Transcript chapter 16 Integ

Chapter 16
Integumentary Disorders
Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.
Thrush (Oral Candidiasis)
• Description
– An infection of the mucous membranes of the mouth
caused by the fungus Candida
– Breastfeeding can transfer infection to mother’s nipples if
good hygiene is not followed
• Signs and symptoms
– White patches that resemble milk curds are visible on the
tongue, the inner lips, the gums, and the oral mucosa
– Anorexia may be present due to discomfort
– Infection can pass along mucous membranes into the GI
tract, causing inflammation of esophagus and stomach
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Thrush
• Treatment and nursing care
– Local application of antibiotic suspensions
– Nystatin swish and swallow
– Individual feeding equipment is necessary,
and the equipment should be sterile
– Effective handwashing is necessary to
prevent reinfection from the mother
– Prevention: mothers with Candida infection
can be treated during the prenatal period
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Diaper Dermatitis (Diaper Rash)
• Inflammation caused by prolonged contact
with an irritant such as urine or feces
• Signs and symptoms
– Red, irritated skin, accompanied by blistering
– Beefy red rash is generally indicative of
Candidiasis
• Treatment and nursing care
– Zinc oxide ointments as barriers
– Vitamin A&D can help prevent diaper dermatitis
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Atopic Dermatitis (Infantile Eczema)
• Description
– Inflammation of genetically
hypersensitive skin to allergens
• Signs and symptoms
– Lesions form vesicles that weep
and develop a dry crust
– Worse in winter than summer,
periods of temporary remission
occur
– Itching is constant, and lesions are
easily infected
• Treatment
– Maintain skin integrity/hydration,
decrease pruritus, identify and
avoid triggers
– Topical corticosteroids,
immunosuppressants,
antihistamines
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Atopic Dermatitis
• Nursing care
– Patients may need to be restrained if they are
scratching the affected area – use mittens
– Medicated baths may be part of the treatment
– Wet dressings are applied to reduce itching
and in some cases to remove crusts
– Infantile eczema is associated with
development of asthma later in life
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Impetigo
• Description
– An infectious disease of the skin caused by
staphylococci or by group A beta-hemolytic
streptococci
– Two classifications: bullous and nonbullous
• Signs and symptoms
– The first symptoms of a nonbullous lesion are red
papules; become small vesicles or pustules
surrounded by redness
– Bullous lesions are first seen as vesicles that
become fluid-filled; eventually rupture, collapse,
and leave a base with a peeling rim
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Impetigo
• Treatment and nursing
care
– Lesions may be cleaned 3
or 4 times a day with soap
and water to remove crusts
– Cleansing is followed by
the application of topical
antibiotic ointment
– Oral antibiotics may also
be given
– Nurses should prevent this
disease with proper aseptic
methods
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Staphylococcus aureus Infection
• Description
– Staphylococcus is a common bacteria that are
found in dust and on the skin
– Normally does not present a problem to
healthy body defenses, but if the number of
organisms increases in infants whose general
resistance is low, skin infections may occur
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Staphylococcus aureus Infection
• Treatment and nursing care
– Antibiotics effective against the particular
strain are administered
– Ointments may be applied locally
– Washing hands before and after touching
each patient and before and after handling
equipment is essential
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Several types of Staph infections
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Cellulitis
• Bacterial infection of skin and subcutaneous tissue
• Caused by streptococcus, staphylococcus, or
Haemophilus influenzae
• Signs and symptoms
– Edematous, tender red skin is warm to the touch
– Can progress to abscess formation, fever
– Septicemia may result
• Treatment and nursing care
– Oral antibiotics (parenteral antibiotics in extreme
cases)
– Warm, moist compresses
– Handwashing is important
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Pediculosis
• Description of 3 types of pediculosis are
– pediculosis capitis, or head lice;
– pediculosis corporis, or body lice;
– pediculosis pubis—“crabs”—or pubic lice
– The adult attaches numerous eggs, known as nits, to the hair
shafts approximately 1/8 inch from the scalp
• Signs and symptoms
– Severe itching of the scalp
