Pediatric Integumentary Disorders

Front 1

 Skin Anatomy Children

Back 1

 Thinner epidermis
-heat loss
-absorption of substances (sunscreen, bug spray, etc)
 Higher water content
-blisters are more likely
 Less pigmented
-sunburn, skin damage
 Sebaceous glands – increase activity in adolescent years (acne)
-Eccrine glands – temperature regulation, not fully developed
-Apocrine glands – body oil, not fully developed

Front 2

 Ethnic Variations
Dark skinned Children

Back 2

 Pronounced skin reactions
-hyper or hypo pigmentation
-lichenification (rough, dry appearance), vesicular and bullous formation
 Scarring and keloid formation

Front 3

 Subjective Data
Integumentary Health History

Back 3

 History of present illness
-onset, location, characteristics, relief, discharge
-general health state
- chronic skin or medical conditions
family or child
- immunizations – 7-21 days after
-family circumstances: pets, outdoor play
-skin care and products used

Front 4

 Integumentary Health promotion

Back 4

Sun protection
 <6 months no exposure to direct sunlight
- sunscreen to exposed areas
 No exposure 10 A-4P sand, concrete, water
 Sunscreen >6 months with SPF 15 (recommended amount because you are more likely to keep reapplying)
amount used (1 ounce for an adult)
eye protection
hat with brim 50%
sunglasses 99%

Front 5

Integumentary
 Objective data
Assessment findings
 Inspection

Back 5

Lesions, location and description
linear or round
macular (flat) or popular (raised) – typically less than 1 cm
vesicular (clear fluid) or pustular (colored, not clear fluid)
wound depth

Front 6

Integumentary  Bacterial infections

Back 6

 -Impetigo
bullous and non bullous
 -Cellulitis
deep local infection
trauma to skin
systemic
 Folliculitis
infection of hair follicle

Front 7

 Impetigo
Nursing management

Back 7

 Characteristics
 Impetigo
papules to vesicles to pustules to crust
Flora
staphylococci , streptococci
 Nursing Management
 Treatment of infection
-antibiotics – crust must be removed so antibiotics can work
-soak
-no squeezing puncturing
 Prevention of infection
hand washing, fingernails
clothing, towels

Front 8

Integumentary  Viral infections

Back 8

 Epidermal cells react with
inflammatory reaction
vesiculation
 Specific nursing care related to the virus and skin manifestations

Front 9

Integumentary Fungal Infections

Back 9

 Superficial infection that live on skin
 Tinea + related body part
tinea corporis, capitis (head), pedis (foot), cruris (jock itch)

 Fungal infections
Nursing considerations
 Drug therapy
 -Topical – usually at least 4-6 weeks of treatment, hard for parents to follow
continue through symptom improvement
2 weeks, 1 inch beyond
oral
 -Oral with high fat foods
Side effects: headache, GI upset, fatigue, insomnia, photosensitivity (give at night)
Liver, renal effects

Front 10

 Diaper Dermatitis
Nursing Considerations Home care

Back 10

 Superabsorbent diaper
decrease wetness
maintains pH
mix of feces and urine
 Diaper changes
 Drying skin air*
 Skin barrier cream
 Cornstarch vs. talc (recommend not to use talc, cornstarch is better)
 Steroid creams controversial due to high absorbency of skin
 Fungal infection nystatin cream
 Satellite lesions indicate fungal infection

Front 11

 Atopic dermatitis

Back 11

 Chronic disorder
extreme itching
skin inflamed, red, swollen skin
10% of population
infants thru adolescent
 Family history in 75%
 Almost always shows up in childhood before adulthood
 Response to specific allergens
foods
environment
temperature/humidity

Front 12

 Atopic dermatitis
Pathophysiology

Back 12

 Trigger antigen > inflammatory process>
itch > causes rash to appear > itching
 Itch causes rash which causes more itching

Front 13

 Atopic dermatitis
Nursing assessment
 -Health History
 -Physical examination

Back 13

 Wiggling or scratching – even infants can scratch
Rash
Disrupted sleep, Irritability
Perception, stress
 Family/child history
rhinitis, asthma, food
 -Physical examination
 Inspection
Skin changes
Flexor, extensor
 Auscultation
wheezing
 Lab testing
serum IgE, skin prick

