ALTERATION IN SKIN INTEGRITYINTEGUMENTARY DISORDERSSTRUCTURE AND FUNCTION OF SKINPowerPoint PresentationSlide 5ASSESSMENT OF THE SKINCONDITIONS TO BE DISCUSSEDECZEMAEczema – 3 typesSlide 10Slide 11Slide 12Infantile eczemaSlide 14Slide 15Childhood eczemaBULLOUS IMPETIGOIMPETIGOSlide 19Slide 20Slide 21Slide 22PEDICULOSIS CAPITIS (LICE)Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29RINGWORMSlide 31Slide 32Slide 33Slide 34ACNESlide 36Slide 37Slide 38Slide 39Slide 40Slide 41PSORIASISSlide 43Slide 44Slide 45NEUROFIBROMATOSIS 1 (NF 1)Slide 47CAFÉ-AU-LAITSlide 49Slide 50LYME DISEASESlide 52Slide 53Slide 54Slide 55Slide 56Slide 57Slide 58Slide 59Slide 60Slide 61Slide 62Slide 63SMALLPOXSlide 65Slide 66Slide 67Slide 68Slide 69Slide 70SMALLPOX VACCINESlide 72SMALLPOX will lead us intoTHE END!ALTERATION IN SKIN INTEGRITY Prof. Unn Hidle Updated Spring 2010INTEGUMENTARY DISORDERSSTRUCTURE AND FUNCTION OF SKIN•Structure: 3 layers–Epidermis–Dermis–Subcutaneous (inner layer of adipose tissue) •Function–First line of defense–Temperature regulation–Excretion of water–Production of vitamin D–Sensation of touch, pain, heat and cold•The skin is controlled by:–The autonomic nervous system–The endocrine glands•Sebaceous glands – production of sebum•Eccrine sweat glands (present at birth; functioning by age 3 years) versus apocrine glands (controlled by adrogens; mature at puberty)•Pediatric differences in skin: Can you think of any?ASSESSMENT OF THE SKIN•Involves inspection and palpation:•Texture•Turgor•Color (circulation, rash, birthmarks)•Areas of pressure•Inflammation•Breakdown or emaciation•Bacterial infection (infant/child = high risk)•Systemic symptoms•Reaction of primary irritants•Toxic erythema (increased risk in children)•Diaper rash: lacerations, infections and sweat retentionCONDITIONS TO BE DISCUSSED•Eczema•Bulleous Impetigo•Pediculosis Capitis (head lice)•Ringworm•Acne•Psoriasis•Neurofibromatosis 1•Lyme disease •SmallpoxECZEMA•Description–= Atopic Dermatitis–A superficial inflammatory process involving primarily the epidermis–A common allergic reaction in children (atopy = genetic predisposition)–Family history of allergies: asthma, allergic rhinitis, hay fever, food allergies, etc.–Childhood eczema often begins in infancy and the rash appears on the face, neck, and folds of elbows and knees–May persist for several years or return after the child is older–Sometimes caused by an allergic sensitivity to foods such as milk, fish, or eggs–Seasonal: gets worse in the fall/winter with artificial heating/decreased humidity in homesEczema – 3 types•Infantile eczema:–2-6 months of age–Usually spontaneous remission by 3 years of age–Generalized lesions (erythema, vesicles, papules, scaling, crusting, oozing, weeping)–Usually symmetrical–Cheeks, scalp, trunk and extensor surfaces of extremities•Childhood eczema:–Occurs at about 2-3 years of age–May follow the infantile form–Flexural areas, wrists, ankles, feet–S/S may include Lichenification (thikenied skin with accentuation of creases from scratching) and Keratosis pilaris (overgrowth & thickening of cornifiec epithelium)•Preadolescent and adolescent eczema–May begin at 2 years of age and continue into adulthood–Similar to childhood lesions with lichenified plaquesECZEMAECZEMA•Assessment–As discussed–NO CURE!•Goal of treatment–Relieve pruritus - # 1 FOCUS!!!!–Hydrate skin–Decrease inflammation–Prevent or control secondary infection•Treatment methods–Dry method baths–Wet method – most common–Relieving pruiritis–Secondary infections•Nursing: What is your role in this picture?ECZEMAInfantile eczemaInfantile eczemaChildhood eczemaBULLOUS IMPETIGO •= impetigo neonatorum•Superficial bacterial skin infection•Most commonly caused by Staphylococcus aureus•Assessment:–Eruption of bulleous vesicular lesions on previously untraumatized skin (compared to impetigo – secondary to trauma)–Usually on buttocks, perineum, trunk, face–Size varies–Bullae contain turbid fluid (vs impetigo – honey crust)–Rupture in 1-2 days – leaves superficial red denuded area with minimal crusting–Differential diagnosis – thermal injuryIMPETIGO•Treatment–Warm saline compresses applied to lesions followed by gentle cleansing–Apply topical antibiotics and sometimes administer oral antibiotics as prescribed•Nursing–Isolation until therapy is instituted–Investigate: persons who have come in contact with infant/child; nursery–Teaching: prevent spread of infectionPEDICULOSIS CAPITIS (LICE)•Description:–= Head lice or “cooties”–Caused by Pediculus humanus capitis–A common parasite in school-aged children (ridicule!)–The “louse” is a blood-sucking organism –Can live away from human host for about 48 hours–Female lays eggs at night–Nits or eggs hatch in approximately 7-10 days–Incubation Period: Eggs incubate for about 1 week (7-10 days) and lice reach sexual maturity in about 2 weeks (life span = approx. 1 month)–Infectious Period: During infestation prior to treatment–Transmission: Direct contact with infected person and indirect contact with infected person’s belongings (scarf, hat, pillow, etc. – NOT PETS!)–Season: Nonspecific, a common problem in schoolsPEDICULOSIS CAPITIS (LICE)•Assessment –Adult lice are small gray specks that may be difficult to see–Nits are visible, tiny silver or gray specks resembling dandruff that are firmly attached to the hairshaft near the scalp•S/S–Itching – caused by the crawling insect and insect-saliva–Mostly in scalp, but may be on other places of body (facial hair, chest, groin, etc.)•Dx:–Observing the white eggs (nits)–Differential diagnosis: dandruff, lint, hair spray etc.•Implementation: –Anti-lice shampoo (medicated)•Permetrhin 1% crème rinse (Nix)•Lindane shampoo 1% (Kwell, Scabane)–Do NOT administer after a warm bath or shower (vasodilation and increased absorption)–Manual removal of nits = KEY!!! •Comb•Tweezers or fingernails–Wash clothes, bedlinen–Remove all hats, scarves, etc–Vacuum all rugs and clean house–TEACHING!–PREVENTION!–“Psychological support” – ANYBODY can get it!–National Pediculosis Association – Established guidelines for schoolsRINGWORM•Dermatophytosis = fungal infection: entire category•Types:–Tinea capitis = head fungi–Tinea cruris