Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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