Week 6 Chapter 45 Flashcards
Epidermis in Children
Thinner blood vessels closer to the surface
Loses heat more readily through skin surface
Substances are more easily absorbed through the skin
Skin contains more water
Epidermis loosely bounds to the dermis
Friction more easily results in blistering or skin breakdown
Less pigmented means ?
Increased risk for UV damage
Reaches in adult thickness in
Late teen years
Darker skin more hypertrophic scarring and keloids
Causes of Integumentary Disorders
Exposure to infectious microorganisms
Hypersensitivity reactions
Hormonal Influences
Genetic predisposition
Injuries
Indicates infection or inflammatory process
CBC
Used to detect inflammation
ESDR
Reveals branching of fungus when viewed under the microscope
KOH Prep
Indicated for atopic dermatitis
IgE
Needle prick for testing for allergens
Patch Testing
Have emergency equipment available for anaphylaxis
Florescent yellow or green in presences for fungal infection
Wood Lamp
Common Lab and Diagnostic Tests
Blood Tests
Cultures
KOH Prep
Potassium Hydroxide
Patch testing
Wood Lamp
Skin Biopsy
Common Medical Treatments for Skin Issues
Wet Dressings
Occlusive Dressings
Emollient lotions and Therapeutic Bathing
Dressing moistened with lukewarm water
Wet Dressing
Used in the presence of itching, crusting, or oozing
Wet Dressing
Pat the child dry
Do not rub skin
Leave damp before applying medication, dressing, or moisturizing
True
Common Skin Medications
Antibiotics
Corticosteroids
Antifungals
Topical immune Modulators
Antihistamines
Isotretinoin
Coal Tar Preparation
Silver Sulfadiazine
Teach family finish the entire course
Antibiotics
Do not use in high potency on face or genitals
Corticosteroids
Bactericidal against gram positive and gram negative bacteria and yeasts
Silver Sulfadiazine
Cover with dressing and avoid if have sulfa allergy
Not for children under 2 months of age
Flat discolored area
Macule
Small raised bump
Papule
Ring around central clearing
Annular
Pustule filled bump
Vesicle
Dry flaky skin
plaques
Reddening of skin
Erythematous
Impetigo
Folliculitis
Cellulitis
MRSA
Staph scalded syndrome
Bacterial Infections
Tinea
Candida Albicans
Fungal
Viral Exanthems
Herpes Simplex
Viral
Caused by Staph A
Beta Hemolytic Streptococci
Impetigo
Papules, vesicles, and pustules
Rapidly breakdown
Form golden adherent crusts
Located on face and extremities
Non bullous Impetigo
Flaccid fluid filled bullae
Rupture
Leaves a thin brown crust
Located in trunk
Bullous Impetigo
Punched out ulcers
Overlying crust
Raised violaceous borders
Ecthyma
Tx of Impetigo
Topical mupirocin or retapamulin : Limited
Extensive: Systemic Antibiotics ( Dicloxacillin, cephalexin)
If MRSA: Trimethoprim- sulfamethoxazole
Highly contagious infection and important to treat to avoid rheumatic fever and acute glomerulonephritis
Impetigo
Sores burst into dry honey colored
Most contagious and most easily spread
More serious form of impetigo that penetrates deeper into the skin causing painful sores into deep ulcers
Ecthyma
Tx of impetigo
No school or daycare
Wash Hands
Separate clothes from other laundry
Wash in hot water
Short filed fingernails
Softly remove crust and debris
Risk factors for CA- MRSA
Turf Burns
Towel Sharing
Participation in Team Sports
Attendance at day care or outdoor camps
Very Contagious and lives on surface of skin
Circular rash, scaly, itchiness
Tinea
Prevent spread and no sharing personal items
Medication for Tinea
Griseofulvin
Takes weeks to months and do not discontinue once itching stops best after high fat meal
Presents differently; hypopigmented, oval, scaly lesions on upper body
Tinea Versicolor
Selenium Sulfide
1-2.5% or Selsun Blue OTC
Acute Hypersensitivity Reactions
Diaper Dermatitis
Contact Dermatitis
Erythema Multiforme
Urticaria
Chronic Hypersensitivity Disorder
Atopic Dermatitis
Chronic Inflammatory Skin Disorders not from Hypersensitivity
Seborrhea
Psoriasis
Change diapers frequently
Avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives
Prevention and management of diaper dermatitis
