Peds Sensory and Integumentary PDF

**[PEDS Sensory ]** - 2 main functions of the ear are hearing and balance. - Otitis media (OM)- middle ear infection that is short-lived - Eustachian tubes in children are more horizontal, hindering fluid and air movement through the tube, allowing organisms to grow and inflammation...

**[PEDS Sensory ]** - 2 main functions of the ear are hearing and balance. - Otitis media (OM)- middle ear infection that is short-lived - Eustachian tubes in children are more horizontal, hindering fluid and air movement through the tube, allowing organisms to grow and inflammation to continue - Children who experience tympanic membrane perforation are at high risk of developing com, hearing loss, and hearing-loss-related challenges OM- infection caused by bacteria, viruses, or both. - Follows an upper respiratory illness that migrates to the ear - EX. Of infections commonly leading to OM 1. Streptococcus pneumoniae 2. Influenza 3. Rhinovirus 4. RSV [Risk Factors of OM ] 1. First/ Secondhand smoke exposure 2. Allergies 3. Attending daycare 4. Respiratory infections 5. Compromised immune system 6. Use of pacifier 7. Not up to date on immunization [Clinical Presentation ] - Rapid onset inflammation, pain in ear, along with difficulty hearing, fever, tearfulness, diarrhea, poor appetite, and vomiting - Child could be pulling at the affected ear and turning head side to side - Otorrhea (drainage) may be present (yellow, green) - Child may report dizziness or unsteady gait because of the infected ear Pneumatic otoscope- may reveal an inflamed and bulging tympanic membrane, with/without purulent otorrhea, and prominent blood vessels [Treatment/ Therapies ] Amoxicillin (moxatag)- antibiotic, penicillin Azithromycin (Zithromax)- antibiotic, macrolide (used if pt is allergic to penicillin) Tell parents to report manifestations of allergy to an antibiotic Moderate Hearing Loss- 40 to 69 Db Expected Hearing- 0 to 20 dB Severe Hearing Loss- 70 to 80 dB Hearing screenings received by newborns are before 1 month old Hearing screen recommendations are in place starting at the age of 4 through 21 years of age, with adjustments made in frequency to meet the client\'s needs. During development and vulnerability, children are more susceptible to hearing loss Trauma or asphyxia during birth, elevated bilirubin levels, rubella, toxoplasmosis, and cytomegalovirus can lead to hearing loss Maternal infection, intake of damaging substances during pregnancy, prematurity (infant born before 37 weeks), hyperbilirubinemia, COM, and repeated exposure to loud environments can contribute to hearing loss. Early hearing screenings, immunization against rubella infection, and timely treatment for AOM and COM have been known to decrease the incidence of hearing loss in children **[Strabismus ]** - When one of the 6 muscles that control eye movement is too weak or not working properly the child develops strabismus - Can improper control of eye movement by the eye muscles and at times the brain - Non-surgical- patch therapy, glasses, eye exercises and ophthalmic atropine - Some children\'s conditions will only improve with surgery **[Eye Trauma]** - Occurs with any injury to the eye - Tears naturally form to flush out something - Sufficient to clear the eye when a benign item such as dirt, dust, or sand, however more severe traumas will require medical attention. [Different types of eye trauma ] - [Penetrating trauma]- when an object penetrates the eye, producing an entry wound without an exit wound, such as a wood particle or small metal particle. - [Perforating trauma]- when an object produces an entry and exit wound, such as a sharp long object - [Ruptured globe]- a puncture or tear to the outermost layer of the eye, involving the sclera, cornea, or both - [Blunt force trauma]- a forceful direct hit to the eye by an object or a fist, can sharply increase intraocular pressure to the point where the pressure cause the sclera to tear Depending on the degree and location of the injury it can lead to permanent vision loss or blindness. Sports, fireworks, chemicals, animals, and environmental objects (such as wood chips or branches and metal) are things children may regularly encounter that present an opportunity for eye trauma to occur.   [Risk Factors ] - Substances that effect judgment, vision or balance - Football - Baseball - Tennis - Sports with flying objects - Falls - Blunt force trauma [Clinical Presentation] - Bleeding - Laceration - Bruising the skin surrounding the eye - Pain - Sensation that something is in the eye - Photophobia (sensitivity to light) - Blurred vision - Floaters - Diplopia - Red eye - Pupil shape - Pupil size not the same - Restricted eye movement - Eye appears outside the eye socket - Rapidly blink - Holding eye shut - Injury may not even appear obvious Gentle ultrasound, x-ray, and computed tomography (CT) scans are studies used to diagnose the extent of eye injury, retinal detachment, and the presence of orbital fracture [Treatments and Therapies ] - Gentle cold compress - Flushing out the eye with water, saline, eye wash - Applying a shield - Prophylactic antibiotics **[Blindness]** - Vision loss that is not corrected by contact lenses, surgery, or glasses - Partial or complete - Legally blind is considered 20/200 feet or worse - Babies born before 30 weeks are screened for retinopathy of prematurity - Prematurity - Eye injury - Diabetes - Eye infection - Genetics - Malnutrition [Clinical Presentation] - Unable to focus on an object or may not follow object as it moves - May cover one eye when looking at something - Verbalize difficulty seeing - Hold objects close to their face - Photophobia - Eye discomfort - Floaters - Sudden vision loss Blindness is diagnosed through an ophthalmology exam [Treatments and Therapies ] - Infection \>\>\> antibiotic therapy - Blindness from Vitamin A deficiency \>\>\>\> Vitamin A supplements - Blindness from trauma\>\>\>\>\>\> corneal transplant or retinal surgery can be performed **[Ocular Cancer ]** - Cancer occurs when atypical or damaged cells in the body replicate and grow at an uncontrolled rate, forming malignant tumors (the presence of cells that are cancerous) - Malignant Tumors can spread to other parts of the body [Retinoblastoma]- cancer that results from the unexpected growth of cells in the retina when they are miss both RB1 genes or have mutated 1. [Hereditary]- causes a mutation of all the RB1 genes in the body including the retina. If a child develops this cancer in or both eyes the child is at risk of developing other types of cancer later in life 2. [Non-hereditary]- causes the RB1 gene mutation to occur unilaterally in one cell of the affected eye. Child is not at risk of developing cancer later in life. - Caused by genetic predisposition and mutation or absence of the RB1 gene [Risk Factors ] - Children under 3 - Exposure to chemicals such as gasoline - Inadequate maternal intake of vegetables and fruits [Clinical Presentation ] - Eye pain - Vision changes - Strabismus - Bulging of the eye - Nonreactive pupil - Color change of iris - Conjunctivitis - White pupil reflex It is important to identify the presence of metastasis. A lumbar puncture can be done to diagnose if retinoblastoma has metastasized to parts of the brain, but this is only done if metastasis is suspected. [Treatment ] Chemotherapy, radiation, surgery to remove tumor, cryotherapy, or laser treatment [Rhabdomyosarcoma] is a soft tissue cancer that results in unexpected cell growth in connective tissue. It can be in the eye or other body areas such as the neck, head, chest, reproductive organs, abdomen, and extremities - Cause of it is unknown - Children younger than 10 - Males - Noonan syndrome - Prenatal exposure to weed - Cocaine - Radiation [Clinical Presentation ] - May develop strabismus - Bulging of the eye - Vision changes [Treatment ] Surgery, chemotherapy, radiation, and stem cell transplant Chemotherapeutic treatment for rhabdomyosarcoma and retinoblastoma can cause infertility in both male and female clients and low sperm count or retrograde ejaculation in male clients. Clients who experience childhood cancer may need fertility assistance in adulthood. **[Dermatitis ]** - Inflammation of the skin that results in manifestations like redness and itching **[Contact dermatitis]** is inflammation occurs when the skin encounters an irritants [Irritants ] Perfumes Jewelry Poison ivy Poison oak Poison sumac **[Allergic Contact Dermatitis (ACD)-]** dermatitis or skin inflammation that occurs as a delayed reaction when a client\'s skin encounters a substance they are allergic or hypersensitive to -worsens with increased exposure time and with concentration of the causative substance -can be caused by agents, abrasion, metals, rubber products, sunscreen, fragrances [Risk Factors ] -exposure to triggering chemicals -can occur inside or outside -all children are at risk for developing contact dermatitis [Clinical Presentation] -redness -pruritus -swelling -vesicles -oozing Allergy patch testing is the gold standard for diagnosing allergic contact dermatitis. Triggering chemicals, such as nickel, fragrances, hair dye, or other additives, are in the patch test. This produces a small, localized reaction on the child's back to help identify what the child is allergic to.