5 Pedia.Integumentary lec

8/7/2019 5 Pedia.Integumentary lec

1/24

THE CHILD WITH INTEGUMENTARY DYSFUNCTION

CARE OF THE

PEDIATRIC CLIENT

WITHDERMATOLOGIC

PROBLEMS

A. Review of the Anatomy andPhysiology of TheIntegumentary System1. Physical Assessment2. Diagnostic Procedure3. Therapeutic Management4. Nursing Management

B. Preliminary Skin Lesions

C. Secondary Skin LesionsD. Eczematous ReactionE. Atopic DermatitisF. Seborrheic DermatitisG. Lyme DiseaseH. ScabiesI. Diaper RashJ. BurnsK. Psoriasis

INTEGUMENTARY DYSFUCNTION

SKIN LESIONS- Lesions of the skin result from a variety of etiologic factors.- Skin lesions originate from:

1. Contact with injurious agentsA. infective organismsB. toxic chemicalsC. physical trauma

2. Hereditary factors

3. External factorsA. allergens

4. Systemic diseasesA. measlesB. lupus erythematousC. nutritional deficiency diseases


2/24

- An agent that may be harmless to one individual may be damagingto another, and a single agent may produce different responses indifferent individuals

- An important factor in the etiology of the skin manifestations is theage of the child.

- Infants are subject to these that appear early in life: Birthmark Malformations Atopic dermatitis

- School age child is susceptible to ringworm of the scalp- Acne is a characteristic skin disorder of puberty- contact dermatitis, such as poison ivy, is seen only when noxious

agent id found in the environment- Tension and anxiety may produce, modify or prolong skin condition

Skin of Younger Children

The major skin layers arise from different embryonic origins.Early in embryonic period, a single layer of epithelial forms fromectoderm, while simultaneously the corium develops from themesenchyme. In the infant and small child the epidermis is looselybound to the dermis.

This poor adherence causes the layers to separate easily duringan inflammatory process to form blisters. This is especially true inpreterm infants, who have propensity to blister formation andseparation of the skin during careless handling (such as removal of

adhesive tape). In contrast, the skin of the older child is thinner andthe cells of all the strata are more compressed.

Pathophysiology of Dermatitis

Inflammatory changes in the skin Acute responses produce intercellular and intracellular edema Formation of intradermal vesicles Initial filtration of inflammatory cells into the epidermis Edema of the dermis

Vascular dilation Early perivascular cellular infiltration

The location and manner of these reactions produce the lesionscharacteristic of each disorder. The changes are usually reversible, andthe skin ordinarily recovers without blemish unless complicatingfactors such as ulceration from the primary irritant, scratching andinfection are introduced or underlying vascular disease develops. In


3/24

chronic conditions permanent effects are seen that vary according tothe disorder, the general condition of the affected individual & theavailable therapy.

Diagnostic Evaluation

HISTORY AND SUBJECTIVE SYMPTOMS

PRURITUS - itching- the common local symptom

Pain or tenderness accompanies some skin lesions Burning, prickling, stinging or crawling sensations ANESTHESIA absence of sensation HYPERESTHESIA excessive sensitiveness HYPESTHESIA or HYPOESTHESIA diminished sensation PARESTHESIA - abnormal sensation(burning or prickling)

These symptoms may remain localized or migrate, may beconstant or intermittent and may be aggravated by a specific activitysuch as exposure to sunlight.

