Ch 43: Peds Integumentary

Question 1

Eczema

Answer 1

(atopic dermatitis)

superficial inflammatory process involving primarily the epidermis

Question 2

Forms of eczema

Answer 2

infantile: begins at 2-6 mo, decreases in incidence w aging, spon. remission by 3 yrs possible.
childhood: occurs at 2-3 yrs, may follow infantile form
preadolescent and adolescent: begins at 12 yrs and may continue into early adulthood or indefinitely

Question 3

eczema locations

Answer 3

adolescent/ early adult: commonly occur in antecubital and popliteal areas

Question 4

eczema treatment

Answer 4

administer antihistamines and topical corticosteroids as prescribed.
administer immunomodulator meds as prescribed.
administer prescribed abx if secondary infections occur.

Question 5

Impetigo

Answer 5

a contagious bacterial infection of the skin caused by beta hemolytic streptococci or staphylococci, or both.
occurs most often in hot, humid months
thick honey colored crusts

Question 6

Impetigo common sites

Answer 6

most common = on the face and around the mouth

then, hands, neck, and extremities

Question 7

Impetigo symptoms

Answer 7

lesions begin as vesicles or pustules surrounded by edema and redness,
progresses to an exudative and crusting stage, vesicles rupture leaving honey colored crusts covering ulcerated bases

Question 8

Impetigo treatment

Answer 8

contact isolation - highly contagious.
remove crusts to allow for healing.
apply topical abx ointments.
infection is communicable for 48 hrs beyond initiation of abx tx
oral abx prescribed if topical do not work.

Question 9

Pediculosis capitis

Answer 9

(lice)
female louse lays her eggs (nits) on the hair shaft, incubation period is 7-10 dys.
lice can survive 48 hrs away from the host.

Question 10

Lice tx

Answer 10

pediculicide product (usually permethrin 1% cream rinse (Nix)) as prescribed.
daily removal of nits with an extra fine tooth metal nit comb.
bedding / toys not washed = sealed in plastic bag for TWO WEEKS.

Question 11

Scabies

Answer 11

parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite).
endemic among schoolchildren and institutionalized populations as a result of close personal contact.

Question 12

Scabies incubation period

Answer 12

female mite burrows into the epidermis, lays eggs, and dies in the burrow after 4-5 wks.
the eggs hatch in 3-5 dys

Question 13

Scabies infectious period

Answer 13

during the entire course of the infestation

Question 14

Scabies assessment findings

Answer 14

pruritic papular rash

burrows on the skin (fine grayish red lines)

Question 15

Scabies interventions

Answer 15

topical application of a scabicide (permethrin (Elimite)) kills the mites.
Lindane should not be used in children < 2yrs (more permeable skin) bc of risk for neurotoxicity and szs
permethrin is applied to all skin surfaces, massaged in, left on the skin for 8-14 hrs, and removed by bathing.
bedding / toys not washed = sealed in plastic bag for FOUR DAYS.

Question 16

Priority Nursing Actions BURNS

Answer 16

1. stop the burning process
2. assess the ABCs
3. begin resuscitation if the child is not breathing
4. remove burned clothing and jewelry
5. cover the wound with a clean cloth
6. keep the child warm
7. transport the child to the ED

Question 17

Pediatric burn considerations

Answer 17

thinner skin
higher risk for fluid/heat loss, dehydration, and metabolic acidosis than adults
more body fluid proportion increases risk of CV problems
burns > 10& of BSA require fluid resus.
smaller muscle mass/ less body fat –> increased risk for protein / calorie deficit.
scarring is more severe
immature immune system
delay in growth may occur after a burn

Question 18

rule of nines

Answer 18

inaccurate for children bc of different body proportions

age related charts to estimate burn area

Question 19

fluid replacement therapy

Answer 19

to determine adequacy of fluid resus. assess:
vital signs (esp HR)
urine output
adequacy of capillary filling
sensorium status

Question 20

fluid replacement fluids

Answer 20

crystalloid solutions are used during the initial phase of therapy; colloid solutions such as albumin, Plasma-Lyte (combo electrolyte solution), or fresh frozen plasma are useful in maintaining plasma volume

Question 21

best way to assess fluid resus

Answer 21

neurological assessment