Download The Integument System

The Integument
System
The skin & associated disorders
NUR 331 On-line study self-study
Dr. Sara Mitchell
Purposes of the skin
Protection
 Impermeability
 Heat regulation
 Sensation

Purposes of the skin

Protection


Protects against trauma, including mechanical,
thermal, chemical, & radiant
Protects by the oily slightly acid secretions of the
sebaceous glands which limit the growth of
bacteria
Purposes of the skin

Impermeability

Seals the skin from the environment

Protects against loss of essential body
constituents to the environment.
Purposes of the skin

Heat regulation

Skin adjusts heat loss to heat production to
maintain the thermal balance of the body.
Purposes of the skin

Sensation


Perceptions (touch, pain, heat, cold) are
transmitted through the nerves that permeate the
skin.
Betrays emotions/feelings
What makes skin in children different?





Eccrine glands do not reach mature function
until 2-3 years of age.
Skin is more alkaline in the first weeks of life.
Subcutaneous fat is poorly developed.
The newborn’s skin is thin an friable.
IgA is decreased until 2-5 years of age.
What makes skin in children different?



Lack of maturity of eccrine glands makes
infants & young children less able to regulate
body temperature
Decreased SQ fat predisposes to hypothermia
Thin skin makes it more susceptible to
external irritants and to infection
Test your knowledge
1. Purposes of the skin include _______, ______, _________,
and ____________.
2. The skin adjusts heat loss to heat production to maintain the
_______ _____ of the body.
3. Skin in children is different because of which of the following?
A. skin is more acidic in the first few weeks of life
B. IgA is increased until around 2-5 years of age
C. Decreased SQ fat predisposes to hypothermia

1. protection ,impermeability, heat regulation, sensation
2. thermal balance 3. C
Test Your Knowledge
Read pages 758-768 and answer the following
questions:
4. Which of the following factors hinder wound healing?
A. Dry wound environment
B. Nutritional deficiencies
C. Impaired circulation
D. all of the above
5. Which of the following factors aids in wound healing?
A. Leaving wound open to dry out
B. Cleaning with hydrogen peroxide and betadine
C. Cooling the affected area
4. D 5. C
Test your knowledge
6. The major nursing function related to bacterial skin
infections are to prevent the spread of infection and
to prevent complications.
 A. True
 B. False
7. Most communicable diseases of childhood are
associated with ______ caused by ________.
6. A 7. rashes/viruses
Infections of the skin
Caused by bacteria

The major nursing functions related
to bacterial skin infections are to
prevent the spread of infection and
to prevent complications.
Bacterial Infections - Name a few
(see page 767 in textbook)

Impetigo





Cause
Course
Management
Caution
Cellulitis

See page 767 in your textbook and figure 18-7 on page 767
What causes impetigo and how does it
progress?


Caused by group A beta
hemolytic and/or staph
aureous
Course is as follows:




Begins as a single reddish
maculae, then becomes
vesicular
Ruptures easily, leaving
superficial moist erosion
Tends to spread peripherally
Exudate dries to form a
heavy honey-colored crust
Impetigo: How is it managed?



Gentle washing with soap and water
Apply topical antibiotic ointment
May occasionally need oral antibiotics


Antibiotics in the penicillin or cephalosporin family are
generally prescribed. Erythromycin is used for those
allergic to penicillin.
Impetigo is VERY contagious

Children diagnosed with impetigo should be instructed to
stay home from daycare/school for 24 hours after
beginning medications
Test your knowledge

Joey is a 7-year-old boy who comes to the school nurse’s office with the complaint
of itchy rash on his face. As the school nurse, you assess the rash to be reddened
papules and pustules with a yellow crust occurring around his mouth and nose.

8. What is your first priority





A. Assess his temperature and lung sounds
B. Have the child wash his hands and call his parents to have Joey see the
doctor
C. Apply calamine lotion to the affected areas
D. All of the above.
9. Which of the following statement demonstrates effective learning by
Joey’s parents regarding his treatment?




