Part 3: Skin Integrity and Related Conditions

ALTERATIONS IN SKIN INTEGRITY


Skin Assessment

  • Inspection
      - Skin color
      - Capillary refill: less than 2 seconds

  • check for bruises, jaundice, pallor, and bumps

  • Palpation
      - Temperature: warm
      - Texture: smooth and soft
      - Moisture: dry
      - Turgor: check on their abdomen

  • Lesions


Dermatitis

Types of Dermatitis- contact, diaper, and seborrheic

  • Contact Dermatitis
      - Allergens, leading to symptoms such as: from poison ivy
        - Itching
        - Redness
        - Swelling
        - Vesicles
      - Treatment options include:
        - Topical corticosteroids
        - Oral corticosteroids for extensive reactions
      - Irritant contact dermatitis: could be from laundry soap or lotions
        - Symptoms include: redness, swelling, vesicles, and exudate
        - Treatment includes emollients and Hydrocortisone


Diaper Dermatitis

  • Causes:
      - Urine and feces combine with moist skin

  • Symptoms:
      - Raw, moist, or weeping macules and papules in contact with the diaper
      - Skin folds are usually spared

  • Treatment:
      - Use moisture barriers
      - Change the diaper with every feed

  • If yeast is the cause, the treatment will be Nystatin Cream


Seborrheic Dermatitis/Cradle Cap

  • Symptoms:
      - Itching
      - Mild redness
      - Waxy or greasy scales on the scalp that are difficult to remove

  • Treatment:
      - Treated with daily shampooing


Mystery Skin Infection Case Study

  • Patient Profile: Tim

  • Symptoms Reported by Mother:
      - Red, watery-looking bumps with yellow fluid around the mouth and nose
      - Previous history of a small cut near the corner of his mouth


Impetigo

  • Definition: Epidermal infection

  • Common Sites of Infection:
      - Face
      - Mouth area
      - Hands
      - Neck
      - Extremities

  • Portal of Entry: Minor skin injuries, they provide an opening for infections

  • Papules that turn into vesicles = honey-colored crusts


Treatment Advice for Impetigo

  • Steps to Recommend:
      - Remove crusts with warm water and antiseptic soap
      - Apply topical bactericidal ointment for 5 days
      - If no improvement, recommend contacting PCP for possible oral antibiotics


Education for Impetigo

  • Contagious Nature: Impetigo is contagious until 24 hours after starting antibiotics

  • Additional Advice:
      - Keep Tim’s fingernails short and clean (to prevent it getting infected)

  • teach our pts hand washing


Fungal Skin Infections

  • Thrush: Characterized by white patches on the oral mucosa

  • could have gotten from mom during delivery

  • will not wipe off if you try to

  • pt will get oral Nystatin

  • Ringworm (Tinea): Affects skin, hair, or nails

  • pt will get antifungal medication


Atopic Dermatitis (Eczema)

  • Definition: Chronic, relapsing, superficial inflammatory condition

  • Symptoms:
      - Intense itching

  • Etiology: Multifactorial disorder including:
      - Genetics
      - Skin barrier defects
      - Immune system dysfunction
      - Environmental exposures

  • food, temp, humidity, and stress could be the cause/ trigger


Physical Assessment Findings

  • Red, dry, cracked skin patches

  • vesicles, exudate, crusts

  • Intense pruritus

  • Excoriation from scratching

  • They will be hyperactive kids due to their itching

  • They can also be irritable


Treatment for Atopic Dermatitis

  • Homecare Instructions for Sam include:
      - Hydrate and lubricate the skin to reduce itching
      - Use low-strength corticosteroids on thin skin

  • pat them dry and apply moisturizer within 3 minutes of getting out of the bath

  • apply moisturizers 3-4 times a day


Managing Flare-ups

  • Options:
      - Nonsteroidal anti-inflammatory ointments: 2-3 times a week
      - Phototherapy: 4-8 weeks
      - Oral antibiotics for secondary infections
      - Diluted bleach baths
      - Oral antihistamines to help sleep for 2-7 nights
      - Wet wrap therapy: apply cream/ lotion, then put on a warm/ wet pair of pjs, and then put a dry pair of pjs on top




Pediculosis Capitis (Lice)

  • Definition: Head lice that live and reproduce on humans

  • Transmission: Spreads through close contact and sharing items like hair accessories, brushes, hats, towels, and bedding

  • don’t fry or jump

  • they crawl from person to person

  • black people don’t get it due to the texture of their hair

  • can lay up to 10 eggs daily


Symptoms of Lice

  • intense itching

  • Presence of “dandruff” that sticks to hair


Treatment for Lice

  • Key Steps:
      - Kill active lice
      - Remove nits
      - Prevent spread or recurrence

  • Pediculicides: Options include NIX, RID in cream rinse or shampoo form

  • RID cream for 2 years and older

  • NIX can be used for 2 months and older


Education on Lice

  • Additional measures in treatment include:
      - Comb out all nits
      - Wash clothing and linens in hot water and dry with hot heat
      - Seal items like helmets and headphones in a bag for two weeks after cleaning
      - Vacuum carpets and furniture


Burns

  • Types of Burns:
      - Thermal:
        - Exposure to flames, scalds, or hot objects
      - Chemical:
        - Touching or ingesting caustic agents
      - Electrical:
        - Exposure to electrical currents from wires, appliances, or high voltage wires
      - Radioactive:
        - Caused by sunlight or radioactive substances

  • Risk Factors: Related to the developmental stage of the individual

  • Infants will normally be thermal

  • Toddlers will normally be thermal, chemical, and electrical

  • Adolescents can be all of them


Classification of Burns by Depth

  • Partial Thickness Burns:
      - Injured tissue can regenerate and heal

  • 1st and 2nd degree

  • pink skin

  • minimal scarring

  • painful

  • Full-Thickness Burns:
      - Injured tissue cannot regenerate; skin grafts are required

  • 3rd degree

  • no pain bc the nerve endings are gone

  • all epidermis is damaged


Serious Burns Criteria

  • Determined by:
      - Depth
      - Percentage of body surface area affected
      - Body parts burned

  • Management Steps:
      - Circulation, Airway, and Breathing must be assessed
      - Stop the burning process: remove burning clothing and jewelry
      - Rinse affected areas, cover them, and transport to the emergency department (ED)


Focus of Treatment for Major Burns

  • Decrease fluid losses

  • Control pain

  • Prevent infection

  • Promote nutrition

  • Salvage all viable tissue


Interventions for Major Burns

  • Fluid Replacement: Use of Lactated Ringer's (LR) or Normal Saline (NS)

  • Pain Control: Via IV opioids

  • Infection Control: Drainage management, assessing edema and color

  • Nutritional Support: Continuous enteral feeds

  • Surgical Management: Salvaging viable burned tissue

  • manage temp closely- they have an increased metabolic rate, so their temp can increase easily

  • supplement vitamins

  • emotional support


Care of Minor Burns

  • Use moist soaks; avoid ice- cool running water

  • Debride any open blisters

  • Apply topical antibiotic medication to any open wounds

  • Cover the area to keep it clean and dry- change dressings every 1-2 days

  • Follow-up: Ensure the importance of follow-up visits

  • Sunburn Prevention: Use SPF 30 or above- 30 minutes before activity

  • feet, hands, and genitals burns need to be treated immediately