Integumentary+Rounds+1

Integumentary Congenital Malformations, Acquired Conditions or Contagions of the Skin:

Newborn rashes and Mongolian spots media type="youtube" key="jQ4mq2PnrrE" width="546" height="408"

Stork bites

Fungus: hair (tinea capitis), trunk (tinea corporis), genital area (tinea cruis, jock itch), feet (tinea pedis, athletes foot)
 * Ring worm **

Treatment depends on area affected Topical antifungals - Selenium Sulfide 2-3 times a week, topical creams clotrimazole, micronazole, tolnaftate, naftifine Oral products may be perscribed for resistant cases Griseofulvin or terbinafine

Nursing education: May be spread from person to person, animal to person, or indirectly by contact with affected linens Continue to take medicine until gone *Id reaction may occur after oral medication this is a reaction to the fungus antigen not the medication

media type="youtube" key="bfczyQbWzP4" width="560" height="315"
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Eczema (Atopic Dermatitis) **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chronic skin disorder characterized by intense itching <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Affects up to 20% of children with 60% of these cases showing up in the first year <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Source is unknown <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Combination of genetics, environmental influences, infectious agents, skin defects and immunologic responses contribute <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Most have T-cell activation and elevated IgE levels

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"><span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Triggers include: temperature, stress, humidity, allergens

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Generally also have xerosis (dry skin) which cracks and allows allergens to penetrate <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Papulovesicular and erythematous lesions, exudate, crusts <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Intense itching <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chronic darkened thickened skin with prominent skin lines (lichenification) often seen in creases and behind the knees <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">No definitive test, history of above symptoms <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">No cure

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hydrate and lubricate the skin with occlusive topical emollients within 3 minutes of leaving the bath <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Further apply creams and moisturizers 3-4 Xs a day <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Topical Corticosteroids may help with flare ups <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ointments are preferred over creams <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Prolonged use of topical corticosteroids can lead to adrenal suppression <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Oral steroids only used for severe exacerbations

media type="youtube" key="MJEIscWQXLo" width="504" height="377"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Usually 9-12 months but can occur at any time <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Urine, feces irritants <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Candida albicans (yeast) secondary infection of severe diaper rash or if on antibiotics <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antifungal topical Nystatin or Myconazole are used then a barrier agent such as zinc oxide is applied. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Avoid over washing or commercial wipes alternatives include using a moisturizer, nonsoap cleanser (cold creme) or dove soap and water to clean the skin.
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Diaper dermatitis: **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">**Seborrheic dermatitis:** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chronic inflammatory reaction of the skin. Most common on the scalp of newborns - <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">cradle cap. Thought to be due to the over production of sebum in the infant. Can also occur on the eyelids, external ear canal, nasolabial folds or the inguinal region. Can be removed with baby oil or shampoo which is allowed to soften the crusts. The head is then rinsed and a comb is used to remove the remaining crusts from the scalp.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">**Pediculosis Capitis - Lice ...** <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Most common in ages 3-12 years <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Less common in AA children <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Live and reproduce on humans <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Do not jump or fly but do move quickly <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Hair to hair contact or indirect with brushes, hats... <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">(Nits) eggs laid on hair shaft <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lice can only live for 3 days off a live host but the eggs hatch in 8-10 days <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Wash clothes in hot water and dry in the dryer for 20 minutes. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">If things cannot be washed bag them for 2-3 weeks

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Permethrin (Nix) cream rinse or pyrethrin shampoos (Rid), repeat in seven days <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Malathion (not as effective), repeat in seven days <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Invermectin (oral agent) days 1 and 8.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">The lice lady...

media type="youtube" key="ogeESQyQYwM?version=3" height="408" width="560"

media type="youtube" key="C-YJMO0Ks7Q" width="560" height="315"
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Scabies... **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Infestation of the mite Sarcoptes Scabiei <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Highly contagious, skin to skin <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Female mite burrows into the upper epidermis to lay eggs which hatch in 3-4 days <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">The larvae then come to the surface mature, mate and then burrow again <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Cycle repeats every 14-17 days <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Reaction to the mites and feces occurs

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Symptoms: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Rash <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Itching which is worse at night <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Burrow lesions may appear like a line <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Scratching may obscure <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lesions often between fingers, toes, behind knees, in elbows, inner thighs...warm areas

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bathe then cover the child in 5% permethrin lotion or Lindane from the neck down, especially hands, fingers, toes, under nails <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Leave this in place for 8-12 hours then wash off <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Use benadryl or atarax for itching which may persist for 6 weeks <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Wash clothes and linens in hot water and dry in hot dryer for 40 minutes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bag other items for 2 weeks

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bacterial infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Most common bacterial skin infection <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Highly contagious <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Face, mouth, nose and hands common <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Staph and strep usual culprits <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Honey crusted lesions <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Topical antibiotics unless extensive (mupirocin) <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Child can return to school 24 hours after treatment started
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Impetigo... **

media type="youtube" key="mNhVG-PITqw?version=3" height="439" width="602"


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Acne **


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">MRSA ( ****<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Methicillin-Resistant Staphylococcus Aureus) **

media type="youtube" key="gU7hrtxBWmA" width="504" height="377"


