Integumentary Dysfunction

Question 1

Impetigo

Answer 1

• Usually starts w/ a little crack
  > running nose
  > chapped lip
• Staph infection of the skin
• Begins as a sore (vesicle) and then it ruptures
• Dry, honey colored crust
• Antibiotics
  > topical or oral

Question 2

Scabies

Answer 2

• Caused by scabie mite as female burrows into epidermis to deposit eggs & feces (tunnel into skin)
• Common in day cares
• Unbelievable itching (pruritus)
  > cool baths, compresses
  > no freezer packs/ice directly on skin
• Inflammation occurs 30-60 days later

Question 3

Scabies - Treatment

Answer 3

• Topical treatment includes scabicides such as permethrin 5% or lindane
• Oral treatment includes Ivermectin if body weight > 15kg

Question 4

Pediculosis Capitis (head lice)

Answer 4

• Infestation of scalp is common in school-age children
• Adult louse lives only 48hrs w/out 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

Question 5

Pediculosis Capitis (head lice) - Treatment

Answer 5

• Pediculicides & removal of nits
• Prevent spread & recurrence
• Return to school at 1 wk after tx started

Question 6

Diaper Dermatitis - Patho

Answer 6

• Usually caused by irritation from urine & feces
  > usually acidic
• Detergents inadequately rinsed from clothing
  > use a detergent free from dye & fragrance
• Chemical irritation
  > esp from chemicals in diapers & wipe
• Candidiasis of diaper area
• Response to illness, teething

Question 7

Diaper Dermatitis - Nursing Considerations

Answer 7

• Alter wetness, pH, & fecal irritants
• Change diaper often

Question 8

Diaper Dermatitis - Treatment

Answer 8

• Clean really well
• Rinse
• DRY
• Apply barrier cream
  > zinc oxide, desitin

Question 9

Contact Dermatitis

Answer 9

• A skin reaction from contact w/ certain substances
• Irritants: these cause direct skin irritation & inflammation, they are the most common cause of contact dermatitis
• Allergens: these cause the body’s immune system to have an allergic reaction, the body releases defense chemicals tht cause skin symptoms, allergens are a less common cause of contact derrmatitis

Question 10

Contact Dermatitis - Common Causes

Answer 10

• Soaps, detergents, food, metals, posion ivy, neomycin, latex, cold
• Incrd risk if child has atopic dermatitis (eczema)

Question 11

Atopic Dermatitis

Answer 11

• Eczema
  > chronic
• Superficial skin inflammation & intense itching
• Allergic component
  > hereditary
• Exacerbations
  > irritant, skin infections, allergens

Question 12

Atopic Dermatitis - Treatment

Answer 12

• Hydration
• Lotions
  > barrier, hydrate, steroid
• Dcring pruritus

Question 13

Therapeutic Management of Pruritus

Answer 13

• Most common complaint w/ skin lesions
• Cooling baths or compresses
• Prevent scratching
  > mittens/covering for younger children
  > short nails
  > antipruritic meds
• Hydrate skin
• Relieve pruritus
  > hydrocortisone
• Reduce inflammation
  > diphenhydramine (benadryl)
• Prevent/control secondaru infection

Question 14

Acne

Answer 14

• Predominantly in adolescents
  > most prevalent pediatric skin condition (peaks 14-19)
• Neonatal acne clears up around 1yr
• Self-limiting
• Mild, moderate, & severe

Question 15

Acne - Therapeutic Management

Answer 15

• General measures/overall health
• Medications
  > oral vs topical

Question 16

Burns

Answer 16

thermal, chemical, electrical
- Extent of injury described in terms of total body surface area: age related charts

Question 17

Burns - Depth of Injury

Answer 17

• 1st degree: superficial
• 2nd degree: partial thickness
• 3rd degree: full thickness
• 4th degree: full thickness & underlying tissue
• > 10% = hospital stay

Question 18

Complications of Burn Injuries

Answer 18

• Immediate threat of airway compromise
• Shock
  > burn & hypovolemic
• Fluid & electrolyte deficits
• Infection
  > local & systemic sepsis
• Inhalation injuries, aspiration, pulmonary edema, pulmonary embolus
• Mutlisystem organ failure
• Contractures, scarring, disfigurations

Question 19

Burns - Therapeutic Management

Answer 19

• Emergency care priorities
  > 1st priority: airway maintenance
  > stop burning process
  > cover curn to prevent contamination
• Transport child to appropriate lvl of care
• Fluid replacement therapy
  > critical in 1st 24hrs
• Nutrition: enhanced metabolic demands
• Medication: antibiotics, analgesics, anesthetics for procedural pain