DISORDERS OF SKIN, EYES AND EARS (Child Health Nursing).pptx

This powerpoint presentation contains bacterial skin infections, fungal infections, viral skin infections, parasitic skin infections and other infections including causes, sign symptoms, diagnostic evaluation and treatment.

1. DISORDERS OF SKIN, EYES AND EARS Prepared By: Sonali Kujur Nursing tutor

2. BACTERIAL SKIN INFECTIONS Impetigo Cellulitis Folliculitis, boils and carbuncles Staphylococcal scalded skin syndrome

3. IMPETIGO Impetigo is a superficial infection of the skin , caused by bacteria. The lesions are often grouped and have a red base. The lesions open and become crusty and have a "honey-color', which is typical of impetigo. Impetigo is contagious and can spread throughout a household, with children reinfecting themselves or other family members.

4. CAUSES Group A B-hemolytic streptococcus • Staphylococcus aureus

5. CLINICAL FEATURES Impetigo usually occurs on the face, neck, arms and limbs , but the lesions may appear in any part of the body. It starts as a small vesicle or fluid-filled lesion . The lesion then ruptures and fluid drains leaving areas that are covered with honey-colored crusts. The lesions may all look different, with different size and shapes . The child may also have swollen lymph nodes (small lumps that are located mostly in the neck, arm, underarm and in the groin area). The lymph nodes become enlarged when child's body is fighting an infection.

6. DIAGNOSTIC EVALUATION Medical history Physical examination Culture of lesions (to confirm the type of bacteria)

7. MANAGEMENT For a child with many lesions, oral antibiotics may be prescribed. If the child has only a few lesions, a topical antibiotic is applied directly to the lesions. Bathe the child daily with an antibacterial soap to help decrease the chance of spreading the infection. Proper hand washing technique by everyone in the household is very important to help decrease the chance of spreading the infection. Keep the child's fingernails short to help decrease the chance of scratching and spreading the infection. Avoid sharing of garments, towels and other household items to prevent the spreading of infection.

8. CELLULITIS It is a deep bacterial infection of the skin. The infection usually involves the face, arms or legs . It may happen in normal skin, but it usually occurs after some type of trauma causing an opening in the skin. This opening can lead to infection.

9. CAUSES Cellulitis is usually caused by a bacterial infection of a wound or area of skin that is no longer intact . The most common bacterial causes of cellulitis include the following: Streptococcus pneumoniae Staphylococcus aureus. Group A Beta-hemolytic streptococcus Other causes may include human or animal bites, or injuries that occur in water.

10. CLINICAL FEATURES Swelling of the skin Tenderness Blisters Warm skin Pain Bruising Headache Chills Feeling weak Red streaks from the original site of cellulitis.

11. Some cases of cellulitis are considered an emergency if any of the following symptoms are present: A very large area of red, inflamed skin . Fever If the area is affected, causing the child to complain of numbness, tingling or other changes in hand, arm, leg, or foot If the skin appears black If the area that is red and swollen is around the child's eye(s) or behind his/her ear(s) If the child has diabetes or has a weakened immune system and develops cellulitis.

12. DIAGNOSTIC EVALUATION Medical history Physical examination Blood and skin samples (type of bacteria that is present)

13. MANAGEMENT Treatment include: Oral or intravenous (IV) antibiotics Surgical Intervention Warm, wet dressings on the infection site If the child's extremity (arm or leg) is affected, elevate the extremity and decrease the amount of activity.

14. COMPLICATIONS The most common complications include the following: Meningitis : An inflammation of the coverings of brain and spinal cord. Septic (Infectious) arthritis : An infection of a joint caused by bacteria. Glomerulonephritis : An inflammation of the kidneys.

15. Folliculitis, boils and carbuncles

16. Folliculitis Folliculitis is the inflammation of hair follicles due to an infection, injury or irritation. It is characterized by tender, swollen areas that form around hair follicles, often on the neck, breasts, buttocks and face .

17. Clinical features Pus in the hair follicle Irritated and red follicles Damaged hair

18. Boils Boils are pus-filled lesions that are painful and usually firm. Boils are usually located in the waist areas, groins, buttocks and under the arm.

