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The Integument System


Protects against trauma, including mechanical, thermal, chemical, & radiant ... The newborn's skin is thin an friable. IgA is decreased until 2-5 years of age. ... – PowerPoint PPT presentation

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Title: The Integument System

The Integument System
  • The skin associated disorders
  • NUR 331 On-line study self-study
  • Dr. Sara Mitchell

Purposes of the skin
  • Protection
  • Impermeability
  • Heat regulation
  • Sensation

Purposes of the skin
  • Protection
  • Protects against trauma, including mechanical,
    thermal, chemical, radiant
  • Protects by the oily slightly acid secretions of
    the sebaceous glands which limit the growth of

Purposes of the skin
  • Impermeability
  • Seals the skin from the environment
  • Protects against loss of essential body
    constituents to the environment.

Purposes of the skin
  • Heat regulation
  • Skin adjusts heat loss to heat production to
    maintain the thermal balance of the body.

Purposes of the skin
  • Sensation
  • Perceptions (touch, pain, heat, cold) are
    transmitted through the nerves that permeate the
  • Betrays emotions/feelings

What makes skin in children different?
  • Eccrine glands do not reach mature function until
    2-3 years of age.
  • Skin is more alkaline in the first weeks of life.
  • Subcutaneous fat is poorly developed.
  • The newborns skin is thin an friable.
  • IgA is decreased until 2-5 years of age.

What makes skin in children different?
  • Lack of maturity of eccrine glands makes infants
    young children less able to regulate body
  • Decreased SQ fat predisposes to hypothermia
  • Thin skin makes it more susceptible to external
    irritants and to infection

Test your knowledge
  • 1. Purposes of the skin include _______, ______,
    _________, and ____________.
  • 2. The skin adjusts heat loss to heat production
    to maintain the _______ _____ of the body.
  • 3. Skin in children is different because of which
    of the following?
  • A. skin is more acidic in the first few weeks of
  • B. IgA is increased until around 2-5 years of age
  • C. Decreased SQ fat predisposes to hypothermia
  • 1. protection ,impermeability, heat regulation,
    sensation 2. thermal balance 3. C

Test Your Knowledge
  • Read pages 758-768 and answer the following
  • 4. Which of the following factors hinder wound
  • A. Dry wound environment
  • B. Nutritional deficiencies
  • C. Impaired circulation
  • D. all of the above
  • 5. Which of the following factors aids in wound
  • A. Leaving wound open to dry out
  • B. Cleaning with hydrogen peroxide and betadine
  • C. Cooling the affected area
  • 4. D 5. C

Test your knowledge
  • 6. The major nursing function related to
    bacterial skin infections are to prevent the
    spread of infection and to prevent complications.
  • A. True
  • B. False
  • 7. Most communicable diseases of childhood are
    associated with ______ caused by ________.
  • 6. A 7. rashes/viruses

Infections of the skinCaused by bacteria
  • The major nursing functions related to bacterial
    skin infections are to prevent the spread of
    infection and to prevent complications.

Bacterial Infections - Name a few(see page 767
in textbook)
  • Impetigo
  • Cause
  • Course
  • Management
  • Caution
  • Cellulitis
  • See page 767 in your textbook and figure 18-7 on
    page 767

What causes impetigo and how does it progress?
  • Caused by group A beta hemolytic and/or staph
  • Course is as follows
  • Begins as a single reddish maculae, then becomes
  • Ruptures easily, leaving superficial moist
  • Tends to spread peripherally
  • Exudate dries to form a heavy honey-colored crust

Impetigo How is it managed?
  • Gentle washing with soap and water
  • Apply topical antibiotic ointment
  • May occasionally need oral antibiotics
  • Antibiotics in the penicillin or cephalosporin
    family are generally prescribed. Erythromycin is
    used for those allergic to penicillin.
  • Impetigo is VERY contagious
  • Children diagnosed with impetigo should be
    instructed to stay home from daycare/school for
    24 hours after beginning medications

