Antihistamine, steroids, Epinephrine

Chronic dermatitis on skin or scalp Infants; called cradle cap Inflammatory reaction to fungus Name of problem.... Treatment....

Seborrhea Medicated shampoo Corticosteroids

Burn Heals in 7 -10 days Blanchable Shiny weeping moist appearance

Partial thickness Epidermidis/ portion of dermis Red/ pink Blister Formation

Burn Classification Non-Blanchable White & Pale Less Painful Scarring & Contractures

Deep partial thickness May require Skin Graft >50% of dermis lost

Burn classification Extends to hypodermis No bleeding or Pain White Waxy leather appearance

Full thickness

Burn classification Epidermidis only No fluid loss 3 - 5 day heal Painful

Superficial Sunburns

To prevent hypothermia IV fluids can be warmed prior to adminstion...

True

Why pressure garments after skin grafts in burn victims...

Scar reduction

Immersion Time for FULL THICKNESS BURNS Temp 120... 124... 127... 133... 140... 149... 156...

120; 10 min 124: 3 min 127: 1 min 133: 15 sec 140: 5 sec 149: 2 sec 156: 1 sec

Frost bite. Rewarm in water this temp.... Deflate blister & leave in place. This complication may arise due to hemolysis of RBC & Muscle destruction...

104° 15 - 30 min Myoglobinuria - (Myoglobin is found in muscle cells & released when they are broken down) Can lead to AKI

Commonly caused by medications started in past 8 weeks or Mycoplasma Pneumonia Name problem when: Hypersensitivity reaction with partial to full epidermal necrosis that involves <10% of BSA.... >30% BSA...

<10% SJS Steven Johnson Syndrome >30% Toxic Epidermal Necrolysis