Peds: Integumentary alteration by Lucy
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| Pediatric Differences in the Skin | Skin thinner,more susceptible to irritants & infection.Ratio of skin surface area to body volume is greater increased absorption.More susceptible to bacterial invasion. Less ability to regulate temperature.
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| Infections of the Skin | Bacterial, Fungal, Viral, Impetigo, Cellulitis, Candidiasis, Tinea, & Herpes simplex virus (HSV).
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| Impetigo | Can be caused by Staphylococci or group A beta-hemolytyic streptococci.Bullous form seen in infants usually staph.Nonbullous form is seen in children&young adults. Incubation period 7-10days.Very contagious Treatment:topical,oral, parenteral antibiotics.
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| Caring For a Child with Impetigo (1) | Teaching: family and children. The child can spread Impetigo merely by touching another part of the skin after scratching infected areas. Keep the child's fingernails short and wash the child's hands frequently with antibacterial soap.
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| Caring For a Child with Impetigo (2) | Emphasize good hand washing and careful hygiene for the entire household. Discourage family members from sharing towels, combs, or eating utensils with the infected child.
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| Cellulitis | Definition:Bacterial infection of subcutaneous tissue&dermis. Associated w/break in the skin.Cause:Strep,S.aureus, H.influenze.Incidence:most common in children>2yrs.Most common in lower extremities,buccal, periorbital area.Patho:failure of immune system.
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| Signs & Symptoms of Cellulitis | Redness, heat, tenderness, swelling. Purple-tinge (H.influenze). Lymphangitis with red streaks, lymph nodes. Fever, malaise, headache.
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| Diagnosis of Cellulitis | CBC, blood cultures, tissue culture. CT scan.
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| Treatment of Cellulitis | Antibiotics. Possible incision & drainage.
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| Candidiasis | Definition:yeast infection, superficial, oral(thrush), lesions in diaper area. Cause:Candida albicans.Incidence:Most common in infants.Newborns acquire during delivery.Older infants from antibiotics,mom's breast,unclean pacifiers&bottles,immunosuppression
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| Signs & Symptoms Candidiasis | Oral: White curdlike plaques on tongue, gums, mucosa. Diaper:bright red, coalesced, lesions spreading out.
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| Dagnosis of Candidiasis | Based on clinical appearance of lesions.
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| Treatment for Candidiasis | Oral: Nystatin oral suspension. Gentian violet, Diflucan. Diaper: topical antifungal agent. Nystatin
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| Fungal Infectiions | Invade stratum corneum, hair, and nails. Fungi are larger than bacteria. Dermatophytes-group of fungi. Diagnosis: based on clinical appearance. Potassium hydroxide confirms.
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| Five Common Types of Tinea Infection | Tinea captitis (scalp), Tinea cruris (groin, buttocks, and scrotum). Tinea unguium (nails & nailbeds). Tinea corporis (trunk, face, extremities) Tinea pedis (feet)
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| Signs & Symptoms of Tinea Capitis | Redness, scaling of scalp, round patches of alopecia, smaall papules at base of hair follicles. Kerion formation:immune reaction to fungus. Children with allergies more susceptible.
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| Treatment for Tinea Capitis | Oral Griseofulvin for 608 weeks. Given with milk or fatty meals. Selenium sulfide shampoo.
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| Signs & Symptoms of Tinea Corporis | Fungal infection of face, trunk, extremities. Characteristic ring-like plaques, pale center, red margins size 1/2 1 inch, itchy.
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| Treatment for Tinea Corporis | Local topical antifungal ointments (3X qd). Treat infectived pets. Rare extensive cases systemic antifungals.
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| Signs & Symptoms of Tinea Cruris | Intense inflammatory reaction. Severe pruritus. Pink papules, scales on inner thighs, groid, scrotium, buttocks.
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| Treatment for Tinea Cruris | Topical antifungals 2X qd to lesions. Loose clothing.
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| Signs & Symptoms of Tinea Pedis | Fine vesiculpustular or scaly lesions. Soles of feet, between toes, under nails. Peeling fissures, maceration in severe cases. Pruritus, burning. May become chronic.
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| Treatment for Tinea Pedis | Topical antifungal agent 2X qd. Griseovulvin for severe cases for minimum of 4 weeks.
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| Herpes Type I | Cold sore.fever blister.may feel tingling,itching, on the lip. Vesicles and crusts form,takes up to 10 days to heal.Communicable in the early phase of the outbreak.Recurrence is common because virus is dormant & activated by stress, menstruation, fever
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| Treatment of Herpes Simplex Type I | Antiviral medication, oral and topical
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| Cause of herpes Simplex Infections | HSV1 (oral type, above waist) HSV2 (below the waist)Transmitted by infected body fluids to skin breaks. Delivery through infected birth canal. Poor handwashing. Burns, eczema, diaper rashes, immunosuppression.
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| incidence of Herpes Simplex infections | Widespread: 50 % of children infected with HSV1 by 5 years. HSV2 is rare before 14 years.
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| Manifestations of Herpes Simplex Infections | Herpes labialis ("cold sore,""fever blister:) Herpetic Gingivostomatitis.Herpetic ocular infection. Herpetic whitlow.
