Download Powerpoint Integumentary

Skin Disorders
Marlene Meador RN, MSN, CNE
Compare skin differences
 Infant: skin not mature at birth
 Adolescence: sebaceous glands become
enlarged & active.
Topical Medications
 Infants & <2 years-Topical medications
should not be used without a physician’s
order (due to greater absorption through
skin and larger skin to body mass ratio)
 Iga does not reach adult levels until 2 to 5
years of age. Infants less resistant to
organisms.
Skin Assessment
 Assess history
 Assess exposure
 Assess character
 Assess sensation
Impetigo
Hemolytic Strept infection of the skin
Incubation period is 7-10 days after contact
 Begins as a reddish macular rash,
commonly seen on face/extremities
 Progresses to papular and vesicular
rash that oozes and forms a moist,
honey colored crust. Pruritis of skin
 Common in 2-5 year age group
Therapeutic Management
 Apply moist soaks of Burrow’s
solution
 Antibiotic therapy- both topical
and systemic
 Patient education
Key Nursing Care
Prevent secondary glomerulonephritis
 Stress teaching to parents:

 Soak prior to applying topical antibiotic
 Keep child away from anyone <2 years of age
 Prevent scratching lesions (spreading)
 Keep toys, towels, linens, clothing separate
 Clean personal items with bleach solution
 May return to public 24 hours after start of antibiotic
treatment
Cellulitis
Cellulitis
 Causative organisms- most commonly
group A streptococci and S. aureus
 Priority Nursing Interventions:
 Antibiotic therapy (pt/family teaching)
 Warm compresses (why?)
 Control of fever and pain
 Monitor for sepsis
Candiditis- Thrush
Overgrowth of Candida albicans
Acquired through delivery
Assessment
 Inspect mouth
 Assess for difficulty eating
 Assess diaper area
Therapeutic Interventions
 Medication
 Oral- for thrush-nystatin suspension or
fluconazole
 Clotrimazole topically for diaper area
 Nursing Care
 Sequence of medication and feeding
 Treatment of mother if breastfeeding
 Care of bottles/nipples and pacifiers
Dermatophytosis (Ringworm)
 Tinea Capitis
 Transmission:
 Person-to-person
 Animal-to-person
S&S:
 Scaly, circumscribed patches to
patchy, gray scaling areas of alopecia.
 Pruritic
 Generally asymptomatic, but severe,
deep inflammatory reaction may
appear as boggy, encrusted lesions
(kerions)
(
http://www.ecureme.com/quicksearch_reference.asp
Diagnosis
Potassium hydroxide
examination
Black Light
Medication Therapy
 Oral- systemic- grieseofulvin daily for
at least 6 weeks (insoluble in watertake with high-fat meal or with milk
products)
 Topical-alone not effective for tinea
capitis:
 Clotrimazole (Lotrimin®)
 Miconazole (Monistat®)
Patient Teaching
 transmitted by clothing, bedding,
combs and animals
 may take 1-3 months to heal
completely, even with treatment
 Child doesn't return to school until
lesions dry
Other Tinea Infections
 Tinea Corporis- ringworm not located
on the scalp (local topical treatment
usually effective)
 Tinea Crusis- (athletes get this)
similar to corporis, treated topically
 Tinea Pedis (any guess what this is?)
Herpes Simplex Virus
Herpes Simplex
 Priority nursing interventions:
 Prevent secondary infections
 Maintain adequate nutrition (if oral
outbreak)
 Prevent spread to others
 Universal precautions
 Isolation from susceptible individuals
What should the nurse report?
“Child sexual abuse should
be considered in any child
with a genital herpes
infection.”
Pediculosis Capitis (lice or cooties!)

http://www.emedicine.com/emerg/topic409.htm
 a parasitic skin disorder caused by lice
 the lice lay eggs which look like white flecks,
attached firmly to base of the hair shaft, causing
intense pruritus
Diagnosis
 Direct identification of egg (nits)
 Direct identification of live insects
Medication Therapy
 treatment: shampoos RID, NIX, Kwell(or Lindane)
shampoo: is applied to wet hair to form a lather and
rubbed in for at least amount of time recommended,
followed by combing with a fine-tooth comb to
remove any remaining nits.
 Patient teaching
 Follow directions of pediculocide shampoos
 Comb hair with fine-toothed comb to remove nits
 Transmission, prevention, and eradication of
infestation
Scabies
http://www.nlm.nih.gov/medlineplus/scabies.html
Sarcoptes scabei mite. Females are 0.3 to 0.4 mm
long and 0.25 to 0.35 mm wide. Males are
slightly more than half that size.
 a parasitic skin disorder (stratum corneum- not living
tissue) caused by a female mite.
 The mite burrows into the skin depositing eggs and fecal
material; between fingers, toes, palms, axillae
 pruritic & grayish-brown, thread-like lesion
http://www.aad.org/pamphlets_spanish/sarna.html
Scabies between thumb and index finger
On foot
Therapeutic Interventions
 transmitted by clothing, towels, close contact
 Diagnosis confirmed by demonstration from skin
scrapings.
 treatment: application of scabicide cream which
is left on for a specific number of hours (4 to
14)to kill mite
 rash and itch will continue until stratum
corneum is replace (2-3 weeks)
Care:
Fresh laundered linen and
underclothing should be used.
Contacts should be reduced
until treatment is completed.
Treat all members of the family
Contact Dermatitis
Atopic –vs- Contact Dermatitis
 Atopic/Eczema
 Contact Dermatitis-
 Genetic family hx
skin inflammation from
skin-to-irritiant contact
 Develop asthma or
 Soaps/detergents
allergic rhinitis later
 Symptoms begin age 1
to 4 months
 Clothing dyes
 Cause unknown
 Lotions, cosmetics
 Urine ammonia
Assessment & Diagnosis
 Infants- Papulovesicular rash and scaly red plaques
(may resemble impetigo)
 Extremely pruitic and dry skin
 Childhood- increases with emotional upset,
sweating, irritating fabrics
 Other triggers- milk, eggs, wheat, soy, peanuts, fish
Interventions & Nursing Care
 Prevent secondary infection- control
itching
 Moisturize skin
 Remove irritants
 Medication
 Parent teaching- long term
Acne
http://www.pathology.iupui.edu/drhood/acne.html
ACNE
Assessment
Closed lesions
Open lesions
Inflamed lesions
Medication Therapy:
 Topical- need to reduce bacteria on skin
 Benzoyl peroxide
 Tretinoin (Retin-A)-avoid exposure to sun
 Oral- antibiotics
 Tetracycline, minocycline, erythromycin
 Isstretinoin (Accutane-no longer available)
 Dietary
 Hygiene
Therapeutic Management
 Goal- to prevent scaring and promote
positive self image in the adolescent
 Individualized according to the severity of
the condition
 3 to 5 months required for optimal results
(4 to 6 weeks for initial improvement)
Nursing Implications
 Provide information regarding the
treatment regimen (don’t forget side
effects of antibiotic therapy and
relationship to oral birth control)
 Provide support and promote positive self
image
 Provide accurate information on the length
of time required for effective treatment
Thank you,
Please contact
Marlene Meador RN, MSN, CNE
if you have questions or concerns
regarding this lecture content.
>^,,^<
[email protected]