Skin Dysfunction Flashcards
Contact Dermatitis
Inflammatory reaction of the skin after contact with an irritant or allergen
What causes contact dermatitis?
allergic or irritant with sensitivity to it
Irritant causes inflammation or contact dermatitis to
everyone
Allergen causes inflammation or contact dermatitis to
specific individual sensitive to it
Diaper Dermatitis Tx
- ointments?
Changing diaper ASAP
- Expose the bottom to air
Apply zincoxide,petroleum ointment, or Desitin
Wipes free of parabens
do not need to clean the cream off when changing bc you can layer over time
Why are cornstarch powders like Talcum be avoided with diaper dermatitis?
not ingested and cause respiratory distressed
- are safe when applied to your hand and bottom
Contact Dermatitis Tx
isolate the cause, limit exposure, and rinse area
Topical (small)
- Corticosteroids (Hydrocortisone)
- Lotions (Calamine)
PO (large like fabric)
- antihistamines (Benadryl)
- Steroids
Skin patch testing
What are the topical agents used for contact dermatitis and when do you use it?
small spots
- Corticosteroids (Hydrocortisone)
- Lotions (Calamine)
What are the oral agents used for contact dermatitis and when do you use it?
Large like fabric
- antihistamines (Benadryl)
- Steroids
Atopic dermatitis =
eczema
Eczema is
chronic relapsing inflammatory skin disorder
Atopic dermatitis results of/Associated with
of genetic factors, environmental agents (allergies or irritants)
Atopic dermatitis risk factors
family history of eczema,asthma, food allergies
(genetic link possible)
- auoimmune
Atopic dermatitis involvement (asymmetrical or symmetrical)
symmetrical on both location
Difference between contact dermatitis and atopic dermatitis?
Location and symmetry
CD = asymmetrical and anywhere
ad = SYMMETRICAL AND SPECIFIC
Atopic dermatitis S/S
severe pruritis (itching)
Atopic dermatitis Infant typical sites
face, inside the elbows, and behind the knees
Atopic dermatitis in older children’s typical sites
antecubital and popliteal area, neck, wrists and feet
Atopic dermatitis adolescents look like
Lichenification
Lichenification
leathery skin due to relapse over time
Atopic dermatitis Tx
hydrate (tepid or colloid)
- emollient application immediately after bath
relieve itching
reduce inflammation
prevent/control secondary infections
Tepid means
slightly cooler
Colloid
adding oatmeal or bran
Pattern to take care of eczema skin
tepid or colloid bath
Pat dry no rubbing
emollient skin immediately after (neurtogena, Aquaphor)
Relieve itching of Atopic dermatitis by
Colloid bath, cool wet compresses, topical corticosteroids, oral antihistamines
Reducing inflammation of Atopic dermatitis
Topical corticosteroids
Non-steroidal immunomodulator creams
How to prevent secondary infections of Atopic dermatitis
short/clean nails
soft cotton clothes not wool
antibiotics if an infection does occur
Seborrheic Dermatitis
sebum exposed
- chronic, recurrent, inflammatory reaction of skin
Seborrheic Dermatitis is most common in
early infancy and adolescents
cradle cap
Seborrheic Dermatitis locations
Eyelids (oily gloss)
External canal
Vasolabial folds
Inguinal region
Scalp - cradle cap
Seborrheic Dermatitis looks like
thick
yellow
scaly and oily patch
- possible itching (irritable)
Seborrheic Dermatitis Tx
Shampoo twice a day
- allow to sit for crusts to soften
- rinse
- fine tooth comb/soft brush to remove crusts
Impetigo is caused by
bacterial skin infection
Impetigo is caused by what bacterial contagions?
Staph aureus
Strep
What is a highly contagious bacterial infection most common on the face?
Impetigo
Impetigo is commonly seen on the
face, around mouth → spreads peripherally
Impetigo is spread by _______ contact
direct
Impetigo Primary at
site
bite
infection
If impetigo is itchy and caused by strep, it can lead to
glomerulonephritis
Impetigo Post-Op care
no daycare or school
HAND WASHING before and after touching infected areas,
separate child clothes and linens,
short and clean nails,
warm washing of cloths
gently remove the crust and debris
Impetigo Tx
Antibiotics (topical)
- Mupirocin (Bactro-van)
- Penicillin for systemic
Gentle cleansing of crusted areas
Don’t rupture the blisters – spread infection and increase secondary infection
Impetigo ruptures should not be ruptured because
spread infection and increase secondary infection
Impetigo is highly communicable for ___________ after antibiotics.
24 hours
Impetigo Nursing Interventions
Institute strict contact precautions
Strict hygiene practices – hand washing
Educate family and visitors on necessary precautions to prevent the spread of infection
Cellulitis is caused by what bacteria
Staph
Strep*
H. influenzae
Cellulitis S/S
Inflammation with intense redness
Pain
Swelling and firm infiltration
Warm to touch
Lymphangitis “ streaking” - common
Possible systemic effects (fever, malaise)
Swollen regional lymph nodes
Is cellulitis contagious?
no, deeper layers of the skin
- caused by in open skin like IV
Cellulitis is what type of infection?