– The hair may become matted
– Occasionally pustules and excoriations are seen about the face
• Treatment and nursing care
– Permethrin (Nix), pyrethrin shampoos, or lindane (Kwell) are
used
– Nits on the head are removed by combing the hair with a finetooth comb (dipped in vinegar)
– Repeat in 3-7 days
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Burns
• Description
– Categorized as thermal, radiation, electrical, or
chemical
– Severe burns cause fluid and electrolyte
imbalances and can affect every body system
– Infection, scarring, and functional disabilities are
major complications of severe burns
• Signs and symptoms
– The burn wound is classified according to
percentage of body surface involved, the depth
and location of the injury, and association with
other injuries
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Burns
• Treatment and nursing care
– ABCs
• Oxygen is given, and O2 Sats monitored closely
• An endotracheal tube is inserted if the child is in
respiratory distress
• An intravenous (IV) infusion is started, and fluid
volume restoration is initiated
• A Foley catheter is placed to monitor urine output
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Burns
• Treatment and nursing care (continued)
– Wound management
• Cool compresses/soothing lotions for superficial burns
• Antimicrobial agent (i.e., bacitracin) for superficial
partial-thickness burns expected to heal within 2 to 3
weeks
• Silvadene is commonly used on partial- and fullthickness burns to prevent wound sepsis
• Burn wounds may be treated as open (wound
uncovered) or may be covered with a range of thin
gauze to bulky gauze
• Range-of-motion exercises, hydrotherapy, and
débridement are used in treatment
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Burns
• Treatment and nursing care (continued)
– Wound management (continued)
• Skin grafts may be necessary in full-thickness burns
where re-epithelialization does not take place
• Allograft: Skin obtained from human cadavers
– Autograft: Obtained from an undamaged area of the
patient’s body
– Infection prevention
• Eschar (burned tissue) must be removed to prevent
infection
• Penicillin or erythromycin
• Antibiotics are only ordered if infection occurs
– Watch carefully for signs of infection
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Burns
• Treatment and nursing care (continued)
– Pain control
• Morphine sulfate -drug of choice for severely burned patients
– Intravenously, PCA pump
– Special attention should be given to respiratory rates when
morphine is given
– Acetaminophen/ codeine may be given for less severe pain
– Nutritional management
• The child may be on nothing by mouth (NPO) restriction for
the first 24-48 hours if the burn is severe and bowel sounds
are absent
• The child requires a high-protein, high-calorie diet
• Oral feedings are preferred, although it may be necessary to
supplement with nasogastric feedings
• Small, frequent feedings of favorite foods should be provided
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Burns
• Treatment and nursing care (continued)
– Social and emotional issues
• Families may be dealing with guilt, anger, grief,
denial, and fear
• Body image concerns become paramount for the
older child as recovery progresses
• Encourage the child to help with bathing, dressing
change, feeding, and other self-care activities
• Provide opportunities for family and child to talk
about feelings and changes in body appearance
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Acne Vulgaris
• Description
– An inflammation of the sebaceous glands and hair follicles in the
skin
• Signs and symptoms
– A comedo is a plug of keratin, sebum, and bacteria
• Open comedo, or blackhead—the surface is darkened by melanin
• Closed comedones, or whiteheads—responsible for the inflammatory
process of acne
• Treatment and nursing care
– A regular well-balanced diet is encouraged
– Patients who are not taking tetracycline or vitamin A benefit from
sunshine
– General hygienic measures of cleanliness, rest, and avoidance
of emotional stress may help prevent exacerbations
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Acne Vulgaris
• Treatment and nursing care (continued)
– Over-the-counter benzoyl peroxide lotions or
prescription-strength gels act to dry & peel the skin
and suppress fatty acid growth
– Change the pillow case frequently
– Topical retinoic acid derivative (Retin-A) aids in the
elimination of keratinous plugs
– Tetracycline, doxycycline, or erythromycin may be
given with topical medications in more serious cases
– Accutane (13-cis-retinoic acid) is now being used for
patients with severe pustulocystic acne (Must be on 2
forms of birth control)
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