Title: The Child with Altered Skin Integrity
1The Child with Altered Skin Integrity
- Jan Bazner-Chandler
- CPNP, CNS, MSN, RN
2Key Function of Skin
- Protection shield from internal injury.
- Immunity contains cells that ingest bacteria
and other substances. - Thermoregulation heat regulation through
sweating, shivering, and subcutaneous insulation - Communication / sensation / regeneration
3Developmental Variances
- Sweat glands function by the time the child is
3-years-old. - The visco-elastic property of the dermis becomes
completely functional at about 2 years. - The neonates dermis is thin and very hydrated
- greater risk for fluid loss
- ineffective barrier against infection
4Neonatal skin lesions
- Vascular birth marks hemangioma
- Port wine stain
- Abnormal pigmentation Mongolian spots
- Neonatal acne small red papules and pustules
appear on face trunk. - Milia white or yellow, 1-2mm papules appearing
on cheeks, nose, chin, and forehead
5Neonatal Dermatology
6Inflammatory Skin Disorders
- Diaper dermatitis
- Contact dermatitis
- Atopic dermatitis or eczema
7Diaper Dermatitis
8Assessment / Interventions
- Identify causative agent
- Cleanse with mild cleaner
- Apply barrier
- Zinc oxide / Desitine
- Expose to air
- Teach hazards of baby powder
9Cradle Cap
- Rash that occurs on the scalp.
- It may cause scaling and redness of the scalp.
- It may progress to other areas.
10Cradle Cap
11Interventions
- If confined to the scalp
- Wash area with mild baby shampoo and brush with a
soft brush to help remove the scales. - Do not apply baby oil or mineral oil to the area
- this will only allow for more build up of the
scales.
12Contact Dermatitis
- Contact dermatitis is an inflammatory skin
condition involving a cutaneous response
occurring when skin is exposed to certain
external natural or systemic substances.
13Assessment
- Occurs in exposed areas of skin
- Face, neck, hands, forearms, legs and feet
- Lesions may be well demarcated resembling the
shape and size of the offending substance
14Nickel Allergy
15Interventions
- Resolves over a few weeks when causative agent is
removed - For itching and edema Burrows solution, topical
corticosteroids - In severe reactions oral corticosteroids
16Atopic dermatitis or Eczema
- Chronic, relapsing inflammation of the dermis and
epidermis characterized by itching, edema,
papules, erythema, excoriation, serous discharge
and crusting. - Patients have a heightened reaction to a variety
of allergens.
17Dermatitis
18Assessment
- Pruritis
- Erythema
- Exudate and crusts
- Common sites cheeks, forehead, scalp, extensor
surfaces of arms and legs
19Multidisciplinary Interventions
- Frequent re-hydration of the skin
- Elidel cream
- To reduce the inflammation topical
corticosteroids - Control the itching antihistamine such as
Benadryl - Control infection topical or oral antibiotics
20Acne Vulgaris
- A chronic, inflammatory process of the
pilosebaceous follicles. - Occurrence 85 of teenager aged 15 to 17 years.
- More common in females than males.
21Assessment
- Over activity of oil glands at the base of hair
follicles - Skin cell plug pores causing white heads and
blackheads - Lesions usually occur on the face, back, chest
and shoulders - Lesions are red and hyperpigmented
22Acne
23Interventions
- Topical medications
- OTC preparations
- Prescription - Topical retinoid preparations
- Prescription - Topical antibiotics may cause
bacterial resistance - Prescription hormone therapy
- Prescription accutane
24Pediculosis
- Head lice infestation ranges from 1 to 40 in
children. - Most common in ages 5 to 12.
- Less common in African American due to the shape
of the hair shaft. - Transmission by direct contact with infected
person, clothing, grooming articles, bedding, or
carpeting.
25 Assessment
- Symptoms itching, whitish colored eggs at shaft
of hair, redness at site of itching.
26Nits
Empty nit case
Viable nit
27Interventions
- Anti-lice shampoo
- Removal of nits
- Washing bedding, towels, anything childs head
may have come in contact with in hot soapy water. - Vacuum all floors and rugs
- Do not need to fumigate the house
- Child can return to school after 1 day of
treatment
28Scabies
- A contagious skin condition caused by the human
skin mite. - Tiny, eight-legged creature burrows within the
skin and penetrate the epidermis and lays eggs - Allergic reaction occurs
- Severe itching
29Assessment
- Pruritus especially profound at night or nap
time. - Lesions may be generalized but tend to distribute
on the palms, soles and axillae - In older children finger webs, body creases,
beltline and genitalia
30Scabies
31Interventions
- Permethrin cream is drug of choice
- Massage into all skin surfaces neck to soles of
feet - leave on for 8 to 14 hours. - Re-apply one week later
32Scabies
33Impetigo
- The most common skin infection in children.