Test your knowledge
  • Joey is a 7-year-old boy who comes to the school
    nurses office with the complaint of itchy rash
    on his face. As the school nurse, you assess the
    rash to be reddened papules and pustules with a
    yellow crust occurring around his mouth and nose.
  • 8. What is your first priority
  • A. Assess his temperature and lung sounds
  • B. Have the child wash his hands and call his
    parents to have Joey see the doctor
  • C. Apply calamine lotion to the affected areas
  • D. All of the above.
  • 9. Which of the following statement demonstrates
    effective learning by Joeys parents regarding
    his treatment?
  • A. I should keep Joeys towels separate from my
    other children.
  • B. Joey should bath in Aveeno baths at night to
    help with the itching.
  • C. I should wash Joeys linen in hot water and
    soak his combs in boiling water.
  • D. Joey should take Acyclovir until all of the
    lesions are gone.
  • 8. B 9.A

Infections of the skinCaused by viral agents
  • Most communicable diseases of childhood are
    associated with rashes caused by viruses

Viral skin infections Name a few
  • Warts
  • Caused by human papillomavirus
  • Occurs anywhere but usually appear on exposed
    areas such as fingers, hands, face, and soles of
  • Hard to get rid of. Tend to disappear
  • Treatment includes cryotherapy, surgical removal,
    or salicyclic acid

More viral skin infections
  • Herpes simplex virus
  • Type I causes clod sores fever blisters
  • Type II causes genital lesions and is sexually
  • Management directed toward keeping lesions moist
    with burrows solution. Topical or antivirals may
    be used. Lesions are made worse by steroids. May
    be fatal in children with decreased immunity.

Test your knowledge
  • 10. Treatment for warts includes which of the
  • A. cryotherapy
  • B. surgical removal
  • C. salicylic acid
  • D. all of the above
  • 11. Warts are caused by the human herpes virus.
  • A. True
  • B. False
  • 12. Children with ringworm should be instructed
    to avoid contact with other children for how long
    after treatment has begun?
  • A. 1 day
  • B. 2 days
  • C. 3 days
  • D. It doesn't matter
  • 10. D 11. B 12. B

Another skin eruption caused by a
virusVaricella-also known as Chicken Pox
  • What causes it?
  • varicella zoster viruses
  • When does it generally occur?
  • Most often occurs in late winter and early spring
  • How is it spread?
  • It is spread by direct contact and droplet
    (airborne) transmission

More on Chicken Pox
  • Is Chicken Pox contagious?
  • It is very contagious. It can be spread starting
    1-2 days before eruption of lesions and until the
    time when all lesions have crusted.
  • When can children return to school or day care?
  • Not until ALL lesions have crusted which is
    usually about 1 week.
  • It is not necessary to wait until all the scabs
    fall off to let the child return to a normal

Chicken Pox Sign Symptoms
  • Red, itchy rash on skin.
  • Rash begins as small, red bumps that look like
    pimples or insect bites.
  • Red bumps develop into thin-walled blisters
    filled with clear fluid, which becomes cloudy
  • Blisters break, leaving open sores, which finally
    crust over to become dry, brown scabs.
  • Fever 100-1020F (may occasionally be higher)

Chicken Pox about the rash
  • Lesions erupt in successive crops, usually
    beginning on the trunk and then spreading to the
    face and scalp.
  • The characteristic rash involves crops of
    teardrop vesicles on an erythematous base.
  • The classic lesion has been described as an "oval
    teardrop on an erythematous base" or a "dew drop
    on a rose petal.
  • A characteristic feature of the rash is that the
    lesions can be in all stages of development

Chicken Pox what is the Incubation period?
  • The incubation period for chicken pox is 10 to 21
    days after exposure.
  • Most cases appear within 14 to 17 days. For
    example, if one child in a family breaks out with
    chickenpox picked up at school, siblings probably
    will show symptoms about 2 weeks later.

ChickenPox What is the treatment
  • Relieve the itch!
  • Cool or tepid oatmeal baths with every 3 to 4
    hours as needed (baths do not spread chickenpox)
  • Calamine lotion (avoid the face, especially the
  • Antihistamines, such as benadryl, may also be
    used for itching
  • Soft/bland foods as indicated as there may be
    painful pox lesions in the mouth
  • Acetaminophen or ibuprofen or fever and general
  • Antiviral medications such as acyclovir may
    occasionally be prescribed at the physicians

Chicken Pox What are the complications?
  • Viral pneumonia
  • Encephalitis
  • Secondary skin infection

Chicken Pox How is it related to shingles?
  • Anyone who has had chickenpox as a child is at
    risk shingles later in life.
  • After infection with chickenpox, some of the
    varicella zoster virus may remain inactive in the
    nerve cells near the spinal cord.
  • Many years later, the virus can reactivate and
    resurface as shingles.
  • When it reactivates, it affects the nerves to the
  • Symptoms, such as a tingling feeling, itching, or
    pain followed by a rash with red bumps and
    blisters appear only on the area of the skin
    that the nerve goes to.