Front 14

 Atopic dermatitis
Medical Management
 -Therapeutic goals
 -Management

Back 14

 -Therapeutic goals
 Hydrate the skin
 Relieve pruritis
 Reduce reoccurrences
 Prevent infection
 -Management
 Bathing water temperature (normal temperature)
length in tub (too long will dehydrate skin), frequency (twice a day)
 Soaps, none, mild
 Lotions timing right after bath (unscented)
 Medications
antihistamines
sedating, non sedating
topical steroids
immune modulators

Front 15

 Atopic dermatitis
Nursing interventions
 -Management
 -Prevention

Back 15

 -Management
 Fingernails
 Clothing, laundering, wools (highly allergenic)
 Wet soaks
 Medications
side effects, application
 Allergies
diet modification
environment allergies
 -Prevention
 Identify at risk children
family history
 Food initiation guidelines
breast milk only
solid food introduction
one new food 5-7 days
Allergy foods 12-18 months
 Altered family processes
-appearance, parental guilt
-time and economic management

Front 16

 -Acne Vulgaris
 Acne
 -Infantile

Back 16

 -Infantile
 Maternal hormone
20% of newborns
 Appears between 2-4 weeks
 Lasts up to 4-6 months Nursing Care
Wash daily clear water
Reassurance
 -Acne Vulgaris
 Most children affected
Males>females
 Begin between 7-10 years
Peak 15-18 years
 Face, chest and back

Front 17

 Acne vulgaris
Pathophysiology

Back 17

 Excess sebum production which clogs follicles that open onto skin
Causes bacterial growth P (roprionibacterium)
and inflammation to nearby tissue

Front 18

 Acne vulgaris
Nursing Assessment
 -Health history
 -Physical Examination

Back 18

 -Health history
 History of acne child and family
 Medication use
corticosteroids, androgens, lithium, phenytoin and isoniazid
 Premenstrual flares
 Perception and emotional distress
 -Physical Examination
 Inspection for acne and scarring; face, upper back and chest
 Oily skin and hair
 Adolescents response – can cause depression

Front 19

Acne Vulgaris
Medical management
 -Therapeutic goals
 -Management

Back 19

 -Therapeutic goals
 Reduction of causes
-bacteria
-decrease sebum production
-eliminate inflammation
 -Management
 General health
stress, diet, rest
 Cleaning
mild cleanser 2 times daily
hair, scalp

Front 20

Acne Vulgaris
 Medical management medications
 -Topical

Back 20

 Treitonoin (Retin-A)
inhibit microcomedones
20 min after washing
pea size, sunscreen
Onset 2 weeks, peak 6
 Benzoyl peroxide
growth of P. acnes
bleach fabric, not skin

Front 21

 Medical management medications
 -Topical
 -Oral

Back 21

 Antibiotic therapy
topical and systemic
combination therapy
 Oral contraceptive
reduce androgen production



 Medical management medications contd
 Isotretinion (Accutane) (page 1511)
reduces sebaceous gland size and sebum production
 I pledge (p. 1511)
2 forms of BC
monthly pregnancy test, VERY TETRAGENIC
blood donation
 Treatment for 20 weeks
 Adverse effects
suicidal ideation
aggressive behavior
mood changes
cholesterol/triglyceride

Front 22

 Acne vulgaris
Nursing management
 -Disturbed body image

Back 22

 -Disturbed body image
Psychological distress
mild or severe
Social withdrawal
 Assess motivation for treatment
 Dispel myths
 Avoid traumatic treatment – can worsen acne
-self-care
-shaving
-helmets

Front 23

 Parasitic skin conditions
Scabies p. 1131-32
 -Health History

Back 23

intense itching NIGHT
contact
-Physical examination
rash feet, body folds
burrows
scraping under microscope

Front 24

 Head lice/ Scabies Medical Management

Back 24

 Topical cream/ shampoo
 scabicide/pediculocide
-SCABIES
applied to entire body, neck down preschool and older; include head and neck in toddlers and younger
-8-12 hours must stay on
-itching may take several weeks to subside
HEAD LICE
hair shampooed and retreated in 7 days/comb
Excessive absorption, neurological, cardiac, pulmonary effects
limited amounts 60 ml > age 6; 30 ml < age 6