unit 6 Flashcards
0
Q
Extrinsic causes of lesions
A
- Physical
- Chemical
- Allergic irritants
- Infectious agents
1
Q
With Younger children
A
-skin layers separate easily inflammatory process = blisters
2
Q
Intrinsic causes of lesions
A
- Infection
- Drug sensitization
- Allergies
3
Q
History assessment when children have lesions includes
A
- Asthma or hay fever?
- When did the lesion first appear?
- Has it changed in appearance?
- New foods or medications?
- Contact with plants, pets, insects, chemicals?
4
Q
Types of lesions
A
Erythema Ecchymosis Petechiae Distribution pattern Configuration/arrangement Configuration/arrangement Macule Papule Vesicle Bulla Nodule Pustule Cyst
5
Q
Common Symptoms of lesions
A
- Pruritus (itching)
- Paresthesia (burning; prickling)
- Anesthesia (absence of sensation)
- Hypoesthesia (diminished sensation)
- Hyperesthesia (excessive sensation)
6
Q
SKIN INFECTIONS include
A
- Bacterial
- Viral
- Fungal
7
Q
Bacterial skin infections
A
- Bacterial Infections – (Table 24.1, p. 885)
- ——Impetigo (Nonbullous and bullous)
- ——Folliculitis (pimple), furnuncle (boil), carbuncle (multiple boils)
- ——Cellulitis—Streptococcus, Staphylococcus, Haemophilus influenzae
- ——Staphylococcal scaled skin syndrome
- ——Methicillin-Resistant Staphylococcus Aureus
- ——Scarlet Fever
8
Q
Viral skin infections
A
Table 15.4, pp. 469 – 473 Rubella (German Measles) Rubeola (Measles) Varicella zoster (Chickenpox) Exanthem Subitum (Roseola Infantum/sixth disease) Erythma infectiosum(fifths disease) Hand, foot, and mouth disease, or herpangina (coxsackie virus)
9
Q
Fungal skin infections
A
- Tinea is a fungal disease of the skin occurring on any part of the body. -Tinea corporis
- Tinea capitis
- Tinea versicolor
- Tinea pedis
- Tinea cruris
- Diaper candidiasis
10
Q
Diaper Dermatitis can come from (Fig. 24.10, p. 888)
A
- Inadequately rinsed cloth diapers
- Chemicals in disposable wipes
- Diarrheal stools
- Monitoring and changing diaper as soon as it becomes wet
11
Q
Characteristics of Atopic Dermatitis- (Eczema) (Fig. 24.11, p. 890)
A
- Infantile: 2-6 mos, remission by age 3
- Childhood: 2-3 years of age
- Pre-teen and teenage: onset at 12 years; may continue lifelong
- Majority – family history (genetic predisposition)
- Symptoms improve with humidity and worsen during winter – dry heat
- Nursing goals: less itching; no secondary infection; skin hydration
12
Q
Factors That May Trigger or Exacerbate Atopic Dermatitis include
A
- Irritants
- Contact and Airborne Irritants
- Microorganisms
- and Other Factors
13
Q
Irritants that affect AD
A
- Soaps and detergents (use of hypoallergenic products are best)
- Disinfectants or cleaning products
- Contact with liquids such as citrus juice
- Perfumed products
- Fabrics with sharp fibers, such as wool or man-made fabrics
- Dust and dirt
14
Q
Contact and Airborne Irritants of AD
A
- Dust mites
- Pet dander, hair, or saliva
- Human dander (dandruff)
- Molds
- Seasonal pollens
15
Q
Microorganisms that affect AD
A
- Staph Aureus
- infections, such as URIs
- Mycologic, such as fungi and dermatophytes
16
Q
Other Factors that may affect AD
A
- Temperature and climate (lack of humidity increases dryness of skin, sweating)
- Foods
- Psychological stressors
- Hormones
- Baths/Showers should be short and thoroughly pat dry
17
Q
Medical management of AD
A
- Use of topical corticosteroids
- Emollients are used for both prevention and during therapy for active AD.
- Oral antihistamines are sometimes recommended for a limited period of time
- Clothing, linens made of either 100% cotton or a cotton blend with at least 80% cotton are recommended.
- Suggest families try products labeled hypoallergenic.
