Integumentary System (Study for Family HESI)

What are some examples of primary lesions?

• Macules

• Papules

• Nodules

• Tumors

• Plaques

• Wheals

• Vesicles

• Bullas

• Pustules

What are some examples of secondary lesions?

• Scales

• Crust

• Fissures

• Ulcers

• Atrophy

What are the two most common causative bacteria for integumentary conditions?

Staphylococcus and Streptococci

Which is more difficult to treat: Staphylococci or streptococci?

Staphylococci

How can integumentary bacterial infections be prevented?

• Good handwashing

• Clean clothes

• Don’t share utensils/razors/towels

• Don’t touch lesion to other body part.

What happens if you squeeze a bacterial lesion?

It may spread the infection or make it worse.

What type of bacteria causes Impetigo contagiosa?

Staphylococcus.

How does impetigo contagiosa progress?

Red macule → Develops vesicles that rupture → Superficial moist erosion occurs → Exudate forms heavy honey-colored crusts.

What is the most common symptom of impetigo contagiosa?

Pruritus.

Is impetigo contagious? Can it spread to other parts of the body?

Yes, yes.

What is usually an adequate treatment for impetigo contagiosa?

Topical antibiotics.

Impetigo contagiosa is most common in what children?

Toddlers and preschoolers.

What is true of the healing of impetigo contagiosa?

It heals without scarring.

What is folliculitis?

Infection of hair follicle (pimple).

What is a furuncle?

A large lesion with more redness and swelling at a single follicle (boil).

What is a carbuncle?

A more extensive lesion with widespread inflammation at several follicles.

What types of bacteria cause folliculitis, furuncles, and carbuncles?

Staph aureus and MRSA.

Are folliculitis, furuncles, and carbuncles contagious? Can they spread to other body parts?

Yes, yes.

Should you squeeze a carbuncle, furuncle, or a folliculitis lesion?

No.

How are folliculitis, furuncles, and carbuncles treated?

• Warm compress

• Topical antibiotics

• Parental antibiotics (if severe)

• Incision and drainage

What type of bacteria cause cellulitis?

Streptococcus, staphylococcus, haemophilius influenzae.

What is cellulitis?

Inflammation of skin and subcutaneous tissue that leads to intense redness, swelling, firm infiltration, and "“streaking”.

Cellulitis may progress and form what?

An abscess.

How is cellulitis treated?

Oral or parenteral antibiotics.

When is hospitalization necessary for cellulitis?

Systemic symptoms are present.

What causes scalded skin syndrome?

Staph aureus toxins.

How does scalded skin syndrome progress?

It starts as a macular erythema with a sandpaper texture. The epidermis then becomes wrinkled causing large blisters to appear and then slough off.

Scalded skin syndrome primarily affects what demographic of children?

Infants and young children (especially those with weak immune systems).

How is scalded skin syndrome treated?

Systemic antibiotics.

What are some complications that may result from scalded skin syndrome?

• Fluid loss

• Impaired temperature regulation

• Secondary infection

During a viral infection, epidermal cells react with inflammation and cause either…

Vesiculation (small blister-like lesions) or proliferation (warts).

Intracellular parasites are a form of _____ infection.

Viral

What type of virus causes Verruca (warts)?

Human papillomavirus.

How are the verruca (warts) described?

• Well circumscribed

• Gray or brown

• Elevated

• Firm papules

• Rough texture

Where are verruca (warts) usually found?

On exposed skin (hands, fingers, and face) but can be anywhere.

Can verruca go away on their own?

Yes.

Verruca are considered autoinoculable. What does this mean?

Repeated irritation will cause enlargement.

What type of Herpes Simplex Virus is associated with cold sores and fever blisters?

Type 1.

What type of HSV is associated with genital lesions?

Type II.

How do HSV vesicles progress?

Start with a reddened base and burn and itch → vesicles dry and form crust → skin exfoliates and healing occurs in 8-10 days.

Regional lymphadenopathy is possible with what type of viral infection of the skin?

HSV.

How is HSV treated?

Oral antivirals.

What is true of HSV and mortality in children?

HSV can be fatal for children with depressed immune systems.

What is another name for molluscum contagiosum?

Pox virus.

How do lesions from molluscum contagiosum (pox virus) appear?

They are flesh colored papules with a central caseous plug → it may be umbilicated and have a pearl apperance.

Where can pox virus appear on the skin?

Anywhere, single to multiple lesions.

What is true of the pox virus and how it resolves?

It usually responds spontaneously (may take up to 3 years)

Is treatment needed for the pox virus?

No.

How can pox virus spread?

Skin-to-skin, autoinoculable, skin-to-fomite transmission.

How are fungal infections spread?

Person-to-person, animal-to-human, in soil.

What type of fungi causes ringworm?

Tinea

What is tinea corporis?

Ringworm of the skin.

What is tinea capitis?