19. Clinical features Pus in the center of the boil Whitish, bloody discharge from the boil

20. Carbuncles Carbuncles are clusters of boils . These are usually found in the back of the neck or thigh .

21. Clinical features Pus in the center of the boils Whitish, bloody discharge from the boils Fever Fatigue

22. Diagnostic evaluation Diagnosis of Folliculitis, boils, and carbuncle: Medical history and physical examination. After examining the lesions, culture of the wound is done to help to verify the diagnosis and the best treatment.

23. Management Specific treatment for Folliculitis, boils and carbuncles may include: for folliculitis- Topical antibiotics For carbuncles and boils, a warm compress may be used to help promote drainage of the lesion Oral or IV antibiotics (to treat the infection) Possible removal of the boils and carbuncles. Carbuncles heal more slowly than a single boil. Keeping the skin clean helps to prevent these conditions from occurring.

24. Fungal skin infections Candidiasis Tinea infection (Ringworms) Tinea versicolor

25. CANDIDIASIS Candidiasis, sometimes called moniliasis . It is an infection caused by yeast on the skin and/or mucous membranes. Although yeast is normally a harmless inhabitant of the digestive system and vaginal area, it may cause an infection when the skin is damaged or when conditions are warm and humid , or when a child has a depressed immune system. Antibiotics can also cause yeast to grow, because the normal bacteria in tissues are killed, letting the yeast grow unhampered.

26. CLINICAL MANIFESTATIONS LOCATION SIGN/SYMPTOMS Skin folds or navel Rash Patches, from the oozes clear fluid Pimples Itching or burning Vagina white/ yellow discharge from vagina Itching Redness in the external area of vagina Burning Penis Redness on the underside of the penis Scaling on the underside of the penis Painful rash on the underside of the penis Mouth White patches on tongue and inside the cheeks Pain Corners of the mouth Cracks/ tiny cuts at the corners of the mouth Nail beds Swelling ,pain Pus, white/yellow nail that separates from nail bed

27. DIAGNOSTIC EVALUATION Medical history Physical examination of child Skin scrapings are taken to confirm the diagnosis with a microscopic examination or culture

28. MANAGEMENT Candidiasis is highly treatable with medicated ointments. Vagina or anus medicated suppositories. Oral thrush medicated mouthwash or lozenges Severe infection may be treated with oral anti-yeast medications.

29. TINEA INFECTIONS (RINGWORM) Different fungi depending on their location on the child's body, causes ringworm. Ringworm is characterized by ring-shaped, red, scaly patches with clear centers.

30. There is an increased risk of contracting ringworm if the child: Is malnourished Has poor hygiene Lives in a warm climate Has contact with other children or pets that have ringworm Is immunocompromised due to disease or medication

31. Common types of ringworm

32. ATHLETE’S FOOT (Tinea pedis or foot ringworm) Tinea pedis or foot ringworm This common condition mostly affects teen and adult mates. It less frequently affects children before puberty. Contributing causes include sweating, not drying the feet well after swimming or bathing, wearing tight socks of shoes, and warm weather conditions. Symptoms of athletes foot may include: Whitening of the skin between the toes Scaling of the feet Itchy rash on the feet Blisters on the feet

33. JOCK ITCH (Tinea cruris or groin ringworm) This condition is also more common in males and occurs more often during warm weather conditions. It is very rare in females . Symptoms of jock itch may include: Red, ring-like patches in the groin area Itching in the groin Pain in the groin area.

34. SCALP RINGWORM(Tinea capitis) Scalp ringworm is highly contagious , especially among children. It occurs mainly in children between the ages of 2-10 years . It rarely occurs in adults. Symptoms of scalp ringworm may include: Red, scaly rash on the scalp Itching of the scalp Hair loss on the scalp Rash elsewhere on the body

35. NAIL RINGWORM (Tinea unguium ) It is an infection of the finger or toe nail , characterized by a thickened and deformed nail. This condition affects the toe nails than the fingernails. It occurs more often in adolescents and adults rather than young children. Symptoms of nail ringworm may include: Thickening of the ends of nails Yellow color of the nails

36. BODY RINGWORM (Tinea corporis) This skin infection is characterized by a ring-like rash anywhere on the body or the face. It occurs in all ages but is seen more frequently in children. It is more common in warmer climates. The symptoms of body ringworm may include: Itching at the affected area Red, circular lesion with raised edges The middle of lesion may become less red as the lesion grows

37. DIAGNOSTIC EVALUATION Medical history Physical examination The lesions of ringworm are unique and usually allow for a diagnosis simply on the basis of physical examination . In addition, a culture of skin scraping of the lesion is done to confirm the diagnosis.