​​​​​​​ [Treatment and Therapies ] - Oatmeal baths, calamine lotion, cool/wet compresses - Over-the-counter antihistamines used to decrease pruritic - Topical corticosteroids (clobetasol) - Prednisone - Antibiotics (if bacterial infection develops) Children can describe pruritus in a variety of ways, including "scratchy," "creepy-crawly," "bad," and "like needles." Pain is also a common theme noted when children discuss pruritus. Itching is a physical manifestation as well as a subjective sensation  Each child may have different triggers, but common ones include certain cleaning chemicals, smoke, hair products, and scented products (like perfume or lotion). Some factors that worsen dermatitis include stress, hot water, pollen, or pet dander. **[Poison Ivy Dermatitis ]** -poison ivy, poison oak, and poison sumac are three plants in the Anacardiaceae family -considered delayed hypersensitivity reaction [Delayed Hypersensitivity reaction-] a late immune response that occurs after contact with an antigen, typically occurring at least 12 hr after exposure [Urushiol]- plant allergen found on the surface of poison ivy, poison oak, and poison sumac leaves, stems and branches [Risk Factors ] Urushiol Pet or animal fur Tools Clothing Other objects can carry urushiol [Clinical Presentation ] Papules (small, inflamed, raised area on the skin) Vesicles (cysts or blisters on the skin that are filled with fluid) Bullae (large, fluid-filled blisters) - If the client has been exposed through airborne it can lead to severe facial edema or respiratory complications With or without treatment rash should resolve within 3 weeks [Treatment and Therapies ] - Diphenhydramine - Topical antihistamines - Prednisone - Tacrolimus (topical) **[Diaper Dermatitis ]** - Most common type of dermatitis in infants and toddlers - Diapers lead to friction due to their constructiveness and excess moisture from urine and stool which as irritants - Stool and Urine on the skin have high enzymatic activity and increase skin pH level, which may lead to a yeast infection from Candida albicans. - Leads to irritation of the stratum corneum Irritation can be caused by increased moisture, chemicals in the diaper, or prolonged contact with urine and stool - Candida fungal and Staphylococcus bacterial infections are common causes of diaper dermatitis - Any child wearing a diaper - Infants at high risk because of their immature skin - Redness or irritation around the diaper area - Edema - Skin erosion - S. Aureus infection may have papules, pustules, and bullous impetigo blisters - S. pyogenes in the folds of skin and appear with maceration of the skin - Candida present red, scaly plaques along with pustules and papules Treatment and Therapies - Frequent diaper changes - Cleansing of the perineal area with water and soap free cleanser - Perfume-free, no soap or essential oil wet wipes - Skin barriers like petroleum, lanolin, or zinc oxide - Topical corticosteroids short term - Nystatin (Candida diaper dermatitis) - Hydrocortisone **[Seborrheic Dermatitis ]** - Cradle cap - Inflammation occurs on the scalp - Fungus called Malassezia - Presents for infants - Self-limiting - Overactive sebaceous glands - Immunodeficiency - Crusty, yellow scales on the top and front of the scalp - Serous fluid may be present - The rash is not painful or pruritic - Scalp care - Emollients - Sofy brush or comb can be used to remove scales - Ketoconazole shampoo **[Atopic Dermatitis ]** - Eczema - Chronic disorder that leads to inflammation of the skin - Dysfunction of the epidermal barrier the skin is more permeable and has increased water loss - Dysfunction leads to the release of cytokines - Cytokines lead to both inflammation and overproduction of keratinocytes causing hyperplasia of the epidermis - Can affect anyone - Usually develops in childhood - Family history increases the risk - Pruritus - Skin flaking - Inflammation - Scalp, face and extremities on infants - Elbow, back of knees, wrists, and forearms on children and adolescents - Adequate hydration to the skin in the form for fragrance-free emollients or ointments - Topical Corticosteroids - Clobetasol - Tacrolimus ointment (steroid-free) - Prednisone - OTC antihistamines - Bathing in diluted bleach ( ¼ cup of bleach in 40 gallons of water) **[Medical