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Skin Integrity (Peds)

Terms in this set (79)

Functions of the Integument System
- protection
- sensitivity
- insulation
- excretion
- synthesis Vitamin D
Epidermis
- the outermost layer
- thin layer that sheds repeatedly
- contains melanocytes
Dermis
- middle layer
- mostly connective tissue which helps skin to stretch and contract
- contains hair follicles, nerves, muscles, sweat & sebaceous glands, blood vessels, and lymph channels
Subcutaneous Layer
fatty layer which helps to connect dermis to muscle and insulate
Sebacious Glands
help lubricate the skin by secreting sebum (lipid substance) directly onto the skin or into the hair follicles
Eccrine Sweat Glands
These open into the skin surface. Responsible for releasing odorless sweat when the body temp rises
Apocrine Sweat Glands
Glands found mostly in axillary and genital region. Secretions contain more lipids and proteins than the eccrine gland secretions which causes "body odor"
Infant
- 40-60% thinner than adults: can cause tearing with minimal friction and makes it harder to regulate temp
- sebacious glands and eccine glands are functional at lower rate
- aprocrine do NOT funtion
decreased amount of melanin
Adolescent
- skin thickens to full thickness: therefore less likely to have injury with minimal friction
- eccrine glands fully functional
- after puberty males sweat more
- apocrine glands are fully functional after puberty
- melanin is now at adult levels providing full skin color and protection against UV light
Temperature (abnormalities)
- skin should be warm to touch
- an increase may indicate fever or inflammation
- decrease in temperature may indicate shock or prolonged cold exposure
Texture (abnormalities)
skin should be smooth, soft, and dry when palpated

abnormalities:
- roughness
- indurations (areas of thickness with distinct border)
- lesions
- abnormal skin color
- dampness (clammy )
Turgor (abnormalities)
skin should be elastic and mobile and show immediate recoil after pinching up

abnormal: tent or slowly return to baseline
Primary Lesion
arise from previously healthy skin and are often the first to response to injury or infection

freckles and beauty spots
Secondary lesions
arise from changes in primary lesions
Macules
flat (non-palpable) pigmented lesion

petachae and purpura
Patch
macule greater than 1 cm
Papule
raised and firm lesion (may or may not be pigmented)
Wheal
irregular raise solid area of inflammation (will blanch)
Vesicle
raised fluid region
Pustule
purulent filled vesicle
Bulla
vesicle larger than 1 cm
Secondary Lesions (examples)
- burrow
- comedone
- crusting
- erosion
- excoration
- fissure
- keloid
- lichenification
- scale
- scar
- ulcer
- telangiectasia
Lesion Patterns
- linear
- annular
- herpetiform
- reticulated
Linear
row or stripe
Annular
ring shaped with central clearing

- ringworm
Herpetiform
clustered or grouped
Reticulated
networked or lacelike

- 5ths disease
Diaper Dermatitis
- primary contact reaction to urine, feces and/or moisture
- raw, moist and or weeping macules and papules of skin with direct contact to diaper
- skin folds are NOT affected
Diaper Dermatitis
(treatment and education)
Tx: topical barrier creams (desitin, aquaphor)

