Integumentary System Flashcards
Skin functions
- protection
- impermeability
- fluid regulation
- heat regulation
- sensation
Dev differences in kids
- epidermis loosely bound to dermis
- skin thinner, BV closer to surface (more likely to get abrasion than bruise)
- more permeable and sus to superficial bac infx
- more likely to have assoc systemic sx with infx
- more apt to respond to a primary irritant
- less pigmentation
General interventions for skin issues
- no powder or cornstarch (aerosolized)
- light, loose, non-irritating clothing (no wool for eczema)
- keep skin clean and dry
- prevent secondary infx; cut nails, apply mittens at night
- prevent infx spread; good handwash, cleaning toys, keep open wounds covered, teach kids not to share combs and hats
- avoid commercial diaper wipes on irritated skin
Diaper dermatitis
- contact or irritant type
- candida albicans (thrush)
- or bacterial infx
Causes of contact dermatitis
Compromised skin…
- chemical irritation
- mechanical irritation
- infection (candida albicans)
- fecal enzymes
- inc skin/diaper pH
- skin wetness
CM of contact diaper dermatitis
Erythema in convex surfaces like thighs, butt, perineum, waist, lower abdomen
- can be bleeding
- not in creases bc skin on skin protects the space
NC for diaper dermatitis
- dry affected area and prevention of contact with the irritant
- keep area open to air as much as possible (while nap, leave diaper open under them, while running around with long shirt on)
- often seen when sleeping through the night
- change wetness immediately
- PREVENTION–ointment like zinc oxide (desitin) or petroleum to barrier when they pee
- wash off feces with water and mild soap
Candida albicans infection (monilia or thrush)
- beefy red, extends into creases, satellite lesions
- precipitate by abx use, immunosupp, exposure to yeast
- treat with anti-fungal cream like nystatin until gone and several days after
MRSA
- bacterial infx caused by strep
- beefy red
- oral med, amoxicillin
Seborrheic dermatitis
- chronic, recurrent inflam scaling dx of the scalp (Cradle cap) and face
- unknown cause
- only in early infancy
- lesions–thick, adherent, yellowish, scaly, oily patches; may be pruritic
Cradle cap NC
- aggressive scrubbing of scalp may prevent
- use olive oil or anti-seborrheic shampoo (may burn) and leave on scalp until crusts are soft, rinse through
- use soft brush to remove softened crusts in morning
Eczema (atopic dermatitis)
- Pruritic inflammation of the skin associated with allergy and a hereditary tendency
- infantile, childhood, and adolescent versions
Eczema management
- find source of allergen or irritation
- relieve pruritis; colloid baths, oral antihistamines
- hydrate skin; don’t dry off after bath and coat in lotion
- dec inflam with topical steroids
- prevent or control secondary infx
- dye free and perfume free products
Eczema NC
- long sleeves and pants
- mild cotton, no scratch
- dye free and perfume free
- humidifier in room
- avoid enviro triggers
- keep nails short (less scratching)
- watch for infx signs
- avoid latex bc more susceptible to allergies
Contact dermatitis
- Causes–response to an antigenic substance exposure (often nickel or dye, exposure to allergic plants)
- reddened irritation caused by allergen pressing on skin that can cause hyperpigmentation
Contact dermatitis NC
Put nail polish, tape, cloth between the allergen and skin if metal; avoid plants
Poison ivy
- redness, swelling, itching at site of contact; advances to streaked or spotty blisters
- flush area immediately after contact with cold, running water
- wash clothing and pets
- scratching does not spread rash but could cause secondary infx
Impetigo
- strep or staph cause
- honey crusted lesions often in moist areas like armpits, creases, around mouth and under nose
- pruritic
Impetigo tx
- soften crusts with moist soaks
- topical bactericidal ointment
- oral abx; cephalexin or PCN
- no school for 24h–spread thru direct contacts
- cover lesions
- no share linens
- prevent scratching
Cellulitis
- deep, locally diffuse infx of skin with systemic manifestations
- caused by strep or H. influenza B
- CM–fever, swelling, heat, tenderness of involved skin; malaise, regional lymphadenopathy
- concern is getting to bone
Cellutitis management
- oral abx
- rest and immobilization
- warm, moist compresses
- hospitalization if joint or facial involvement
Herpes simplex
Viral infx of skin and mucus membranes
- clusters of vesicles filled with clear fluid
- CM: burning, itching, vesicles on inflam base which dries forming a crust followed y exfoliation and spontaneous healing in 8-10 days
