UNIT 11 INTEGUMENTARY Flashcards
Skin differences in children
Skin blisters easily
Skin is thinner in infants
Skin is more susceptible to superficial bacterial infection
They are more frequently affected by chronic atopic dermatitis (eczema)
Infant’s skin is more prone to develop a toxic erythema as a result of skin
eruptions or drug reactions
Which of the following statements are true following the skin differences in children?
A. A Childs skin is thicker in the infant stage than toddler stage.
B. Due to passive immunity infants are less susceptible to superficial bacterial infection
C. Children are more frequently affected by eczema.
D. Toxic erythema is life-threatening
C. Children are more frequently affected by eczema.
S/s of skin disorders in children
HISTORY & SUBJECTIVE SYMPTOMS
Pruritus(itching)
Pain or tenderness
Stinging; burning; prickling; crawling
Alterations in local feeling
Previous allergic conditions or skin disease
Onset
Your pediatric patient has just been admitted . He presents with honey-crusted blisters around the lips and nose. What skin disorder would you suspect this patient having?
A. Lice
B.Insect bite
C. Ezema
D. Impetigo
D. Impetigo
What is included in the assessment of skin for a pediatric patient?
OBJECTIVE FINDINGS
Physical examination
Rash: describe, size, texture, location
Type of lesion: primary & secondary
LABORATORY STUDIES
Blood work (CBC, ESR); specifics to r/o systemic diseases
Microscopic exams, cultures, skin scrapings, biopsy
Allergic skin testing
Which of the following statements is the priority teaching for a patient with impetigo?
A. Your child can join sports with Impetigo because it does not contract easily.
B. Ensure that you wash your hands and that you teach your child proper hand hygiene.
C. The child can go back to school the same day they are diagnosed.
D. Keep your child’s nail long to relieve itchiness.
B. Ensure that you wash your hands and that you teach your child proper hand hygiene.
S/S of impetigo
- Blisters and honey-colored crusts
- Erythema
- Pruritus
- Burning
- Secondary lymph node involvement can be present
What is impetigo and how is it caused
Impetigo is a contagious bacterial infection of
the skin caused by group A streptococcus (GAS; Streptococcus pyogenes) and Staphylococcus aureus; it occurs most commonly during hot, humid months.
How is impetigo treated? Patient teaching for Impetigo
Remove crusts,
topical antibiotic
Prevent spread
To prevent skin cracking, apply emollients and instruct parents in the use of emollients. Keep the child’s fingernails short.
Instruct parents in the methods to prevent the spread of the infection, especially careful handwashing.
Inform parents that the child needs to use separate towels, linens, and eating utensils and dishes. Bleach the bathtub after each use.
Inform parents that all linens and clothing used by the child need to be washed with detergent in hot water separately from the linens and clothing of other household members.
Acne
Experienced by 50% of adolescents by end of teenage years
Cause of acne
Testosterone;
stimulation of sebaceous glands
How can acne be treated
Overall healthy lifestyle
Proper hygiene
Low fat diet (cholesterol)
Instruct the client in prescribed skin-cleansing methods, with emphasis on not scrubbing the face and using only prescribed topical agents.
- Instruct the client in the administration of topical or oral medications as prescribed.(thin layer)
- Instruct the client not to squeeze, prick, or pick at lesions.
- Instruct the client to use products labeled non- comedogenic and cosmetics that are water-based and to avoid contact with products with an excessive oil base.
- Instruct the client on the importance of follow- up treatment.
What is Lice(Pediculosis Capitis)
Parasitic infection that is common in childhood. Easily spread
Pediculosis capitis refers to an infestation of the hair and scalp with lice.
The most common sites of involvement are the occipital area, behind the ears at the nape of the neck, and occasionally the eyebrows and eye- lashes.
S/S of Lice
Child scratches scalp excessively.
■ Pruritus is caused by the crawling insect and insect saliva on the skin.
■ Nits (white eggs) are observable on the hair shaft (it is
mportant to differentiate nits from lint or dandruff, which flakes away easily).
■ Adult lice are difcult to see and appear as small tan or grayish specks, which may crawl quickly.
Nursing Intervention for Lice
Application of pediculicides & manual removal of the nits.
Permethrin 1% cream rinse (Nix) (available w/out prescription)
(most products used to treat pediculosis cannot be used on children younger than 6 months of age).
Malathion (need prescription, more potent)
Prevent spread
Daily removal of nits with an extra-fine-tooth metal nit comb needs to be done as a control measure after use of the pediculicide product (gloves need to be worn for removal of nits); hairbrushes or combs would be discarded or soaked in boiling water for 10 minutes.
Instruct parents that siblings may also need treatment; grooming items would not be shared, and a single comb or brush needs to be used for each individual child.
Instruct parents that bedding and
clothing used by the child for the previous 2 days before diag- nosis should be laundered in hot water with de- tergent and dried in a hot dryer for 20 minutes; bedding and clothing need to be changed daily and laundered.
Instruct parents that nonessential bedding and clothing can be stored in a tightly sealed plastic bag for 2 weeks and then washed.
Teach the child not to share clothing, headwear, brushes, and combs.
Lice on the eyelashes or eyebrows may need to be removed manually.