Educate parents to change diapers at least q2h, try diaper free times to help air out, use alcohol free wipes or just damp soft rag
Diaper Candidiasis
- Secondary infection d/t Candida albicans
- typically main cause of severe diaper rash
beefy red plaques, and satellite lesions
- skinfolds typically AFFECTED
- Tx: antifungal cream
Seborrheic Dermatitis (Cradle Cap)
- recurrent inflammation thought to be d/t overgrowth of yeast
- mild eryethematous, waxy, scaling, yellow and red patches with greasy scaling
- can be in eyebrow area
- 0-3 months of age and adolescence
Cradle Cap Tx
- daily washing of hair with baby shampoo, and can use soft baby hairbrush or soft toothbrush to loosen the plaques
adolescents may use shampoos with selenium (head and shoulders)
Contact Dermatitis
- inflammation of the skin secondary to direct contact with an irritant or allergen
- caused by TOPICAL irritants and allergens
- can be mild erythematous areas to painful pruritic red swollen areas
- can include vesicles with exudeate if contact continues
Contact Dermatitis Tx
- removal and avoidance of trigger
- oatmeal baths and lotions
- antihistamines
- topical/oral corticosteroids if severe
Atopic Dermatitis (eczema)
- effects 20% of infants, children, and teens
- 60% develop within the first year of life
- very pruritic, erythematous, papulovesicular lesions with exudate, crusting, and bleeding
- can be worsened by both allergic and non-allergic triggers
- can be very disruptive of sleep d/t severe pruritis
Eczema Dx
Dx will include a pruritic rash and 3 of the following:
- Hx of flexural dermatitis
- Hx of respiratory allergic condition in first degree relative
- Hx of dry skin in last 1 year
- rash before age 2
- visible rash on cheeks, forehead, flexoral, or extensor areas in infant
Eczema Management (non-pharmacological)
- educate parents there is NO cure and the rash will reoccur
- #1 priority: keep skin hydrated and well-lubricated at all times
- avoid hot baths and avoid daily baths (bathe every other day to q3days)
- avoid soaps, lotions, detergents that smell pretty or look pretty (dyes, perfumes)
- apply emollient/barrier creams to damp skin after baths
Eczema Management (pharmacological)
- topical corticosteroids can be given for mind-severe flares
- oral corticosteroids should be used sparingly for severe flare-ups
- oral antihstamines can be given for pruritis as well as sedative for nighttime scratching
- if secondary infection occurs can use topical and/or oral antibiotics
- allergy skin testing can be performed to determine possible food and/or environmental allergens
- avoidance is key
Impetigo
- most common bacterial skin infection in children
- highly contagious
causes characteristic Honey-Colored Crusts
- caused by staph aureus and or group a hemolytic strep
- most common with infants and up to age 5
Impetigo Tx and Education
Tx:
- mild infections: topical antibiotics
- more severe or larger areas: oral antibiotics

Educate parents:
keep lesions as clean as possible; hand hygiene for everyone; no sharing clothes/towels
Foliculitis
- superficial inflammation of hair follicles d/t infection, trauma, or irritation
- typically d/t staph aureus
- tiny dome shaped yellow and red pustules
- found in clusters
- associated with pruritus, pain, and localized swelling
Foliculitis Tx and Education
Tx: includes washing areas with topical antibacterial cleanser

Educate: shower daily and immediately after exercise
Molluscum Contagiosum
- caused by pox virus
- spread by direct skin contact (including sexual contact) and contact with contaminated clothing/towels
- pear like or flesh colored papules 1-5 mm in size
- painless
- lesions will be umbilicated and can develop white cheesy white discharge
- found on trunk within 6 months by can reoccur for 2-4 years
Molluscum Contagiosum Tx and Education
Tx:
no treatment typically necessary
secondary infection d/t excoriation: oral/topical antibiotics
severe infection: cyotherpay or canthardin

Educate: importance of decreasing transmission
Oral Candidiasis (Thrush)
- most common in newborns, children using inhaled corticosteroids, strong or repeat oral antibiotic use
- white plaques on oral mucosa (cannot be scratched off), can bleed with attempts to remove
Thrush Tx and Education
Tx: oral nystatin
Education: proper use of corticosteroid inhalers
Dermatophytoses
- tinea is a fungal infection that can affect all 3 main parts of the integument system (hair, skin, nails)
- can be spread person to person animal to person, and d/t contact with contaminated objects such as clothing
- head, mid-arm, genital area, feet
Dermatophytoses Tx
topical anti-fungals and in more severe cases oral anti-fungals
Pediculosis Capitis (Lice)
- most common in ages 3-12
- ALL socioeconomic populations are affected
- African-American population rarely affected
Lice: Spread and Tx
Spread:
direct hair to hair contact or hair contact with contaminated objects (towel, brush, hats)

