Integumentary Dysfunction
Chapter 47 Integumentary Dysfunction All Elsevier items and derived
items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier
Inc. Skin Lesions Contact with injurious agents Hereditary
factors
External factor that produces a reactionin the skin (allergens)
Systemic disease in which lesions area manifestation (measles) All
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Inc., an imprint of Elsevier Inc. Examples of Age-Related Skin
Manifestations
Infants: birthmarks Early childhood: atopic dermatitis School-age
children: ringworm Adolescents: acne Anxiety may produce, modify or
prolong skin conditions All Elsevier items and derived items 2014,
2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Types of
Lesions Erythema Ecchymoses (bruises) Petechiae
Primary lesions Macules, papules, vesicles Secondary lesions
Distribution pattern Configuration and arrangement All Elsevier
items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an
imprint of Elsevier Inc. Wounds Structural or physiologic
disruption of the skin
Activates tissue repair responses Acute Heal uneventfully in 2-3
weeks Chronic Do not heal Associated with complications All
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Inc., an imprint of Elsevier Inc. Factors That Influence
Healing
Moist, crust-free environment Nutritional deficiencies Stress
Medications Infection Diseases Peripheral vascular disease All
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Inc., an imprint of Elsevier Inc. General Therapeutic Management of
Skin Lesions
Dressings Topical therapy Active ingredients Cost and instructions
for use Topical corticosteroids Systemic therapy All Elsevier items
and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint
of Elsevier Inc. Signs of Wound Infection
Increased erythema, especially beyond wound margins Edema Purulent
exudate Pain Increased temperature All Elsevier items and derived
items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier
Inc. Wound Care Basics Parents can generally manage wound care at
home
Wash wound with mild soap and water and rinse Avoid
povidone-iodine, alcohol, and hydrogen peroxide Cover open wound
Leave wide margin of intact skin around dressing Remove dressing if
leakage occurs; remove carefully Lacerations All Elsevier items and
derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of
Elsevier Inc. Relief of Symptoms Pruritus: most common complaint
with skin lesions
Cooling baths or compresses Prevent scratching Mittens/covering for
younger children Short nails Antipruritic medications All Elsevier
items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an
imprint of Elsevier Inc. Infection of the Skin Bacterial infections
Abscess formation
Severity: varies with skin integrity, immune and cellular defenses
Examples: impetigo contagiosa, pyoderma, cellulitis All Elsevier
items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an
imprint of Elsevier Inc. Infection of the Skin (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Infection of the Skin
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Viral Skin Infections Most
communicable diseases of childhood produce characteristic rash
Rubeola, rubella, and chickenpox Less common: verruca, herpes
simplex types I and II, varicella zoster, molluscum contagiosum All
Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Dermatophytosis (Fungal
Infection)
Superficial infections that live on the skin Ringworm: caused by a
group of filamentous fungi Transmission from person to person or
from infected animal to human Examples: tinea capitis, tinea
corporis, tinea pedis, candidiasis All Elsevier items and derived
items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier
Inc. Dermatophytosis (Fungal Infection) (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Systemic Mycotic (Fungal)
Infections
Invade viscera and skin Wide spectrum of disease May appear as
granulomatous ulcers, plaques, nodules, and abscesses All Elsevier
items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an
imprint of Elsevier Inc. Contact Dermatitis Inflammatory reaction
of skin to chemical
Initial reaction in the exposed region Characteristic sharp
delineation between inflamed and normal skin Primary irritant
Sensitizing agent Examples: diaper dermatitis, reaction to wool,
reaction to specific chemical All Elsevier items and derived items
2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Poison Ivy, Oak, and Sumac
Exposure to plants leads to localized lesions Lesions are caused by
urushiol from plants leaves and stems Sensitivity may develop after
one or two exposures and may change over time Urushiol penetrates
through the epidermis and bonds with the dermal layer All Elsevier
items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an
imprint of Elsevier Inc. Poison Ivy, Oak, and Sumac (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Drug Reactions Adverse drug
reactions are most often seen in skin (rashes are most common
reaction) Reactions may be immediate or delayed after
administration of drug Treatment: discontinue offending drug;
administer antihistamines, corticosteroid therapy if reaction is