Check if the child has allergic conditions such as asthma orfever or history of previous skin disease

Objective Findings

Provide significant formation:

Distribution Size Morphology Arrangement

Cause:EXTRINSIC CAUSES

Physical Chemical Allergic irritants

Infectious agent1. fungi2. viruses3. animal parasite

INTRINSIC CAUSES

Infection (measles or chicken pox) Drug sensitization


4/24

Other allergic phenomena

LESION

1. ERYTHEMA a reddened area caused by increased amounts of

oxygenated blood in the dermal vasculature2. ECCHYMOSES (Bruises) Localized red or purple

discolorations caused by the extravasations of blood into dermisand subcutaneous tissues

3. PETECHIAE pinpoint, tiny and sharp circumscribed spots inthe superficial layers of the epidermis

4. PRIMARY LESIONS skin changes produced by a causativefactor; common primary lesions in pediatric skin disorders aremacules, papules & vesicles

MACULE flat, non palpable, circumscribed, less than 1 cm

in diameter, brown, red, purple, white or tan in color(eg: freckles, flat moles, rubella, rubeola) PATCH flat, non palpable, irregular in shape, macule that

is greater than 1 cm in diameter(eg: Virtiligo, port wine marks)

PLAQUE elevated, flat topped, firm, rough, superficialpapule greather than 1 cm in diameter, may be coalescedpapules

(eg: Psoriasis, seborrheic and actinic keratoses) WHEAL elevated, irregularly shaped area of cutaneous

edema, solid, transient, changing, variable diameter, pale

pink with lighter center(eg: Urticaria, insect bites)

5. DISTRIBUTUION PATTERN the pattern in which lesions aredistributed over the body, whether local or generalized and thespecific areas associated with the lesions

6. CONFIGURATION AND ARRANGEMENT the size, shape &arrangement of a lesion or groups of lesions (eg: discrete,clustered, diffuse of confluent)

Laboratory Studues

Microscopic examinations Cultures Skin scraping Biopsy Cytodiagnosis Patch testing Wood light examination Allergic skin testing


5/24

Other laboratory test such as blood count and sedimentationrate

WOUNDS

- structural or physiologic disruptions of the skin that areactivate normal or abnormal tissue repair responses.

ACUTE WOUND those that heal uneventfully within 2-3weeks

CHRONIC WOUND those that do not heal in expected timeframe or are associated with infections

Cofactors that disrupt or delay wound healing:

Epidermal Injuries

Abrasions are the most common epidermal wounds in children,usually in the form of skinned knee or elbow. Epithelial tissue iscomposed of labile cells, which are constantly destroyed and replacedthroughout the lifespan.

Papule-elevated; palpable; firm; circumscribed; less than 1cmin diameter ; brown , red, pink, tan, or bluish red color

Examples: warts; drug-related eruptions; pigmented nevi

Nodule- elevated; firm; circumscribed; palpable; deeper in

dermis than papule; 1 to 2cm in diameterExamples: Erythema nodosum; lipomas

Vesicle- elevated; circumscribed; superficial; filled with seriousfluid; less than 1cm in diameter

Examples: Blister, varicella

Pustule- elevated; superficial; similar to vesicle but filled withpurulent fluid

Examples: Impetigo; acne; variola

Bulla- vesicle greater than 1 cm in diameterExamples: Blister; pemphigus vulgaris

Cyst- elevated; circumscribed; palpable; encapsulated; filledwith liquid or semisolid material

Examples: Sebaceous cyst


6/24

Injury to Deeper Tissues

Tissues composed of permanent cells such s muscle and nervecells re unable to regenerate. These tissues repair themselves bysubstituting fibrous connective tissues for the injured tissue. This

fibrous tissue, or scar, serves as a patch to preserve or restore thecontinuity of the tissue. Wounds involving permanent cells includesurgical incisions, lacerations, ulcers, evulsions, and full-thicknessburns.

Process of Wound Healing

When the skin is injured, its normal protective barrier function isbroken. In the healthy immunocompetent individual, acute traumatic,abrasions, lacerations, and superficial skin and soft-tissue injuries healspontaneously without complications. The four stages of woundhealing include hemostasis, inflammation, proliferation andremodeling. Some authorities combine the first two phases. In thehemostasis phase, platelets act to seal off the damaged blood vesselsand to form a stable clot.

