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Peds Exam 3 > Dermatology/integumentary system > Flashcards

Dermatology/integumentary system Flashcards

1
Q

ecchymoses

A

bruising

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2
Q

petechiae

A

pinpoint red or purple spots caused by bleeding under the skin

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3
Q

Etiology of petechiae

A
  • can be brought on by coughing, vomiting, distress
  • it’s the breaking of capillary (via force)
  • platelets aren’t working so there’s bleeding under the skin
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4
Q

what are the 2 big reasons we get concerned when we see petechiae?

A

1) meningitis (most common)

2) idiopathic thrombocytopenci pupura (ITP)

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5
Q

How do you test if the red or purple spots are petechiae?

A

press to see if it blanches (if yes, it IS petechiae)

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6
Q

what is a secondary lesion?

A

lesion caused from a primary lesion caused by scratching or rubbing

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7
Q

macule

A

small, flat, circumscribed skin spot (not raised or depressed)

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8
Q

papule

A

a small, raised, solid pimple or swelling, often forming part of a rash on the skin and typically inflamed but not producing pus.

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9
Q

which two bacterias normally harbor on the skin

A

staph and strep

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10
Q

how do bacterial skin infections come about?

A

any process leading to a breach in the skin barrier (trauma, abrasions, shaving, insect bites, scratching) can predispose to development of a skin infection bc staph and strep are found on the skin

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11
Q

What are the 3 most common bacterial skin infections?

A
  1. impetigo
  2. folliculitis, furuncle, carbuncle
  3. cellulitis
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12
Q

what is impetigo

A
  • papules that progress to vesicles surrounded by erythema and then become pustules and break down to form thick adherent crusts (honey golden appearance)
  • lesions usu involve face (most common) and extremeties, usu in clusters
  • PRURITIC
  • most likely staph or strep
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13
Q

In what demographic is impetigo most common?

A

ages 2-5 years

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14
Q

what is the treatment for impetigo

A
  • Topical antibiotics (mupirocin) and/or
  • Oral antibiotics (cephalosporins) (if infection is near eyes or if widespread)
  • **handwashing is KEY to prevent spread
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15
Q

furuncle

A

boil

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16
Q

folliculitis

A

inflammation of hair follicles

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17
Q

carbuncle

A

A group of pus-filled bumps forming a connected area of infection under the skin.

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18
Q

Folliculitis, furuncles, carbuncles…what are they?

A
  • starts with infection of hair follicle
  • purulent material extends to the dermis and into the subcutaneous tissue
  • starts by small abscess formed (furuncles) leads to carbuncles (several inflamed follicles into a single inflammatory mass)
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19
Q

Where are folliculitis, furuncles, carbuncles typically seen? And what causes them?

A
  • seen in areas exposed to friction and perspiration (back of neck, face, axillae, buttocks
  • often caused by old razor or HOT TUBS!
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20
Q

What is the Tx of Folliculitis, furuncles, carbuncles?

A
  • warm compresses (promotes drainage)
  • incision and drainage (“I and D”)
  • obtain culture to r/o MRSA
  • NEVER SQUEEZE (can push infection deeper)
  • role of antibiotics is not yet clear
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21
Q

What is cellulitis?

A

inflammation of skin and subcutaneous tissues and may involve upper dermis and superficial lymphatics - usually a complication of a wound or trauma

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22
Q

Signs and Sx of cellulitis

A
  • skin erythema
  • edema
  • WARMTH
  • inflammation of regional lymph nodes
  • “streaking”
  • fever
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23
Q

Which types of cellulitis are more severe?

A

periorbital and perianal cellulitis (these require hospitalization
-periorbital cellulitis often starts out as conjunctivitis

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24
Q

what is the treatment for cellulitis?

A
  • elevation of affected area
  • rest and immobilization of affected area
  • oral antibiotics
  • IV antibiotics (if involved area is near joint, eyes or face
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25
Q

What is the nursing management for cellulitis?

A
  • ***HANDWASHING (very contagious)
  • clothing directly touching affected area needs to be cleaned in HOT water and changed daily
  • discard razors
  • prevent spread of infection (caution child against touching involved area)
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26
Q

two most common viral skin infections?

A
  1. warts

2. herpes simplex (1 and 2)

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27
Q

What are the common causes of warts? (2)

A

HPV and verruca plataris (plantar warts)

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28
Q

what is a wart?

A
  • well-circumscribed, gray or brown, elevated, firm papules

- rough texture

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29
Q

Where are warts mostly seen?