38. MANAGEMENT Treatment for scalp ringworm (Tinea capitis) may include the following: Oral anti-fungal medication : This medication is usually prescribed for 4-8 weeks. Some children require longer treatment. Use of a special shampoo (to help eliminate the fungus). Treatment for ringworm of the body, groin, and foot is usually a topical anti-fungal agent or an oral antifungal medication. The length of the treatment depends on the location of ringworm.

39. TINEA VERSICOLOR Tinea versicolor is a common fungal skin infection characterized by light or dark patches on the skin. Patches are most often found on the chest or back and prevent the skin from tanning evenly. It occurs mostly in adolescence and early adulthood, but it can occur at any time.

40. CLINICAL MANIFESTATION Usually, the only symptom of Tinea versicolor is white, pink or light brown patches. Patches may scale slightly but rarely itch or hurt. Other common characteristics of the rash include : White, pink or brown patches mostly noticeable in summer Infection only on the top layers of the skin The rash usually occurs on the trunk Patches worsen in heat, humidity or if the child is on steroid therapy or has a weakened immune system.

41. DIANOSTIC EVALUATION Medical history Physical examination of the child. In addition, the physician may use an ultraviolet light to see the patches more clearly. Also, skin scrapings of the lesions may be taken to help in confirming the diagnosis

42. MANAGEMENT Treatment usually includes the use of medicated antimicrobial dandruff shampoo on the skin as prescribed by physician. The shampoo is left on the skin overnight and washed off in the morning. To be effective, the shampoo treatment may be required for several nights. Topical creams or oral antifungal medications may be prescribed.

43. VIRAL SKIN INFECTIONS

44. WARTS Warts are non-cancerous skin growths caused by the papilloma virus . Warts are more common in children than adults, although they can develop at any age. Warts can spread to other parts of the body and to other persons. There are many different types of warts due to many different papilloma virus types (more than 100). Warts are not painful, except when located on the feet. Most warts go away, without treatment, over an extended period of time

45. TYPES OF WARTS Common warts : Growth around nails and the back of hands; usually have a rough surface, grayish yellow or brown in color Foot warts : Located on the soles of feet (plantar warts) with black dots (clotted blood vessels that once fed them) . These warts are painful Flat warts : Small, smooth growths that grow in groups up to 100 at a time, most often appear on child's face. Genital warts : Grow on the genitals, are occasionally sexually transmitted; soft and do not have a rough surface like other common warts. Filiform warts : Small, long, narrow growths that usually appear on eyelids, face, or neck.

46. MANAGEMENT Warts in children often disappear without treatment. Treatment may include: Application of salicylic and lactic acid (which soften the infected area) Freezing with liquid nitrogen Laser surgery

47. MOLLUSCUM CONTAGIOSUM

48. RUBELLA (GERMAN MEASLES) Rubella is a viral illness that results in a viral exanthem. It spreads from one child to another through direct contact with discharge from the nose and throat. However, a fetus that contracts rubella from his or her mother while she is pregnant can have severe birth defects and consequences.

49. CAUSES Rubella is caused by a virus, called Rubivirus . It can be spread from a pregnant mother to the unborn child It spreads from secretions of another infected person. It is most prevalent in late winter and early spring. Rubella is preventable by proper immunization with the rubella vaccine.

50. CLINICAL MANIFESTATIONS

51. CHILDHOOD RUBELLA Rubella may begin with a period of not feeling well, a low grade lever and diarrhea. This may last one to five days. The rash then appears as pink areas of small, raised lesions . The rash begins on the face and then spreads down to the trunk, arms, and legs. The rash on the face usually improves as it spreads to the arms and legs. The rash usually fades by third to fifth day . Lymph nodes in the neck may also become enlarged.