A. “I should keep Joey’s towels separate from my other children.”
B. “Joey should bath in Aveeno baths at night to help with the itching.”
C. “I should wash Joey’s linen in hot water and soak his combs in boiling
water.”
D. “Joey should take Acyclovir until all of the lesions are gone.”
8. B 9.A
Infections of the skin
Caused by viral agents

Most communicable diseases of
childhood are associated with
rashes caused by viruses
Viral skin infections :
Name a few

Warts




Caused by human papillomavirus
Occurs anywhere but usually appear on exposed
areas such as fingers, hands, face, and soles of
feet.
Hard to get rid of. Tend to disappear
spontaneously
Treatment includes cryotherapy, surgical removal,
or salicyclic acid
More viral skin infections

Herpes simplex virus



Type I – causes clod sores & fever blisters
Type II – causes genital lesions and is sexually
transmitted
Management directed toward keeping lesions
moist with burrows solution. Topical or antivirals
may be used. Lesions are made worse by steroids.
May be fatal in children with decreased immunity.
Test your knowledge



10. Treatment for warts includes which of the following?

A. cryotherapy

B. surgical removal

C. salicylic acid

D. all of the above
11. Warts are caused by the human herpes virus.

A. True

B. False
12. Children with ringworm should be instructed to avoid contact with
other children for how long after treatment has begun?

A. 1 day

B. 2 days

C. 3 days

D. It doesn't matter
10. D; 11. B; 12. B
Another skin eruption caused by a virus
Varicella-also known as Chicken Pox

What causes it?


When does it generally occur?


varicella zoster viruses
Most often occurs in late winter and early spring
How is it spread?

It is spread by direct contact and droplet
(airborne) transmission
More on Chicken Pox

Is Chicken Pox contagious?


It is very contagious. It can be spread starting 1-2 days
before eruption of lesions and until the time when all
lesions have crusted.
When can children return to school or day care?


Not until ALL lesions have crusted which is usually about
1 week.
It is not necessary to wait until all the scabs fall off to let
the child return to a normal schedule
Chicken Pox – Sign & Symptoms

Red, itchy rash on skin.




Rash begins as small, red bumps that look like
pimples or insect bites.
Red bumps develop into thin-walled blisters filled
with clear fluid, which becomes cloudy
Blisters break, leaving open sores, which finally
crust over to become dry, brown scabs.
Fever 100-1020F (may occasionally be higher)
Chicken Pox – about the rash




Lesions erupt in successive
crops, usually beginning on the
trunk and then spreading to the
face and scalp.
The characteristic rash involves
crops of teardrop vesicles on an
erythematous base.
The classic lesion has been
described as an "oval teardrop on
an erythematous base" or a "dew
drop on a rose petal.“
A characteristic feature of the
rash is that the lesions can be in
all stages of development
simultaneously.
Chicken Pox – what is the Incubation
period?


The incubation period for chicken pox is 10 to
21 days after exposure.
Most cases appear within 14 to 17 days. For
example, if one child in a family breaks out
with chickenpox picked up at school, siblings
probably will show symptoms about 2 weeks
later.
ChickenPox – What is the treatment

Relieve the itch!






Cool or tepid oatmeal baths with every 3 to 4 hours as
needed (baths do not spread chickenpox)
Calamine lotion (avoid the face, especially the eyes)
Antihistamines, such as benadryl, may also be used for
itching
Soft/bland foods as indicated as there may be painful pox
lesions in the mouth
Acetaminophen or ibuprofen or fever and general aches
Antiviral medications such as acyclovir may occasionally
be prescribed at the physicians discretion
Chicken Pox – What are the
complications?



Viral pneumonia
Encephalitis
Secondary skin infection
Chicken Pox – How is it related to
shingles?





