Lecture 15: Skin conditions and when to refer Flashcards
Fever-Notify MD if
* unusally drowsy
* Very fussy
* Been in a very hot place such as overheated car
* immune system problems
* Sickle cell disease
* Cancer
* Taking steriods
* Still acts sick once his fever has beeen brought down
* Seems to be getting worse
Symptoms:
* Stiff neck - might be meneingitits
* HA - might be meningitits
* Sore throat - might be strep
* Ear pain - some kind of infection
* Unexplaned rash
* Repeated vomiting or diarrhea
<3 months what temp is considered a fever?
* What should you do for it?
100.4
ER if MD not available
3-12 months whats considered a fever?
* What should you do for it?
102.2
ER if MD not available
For any age child over 12 months whats considered a fever?
* What should you do for it
> 104
ER if MD not avilable
at risk for seizures above this
KNOW: untreated fever under 3 months can easily lead to neurological deficits (think developing CP from this)
how long does a fever have to persist for a child younger than 2 for you to call MD?
24 hours
how long does fever have to persist for you to call MD for a child over 2
72 hours
What is considered a fever emergency? (emergency room)
> 105
any fever with new onset seizure
Fever with stiff neck/neck pain - remember, sometimes can say their neck hurts because of throat pain
* will often say “neck feels heavy” w/ meningitis
Fever with severe HA
* if the have hx of migrains this is different becaue its their normal HA’s
Fever w/ difficulty breathing
Conjunctivitits (pink eye)
* bacterial or viral
white of eye and the inside of lower lid become red
* typically lasts 7-10 days
* Highly contagious - general rule 24 hours after eye drops for bacterial to return to school or clinic
* Redness in one or both eyes
* Itchiness in one or both eyes
* A gritty feeling in one or both eyes
* A discharge in one or both eyes that forms a crust during the night
* Tearing
send them home if they have this
Boils, abscess and cellulitits
* bacterail infections of the skin that usually begin from a scratch or bug bite and progress to a red nodule that fills w/ puss
* Incubation period = unknown
* Staph and strep = common cause of most
* Bacterial infection becomes more aggressive and overpowers normal defenses against infection
* Can treat for PT 24 hours after antibiotics and covered
bacterail = need to be on antibiotics for 24 hours before coming to clinic
Virial = need to be symptom free before returning to clinic
Superficil infections with a thin layer of skin over fluid
Boils
Larger and deeper than boils with redness and painful swelling over an area filled w/ pus
Abscesses
Infection within the skin and the area just beneath it; the skin is red and tender
* does it spread quickly?
Cellulitits
can spread quickly
often happens post op - often caused by strep/staph
* typically we want the area covered
* if bacterail = on antibiotics for 24 hours before PT
Methicillin-Resistant Staphylococcus Aureus (MRSA) - very common in hospitals
* cause of more serious infections
* Contagious when the infected area is open and drainage is present
* Use good hand-hygiene - need to actually scrub hands to get rid of it
* Eczema is a risk factor for MRSA - because its open lesions
* Cover lesions if they are draining
* May need antibiotic treatment
* Surgical drainage without antibiotics may be used for an abscess
* Antibiotics should be given according to instructions - pts need to finish antibiotics because thats where antibiotic resistent bacteria comes from
* No effective and long lasting way to eliminate MRSA from child care settings and families
* Commonly lives on skin and in noses of those not infected - so its all over the place
its bad when immune system is comprismied or it gets into an open wound
how MRSA starts (not tested on these pictures)
Heat rash (Prickly heat or Miliaria)
* Sweat gland pores become blocked
* Looks like patches of small pink or red bumps or blisters
* usually under clothing or spots where skin tends to fold-on the neck, elbows, armpits, or thighs - typically happens where they’re hot (makes sense in these areas like skin folds because it gets hotter there)
How to treat
* Keep kids cool
* Pay attention to hot spots
* Wash areas of the skin that stay wet with sweat, urine, or drool
* Keep skin bare
* Do not apply skin ointments
Poison IVy and Other Plant Rashes
* Burning, intensely itchy rash where skin touches plant
* Allergic skin reaction causes redness, swelling and blisters - so theres a chance you might not be reactive to it
* Wash cloths, hands and area affected cautiously
* Soothing salves
* Avoid ointments containing anesthetics or antihistamines
* Usually 1% hydrocortisone cream
* OK to treat in PT if stable and covered - can transfer to yourself if not covered
Talk w/ pediatrician:
* Child is especially uncomfortable