What about the chicken pox vaccinehttp//www.vacc
  • In use since 1995
  • 70-85 effective at preventing mild infection and
    more than 95 effective in preventing moderate to
    severe disease.
  • Given to all children older than 12 months of
    age, as well as adults who have not had the

Chicken Pox test your knowledge
  • 13. Tommy has been diagnosed as having chicken
    pox. His mom ask you how the disease is spread.
    Your best response is
  • A. by direct contact with the lesions
  • B. by an infected person breathing on you
  • C. by kissing an infected person
  • D. all of the above
  • 14. Tommys best friend has chicken pox. His mom
    is worried about Tommy getting the disease as
    well and ask you what the early signs are. Your
    best response is
  • A. Symptoms develop 3-5 days after exposure
  • B. Lesions usually begin on the trunk
  • C. The rash begins as small, red bumps that look
    like pimples
  • D. B C
  • E. A only
  • 13. D 14. D

Chicken Pox test your knowledge
  • 15. It has been 10 days since his exposure to
    chicken pox and Tommy has not developed signs of
    the disease. His mom ask if he is out of the
    woods. Your best response is what?
  • A. It is unlikely Tommy will develop chicken pox
    from this exposure
  • B. The incubation period for chicken pox is 5-7
  • C. Most cases of chicken pox appear within 14 to
    17 days of exposure.
  • D. It is impossible to tell if Tommy will develop
    chicken pox.
  • 16. Tommy does not develop chicken pox but his
    brother does. Tommys mom ask what she should do
    to treat the disease. Your best response is what?
  • A. Avoid baths because of risk of causing the pox
    to spread.
  • B. Apply calamine lotion for the itch
  • C. Give acetaminophen for fever and aches
  • D. A only
  • E. B C
  • 15. C 16. E

Chicken Pox test your knowledge
  • 17.Tommys mom needs to return to work. She ask
    when her son while likely to able to return to
    school. Your best response is what?
  • A. When all of the scabs have fallen off
  • B. When all lesions have crusted and are no
    longer fluid filled vesicles
  • C. When she hasnt seen any new lesion for 48
  • D. All of the above
  • 17. B

Skins infections caused by fungi
  • Tinea captitis fungal infection of the scalp
  • Tinea corporis fungal infection of the body
  • Tinea curis fungal infection of the scrotal and
    genital area
  • Tinea pedis -athlete's foot

Skins infections caused by fungi
  • Management
  • Skin infections treated with topical antifungal
    creams for 6-8 weeks
  • Scalp infections because the fungi are deep in
    the hair shaft tinea capitis must be treated with
    systemic antifungal medications such as
    grieseofulvin for 6-weeks
  • Ringworm is contagious. Children with ringworm
    should be instructed to avoid contact with other
    for 48 hours after treatment is started.

Different forms of tinea What does it look like?
Tinea Capitis
Tinea Corporis- face trunk
Tinea cruris groin, buttocks, scrotum
Tinea Pedis
  • Definition an endemic infestation caused by the
    scabies mite sacroptes scabiei. The mite can
    barely be seen by the naked eye
  • Clinical manifestations the mite burrows under
    the skin causing an allergic reaction. Recognized
    by their tracks small lines in the skin that
    look like scratches about ¼ inch long. Usually
    appear at wrists, buttocks, underarms, groin, and
    especially in the webs between fingers and toes.
  • Therapeutic management scabicide such as
    Elimite (5 permethrin)
  • Nursing considerations education about
    transmission and management

More on scabies
Pediculosis capitisa fancy name for head lice
or cooties
  • Definition an infestation of the scalp by
    Pediculus humanus capitus
  • Clinical manifestations causes intense itching.
    Very common especially in school children
  • Therapeutic management comb nits out. Treat
    with 1 permethrin shampoo.
  • Nursing considerations head lice are very
    contagious. All family members should be
    treated. Anything that has come in contact with
    the scalp, brush, hats, bed linens, ect.. needs
    to be cleaned

Poison Ivy,Oak, Sumacitchy, itchy, itchy page
767 in textbook
  • Definition
  • A contact dermatitis that occurs when skin comes
    in contact with the dry or succulent portion of
    any of the three of these plants. The offending
    substance is an oil called urushiol
  • Clinical manifestations
  • Contact produces localized, streaked, or spotty,
    oozing and painful impetigious lesions. The
    substance begins to take effect as soon as it
    touches the skin. It soaks in and causes an
    immune response. A full-blown reaction is evident
    after about 2 days.