Inflammation, the second stage of wound healing, presents aclinical picture that involves erythema, swelling and warmth oftenassociated with pain at the wound site. The inflammation phaseinvolves whit blood cells such as the neutrophils, monocytes, and

macrophages.The proliferative phase, which includes granulation and

contracture, is the third stage of healing. This phase lasts from 4 to 21days in acute wounds depending on the size of the wound. The phaseis characterized clinically by the presence of granulation tissue, thebeefy, pebbled red tissue in the wound base. Fibroblasts orimmature connective tissue cells secrete collagen, which provides thefoundation for dermal regeneration. Angiocytes regenerate the outerlayers of capillaries and endothelial cells produce the lining in aprocess called angiogenesis. The keratinocytes are responsible for

epithelialization. In the final stage of epithelialization, contractureoccurs as the keratinocytes differentiate and form the protective outerlayer or stratum corneum of the skin.


7/24

Scale- heaped-up keratinized cells; flaky exfoliation; irregular;thick or thin; dry or oily; varied size; silver, white, or tan incolor

Examples:psoriasis; exfoliative dermatitis

Crust- dried serum blood, or purulent exudate; slightlyelevated; and varies; brown, red, black, tan or straw in color

Examples:Scab in abrasion

Lichenification- rough, thickened epidermis; accentuated skinmarkings caused by rubbing or irritation; often involves flexoraspect of extremity

Example: chronic dermatitis

Scar- thin to thick fibrous tissue replacing injured dermis ;

irregular; pink, red, or white in color; may be atropic orhypertrophicExample:healed wound or surgical incision

Keloid- irregularly shaped, elevated, progressively enlargingscar; grows beyond boundaries of wound; caused by excessivecollagen formation during healing

Example:Keloid from ear piercing or burn scar

Excoriation- loss of epidermis; linear or hallowed-out crustedarea; dermis exposed Exmples:Abrasion; scratch

Fissure- linear crack or break from epidermis to dermis; small;deep; red

Examples:Athletes foot; cheilosis

Erosion- loss of all or part epidermis; depressed; moistglistening; follows rupture of vesicle or bulla; larger thanfissure

Examples: Varicella; variola following rupture

Ulcer- loss of epidermis and dermis; concave; varies in size;exudative; red or reddish blue

Examples: Decubiti; stasis ulcers

Remodeling or maturation is the final phase of the healingprocess. This phase occurs in the dermis as fibroblasts increase thetissue tensile strength and gradually replace Type 3 collagen in thescar tissue with Type 1 collagen, thicken the collagen fibers, and


8/24

reorient the collagen fibers long the lines of tissue tension. Remodelingand maturation occurs over several months and can take up to 2years. The phases of wound healing are complex and may interrupted by disease conditions, medications, and other systemic andlocal factors that influence the healing process. When a wound does

not follow the normal wound healing trajectory, it may become stuckin one of the stages and become a chronic wound.

Factors that influence Healing

A revolution in wound healing has occurred in the last twodecayed. Emphasis has shifted from interventions aimed amaintaining a dry environment to those promotes a moist, crust freeenvironment that enhances the migration of the epithelial cells acrossthe wound and facilitates remodeling. An acute full-thickness woundkept in a moist environment usually re-epithelializes in 12 to 15 days,were us the same wound when kept open to the air heals in about 25to 30 days.

Factors That Delay Wound Healing

Factors Effect on Healing

Dry wound environment Allows epithelial cells to dry out and die;impairs migration of epithelial cellsacross wound surface

Nutritional deficiencies

Vitamin A Results in inadequate inflammatoryresponse

Vitamin B1 Results in decreased collagen formation

Vitamin C Inhibits formation of collagen fibers andcapillaries development

Protein Reduces supply for amino acids for tissuerepair

ZincImpairs epithelialization

Immunocompromise Results in adequate or delayedinflammatory response


9/24

Impaired circulation Inhibits inflammatory response andremoval of debris from wound area