Anyone who has had chickenpox as a child is at risk
shingles later in life.
After infection with chickenpox, some of the varicella
zoster virus may remain inactive in the nerve cells near
the spinal cord.
Many years later, the virus can reactivate and resurface as
shingles.
When it reactivates, it affects the nerves to the skin.
Symptoms, such as a tingling feeling, itching, or pain
followed by a rash with red bumps and blisters appear
only on the area of the skin that the nerve goes to.
What about the chicken pox vaccine
http://www.vaccineinformation.org/varicel/qandavax.asp



In use since 1995
70-85% effective at preventing mild infection
and more than 95% effective in preventing
moderate to severe disease.
Given to all children older than 12 months of
age, as well as adults who have not had the
disease.
Chicken Pox – test your knowledge
13. Tommy has been diagnosed as having chicken pox. His mom ask you how the
disease is spread. Your best response is:
A. by direct contact with the lesions
B. by an infected person breathing on you
C. by kissing an infected person
D. all of the above
14. Tommy’s best friend has chicken pox. His mom is worried about Tommy getting
the disease as well and ask you what the early signs are. Your best response is:

A. Symptoms develop 3-5 days after exposure

B. Lesions usually begin on the trunk

C. The rash begins as small, red bumps that look like pimples

D. B & C

E. A only
13. D; 14. D
Chicken Pox – test your knowledge
15. It has been 10 days since his exposure to chicken pox and Tommy has not
developed signs of the disease. His mom ask if he is out of the woods. Your best
response is what?

A. It is unlikely Tommy will develop chicken pox from this exposure

B. The incubation period for chicken pox is 5-7 days

C. Most cases of chicken pox appear within 14 to 17 days of exposure.

D. It is impossible to tell if Tommy will develop chicken pox.
16. Tommy does not develop chicken pox but his brother does. Tommy’s mom ask
what she should do to treat the disease. Your best response is what?





A. Avoid baths because of risk of causing the pox to spread.
B. Apply calamine lotion for the itch
C. Give acetaminophen for fever and aches
D. A only
E. B & C
15. C; 16. E
Chicken Pox – test your knowledge
17.Tommy’s mom needs to return to work. She ask when her son
while likely to able to return to school. Your best response is
what?
 A. When all of the scabs have fallen off
 B. When all lesions have crusted and are no longer fluid
filled vesicles
 C. When she hasn’t seen any new lesion for 48 hours
 D. All of the above

17. B
Skins infections caused by fungi

Tinea captitis – fungal infection of the scalp

Tinea corporis – fungal infection of the body

Tinea curis – fungal infection of the scrotal
and genital area

Tinea pedis -athlete's foot
Skins infections caused by fungi

Management



Skin infections: treated with topical antifungal creams for
6-8 weeks
Scalp infections: because the fungi are deep in the hair
shaft tinea capitis must be treated with systemic antifungal
medications such as grieseofulvin for 6-weeks
Ringworm is contagious. Children with ringworm should
be instructed to avoid contact with other for 48 hours after
treatment is started.
Different forms of tinea – What does it look
like?
Tinea Capitis
Tinea Corporisface & trunk
Tinea cruris – groin, buttocks,
& scrotum
Tinea Pedis
Scabies

Definition –an endemic infestation caused by the scabies mite
sacroptes scabiei. The mite can barely be seen by the naked
eye

Clinical manifestations – the mite burrows under the skin
causing an allergic reaction. Recognized by their tracks
…small lines in the skin that look like scratches about ¼ inch
long. Usually appear at wrists, buttocks, underarms, groin,
and especially in the webs between fingers and toes.

Therapeutic management – scabicide such as Elimite (5%
permethrin)

Nursing considerations – education about transmission and
management
More on scabies
Pediculosis capitis:
a fancy name for head lice or “cooties”

Definition – an infestation of the
scalp by Pediculus humanus
capitus

Clinical manifestations –causes
intense itching. Very common
especially in school children

Therapeutic management – comb
nits out. Treat with 1% permethrin
shampoo.