Poison Ivy Rash What does it look like?
  • The oil contained in the plant leaves irritates
    the skin.
  • The redness and blistering from the rash is often
    arranged in streaks or lines, because the leaf
    brushes across the body in a line as an
    individual walks past.

Poison Ivy,Oak, Sumacitchy, itchy, itchy
  • Therapeutic management
  • The primary goal of treatment is to lessen the
    itch and prevent secondary infection. Calamine
    lotion, baths in aveeno or baking soda are
    helpful in relieving the itch. Oral benadryl can
    be used as well as topical hydrocortisone. If
    the out break is extensive or if it is near the
    eyes systemic steroids (i.e. prednisone) is often
  • Nursing considerations
  • Wash area immediately with cold running water to
    neutralize the urushiol. Remove and wash all
    clothing that may have come in contact with the

Poison Ivy,Oak, Sumacitchy, itchy, itchy
  • Common myth
  • Poison ivy, oak, or sumac can not be spread from
    person to person. There must be contact with the
    urushiol oil before a contact dermatitis response
    can occur. Contact can be directly from a plant,
    from clothing, or perhaps from the fur of a
    family pet who has been romping in the woods.

Test your knowledge
  • A mother calls the clinic nurse to ask advice
    regarding her child and possible contact with
    poison ivy.
  • 18. If the contact was in the last 15 minutes,
    which of the following actions should be
  • A. Wash the child with dishwasher detergent
  • B. Flush the skin with cold running water
  • C. Have the child bathe in warm water
  • D. Have the child shower in hot water.
  • 19. Clothing the child was wearing should be
  • A. Burned
  • B. Placed in a plastic bag and put out with the
  • C. Placed in the laundry hamper along with other
  • D. Washed separately in hot water and detergent
  • Answers 18. B 19. D

SunburnOchy,Ochy, Ochy
  • Prevention
  • Sunscreen and sunblocks. SPF 15 or greater. Avoid
    mid day sun exposure
  • Treatment
  • Involves stopping the burning process, decreasing
    the inflammation process, and rehydrating the
    skin. Cool tap water soaks or immersion in a
    tepid water bath for 20 minutes or until the skin
    is cool. Apply moisturizing lotion. Use Tylenol
    for discomfort.

Atopic DematitisOu wee baby
  • What is it?
  • Also referred to as eczema. It is a chronic
    inflammation of the dermis and epidermis which
    causes itching, edema, papules, erythema,
    excoriation, serous discharge and crusting.
  • Who gets it?
  • see page 580 in your textbook for the different
    age groups. There is often a family history of
    eczema of some other chronic allergy related

Atopic DematitisOu wee baby (continued)
  • Management
  • Basic skin care
  • Frequent baths but also apply moisturizing lotion
    within three minutes after bath (while the skin
    is still damp.

Atopic DematitisOu wee baby (continued)
  • Medications to relieve itch or secondary
  • Topical steroids
  • Oral antihistamines
  • Antibiotics for secondary infection
  • Education, Education, Education!
  • Parents must understand this is a chronic
    condition that reoccurs. There is no one time
    fix. If they do not understand this they will
    only be frustrated with the medical system for
    not curing their child

Diaper RashWhat are the causes
  • Caused by a prolonged and repetitive contact with
    an irritant, i.e. urine, feces, soap, detergents.
  • Wetness, increased skin Ph, and fecal irritants
    all work together to cause the rash.

Diaper RashWhat is the treatment
  • Use zinc oxide paste to help create a moisture
    barrier so that the irritated skin can heal
  • Clean the area very gently
  • Use a cleanser only after the infant has had a
    bowel movement
  • Use nonirritating wipes
  • Use super-absorbent diapers. Research has shown
    that some diapers with super absorbency and
    petroleum layers helps reduce the incidence of
    diaper rash