Integumentary system Dr: SAHAR Anwar rizk

Anatomy and physiology : Dermis: consists largely of fibroblasts Sebaceous gland: are active at birth due to influence of maternal hormone 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 : Prevent the spread of infection & complication& isolate the child Careful hand washing before and after contact with the child Ask the child to don’t touch the lesion when awake 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: Warm compresses to increase circulation Cold compresses used to relive pain Immobilization is recommended for comfort and decrease edema

B-Fungal infection The body has several defense mechanisms: Nutritional status General health 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 Thrush: Creamy whit plaque on mucus membrane and lateral border of the tongue Lesion cover the oral cavity &cause mild discomfort Candidal diaper : 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: Oral nystatin 4-6 hrs interval &continue 48hrs after resolution of the symptom 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 worm of Ring scalp (Tinea Capital) worm of Ring of skin (Tinea corporis) worm of Ring of feet (Tinea pedis)

Tinea Capital 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 It is infestation of child with pediculi There are three types: Pediculosis Capital Pediculosis pubic : pubic in old, in eyelashes in young children Pediculosis corporis (body) Each type caused by different louse

Pediculosis capitis Incidence and Etiology : It is a head lice, it is common in children 3-10 years. The risk increase in girls ,at school age. It transmitted through head to head contact. 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 : Abdominal pain, distention Enlarged abdomen, anorexia, fever Diagnoses: egg can be detected by stool analysis

complication Intestinal obstruction, pneumonia, cough with blood stain, peritonitis. Transmission: Contact with contaminated stool 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 Good hand washing: After contact with infected child Bed linen, clothes, after toilet Keep the child nail short Treatment: mebedazole