Integumentary Dysfunction
Chapter 47 Integumentary Dysfunction All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Skin Lesions Contact with injurious agents Hereditary factors
External factor that produces a reactionin the skin (allergens) Systemic disease in which lesions area manifestation (measles) All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Examples of Age-Related Skin Manifestations
Infants: birthmarks Early childhood: atopic dermatitis School-age children: ringworm Adolescents: acne Anxiety may produce, modify or prolong skin conditions All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Types of Lesions Erythema Ecchymoses (bruises) Petechiae
Primary lesions Macules, papules, vesicles Secondary lesions Distribution pattern Configuration and arrangement All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Wounds Structural or physiologic disruption of the skin
Activates tissue repair responses Acute Heal uneventfully in 2-3 weeks Chronic Do not heal Associated with complications All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Factors That Influence Healing
Moist, crust-free environment Nutritional deficiencies Stress Medications Infection Diseases Peripheral vascular disease All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. General Therapeutic Management of Skin Lesions
Dressings Topical therapy Active ingredients Cost and instructions for use Topical corticosteroids Systemic therapy All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Signs of Wound Infection
Increased erythema, especially beyond wound margins Edema Purulent exudate Pain Increased temperature All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Wound Care Basics Parents can generally manage wound care at home
Wash wound with mild soap and water and rinse Avoid povidone-iodine, alcohol, and hydrogen peroxide Cover open wound Leave wide margin of intact skin around dressing Remove dressing if leakage occurs; remove carefully Lacerations All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Relief of Symptoms Pruritus: most common complaint with skin lesions
Cooling baths or compresses Prevent scratching Mittens/covering for younger children Short nails Antipruritic medications All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Infection of the Skin Bacterial infections Abscess formation
Severity: varies with skin integrity, immune and cellular defenses Examples: impetigo contagiosa, pyoderma, cellulitis All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Infection of the Skin (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Infection of the Skin (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Viral Skin Infections Most communicable diseases of childhood produce characteristic rash Rubeola, rubella, and chickenpox Less common: verruca, herpes simplex types I and II, varicella zoster, molluscum contagiosum All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Dermatophytosis (Fungal Infection)
Superficial infections that live on the skin Ringworm: caused by a group of filamentous fungi Transmission from person to person or from infected animal to human Examples: tinea capitis, tinea corporis, tinea pedis, candidiasis All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Dermatophytosis (Fungal Infection) (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Systemic Mycotic (Fungal) Infections
Invade viscera and skin Wide spectrum of disease May appear as granulomatous ulcers, plaques, nodules, and abscesses All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Contact Dermatitis Inflammatory reaction of skin to chemical
Initial reaction in the exposed region Characteristic sharp delineation between inflamed and normal skin Primary irritant Sensitizing agent Examples: diaper dermatitis, reaction to wool, reaction to specific chemical All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Poison Ivy, Oak, and Sumac
Exposure to plants leads to localized lesions Lesions are caused by urushiol from plants leaves and stems Sensitivity may develop after one or two exposures and may change over time Urushiol penetrates through the epidermis and bonds with the dermal layer All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Poison Ivy, Oak, and Sumac (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Drug Reactions Adverse drug reactions are most often seen in skin (rashes are most common reaction) Reactions may be immediate or delayed after administration of drug Treatment: discontinue offending drug; administer antihistamines, corticosteroid therapy if reaction is very severe All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Foreign Bodies Splinters of wood Cactus spines
Can be removed with needle and tweezers Cactus spines Can be removed with glue or scotch tape May necessitate medical treatment if difficult to see or remove Fish hook, pieces of glass All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Arthropod Bites and Stings
Arthropods: most are harmless Seek medical attention immediately for these exceptions: Scorpion bites Black widow/brown recluse spider bites Bees: stinger penetrates skin Remove stinger as soon as possible Sensitization to bee stings may result in anaphylaxis All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Arthropod Bites and Stings (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Scabies Caused by scabies mite as female burrows into epidermis to deposit eggs and feces Inflammation occurs days later Topical treatment includes scabicides such as permethrin 5% or lindane Oral treatment includes ivermectin if body weight >15 kg All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Pediculosis Capitis (Head Lice)
Infestation of the scalp is common in school-age children Adult louse lives only 48 hours without human host; female louse has potential life span of 30 days Female lice lay eggs (nits) at base of hair shaft Nits hatch in 7-10 days Treatment includes pediculicides and removal of nits Prevent spread and recurrence All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Pediculosis Capitis (Head Lice) (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Infections Transmitted by Arthropods
Rickettsiae: Rocky Mountain spotted fever transmitted by infected fleas, ticks, and mites Lyme disease: most common tick-borne disorder in United States Characteristic rash: confirms diagnosis Focus: on prevention All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Infections Transmitted by Arthropods (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Bites from Pets and Wild Animals
Common pediatric problem Majority of victims of dog bites: boys between the ages of 5 and 9 years Wound care Prophylactic antibiotics for some types of bites Rabies concern Prevention All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Human Bites Lacerations from teeth of other humans Risk of infection
