Nursing care of the child with an integumentary disorder

Question 1

Difference in Skin Between Children and Adults

How are infants’ epidermis?

Answer 1

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

Question 2

Difference in Skin Between Children and Adults

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

How does this effect heat?

Answer 2

Infant loses heat more readily through skin surface.

Question 3

Difference in Skin Between Children and Adults

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

How does this effect absorption?

Answer 3

Allows substances to be absorbed through skin quicker.

Question 4

Difference in Skin Between Children and Adults

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

When does infants’ skin reach adult thickness?

Answer 4

Does not reach adult thickness until late teen years.

Question 5

Difference in Skin Between Children and Adults

What does infants skin contain more of compared to adults?

Answer 5

Infant’s skin contains more water.

Question 6

Difference in Skin Between Children and Adults

Infant’s skin contains more water.

How is epidermis?

Answer 6

Epidermis is loosely bound to the dermis.

Question 7

Difference in Skin Between Children and Adults

Infant’s skin contains more water.

What can effect layers of skin?

Answer 7

Friction may easily cause separation of layers, resulting in blistering or skin breakdown.

Question 8

Difference in Skin Between Children and Adults

Infant’s skin contains more water.

Why is infants skin at more risk for UV damage?

Answer 8

Infant’s skin is less pigmented, therefore at risk for UV damage.

Question 9

Causes of Integumentary Disorders in Children:

What can they be exposed to that could lead to integumentary disorders?

Answer 9

Exposure to infectious microorganisms.

Question 10

Causes of Integumentary Disorders in Children:

What kind of reactions can occur?

Answer 10

Hypersensitivity reactions.

Question 11

Causes of Integumentary Disorders in Children:

What are other causes of skin disorders?

Answer 11

Genetic predisposition.

Injuries.

Question 12

Causes of Integumentary Disorders in Children:

How does darker skin compare to fairer skin?

Answer 12

Darker skin tends to develop hypertrophic scarring and keloids more so than fair skin.

Question 13

Common Laboratory and Diagnostic Tests

Answer 13

Labs:

Immunoglobulin E (IgE)

Culture and sensitivity of wound drainage

Potassium hydroxide (KOH) prep

Patch or skin allergy testing

Wood lamp

Question 14

Common Laboratory and Diagnostic Tests

What kind of labs are done?

Answer 14

Labs: CBC, erythrocyte sedimentation rate (ESR)

Question 15

Terms to Describe Alterations in Integument

Answer 15

Macule

Papule

Annular

Pruritus

Vesicle, pustule

Scaling, plaques

Hypo-, hyperpigmented

Erythematous

Question 16

Types of Infections of the Skin

Answer 16

Bacterial:

Fungal

Viral

Question 17

Types of Infections of the Skin

Bacterial: What are examples?

Answer 17

bullous and nonbullous impetigo, folliculitis, cellulitis, MRSA, Staphylococcal scalded skin syndrome.

Question 18

Types of Infections of the Skin

Bacterial: What are they often caused by?

Answer 18

Often caused by Staph aureus or group A β-hemolytic streptococcus (normal flora).

Question 19

Types of Infections of the Skin

Fungal: What are examples?

Answer 19

multiple types of tinea (pedis, corporis, versicolor, capitis and cruris), Candida albicans.

Question 20

Types of Infections of the Skin

Viral: What are examples?

Answer 20

viral exanthems, Herpes simplex.

Question 21

Fungal Infections of the Skin

Answer 21

Tinea pedis:

Tinea corporis:

Tinea versicolor:

Tinea capitis:

Tinea cruris:

Question 22

Fungal Infections of the Skin

Tinea pedis

Answer 22

fungal infection on the feet.

Question 23

Fungal Infections of the Skin

Tinea corporis:

Answer 23

fungal infection on the arms or legs.

Question 24

Fungal Infections of the Skin

Tinea versicolor:

Answer 24

fungal infection on the trunk and extremities.

