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N114 Integument

N114 - Integument dysfunction

What is a highly contagious, superficial bacterial skin infection characterized by local inflammation & infection? Impetigo
How is impetigo contracted? By a portal of entry, scratch or insect bite allows introduction of bacteria.
What bacteria can cause impetigo? Staph or group A strep
What are the two forms of impetigo? Impetigo contagiosa - crusted lesions & bullous impetigo - fragile bullae or fluid filled blister.
What are the clinical manifestations of impetigo? Begins as small red macules and progress to small, thin roofed vesicles that rupture easily & expose weeping skin. Has a honey colored drainage.
What else can impetigo effect? May cause regional lymphadenopathy.
Where do the lesions normally appear? Most often appear on the face around the mouth and nose. Occasionally occur on back of knees and buttocks.
What treatment is used for impetigo? Topical antibiotic therapy if only a few lesions are present. Keflex or Dynapen can be given orally if lesions are widespread and do not respond to topical treatment.
What nursing management is associated with impetigo? Finish all antibiotics, use gentle soaking to remove crusts, keep nails cut short to prevent further infection, no sharing of towels or personal items, out of school for 24-48 hours after the start of antibiotics.
What is the clinical name for head lice? Pediculosis Capitis.
How is head lice transmitted? Head to head contact, sharing of hats, combs, bedding, & personal items.
What is the lifespan of a louse? Females lay approx 4-10 eggs a day. Eggs are called nits. Nymphs emerge in 7-10 days and mature in 7-14 days. Life span is approx 30 days.
What are the symptoms of an infestation? Persistent itching caused by crawling insect & saliva on skin. Most commonly located in the occipital area, behind the ears & nape of neck.
What is the preferred treatment for pedidulosis? Nix will kill both the lice & nits with one applications. Other products Rid, A-200, Kwell, Scabene require retreatment after nymphs hatch.
What are some alternative treatments? Listerine & Cetaphil
What causes scabies? The scabies mite, Sarcoptes scabiei.
How is scabies transmitted? Close person to person contact, fomite transfer may occur.
What happens after infection? Incubation period is 2 to 6 weeks. Once on human skin, mites burrow into epidermis to deposit eggs & feces - travels in a linear fashion.
What is the major symptom of a scabies infection? Inflammatory response occurs where the mites travel. Severe pruritis occurs usually at night.
How is scabies diagnosed? A microscopic exam of scraping from papule.
What is the treatment for scabies? 5% permethrine cream (Elimite) is preferred treatment. One application is usually sufficient. All household members should be treated.
What is atopic dermatitis? Commonly know as eczema.
What causes eczema? Does appear to be a relationship to allergies, family history of eczema, asthma.
What is the pathology of eczema? It is thought to be an autoimmune disorder.
What are the symptoms of eczema? Persistent pruritus and scratching.
What does an acute lesion look like? Acute - pruritic erythematous papules, may have serous exudate & crusting.
What does an subacute lesion look like? Subacute - papules are excoriated with fine scaling, mild linchenification may be present.
What is linchenfication? Thickening of the skin
What does a chronic lesion look like? Chronic - marked lichenfication is present. Fibrotic papules and hyper or hypopigmentation are present.
Where to the lesions occur? Distribution varies by age. Infancy - primarily on face, scalp & extensor (outside) surfaces of extremities. By age 2 - lesions on the flexural surfaces of the body, antecubital, popliteal, wrists ankles & neck
What is the 1st goal to managing eczema? Relieve pruritis - oral antihistamine, non-medical - cornstarch or oatmeal baths.
What is the 2nd goal to managing eczema? Hydrate skin - moisturizing emollients - contain lipids - best used withing 3 minutes of bathing.
What is the 3rd goal to managing eczema? Reduce inflammation - topical steroids, use least potent steroid that is effective
What is the 4th goal to managing eczema? Prevent or control secondary infection - keep fingernails short, avoid irritants, use mild detergent, no wool clothing
What is the pathology of diaper dermatitis or diaper rash? Skin breakdown occurs due to prolonged contact with physical & chemical irritants. Urine pH, stool consistency, frequency of urine & stool, type of diaper & friction.
What is the clinical symptoms of normal diaper rash? Area is shiny red. In severe cases, vesicles, papules and scaling may occur.
How is candidal diaper dermatitis different? Caused by overgrowth of Candida albicans. Site appears beefy read with satellite pustules.
How can diaper rash be prevented? Frequent diaper changes. Use of barrier creams (desitin & butt paste). Avoid powder.
How is diaper rash treated? Low dose steroid creams for severe cases. Candida infections require an antifungal agent like nystatin (Mycostatin).
What is seborrheic dermatitis? Also known as cradle cap.
What can cause cradle cap? Inflammatory changes thought to result from dysfunction of sebaceous glands & hormonal activity. May be caused by yeast overgrowth in adolescents.
What are the clinical manifestations of cradle cap? Thick, adherent, whitish yellow, scaly, oily patches on scalp.
Where is cradle cap found? Infants - mostly found on scalp. Adolescents - begins on scalp, may involve eyebrows, forehead, eyelids, external ear canals, inguinal region (groin).
What is the treatment for cradle cap in infants? Daily washing of hair, let shampoo petroleum jelly, or mineral oil in place, then remove with a fine toothed comb.
What is the treatment for cradle cap in adolescents? May use medicated shampoo containing sulfur or salicylic acid. Topical corticosteroid with or with out sulfur or salicylic acid may be used.
What causes acne (acne vulgaris)? Has been associated with increased androgen & sebum production.
What other factors can contribute to acne? Heat, oil-based cosmetics, menstrual cycle, steroid administration. Stress
What three factors are involved in the development of acne? Excessive sebum production. Formation of comedones, either open (blackhead) or closed (whitehead). Overgrowth of propioni bacterium acnes-a benign organism always present on the skin.
What is comedonal acne? Obstructive & noninflammatory. Comedones are the characteristic lesions, may be open or closed.
What is inflammatory acne? Characterized by inflammatory papules-red lesions, pustules-contain pus & nodules-larger and deeper in dermis, more likely to cause scaring.
How is tretinoin (retin A) used? Used for comedonal acne. Interrupts the process that forms comedones.
How is benzoyl peroxide used? Kills propioni-bacterium acnes organism. Effective against both inflammatory & noninflammatory acne.
How are topical antibacterial agents used? Used with inflammatory lesions accompany comedones. Clindamycin & Benzamycin
How do oral contraceptives help acne? Reduce andogen production.
How is Accutane used? Reserved for severe cystic acne. Decreased sebum production, given for 20 weeks. Can cause dry skin & eyes, decrease night vision, headaches, mood changes, depression & suicidal tendencies. Accutane has teratogenic effects.
What other therapies are used to treat acne? Laser & light therapy to reduce sebum production. Chemical peel & microdermabrasion.
Created by: jrb265