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
Chapter 16 Integumentary Disorders Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. Thrush (Oral Candidiasis) • Description – An infection of the mucous membranes of the mouth caused by the fungus Candida – Breastfeeding can transfer infection to mother’s nipples if good hygiene is not followed • Signs and symptoms – White patches that resemble milk curds are visible on the tongue, the inner lips, the gums, and the oral mucosa – Anorexia may be present due to discomfort – Infection can pass along mucous membranes into the GI tract, causing inflammation of esophagus and stomach Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-2 Thrush • Treatment and nursing care – Local application of antibiotic suspensions – Nystatin swish and swallow – Individual feeding equipment is necessary, and the equipment should be sterile – Effective handwashing is necessary to prevent reinfection from the mother – Prevention: mothers with Candida infection can be treated during the prenatal period Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-3 Diaper Dermatitis (Diaper Rash) • Inflammation caused by prolonged contact with an irritant such as urine or feces • Signs and symptoms – Red, irritated skin, accompanied by blistering – Beefy red rash is generally indicative of Candidiasis • Treatment and nursing care – Zinc oxide ointments as barriers – Vitamin A&D can help prevent diaper dermatitis Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-4 Atopic Dermatitis (Infantile Eczema) • Description – Inflammation of genetically hypersensitive skin to allergens • Signs and symptoms – Lesions form vesicles that weep and develop a dry crust – Worse in winter than summer, periods of temporary remission occur – Itching is constant, and lesions are easily infected • Treatment – Maintain skin integrity/hydration, decrease pruritus, identify and avoid triggers – Topical corticosteroids, immunosuppressants, antihistamines Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-5 Atopic Dermatitis • Nursing care – Patients may need to be restrained if they are scratching the affected area – use mittens – Medicated baths may be part of the treatment – Wet dressings are applied to reduce itching and in some cases to remove crusts – Infantile eczema is associated with development of asthma later in life Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-6 Impetigo • Description – An infectious disease of the skin caused by staphylococci or by group A beta-hemolytic streptococci – Two classifications: bullous and nonbullous • Signs and symptoms – The first symptoms of a nonbullous lesion are red papules; become small vesicles or pustules surrounded by redness – Bullous lesions are first seen as vesicles that become fluid-filled; eventually rupture, collapse, and leave a base with a peeling rim Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-7 Impetigo • Treatment and nursing care – Lesions may be cleaned 3 or 4 times a day with soap and water to remove crusts – Cleansing is followed by the application of topical antibiotic ointment – Oral antibiotics may also be given – Nurses should prevent this disease with proper aseptic methods Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-8 Staphylococcus aureus Infection • Description – Staphylococcus is a common bacteria that are found in dust and on the skin – Normally does not present a problem to healthy body defenses, but if the number of organisms increases in infants whose general resistance is low, skin infections may occur Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-9 Staphylococcus aureus Infection • Treatment and nursing care – Antibiotics effective against the particular strain are administered – Ointments may be applied locally – Washing hands before and after touching each patient and before and after handling equipment is essential Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-10 Several types of Staph infections Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-11 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-12 Cellulitis • Bacterial infection of skin and subcutaneous tissue • Caused by streptococcus, staphylococcus, or Haemophilus influenzae • Signs and symptoms – Edematous, tender red skin is warm to the touch – Can progress to abscess formation, fever – Septicemia may result • Treatment and nursing care – Oral antibiotics (parenteral antibiotics in extreme cases) – Warm, moist compresses – Handwashing is important Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-13 Pediculosis • Description of 3 types of pediculosis are – pediculosis capitis, or head lice; – pediculosis corporis, or body lice; – pediculosis pubis—“crabs”—or pubic lice – The adult attaches numerous eggs, known as nits, to the hair shafts approximately 1/8 inch from the scalp • Signs and symptoms – Severe itching of the scalp – The hair may become matted – Occasionally pustules and excoriations are seen about the face • Treatment and nursing care – Permethrin (Nix), pyrethrin shampoos, or lindane (Kwell) are used – Nits on the head are removed by combing the hair with a finetooth comb (dipped in vinegar) – Repeat in 3-7 days Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-14 Burns • Description – Categorized as thermal, radiation, electrical, or chemical – Severe burns cause fluid and electrolyte imbalances and can affect every body system – Infection, scarring, and functional disabilities are major complications of severe burns • Signs and symptoms – The burn wound is classified according to percentage of body surface involved, the depth and location of the injury, and association with other injuries Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-15 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-16 Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-17 Burns • Treatment and nursing care – ABCs • Oxygen is given, and O2 Sats monitored closely • An endotracheal tube is inserted if the child is in respiratory distress • An intravenous (IV) infusion is started, and fluid volume restoration is initiated • A Foley catheter is placed to monitor urine output Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-18 Burns • Treatment and nursing care (continued) – Wound management • Cool compresses/soothing lotions for superficial burns • Antimicrobial agent (i.e., bacitracin) for superficial partial-thickness burns expected to heal within 2 to 3 weeks • Silvadene is commonly used on partial- and fullthickness burns to prevent wound sepsis • Burn wounds may be treated as open (wound uncovered) or may be covered with a range of thin gauze to bulky gauze • Range-of-motion exercises, hydrotherapy, and débridement are used in treatment Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-19 Burns • Treatment and nursing care (continued) – Wound management (continued) • Skin grafts may be necessary in full-thickness burns where re-epithelialization does not take place • Allograft: Skin obtained from human cadavers – Autograft: Obtained from an undamaged area of the patient’s body – Infection prevention • Eschar (burned tissue) must be removed to prevent infection • Penicillin or erythromycin • Antibiotics are only ordered if infection occurs – Watch carefully for signs of infection Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-20 Burns • Treatment and nursing care (continued) – Pain control • Morphine sulfate -drug of choice for severely burned patients – Intravenously, PCA pump – Special attention should be given to respiratory rates when morphine is given – Acetaminophen/ codeine may be given for less severe pain – Nutritional management • The child may be on nothing by mouth (NPO) restriction for the first 24-48 hours if the burn is severe and bowel sounds are absent • The child requires a high-protein, high-calorie diet • Oral feedings are preferred, although it may be necessary to supplement with nasogastric feedings • Small, frequent feedings of favorite foods should be provided Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-21 Burns • Treatment and nursing care (continued) – Social and emotional issues • Families may be dealing with guilt, anger, grief, denial, and fear • Body image concerns become paramount for the older child as recovery progresses • Encourage the child to help with bathing, dressing change, feeding, and other self-care activities • Provide opportunities for family and child to talk about feelings and changes in body appearance Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-22 Acne Vulgaris • Description – An inflammation of the sebaceous glands and hair follicles in the skin • Signs and symptoms – A comedo is a plug of keratin, sebum, and bacteria • Open comedo, or blackhead—the surface is darkened by melanin • Closed comedones, or whiteheads—responsible for the inflammatory process of acne • Treatment and nursing care – A regular well-balanced diet is encouraged – Patients who are not taking tetracycline or vitamin A benefit from sunshine – General hygienic measures of cleanliness, rest, and avoidance of emotional stress may help prevent exacerbations Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-23 Acne Vulgaris • Treatment and nursing care (continued) – Over-the-counter benzoyl peroxide lotions or prescription-strength gels act to dry & peel the skin and suppress fatty acid growth – Change the pillow case frequently – Topical retinoic acid derivative (Retin-A) aids in the elimination of keratinous plugs – Tetracycline, doxycycline, or erythromycin may be given with topical medications in more serious cases – Accutane (13-cis-retinoic acid) is now being used for patients with severe pustulocystic acne (Must be on 2 forms of birth control) Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-24