Transcript Integumentary Disorders

Integumentary Disorders
in Children
NUR 106
Diaper Rash




Most common cause is irritant dermatitis
Contributing factors – infrequent diaper
changing, poorly washed and rinsed
diapers, incomplete or infrequent washing
of the diaper area, over cleaning can also
cause.
Prevention – Use antiseptic wipes with
each diaper change, expose diaper area to
air, Sunshine is helpful, frequent diaper
changes
Tx – desitin or hydrocorisone creams
Cradle Cap



Caused by a lipophilic
skin surface-dwelling
yeast
Clinical manifestation – a dry or greasy
scaly eruption on an inflammatory base.
Primarily affects the scalp, eyebrows,
eyelids, and pubic area.
Tx – frequent shampooing and use of mild
medication, such as hydrocortisone
Infantile Eczema
A superficial inflammatory process involving
primarily the epidermis
Usually begins at 2 to 6 months and undergoes
spontaneous remission by 3 years of age
Tx – avoid exposure to irritants, improve
hydration, apply cool, wet compresses,
administer antihistamines and topical
corticosteriods as ordered
Atopic Dermatitis




A type of pruritic eczema that begins during
infancy
Hereditary tendency
Often associated with history of food
allergies, allergic rhinitis, and asthma
Three forms



Infantile eczema: begins 2-6 months age
Childhood eczema: may follow infantile form
Preadolescent and adolescent: 12 yrs to early
adult age
Therapeutic Management
of Atopic Dermatitis




Relieve pruritis
Hydrate skin
Reduce inflammation
Prevent/control secondary infection
Prickly Heat




Common problem
caused by blockage
of the sweat glands.
S&S – red, pinhead-sized vesicular-papular
rash, and itching
Overdressing children should be avoided
May use 1% hydrocortisone cream
Poison Ivy, Oak, and Sumac




Produces localized lesions
Caused by urushiol from plant’s leaves
and stems
Sensitivity may develop after one or
two exposures and may change over
time
Therapeutic management
Drug Reactions



Adverse drug reactions are most often
seen in skin (rashes most common
reaction)
May be immediate or delayed following
administration of drug
Treatment: discontinue drug,
antihistamines, corticosteroid therapy if
very severe
Arthropod Bites and Stings



May cause mild to moderate discomfort
Manage with symptomatic measures
and prevention of secondary infection
Bees: stinger penetrates into skin


Remove stinger ASAP
Sensitization to bee stings may result in
anaphylaxis
Infections Transmitted
by Arthropods




Rickettsiae: Rocky Mountain spotted
fever transmitted by infected fleas,
ticks, and mites
Lyme disease: most common tick-borne
disorder in US
Vaccine against Lyme disease
Focus on prevention
Animal Bites




Common pediatric problem especially
<4 years
Wound care
Prophylactic antibiotics for some types
of bites
Rabies concern
Human Bites



Lacerations from teeth of other humans
Risk of infection
Wound care
Impetigo




Often secondary
infection spread from
another lesion
Organisms
Staph aureus
Beta h. strep
Pustules form
w/ honey colored drainage
Tx w/ topical & oral antibiotics
Prevent scratching

Ringworm


Is caused by several
types of fungi, routes
of transmission are
from person to
person, and animal to
person
May be on the scalp,
skin, or feet
Tx – may include oral
griseofulvin and/or
topical antifungal
ointment
Scabies



An endemic infestation
caused by the scabies mite,
the pregnant female burrows
under the skin to bury her eggs
Usually found between fingers, under the
arms, bend of leg and knee
Tx – Kwell cream (not in infants), entire
family should be treated, wash bed linen and
place in dryer, non-washable should be
bagged for 14 days
Scabies
Lice





Infestation of the scalp by pediculosis humanus
capitis
S&S – Itching, small, grayish, oval eggs (nits) attach
to the hair shaft
Tx – Nix, RID, Kwell shampoo (Kwell not
recommended for children under 50 lbs, due to
nervous system toxicity
After shampoo nix must be removed with a fine tooth
comb
Entire family should be treated, wash bed linen, hats,
and headbands in hot water
Lice
Infestation
ACNE



Affects about 85% of
adolescence
Etiology unclear
Production of sebum, or fatty secretion of the
oil glands, is stimulated by certain hormones
during adolescence, skin microorganisms
utilize sebum as food sources. The pore clogs
and blackheads form.
ACNE








TX – Reinforce self-care, bolstering selfesteem, and preventing scarring
Well balanced diet,
8 hours of sleep,
8 glasses of water per day,
stress management,
exercise
Clean with mild soap several times a day and
frequent shampooing
Retin-A – may take 4-6 weeks to see
improvement
Burns




Toddlers and young children most
common burns are scalds
Older children often involves clothing
Prevention of infection is primary
concern
Burns involving more than 10% of total
body surface require some form of fluid
resuscitation
Burns Nursing Considerations
Emergency care
Stop the burning
process
Assess the victim’s
condition
Cover the burn
Transport to medical
aid
Provide reassurance





Major burns
Airway
Fluid replacement
therapy
Nutrition
Medication
Burns




Tx – Debridement - hydrotherapy
Dressing changes
Skin grafts
Long term – scarring and psychosocial
support
Sunburn



Ultraviolet A waves
Ultraviolet B waves
Importance of protection: sunscreens
Cellulitis
Strept, Staph, Hib


Inflammation of skin and subcutaneous tissues
Intense redness, swelling, & firm infiltration,
Lymphangitis streaking
May progress to abscess
Fever, malaise
Tx = Oral or IV antibiotics
Rest
Heat compresses