Integumentary System

Question 1

Skin functions

Answer 1

• protection
• impermeability
• fluid regulation
• heat regulation
• sensation

Question 2

Dev differences in kids

Answer 2

• epidermis loosely bound to dermis
• skin thinner, BV closer to surface (more likely to get abrasion than bruise)
• more permeable and sus to superficial bac infx
• more likely to have assoc systemic sx with infx
• more apt to respond to a primary irritant
• less pigmentation

Question 3

General interventions for skin issues

Answer 3

• no powder or cornstarch (aerosolized)
• light, loose, non-irritating clothing (no wool for eczema)
• keep skin clean and dry
• prevent secondary infx; cut nails, apply mittens at night
• prevent infx spread; good handwash, cleaning toys, keep open wounds covered, teach kids not to share combs and hats
• avoid commercial diaper wipes on irritated skin

Question 4

Diaper dermatitis

Answer 4

• contact or irritant type
• candida albicans (thrush)
• or bacterial infx

Question 5

Causes of contact dermatitis

Answer 5

Compromised skin…
- chemical irritation
- mechanical irritation
- infection (candida albicans)
- fecal enzymes
- inc skin/diaper pH
- skin wetness

Question 6

CM of contact diaper dermatitis

Answer 6

Erythema in convex surfaces like thighs, butt, perineum, waist, lower abdomen
- can be bleeding
- not in creases bc skin on skin protects the space

Question 7

NC for diaper dermatitis

Answer 7

• dry affected area and prevention of contact with the irritant
• keep area open to air as much as possible (while nap, leave diaper open under them, while running around with long shirt on)
• often seen when sleeping through the night
• change wetness immediately
• PREVENTION–ointment like zinc oxide (desitin) or petroleum to barrier when they pee
• wash off feces with water and mild soap

Question 8

Candida albicans infection (monilia or thrush)

Answer 8

• beefy red, extends into creases, satellite lesions
• precipitate by abx use, immunosupp, exposure to yeast
• treat with anti-fungal cream like nystatin until gone and several days after

Question 9

MRSA

Answer 9

• bacterial infx caused by strep
• beefy red
• oral med, amoxicillin

Question 10

Seborrheic dermatitis

Answer 10

• chronic, recurrent inflam scaling dx of the scalp (Cradle cap) and face
• unknown cause
• only in early infancy
• lesions–thick, adherent, yellowish, scaly, oily patches; may be pruritic

Question 11

Cradle cap NC

Answer 11

• aggressive scrubbing of scalp may prevent
• use olive oil or anti-seborrheic shampoo (may burn) and leave on scalp until crusts are soft, rinse through
• use soft brush to remove softened crusts in morning

Question 12

Eczema (atopic dermatitis)

Answer 12

• Pruritic inflammation of the skin associated with allergy and a hereditary tendency
• infantile, childhood, and adolescent versions

Question 13

Eczema management

Answer 13

• find source of allergen or irritation
• relieve pruritis; colloid baths, oral antihistamines
• hydrate skin; don’t dry off after bath and coat in lotion
• dec inflam with topical steroids
• prevent or control secondary infx
• dye free and perfume free products

Question 14

Eczema NC

Answer 14

• long sleeves and pants
• mild cotton, no scratch
• dye free and perfume free
• humidifier in room
• avoid enviro triggers
• keep nails short (less scratching)
• watch for infx signs
• avoid latex bc more susceptible to allergies

Question 15

Contact dermatitis

Answer 15

• Causes–response to an antigenic substance exposure (often nickel or dye, exposure to allergic plants)
• reddened irritation caused by allergen pressing on skin that can cause hyperpigmentation

Question 16

Contact dermatitis NC

Answer 16

Put nail polish, tape, cloth between the allergen and skin if metal; avoid plants

Question 17

Poison ivy

Answer 17

• redness, swelling, itching at site of contact; advances to streaked or spotty blisters
• flush area immediately after contact with cold, running water
• wash clothing and pets
• scratching does not spread rash but could cause secondary infx

Question 18

Impetigo

Answer 18

• strep or staph cause
• honey crusted lesions often in moist areas like armpits, creases, around mouth and under nose
• pruritic

Question 19

Impetigo tx

Answer 19

• soften crusts with moist soaks
• topical bactericidal ointment
• oral abx; cephalexin or PCN
• no school for 24h–spread thru direct contacts
• cover lesions
• no share linens
• prevent scratching

Question 20

Cellulitis

Answer 20

• deep, locally diffuse infx of skin with systemic manifestations
• caused by strep or H. influenza B
• CM–fever, swelling, heat, tenderness of involved skin; malaise, regional lymphadenopathy
• concern is getting to bone

Question 21

Cellutitis management

Answer 21

• oral abx
• rest and immobilization
• warm, moist compresses
• hospitalization if joint or facial involvement

Question 22

Herpes simplex

Answer 22

Viral infx of skin and mucus membranes
- clusters of vesicles filled with clear fluid
- CM: burning, itching, vesicles on inflam base which dries forming a crust followed y exfoliation and spontaneous healing in 8-10 days
- worse in times of stress
- tx with topical, warm compresses
- eating and hydration considerations

