112-skin

Rotavirus

\-Intestinal virus

\-Extremely contagious

\-Transmitted through: stool, saliva, and poor handwashing

\-Common in fall and winter

\-Resistant to: disinfectant solutions, and antibacterial soaps

Interventions for pneumococcus

\-Mild cases

\-Severe cases: hospitalization

Nursing considerations for mumps

Complications- epididymitis in males, fertility issues, meningitis, encephalitis

Incubation period for influenza

24-72 hours

Cause of rocky mountain spotted fever

Ticks

Layers of the skin

\-Epidermis

\-Dermis

\-Subcutaneous fat

Accessory structures of the skin

\-Sebaceous glands

\-Sweat glands

\-Nails

What is skin sensitive to

\-Temperature

\-Touch

\-Pain

\-Pressure

Chemical skin reaction

\-laundry detergent

\-drugs

Allergic skin reactions

\-Food allergies

\-Skin allergies

Microbial skin reactions

\-Fungal skin infections

\-Viral skin infections

\-Parasitic skin infections

biggest cause of rashes (exanthems)

Viral infections

Wheals

round, elevated skin lesions, often temporary, that look white in the center and are surrounded by red inflammation

Braden Q scale

adopted from adult version of the Braden Scale created for pediatric patients

Common areas of skin breakdown

Back of head, nose, buttocks, groin, back, chest, face, ears

Infant skin

\-Sensitive and thinner

\-Marks mistaken for birthmarks

\-Bruise easily

\-More reactive and sensitive

Macular rash

***flat rash with circumscribed boundaries and color changes***

papular rash

***raised, solid lesion with circumscribed boundaries and color changes***

vesicle

***rash with raised, clear, fluid-filled lesion***

Hives

uticaria

Considerations for skin healing

\-Heat can irritate a rash

\-Warm packs for infectious lesions

***(contact precautions)***

\-No cornstarch or baby powder to rash

***(prevent inhalation) (use pastes and lotions instead)***

\-Prevent scratching

***(cover hands with socks or mittens, elbow restraints)***

\-Use care with oral/topical antihistamines

***(doctors orders and double check)***

\-Preventing the spread of infection

***(ppe and contact isolation prn)***

\-Clothing

(loose clothing. Cotton material, wash soiled clothing and bedding separate from other clothes)

Factors that influence wound healing

—Wound base environments

***(keep moist, free of pus)***

—Nutrition

***(Vitamins, zinc, protein)***

—Circulation

***(pressure ulcers and smoking reduce circulation)***

—Chronic illnesse

***(diabetes, and anemia delay healing)***

Ensure clothing fits loosely and is made of cotton

The mother of a toddler is upset because the child experiences rashes in the winter. What should the nurse suggest to help with this skin condition?

Cause of Lyme disease

Ticks

Meningococcemia

antibiotics are needed to save life

Hemangioma

Birth marks that are benign tumors

Warts

caused by papilloma virus

Styes

infection and swelling of eyelid gland

Candidiasis

yeast infection

Herpes simplex

type 1 cold sore, type 2 genital

Frostbite

warm water and immerse hands and drink warm fluids

Contact dermatitis (diaper rash) assessment

\-Bright red maculopapular rash

\-Weeping skin rash

\-Irritability or inconsolable

Contact dermatitis interventions

\-Keep skin clean and dry

\-Change diaper often

\-Wash skin with soap and water

\-Leave skin open to air

Nursing considerations for contact dermatitis

change diaper quickly

zinc oxide cream

Assessment for poison ivy, oak, and sumac

\-Severe pruritus (itching)

\-Red streaks

\-Vesicles

Interventions for poison ivy, oak, and sumac

\-Wash skin

\-Wash clothing

\-Calamine lotion

\-Topical/oral antihistamines

Assessment for cellulitis

\-Warmth, edema, tenderness

\-Red “streaking” lines

\-Fever

\-Enlarged lymph nodes

\-Elevated WBC

Risk factors for cellulitis

immunocompromised, diabetic

Interventions for cellulitis

-Oral antibiotic

\-IV antibiotics

\-Warm packs

\-Non occlusive dressings

Nursing considerations for contact precautions

\-Contact Precautions

\-Blood cultures

Eczema

autoimmune inflammatory skin disorder

Triggers for eczema

Food, winter, saliva, dust, pollen, pet dander, dry skin, sweating, heat, infection

Lab and diagnostic tests for eczema

none

Assessment for eczema

\-History of allergies

\-Red, scaling papules and vesicles

\-Common in warm and moist locations

\-Also scalp, cheeks, wrists, neck, hands, groin

\-Lichenification

Interventions for eczema

\-Prevent infections (keep nails short)

\-Shower after sweating,  lotion

\-Steroid creams

\-Topical immunomodulators

\-No bubble bath or bath oils

\-No wool, synthetics, etc

\-No harsh detergents, soaps, perfumes, lotions

\-No tight clothing

\-No scratching, licking, chewing site

Thrush assessment

-Itching burning irritation

\-White plaques inside mouth

\-“satellite” lesions (small lesions around main lesion)

Interventions for thrush

\-Mouth (oral antifungals)

\-Skin (topical antifungals, cool water soaks, expose area to air)

Nursing considerations for thrush

Education to parents about patient not wanting to eat. Cold foods that soothe mouth

Tinea captis

Scalp. Patchy hair loss, scaling on scalp

Tinea pedis

Athletes foot, red rash between toes, painful and itchy, deep fissures between toes