A

in exposed areas (fingers, hands, face)

-may be single or multiple

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30
Q

Can you treat warts with antibiotics?

A

no! (it’s a virus)

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31
Q

Why are warts difficult to treat (3 reasons)

A
  • it can hide inside cells (intracellular parasites)
  • they can be dormant for a while and then “wake up”
  • you can’t treat with antibiotics
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32
Q

What is the treatment for warts?

A
  • destructive therapy (surgical removal by dermatology)
  • cryotherapy with liquid nitrogen
  • laser, lactic retinoic and saliclylic acid solutions (typically OTC and not as effective)
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33
Q

What are the 2 types of Herpes Simplex Virus?

Differentiate btwn the 2

A
  • Type 1: cold sores, fever blisters (90% of ppl have this!)
  • Type 2: genital
  • both are characterized by clustered, grouped, burning, itching vesicles (vesicles form a crust)
  • sores typically have spontaneous healing after 8-10 days
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34
Q

where is HSV typically seen?

A

-lips, nose, genitalia and buttocks

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35
Q

What is the treatment for HSV?

A
  • topical therapy: Penciclovir (may shorten duration, must use asap after outbreak)
  • oral antiviral: Acyclovir (earlier you start Tx the better)
  • Valacyclovir (Valtrex): used for recurrent genital herpes
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36
Q

For how long is HSV contagious?

A

for 1 week after outbreak

37
Q

Name 3 common fungal skin infections

A
  1. Tinea capitis (ringworm on scalp)
  2. tinea corporis (ringworm on body)
  3. tinea pedis (ringworm on feet/athletes foot)
38
Q

What is tinea capitis?

A

-ringworm on scalp
-scaly, circumscribed patches w areas of alopecia (hair loss is usu in circular pattern)
-may be pruritic
-

39
Q

How is tinea capitis spread?

A
  • child-to-child directly or via shared hats, combs, brushes, barrettes, rollers
  • may also be transmitted from household pets (*esp CATS)
40
Q

How long does tinea capitis typically last?

A

can last months to years

41
Q

In what demographic is tinea capitis more common?

A
  • high incidence in prepubertal children (2-10 yrs)
  • 5x more likely in boys
  • more common in populations with coarse hair
42
Q

What is the treatment for tinea capitis?

A
  • Oral antifungal: Griseofluvin
  • If a “kerion” is present (boggy inflammation d/t allergic Rx to fungus) then a 7-10 day course of prednisone is added to regimen
43
Q

Education about oral antifungal GRISEOFLUVIN

A
  • must be given for 6-12 weeks

- should be taken with high fat or it won’t absorb (advise to take w whole milk)

44
Q

What is tinea corporis?

A
  • ringworm on body
  • Generally round or oval, erythematous scaling patch that spreads peripherally and clears centrally; may involve nails
  • multiple lesions, may be pruritic
45
Q

How is tinea corporis transmitted?

A

-direct contact or contact with inanimate objects. USU FROM ANIMAL ORIGIN (infected pets)

46
Q

Which areas of the body are typically impacted with tinea corporis?

A

-Non-hairy body parts (face, trunk, under arms)

47
Q

What is the Tx of tinea corporis?

A
  • Daily application of topical antifungals (clotrimazole, micronazole), should be applied for 3x/day for at least 2 weeks (plus 1-2 weeks after no sign of lesions bc it tends to come back)
  • may need oral GRISEOFULVIN (if topical is ineffective)
48
Q

What is tinea pedis?

A
  • ringworm of the feet (aka athletes foot)
  • intensely pruritic erythematous vesicles or bullae btwn toes and on soles of feet
  • often follow activities that cause feet to sweat
  • may be intermittent, recurrent or chronic
    • –chronic tinea pedis (if untreated) can cause scaling and spread to nails)
49
Q

What is the Tx of tinea pedis/athletes foot?

A
  • Topical antifungal cream for 4 weeks (interdigital)

- chronic tinea pedis may require oral antifungal therapy (up to 8 weeks)

50
Q

Nursing management and recommendations for ringworm/tinea

A
  • emphasize good health and hygiene
  • avoid exchanging grooming items, headgear, SHOES
  • affected child should have their own towel
  • protective head cap can be used to prevent spreadingi fungus to bedding
  • household pets should be examined for fungus
  • important to keep areas clean and dry as much as possible (aerate!!)
  • change socks daily
51
Q

When can a child with ringworm return to school?

A

-Child may return to school after 24 hours on antifungal meds (even though the ringworm or fungus infection may still be visible)

52
Q

What is dermatitis?