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Viral Infectious skin disorders: **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Molluscum Contagiosum <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Caused by the pox virus. Flesh colored papules with a central caseous plug. Will resolve in 18 months or be treated with tretinoin gel or cantharidin liquid curettage or cryotherapy. Spread by skin to skin contact and autoinnoculation.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Warts - (Papillomavirus) <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Common in children usually on exposed areas such as fingers, hands, face or feet. Can resolve spontaneously but can autoinoculate. Removal by surgery, electrocautery, cryotherapy, salicylic or retinoic acid.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 160%;">Vitiligo <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">media type="youtube" key="za6nv-CK4xQ" height="341" width="615" align="left"

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 200%;">**Insect bites and stings:** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Occur frequently in children <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Concerns are insects that carry disease, are venomous, or can cause an allergic reaction

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assist child to remain calm, remove insects or bees, remove stingers, administer benadryl. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">If a food stuff is suspected observe for signs and symptoms of severe allergic reaction i.e. swelling, difficulty breathing. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Epinephrine may be necessary. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Once an allergy is known about an epi-pen may be needed.
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Anaphylactic Reaction - anaphylaxis **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">**Lyme Disease** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Most common tick borne disease in the US. Caused by spirochete Borrelia burgdorferi which enters through the saliva or feces of ticks.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Stage 1: Tick bite is followed by erythema migrans in 3-31 days. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Stage 2: Systemic involvement of cardiac, neurologic and musculoskeletal systems. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Stage 3: Musculoskeletal pain and neurological symptoms.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Treatment is amoxicillin if 8. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Erythromycin if allergic to penicillins.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Parental education most important: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Avoid tick areas, wear light colored clothing <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Perform <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">tick checks <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Be alert to skin rashes <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Use insect repellant <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> with permethrin or DEET. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Do not apply these to the face, hands or open sores. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Wash off once inside.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">**Rocky Mountain Spotted fever** <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Caused by the dog tick which harbors R. rickettsii.

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">To remove the tick, grasp with tweezers as close as possible to the point of attachment. Pull straight up. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Must have been on for at least two hours to transmit infection. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Wash hands thoroughly to prevent disease transmission <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Mark day of bite on calendar. <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Educate parents to signs and symptoms of disease

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Symptoms can occur gradually or suddenly: fever, malaise, anorexia, myalgia, vomiting, severe headache. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Treatment with tetracycline or chloramphenicol. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;"> This disease can be mild in intensity or fulminating and fatal.

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 130%;">media type="youtube" key="0wotB38WrRY" height="408" width="560"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Mosquitos, Fleas ** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Rarely systemic reactions - cool compresses and antihistamines <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Can carry West Nile Virus

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Bees, Wasps ** - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Remove stinger <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cool compress <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Rub meat tenderizer and drop of water into site for pain, 'After Bite' <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antihistatmines <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Severe reactions may need glucocorticosteroids and epinephrine <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">In case of severe rx keep child calm and get emergency tx

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Fire Ants ** - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cool compress <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antihistamine <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Severe reaction same as for bees

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Black widow spider -** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Initial sting, can see two fang marks <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Apply ice <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antihistamine, opioids, benzodiazepines for muscle spasms, <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hydrocortisone <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antivenom IV for severe reaction (if not allergic to horse serum)

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Brown Recluse spider ** - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Apply ice, cool compresses, cleanse wound <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Analgesics for pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Anti-inflammatory medication <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antibiotics as needed for secondary infection

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Snake bites ** - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Keep below level of heart, <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Keep calm (faster heart rate spreads venom faster) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ice or cool compress to slow spread <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Help child identify snake <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Remove constricting clothing <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Take off rings, jewlry <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antivenom is diluted in IV fluids and administered slowly

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Dog bites ** - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Occur most often with ages 5-9 <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Report <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Rabies investigation

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cat scratch disease ** - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Caused by the bite or scratch of a cat or kitten. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Positive bite or scratch history <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Regional lymphadenitis <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Serological identification. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Antibiotics may speed recovery.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">**<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Contact Dermatitis: ** <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Poison ivy, oak or poison sumac <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Leaves of 3 let me be, leaves of five, let me thrive <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nickle in jewelry, snaps <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Wool, feathers, dyes, soaps etc. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Mild cases are treated with topical corticosteriods <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">More severe cases with systemic corticosteroids.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Urushiol is the oil from poison oak, ivy and poison sumac. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">It can be picked up directly from the plant or indirectly from pets or clothes that have come in contact with the plant. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Wash the skin as soon as exposure is suspected. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ivy block is a creme that can protect the skin from the oil...a general lotion barrier has proved as useful

Newborn rashes: https://youtu.be/jQ4mq2PnrrE

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Eczema video located at http://youtu.be/MJEIscWQXLo

MRSA video located at http://youtu.be/gU7hrtxBWmA

Eczema https://youtu.be/bfczyQbWzP4

Scabies https://youtu.be/C-YJMO0Ks7Q

Tick removal http://youtu.be/0wotB38WrRY

Vitiligo http://youtu.be/za6nv-CK4xQ

Insect and snake bites http://www.healthline.com/health/first-aid/bites-stings#Overview1