Reduces supply of nutrients to wound area

Stress (Pain, poor sleep) Releases catecholamines that causevasoconstriction

Antiseptics

Hydrogen peroxide Toxic to fibroblasts; can causesubcutaneous gas formation (mimicsgas-forming infection)

Povidone-iodine Toxic to white and red blood cells and

fibroblastsChlorhexidine Toxic to white blood cells

MedicationsCorticosteroids Impair phagocytosis

Inhibits fibroblasts proliferationDepress Formation of granulation tissueInhibit wound contraction

Chemotherpy Interrupts the cell cycle, damages DNA

Antiinflammatory drugs decrease the inflammatory phase

Foreign bodies Increase inflammatory responseInhibit wound closure

Narcotics Increases inflammatory responseIncreases tissue destruction

GENERAL THERAPEUTIC MANAGEMENT


10/24

Some skin disorders demand aggressive therapy, but by andlarge the major aim of the treatment is to prevent further damage,eliminate the cause, prevent complications & provide relief discomfortwhile tissues undergo healing. Factors that contribute to t

development of dermatitis and that prolong the course of the diseaseshould be eliminated when possible.

- The most common causative agent of dermatitis in infants, childrenand adolescents are Environmental factors:

Soaps Bubble baths Shampoos Rough or tight clothing Wet diapers

Toys Blankets

Natural elements:

Dirt Sand Heat Cold Moisture Wind

- Dermatitis may also result from home remedies and medications.

Dressings

No one dressing meets the needs of all wounds.

-The traditional drygauze dressing should not be used on openwounds, because:

it allows the wound surface to dry, does little to prevent bacterial invasion,

adheres to the dried scab so that removal disturbs the newlyregenerating epithelial

In most instances, traditional gauze dressings have beenreplaced with moist wound healing dressings.

MOIST WOUND HEALING- increases the rate of collagen synthesis &reepithelialization & decreases pain and inflammation.


11/24

Dressing should always be changed when they are loose orsoiled. They should be changed more frequently in areas wherecontamination is likely:

sacral area the buttocks the tracheal area or when the infection is suspended or present

Topical Therapy

- Several agents and methods are available for treatment.- In selecting a therapeutic regimen, the practitioner considers:

1. The choice of active ingredient

2. the proper vehicle or base3. the cosmetic effects4. the cost5. instructions for use

Over treatment is avoided. For example, when dermatitis isacute, topical applications should be mild and bland to avoid furtherirritation. Broken or inflamed skin, especially in children is moreabsorbent than intact skin, and chemicals that are nonirritating tointact skin may be quite irritating to inflamed skin.

Topical Corticosteroid Therapy

Glucocorticoids are the therapeutic agents used most frequentlyfor skin disorders. Their local anti-inflammatory effects are merelypalliative, so the medication must be applied until the conditionundergoes a remission or the causative agent is eliminateCorticosteroids are applied directly to the affected area, are essentiallynonsensitizing, and have only minor side effects. As with the use ofany steroids, their use in large amounts may mark signs of infections.

Most parents and children apply too much topicahydrocortisone; therefore, they should be counseled that it is botheffective and economical to apply only a thin film and to massage itinto the skin. Parents and children should also be advised to use theapplication for no more than 5 to 7 days because these agents maycause depigmentation and other changes the skin

Other Topical Therapies


12/24

chemical cautery (especially useful for warts) cryosurgery electrodesiccation (chiefly used for warts, glaucomas & nevi) ultraviolet therapy (especially for birthmarks)

acne therapies such as dermabrasion and chemical peels

Systemic Therapies

Systemic drugs may be used as an adjunct to topical therapy insome dermatologic disorders. The drugs most frequently used are:

corticosteroids antibiotics antifungal agents

Corticosteroids are valuable because of their capacity to inhibitinflammatory and allergic reactions. Dosage is carefully adjusted andgradually tapered to the minimum dose that is effective and tolerated.

Antibiotics are used in severe or widespread skin infections.Antifungal agents are the only means for treating systemic

fungal infections.