Tinea ungium

Nails

Tinea cruris

Jock itch. Itching in groin and skin folds, occurs after sweating

Tinea corporis

Body, extremities, trunk, perfect round circles red with sharp margins

Tinea versicolor

Uneven pigmentation of the skin. Uneven tanning. Common in adolescence

Tinea capitus interventions

scalp & hair-topical antifungal shampoos

Tinea pedis interventions

“athletes foot”-topical antifungal cream, sandals in public showers

Tinea cruris interventions

groin “jock itch”- topical antifungal, change underwear immediately, don’t leave clothes in gym bags

Tinea corporis interventions

groin, extremities, trunk- topical antifungals

Nursing considerations for ringworm

Education. Cleaning wrestling pads

Scabies

\-Skin infection with tiny mites that burrow into skin

\-Lay eggs along burrow tract, Eggs hatch every 30 days, After hatching travel to skin surface

Assessments for scabies

\-Intense itching that interrupts sleep

\-burrows

\-Rash with macules, papules, bright red erythema

\-Skin scrapings

Interventions for scabies

\-Thin layer scabicide (permethrin cream)

\--Lindane lotion

\-Entire family may need treatment

\-Wash all clothing, linen, blankets

\-Vacuuming furniture, floors, carpets, car interiors

\-Store non-washable items in sealed bags for 3-4 weeks

Nursing considerations for scabies

\-Education. Burrows present 2-3 weeks after treatment. Don’t share bedding, clothes, and personal hygiene items

Impetigo

highly contagious rash caused by staphylococci or group A β-hemolytic streptococci

Most common places for impetigo

face around the mouth

Assessments for impetigo

\-Rash that progresses from macular to papular to pustular

\-Vesicles

\-Honey colored crust

\-Mild enlarged lymph nodes

\-Burning and pruritus

\-Hx of insect bites/stings

\-Hx of family members with similar rash

Interventions for impetigo

\-Bacitracin ointment

\-Oral antibiotics

\-Cut nails short

\-Don’t use same linens or washcloths  

Nursing considerations for impetigo

Remove scabs gently

Lice

\-highly communicable parasites

\-Spread via: hats, jackets, etc.

\-Do not fly or jump

\-Lay eggs at base of the hair shaft (nit)

\-Hatch every 10-14 days.

\-Adults can only live 48 hours without a host, nits 8-10 days

Assessments for lice

\-Intense itching

\-Presence of lice

\-Presence of nits

\-Length of infection determined by: distance from the scalp to the nit

Interventions for lice

\-Pediculicide

\-Each nit egg sac must be removed

\-Treat environment

Acne

\-clogging of pores with sebum, medium for bacterial growth

\-form comedones or open comedones

Assessments for acne

\-Clogged pores

\-Comedones

\-Possible scarring

\-Impact on self-esteem

Interventions for acne

\-Wash face daily

\-2% salicylic acid

\-Do not reuse washcloths

\-Antiacne cream - Benzoyl peroxide

\-Warm cloth compress

\-Do not pop or squeeze

\-Naturopathic remedies 

\-Oral antibiotics 

\-Accutane

Nursing considerations for acne

Not caused by diet, hygiene, or emotions… but can exacerbate acne

Cause of electrical burns

Current passes through body.

Cause of thermal burns

Direct contact with hot metal, water or fumes

Cause of chemical burns

Exposed to battery acid

Cause of radioactive burns

Solar burns.

Cause of immersive burns

Body part immersed in hot water.

First degree (partial thickness) burns

\-Epidermal layer only

\-Painful, dry, red, edematous

Second degree (partial thickness) burns

\-Epidermis down into dermis

\-Edematous and weeping, Painful

\-May require: grafting

Third degree (full thickness) burns

\-Epidermis, dermis, subcutaneous fat, structures

\-Leathery dead tissue

\-Does not blanch

\-Most have no pain

Fourth degree (full thickness) burns

Extends to or through the bone

Assessments for childhood burns

\-Rule of nines

\-Minor (less than 10 percent of body area and partial thickness)

\-Major (full thickness and more than 10 percent body area. Or involves respiratory tract, or soft tissue injury)

Priorities for childhood burns

1\.**Airway assessment**, CPR if needed

2\.Lips/mouth (intubate)

3\.shock symptoms

4\.Signs of hypovolemia

5\.Pain level

6\.Fluid shift

7\.Renal function and urine output

8\.LOC

9\.Signs of infection (not a priority in the first 24 hours)

Rule of nine percentages for children

\-Face 18%

\-Back 18%

\-front trunk 18%

\-arm 9%

\-genital area 1%

\-leg 13.5%

Interventions for childhood burns

\-CPR

\-Stop the burning process

\-Treat shock

\-Use sterile technique

\-Relieve pain

\-Elevate to help with edema

\-Monitor labs

\-Monitor fluid balance

\-Restore protein loss

\-Daily weight

\-Blood transfusions

\-Cool water

\-Topical medications to promote healing and provide protection 

Assessment for tattoos and piercings

\-Warmth

\-Redness

\-Pus

\-Discomfort

\-Allergy to metal

Interventions for tattoos and piercings

\-Remove if allergy

\-Keep clean

\-No tub bath, swim, hot tub until healed

\-Sunblock over tattoos

Nursing considerations for tattoos and piercings

\-Education to prevent infection such as HIV or hepatitis

\-Negative long-term effects of tattoos such as regrets

Apply sunblock over the tattoo

The mother of a 13-year-old is upset because the child had a tattoo placed on the upper arm. What should the nurse instruct this mother?

Standard precautions

Handwashing, gloves.

Airborne precautions

Mask, private room, gown, gloves, goggles

Droplet precautions

Gown, mask, gloves

Contact precautions (enteric)

Gloves, gown

Expanded contact

Gown, gloves, handwashing only (no hand sanitizer)

Protective precautions

Gowning, gloves, mask, garbage outside the room 

Immunity

develop antibodies against: bacteria, viruses, and toxins

Antigen

foreign substance that stimulates formation of antibodies