Skin Disorders Marlene Meador RN MSN

1. Skin Disorders Marlene Meador RN MSN

2. Compare skin differences • Infant: skin not mature at birth • Adolescence: sebaceous glands become enlarged & active.

3. Topical Medications Infants & <2 years-Topical medications should not be used without a physician’s order (due to greater absorption through skin and larger skin to body mass ratio) Iga does not reach adult levels until 2 to 5 years of age. Infants less resistant to organisms.

4. Skin Assessment • Assess history • Assess exposure • Assess character • Assess sensation

5. Impetigo http://www.emedicine.com/emerg/topic283.htm Impetigo became infected • Hemolytic Strept infection of the skin • Incubation period is 2-5 days after contact

6. Begins as a reddish macular rash, commonly seen on face/extremities • Progresses to papular and vesicular rash that oozes and forms a moist, honey colored crust. Pruritis of skin • Common in 2-5 year age group

7. Therapeutic Management • Apply moist soaks of Burrow’s solution • Antibiotic therapy- both topical and systemic • Patient education

8. Key Nursing Care • Prevent secondary glomerulonephritis • Stress teaching to parents: • Soak prior to applying topical antibiotic • Keep child away from anyone <2 years of age • Prevent scratching lesions (spreading) • Keep toys, towels, linens, clothing separate • Clean personal items with bleach solution • May return to public 24 hours after start of antibiotic treatment

9. Cellulitis • Causative organisms- most commonly group A streptococci and S. aureus • Priority Nursing Interventions: • Antibiotic therapy (pt/family teaching) • Warm compresses (why?) • Control of fever and pain • Monitor for sepsis

10. Candiditis- Thrush Overgrowth of Candida albicans Acquired through delivery

11. Assessment • Inspect mouth • Assess for difficulty eating • Assess diaper area

12. Therapeutic Interventions • Medication • Oral- for thrush-nystatin suspension or fluconazole • Clotrimazole topically for diaper area • Nursing Care • Sequence of medication and feeding • Treatment of mother if breastfeeding • Care of bottles/nipples and pacifiers

13. Dermatophytosis (Ringworm) • Tinea Capitis • Transmission: • Person-to-person • Animal-to-person

14. S&S: • Scaly, circumscribed patches to patchy, gray scaling areas of alopecia. • Pruritic • Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)

15. http://www.ecureme.com/quicksearch_reference.asp

16. Diagnosis • Potassium hydroxide examination • Black Light

17. Medication Therapy • Oral- systemic- grieseofulvin daily for at least 6 weeks (insoluble in water- take with high-fat meal or with milk products) • Topical-alone not effective for tinea capitis: • Clotrimazole (Lotrimin®) • Miconazole (Monistat®)

18. Patient Teaching • transmitted by clothing, bedding, combs and animals • may take 1-3 months to heal completely, even with treatment • Child doesn't return to school until lesions dry

19. Other Tinea Infections Tinea Corporis- ringworm not located on the scalp (local topical treatment usually effective) Tinea Crusis- (athletes get this) similar to corporis, treated topically Tinea Pedis (any guess what this is?)

20. Herpes Simplex • Priority nursing interventions: • Prevent secondary infections • Maintain adequate nutrition (if oral outbreak) • Prevent spread to others • Universal precautions • Isolation from susceptible individuals

21. What should the nurse report? “Child sexual abuse should be considered in any child with a genital herpes infection.”

22. Pediculosis Capitis (lice or cooties!) • http://www.emedicine.com/emerg/topic409.htm • a parasitic skin disorder caused by lice • the lice lay eggs which look like white flecks, attached firmly to base of the hair shaft, causing intense pruritus

23. Diagnosis • Direct identification of egg (nits) • Direct identification of live insects

24. Medication Therapy • treatment: shampoos RID, NIX, Kwell(or Lindane) shampoo: is applied to wet hair to form a lather and rubbed in for at least amount of time recommended, followed by combing with a fine-tooth comb to remove any remaining nits.

25. Patient Teaching • Follow directions of pediculocide shampoos • Comb hair with fine-toothed comb to remove nits • Transmission, prevention, and eradication of infestation

26. Scabies http://www.nlm.nih.gov/medlineplus/scabies.html Sarcoptes scabei mite.  Females are 0.3 to 0.4 mm long and 0.25 to 0.35 mm wide.  Males are slightly more than half that size. • a parasitic skin disorder (stratum corneum- not living tissue) caused by a female mite. • The mite burrows into the skin depositing eggs and fecal material; between fingers, toes, palms, axillae • pruritic & grayish-brown, thread-like lesion

27. http://www.aad.org/pamphlets_spanish/sarna.html Scabies between thumb and index finger On foot

28. Therapeutic Interventions • transmitted by clothing, towels, close contact • Diagnosis confirmed by demonstration from skin scrapings. • treatment: application of scabicide cream which is left on for a specific number of hours (4 to 14)to kill mite • rash and itch will continue until stratum corneum is replace (2-3 weeks)

29. Care: • Fresh laundered linen and underclothing should be used. • Contacts should be reduced until treatment is completed.

30. Atopic/Eczema Cause unknown Genetic family hx Develop asthma or allergic rhinitis later Symptoms begin age 1 to 4 months Contact Dermatitis- skin inflammation from skin-to-irritiant contact Soaps/detergents Clothing dyes Lotions, cosmetics Urine ammonia Atopic / Contact Dermatitis

31. Assessment & Diagnosis • Infants- Papulovesicular rash and scaly red plaques • Extremely pruitic and dry skin • Childhood- increases with emotional upset, sweating, irritating fabrics • Other triggers- milk, eggs, wheat, soy, peanuts, fish

32. Interventions & Nursing Care • Prevent secondary infection- control itching • Moisturize skin • Remove irritants • Medication • Parent teaching- long term

33. Acne http://www.pathology.iupui.edu/drhood/acne.html ACNE

34. Assessment • Closed lesions • Open lesions • Inflamed lesions

35. Medication Therapy: • Topical- need to reduce bacteria on skin • Benzoyl peroxide • Tretinoin (Retin-A)-avoid exposure to sun • Oral- antibiotics • Tetracycline, minocycline, erythromycin • Isstretinoin (Accutane-no longer available) • Dietary • Hygiene

36. Therapeutic Management • Goal- to prevent scaring and promote positive self image in the adolescent • Individualized according to the severity of the condition • 3 to 5 months required for optimal results (4 to 6 weeks for initial improvement)

37. Nursing Implications • Provide information regarding the treatment regimen (don’t forget side effects of antibiotic therapy and relationship to oral birth control) • Provide support and promote positive self image • Provide accurate information on the length of time required for effective treatment

38. Thank you,let me know if you have any questions regarding my lectures. >^,,^< mmeador@austincc.edu