NURSING CARE OF THE CHILD- Signs of wound infection are

o Edema

o Purulent exudateso Pain

o Increased temperature

- The frequency of wound assessment depends on the severity andcomplexity of the wound- wound bed is assessed for:

o Color

o Drainage

o Odor

o Necrosiso Granulation tissue

o Fibrin slough

o Undermining

o Condition of the wound edges

o Color condition of the surrounding skin


13/24

Wound care

- the parents are instructed to wash their hands and then wash thewound gently with mild soap and water or with normal saline

- open wounds are covered with a dressing, such as a commercial

adhesive bandage, although larger wounds may benefit from the useof occlusive dressings.

- Dressings are removed carefully to protect intact skin and theepithelial surface of the wound

- pull parallel

Relief of symptoms

-Most therapeutic regimes for skin lesions are directed toward relief ofpruritus, the most common subjective complaint

- Anti pruritic medications such as dephenhydramine (benadryl) orhydroxyzine (atarax) may be prescribed for severe itching, especiallyif it disturbs the childs rest

Topical Therapy

- wet compress or dressings cool the skin by evaporation, relieveitching and inflammation and cleanse the area by loosening andremoving crusts and debris.

- A variety of ingredients, such as plain water or burrow solution(available without prescription) can be applied on kerlix gauze, plain

gauze-soaks are often used for removal of crusts and for their mild

astringent action- baths are useful in the treatment of widespread dermatitis evenly

distributing the soothing antipruritic and anti inflammatory effects ofthe solution,usually oatmeal or mineral oil preparations

- topical applications are applied to skin lesions to ease discomfort,prevent further injury and facilitates healing

HOME CARE AND FAMILY SUPPORT

-Parents of other children may fear that their children will catch thedisorder. Occasionally the affected childs own family membersreduce their interaction or physical contact with the child.

- Normally, the skin harbors a variety of bacterial flora, including themajor pathogenic varieties of staphylococci. The degree ofpathogenecity of the organism depends on its invasiveness and


14/24

toxicity, skin integrity of the skin and the immune and cellulardefenses of the host. Children with congenital or acquiredimmunodeficiency disorders (such as AIDS), those in debilitatedcondition, those with generalized malignancy such as leukemialymphoma are at risk for developing bacterial infections

BACTERIAL INFECTIONS


15/24

DISORDERS/ORGANISM MANIFESTATIONS MANAGEMENT COMMENTS

Impetigo contagiosa- staphylococcus

pyoderma- staphylocossus- strephtococcus

FOlliculitis (pimple),furuncle (boil),

carbuncle (multiple boils) staphylococcus aureus

Cellulitis streptococcus,staphylococcus,haemophilus influenzae

- Begins as a reddishmacule- becomes vescicular- ruptures easily,leaving superficial,moist erosion- tends to spreaperipherally insharply marginated

irregular outlines- exudates dries toform honey-coloredcrusts- pruritus common- systemic effects:minimal orasymptomatic

-

deeper extension ofinfection into dermis- tissue traction moresevere- systemic effects:fever. Lymphagitis

- folliculitis: infectionof hair follicle- furuncle: larger

lesion with moreredness and swellingat a single follicle- carbuncle: moreextensive lesion withwidespreadinflammation andpointing at severalfollicular orifices-systemic effects:

malaise, if severe

inflammation of skinand subcutaneoustissues with intenseredness, swelling andfirm infiltration- lymphagitis

streaking frequentlyseen

- careful removalof underminedskin, crusts &debris bysoftening with1:20 burowsolutioncompresses- topical

application ofbactericidalointment- systemicadministration oforal or pareteralantibiotics(penicillin) insevere orextensive lesions

soap and watercleansing- wet compresses- bathing withantibacterial soapas prescribed

skin cleanliness- local warm,moist compresses

- topicalapplication ofantibiotic agents- systemicantibiotics insevere cases- incision anddrainage ofsevere lesion,followed by

wound irrigationswith antibiotics orsuitable drainimplantation

oral or pareteralantibiotics- rest andimmobilization ofboth affected areand child