What is Dermatitis
inflammatory reaction of skin that evokes hypersensitivity response
What is Dermatitis caused by
Caused by chemical substance (natural or synthetic
S/s of Dermatitis
Sharp delineation of normal and affected skin
Itching; may be painful
Nursing intervention of Dermatitis
Mild cases: topical steroids
Moderate: 2 wk course of strong topical steroids
Severe: systemic corticosteroids
What is the cause of Diaper Dermatitis
Caused by prolonged exposure to urine,
feces, or diaper chemicals
S/S of Diaper Dermatitis
Sharply demarcated edges, primarily on
convex areas and in folds
May cause secondary infections: Candida albicans
Treatment for Dermatitis
Treatment
Prevention
Avoid further irritation
Application of ointments
Eczema
- Superficial inammatory process involving primarily the epidermis; there are many types, some of which include atopic dermatitis, contact dermatitis, and stasis dermatitis.
- Associated with family history of the disorder, allergies, asthma, or allergic rhinitis
- The major goals of management are to relieve pruritus, lubricate/hydrate the skin, reduce inflammation, and prevent or control secondary infections.
Management Goal of Ezema
- Hydrate the skin
- Relieve pruritus
- Reduce flare-ups or inflammation
- Prevent and control secondary infection
Treatment of Eczema
Treatment
Avoid exposure to irritants or allergens
Antihistamines
Topical immunomodulators
Topical steroids
Mild sedatives
Antibiotics if secondary infection
S/s of Eczema
- Itching
- Redness
- Scaliness
- Minute papules (rm, elevated, circumscribed
lesions <1 cm in diameter) and vesicles (similar
to papules but uid-lled) - Weeping, oozing, and crusting of lesions
- Lesions can occur on scalp and face, creases of
elbows and knees, neck, wrists, and ankles. It is uncommon in all age-groups to see lesions in the axillary, gluteal, or groin area.
Nursing Interventions for ECZMA
Baths and moisturizers are important. Oatmeal
baths are soothing as oatmeal has emollient characteristics. Bathing water needs to be tep- id, with baths limited to 5 to 10 minutes and the skin moisturized immediately afterward. A thick cream or ointment would be used, such as petroleum jelly for the face or a thick moistur- izing cream for the body.
2. Iftopicalmedicationsareprescribed,theyneed to be applied within 3 minutes after the bath. Topical medications are applied before creams or ointments.
3. Antihistamines and topical corticosteroids may be prescribed; corticosteroids are applied in a
thin layer and are rubbed into the area thor- oughly.
Antibiotics may be prescribed if secondary in- fections occur.
Avoid exposure to skin irritants, such as irritat- ing soaps, detergents, fabric softeners, diaper wipes, and powder.
Cool, wet compresses applied for short periods may help soothe the skin and alleviate itching; pat skin dry between cooling treatments. Preventorminimizescratching;keepnailsshort and clean, and place gloves or cotton socks over the hands. Eliminateconditionsthatincreaseitching,such as wet diapers, excessive bathing, ambient heat, woolen clothes or blankets, and rough fabrics or furry stuffed animals; exposure to latex would also be avoided.
Instruct parents to wash clothing in a mild de- tergent and rinse thoroughly; putting the clothes through a second complete wash cycle without detergent minimizes the residue remaining on the fabric.
Animal bites
Children are more often bitten by animals belonging to the family or to neighbors
than by stray animals
Incidence is highest in boys between 5-9yo
Likelihood of infection very high and is of most concern
Treatment for animal bites
Treatment
Cleansing/treatment of wound
Antibiotics
Rabies & tetanus vaccinations
Animal bite prevention
Avoid strange and nervous appearing animals
Get family pets fully vaccinated
Spay or neuter pets (reduces aggression)
Never take a pet by surprise, make them aware of your presence before
approaching
If a threatening animal approaches, don’t make eye contact. Remain motionless
Allow animal to sniff child before the child attempts to pet it
Do not tease or mistreat the animal in any way. Be sure kid’s maturity level is
appropriate to play or care for the animal
Insect bite
Scorpions, black widow & brown recluse are only arachnids with venom deadly
enough to require immediate medical attention
Insect bite treatment
Treatment
Remove stinger, if left in the body
Cold compresses
Calamine lotion
Prevention of secondary infection
What is a complication of insect bite?
Anaphylaxis
What is Lyme disease?
An infection caused by the spirochete Borrelia burgdorferi, acquired from a tick bite (ticks live in wooded areas and survive by attaching to a host)
- Infection with the spirochete stimulates inflammatory cytokines and autoimmune mecha- nisms.
What is a classical sign of Lyme disease?
The typical ring-shaped rash of Lyme disease does not occur in all clients. Many clients never develop a rash.
If a rash does occur, it can occur anywhere on the body, not only at the site of the bite.
ring-like rash
Are people who hunt in the woods at higher risk to contract Lyme disease
A. Yes
B. No
A. Yes
Prevention and patient education for Lyme disease
Avoid tick-infested areas; or wear light-colored clothing so tick can be spotted easily
* Tuck pant legs in socks, wear long sleeved shirts when in wooded areas
- Perform regular tick checks (scalp, neck, armpits, groin areas)
- Repellants
Lyme disease treatment
Early antibiotic treatment
With early Lyme disease- treat for 14 to 21 days; if removed tick by themselves- monitor
for 30 days for s/s
