Transcript Treatment
Pediatric Skin Disorders Compare skin differences Infant: skin not mature at birth Adolescence: sebaceous glands become enlarged & active. Skin Assessment Assess history Assess exposure Assess character Assess sensation Dermatitis Dermatitis Inflammation of the skin that occurs in response to contact with an allergen or irritant; also referred to as “contact dermatitis” Dermatitis Common irritants: Soap, fabric softeners, lotions, urine and stool ♦ Common allergens poison ivy, poison oak lanolin, latex, rubber nickel, fragrances Dermatitis: signs and symptoms Erythema Edema Pruritus Vesicles or bullae that rupture, ooze and crust Dermatitis: Treatment Medications – Application of a corticosteroid topical agent: remind pt to continue use for 2-3 wks after signs of healing – Application of protective barrier ointments Oatmeal baths, cool compresses Antihistamines given for sedative effect Eczema Chronic superficial skin disorder characterized by intense pruritis Eczema: signs and symptoms Erythematous patches with vesicles Pruritis Exudate and crusts Drying and scaling Lichenification (thickening of the skin) Eczema, cont. Goal of Treatment Hydrate the skin Treatment of Eczema Emollients (creams which lubricate the skin) Oral antihistamines (control itching) Antibiotics (treat superinfections) Corticosteroids (anti-inflammatories) Immunomodulators (inhibit T lymphocyte activation) AVOID SOAPS! Acne Acne Inflammatory disease of the skin involving the sebaceous glands and hair follicles. Contributing factors include: heredity, hormonal influences and emotional stress Acne: Three main types Follicular plugs Pustular papules Cystic nodules Patient teaching Do not pick! This increases the bacterial count on the surface of the skin and opens lesions to infection which worsens scarring Remind patients that the treatment will not show improvement until about 4-6 weeks but they must consistently follow the regime set up by the physician Medical treatment for acne Topical (Benzoyl peroxide, Tretinoin (RetinA), topical preferred to systemic; however, both may be needed Oral: Tetracycline, minocycline, erythromycin; estrogen for female pts., Accutane Acne: Nursing care Avoid picking and squeezing Use gentle skin cleansers Avoid use of astringents containing ETOH Avoid hats or abrasive rubbing of the skin Wash hands after handling greasy foods Limit use of petrolatum-based hair products; hair away from face Use oil-free makeup, protections from windy, cold weather Continue therapy even when improved Impetigo http://www.emedicine.com/emerg/topic283.htm Impetigo became infected Hemolytic Strep infection of the skin Incubation period is 2-5 days after contact Begins as a reddish macular rash, commonly seen on face/extremities Progresses to papular and vesicular rash that oozes and forms a moist, honey colored crust. Pruritis of skin Common in 2-5 year age group Therapeutic Management Apply moist soaks of Burrow’s solution Antibiotic therapy: Keflex for 10 days Patient education Therapeutic Interventions for impetigo Goal: prevent scarring and promote + self image. Individualize treatment to gender, age, and severity of infection Takes 4-6 wks to improve What is the major nursing implication here? Candiditis- Thrush Overgrowth of Candida albicans Acquired through delivery Thrush Characterized by white patches in the mouth, gums, or tongue Treated with oral Nystatin suspension: swish and swallow Dermatophytosis (Ringworm) Tinea Capitis fungal infection known as “ringworm” Transmission: – Person-to-person – Animal-to-person S&S: Scaly, circumscribed patches to patchy, gray scaling areas of alopecia. Pruritic Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions) http://www.ecureme.com/quicksearch_reference.asp Clinical manifestations Fungal infection of the stratum corneum, nails and hair (the base of hair shaft causing hair to break off…rarely permanent) Scaly, patches Pruritis Generally asymptomatic, but severe reactions may appear as encrusted lesions Tinea: signs and symptoms Therapeutic Interventions Transmitted by clothing, bedding, combs and animals (cats especially) May take 1-3 months to heal completely, even with treatment Child doesn’t return to school until lesions dry Diagnosis Potassium hydroxide examination Black Light Medication Therapy Antifungals: – Oral griseofulvin (Lamisil) • Give with fatty foods to aid in absorption • Treatment is 4-6 wks • Can return to daycare when lesions are dry Pediculosis Capitis (lice) http://www.emedicine.com/emerg/topic409.htm a parasitic skin disorder caused by lice the lice lay eggs which look like white flecks, attached firmly to base of the hair shaft, causing intense pruritus Diagnosis Direct identification of egg (nits) Direct identification of live insects Pediculosis Medication Therapy Treatment: shampoos RID, NIX, Kwell(or Lindane) shampoo: is applied to wet hair to form a lather and rubbed in for at least amount of time recommended, followed by combing with a fine-tooth comb to remove any remaining nits. Scabies http://www.nlm.nih.gov/medlineplus/scabies.html Sarcoptes scabei mite. Females are 0.3 to 0.4 mm long and 0.25 to 0.35 mm wide. Males are slightly more than half that size. A parasitic skin disorder (stratum corneumnot living tissue) caused by a female mite. The mite burrows into the skin depositing eggs and fecal material; between fingers, toes, palms, axillae pruritic & grayish-brown, thread-like lesion http://www.aad.org/pamphlets_spanish/sarna.html Scabies between thumb and index finger On foot Therapeutic Interventions transmitted by clothing, towels, close contact Diagnosis confirmed by demonstration from skin scrapings. treatment: application of scabicide cream which is left on for a specific number of hours (4 to 14)to kill mite rash and itch will continue until stratum corneum is replaced (2-3 weeks) Care: Fresh laundered linen and underclothing should be used. Contacts should be reduced until treatment is completed.