- hot moistcompresses to

- tends to healwithout scaringunless secondaryinfection-autoinoculatebleand contagious- very common intoddler,

preschooler- may besuperimposed oneczema

inoculable andcontagious- may heal withor withoutscarring

- autoinoculableand contagious- furunclea and

carbuncle tend toheal with scarforamation- a lesionshould \never besqueezed

hospitalizationmay benecessary forchild withsystemicsymptoms

- otitis mediamay be


16/24

VIRAL INFECTIONS

- viruseso Intracellular parasites

o Produce their effect by using the intracellular substances of

the host cellso Composed of only DNA or RNA core enclosed in an

antigenic protein shell, unable to provide for their ownmetabolic needs to provide for their own metabolic needs

or to reproduce themselves

DERMATOPHYTOSES (FUNGAL INFECTIONS)

- (ringworm) are infections caused by a group of closely relatedfilamentous fungi that invade primarity the :o Stratum

o Corneum

o Hair

o Nails

- these are superficial infections that live on but not in, the skin.- designed by the latin word tinea, with further designation related tothe area of the body where they are found.

Example: tinea capilis (ringworm of the scalp)- Infections are most often transmitted from one person to another orfrom infected animals to humans.

Nursing Considerations

- when teaching families how to care for ringworm, the nurse should

emphasize good health and hygiene. Because of the disease,affected children should not exchange grooming items, headgear,scarves or other articles of the apparel that have been in proximity tothe infected area with other children.


17/24

- treatment with the drug griseofulvin frequently continues for weeksor months and because subjective symptoms subside, children orparents may be tempted to decrease or discontinue the drug.

Viral Infections

INFECTION MANIFESTATION MANAGEMENT COMMENTS

Verruca(warts)Cause:humanpapillomavirus

(varioustypes)

- Verrucaplantaris(plantar wart)

- usually wellcircumscribed grayor brown,elevated, firmpapules with a

roughened finelypapillomatoustexture- occur anywhere,but usually appearon exposed areassuch asfingers,hands, face andsoles- may be singleormultiple

asymptomatic

- located on theplantyar surface offeet and because

of pressure arepractically flat;may besurrounded by acollar ofhyperkeratosis

- not uniformlysuccessful- local destructivetherapy,individualized

according tolocation, type &number- surgicalremoval,electrocautery,curettage,cryotherapy (liquidnitrgogen) causticsolutions (lacticacid and salicylicacid in flexible

collodion, retinoicacid, salicylic acidplasters)x-raytreatment, laser

-apply causticsolution to wart,wear foam insole

with hole cut torelieve pressure onwart; soak 20minutes after 2-3days; repeat untilwart comes out

- common inchildren- tend todisappearspontaneously

- courseunpredictable- mostdestructivetechniquestend to leavescars-autoinoculable- repeatedirritation will

cause toenlarge- apply topicalanestheticEMLA

- destructivetechniquestend to leave

scarsm whichmay causeproblems withwalking


18/24

- Herpessimplex virusType I (cold

sore, fever,blister)

Type II(genital)

-Varicellazoster virus

(herpeszoster;shingles)

- grouped, burning& itching vescicleson inflammatorybase. Usually onnear mucotaneous

junctions (lips,genitals, buttocks)- vesicles dry,forming a crust,followed byexfoliationandspontaneoushelaing in 8-10days- may be

accompanied byegionallymphadenopathy

- caused by samevirus that causedvaricella (chickenpox)- virus has affinityfor posterior rootganglia, posterior

horn of spinal cordand skin crops ofvesicles usuallyconfined todermatonefollowing alongcourse of affectednerve

- avoidance ofsecondaryinfection- burrow solutioncompresses during

weeping stages- topical therapy(penciclovir) canshorten duration ofcold sores- oral antiviral(acyclovir) forinitial infection orto reduce severityin recurrence

