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Peds Exam 5 > Integumentary > Flashcards

Integumentary Flashcards

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1
Q

Difference in Skin Between Children and Adults

A
  • Infant’s epidermis is thinner and blood vessels are closer to the surface.
  • Infant’s skin contains more water.
  • Infant’s skin is less pigmented,
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2
Q

Infant’s epidermis is thinner and blood vessels are closer to the surface so that means..

A

Infant loses heat more readily through skin surface.
Allows substances to be absorbed through skin quicker
Dehydrate quicker

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3
Q

Infant’s skin contains more water, which means..

A

Epidermis is loosely bound to the dermis.
Friction may easily cause separation of layers, resulting in blistering or skin breakdown.

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4
Q

Infant’s skin is less pigmented, which means…

A

at risk for UV damage.

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5
Q

Age-Related Skin Manifestations

A
  • Infants: Birthmarks; diaper dermatitis (Mongolian spots mistaken as bruising)
  • Early childhood: Atopic dermatitis; viral illness
  • School-age children: Ringworm
  • Adolescents: Acne; contact dermatitis
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6
Q

Atopic Dermatitis (Eczema)

A

Frequently seen in infants/kids with asthma
Incidences decrease with age
Allergy response- foods, detergents, soaps, shampoo, fabrics

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7
Q

Atopic Dermatitis (Eczema) s/s

A

dematous, Pruritic(itchy), weep and crust
Mostly seen on cheeks, distal surfaces arms and legs
Scratching cause skin break down leading to infection – scratching creates huge portal of entry for infection

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8
Q

Treatment for Eczema

A
  • avoid dressing to much-too hot
  • No solid foods until 6month
  • Avoid triggers (Heat causes reaction and causes them to itch more)
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9
Q

How to introduce solid foods to babies

A

· 1 solid food over for 4-7 days to see if react to it

o if do more than 1 don’t know what reacting to

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10
Q

Preventative tx eczema

A

Oral/topical antihistamines

Benadryl

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11
Q

Flare up tx eczema

A

topical steroids, antibiotics for 2ndary infections

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12
Q

Skin hydration eczema

A

tepid baths, emollients afterwards, soft cotton clothing

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13
Q

Nursing Dx Eczema

A

Impaired skin integrity, Pain, risk for infection, Knowledge deficit

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14
Q

Diaper Dermatitis

A
  • Usually from irritation of urine and feces
  • Detergents inadequately rinsed from clothing
  • Chemical irritation (especially from diaper wipes)
  • Folds or creases in the groin are usually unaffected
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15
Q

most chemicals put on baby from…

A

Wipes, Take wipes, wash out with water then put on baby

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16
Q

Nursing considerations for diaper dermatitis

A

include altering wetness, pH, and fecal irritants

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17
Q

Candidiasis of diaper area***

A

Yeast infection

_Skin folds or creases in the groin are affected
Satellite lesions are apparent_
Goes everywhere
Feed yogurt

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18
Q

Bacterial Infections of the Skin

A

Bullous and nonbullous impetigo
Folliculitis
Cellulitis
Staphylococcal scalded skin syndrome

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19
Q

Impetigo

A

Most common in toddlers and preschoolers
Mostly during Summer, highly contagious
Staph Aureus
Vesicular, blister-like rash (Rash usually on face around bottom lip/chin)

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20
Q

Impetigo Discharge**

A

dries to a honey colored crust

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21
Q

Impetigo treatment

A

remove crusting, oral and or topical antibiotics

Take off crust so good application of antibiotics

Teach parents to wash hands!

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22
Q

Cellulitis

A

All ages
Staph Aureus, Grp A streptococci, MRSA
Enters through a puncture wound, scrathc , abraision
Begins as an inflammatory response but bacteria proliferates and migrates to sub Q layer of skin
Can also be in body already because carrier then float and land in certain area

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23
Q

Cellulitis s/s

A

redness, edema, warmth, pain, FV, malaise, lymphadenopathy

Get the hugh around the area of infection – blueberry appearance**

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24
Q

cellulitis dx

A

wound, Cx, CBC, Bld Cx.

