Download Integumentary system Dr: SAHAR Anwar rizk

Integumentary
system
Dr: SAHAR Anwar rizk
• Anatomy and physiology :
1. Dermis: consists largely of fibroblasts
2. Sebaceous gland: are active at birth
due to influence of maternal hormone
3. Apocrine glands: become functional
around 8-10 years
Skin disease in children may be due
to any of the following:
• Bacterial infection: as impetigo
contagiosa or cellulitis
• fungus: as Candida
• Skin Parasites: in scabies or
pediculoses
A-Bacterial infection: 1- (impetigo contagiosa)
• It is a highly contagious superficial skin
bacterial disease (staphylococcus aureus,
bacteria hemolytic streptococci)
• IT characterized by localized inflammation and
infection in epidermis
• There is two major disease cause impetigo
1-characterized by crusted lesion
2-characterized by fragile bulla( brown shriner)
Incidence and Etiology
• It is more prevalent during mid to
late summer& humid climate
• Peak incidence among children 2-6
years,
• Causes :
• poor sanitation
• It most commonly spread by direct
contact
Clinical manifestations
• Lesion that begin as small red macules and
progress to small, thin vesicles or pustules
that rupture easily and exposed weeping
.The crusts fall &no traces.
• Systemic symptoms such as : weakness,
fever & diarrhea
• It appear in the face, around the mouth
• Pruritus is associated with child scratches
Treatment and Nursing
Management
• Eliminating the causative organism:
1- By topical antibiotic therapy in case of
few lesions
2-If lesion wide spread or don’t respond,
administer oral systematic antibiotics.
3-Nursing Assessment :
Observe for presence of high temp,
respiratory rate, heart rate, dermatitis,
lymphadenopathy .
• Teach the care giver to :
1. Prevent the spread of infection &
complication& isolate the child
2. Careful hand washing before and after
contact with the child
3. Ask the child to don’t touch the lesion
when awake
4. Use comfort measure :
-such as genital soaking & remove the
crust with warm soapy water.
-Keep the child nail cut short
2-Cellulitis
• Cellulites : is a bacterial infection involving the
dermis and subcutaneous gland
• Incidence and Etiology:
-occur at any age
-1-2 days following trauma that disrupt the skin
-Streptococcus pyogenes &staphylococcus
-children with cellulites of head have incident of
trauma
Path physiology :bacteria inter the skin ,
after minor trauma
infection in connective tissue
Clinical manifestation
• Erythema, swelling, warmth, and pain
• Lymphangitis , lymphadenopathy,
• Systemic symptoms as: fever, chills,
malaise
• Child with facial erythema due to
influenza type B are at risk for
meningitis
Treatment& Nursing
management
•
•
Systemic antibiotic
Hospitalization in case of febrile &
acutely ill & use IV antibiotic
• COMFORT Measure:
1. Warm compresses to increase circulation
2. Cold compresses used to relive pain
•
Immobilization is recommended for
comfort and decrease edema
B-Fungal infection
• The body has several defense
mechanisms:
1. Nutritional status
2. General health
3. Skin properties: as PH, Rate of
epithelial turn over inhibit fungal
infection
1-Candidiases
• Candidiases & moniliases are the most
common type of infection
• Candida albicance a commensally fungal
of the mouth & gastroenteritis
• It exist in 2 form yeast and spore
• Incidence and Etiology:
• Incidence of thrush in infant 2-4%
candidiasis
Candidia diaper
• Etiology :
A-Causes related to child :Alteration in immune
system & from vaginal canal& bottle nipple
• Use of antibiotic therapy &endocrine disease &
immunosuppressive therapy
• Child with anemia &asthma (corticosteroid)
B-Causes related to diaper:
• have macerated mucous membrane
• Improper use of diaper
• Wear of nylon
Clinical manifestation
1. Thrush:
2. Creamy whit plaque on mucus membrane and
lateral border of the tongue
3. Lesion cover the oral cavity &cause mild
discomfort
Candidal diaper :
1. Acute onset of erythema begin in perineal
area
•
erythematous skin occur in apposed surface
as axillae
Treatment& Nursing
management
Candidal diaper:
• change diaper as soon as soiled
• Avoid over washing the skin
• Apply ointment as Zink oxide nystatine
cream & or 1%hydrocortisone
• keep the area dry and exposed to air
Thrush:
1. Oral nystatin 4-6 hrs interval &continue 48hrs
after resolution of the symptom
2. nystatin cream to nipple with Candida
2- tinea
• Definition:
It is a superficial fungus infection of
the skin. It is highly contagious
• Classification: according to part
affected
1. worm of Ring scalp (Tinea Capital)
2. worm of Ring of skin (Tinea corporis)
3. worm of Ring of feet (Tinea pedis)
Tinea Capital
•
•
•
1.
