1. Chapter 16 Integumentary Disorders
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2. 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
How may an infant come into contact with Candida?
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3. 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
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4. 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
Can also be caused by irritants in diapers or diaper wipes, or cloth diapers washed in harsh detergent.
Why is powder not recommended?
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5. 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
What causes lichenification?
Development of symptoms indicate that the infant is oversensitive to certain substances called allergens, which enter the body via the digestive tract (food), by inhalation (dust, pollen), by direct contact (wool, soap, strong sunlight), or by injections (insect bites, vaccines).
Because lesions are easily infected, young patients with eczema should not be exposed to adults with cold sores.
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6. 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
What is an “elimination” diet?
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7. Impetigo Description Signs and symptoms
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
The bullous form, seen primarily in infants, is usually caused by Staphylococcus aureus, whereas the nonbullous type can been seen in children of all ages and is caused by either staphylococci or streptococci.
What does nursing care of a child with impetigo primarily consist of?
Parents need instructions regarding mode of transmission, which is person-to-person, and preventive measures.
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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
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9. 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
What is septicemia or bacteremia?
Infection may spread easily from one infant to another in the newborn nursery.
Pustules must be reported and appropriate isolation precautions taken to prevent further exposure.
Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

10. 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
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11. Several types of Staph infections
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13. 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
Can occur from bug bites or trauma.
Can be associated with other conditions; i.e., otitis media.
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14. 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 fine-tooth comb (dipped in vinegar)
Repeat in 3-7 days
Which sex is more commonly affected by head lice? Why?
The parasite may be acquired from hats, combs, or hairbrushes.
It is easily transferred from one child to another and is seen most frequently in the school-age child and in preschool children who attend daycare centers.
Clothing or bedding is laundered in hot water.
Mattresses may be sprayed with a disinfectant.
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15. Burns Description Signs and symptoms
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
Burns are a leading cause of accidental death in children.
What is one common preventable burn?
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18. 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
The primary goal in the initial treatment of major burns is the maintenance of an airway and the prevention of shock.
When should airway obstruction be suspected?
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19. 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 full-thickness 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
Tetanus prophylaxis should be given if the child is not current in this immunization.
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20. 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
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21. 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 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
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22. 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
How can the nurse help the patient and family ventilate negative feelings?
Activities appropriate for the child’s age and condition should be provided.
Schooling needs should be met when the child is of school age.
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23. Acne Vulgaris Description Signs and symptoms
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
Why do the sebaceous follicles enlarge and secrete increased amounts of a fatty substance during puberty?
Acne is usually seen on the chin, the cheeks, and the forehead; it can also develop on the chest, upper back, and shoulders.
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24. 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)
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