Pediatric Nursing: Integumentary Problems

Question 1

Eczema (Dermatitis): description and assessment

Answer 1

• superficial inflammatory process involving primarily the epidermis.
• many types and include: atopic dermatitis, contact dermatitis, and stasis dermatitis.
• associated with family history, allergies, asthma, or allergic rhinitis.
• goals of management are to relieve pruritus, lubricate the skin, reduce inflammation, and prevent or control secondary infections.
• assessment: redness, scaliness, itching, minute papules and vesicles, weeping, oozing, and crusting of lesions. Can occur on scalp and face (infants), creases of elbows and knees, neck, wrists, ankles, or creases between the buttocks and legs.

Question 2

Eczema (Dermatitis): forms and interventions

Answer 2

• Infantile: usually begins at 2-6m and decreases in incidence with aging. Spontaneous remission may occur by 3y.
• Childhood: may follow the infantile form; occurs at 2-3y.
• Preadolescent and adolescent: begins at about 12y and may continue into the early adult years or indefinitely.
• Interventions: baths and moisturizers are important; water should be tepid and bath should be limited to 5-10 min, and the skin should be moisturized immediately after the bath; a thick cream or ointment should be used (such as petroleum jelly).
  If topical meds are prescribed, should be applied within 3 min after bath.
  Antihistamines and topical corticosteroids may be prescribed (apply a thin layer and rub the area).
  ATB may be precribed if secondary infection occur.
  Avoid exposure to skin irritants and eliminate conditions that increase itching.
  Cool, wet compresses applied for short periods may help soothe and alleviate skin. Prevent scratching by keeping nails short and clean, and placing gloves or cotton socks over hands..
  Instruct parents to wash clothing in a mild detergent and rinse thoroughly, prevent infections, and monitor lesions.

Question 3

Impetigo: description and assessment

Answer 3

• is a contagious bacterial infection of the skin caused by B-hemolytic streptococci or staphylococci or both; it occurs most commonly during hot, humid months.
• can occur because of poor hygiene and it can be a primary or secondarily infection.
• most common sites: face and around the mouth, and then on the hands, neck, and extremities.
• begins as vesicles or pustules surrounded by edema and redness.
• lesions progress to an exudative and crusting stage; after crusting of the lesions, the initially serous vesicular fluid becomes cloudy, and the vesicles rupture, leaving honey-colored crusts covering ulcerated bases.
• assessment: blisters and crusts, erythema, pruritus, burning, secondary lymph node involvement can be present.

Question 4

Impetigo: Interventions

Answer 4

• institute contact isolation and use standard precautions. Strict hygiene practices are important because impetigo is a highly contagious condition.
• apply topical ATB ointments with a clean/sterile cotton swab without touching the tube opening with fingers or skin. Infection is communicable for 24-48h beyond initiation of treatment.
• cover lesions with gauze bandages and tape to prevent the spread.
• assist the child with daily bathing with antibacterial soap as prescribed.
• apply warm water compresses to the lesions 2 or 3 times daily, followed by mild soap and water rinse to soften crusts for removal and to promote healing.
• oral ATB may be prescribed if there is no response to topical ATB treatment.
• complying with the treatment is important because secondary infections such as glomerulonephritis may result.
• apply emollients to prevent skin cracking.
• instruct parents on methods to prevent infection (hand-washing), that child needs separate towels, linens, dishes, and eating utensils. All linens and clothing used by the child should be washed with detergent in hot water separately.

Question 5

Pediculosis capitis (Lice): description and assessment

Answer 5

• refers to an infestation of the hair and scalp with lice.
• most common sites: occipital area, behind the ears at the nape of the neck, and occasionally the eyebrows and eyelashes.
• female louse lays her eggs (nits) on the hairs shaft, close to the scalp.
• incubation period is 7-10 days.
• lice can survive for 48h away from the host; nits shed in the environment can hatch in 7-10 days.
• head lice live and reproduce only in humans and are transmitted by direct and indirect contact (hats, towels, brushes).
• all contacts of the infested child should be examined.
• assessment: child scratches scalp excessively, pruritus is caused by the crawling insect and its saliva on the skin. Nits are observable on the hair shaft. Adult lice are difficult to see and appear as small tan or grayish specks that move quickly.

Question 6

Pediculosis capitis (Lice): interventions

Answer 6

• use of pediculicide product as prescribed and daily removal of nits with a extra-fine-tooth metal nit comb (as a control measure).
• hair brushes or combs should be discarded or soaked in boiling water for 10 min.
• instruct parents that bedding and clothing used by the child for the previous 2 days before diagnosis should be laundered in hot water with detergent and dried in a hot dryer for 20 min.
• bedding and clothing needs to be changed daily and laundered.
• seal toys that cannot be washed or dry-cleaned in plastic bag for 2 weeks.
• furniture and carpets need to be vacuumed frequently and the dust bag should be discarded after.

Question 7

Scabies: description and assessment

Answer 7

• is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite)
• is endemic among schoolchildren and institutionalized populations as a result of close personal contact.
• incubation period: female mite burrows into the epidermis, lays eggs, and dies in the burrow after 4 to 5 weeks. The eggs hatch in 3-5 days, and larvae mature and complete their life cycle.
• infectious period: during the entire course of the infestation.
• assessment: pruritic papular rash, burrows into the skin (fine grayish red lines that may be difficult to see).
• transmitted by close personal contact with an infected person. Household members and contacts should be treated simultaneously.

Question 8

Scabies: interventions

Answer 8

• topical application of a scabicide.
• various products are available (prescription needed).
• lindane shampoo should not be used in children < 2y because of neurotoxicity ans seizures.
• instruct parents on application and be aware of contraindications regarding use.
• scabicide is not applied to the face or head, only from neck down.
• when permethrin is prescribed, it is applied to cool dry skin at least 30 min after bathing; the cream is massaged thoroughly and gently into all skin surfaces from head to the soles of the feet, left on the skin for 8-14h, and then removed by bathing; a repeat treatment may be necessary.
• instruct parents that all clothing, bedding, and pillowcases used by the child need to be changed daily, washed in hot water with detergent, dried in a hot dryer, and ironed before reuse; this process should be continue for at least 1 week.
• nonwashable toys and other items should be sealed in plastic bags for at least 4 days.
• anti-itch topical treatment may be necessary and ATB may be prescribed for secondary infections.

Question 9

Burn Injuries: pediatric considerations

Answer 9

• higher mortality rate in very young children.
• child’s skin is thinner.
• severely burned children are at increased risk for fluid and heat loss, dehydration, and metabolic acidosis.
• higher proportion of body fluid to body mass in children increases the risk of cardiovascular problems.
• burns involving 10% of the total body surface area require some form of fluid resuscitation.
• infants and children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults.
• scarring is more severe.
• immature immune system presents an increased risk of infection.
• a delay in growth may occur after a burn.
• adult rule of nines does not apply to children.

Question 10

Burn Injuries: priority nursing actions

Answer 10

• stop the burning process.
• assess for a patent airway.
• begin resuscitation measures if necessary using CAB.
• remove burned clothing and jewelry.
• cover the wounds with a clean cloth (sterile dressings on arrival to the health care facility).
• keep the child warm.
• transport to emergency department.

Question 11

Burn Injuries: Fluid replacement therapy (in children)

Answer 11

• to determine adequacy of fluid resuscitation, VS, urine output, adequacy of capillary filling, and sensory status are assessed.
• fluid replacement is necessary during the initial 24h period after burn injury.
• several formulas are available to calculate the child’s fluid needs, and depend on PHCP.