Alterations in Child 's Fluid & Electrolyte & Skin Flashcards
Pediatric Concerns: Fluid Balance
Have proportionately greater amount of body water than adults
Isotonic Dehydration
Hypotonic Dehydration
Hypertonic Dehydration
Signs of Dehydration
Dry skin, mucous membrane
Poor turgor
Sunken fontanelle
Poor perfusion
Weight loss
Tachycardia
Tachypnea
High urine specific gravity
Clinical Measurement
Daily weights
1kg change=1000ml of change
Wt loss indication of dehydration
5% loss = mild
- Irritable
- Vitals normal
- Skin & fontanelle normal
- Mucous membranes may be dry
- Urine may be low
6-9% loss = moderate
10% or more loss = severe (Shock)
- Lethargic: Comatose
- Low BP
- Increased HR
Nursing Care for Extracellular Fluid Volume Deficit
Prevent dehydration
Close assessment
Daily weights
Strict I & Os
Oral rehydration therapy
IV Therapy
Family teaching
Differences Between Infant Skin & Adult Skin
Thinner
Loss heat more readily
Contains more water
Bacteria can access easier
Infants are less pigmented placing the infant at risk of skin damage from UV radiation
Differences in Dark-Skinned Children
Children tend to have more pronounced cutaneous reaction.
Hypopigmentation or hyperpigmentation can affect areas of healing.
Dark- skinned children tend to have more prominent papules, follicular responses, lichentification, vesicular or bullous reactions.
Hypertrophic scaring and keloid formation occurs more often
Causes of Integumentary Disorders
Exposures to infectious microorganisms
Hypersensitivity reactions
Hormonal influences
Genetic predisposition
Injuries
Macule
Not-raised
Papule
Raised bump
Annular
Circular
Pruritus
Itching
Vesicle/ Pustule
Bump that contains pus
Scaling/ Plaques
Hypopigmentation
Hyperprigmentation
Erythematous
Reddening of the skin
Integumentary Assessment
Health History
- Determine the chief complaint
- Document HPI, location, duration, characteristics
- Note the child’s general health & discuss recent changes
Physical exam
- Perform complete exam noting any abnormalities
Lab Testing
- Used to help diagnose a disorder
- Most Common:
Impetigo
Bacterial infection
Common in summer
Epidermal, contagious
Staph or Strep
Most common sites
- Face, mouth, hands
Vesicles, pustules and redness
Nursing care
- Removal of yellow crust.
- Antibiotics
-Hygiene
Folliculitis
Infection of the hair follicle
Occurs due to poor hygiene, contact with contaminated water, maceration, moist environment, or use of occlusive emollient products.
Treatment
- Aggressive hygiene and warm compression
-Topical Mupirocin and occasionally oral antibiotics
Cellulitis
Localized infection and inflammation of the skin
The bacteria may gain entry to he skin via an abrasion, laceration , insect bite, foreign body, or impetiginous lesion.
Treatment- Mild cases are treated with Cephalexin or Augmentin
-More severe cases or orbital cellulitis requires IV management
Risk Factors for MRSA
Turf burns
Towel sharing
Participation in team sports
Attendance at daycare or outdoor camps
Tinea Capitis
Fungal infection affecting the scalp
Tinea Cruris
Fungal infection affecting the groin
Tinea Pedis
Fungal infection affecting the feet
Tinea Corporis
Affecting any other parts of the body
Tinea vesicolor
Presents differently, hypopigmented lesions on upper body due to fungal infection
Oral Candidiasis
Sources:
- Breastfedding infant
- Corticosteroids
- Antibiotics
- Immunocompromised
Treatment:
- Nystatin or Clotrimazole (adult)
Nursing Care:
- Boil pacifier, bottles, nipples
- Apply med w/ swab or swish and swallow
Dermatophytoses
Common sites
-Hand, skin and nails
Dry scaly patches
-May be circular
-Immunocompromised
Treatment
-Keep area cleana and dry
-Oral anti-fungals such as Griseofulvin.
-Check pets and family members for infection
Acne Vulgaris
Affects about 85% of adolescents between the ages of 7-16
This occurs most frequently on the face, chest and back.
Risk factors include pre or adolescent age, male gender( due to androgens), and oily conplexion.
Management
-Focuses on reduction of propionbacteriem acne, sebum production, normalizing skin shedding, and elimination inflammation.
- Meds- benzoyl peroxide, salicylic acid, retinoids, and topical or oral antibiotics
Atopic Dermatitis
Genetic Immune disorder
Erythematous patches
- Vesicles , crusts
- Pruritus
Nursing care
-Wet dressings for oozing
- Occlusive for moisture
-Assess environment
- Meds- antihistamine, corticosteriods, antibiotics,
immunomodulators
Contact Dermatitis
Causes
Antigenic substance exposure
Allergy to nickle or cobalt in clothing, hardware, or dyes
Exposure to highly allergenic plants; poison ivy, oak, and sumac
Complications
Secondary bacterial infections
Licenification or hyperpigmentation
- Meds- antihistamine, corticosteriods, antibiotics,
Diaper Dermatitis
Inflammatory reaction of the skin in the diaper area.
This is a non-immunologic response to a skin irritant
- Prolonged exposure to urine and feces may lead to skin breakdown.
