chapter 16 integumentary disorders copyright © 2012 by saunders, an imprint of elsevier, inc

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

Copyright © 2012 by Saunders, an imprint of Elsevier, Inc. 16-2

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


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


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


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


Impetigo

• Description– 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


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


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


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


Several types of Staph infections


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


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


Burns

• Description– 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

• 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


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


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


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


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


Acne Vulgaris

• Description– 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


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)


chapter 16 integumentary disorders copyright © 2012 by saunders, an imprint of elsevier, inc

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