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 How may an infant come into contact with Candida? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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.

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? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 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.

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.

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.

Several types of Staph infections Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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? Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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.

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.

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. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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. Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

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.