Ringworm of the scalp.

What is tinea pedis?

Athlete’s foot.

What is tinea cruris?

Ringworm in the groin region.

How are the lesions described in ringworm?

Scaly, patchy, circumscribed, and pruritic.

What type of ringworm is usually unilateral?

Tinea corporis.

How is ringworm treated?

• Topical antifungals (-azole) (first line)

• Topical selenium sulfide shampoos (Selsun Blue)

• Oral antifungals (if severe or if topicals are ineffective)

What fungal infection does Griseofulvin treat?

Ringworm.

What are the nursing implications of Griseofulvin?

• Take it with fatty foods.

• May have to take for weeks to months for the effects.

• Lab monitoring is required for prolonged use.

What bacteria causes Candidiasis?

Candida albicans.

Yeast infections, thrush, diaper rash, etc. are caused by what fungus?

Candida albicans (Candidiasis)

Where does Candida albicans grow?

In chronically moist areas.

What are some symptoms of Candidiasis?

• Inflammation

• White exudate

• Peeling

• Easy bleeding

• “Yeasty’ odor

• Pruritic

What is true of the recurrence of Candidiasis?

It can be chronic.

How is Candidiasis treated?

• Topical (-azole) (first line)

• Oral (nystatin, -azoles)

• I.V. (if severe/systemic)

What type of fungal infections can invade the viscera and skin?

Mycotic (systemic/deep)

Where do mycotic fungi live and what is true of their spores?

They live in soil and their spores become airborne.

Mycotic fungal infections are most commonly associated with conditions of what organ system?

Respiratory system.

How are mycotic infections typically acquired?

By inhaling spores.

What are some cutaneous lesions found from mycotic fungi?

• Ulcers

• Plaques

• Nodules

• Abscesses

What is the pathophysiology of contact dermatitis?

1. Skin comes into contact with irritating agent.

2. Inflammatory reaction occurs.

3. Vesicles or bullae form on an erythematous base.

What is the most constant symptom of contact dermatitis?

Pruritus.

Where is contact dermatitis usually seen?

On exposed skin areas (face, neck, hands, forearms, lower legs)

What types of plants can cause contact dermatitis?

• Poison Oak

• Poison Ivy

• Poison Sumac

What from animals can cause contact dermatitis?

• Fur

• Wool

• Feathers

What metal can cause contact dermatitis?

Nickel

What synthetics can cause contact dermatitis?

• Dyes

• Cosmetics

• Perfumes

• Soaps

• Bubble Baths

What is the primary goal in treatment for contact dermatitis?

Prevent further exposure to irritating substance.

What are some nursing education points for patients with contact dermatitis?

• Teach child to ID plants or other irritants to avoid.

• Don’t scratch lesions.

• Immediately wash with soap and cold water.

How is contact dermatitis treated?

• Calamine lotion

• Topical/oral corticosteroids

• Antihistamines (for itching)

How long does it take for contact dermatitis to dry and heal?

10 to 14 days.

When a drug reaction occurs, what is the primary organ affected?

Skin.

Which do drug reactions occur more often in: IV or PO medications?

I.V. medications.

What should you do if a patient has a drug reaction while receiving an I.V. medication?

Stop the infusion and maintain the IV with NS.

What is a critical nursing action after administering any medication to a child, especially a new prescription?

Assess the child frequently (to monitor for immediate or delayed reactions).

What are some symptoms of drug reactions?

• Urticaria/Pruritus (child may start scratching before they say they itch)

• Fever

• Malaise

• GI Upset

• Anemia

• Liver damage

• Kidney damage

What type of drug reaction is extensive and has epidermal necrosis?

Stevens-Johnson syndrome.

What are the 2 most frequent culprits of drug reactions?

Penicillins, sulfonamides.

What should be done with all foreign bodies?

They should be washed around thoroughly with soap and water.

How should a sliver be removed from a child?

Use tweezers if possible, but a sterilized needle can also be used.

What is the golden rule of removing a foreign body from a child?

The child should be calm and cooperative before a removal can be attempted.

Removal of what item requires medical evalutation?

Fishhooks.

How should large cacti prickles be removed?

With tweezers.

How can small/fine cacti spines be removed?

1. Apply a water soluble glue to the spines and then cover with gauze.

2. Once glue dries, pull off with gauze.

3. OR

4. Apply hair removal wax or body sugar, let dry, then remove.

5. Cellophane tape.

How would the reactions be described for flies/mosquitoes/fleas?

Mild.

What is the initial action if a patient has a reaction to a fly/mosquito/flea?

Remove the source.

How are reactions to flies/mosquitoes/fleas prevented?

Insect repellent.

What is the treatment focus of reactions to flies/mosquitoes/fleas?

Treat symptoms of itching, prevent secondary infections.

What are the classic bite locations for chiggers?

Sock line/waistband/skin folds.