Reactions ]** - Maculopapular- a type of skin rash where both macules and papules are present -The medications that often trigger this rash include allopurinol, various antibiotics (piperacillin, amoxicillin, ampicillin, cephalosporins, sulfonamides, clindamycin, and tetracyclines), anticonvulsants, and antiretroviral drugs The medications may interact directly with immune receptors, or they may bond with peptides to become antigenic. The antigenic peptides bond with other molecules and are eventually taken to T cells. Next, the inflammatory response occurs, and T cells travel through the skin, causing an eruption of macules and papules **[Insect Bites and Stings ]** - Mild to serve - Mosquitoes, ticks, flies, fleas, spiders, and bites mites - Mosquitoes feed blood from capillaries or small veins - Ticks and some flies feed from pool of blood that develops due to their bite - Stings: Bees, yellow jackets, hornets, wasps, and fire ants - Injection of venom from stinger can lead to anaphylaxis **[Mosquitos]**- elongated mouth that allows them to the blood out of capillaries, usually mild bites, children do not feel them, bites become pruritic and a visible welt **[Chiggers]**- bites not initially felt, reaction to saliva causes intense pruritus, known to bite around the top of the sock or belt line **[Flies]**- bite the skin and inject specific saliva with anticoagulant properties, this allows them to suck the blood **[Ticks]**- painless bite, injects fluid with anticoagulant properties, then feeds off the blood, Biggest concern is Lyme disease and Rocky Mountain spotted fever **[Spiders]**- brown recluse and black widow are the most dangerous spiders, Brown prefers dark and dry places like child's extremities. Black widows prefer dark spaces and bite when they feel threatened **[Mites-]** scabies is caused by mites that occur after prolonged contact. Mites burrow under the stratum corneum and lay eggs **[Insect Stings]**- Stings in self-defense and releases venom within a couple of seconds. Fire ants and wasps can produce multiple stings **[Scorpions-]** most stings are mild localized reactions. Black scorpions are known to cause adverse effects in children such as hypertension, tachycardia, arrhythmias, and myoclonus [Risk Factors for Insect Bites ] - Wearing dark-colored clothing - Exposed skin - Type O blood - Having ketones and lactic acid in your blood - Weak malnourished people - Edema and pruritus at the site of the bite - Most bites have a single puncture - Spider bites can have dual puncture - Children are most likely to develop hives after insect bite - Brown recluse spider can lead to necrosis (cell death) [Lyme Disease Stages ] Stage 1 -- occur within 1 month of infection Manifestations: circular rash called erythema migrans Flu-like S/S Left untreated, it can lead to joint pain, cardiac problems, neurological problems Stage 2 -- occur 1 to 3 months after infection Headache, chest pain, diplopia, joint pain Stage 3 -- occurs within months or years Bell palsy, cognitive deficits, seizures, and cardiac arrhythmia Treatments and Therapies - Cleaning site - Removing stingers - Applying ice - NSAIDs for pain - Calamine lotion - Topical Corticosteroids - Oral antihistamines - Systemic corticosteroids - Rocky Mountain Fever \>\>\>\>\> Doxycycline - Lyme disease under 8 \>\>\> Amoxicillin - Lyme disease over 8 \>\>\>\>\> doxycycline **[Animal Bites ]** - Dog bites usually occur in head, and neck regions in children - In Older children it occurs in the extremities - Cats cause deep narrow bites increasing the risk of infections like osteomyelitis (inflammation of the bone) Cat scratch disease typically presents as a localized reaction with lymphadenopathy at the site of the scratch or bite in children. If there is visceral organ involvement, the spleen and liver may be involved. This presents with abdominal pain, weight loss, hepatomegaly or splenomegaly, and a fever of unknown origin.  