Once rash has occurred follow this:
Allow infant or child to go diaperless for a period of time each day to allow rash to heal
Blow dry the diaper area/ rash area with the dryer set on the warm setting for 3-5 minutes
Antigenic substance exposure
Allergy to nickel or cobalt
Exposure to highly allergenic plants and sumac
Causes of contact dermatitis
Erythematous Papulovesicular Rash
Complications of Contact Dermatitis
Secondarily Bacterial Skin Infection
Lithification or hyperpigmentation
Develops when you have an allergic reaction
Allergic Contact Dermatitis
Causes
Poison Ivy
Nickel
Food
Fragrances
Develops when something irritates the skin over time
irritant contact dermatitis
Soaps, cleaners, water, oils, hair dyes
Common Symptoms
Burning, itchy skin, stinging, blisters
Any substance capable of inducing a specific immune response
Antigenic
Causes of Urticaria
Foods
Drugs
Animal Stings
Infections
Stress
Environmental Stimuli
Nursing Assessment for Urticaria
Detailed history of:
New foods
Medications
Symptoms of recent infection
Changes in environment
Unusual Stress
Inspect skin and mucous membranes for raised red hives
Assess airway and breathing ( hypersensitivity may affect resp. status)
Asthma, allergic rhinitis, food allergies
Atopy Family
Characterized by extreme itching
Dry, red, scaly rash with lithification and hypertrophy
Triggers of Eczema
Foods
Environment
High and Low temperatures
Sweating, scratching, stress
Nursing management of Atopic dermatitis
Promoting skin hydration, maintain skin integrity, prevent infection
Education for Atopic Dermatitis
Trim nails, lukewarm, pat dry with towels, apply moisturizer after bathing, cotton clothing
Affects 85% of adolescents
Sebaceous glands start producing oil combined with increased production of hormones
Acne
Therapeutic Management of Acne
Cleanse the skin gently twice a day
Use benzoyl peroxide, salicylic acid, retinoids, and topical and oral antibiotics- tetracycline
Birth control for females
Isotrenoin for severe cases- Females need 2 forms of birth control
Most common skin condition occurring in childhood.
Acne
Comedones are noninflammatory lesions with 2 types
Open- Blackheads
Closed- White
Acne is severe then depression may occur
Burns include
Superficial
Partial Thickness
Deep Partial Thickness
Deep Partial Thickness
Full Thickness
Who is at highest risk for burns?
Younger children
3rd leading cause of death between ages 1-4 yrs
Partial thickness greater than 10% of TBSA
Burns that involve face, hands, and feet, genetalia, or major joints
Full thickness of any size
Chemical or electrical burns
Inhalation Injury
Burn injury with preexisting conditions
Referral to Burn Center
Painful
No edema
redness
Blanches with pressure
Superficial Burn
Blistered Moist
Painful
Partial Thickness
Dru
Discolored
No pain
Full Thickness
Restoring and Maintaining Fluid Volume
Based on BSA
Use LR in 1st 24hrs in smaller add with dextrose
Most volume administered in first 8 hours
Administer colloid fluid later in therapy when capillary permeability less concern
Monitor childs urine output
Daily weights
Monitor electrolyte levels
Nursing Interventions for children with extensive burns
Promoting oxygenation and ventilation
restoring and maintaining fluid volume
Prevent hypothermia
Cleansing the burn
Preventing the infection
Managing pain
Treating infected burns
Providing burn rehab
Teaching Points in Avoiding Animal Bites
Never provoke a dog with teasing
Get adult permission before interacting with a dog
Do not bother an eating, sleeping, or nursing dog
Avoid high pitch or screaming around dogs
Display closed fist for dog to sniff
Keep ferrets away from face
Infestation of the skin by sarcoptic scabies mite
Easily transmitted through skin to skin contact
causes generalized intractable pruritus usually worse at night
Mites burrow into epidermis and lay eggs
Scabies
Therapeutic Management of Scabies
Permethrin 5% topical neck down and leave for 8 hours
All household members should be treated
Hot water laundry or dry cleaning
Items can not be washed should be placed in a bag