- worse in times of stress
- tx with topical, warm compresses
- eating and hydration considerations
Verruca (warts)
- epidermal benign tumor caused by human papilloma virus
- CM–solitary flesh-colored papule with an irregular, scaly surface; may have pin point black spots
- Tx: cryotherapy, salicylic acid paints
- education; most disappear with time, repeated irritation may worsen
Erythema infectisum (fifth disease)
From parvovirus
- rash, minor itching, tiredness, sore throat, fever
- fetal death if mom gets while preg
- aplastic crisis–kids with hemolytic disease or immunodeficiency
Fifth disease rash
- slapped face that disappears w/i 1-4 days
- maculopapular red spots, upper and lower extremities, lacey appearance on trunk
- don’t really treat
Chicken pox (Varicella)
- caused by varicella zoster virus
- spread primarily via resp tract secretions and contact with skin lesions
- communicable; one day before rash appears until all lesions are crusted over (no school until all CRUSTED)
- incubation period–14-21 days
Varicella CM
- slight fever
- malaise
- anorexia
- itchy rash
Varicella tx
- help with itching
- cool bath
- calamine lotion
- acycline
- watch for secondary infx like pneumonia
Varicella NC
- strict iso when hospitalized
- immunize at 12M and 4Y
- may bet varicella-zoster immune globulin (VZIG)
- iso at home until all crusted
- good skin care
- no aspirin
Tinea corporis
Ringworm on body
Tina capitis
Causes alopecia and inflam, crustiness
Tinea cruris
- jock itch
- in groin crease
Tinea (Ringworm)
- transmitted person to person or animal to person
- tx with topical or oral antifungal infx
- capitis needs oral (hard on liver so get liver enzymes after 6W on it)
Tinea (ringworm) NC
- emphasize good health and hygiene
- examine household pets
- teach kids not to share hats, scarves, helmets
Pediculosis (head live)
- infestation of the hair or scalp by pediculus humanus capitis
- lice or nits (eggs) found in hair usually behind ears, nape of neck
- intense pruritis; possible excoriation of skin
Lice tx
- permetherin rinse or shampoo for 10 minutes (made of chemicals)
- malation on dry hair for 8-12h
- Kwell shampoo–toxic, non-ovicidal
- must pick nits out of hair
Education for head lice
- avoid shampoo contact with eyes
- don’t treat in bathtub or shower
- apply only to infected area on infected individuals
- wash bedding, cloths in hot water and dry in hot dryer for 20 minutes 1x/W
- comb out nits with fine tooth comb
- soak brushes and combs
- store unwashables in sealed plastic for 2W
Scabies
Impregnated mite burrows into the stratum corneum of the epidermis and deposits her eggs and feces
- intense itchy
- maculopapular lesions, intertriginous areas
Scabies management and NC
- whole household sleeps with Permethrin on skin
- Neurotoxic Lindane for resistance cases
- Ivermectin CI in kids under 5
- follow directions carefully
- treat all contacts
Sunburn prevention and tx
- PABA free sunscreen after 6M (lotion is better than aerosol)
- avoid exposure btwn 10-4
- tx with cool water (not direct ice)
- NSAIDs for pain
- clean dressing
- don’t pop blisters of peel dead skin
- stay hydrated
Facial acne in adolescent
- caused by inc production of sebum in sebaceous glands, familial aspect
- blackhead, whitehead, cystic lesions
- negative body image affect
Acne intervention
- good facial hygeine
- squeezing not recommended
- first line–OTC benzoyl peroxide–can dry skin so good facial lotion
Bites and stings
Minor rxn
- bite or sting mark
- stinger, tentacle or venom sac
- redness
- swell
- pain or tenderness
Severe rxn
- anaphylaxis
sting tx
- apply icepack
- remove stinger with credit card or tweezer
- NSAID
- watch for swelling–Benadryl–esp around airway
- call 911 if known allergy
- wash with soap and water
Tick bites
- not poisonous but can transmit Rocky mt spotted fever or Lyme disease
- bite into skin, embed mouth parts
- can remain for days if undetected
- tx not needed but watch for Lyme disease
Lyme disease CM
- rash
- fever
- chills
- severe HA
- joints and muscle aches
- go into clinic
Preventing tick bites
- keep lawn mowed, brush cleaned up, wood piles stacked
- wear socks, tuck long pants in
- wear light colored clothes
- don’t lay linens on ground
- walk in middle of paths
- comb thru hair after being in infested area
- CHECK BODY after hikes
- teach how to look for s/s
First aid for tick bites
- removed by grasping close to skin with tweezers, pull gently until tick lets go
- wash area with soap and water
- antiseptic or topical antibac on site