Tx:
Pediculicide shampoo (pyrethrin) and/or ovicidal rinse shampoo (Nix-permethrin)
- should be applied X 10min rinsed then nits removed by comb
What are nits?
- wingless clear/yellow/brown insect about the size of a sesame seed
- nits are silvery/white. yellow or darker and about 1 mm in size
- females can lay up to 10 nits (eggs) a day
Scabies
- highly contagious and highly pruritic
- cause erythematous burrows, linear pustules and papules mostly found on hands and feed (especially webbing of digits
Scabies: Spread and Tx
Spread:
skin to skin contact and contact with contaminated objects (sheets, towels)

Tx:
Permetrin Cream
Acne Vulgaris
- most common skin disorder in pediatric population
- affects 85% of children 12-25
- infants can develop acne during 1st month, typically resolves within 1-3 months
- affects all ethnicities and both male and females; although severe acne is more common in males
- caused when increased hromones increase sebum production resulting in obstruction of follicle canals with comedones
Acne Lesions
- closed comedone
- open comedone
- nodules
- cysts
Closed comedone
whiteheads
Open comedone
blackheads
Nodules
inflammation of several hair follicles
Cysts
compressible nodules without overlying inflammation
Mild Acne Dx
non-inflammatory comedones
Moderate Acne Dx
inflammatory comedones, papules, and pustules
Moderate/Severe Dx
inflammatory, numerous papules, localized cysts OR nodules, face, ches, and back involvement
Severe Acne Dx
nodular AND cystic acne on face, back, and chest; numerous cystic lesions and pustules may be present
Acne Tx: Education
- daily hygiene (remind family improvement can take up to 8 weeks after any acne treatment begins)
- sweating, heat, humidity, and emotional stress may cause worsening in flare-ups even w/ treatment
- misconceptions: NO foods have been identified as a cause but any skin injury requires good nutrition to aid in healing
Acne Tx: Medication
- topical medications: topical anitbiotics, benzoyl peroxide, azelaic acid, and retinoid
- oral medications: antibiotics, oral contraceptives, and sprironolactone
- Isotretinoin (Acutane): used as last resort due to major side effects
Burns Stats
- burns are 1 or the top 5 leading causes of injury-related deaths among children 1-14
- 10-25% of all burns in children are due to abuse
Burn Types
- thermal
- chemical
- electrical
- radiation
Thermal Burns
exposure to flames, scalds, or hot objects (stove)
Chemical Burns
touching or ingestion of caustic agent
Electrical Burns
when direct current from high voltage wires, electrical wires, or appliances pass through the issue
Radiation Burns
exposure to radioactive substance or sunlight
First-degree Burns
- affect only the outer layer of the skin
- cause pain, redness, and swelling
Second-degree Burns
(partial thickness)
- affect both the outer and underlying layer of skin
- cause pain, redness, swelling, and blistering
Third-degree Burns
(full thickness)
- extend into deeper tissues
- cause white or blackened, charred skin that may be numb
Nursing Management of Burns
- fluid replacement/balance
- support both emotional and nutritional
- pain management
- wound care
Urticaria (Hives)
- lesions are erythematous, raised wheals, that are pruritic and evanescent (move from place to place)
- lesions should blanch
- most episodes in children are acute in nature and are found to be d/t a viral infection
Chronic Urticara
classified as hive episodes that last or reoccur longer than 6 weeks
Hives Common Triggers
- food
- medications
- insect bites
- latex
- less common-exercise, cold, pressure, heat, sun
- viruses
- animal dander and other environmental allergens
Hives Tx
- avoid any known triggers
- oral antihistamines
- oral corticosteroids
- avoid hot baths
- may require allergen skin testing and evaluation
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