- and who can be affected?
opportunistic (not contagious)
- area od broken skin
- immunocompromised/diabetes
Cellulitis Tx
Antibiotics
Oral - Choice
Elevation, immobilization
Pain relievers
Type 1 Herpes Simplex
Cold sore/fever blister
Type 2 Herpes Simplex
Genital/sexually transmitted
Varicella skin lesions are
(pruritic rash – itchy
papules and vesicles
Weeping
Crust over within 7 days (no longer contagious)
Varicella s/s systemic
fever
malaise
contagious 1-2 days before rash to crust
Varicella isolation
airborne and contact
- skin to skin or respiratory
Varicella Tx
- stop the itch (apply topical diphenhydramine cream
- acetaminophen (no aspirin = reye syndrome risk
- Immunocompromised (Acyclovir – antiviral)
- No longer infectious after lesions crust over
T1 Herpes Simplex once exposed to it then it is
always present
Herpes Simplex Triggers
Herpes Simplex S/S
Tingling, numbness, burning, itching
Small erythematous, tender area clusters of blisters
Blisters begin to dry yellow crusting
Healing occurs in 8-10 days
Herpes Simplex HEALS after
8-10 days
Herpes Simplex Tx
control outbreaks
Antivirals
- Acyclovir (Zovirax)
- Valacyclovir (Valtrex)
Pain relievers
Herpes is what type of infection
viral
Dermatophytoses- Tinea aka
Ringworms
Dermatophytoses- Tinea is what type of infection
fungal
Dermatophytoses- Tinea (Ringworms) live where
lives on
- not in the skin or nails
Tinea capitis is located where
Ringworms on the head
Tinea capitis is transmitted by
person to person
animal to person
Tinea capitis Tx
Oral antifungals
Grisiofulvinor terbinafine
Selenium sulfide shampoo
- twice a week
- Severe drying and smell
Tinea capitis Tx should be used for how long
Griseofulvin and selenium sulfide shampoo for 2 weeks
Tinea capitis lookslike
Lesions of the scalp and hair falls out temporary
If tinea capitis is untreated then
go deeper and cause kerion and scar
Griseofulvin needs to be taken with
high-fat foods for better absorption and less GI upset
- same time
Selenium sulfide shampoo
applied for 5-10 minutes 2-3 times per week
- severe drying and smell
Tinea corporis
Ringworm of the body, skin, nails
Tinea corporis tranmisson
infected pet
human, soil, or fomite
Tinea corporis looks like
Small lesion and larger with a clear center and ring appearance
- leaves scaly patch
Tinea corporis Tx
Griseofulvin only
Tinea cruris aka
Jock Itch
Tinea cruris s/s and location
Pruritic
Medial proximal aspect of thigh/cruralfold (may involve scrotum in males)
Tinea cruris Tx
local application of antifungal creams
Tinea pedis
Athlete’s foot
- Ringworm
Tinea pedis s/s and location
Pruritis
Lesions on plantar surface of foot,between toes
Tinea pedis Tx
Local application of antifungal creams
Oral antifungals
Soaks with Burrow solution (water with aluminim acitate)
Tinea pedis common areas to get
Fungus grows in moist areas
- Locker room, swimming pools, and showers
Tinea pedis Teachings
don’t share, well-ventilated shoes, light socks,
Lyme disease is caused by
tick infected with Borrelia burgdorferi
Prevention of Lyme Disease
wear repellent
check daily
shower after outdoors
HCP if fever or rash
Erythema Migrans
bullseye rash in Lyme disease
S/S of Lyme Disease
rash (bullseye)
fatigue
swollen joints
LOC decline
fever with HA
SENSITIVE TO LIGHT AND DARK
no sleep and night sweats
neuro
skin outbreaks
heart prob
mood swings
Lyme disease can develop how long after the tick bite
3-30 days
If Lyme disease is left untreated
bacteria migrate to the nervous, heart and joint systems
With Lyme disease what does the tick do?
attaches and buries head in the skin
- module at the site
When removing the tick from the skin,
get the body AND HEAD out of the skin
If Lyme disease is suspected o confirmed by lab test, then
single dose antibiotics
What antibiotic is used for children over 8 with Lyme Disease?
Doxycycline
What antibiotic is used for children under 8 with Lyme Disease?
Amoxicillin or Cefuroxime
What lab test is run for Lyme Disease?
Sarcoptes scabiei aka
Scabies
- skin infestation with microscopic mite
Sarcoptes scabiei is spread by
direct prolonged 6contact with the infected person
Sarcoptes scabiei can live how long inside of a person
1-2 months
Sarcoptes scabiei can live how long outside of a person?
48-72 hours
Sarcoptes scabiei does what to the skin
burrows into the skin and lays eggs
- makes a trail
In Sarcoptes scabiei, how long until the s/s appear?