Nursing care
-Prevention is the best management
-Frequent diaper changes
- Topical agents such as vitamins A,D and E; zinc oxide, nystatin, or petrolatum
Seborrheic Dermatitis
Inflammatory dermatitis that may occur to the skin or scalp.
In infants it occur most often to the scalp and it is called Cradle cap
- This usually resolves over weeks or months
- In adolescents it usually develops on the scalp, eyebrows, eyelashes, behind the ears, and between the shoulder blades.
Nursing care
- Meds-antidandruff shampoo containing selenium sulfate, ketoconazole, corticosteroids
Pediculosis
Transmitted from human hair
Nits are attached to shaft
Nursing Management
-Assess with bright light and magnifying glass
-Nit removal/pediculocide shampoo
-Prevention/ envirnmental
Scabies
Transmitted skin/skin
Mite burrows in epidermis
Papules, pustules, burrows
Pruitus
Nursing Management
-Scabicide lotion
-Prevention/ environmental
Erythema Multiforme
This a acute, self limiting hypersensitivity reaction.
It may occur in response to a viral infections, such as Adenovirus or Epstein- Barr virus;Mycoplasma pneumoniae infection; or a drug( sulfa drug, penicillins or immunizations) or food reaction
Stevens- Johnson syndrome and toxic epidermal necrolysis are the most severe form of erythema multiforme
Nursing care
-Management is generally supportive care because it resolves on its own
What is the 3rd leading cause of accidental death of children in U.S. ?
Burns
High Risk Groups for Burns
Children under 4 years.
Working males
Elderly over 70 years
Burn Assessment
Risks Associated with Age.
Infant: thermal burns
-Accident or abuse.
Toddler : thermal, electrical, contact.
-Exploration of environment
Preschool : scalding, contact
-Hot appliances
School- Age and Adolescent: All Types
-Experimentation
In children the head is greater in proportion to other body parts or surface area and children have greater proportion
- The head proportion decreases as they grow
Locations of Burns & Factors
Head and neck-smoke inhalation, lung damage, alteration in respirations.
Circumferential- circular occlusion of chest or extremity.
Electrical - causes deep damage, electrical conduction can affect the heart.
Perineal-high risk of contamination
1st Degree Burns
Superficial, Partial Thickness Loss
Epidermis only, quick healing, sunburn
2nd Degree Burns
Partial Thickness Loss
Epidermis plus upper dermis, 10-14 day healing, very painful.
3rd Degree Burns
Full Thickness Loss
All layers, no pain, grafting required, underlying structures affected, no pain because nerves are destroyed
Intercellular Dehydration, Extracellular Edema – Hemovolemic Stage
Increase in capillary permeability
Plasma seeps into surrounding tissues, causing edema
- Occurs from time of burn, first 24 +hours after the burn.
Increased heart rate, decreased cardiac output.
Decrease in blood flow
Oliguria
Increase in epinephrine, ADH, and aldosterone
Fluid shifts from vascular to interstitial spaces, causing intracellular dehydration, and extracellular edema.
Increase HCT
Monitor VS, I &O’s, give IV fluids, encourage po fluids, give blood replacement as ordered.
Increased heart rate, decreased cardiac output.
Metabolic acidosis state
Full Thickness Burn Care: Initial
Assess airway- HOB elevated, pulse ox.
Maintain fluids(third spacing can lead to hypovolemic shock)
Promote tissue perfusion- assess eschar carefully.
Control pain- medicate before all dressing changes
Prevent of infection-gown, gloves, mask
Full Thickness Burn Care: Special Care Needs
Escharotomy
Debridement
Grafting
-Auto, Xeno, Homo
Eye, lip, hand damage
Perineal
Full Thickness Burn Care: Later
Control Pain
Prevent Infection
Promote physical mobility
Moniter for GI aleratons
Ensure adequate nutrition and fluid balance
Provide anxiety management
Treat body- image issues.
Restoring & Maintaining Fluid Volume: Burns
Fluid calculation based on the body surface area burned (Fig. 45.22)
Use of a crystalloid (Ringer’s lactate) during the first 24 hours; in smaller children, a small amount of dextrose may be added
Administration of most of the volume during the first 8 hours (amounts and timing of fluid volume resuscitation will vary from child to child)
Reassessment of the child and adjustment of the fluid rate accordingly; fluid requirements greatly decrease after 24 hours and should be adjusted to reflect this.
Administration of a colloid fluid later in therapy once capillary permeability is less of a concern
Monitoring of the child’s urine output as part of ongoing assessment of response to therapy, expecting at least 1 mL/kg/hr
Daily weights obtained at the same time each day (the best indicator of fluid volume status)
Monitoring of electrolyte levels (particularly sodium and potassium) for their return to normal levels
Child-Abuse Burns
Inconsistent history given when caregivers are interviewed separately.
Delay in seeking treatment by caregiver.
Uniform appearance of the burn, with clear delineation of burned and nonburned area (as with a hot object applied to the skin).
In the case of a scald-induced burn, lack of spattering of water but evidence of the so-called “porcelain-contact sparing,” where the portion of the child’s skin that was in contact with the tub or sink is not burned (commonly seen with a forced immersion in extremely hot water used as punishment).
Flexor-sparing burns or burns that involve the dorsum of the hand.
A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water)
