Week 6 Chapter 45 Flashcards by Steven Singh

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

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Skin contains more water

Epidermis loosely bounds to the dermis

Friction more easily results in blistering or skin breakdown

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Less pigmented means ?

Increased risk for UV damage

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Reaches in adult thickness in

Late teen years

Darker skin more hypertrophic scarring and keloids

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Causes of Integumentary Disorders

Exposure to infectious microorganisms
Hypersensitivity reactions
Hormonal Influences
Genetic predisposition
Injuries

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Indicates infection or inflammatory process

CBC

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Used to detect inflammation

ESDR

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Reveals branching of fungus when viewed under the microscope

KOH Prep

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Indicated for atopic dermatitis

IgE

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Needle prick for testing for allergens

Patch Testing

Have emergency equipment available for anaphylaxis

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Florescent yellow or green in presences for fungal infection

Wood Lamp

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Common Lab and Diagnostic Tests

Blood Tests
Cultures
KOH Prep
Potassium Hydroxide
Patch testing
Wood Lamp
Skin Biopsy

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Common Medical Treatments for Skin Issues

Wet Dressings
Occlusive Dressings
Emollient lotions and Therapeutic Bathing

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Dressing moistened with lukewarm water

Wet Dressing

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Used in the presence of itching, crusting, or oozing

Wet Dressing

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Pat the child dry
Do not rub skin
Leave damp before applying medication, dressing, or moisturizing

True

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Common Skin Medications

Antibiotics
Corticosteroids
Antifungals
Topical immune Modulators
Antihistamines
Isotretinoin
Coal Tar Preparation
Silver Sulfadiazine

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Teach family finish the entire course

Antibiotics

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Do not use in high potency on face or genitals

Corticosteroids

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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

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Flat discolored area

Macule

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Small raised bump

Papule

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Ring around central clearing

Annular

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Pustule filled bump

Vesicle

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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