30-60 days
- everyone in contact with them between that time will need to be tested
Sarcoptes scabiei s/s
Burrow tracks
Severe pruritis
Small, lesions develop into blisters
Usually on hands, wrists, feet or ankles
Sarcoptes scabiei Tx and who?
- Whole family and anyone with contact
Scabicide - Permethrin (Elimite)**
Treat personal items
Lotions
Topical steroid for itch
Antibiotics- secondary infections
Permethrin (Elimite)** needs to be applied
from neck down to toes in skin folds and nails
- left on 8-14 hours (bedtime with bath in the morning to remove)
Sarcoptes scabei personal items
Vacuum everything furniture wise
All clothes and bedding need to be washed in hot water (BURN)
Conceal in plastic bag for 2 weeks to suffocate
Pediculosis capitus aka
head lice
Pediculosis capitus is what type of infection
parasitic
Pediculosis capitus common in
school-aged children
Pediculosis capitus transmission
person to person
object to person
NOT ANIMALS
Do Pediculosis capitus jump or fly?
no
Pediculosis capitus look like
dandruff but does not move
Small, grayish-tan, wingless insect
Visible
Use claws to hold to the hair shaft
Pediculosis capitus can live up to how long away from humans
2 days
What is the life span of a female head lice
1 month
Nymphs and eggs of head lice look like _________ and feed off of
white grayish specks and feed off the blood of scalp
Pediculosis capitus s/s
red lesions and constant scratching
- caused by crawling and saliva
Pediculosis capitus Tx
Daily Medicated shampoo (Nix)with mechanical removal with lice combs
- wash all linens
- vacuum dry clean non-laundry items
- seal in a plastic bag for 2 weeks
repeat Tx every 7 days
- antibiotics for secondary infection
Pediculosis capitus students are
Go home at the end of the day and only return after the treatment with sign
Acne vulgaris is a common skin problem of
adolsecence
Acne vulgaris has a link with
genetic
Acne vulgaris is an overgrowth of
P. acnes
Acne vulgaris formation
Comedone
- open (white)
- closed (black)
Acne vulgaris causes
Hormones, cosmetics, exposure to oils, possible link to dairy
Acne vulgaris Tx
General health promotion
Gentle cleansing, hair and scalp hygiene
Oil-free make-up
Keep your hands off!!
Lotions/creams
Medications
What medications are used for Acne vulgaris?
Retinoids – 1st (Retinae)
Topical Antibacterial Agent
Systemic Antibiotics
Oral Contraceptives
- Reduce antigen production and ability of sebum oil
If using topical creams, educate to avoid
sun or use sun screen
- Photosensitivity
In Burns, what guides Tx?
extent (TBSA)
- Rule of Nine an lund Browder
depth
- 1st - 4th degree
Severity
- TBSA %
- Location
- Child’s age
- Health
Causes of burns
thermal (extreme heat, cold)
chemical
electrical
radioactive
Accidental
Intentional
Accidental burns types
inadequate supervision
curiosity
inability to escape burning agent
Rule of Nine in Infants
9% on each part
Front of head and Back of head = 18%
same with thoracic and lumbar both fully = 18% on both sides
Both arms = 9% each
Both legs = 14% each - chubs
the [palm and groin = 1% each
Rule of Nines difference for others
Head = 9
Front and Back = 18% each
Arms = 9 each
Leg = 18 each
palm and groin = 1%
1st degree Burn
superficial
-destruction of the epidermis only (Sensory intact) – bad sunburn
2nd degree Burn
partial thickness
-destruction of the epidermis and some of the dermis (blisters within minutes and sensory intact)
– boiling water (red and moist looking)
3rd degree Burn
full-thickness
- destruction of epidermis, dermis and underlying SQ tissue
(charry black look, visible veins) – feel no sensory or pain
4th degree Burn
full-thickness
burned through the epidermis, dermis, sub Q, and involves the fascia , muscle, and bone - feel no sensory or pain
At what degree of burn do you not have sensory intact feeling?
3rd
With burn patients they are at risk for
sepsis
shock
Care of Minor Burns
Soothe with and vaccine?
Apply cold compress/cold rinse
Analgesia - pain
Cleanse with soap/water – avoid friction
Tetanus – wound by bacterial toxin
Antimicrobial ointment
Loose clothing
Sunburn – apply moisturizer
Care of Moderate and Severe Burns
1stMaintain airway, Oxygen
Large bore IV fluids
Observe closely for s/s shock
Pain mgmt
Wound care/Escharotomy
Nutritional support
Skin and musculoskeletal care
Emotional/psychosocial support
Atraumatic Care for Burn Care
- Have all materials ready before beginning the procedure.
- Administer appropriate analgesics and sedatives.
- Remind the child of the impending procedure to allow sufficient time to prepare.
- Allow the child to test and approve the temperature of the water.
- Allow the child to select the area of the body on which to begin.
- Allow the child to request a short rest period during the procedure.
- Allow the child to remove the dressings if desired
- Provide something constructive for the child to do during the procedure (e.g., holding a package
of dressings or a roll of gauze). - Inform the child when the procedure is near completion.
- Praise the child for cooperation