52. CONGENITAL RUBELLA Rubella (that the child contracted from his/her mother while in utero) can result in many problems, Cataract in the eyes Heart problems Mental retardation Growth retardation Enlarged liver and spleen Skin lesions Bleeding problems

53. DIAGNOSTIC EVALUATION Medical history Physical examination

54. MANAGEMENT Since it is a viral infection, there is no cure for rubella. Treatment may include: Rest Increased fluid intake

55. RUBELLA (MEASLES) It is a viral illness that results in a viral exanthem. It spreads from one child to another through direct contact with discharge from the nose and throat of infected child. Sometimes it spreads through air-borne droplets from and an infected child.

56. CAUSES The virus that causes measles, is classified as Morbillivirus belonging to Paramyxoviridae family.

57. CLINICAL MANIFESTATION It may take between 7 and 14 days for a child to develop symptoms of rubeola after being exposed to the disease. The child is contagious four days before the onset of signs and symptoms and four days after the rash develops .

58. EARLY PHASE SERIOUS COMPLICATIONS Hacking cough ear infections Redness and irritation in eyes pneumonia Fever croup Small red spots with white center inflammation of the brain deep, red flat rash that starts in the face and spreads on trunk, arm, leg and feet.

59. DIAGNOSTIC EVALUATION Medical history Physical examination Blood or urine tests may be done to confirm the diagnosis.

60. MANAGEMENT Increased fluid intake Acetaminophen for fever World Health Organization (WHO) recommends two doses of Vitamin A for all children to help prevent eye damage and blindness (that may occur as a complication of measles) MMR

61. CHICKENPOX Chickenpox is a highly infectious disease caused by Varicella zoster virus (VZV), a form of herpes virus. Transmission occurs from person-to-person by direct contact or through the air by coughing or sneezing.

62. Sign & SYMPTOMS Fatigue and irritability, one to two days before the rash begins. Itchy rash on the trunk, face, scalp, armpits, upper arms, legs and inside the mouth. Fever Feeling ill Decreased appetite Muscle and/or joint pain Cough or runny nose

63. DIAGNOSTIC EVALUATION Medical history Physical examination

64. MANAGEMENT Acetaminophen for fever (DO NOT GIVE ASPIRIN) Antibiotics for treating bacterial infections Calamine lotion (to relieve itching) Antiviral drugs (for severe cases) Increased fluid intake (to prevent dehydration) Bed rest Cool baths (to relieve itching)

65. PARASITIC SKIN INFECTIONS

66. SCABIES Scabies is an infestation of mites (tiny insects ) characterized by small red bumps and intense itching This highly contagious infection often spreads from person to person when they are having close personal contact. The itching is caused by the mites burrowing into the skin where they lay eggs that hatch a few days later. Scabies can affect people of all ages. Scabies occurs mostly in children and young adults.

67. CLINICAL MANIFESTATIONS Itching, usually severe Rash, with small pimples or red bumps Scaly or crusty skin (with advanced conditions).

68. DIAGNOSTIC EVALUATION Skin scrapping

69. MANAGEMENT Applications of prescribed creams and lotions, such as Permethrin and Lindane solutions. Oral antihistamine medication (to help relieve itching). In some cases, topical ointments are recommended In addition, it is important to wash all clothes and bedding in hot water and dry in a hot dryer. The itching may continue for many weeks after the initial treatment of the scabies.

70. DISORDERS OF EYE

71. CONJUNCTIVITIS Conjunctivitis (pink eye) is an inflammation of the conjunctiva of eye.

72. CAUSES Conjunctivitis during childhood is caused due to allergy or infection by bacteria or virus. The most common bacterial causes are Hoemophilus influenzae Streptococcus pneumonice Chlamydia. Viruses that cause conjunctivitis are Adenovirus Herpes virus .

73. CLINICAL MANIFESTATION Redness of eye (hyperemia) Tearing and itching in eyes Exudation (flaky and sticky substance on eye lid margins) Other symptoms may include: Photophobia Pseudoptosis (drooping of upper eyelid) Periorbital cellulitis Pain in eye Fever.