Rough play During fights Child abuse Risk of infection Wound care Tetanus toxoid All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Cat Scratch Disease Most common cause of regional lymphadenitis
Follows the scratch or bite of an animal 99% of cases: a cat or kitten Benign self-limiting disease Resolves in 2-4 months Treatment is supportive, includes antibiotic therapy All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Diaper Dermatitis Pathophysiology Clinical manifestations
Usually caused by irritation from urine and feces Detergents inadequately rinsed from clothing Chemical irritation (especially from diaper wipes) Clinical manifestations Include candidiasis of diaper area Nursing considerations: alter wetness, pH, and fecal irritants All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Diaper Dermatitis (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Diaper Dermatitis (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Atopic Dermatitis (Eczema)
A type of pruritic eczema that begins during infancy Hereditary tendency Often associated with history of food allergies, allergic rhinitis, and asthma All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Atopic Dermatitis (Eczema) (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Types of Atopic Dermatitis
Three forms, based upon childs age Infantile eczema: begins at 2-6 months of age Childhood eczema: occurs at 2-3 years of age Preadolescent and adolescent: occurs at 12 years of age to early adulthood All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Therapeutic Management of Atopic Dermatitis
Hydrate the skin Relieve pruritus Reduce inflammation Prevent/control secondary infection All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Seborrheic Dermatitis
Chronic, recurrent inflammatory reaction of the skin; cause unknown Commonly occurs on scalp (cradle cap) Also seen on eyelids, nasolabial folds, ears Treatment: remove crusts, use antiseborrheic shampoo All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Acne Predominantly in adolescents (50% of teenagers) Pathophysiology
Involves hair follicle and sebaceous glands Comedogenesis Therapeutic management General measures/overall health Medications (tretinoin) All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Acne (Cont.) All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Thermal Injury Burns Toddlers: hot-water scalds
Older children: flame-related burns Child abuse Child playing with matches or lighters: accounts for 1 per 10 house fires All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury
Extent of injury described in terms of total body surface area: age-related charts Depth of injury First-degree: superficial Second-degree: partial thickness Third-degree: full thickness Fourth-degree: full thickness and underlying tissue Severity of injury All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Severity of Burn Injury
Major burn injury: treat in specialized burn center Moderate burn injury: treat in hospital with expertise in burn treatment Minor burn injury: treat in outpatient setting All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Type of Burn Injury Thermal agents Electrical injuries Chemical burns
Flame, hot surfaces, hot liquids Electrical injuries Chemical burns Inhalation or ingestion of toxic substances All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Pathophysiology of Burn Injuries
Systemic response involving capillary permeability Edema Hypovolemia Anemia All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Complications of Burn Injuries
Immediate threat of airway compromise Profound shock Infection (local and systemic sepsis) Inhalation injuries, aspiration, pulmonary edema, pulmonary embolus All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Therapeutic Management of Burn Injuries
Emergency care priorities Stop burning process Assess childs condition Cover burn to prevent contamination Transport child to appropriate level of care Provide reassurance All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Therapeutic Management of Burn Injuries (Cont.)
First priority: airway maintenance Fluid replacement therapy: critical in first 24 hours Nutrition: enhanced metabolic demands Medication: antibiotics, analgesics, anesthetics for procedural pain All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Wound Management Primary excision Dbridement
Topical antimicrobial agents Biologic skin coverings Allograft (human cadaver skin) Xenograft (porcine skin) Synthetic skin substitutes Split-thickness skin grafts (sheet or mesh graft) All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Wound Management (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Wound Management (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Wound Management (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Care of Minor Burns Wound cleansing Dbridement Dressings
Removal of blisters (controversial) Dressings Covering wound with antimicrobial ointment or use of occlusive dressings (controversial) All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Burns: Long-Term Care Begins once wound coverage has been achieved
Prevention/management of contractures Physical/occupational therapy Multidisciplinary team Facilitate adaptation of child and family Prevention of burn injuries All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Burns: Long-Term Care (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Burns: Long-Term Care (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Sunburn Ultraviolet A waves Ultraviolet B waves
Photosensitivity is an allergic reaction Ultraviolet B waves Importance of protection: sunscreens Amount of ultraviolet exposure influenced by numerous factors Time of day Altitudes, nearness to the equator Snow, sand, and water All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Cold Injury Chilblain Frostbite
Redness/swelling especially of hands when exposed Vasodilation, edema, bluish patches, itching and burning; symptoms continue after rewarming; usually resolve in a few days Frostbite Tissue damage is caused by ice crystals in tissues Blisters appear hours after rewarming Treatment of blisters is similar to burn treatment All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Question The nurse is talking to the parents of a child with pediculosis capitis. When explaining how to manage pediculosis capitis, the nurse should state A. You will need to cut the hair shorter if infestation and nits are severe. B. You can distinguish viable from nonviable nits and remove all viable ones. C. You can wash all nits out of hair with a regular shampoo. D. You will need to remove nits with an extra-fine tooth comb or tweezers. All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.