What would you include in a health hx of the skin?
Chief Complaint Changes in Diet
Onset Surgeries
Location Duration Environment
Characteristics Immunizations
Medications
Chronic Illnesses
On Physical exam, what will be looked for?
How they are distributed
Linear Poison Ivy
Circular like ring worm
What is morbilliform?
Bulls eye type marking. Spider bite.
Nonbullous Impetigo
a secondary infection or skin disorder
happens in a previous cut..caused by Strep
Contagious until lesions are healed
Bullous Impetigo
happens on intact skin.
staph aureus
Contagious until lesions are healed
Folliculitis
Hair follice infection
Occurs on extremities, buttock, scalp, face
Cellulitis
Localized infection and inflammation of the skin
Follows skin trauma
Occurs on face, arms, legs, and surrounding wounds
Ritters Disease
Staphlococcal scalded skin syndrome
Dry, red, scalled skin
Abrubt onset
Rare after 5
Commonly occurs on face, groin, neck and axillary region
MRSA
With children: Occurs more commonly after spider bites or insect bites
Community acquired: Sharing towels, shaving, locker rooms, poor hygiene and sports equipment
Mupirocin Bactroban
Topical antibiotic
3X daily for 10 days
Erythema, dry skin, pruritus, burning and stinging: S/E
Don't use close to the eyes!
How to educate a parent on Bacterial skin infection
Common abx education
Wash hands before and after applying medication
Keep childs fingernails short and clean
Soak impetigo lesions with cool compress and pat dry prior to applying topical anitbiotic
What is tinea corporis?
Ring worm usually caused by pets
Fungal infection of epidermal layer
occurs anywhere
What is tinea capitis?
Fungal infection of single hair follicle.
If it grows green under Wood's light, the causative agent is Microsporum
Fungal culture reliable for dx
May take up to 3 months before all lesions have faded
Wash all linens and clothes in hot water
Tinea versicolor: White spots
Malassezia furfur is the causative agent
Occurs in young adults and adolescents
No permanent damage
May take several months for normal skin pigmentation to return
Tinea Cruris
Jock itch
Wear cotton underwear
Clothing should be loose fitting
good hygiene after sports
contagious
Hypersensitivity Reactions
Diaper Dermatitis
Atopic Dermatitis
Contact Dermatitis
Erythema Multiforme
Urticaria
Diaper Dermititis
Prolonged exposure to urine and stool
Not changing the babies diaper
Flat red rash in convex folds
shiny with or without papules
If untreated gets more severe and widespread
Best managament is prevention.
Tx for diaper dermititis
PREVENTION. AIR. Fragrance free wipes.
Atopic Dermititis
Eczema
50% of kids with eczema also have asthma
Itching-causes sleep deprivation and self-image disturbance
Develops within first year or by age five
Itchy patchy dry skin
Bacterial superinfection can result
Eczema
May outgrow
Usually response to some kind of allergen: Eggs, wheat, milk, peanuts
Managing Eczema
Warm water...not hot
Hydrate the skin without perfumed lotions
Labs: Serum IgE will be elevated
Keep fingernails short and clean
antihistamine
Claritin Zertec during day..heavier meds at night
Contact Dermititis
Most common in children:
Poison Ivy, sumac, western poision oak
Oils from leafs of plants or even dead plants can transmit oils
Lasts 2-4 weeks
Contact Dermititis
Not Contagious!
Secondary infection
Thick, leathery skin: Lichenification Results from scratching
Hyperpigmentation: tx with topical steriods and systemic steriods
Erythema Multiforme
Sudden. Self-Limiting.
Uncommon in children. Response to viral infections, drugs or food.
Steven Johnson syndrome: Most severe form of E.M.
1- to 14-day history of fever, malaise, headache, generalized aching, emesis, and diarrhea
Sudden onset of high fever with rash appearing
Rash is characteristic of erythema multiforme with the addition of inflammatory bullae on at least two types of mucos
Tx for Erythema Multiforme
It is contagious. Needs Isolation. Takes 1-14 days to heal. Discontinue causative agent. Hydrate orally. Pain meds. Soothing mouthwash. Hydrogen peroxide to debride oral lesions.
Uticaria
Hives. Erythema and wheals appear.
Resolves in days or up to 6 weeks
Drugs, foods, animal stings, infections, environmental or stress.
For a health assessment of uticaria, the nurse will get the following:
Health hx
Assessment of skin
Do the hives blanch with pressure? Itch? Migrate?
Angioedema present possibly.
Occurs mainly on face, extremities or genitalia.
ALWAYS ASSESS AIRWAYS.
Tx for Uticaria
Remove allergen.
Give antihistamines and steriods, topical creams. Epipephrine in severe cases.
Psoriasis
Chronic periods of remission and exacerbation.
Peak onset is around 15-25 years. 50% have fam hx.
Where is psoriasis normally located?
Scalp, elbows, genital areas, and knees
What does psoriasis look like?
Plaques with silvery or yellow-white scales.
How does a nurse treat psoriasis?
Sunlight
Emollients/Moisturizers
Topical anti-inflam.
Tar shampoos
Mineral oil
Warm towels
Verrucae
Viral infection. 1-6 MO of incubation time. Flesh colored, dirty looking. Hands, feet, anywhere. Cause: Papillomavirus
Burns
75% preventable.
Classifications of burns:
Superificial: Epidermal layer, no scarring. heals 4-5d. Painful. red. edematous
Partial thickness: Epidermis AND Dermis: No scarring. 2 wks. Painful, edematous, blisters or appears wet.
Deep-Partial thickness: Longer to heal. Scarring. Surgery needed. Pai
Tx of burns:
Initial IV is LR.
ABCs
Labs
Fluid replacement
Nutritional Status
Daily Weights
Monitor I&O
Burn Management
Prevent hypothermia
Infection
Clean the burn
Debridement
Pain Manangement
Rehab.
Page 1519...Must know...
Keep hot water heater temperature lower than 120� F.
Test bath water temperature before bathing children.
Keep children away from open flames, stoves, and candles.
Cook with pots on the inside of the stove with the handles turned in.
Keep children away fr
Frostbite: First degree
Superficial: White plaques with surrounding erythema
2nd Degree
Blistering with erythema and edema
3rd Degree
Hemorrhagic blisters due to NECROSIS.
4th Degree
Losing body parts.
Tx of frostbite
Prevention.
Remove wet clothing.
Avoid vigorous massage
Immerse affected area in 104 degree water for 15-30 min.
Splint