Question 25

Fungal Infections of the Skin Tinea capitis:

Answer 25

fungal infection on the scalp, eyebrows, or eyelashes.

Question 26

Fungal Infections of the Skin Tinea cruris:

Answer 26

fungal infection on the groin.

Question 27

Risk Factors for CA-MRSA

Answer 27

Turf burns. Towel sharing. Participation in team sports. Attendance at day care or outdoor camps.

Question 28

Types of Inflammatory Skin Conditions

Answer 28

Acute hypersensitivity reactions Chronic hypersensitivity disorder Chronic inflammatory skin disorders not from hypersensitivity

Question 29

Types of Inflammatory Skin Conditions Acute hypersensitivity reactions: What are examples?

Answer 29

Diaper dermatitis, contact dermatitis, erythema multiforme, and urticaria.

Question 30

Types of Inflammatory Skin Conditions Chronic hypersensitivity disorder

Answer 30

Atopic dermatitis.

Question 31

Types of Inflammatory Skin Conditions Chronic inflammatory skin disorders not from hypersensitivity

Answer 31

Seborrhea and psoriasis.

Question 32

Contact Dermatitis: Causes:

Answer 32

Response to an antigenic substance exposure. Allergy to nickel or cobalt in clothing, hardware, or dyes. Exposure to highly allergenic plants: poison ivy, oak, and sumac.

Question 33

Contact Dermatitis: Complications

Answer 33

Secondary bacterial skin infection. Lichenification or hyperpigmentation.

Question 34

Prevention and Management of Diaper Dermatitis Prevention: What should be done with diapers?

Answer 34

Change diapers frequently. Change stool-soiled diapers as soon as possible.

Question 35

Prevention and Management of Diaper Dermatitis Prevention: What should be avoided?

Answer 35

Avoid rubber pants.

Question 36

Prevention and Management of Diaper Dermatitis Prevention: What should be done to manage?

Answer 36

Gently wash the diaper area with a soft cloth, avoiding harsh soaps.

Question 37

Prevention and Management of Diaper Dermatitis Prevention: What should be noted about wipes?

Answer 37

Use baby wipes on most children, but avoid wipes that contain fragrance or preservatives.

Question 38

Prevention and Management of Diaper Dermatitis What to do if a rash has appeared?

Answer 38

Do all the prevention measures (in previous cards) Allow the infant or child to go diaperless for a period of time each day to allow the rash to heal. Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3 to 5 minutes.

Question 39

Classification of Acne

Answer 39

Mild Moderate Severe

Question 40

Classification of Acne Mild acne manifestations include?

Answer 40

Primarily noninflammatory lesions (comedones)

Question 41

Classification of Acne Moderate acne manifestations include?

Answer 41

Comedones plus inflammatory lesions such as papules or pustules (localized to face or back)

Question 42

Classification of Acne Severe acne manifestations include?

Answer 42

Lesions similar to moderate acne, but more widespread, and or presence of cysts or nodules. Associated more frequently with scarring

Question 43

Classification Criteria for Burns How is it assigned?

Answer 43

Assigned by extent of injury:

Question 44

Classification Criteria for Burns Assigned by extent of injury:

Answer 44

Superficial: Partial thickness: Deep partial thickness: Full thickness:

Question 45

Classification Criteria for Burns Assigned by extent of injury: Partial thickness:

Answer 45

involves epidermis and portions of dermis.

Question 45

Classification Criteria for Burns Assigned by extent of injury: Superficial:

Answer 45

only epidermis.

Question 46

Classification Criteria for Burns Assigned by extent of injury: Deep partial thickness:

Answer 46

extends deeper into dermis.

Question 47

Classification Criteria for Burns Assigned by extent of injury: Full thickness:

Answer 47

extend through the epidermis, dermis, and hypodermis.

Question 48

Criteria for Transfer to a Burn Unit How much of total body surface is affected?

Answer 48

Partial thickness burns greater than 10% of total body surface area.