74. DIAGNOSTIC EVALUATION The diagnosis is made mainly on the basis of clinical features.

75. MANAGEMENT CAUSE MANAGEMENT Viral hygiene, rest Bacterial antibiotic eye drops Chlamydial systemic antibiotics, antiviral agents Allergic antihistamine eye drops Chemical avoid the irritating substance

76. OPTHALMIA NEONATRUM Purulent discharge from eye of a newborn, within 21 days of birth is known as ophthalmia neonatorum. Most cases, develop this condition within 48-72 hours of life . It is mostly bilateral.

77. CAUSES Neisseria gonorrhoeae Staphylococcus aureus Escherichia coli Pseudomonas aeruginosa Certain viruses and Chlamydia trachomatis.

78. MODE OF INFECTION Intrauterine infection. Infection during the process of delivery (most common) Infection after birth. Infection after birth

79. CLINICAL MANIFESTATIONS Eyelids are tense and swollen. Conjunctiva is congested and swollen. Excessive tearing or turbid and thick discharge from eyes.

80. MANAGEMENT A swab must be taken from purulent eye discharge and sent for culture and sensitivity. Depending upon the result, the physician prescribes appropriate antibiotic ointment or eye drops . Crystalline Penicillin Chloramphenicol Erythromycin or Gentamicin eye drops may be prescribed by the physician.

81. RETINITIS Inflammation of retina. It usually occurs in association with inflammation of choroid or optic nerve.

82. STYE (HORDEOLUM) Stye or hordeolum is an infection of the sebaceous glands near the eye lashes. A pustule in the eyelash follicle is known as stye.

83. CAUSES It is caused by bacterial or viral infection. It is most often caused by staphylococcus infection

84. CLINICAL FEATURES Pustule in eyelash Pain and tenderness Localized swelling of eyelid Redness in eye

85. MANAGEMENT Warm compress must be applied on eye, several times in a day. Eye care is done frequently. Antibiotic(ERYTHROMYCIN) eye drops are instilled.

86. CATARACT Cataract is the development of opacity in the crystalline lens of eye. As a light cannot pass through the opacity, vision becomes blurred.

87. TYPES Unilateral or bilateral Partial or complete Congenital or acquired.

88. CAUSES

89. CONGENITAL CAUSES Intrauterine infections in early months of pregnancy like German measles and toxoplasmosis Maternal malnutrition Galactosemia Chromosomal anomalies like Down's syndrome Ocular malformation Mental retardation

90. ACQUIRED CAUSES Trauma Retrolental fibroplasia Uveitis Glaucoma

91. DIAGNOSTIC EVALUATION Infants with a family history or prenatal history placing them at risk for cataract.

92. MANAGEMENT CATARACT- The definitive treatment for cataract is surgical removal of the cataract from affected eye. Postoperative Care- After surgery the child needs eye patching or shielding for several days. Instillation of antibiotic and steroidal eye drops(ZYTREC) several times a day.

93. GLAUCOMA Glaucoma is the condition of increased intraocular pressure (IOP), causing gradual loss of sight.

94. TYPES Congenital or infantile glaucoma : It occurs in children under 3 years of age. It may be present at birth. Juvenile glaucoma : It affects children older than 3 years of age and is usually secondary to some other

95. CAUSES It is caused due to defect in the drainage system of eye. It is usually by a developmental anomaly of the iridocorneal angle of eye known as trabeculodysgenesis Juvenile causes due to some other disease like retinoblastoma, trauma to the eye.

96. CLINICAL MANIFESTATIONS Excessive tearing (epiphora) Involuntary closing of eyelid Photophobia Enlargement of eyeball ( buphthalmos ) Haziness or clouding of cornea Pain in the eyeball

97. DIAGNOSTIC EVALUATION Intra ocular pressure of eye is measured by tonometry. The normal pressure is 12-20mmHg For measurement of IOP in infants and young children, anesthesia may be required.

98. MANAGEMENT Goniotomy or trabeculotomy is done to channel of outflow of aqueous humor from the anterior chamber of the eye, thereby reducing the IOP.

99. PTOSIS Drooping of upper eyelid caused by weakness of ocular muscles is known as ptosis. It occurs due to weakness of levator palpebrae or less frequently, the muller muscles.

100. CAUSES Myasthenia gravis Eyelid injuries Third nerve palsy.

101. MANAGEMENT The problem needs surgical correction to raise the eyelid and increase visual field. Patching of the eye needed postoperatively for few days.