- Skin Care
a. Irritants should be washed off as soon as possible.
b. Addition of colloidal oatmeal to the water is soothing.
c. Immediately after medication application, smooth a thin layer of an emollient product over the skin d. Nails should be kept short, clean to minimize damage that may occur during scratching.
e. Children should be encouraged to try not to scratch
18
Q
Poison Ivy, Oak, and Sumac (Fig. 24.12, p. 891) information
A
- Caused by the plant’s oil – urushiol – very potent as it penetrates through the epidermis and bonds with the dermal layer (initiates immune response)
- Even smoke from burning brush piles can produce a reaction
- Animal not affected but are carriers (fur and saliva)
- Lesions are blisters
- Healing and end of itching = 10-14 days
19
Q
treatment of Poison Ivy, Oak, and Sumac
A
- Immediately wash with soap and warm water
- Avoid harsh soap and scrubbing
- Thoroughly launder all contact clothing – hot water
- Prevent scratching – risk for secondary infection
- Prevent scratching – risk for secondary infection
- Prevention – teach to recognize plants
- Meds: Benadryl, topical corticosteroids (limit use of calamine/caladryl in children)
20
Q
Seborrheic Dermatitis- (Fig. 24.15, p. 893) facts
A
- Inflammatory reaction to the fungus Pityrosporum ovale and is worsened by peak sebaceous gland activity in infancy and adolescent (hormonal influence)
- Cradle cap – scalp lesions are yellow, greasy-appearing plagues
- Prevention – adequate scalp hygiene
- Mild shampoo to soften crusts, then rinse and comb to remove
- Antidandruff shampoos containing selenium sulfide, or ketoconazole.
21
Q
Adolescent Acne (≥ 12 years) (Fig. 24.17, p. 896)
A
-Most common skin condition in adolescence involving the hair follicle and sebaceous
glands over face, neck, chest, and upper back
-Peak years: 16-17 in females and 17-18 in males
-Causes
—- Hormonal
—–Cosmetics
—–No association with dietary intake
—–Psychological factors (emotional stress)
22
Q
Topical medications for adolescent acne
A
-Topical
• Retinoid agents (Adapalene, Tazarotene, Tretinoin)
• Benzoyl peroxide formulations (numerous OTC and prescription products)
• Antibiotics (Clindamycin, Erythromycin, Sodium sulfacetamide, Sulfur)
• Combination products
-Antibiotic-benzoyl peroxide
-Antibiotic-retinoid
-Benzoyl peroxide-retinoid
• Keratolytic agents (e.g. salicylic acid)
• Anti-inflammatory agents (e.g. dapsone)
23
Q
Systemic medications for adolescent acne include
A
- Oral antibiotics
- —-Tetracycline derivatives (Doxycycline, Minocycline, Tetracycline)
- —-Macrolide derivatives (Azithromycin, Erythromycin)
- —-Cephalosporins (Cephalexin)
- —-Penicillins (Amoxicillin)
- —-Trimethoprim-sulfamethaxole (Septra)
- —-Combination oral contraceptives
- —-Hormonal agents (Spironolactone)
- —-Systemic retinoids (Isotretinoin, Accutane)
24
Parasitic Infections include
- Scabies
| - Pediculosis Capitis (head lice)
25
Scabies
- caused by a mite – burrows into epidermis
- Appears as papules, burrows, vesicles with intense itching
- Scabicides:
- Elimite cream
- Teaching points
- ------cream should remain on skin 8-12 hours then removed by bathing
- ------will kill mite immediately but rash and itch persist 2-3 weeks
26
Pediculosis Capitis (head lice)
- Female parasite lays her eggs (nits) at the base of the hair shaft where it is warm. Nits hatch 7-10 days
- Itching, appearance of nits
- Stress to parents anyone can get head lice
- Lice do not jump or fly – transmission by shared personal items
- ------Combs, scarves, caps, PJ parties, coats
- For tips on preventing the spread or recurrence Over-the-counter products (Rid, Nix, LiceMD), home remedies (mayonnaise, olive oil), prescription (Ovide lotion, Natroba, Ulesfia lotion)
- Psychologic effects – stressful for children
- -----Avoid radically cutting hair/ shaving head – teased by peers. Lice infest short hair as readily as long hair
27
Vector-Borne Infections
- Lyme Disease – most common tick-borne (deer) in Northeast US
* Stages 1-3 with 2 being most serious – involve cardiac, musculoskeletal, and neurologic
- Early diagnosis in stage 1 – recognize characteristic rash (Erythema migrans) and begin immediate implementation of Amoxicillin (10-14 day course). Fig. 15.4, p. 480
- Prevention – teach parents to protect children from exposure to ticks