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25
cellulitis tx
* IV antibiotics (vanc) * Tylenol/motrin * Warm compresses, I&D * Pack dressing and leave in, change every 2 days
26
nursing dx cellulitis
Impaired skin integrity, Infection, Knowledge deficit, Pain Knowledge deficit – how to take care of, how got, how to prevent
27
Tinea pedis:
fungal infection on the feet, athelete’s foot
28
Tinea corporis:
fungal infection on the arms or legs- ring worm
29
Tinea versicolor:
fungal infection on the trunk and extremities
30
Tinea capitis:
fungal infection on the scalp, eyebrows, or eyelashes (ringworm)
31
Tinea cruris:
fungal infection on the groin
32
fungal infection s/s
S/S- skin red, itchy, dry, scaly, distinct ring rash Patches of hair may fall out where ring worm is at
33
fungal infection tx
* topical or oral antifungal * Scalp usually oral treatment- **_griseofulvin_** (PO or topically) * Teach hygeine
34
scalp fungal infection tx\*\*
**_griseofulvin_** PO
35
Pediculosis
LICE * Capitis- head- lesions behind ears and on neck from scratching- nits- removed with a fine toothed comb * Corporis- Body * Pubis- pubic- sexual contact
36
Most obvious sign of lice\*\*
constantly scratching head
37
Pediculosis tx
Treat everyone in the house even if no s/s Put rid kick in hair and comb to get nits (eggs) out
38
Scabies
Caused by scabies mite as female burrows into the epidermis to deposit eggs and feces Inflammation occurs 30 to 60 days later Usually around torso and around finger
39
scabies s/s
Intense pruritus
40
scabies tx
Elimite
41
bee stings
* May cause mild to moderate discomfort- apply cool compresses * Manage with symptomatic measures and prevention of secondary infection * With beestings, the stinger penetrates the skin * Sensitization to beestings may result in anaphylaxis
42
why apply cool compress to bee sting
vasoconstricts to keep venom from spreading, so decrease swelling
43
If stinger is left in pt then
Remove the stinger as soon as possible – use edge of object to scratch out, don’t use tweezers
44
If Sensitization to beestings may result in anaphylaxis then tx with \*\*
**_epipen_**
45
**_Macules_\*\* -**
flat brown, mole less than 1 cm diameter
46
**_Vesicles_** -
bullae- elevated,circumscribed , less than 1 cm diameter, serous fluid
47
Acne
predominantly in adolescents Pathophysiology * Involves hair follicles and sebaceous glands * Comedogenesis (clogs pores, black heads)
48
Topical Acne Medications
Topical – benzoyl peroxide and Retin-A
49
Medication given for Acne only after not responding to other treatment\*\*
Accutane * Sucks moisture out of skin * Will lose weight * Blood work every month * **_Terrible birth defects_** * **_Puts at a higher risk for fractures_**
50
Acne nursing dx
body image/self esteem
51
Burns
Toddlers: Hot water scalds Older children: Flame-related burns Child abuse – cig burns, curling iron burns Child with matches or lighters accounts for 1 in 10 house fires
52
Characteristics of Burn Injury
Extent of injury described as total body surface area (TBSA)
53
depth of burn injury\*\*
* Superficial (first degree) * Partial thickness (second degree) * Full thickness (third degree) * Full thickness plus underlying tissue (fourth degree)
54
Superficial (first degree)
only epidermis, feels pain, no blisters usually heal without scarring within 4-5 days
55
Partial thickness (second degree)
epidermis and dermis, red, blisters, not popped, very painful, heal within 2 weeks with minimal risk of scarring do not pop blisters
56
Full thickness (third degree)
pale white, no hair, don’t feel pain-numb, take longer to heal, changes in hair, nail, and sebaceous glands, extend through epidermis, dermis, and hypodermis, extensive scaring deep tissue damage
57
Full thickness plus underlying tissue (fourth degree)
if underlying tendons and/or bone damanged
58
Assessment of burns
Primary survey-ABCs- measure end tidal CO2, carboxyhemoglobin (carbon monoxide)can cause a false high O2 sat.have cherry red lips Secondary- type of burn, pattern, blistering, eschar, MOI (chem burn/flash burn), depth
59
severity of burn injury
Major burn injury is treated in a specialized burn center Moderate burn injury is treated in a hospital with expertise in burn treatment Minor burn injury is treated in an outpatient setting If walk into hospital then your responsibility
60
Inhalation Injury
Trauma after inhalation of heated gases and toxic chemicals produced during combustion Upper airway obstruction may require endotracheal intubation If see cinged eyebrows/burn on skin, get ready to intabate because airway will swell
61
Inhalation Injury s/s\*\*
sut nose, mouth, cinged facial hair, eyebrows, nose hair
62
Pathophysiology of Thermal Injuries
* Systemic response involving increased capillary permeability leading to vasodilatation * Edema-H2O, electrolytes, protein leak from vasculature into tissue as a result of the increased hyodrostatic pressure * Hypovolemia- fluid loss occurs at 5-10 more in burned skin * Initially a decreased cardiac output occurs but then changes to a hypermetabolic state that can lead to insulin resistance and increased protein catbolism
63
because pts are in a hypermetabolic state, what type of diet?
high protein and high carb
64
Complications of Burn Injuries \*\*\*
**Immediate threat of airway compromise Profound shock- most immediate threat to life Infection (local and systemic sepsis)- _after the acute phase_** Inhalation injuries, aspiration, pulmonary edema, pulmonary embolus
65
at risk for infection after what phase of burn\*\*
acute phase
66
Burns: Therapeutic Management
* First priority is airway maintenance * Fluid replacement therapy is critical in the first 24 hours - So 1st secure airway, then flood with fluids so no shock * Prevent infection * Restore function * Skin doesn’t have elasticity anymore – can’t move – have to go to burn unit to get function of joint * Nutrition for enhanced metabolic demands - High protein – low carbs
67
what can lead to a false O2 sat reading in burn pt
high levels of carboxyhemoglobin
68
care of major burns
* Primary excision – removing dead skin * Débridement- whirl pool, premedicate - Washes off dead skin​ * Typically give morphine before * Topical antimicrobial agents – Silvaderx, vasotracin – keep moist and wrap it * Biologic skin coverings * Allograft (human cadaver skin) * Xenograft (porcine skin) * Synthetic skin substitutes * Split-thickness skin grafts (sheet or mesh grafts)
69
Care of minor burns
* Wound cleansing – run under cool water, don’t pop blister, clean with little antimicrobial soap, put basic tracin or silvadin on * Débridement - To pop the blister or not to pop the blister * Dressings - Controversy regarding whether to cover the wound with antimicrobial ointment or occlusive dressings * Typically silvade
70
rehabilitation after major burns
Begins once wound coverage has been achieved Prevention or management of contractures Physical and occupational therapy Multidisciplinary team Facilitate adaptation of the child and family
71
depth of burns pic
72
Common skin injury in children due to ultraviolet exposure
sunburn
73
Nursing Implications - Sunburns
EDUCATION: * Importance of protection with sunscreen application above 6 months of age \ * Can’t put sunscreen on before 6 months, so baby should not be out in sun * **_If younger know shade and clothes_** * Clothing * Limiting risk of injury or exposure- stay in shade or inside

Peds Exam 5 (5 decks)

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