A

inflammatory changes in the skin

53
Q

what are the two types of dermatitis? Differentiate btwn the 2.

A
  1. contact: transmitted by touching (e.g. poison ivy)
    —anyone can get it who touches it
  2. atopic: immunoglobulin response/it’s genetic (e.g. asthma and eczema)
    –not everyone will get this, you need to have an underlying genetic predisposition
    We CANT distinguish by looking at it. Need a thorough Hx!
54
Q

Atopic dermatitis is also known as

A

eczema

55
Q

What is atopic dermatitis (eczema)?

A
  • Appears to involve genetic defect in the proteins supporting the epidermal barrier
  • May have elevated IgE levels- associated with asthma and higher sensitivity to allergens
  • Environmental allergens, irritants, and microbes penetrate skin and come in contact with immune cells leading to release of proinflammatory mediators
56
Q

Triggers of atopic dermatitis (eczema)?

A
  • Triggered by food allergens, environmental allergens, topical irritants
  • also linked to family Hx of asthma
57
Q

Which parts of body are most commonly affected by atopic dermatitis (eczema)?

A
  • Involves antecubital fossae and popliteal fossae (most common areas)
  • also neck, areas around eyes, fronts of ankles
  • hands, face and scalp (common sites for infantile eczema)
58
Q

When do most children have first onset of eczema?

A

-Majority have onset before age 5

59
Q

what are the clinical manifestations of eczema (atopic dermatitis)?

A
  • red, scaly, crusted lesions
  • pruritic
  • can include vesicles
  • may have scratch marks
  • generally dry skin throughout
  • Involves antecubital fossae and popliteal fossae (most common areas)
  • also neck, areas around eyes, fronts of ankles
60
Q

What is the treatment of eczema (atopic dermatitis)

A
  • eliminate exacerbating factors (excessive bathing (too much water can make it worse), low humidity, emotional stress, overheating of skin, exposure to detergent
  • Maintain skin hydration (aquaphor, eucerin, petroleum jelly) [apply 2-3 times per day]
  • control pruritis (antihistamines)
  • therapy for inflammation (corticosteroids)
  • management of infections (antibiotics (if rash becomes infected)
61
Q

Is eczema contagious?

A

nope

62
Q

What is contact dermatitis

A

-inflammatory Rx of the skin d/t chemical substances (natural or synthetic)

63
Q

Most common type of contact dermatitis seen in peds?

A

-diaper dermatitis

64
Q

Signs and Sx of contact dermatitis?

A

-erythema, bullae, swollen base, constant pruritis

65
Q

Common causes of contact dermatitis

A
  • diaper dermatitis
  • plants (poison ivy)
  • irritants (wool, furs, metals, oils, dyes, cosmetics, perfumes, soaps)
66
Q

Where is contact dermatitis typically seen on the body?

A

-in an exposed region (face, neck, back of hands, forearms, lower legs

67
Q

What is diaper dermatitis

A
  • type of contact dermatitis
  • prolonged, repetitive exposure to urine, feces, soaps, friction
  • peak age is 9-12 months
  • convex surfaces or in-folds of skin are often SPARED if from urine or feces (good way to distinguish btwn contact and atopic derm)
68
Q

Nursing management of diaper dermatitis

A
  • avoid irritant! (goes for all types of dermatitis)
  • wetness and fecal irritant: change diaper frequently and leave open to air in btwn diaper changes
  • use superabsorbent disposable diapers
  • AVOID WIPES AND PERFUMED SOAPS
  • use water and mild soap to clean and then leave open to air before putting diaper back on
69
Q

Name 3 common skin disorders due to mite/insect contact

A
  1. scabies
  2. head lice
  3. lyme disease
70
Q

What is scabies?

A
  • an infestation of the skin cased by scabies mite (sarcoptes scabei)
  • highly contagious!!!
71
Q

How is scabies transmitted?

A

DIrect contact (person to person)

  • crowded conditions increase the prevalence
  • more common in winter than in summer
72
Q

what are the clinical manifestations of scabies?

A
  • itching (often severe and worse at night)
  • small, erythematous, papules
  • typically seen in btwn fingers, hands and wrist, feet and ankles
  • HOCKEY STICK/burrows presentation COMMON
73
Q

What is the Tx of scabies?

A
  • Topical Permethrin cream: ALL OVER BODY (head to toe!)
  • cream applied over night (8-14 hours) and washed off in AM
  • rash takes a few days to go away but itching should be gone after Tx and no NEW lesions should be forming
74
Q

Nursing management of scabies

A
  • entire household should be treated
  • control of transmission
    • –scabies survives for 24-36 hours (longer in cold) without human contact
    • -all clothing, bedding, stuffed animals must be bagged for more than 36 hrs (to suffocate mites) and then washed in hot water, hot dryer, or dry cleaning
75
Q

what is Pediculosis capitis (head lice)?