Nursing considerations – head lice
are very contagious. All family
members should be treated.
Anything that has come in contact
with the scalp, brush, hats, bed
linens, ect.. needs to be cleaned
Poison Ivy,Oak, Sumac:
itchy, itchy, itchy page 767 in textbook

Definition


A contact dermatitis that occurs when skin comes in
contact with the dry or succulent portion of any of the
three of these plants. The offending substance is an oil
called urushiol
Clinical manifestations

Contact produces localized, streaked, or spotty, oozing
and painful impetigious lesions. The substance begins to
take effect as soon as it touches the skin. It soaks in and
causes an immune response. A full-blown reaction is
evident after about 2 days.
Poison Ivy Rash –What does it look
like?


The oil contained in the
plant leaves irritates the
skin.
The redness and blistering
from the rash is often
arranged in streaks or lines,
because the leaf brushes
across the body in a line as
an individual walks past.
Poison Ivy,Oak, Sumac:
itchy, itchy, itchy (continued)

Therapeutic management


The primary goal of treatment is to lessen the itch and prevent
secondary infection. Calamine lotion, baths in aveeno or baking soda
are helpful in relieving the itch. Oral benadryl can be used as well as
topical hydrocortisone. If the out break is extensive or if it is near the
eyes systemic steroids (i.e. prednisone) is often used.
Nursing considerations

Wash area immediately with cold running water to neutralize the
urushiol. Remove and wash all clothing that may have come in
contact with the plant.
Poison Ivy,Oak, Sumac:
itchy, itchy, itchy (continued)

Common myth

Poison ivy, oak, or sumac can not be spread from
person to person. There must be contact with the
urushiol oil before a contact dermatitis response
can occur. Contact can be directly from a plant,
from clothing, or perhaps from the fur of a
family pet who has been romping in the woods.
Test your knowledge
A mother calls the clinic nurse to ask advice regarding her child and
possible contact with poison ivy.
18. If the contact was in the last 15 minutes, which of the following
actions should be recommended?




A. Wash the child with dishwasher detergent
B. Flush the skin with cold running water
C. Have the child bathe in warm water
D. Have the child shower in hot water.
19. Clothing the child was wearing should be





A. Burned
B. Placed in a plastic bag and put out with the trash
C. Placed in the laundry hamper along with other clothes
D. Washed separately in hot water and detergent
Answers 18. B; 19. D
Sunburn:
Ochy,Ochy, Ochy

Prevention
 Sunscreen and
sunblocks. SPF 15
or greater. Avoid
mid day sun
exposure

Treatment

Involves stopping the
burning process, decreasing
the inflammation process,
and rehydrating the skin.
Cool tap water soaks or
immersion in a tepid water
bath for 20 minutes or until
the skin is cool. Apply
moisturizing lotion. Use
Tylenol for discomfort.
Atopic Dematitis:
Ou wee baby

What is it?


Also referred to as eczema.
It is a chronic inflammation
of the dermis and epidermis
which causes itching,
edema, papules, erythema,
excoriation, serous discharge
and crusting.
Who gets it?

* see page 580 in your
textbook for the different
age groups. There is often a
family history of eczema of
some other chronic allergy
related condition.
Atopic Dematitis:
Ou wee baby (continued)

Management

Basic skin care

Frequent baths but also apply moisturizing lotion
within three minutes after bath (while the skin is
still damp.
Atopic Dematitis:
Ou wee baby (continued)


Medications to relieve itch or secondary infection
 Topical steroids
 Oral antihistamines
 Antibiotics for secondary infection
Education, Education, Education!
 Parents must understand this is a chronic condition
that reoccurs. There is no one time fix. If they do not
understand this they will only be frustrated with the
medical system for not “curing” their child
Diaper Rash:
What are the causes


Caused by a prolonged and
repetitive contact with an irritant, i.e.
urine, feces, soap, detergents.
Wetness, increased skin Ph, and
fecal irritants all work together to
cause the rash.
Diaper Rash:
What is the treatment



Use zinc oxide paste to
help create a moisture
barrier so that the
irritated skin can heal
Clean the area very
gently
Use a cleanser only
after the infant has had
a bowel movement


Use nonirritating wipes
Use super-absorbent
diapers. Research has
shown that some
diapers with super
absorbency and
petroleum layers helps
reduce the incidence of
diaper rash