- ---Light-colored clothing
- ---Tuck pant legs into socks
- ---Long-sleeved shirt in wooded areas
- ---Walk in the center of trails
- ---American Lyme Disease Foundation
28
Nonbullous impetigo skin findings can include
- Papules progressing to vesicles then painless pustules with a narrow erythrmatosus border
- Honey-colored exudate which forms a crust on the ulcer-like base
29
Nonbullous impetigo treatment
- Use a limited amount of topical mupirocin ointment
- For numerous lesions, oral first-generation cephalosporin is indicated
- Clindamycin may be needed for MRSA
- Remove honey-colored crust with cool compresses BID
30
Bulbous impetigo skin findings
- Red macules and bulbous eruptions on an erythematous base
| - Size may be from a few millimeters to several centimeters
31
Bulbous impetigo treatment
- Oral first generation cephalosporin
| - Good hygiene
32
Folliculitis skin findings
-Red, raised hair follicles
33
Folliculitis skin treatment
-Treat with aggressive hygiene
34
cellulitis skin findings
- Localized reaction
- Erythema, pain, edema
- Warmth at site of skin disruption
35
cellulitis treatment
- Mild cases are usually treated with cephalexin or amoxicillin/clavulanic acid
- More severe cases and peri orbital or orbital cellulitis require IV cephalosporins
36
Staphylococcal scalded skin syndrome skin findings
- Flattish Bullard that rupture within hours
| - Red, weeping surface is left, most commonly on face, groin, neck, and auxiliary region
37
Staphylococcal scalded skin syndrome treatment
- Mild to moderate cases are treated with oral cephalexin, dicloxacillin, or amoxicillin/ clavulanic acid
- Severe cases are managed similar to burns with aggressive fluid management and IV oxacillin or Clindamycin
38
Rubella (German measles)
- Is caused by rubella virus
- Transmitted by direct or indirect contact with droplets, primarily by nasopharyngeal secretions, but also in blood, stool, and urine
- Can be transmitted from other to fetus
- Peak in late winter early spring
- Communicable 7 days before to 7 days after onset of rash
39
rubella symptoms include
- Swollen or enlarged lymphnodes (lymphadenopathy) in the retroauricular, posterior, cervical, and postoccipital 24 hours before the onset of the rash lasting up to 1 week
- Rash begins on face and spreads quickly down the neck, trunk, and extremities; disappears in same order it spread, usually by third day. On the second day the rash may appear pinpoint.
- Desquamation is minimal
- Mild pruritus
- Polyarthralgia and polyarthritis
40
rubella complications
- Encephalitis and thrombocytopenia can happen but it is rare
- Maternal rubella during pregnancy can result in miscarriage, fetal death, or congenital malformations
41
rubella treatment
- Usually mild and self-limiting
| - Treatment is mainly supportive in nature
42
rubella nursing implications
- Comfort measures such as antipyretic, antipruritics, and analgesics for joint pain
- Droplet precautions for the duration of the illness in the hospitalized child
- Avoid exposure to pregnant women
43
Rubeola measles
- Caused by measles virus
- Transmitted by direct or I directed contact with droplets, primarily by nasopharyngeal secretions, but also blood and urine, highly contagious
- Incubation period 8 to 12 days
- Communicable 1 to 2 days before the onset of symptoms 3 to 5 days before onset of rash until 4 to 6 days after rash has appeared
44
rubeola measles symptoms
- Prodromal phase 2 to 4 days consisting of fever, cough, coryza, conjunctivitis
- Followed by koplik spits, bright red spots with blue white centers on mucous membranes, mainly baccalaureate mucosa; look like tiny grains of white sand surrounded by red rings
45
rubeola measles complications
- Otitis media
- Pneumonia
- Croup
- Diarrhea common in children; acute encephalitis
46
Rubeola measles treatment
- Mainly supportive, including antipyretics, bed rest, and adequate fluid intake
- Possible V. A supplementation in children 6 months to 2 years hospitalized for measles or it's complications or those with immunodeficiency
47
Rubeola measles nursing implications
- Comfort measures, such as antipyretics and antipruritics
- clean eyes with warm, moist cloth to remove secretions
- Cool mist humidification to alleviate coryza and cough
- Airborne precautions until 4 days after onset of rash