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| Clinical Course of Herpes Labialis (Cold Sore) | Prodromes: burning, itching, tingling. Symptoms appear 2days-2weeks after exposure. Lesions: Clusters of fluid-filled vesicles. Ulcerations then dry & crust within 7-14days.
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| Manifestations of Herpes Gingivostomatitis | Severe oral infection affects children younger than 5 years. Vesicles, ulcerations. edematous throat, painful cervical lymph nodes. Chills, fever, bad breath, & drooling.
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| Herpetic Ocular Infection | Irritation & Inflammation of conjunctiva, cornea. Vesicles on eyelid, mucous membranes of eye.
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| Herpetic Whitlow | Vesicles, swelling, pruritis, pain in affected fingers.
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| Diagnosis of Herpes Simplex Infections | Clinical manifestations, pt. history. Tissue culture.
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| Treatment for Herpes Simplex Infections | Symptomatic, oral acyclovir, IV acyclovir for immunocompromised Kidsk ocular infection, encephalitis.
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| Pediculosis | Three types: Pediculosis capitis (head lice), Pediculosis corporis (body lice), Pediculosis pubis (pubic lice "crabs"). survival depends on blood extracted from infected person.
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| Lice | Small, blood-sucking insects 2mm - 4mm. Live only on humans. Transmission: Direct contact infected humans. Indirect contact infested objects. Clean hair is no deterrent.
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| Incidence of Lice | 6-12 million cases each year in kids 3-12 yrs. Rare in African-American. Twice as common in girls. All socioeconomic groups affected. Pubic lice seen in adolescents.
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| Pediculosis Capitis (head lice) | Nits visible, attached to shafts. Silvery specks. Common behind ears, nape of neck. Adult lice difficult to see.
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| Pediculosis Corporis (body lice) | Papular, rose-colored dermatitis. Intense itching. Nits attach to seams of child's clothing, bedding.
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| Pediculosis Pubis (pubic lice, crabs) | Lice found in pubic hair, facial hair, axillae, body surface. Intense pruritis. Blue spots (maculae ceruleae) on trunk, thighs, with heavy infection.
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| Diagnoisis of Pediculosis | Identification of nits or lice on scalp. Pubic lice by symptoms, visual inspection.
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| Treatment of Pediculosis | Kill active lice. OTC products (RID, Triple X, Nix) two treatments 1 week apart. Remove nits. Prevent spread or re-occurrence. Treat environment by washing clothes, bedding. Examine other family members, classmates, vacuum.
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| Scabies | Parasitic. Caused by female mite. Burrows under skin and lays eggs, especially between fingers. Burrows contain egg and feces. Thrives in moist body folds. Spread by close personal contact.
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| Treatment for Scabies | The application of Permethrin. All family members, as well as the home and car, require treatment.
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| Insect Bites | Most insect bites are not serious. Sensitive children severely allergic.
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| Dangerous Insects (Brown Recluse) | Brown Recluse: Mild stinging at time of bite. Painful, redness, blister. venom is necrotoxic. Ulcer takes several months to heal. Treatment:Immobilize, elevate extremity. No anti-venom.
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| Dangerous Insects (Black Widow) | Symptoms: Bite initially painless. Pain develops in 1hour. Severe muscle pains, numbness. Puncture site red, swollen, itchy. Neurotoxin:dizziness, headache, cramps, tremors,tachypnea. Shock renal failure in young children.
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| Treatment for Black Widow bites | Hospitalization for children. Supportive care (IV Ca Gluconate, muscle relaxants, tetanus prophylaxis.)
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| Dangerous Insects (Scorpions) | Most not dangerous, rarely attack humans. Centruroides sculpturatus (found in AZ). Extremely poisonous. Can be fatal to children >3 yrs.
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| Symptoms of Scorpion bite | Sting is very painful. Local reaction at puncture site. systemic reactions: tachycardia, HTN, dysrhythmias, seizures, pulmonary edema, coma.
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| Treatment for Scorpion Bite | Ice packs, tourniquet (proximal to site to slow venom). Topical steroids, antihistamines. Severe reactions: supportive care. No narcotics, anti-venom. Prevention: wear shoes, inspect shoes & clothing.
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| Animal Bites | Most common:Dogs; 2nd most cats; followed by domestic and wild rodents. Complications:infection, mechanical destruction of skin, muscles, tendons, blood vessels, bone. Risk of rabies. If bites on face,neck, seek medical attention.
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| Cat Bites (Cat scratch fever) | Deep puncture wounds, can involve tendons and joint capsules. Greater incidence of infection: septic arthritis, osteomyelitis, tenosynovitis.
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| Animal Bite Initial Treatment | Initial treatment:clean with copious irrigation, debridement, tetanus prophylaxis, and analgesics as needed.
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| Animal Bite Secondary Treatment | Puncture wounds left open. Laceration loosely sutured. Wounds over joints splinted. Rabies prophylaxis:essential in management of animal bites. Initial injection:Rabies immune globulin.Series of 5 injections of human diploid cell vaccine:Days 0-3-7-14&28.
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