- Valacyclovir(Valtrex), an oralantiviral used forepisodic herpes,reduces pain,stops viralshedding & has amore convenientadministrationschedule thanacyclovir

- symptomatic- analgesics forpain- mild sedationsometimes helpful- local moistcompresses

- drying lotionsmay be helpful- ophthalmicvariety; systemiccorticotrophin(adenocorticotropichormones{acth})corticosteroids

- heal withoutscarring unlesssecondaryinfection- Type I cold

sores can beprevented byusingsunscreensprotectingagainstultraviolet A(UVA) andultraviolet B(UVB) light to

prevent hipblisters- aggravatedbycorticosteroids- positivephysiologiceffect fromtreatment- may be fatalin children with

depressedimmunity

- pain inchildrenusuallyminimal- postherpeticpain does notoccur in

children- chicken poxmay followexposure;isolate affectedchild fromother childrenin a hospital or


19/24

MOlluscumcontaglosumCause: pox

virusSmall benign

tuomors

- usually precedeby neurologicpain,hyperparesthesiasoritching

- may beaccompanied byconstitutionalsymptoms

- fleshed coloredpapules with acentral caseousplug (umbilicated)- usually

asymptomatic

- acyclovir- lidoderm topicalanesthetic

- cases in wellchildren resolvepontaneously inabout 18 months- treatmentresrved for

troublesome cases- apply topicalanesthetic EMLAand remove withcurette- use tretinoin gel0.01% orcatharidin(cantharone) liquid- curettage orcryotherapy

school- may occur inchildren withdepressedimmunity; can

be fatal

- common inschool age

children- spread byskin to skincontactincludingautoinoculationand fomite toskin contact

SYSTEMIC MYCOTIC (FUNGAL) INFECTIONS

- Viruses (systemic or deep fungal) infections have a capacity toinvade the viscera, as well as the skin. The most common infectionsare the lung diseases, whicha are usually acquired by inhalation offungal spores.

- produce a variable spectrum of disease- they are not transmitted from person to person but appear to reside

in the soil from which their spores are airborne.

SKIN DISORDERS RELATED TO CHEMICAL OR PHYSICALCONTACTS

CONTACT DERMATITIS


20/24

- is an inflammatory reaction of the skin to chemical substances,natural or synthetic, that evokes a hypersensitivity response or directirritation

- the cause maybe a primary irritant or a sensitizing agents- A primary irritantis one that irritates the skin

- A sensiztizing agentproduces an irritation on those individuals whohave met the irritant or something chemically related to it

- the major goal in treatment is to prevent further exposure of the skinto the offending substance


- skin manifestations in specific areas suggest limited contact, such asaround the eyes (mascara), areas of the body covered by clothingbut not protected by undergarments (wool), or areas of the body notcovered by clothing (ultraviolet injury)

POISON IVY, OAK & SUMAC

- contact with the dry od succulent portions of any of the threepoisonous plantso Ivy

o Oak

o Sumac

- produces localized, streaked or spotty, oozing and painful

impetigenous lesions.

Therapeutic Management

- treatment of the lesions includes calamine lotion, soothing.- Burrow solution compresses or Aveeno baths to relieve discomfort


- the area is immediately flushed (15 minutes) with cold running waterto neutralize the urushiol not yet bounded to the skin

- Harsh soap is contraindicated because it removes protective skin oilsand dilutes the urushiol, allowing it to spread hard scrubbing irritatesthe skin

Prevention: is best accomplished by avoiding contact and removingthe plant from the environment.


21/24

DRUG REACTIONS

- adverse reactions to drugs are seen more often in the skin than inany other organ, although any organ of the body can be affected

- The manifestations may be associated with the side effects orsecondary effects of a drug, either of which are unrelated to itsprimary pharmacologic actions

- manifestations of drug reactions may be delayed or immediate- A period of 7 days is usually required for a child to develop

sensitivity to a drug that has never been administered previously.