2.
3.
4.
5.
It is the most common dermal infection children &
occur frequently at school age
It transmitted more often from contact with fomites
than direct contact
Clinical manifestation:
Lesion inform of circular patch about 2inch in
diameter with or without alopecia
Alopecia are demarcated with or without erythema
Skin become scaly & black dotes result from broken
hair
crusting, pustules ,and lymphadenopathy
Kerions ,are moist, boggy, scalp nodule
Tinea capital
Treatment& Nursing
management
• Oral administration of grisefofulvin +the
use of shampoos containing 1%selenium
sulfide help to limit the spread of spores.
• Terbinafine & fluconazole help in short
treatment
• Head should covered with skull cap that
must be washed daily
• All object that have come into contact
with the infected child must clean
thoroughly.
Infestation
A-scabies :
-caused by scabies mite
-it transmitted from person to person
- Incubation period 2-6 week during this
period the infection can transmitted
-Parasite burrows itself in the skin for
depositing egg
Clinical Manifestation
• Parts that involved are moist, wet skin
i.e, axilla, between fingers, toes, around
umbilicus, genitalia.
• Lesions appear as dark blue lines
indicating the path used by the itch mite
to burrow itself& color due to fecal
deposition
• Sever itching
• in second infection ,papules, vesicles,
pustules occur
Treatment& Nursing
management
• Permethrin or preparation contain
DDT as benzyle
• The child should bathe in tepid water
the skin dry, the scabicide applied
• Attention should given to folded area
• Then child put in clean clothes
• All child clothes and bedding should
be washed in hot water and dried in
a hot dryer
• Cut the nail &prevent the scratch.
pediculosis
•
•
1.
2.
It is infestation of child with pediculi
There are three types:
Pediculosis Capital
Pediculosis pubic : pubic in old, in
eyelashes in young children
3. Pediculosis corporis (body)
Each type caused by different louse
Pediculosis
capitis
• Incidence and Etiology :
1. It is a head lice, it is common in
children 3-10 years.
2. The risk increase in girls ,at school
age.
3. It transmitted through head to head
contact.
4. The classroom considered as a
primary source of infestation.
Path physiology
• Head lice can crawl quickly on dry
hair. The female lives on scalp and lay
4-10 egg, it attached to end of hair
(nit), water insoluble substance holds
the nits to hair
Treatment& Nursing
management
• Use of pediculocides to remove the nit
• A solution of 1% permethrin for killing
pediculosis
• Combing hair with fine toothcomb dipped
in hot
• Antibiotics if pustules appear in neck
• Clothes and head cover should cleaned
boiled and dried
Clinical Manifestation
• Persistent itching , pruritus in the
occipital area.
• Persistent scratching result in excoriation
& secondary infection.
• Enlargement of posterior cervical gland
Intestinal parasite
•
1-Ascariases:
•
Etiology: Ascariases lumbricoides
• Clinical manifestation :
1. Abdominal pain, distention
2. Enlarged abdomen, anorexia, fever
•
Diagnoses: egg can be detected by stool
analysis
complication
• Intestinal obstruction, pneumonia,
cough with blood stain, peritonitis.
• Transmission:
1. Contact with contaminated stool
2. Food can be contaminated when
feces used as fertilizer.
incidence
• Most common in warm climate
• Poor sanitary area, in children 1-4 year
• Incubation: 4-8 week
• Control: -sanitary disposal of feces
-treatment of feces before using as
a fertilizer
-vegetables must thoroughly cooked
or soaked in diluted iodine
• Treatment: mebedazole
2-pinworm(enterobius)
• It is a nocturnal and itching sleeplessness.
Diagnoses :direct visualization of worm
Complication: move of worm to appendix,
female genital tract, peritoneal
cavity
Transmission: fecal- oral, ingestion or inhalation of egg
egg contaminated any thing as toys.
Incidence: most common in preschool and school child ,in
crowded place
Incubation:1-2 months
control
•
1.
2.
•
Good hand washing:
After contact with infected child
Bed linen, clothes, after toilet
Keep the child nail short
Treatment:
mebedazole