Question 23

Verruca (warts)

Answer 23

• epidermal benign tumor caused by human papilloma virus
• CM–solitary flesh-colored papule with an irregular, scaly surface; may have pin point black spots
• Tx: cryotherapy, salicylic acid paints
• education; most disappear with time, repeated irritation may worsen

Question 24

Erythema infectisum (fifth disease)

Answer 24

From parvovirus
- rash, minor itching, tiredness, sore throat, fever
- fetal death if mom gets while preg
- aplastic crisis–kids with hemolytic disease or immunodeficiency

Question 25

Fifth disease rash

Answer 25

- slapped face that disappears w/i 1-4 days - maculopapular red spots, upper and lower extremities, lacey appearance on trunk - don't really treat

Question 26

Chicken pox (Varicella)

Answer 26

- caused by varicella zoster virus - spread primarily via resp tract secretions and contact with skin lesions - communicable; one day before rash appears until all lesions are crusted over (no school until all CRUSTED) - incubation period--14-21 days

Question 27

Varicella CM

Answer 27

- slight fever - malaise - anorexia - itchy rash

Question 28

Varicella tx

Answer 28

- help with itching - cool bath - calamine lotion - acycline - watch for secondary infx like pneumonia

Question 29

Varicella NC

Answer 29

- strict iso when hospitalized - immunize at 12M and 4Y - may bet varicella-zoster immune globulin (VZIG) - iso at home until all crusted - good skin care - no aspirin

Question 30

Tinea corporis

Answer 30

Ringworm on body

Question 31

Tina capitis

Answer 31

Causes alopecia and inflam, crustiness

Question 32

Tinea cruris

Answer 32

- jock itch - in groin crease

Question 33

Tinea (Ringworm)

Answer 33

- transmitted person to person or animal to person - tx with topical or oral antifungal infx - capitis needs oral (hard on liver so get liver enzymes after 6W on it)

Question 34

Tinea (ringworm) NC

Answer 34

- emphasize good health and hygiene - examine household pets - teach kids not to share hats, scarves, helmets

Question 35

Pediculosis (head live)

Answer 35

- infestation of the hair or scalp by pediculus humanus capitis - lice or nits (eggs) found in hair usually behind ears, nape of neck - intense pruritis; possible excoriation of skin

Question 36

Lice tx

Answer 36

- permetherin rinse or shampoo for 10 minutes (made of chemicals) - malation on dry hair for 8-12h - Kwell shampoo--toxic, non-ovicidal - must pick nits out of hair

Question 37

Education for head lice

Answer 37

- avoid shampoo contact with eyes - don't treat in bathtub or shower - apply only to infected area on infected individuals - wash bedding, cloths in hot water and dry in hot dryer for 20 minutes 1x/W - comb out nits with fine tooth comb - soak brushes and combs - store unwashables in sealed plastic for 2W

Question 38

Scabies

Answer 38

Impregnated mite burrows into the stratum corneum of the epidermis and deposits her eggs and feces - intense itchy - maculopapular lesions, intertriginous areas

Question 39

Scabies management and NC

Answer 39

- whole household sleeps with Permethrin on skin - Neurotoxic Lindane for resistance cases - Ivermectin CI in kids under 5 - follow directions carefully - treat all contacts

Question 40

Sunburn prevention and tx

Answer 40

- PABA free sunscreen after 6M (lotion is better than aerosol) - avoid exposure btwn 10-4 - tx with cool water (not direct ice) - NSAIDs for pain - clean dressing - don't pop blisters of peel dead skin - stay hydrated

Question 41

Facial acne in adolescent

Answer 41

- caused by inc production of sebum in sebaceous glands, familial aspect - blackhead, whitehead, cystic lesions - negative body image affect

Question 42

Acne intervention

Answer 42

- good facial hygeine - squeezing not recommended - first line--OTC benzoyl peroxide--can dry skin so good facial lotion

Question 43

Bites and stings

Answer 43

Minor rxn - bite or sting mark - stinger, tentacle or venom sac - redness - swell - pain or tenderness Severe rxn - anaphylaxis

Question 44

sting tx

Answer 44

- apply icepack - remove stinger with credit card or tweezer - NSAID - watch for swelling--Benadryl--esp around airway - call 911 if known allergy - wash with soap and water

Question 45

Tick bites

Answer 45

- not poisonous but can transmit Rocky mt spotted fever or Lyme disease - bite into skin, embed mouth parts - can remain for days if undetected - tx not needed but watch for Lyme disease

Question 46

Lyme disease CM

Answer 46

- rash - fever - chills - severe HA - joints and muscle aches - go into clinic

Question 47

Preventing tick bites

Answer 47

- keep lawn mowed, brush cleaned up, wood piles stacked - wear socks, tuck long pants in - wear light colored clothes - don't lay linens on ground - walk in middle of paths - comb thru hair after being in infested area - CHECK BODY after hikes - teach how to look for s/s

Question 48

First aid for tick bites

Answer 48

- removed by grasping close to skin with tweezers, pull gently until tick lets go - wash area with soap and water - antiseptic or topical antibac on site