* Rash is severe and/or isnt going away
* Rash is on face or groin area
* Signs of infection (fever, redness, swelling beyond the poison ivy or oak lesions)
Eczema Atopic Dermatitis – very common
* Chronic condition common in children
* Causes patches of dry, scaly red skin
* Flares in cold, sweating and chlorine
* Moisturize
* Dress Wisely
* Don’t scratch – pat, pat, pat
* Talk with pediatrician if affecting functionally
* OK for therapy but be cautious with skin – so like don’t put electrode patches over that area. Adults in the hospitals will ask for special sheets, towels, etc… if they used ones washed a certain way it can flare
* Watch for lotions, detergents, etc
Impetigo – much more common in kids – need to be on antibiotics 24 hours before treatment (common rule of thumb)
* Bacterial skin infection
* Common during hot, humid weather – so no season for it in FL because its hot all the time
* Causes a rash that may have fluid filled blisters or an oozing rash covered by crusted yellow scabs
* More likely to develop where there is a break in skin (around insect bites)
* Clean and cover
* Avoid scratching
* Talk w/ pediatrician
* Wait to treat until antibiotics and covered
Insect Bites and Stings
* Can cause a severe allergic reaction/anaphylaxis
* Remove stingers and ticks – depends on what state you’re in. in FL. Considered an invasive procedure and we can’t do it. But in some states PT’s can – can come to PT
* Clean the skin
* Treat swelling
* Help relieve the itch
Molluscum Contagiosum – little pearly bumps
* Viral infection-Poxvirus
* Pearly bumps on the skin on a child’s chest, back, arms or legs – but can be anywhere
* Dome-shaped bumps “water warts” may have a dimple in the center
* More common in hot, humid climates
* Wait it out is really the best thing to do – however, you can also burn them off if you keep touching them and spreading them to yourself
* Stop the spread
* Avoid scratching
* OK to treat if covered
* Shouldn’t be in swimming pools or around other kids unless its covered
* Remember, if its not spreading you don’t have to treat it. Will eventually go away on its own but takes awhile
Tinea (Ringworm)
* Fungus
* Thrives in warm, damp conditions (think body to body contact – often wrestlers)
* Can appear on scalp or other parts of the body
* Rash from infection tends to form round or oval spots that become smooth in the center as they grow while border remains red and scaly
* Can spread quickly
* Contagious as long as rash is present
* Stop the spread
* Talk w/ pediatrician
* Can be treated by PT if covered – however, if they’re covered its unrealistic to cover and treat
Hand, Foot and Mouth Disease
* Common during summer and early fall
* Most common in younger children
* Child care centers, preschools, and camps
* Caused by Enterovirus coxsackie
* Starts w/ a fever, sore throat, and runny nose-then a rash w/ tiny blister may appear:
o In the mouth (inner cheeks, gums, sides of the tongue or back of the mouth)
o Fingers or palms of hands
o Soles of feet
o Buttocks
* Symptoms are the worst first few days, usually gone within a week
* Monitor symptoms. Call pediatrician if fever lasts more than 3 days or if child is not drinking fluids
* Ease the pain
* Avoid dehydration
* Do not treat until cleared
Acne Vulgaris
* Most common skin disease
* * Occurs primarily between the ages of 12 and 25 years
* Develops at sebaceous follicles located primarily on the face and upper parts of the chest and back
* Skin protection
we need ot be careful to protect these pts skin. not going to put electrodes of this and avoid tons of pressures / lotions
Hold therapy: reasons to hold therapy
* Fever
* Nausea/Vomiting (not related to medication) – if they’re on chemo its fine because they’re on medication and that’s what’s causing it.
* Diarrhea – unless on medication that causes this
* Seizure (if hx of seizure based on postictal state) – postictal state = state after seizure (can continue therapy if the seizures are regular, just ask the kid)
* Lice
* Skin conditions (receiving medical treatment)
Emergency treatment
* New onset of seizures – even if they have a diagnosis where you would expect seizures
* New onset of chest pain or difficulty breathing not explained by current medical issues
* Acute injury – think falling or breaking a bone
* Acute change in tone – may indicate stroke – Red flag!!!
* Anaphylaxic response – or suspected that they might have it – so if you’re allergic to bees and get stung – call 911 – get EpiPen out and wait, don’t use before there allergic rxn. Call 911 and ask what to do before using it (you avoid liability this way) – if it’s there EpiPen it’s fine to stab. If it’s your EpiPen that’s where problems arise
* Fever as stated before (numbers from previously in lecture) 105 for adults (under 3 months = 102.2) (3-12 months = 100.4)