Treatment and Therapies - Debridement - Azithromycin - Rifampin - Amoxicillin-clavulanate - Tetanus shot **[Human Bites]** - Minor laceration, erythema or bruising - Can cause oral flora and skin flora to enter the wound like Group A streptococcus and Staphylococci - Semicircle mark - Brusing/ redness **[Psoriasis ]** - Inflammatory disorder with innate and adaptive immune system involvement - Leads to epidermal hyperplasia because of excessive keratinocyte proliferation - HLA type Cw6 - Infections - Trauma - Stress - Obesity - Some medications - Decreased exposure to UV light and low humidity level may aggravate psoriasis [Clinical Presentation ] - Guttate psoriasis presents as small papules that are scaly, round, and red - Guttate psoriasis is connected to group A streptococcal infection - Chronic plaque psoriasis- round plaques, edges are well defined but in children may be less clear - Chronic plaques are bright red covered with grey to white scale - Usually distributed symmetrically and most commonly appear on the knees, elbows, scalp, face or diaper area - Topical medications - Oral meds - Injections - UV light therapy - OTC unscented moisturizers - Topical corticosteroids - Often during summer months psoriasis improves - Methotrexate - Etanercept A lack of physical activity can increase diabetes, obesity, and hypertension in children who have psoriasis.  **[Acne ]** - Involves epidermis, dermis, sebaceous glands, and androgens - Androgens increase the production of sebum and proliferation of the epidermis - Sebum gets stuck in hair follicle causing it to rupture and inflammation occurs within the dermis - Lesions on the face, arms, trunk, or back **[Risk Factors ]** - Certain meds (steroids and anticonvulsants - Excess sunlight - Clothing that causes friction - Endocrine conditions (polycystic ovarian syndrome) - genetics - high sugar foods - oil-based face products - increased stress - anxiety - anger Clinical Presentation - Infantile acne presents as comedones, papules, and pustules over the cheeks - Mid-childhood acne occurs on the forehead, cheeks, or nose and presents with inflammation lesions. Ages 1 to 7 - Preadolescent Acne presents with comedones on forehead, nose and chin - Adolescent Acne (4 different grades) 1. Open and closed comedones 2. Includes inflammatory papules 3. Includes pustules 4. Includes nodules and cysts Nodules, Papules, and Pustules are acne lesions that contain bacteria. **[Tanner Staging]**- scale used to assess pubertal development, including physical and secondary sex characteristics Treatment and Therapies - Mild acne- topical agents, like benzoyl peroxide - Moderate acne- doxycycline first line of meds, can take azithromycin - Hormonal meds- spironolactone or oral contraceptives - Severe acne- Isotretinoin **[Cellulitis ]** - Bacterial skin infection that results from disruptions of the skin barrier from trauma -  It can occur following stings or bites from insects or animals, abrasions, puncture wounds, or other causes of impaired skin integrity - The most common causative agent is group A Streptococcus, but it can be caused by a variety of bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) Risk Factors - Skin injury - Skin trauma - Atopic dermatitis - Psoriasis - Edema - Obesity - HIV - Pre-existing skin infections Treatments and Therapies - Antibiotics - MRSA \>\>\>\> oral clindamycin (if concerns for MRSA) - IV antibiotics - Vancomycin - Cefazolin - Oxacillin If left untreated or not diagnosed infection in blood stream can occur (bacteremia) and osteomyelitis Bacteria from the bloodstream can also travel to the heart causing endocarditis (infection in, inner layer of heart muscle) If it goes untreated, it can lead to sepsis, bacteremia, osteomyelitis, or endocarditis due to bacteria entering the bloodstream or bone. In the event of these complications, children will require longer treatment and may need surgery.  **[Thermal Injury ]** - Very damaging to the skin - Burns affect epidermis, dermis, hair follicles, and glandular tissues - Risk of decreased perfusion surrounding the area of coagulation - After treatment children still have a long-term hypermetabolic response that causes an increase in metabolic rate [Heat Injuries]- contact with a hot object, flames, hot liquids, or steam. Epidermis and part of the dermis [Electrical burns]- electrical current turns into heat while passing through the body. [Chemical burns]- including altered skin pH, cellular membrane injury, toxic effects on the metabolic process [Radiation Burns]- [ ] sunburns, ionizing radiation causes damage to the skin [Superficial burns]- epidermis, moderate pain (sunburns) red, painful without blisters, blanch with pressure [Partial Thickness]- -  [Deep partial-thickness] burns involve more of the dermis and damage to the hair follicles and glandular tissue. It is painful and may become infected - [A deep partial-thickness] burn includes superficial nerve endings, and thus, pressure causes pain [Full Thickness]- affects the entire dermal layer and the subcutaneous tissue underneath. White, gray, or charred black and no blisters. Pain may occur