102. REFRACTIVE ERRORS Refraction is the process by which the cornea and lens of the eye bend light rays, to focus on the retina. When the bending of rays and length of eyeball are uncoordinated, the image does not fall on a single point on retina. This results in refractory errors. When refraction is normal it is known as ‘emmetropia’

103. CAUSES Abnormal curvature of refractive surfaces Abnormal position of refractive surfaces Abnormal anterio -posterior length of eyeball. Abnormal refractive index of refractive media of eyeball, ie . lens (as in cataract) and vitreous humor (after vitrectomy).

104. TYPES Myopia (Nearsightedness) Hyperopia (Farsightedness) Astigmatism (Blurred vision

105. MYOPIA Myopia is the condition in which the parallel rays from distant object focus in front of retina.

106. TYPES Congenital myopia: It is present at birth and may be unilateral or bilateral. It is usually with convergent squint. Simple myopia: This is the commonest type and is not associated with any degenerative changes in retina and choroid. It starts in early adolescence, increases during school years and becomes stationary after the age of 25 years. Progressive myopia: This type progresses rapidly and is accompanied by degenerative changes in vitreous, choroids and retina.

107. CLINICAL MANIFESTATIONS Dimness of vision for distant objects: The child usually complains that he/she cannot writing on blackboard in school. If the defect is severe, apart from dimness of vision for distant objects, the child complains headache on reading. The child is seen holding books closely to eyes, while reading.

108. MANAGEMENT The defect should be corrected by prescribing a concave lens; of appropriate strength for the child. Photorefractive keratectomy laser surgery may be used to correct myopia.

109. HYPEROPIA (FARSIGHTEDNESS) Hyperopia is the condition in which parallel rays from a distant object focus behind the retina. Thos most common refractory error.

110. CLINICAL MANIFESTATIONS Diminished vision, both for near and distant objects. In less severe hyperopia, the child complains of reading problem. There may be headache, transient blurring of vision (particularly while reading), pain in eyes, heaviness of eyelids and redness of eyes.

111. MANAGEMENT This refractory error can be corrected by using convex lens of proper strength.

112. ASTIGMATION Astigmatism is the refractory error in which refraction differs in different meridians of eye. In the horizontal meridian, the eye is emmetropic while in the vertical meridian, it is hypermetropic or myopic.

113. TYPES Irregular astigmatism : Here, the rays of light are reflected very irregularly due to irregular corneal curvature, as in case of corneal scar. Regular astigmatism : In this type, the meridians of greatest and least curvature are at right angles to each other. They are called principal meridians. It is of the following types: Simple astigmatism : In this type, one meridian is emmetropic (normal refraction) while other is either myopic or hypermetropic/ hyperopic. Compound astigmatism : In this type, both the meridians are either myopic or

114. MANAGEMENT For the correction of regular astigmatism, cylindrical lens of proper strength is prescribed . In case of irregular astigmatism, correction in eye sight can't be made with cylindrical lens, but use of contact can be helpful

115. SQUINT Misalignment of visual axis The visual line of each eye does not simultaneously focus on the same object due to lack of muscle coordination resulting in a crossed eye appearance.

116. TYPES Paralytic or non concomitant type Non-paralytic or concomitant type Esotropia Exotropia Hypertropia

117. ESOTROPIA Convergent Eyes turn towards the midline.

118. EXOTROPIA divergent eyes turn away from the midline

119. HYPERTROPIA Eyes are out of vertical alignment. one pupil appears higher than the other.

120. NURSING MANAGEMENT Minimise effects of vision loss Minimise body image disturbance Prevent injury Promote normal growth and development Parental education

121. Minimise effects of vision loss Encourage and assist parents in obtaining corrective lenses for child Assist parents in locating and finding resources such as financial assistance, special education, in braille or parental support groups.

122. Minimise body image disturbance encourage parents to focus on normalisation rather than being protective towards the child. allow the child to play with peers and make his life as normal as possible encourage parental acceptance towards appearance of the child

123. Prevent injury instruct the child to use a cane or other walking assistance device

124. Promote normal growth and development encourage the parents to provide many sensory opportunities to the child such as manipulatory objects, hearing various sounds, noting the smell in environmrent.