Question 49

Criteria for Transfer to a Burn Unit Burns that involve what part of the body?

Answer 49

Burns that involve the face. Burns that involve the hands and feet, genitalia, perineum, or major joints.

Question 50

Criteria for Transfer to a Burn Unit Burns caused by what?

Answer 50

Electrical burns, including lightning injury. Chemical burns. Inhalation injury.

Question 51

Hypersensitivity Reactions and Causative Agents What kind of reaction is it? What is it due to?

Answer 51

Hypersensitivity reaction is an inflammatory reaction in the skin due to exposure to a local noxious agent (bee sting) or as a result of a systemic reaction to an allergen (erythema multiforme).

Question 52

Hypersensitivity Reactions and Causative Agents How can hypersensitivity reactions present?

Answer 52

Can be acute or chronic (atopic dermatitis).

Question 53

Hypersensitivity Reactions and Causative Agents Can be acute or chronic (atopic dermatitis).

Answer 53

Erythema multiforme (EM): Stevens–Johnson and toxic epidermal necrolysis are extreme forms of EM.

Question 54

Common Medical Treatments

Answer 54

Wet dressings Occlusive dressings Emollient lotions and creams Therapeutic bathing Skin biopsy

Question 55

Common Medications

Answer 55

Antibiotics (topical, systemic) Corticosteroids (topical) Antifungals (topical, systemic) Topical immune modulators (moderate to severe atopic dermatitis) Antihistamines Isotretinoin (cystic or severe acne) Coal tar preparations (psoriasis, atopic dermatitis) Silver sulfadiazine 1% (burns)

Question 56

Common Medications Antibiotics- how are they used?

Answer 56

Antibiotics (topical, systemic)

Question 57

Common Medications Corticosteroids- how are they used?

Answer 57

Corticosteroids (topical)

Question 58

Common Medications Antifungals- how are they used?

Answer 58

Antifungals (topical, systemic)

Question 59

Common Medications Topical immune modulators - what are they used for?

Answer 59

Topical immune modulators (moderate to severe atopic dermatitis)

Question 60

Common Medications Isotretinoin - what are they used for?

Answer 60

(cystic or severe acne)

Question 61

Common Medications Coal tar preparations - what are they used for?

Answer 61

Coal tar preparations (psoriasis, atopic dermatitis)

Question 62

Common Medications Silver sulfadiazine 1% - what are they used for?

Answer 62

(burns)

Question 63

Nursing Assessment for Urticaria: What should you collect?

Answer 63

Detailed history of new foods, medications, symptoms of recent infection, changes in environment, or unusual stress.

Question 64

Nursing Assessment for Urticaria: What should you inspect?

Answer 64

Inspect the skin for raised edematous hives on body or mucous membranes.

Question 65

Nursing Assessment for Urticaria: What should you assess? Why?

Answer 65

Assess airway and breathing as hypersensitivity may affect respiratory status.

Question 66

Causes of Urticaria

Answer 66

Foods Drugs Animal stings Infections Environmental stimuli Stress

Question 67

Drug reactions: Where are adverse drug reactions most often seen? What are the most common reactions?

Answer 67

Adverse drug reactions are most often seen in skin (rashes most common reaction)

Question 68

Drug reactions: How does the adverse drug reaction occur?

Answer 68

May be immediate or delayed following administration of drug

Question 69

Drug reactions: Treatment

Answer 69

Discontinue drug Antihistamines Corticosteroid therapy if very severe

Question 70

Teaching Points for Avoiding Animal Bites

Answer 70

Never provoke a dog with teasing or roughhousing. Get adult permission before interacting with a dog, cat, or other animal that is not your pet. Do not bother an eating, sleeping, or nursing dog. Avoid high-pitched talking or screaming around dogs. Display a closed fist first for the dog to sniff. Keep ferrets away from the face. If a cat hisses or lashes out with the paw, leave it alone.