A
  • Head louse is gray-white, 2-4mm insect, legs attach to hair and mouth suck blood from the scalp
  • eggs “nits” cement firmly to the base of the hair (eggs are white and more visible) eggs hatch in 8 days
76
Q

what is the lifespan of female louse (lice)

A

about 1 month (she lays 7-10 eggs/day

77
Q

For how long can lice survive off the body?

A

more than 48 hours!

78
Q

How are head lice transmitted?

A
  • from person to person or on items such as hats, caps, scarves, coats
  • lice do NOT jump or fly!
79
Q

What are the clinical manifestations of head lice?

A
  • most are asymptommatic
  • itching may occur
  • nits can be seen on hair shafts, behind ears, nape of neck
  • (can be distinguished from dandruff bc the nits STICK firmly to hair)
80
Q

What is the Tx for head lice?

A
  • Topical Pediculicide (Rid, Nix)
    • –wash hair w shampoo, rinse and towel dry (repeat 2x, more effective)
    • –apply insecticide cream or gel liberally to scalp and leave on for 10 min before rinsing w water
    • –wet-comb to remove lice (add a lubricant: oil, cream rinse) every 2-3 days
    • –hot air Tx (30 min of hot air-100% effective)
  • Do not need to treat entire household unless you can see lice on them or unless they share a bed
  • home remedies (mayonnaise, oils, petroleum jelly, oils, vinegar, butter, alcohol DO NOT KILL LOUSE EGGS
81
Q

Nursing mngment of head lice

A

prevent head lice spread!!

  • examine everyone in household for lice
  • anyone who sleeps in same bed should be treated
  • clothing, bedding and towels used within 48 hrs before Rx should be washed in hot water and dried in dryer on hot setting
  • vacuum carper, furniture and car seats
  • **items that can’t be washed or vacuumed can be sealed inside a plastic bag for TWO WEEKS
  • boil combs, brushes, hair accessories for 10 min
82
Q

When can a child with head lice go back to school?

A

after one Tx with insecticide (you still might be able to SEE lice but they’re dead and no longer contagious

83
Q

What is lyme disease?

A

-tick borne illness caused by the spirochete borrelia burgdoferi which enters the skin and bloodstream through the saliva and feces of the ticks, especially the deer tick

84
Q

What are the 3 clinical stages of lyme disease?

A
  1. ERYTHEMA MIGRANS at site of bite (within 1 month following tick bite (66%)-Cutaneous phase
  2. EARLY DISSEMINATED DISEASE (multiple erythema migrans lesions - 23%) - occurs 3 to 10 weeks after innoculation; neurologic and/or cardiac (0.5%) findings can occur several weeks after cutaneous phase
  3. LATE LYME DISEASE is associated with arthritis (7%) involving 1 or a few large joints (esp knee) and/or neurologic problems (4%) (encephalopathy). May develop months to a few yrs after initial infection
85
Q

What are the clinical manifestations of lyme disease?

A

o erythema migrans lesion: characteristic annular (circular) red rings (bull’s eye appearance)
o Serologic test IgM antibodies and IgG antibodies to B.burgdorferi
o Body takes 6 wks to mount an immunoglobulin response, so if check immediately (1st 6 weeks after bite), may give you a false negative
- lesion is described as “burning,” feels warm to the touch, and occasionally is pruritic.
-The single annular rash may be associated with fever, myalgia, headache, or malaise.

86
Q

If someone was bitten by a tick and suspects lyme disease, when should you advise them to go get tested?

A

o Educate ppl to wait 6 weeks to get tested

o **Signs & Sx may appear up to 32 days after the initial bite.

87
Q

What is the Tx for Lyme disease?

A

-children under 8 yo (amoxicillin)
-children over 8 yo (doxycycline)
-Tx is 14-21 days
Other at-home comfort treatments: lavender oil, citronella oil

88
Q

Nursing management

A

Educate parents on PREVENTION!
• Protect children from exposure to ticks (esp when in woods)
• wear light colored clothing (ticks can be better spotted)
• Tuck pant legs into socks
• Wear long-sleeved shirts tucked into pants
• Perform regular tick checks
• Bug sprays with DEET can help
-educate parents about how to remove ticks (grasp firmly with tweezer pull straight out)

Peds Exam 3 (4 decks)

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