FOREIGN BODIES

- parents remove small wooden splinters with a needle and tweezersthat have been sterilized with alcohol or a flame

- the area around the silver is washed with soap and water beforeremoval is attempted.

-small cactus prickles or spines are troublesome to remove, but thefollowing methods may prove helpfulo Apply a thin layer of water soluble household glue and cover with

gauze; when the glue dries, peel off the gauzeo Apply hair removal was or body sugar (Aplon), let dry, and

removeo Place the cellophane tape, sticky side down, over the spines and

lift off

SKIN DISORDERS RELATED TO INSECT AND ANIMAL CONTACTS

SCABIES

- is an endemic infestation caused by the scabies mite, sarcoptesscabies. Lesions are created as the impregnated female burrows intothe stratum conreum of the epidermis (never into living tissue) to

deposit her eggs and feces


- the treatment of scabies is the application of a scabicide- currently, permethrin 5% cream (Elimite) is the drug- Permethrin is preffered because it is safer, it avoids the risk of

neurotoxicity and it is more eefective than lindane.


22/24

Clinical Manifestations of Scabies

LESION

Children minute grayish-brown, threadlike (mite burrows), pruriticblack dot at end of burrow (mite)

Infants eczematous eruption, pruritus

DISTRIBUTION

Generally in intertriginous areas-interdigital, axillary-cubital, popliteal,inguinal

Children older than 2 years of age primarily hands and wristChildren younger than 2 years primarily feet and ankles

PEDICULOSIS CAPITIS

- (head lice) is an infection of the scalp by Pediculous humanus capitis- a common parasite in school age children- the adult louse lives only about 48 hours when away from a human

host and the lifespan of the average female is 1 month.- the female lay eggs at night at the junction of a hair shaft and close

to the skin because the eggs need a warm environment- the nits or eggs, hatch in approximately 7-10 days. Itching is usually

the only symptom.

Diagnostic Evaluation

- diagnosis is is made by observation of the white eggs (nits) firmlyattached to the hair shafts

- adult lice are more difficult to locate

- nits must be differentiated from dandruff, lint, hair sprays and otheritem of similar size and shape

Therapeutic management

- treatment consists of the application of pediculicides and manualremoval of nit cases


23/24

- the drug of choice in infantrs and children is permethrin1 % crmerinse (Nix), which kills adult lice and nits

-Malathion, 0.5 % (Ovide) approved for treatment for treatment ofhead lice is available only by prescription

Nursing Consideration

-An important nursing role is providing the parents with educationabout pediculosis

- anyone can get pediculosis- it has no respect for age, socio economic level or cleanliness

Preventing the Spread and Reoccurence of Pediculosis

- machine wash all washable clothing, towels and bed linens in hot,water and dry dryer for at least 20 minutes. Dry clean nonwashableitems

- Throroughly vacuum carpets, car seats, pillows, stuffed animals,rugs, mattresses and upholstered furniture

- seal nonwashable items in plastic bags for 14 dyas if unable to dryclean or vacuum

- soak combs, brushes and hair accessories in lice killing products for 1hour or in boiling water for 10 minutes

- in day care centers, store childrens clothing items such as hats andscarves and other headgear in separate cubicles

- discourage the sharing of items such as hats, scarves, hairaccessorie, combs and brushes among children in group in groupssettings such as day care centers

- avoid physical contact with infested individuals and their belongingsespecially clothing and bedding

- inspect children in a group setting regularly for head lice

ANTROPOD BITES AND STINGS

- bites and stings account for a significant amount of mild to moderate

discomfort in children- most bites and stings are managed by simple symptomaticmeasures, such as compresses , calamine lotion& prevention ofsecondary infection

- anthropods include insects and arachnids, such as mites, tiks, spidersand scorpions


24/24

5 Pedia.Integumentary lec

Documents

Transcript of 5 Pedia.Integumentary lec