- Causative agent is carried in the nasal area.
- Bacteria invade the superficial skin.
34Causative agent
- Group A beta-hemolytic streptococcal (GABHS)
- Staph aureus
35Impetigo
36Spread
- Highly contagious
- Common in young children
- Spread through physical contact
37Interventions
- Wash hands
- Wash lesion with soap and water
- Topical antibiotics
- Bactroban
- Altabax
- PO antibiotics Keflex 1st generation
cephalosporin
38Impetigo / cellulitis
39Cellulitis
- A full-thickness skin infection involving dermis
and underlying connective tissue. - Any part of the body can be affected.
- Cellulitis around the eyes is usually an
extension of a sinus infection or otitis media.
40Diagnostic Tests
- WBC count
- Blood culture
- Culturing organism from lesion aspiration.
- CT scan of head with peri-orbital cellulitis
- If cellulitis in the eye area may spread to brain
41Assessment
- Characteristic reddened or lilac-colored, swollen
skin that pits when pressed with finger. - Borders are indistinct.
- Warm to touch.
- Superficial blistering.
42Cellulitis
43Cellulitis monitor spread
44Interdisciplinary Interventions
- Hospitalization if large area involved or facial
cellulitis - IV antibiotics
- Tylenol for pain management
- Warm moist packs to area if ordered
- Assess for spread
- If peri-orbital test for ocular movement and
vision acuity
45Poison Oak, Ivy and Sumac
- Three potent antigens that characteristically
produce an intense dermatologic inflammatory
reaction when contact is made between the skin
and the allergens contained in the plant.
46Poison Ivy
47Interventions
- Prevention
- Wear long pants when hiking or playing in wooded
areas - Wash with soap and water to remove sticky sap
- Cleanse under finger nails
- Sap on fur, clothing or shoes can last up to 1
week if not cleansed properly - Topical cortisone to lesions
- Oral prednisone if extensive
48Systemic Response
49Thermal Injuries
- Young children who have been severely burned have
a higher mortality rate than adults. - Shorter exposure to chemicals or temperature can
injure child sooner. - Increased risk for for fluid and heat loss due to
larger body surface area.
50Burns in Children
- Burns involving more that 10 of TBSA require
fluid resuscitation - Infants and children are at increased risk for
protein and calorie deficiency due to decreased
muscle mass and poor eating habits - Scarring in more severe
51Percentage of Areas Affected
52Burns in Children
- Immature immune system can lead to increased risk
of infection. - Delay in growth may follow extensive burns.
53Alert
- The most common cause of unconsciousness in the
flame burn patient is hypoxia due to smoke
inhalation. - Look for ash and soot around nares.
54Immediate Interventions
- Airway management
- Large bore needle for fluids (plasma or blood)
- Nasogastric tube to maintain gastric
decompression - Foley catheter for urine specimen and monitor
output - Evaluate burn area and determine the extent and
depth of injury - Accurate weigth
55Flame Burn
56Depth of Burns
57First Degree Burn
- Involves only the epidermis and part of the
underlying skin layers. - Area is hot, red, and painful, but without
swelling or blistering. - Sunburn is usually a first-degree burn.
58Second Degree Burn
- Involves the epidermis and part of the underlying
skin layers. - Pain is severe.
- Area is pink or red or mottled.
- Area is moist and seeping, swollen, with blisters.
59Third Degree or Full-thickness
- Involves injury to all layers of skin.
- Destroys the nerve and blood vessels
- No pain at first
- Area may be white, yellow, black or cherry red.
- Skin may appear dry and leathery.
60Electrical Burn
61Wound Management
Dead skin and debris are Carefully trimmed.
Gauze with ointment is applied to burn wound.
62Wound Management
Bowden, Dickey, Greenberg text Children and Their
Families
63Skin Grafts
Healed donor site
Removal of split-thickness Skin graft with
dermatone.
64Compartment Syndrome
Escharotomy / fasciotomy in a severely burned arm.
65Burn Wound Covering
66Therapy to Prevent Complications
Elasticized garment and air-plane splints.
Physical therapy to prevent contracture deformity.
67Keep Kids Safe