very severe All Elsevier items and derived items 2014, 2010, 2006,
2002, Mosby, Inc., an imprint of Elsevier Inc. Foreign Bodies
Splinters of wood Cactus spines
Can be removed with needle and tweezers Cactus spines Can be
removed with glue or scotch tape May necessitate medical treatment
if difficult to see or remove Fish hook, pieces of glass All
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Inc., an imprint of Elsevier Inc. Arthropod Bites and Stings
Arthropods: most are harmless Seek medical attention immediately
for these exceptions: Scorpion bites Black widow/brown recluse
spider bites Bees: stinger penetrates skin Remove stinger as soon
as possible Sensitization to bee stings may result in anaphylaxis
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Arthropod Bites and Stings
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Scabies Caused by scabies mite as
female burrows into epidermis to deposit eggs and feces
Inflammation occurs days later Topical treatment includes
scabicides such as permethrin 5% or lindane Oral treatment includes
ivermectin if body weight >15 kg All Elsevier items and derived
items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier
Inc. Pediculosis Capitis (Head Lice)
Infestation of the scalp is common in school-age children Adult
louse lives only 48 hours without human host; female louse has
potential life span of 30 days Female lice lay eggs (nits) at base
of hair shaft Nits hatch in 7-10 days Treatment includes
pediculicides and removal of nits Prevent spread and recurrence All
Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Pediculosis Capitis (Head Lice)
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Infections Transmitted by
Arthropods
Rickettsiae: Rocky Mountain spotted fever transmitted by infected
fleas, ticks, and mites Lyme disease: most common tick-borne
disorder in United States Characteristic rash: confirms diagnosis
Focus: on prevention All Elsevier items and derived items 2014,
2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Infections Transmitted by Arthropods (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Bites from Pets and Wild
Animals
Common pediatric problem Majority of victims of dog bites: boys
between the ages of 5 and 9 years Wound care Prophylactic
antibiotics for some types of bites Rabies concern Prevention All
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Inc., an imprint of Elsevier Inc. Human Bites Lacerations from
teeth of other humans Risk of infection
Rough play During fights Child abuse Risk of infection Wound care
Tetanus toxoid All Elsevier items and derived items 2014, 2010,
2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Cat Scratch
Disease Most common cause of regional lymphadenitis
Follows the scratch or bite of an animal 99% of cases: a cat or
kitten Benign self-limiting disease Resolves in 2-4 months
Treatment is supportive, includes antibiotic therapy All Elsevier
items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an
imprint of Elsevier Inc. Diaper Dermatitis Pathophysiology Clinical
manifestations
Usually caused by irritation from urine and feces Detergents
inadequately rinsed from clothing Chemical irritation (especially
from diaper wipes) Clinical manifestations Include candidiasis of
diaper area Nursing considerations: alter wetness, pH, and fecal
irritants All Elsevier items and derived items 2014, 2010, 2006,
2002, Mosby, Inc., an imprint of Elsevier Inc. Diaper Dermatitis
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Diaper Dermatitis (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Atopic Dermatitis (Eczema)
A type of pruritic eczema that begins during infancy Hereditary
tendency Often associated with history of food allergies, allergic
rhinitis, and asthma All Elsevier items and derived items 2014,
2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Atopic
Dermatitis (Eczema) (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Types of Atopic Dermatitis
Three forms, based upon childs age Infantile eczema: begins at 2-6
months of age Childhood eczema: occurs at 2-3 years of age
Preadolescent and adolescent: occurs at 12 years of age to early
adulthood All Elsevier items and derived items 2014, 2010, 2006,
2002, Mosby, Inc., an imprint of Elsevier Inc. Therapeutic
Management of Atopic Dermatitis
Hydrate the skin Relieve pruritus Reduce inflammation
Prevent/control secondary infection All Elsevier items and derived
items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier
Inc. Seborrheic Dermatitis
Chronic, recurrent inflammatory reaction of the skin; cause unknown
Commonly occurs on scalp (cradle cap) Also seen on eyelids,
nasolabial folds, ears Treatment: remove crusts, use antiseborrheic
shampoo All Elsevier items and derived items 2014, 2010, 2006,
2002, Mosby, Inc., an imprint of Elsevier Inc. Acne Predominantly
in adolescents (50% of teenagers) Pathophysiology
Involves hair follicle and sebaceous glands Comedogenesis
Therapeutic management General measures/overall health Medications
(tretinoin) All Elsevier items and derived items 2014, 2010, 2006,
2002, Mosby, Inc., an imprint of Elsevier Inc. Acne (Cont.) All
Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Thermal Injury Burns Toddlers:
hot-water scalds
Older children: flame-related burns Child abuse Child playing with
matches or lighters: accounts for 1 per 10 house fires All Elsevier
items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an
imprint of Elsevier Inc. Characteristics of Burn Injury
Extent of injury described in terms of total body surface area:
age-related charts Depth of injury First-degree: superficial
Second-degree: partial thickness Third-degree: full thickness
Fourth-degree: full thickness and underlying tissue Severity of
injury All Elsevier items and derived items 2014, 2010, 2006, 2002,
Mosby, Inc., an imprint of Elsevier Inc. Characteristics of Burn
Injury (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Characteristics of Burn Injury
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Severity of Burn Injury
Major burn injury: treat in specialized burn center Moderate burn
injury: treat in hospital with expertise in burn treatment Minor
burn injury: treat in outpatient setting All Elsevier items and
derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of
Elsevier Inc. Type of Burn Injury Thermal agents Electrical
injuries Chemical burns
Flame, hot surfaces, hot liquids Electrical injuries Chemical burns
Inhalation or ingestion of toxic substances All Elsevier items and
derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of
Elsevier Inc. Pathophysiology of Burn Injuries
Systemic response involving capillary permeability Edema
Hypovolemia Anemia All Elsevier items and derived items 2014, 2010,
2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Complications
of Burn Injuries
Immediate threat of airway compromise Profound shock Infection
(local and systemic sepsis) Inhalation injuries, aspiration,
pulmonary edema, pulmonary embolus All Elsevier items and derived
items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier
Inc. Therapeutic Management of Burn Injuries
Emergency care priorities Stop burning process Assess childs
condition Cover burn to prevent contamination Transport child to
appropriate level of care Provide reassurance All Elsevier items
and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint
of Elsevier Inc. Therapeutic Management of Burn Injuries
(Cont.)
First priority: airway maintenance Fluid replacement therapy:
critical in first 24 hours Nutrition: enhanced metabolic demands
Medication: antibiotics, analgesics, anesthetics for procedural
pain All Elsevier items and derived items 2014, 2010, 2006, 2002,
Mosby, Inc., an imprint of Elsevier Inc. Wound Management Primary
excision Dbridement
Topical antimicrobial agents Biologic skin coverings Allograft
(human cadaver skin) Xenograft (porcine skin) Synthetic skin
substitutes Split-thickness skin grafts (sheet or mesh graft) All
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Inc., an imprint of Elsevier Inc. Wound Management (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Wound Management (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Wound Management (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Care of Minor Burns Wound
cleansing Dbridement Dressings
Removal of blisters (controversial) Dressings Covering wound with
antimicrobial ointment or use of occlusive dressings
(controversial) All Elsevier items and derived items 2014, 2010,
2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Burns:
Long-Term Care Begins once wound coverage has been achieved
Prevention/management of contractures Physical/occupational therapy
Multidisciplinary team Facilitate adaptation of child and family
Prevention of burn injuries All Elsevier items and derived items
2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Burns: Long-Term Care (Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Burns: Long-Term Care
(Cont.)
All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Sunburn Ultraviolet A waves
Ultraviolet B waves
Photosensitivity is an allergic reaction Ultraviolet B waves
Importance of protection: sunscreens Amount of ultraviolet exposure
influenced by numerous factors Time of day Altitudes, nearness to
the equator Snow, sand, and water All Elsevier items and derived
items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier
Inc. Cold Injury Chilblain Frostbite
Redness/swelling especially of hands when exposed Vasodilation,
edema, bluish patches, itching and burning; symptoms continue after
rewarming; usually resolve in a few days Frostbite Tissue damage is
caused by ice crystals in tissues Blisters appear hours after
rewarming Treatment of blisters is similar to burn treatment All
Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby,
Inc., an imprint of Elsevier Inc. Question The nurse is talking to
the parents of a child with pediculosis capitis. When explaining
how to manage pediculosis capitis, the nurse should state A. You
will need to cut the hair shorter if infestation and nits are
severe. B. You can distinguish viable from nonviable nits and
remove all viable ones. C. You can wash all nits out of hair with a
regular shampoo. D. You will need to remove nits with an extra-fine
tooth comb or tweezers. All Elsevier items and derived items 2014,
2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.