Chapter 24: Nursing Care of the Child with an Integumentary Disorder

The nurse is discussing dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction? a) Peanut butter and jelly sandwich b) Carrot and celery sticks c) Tomato soup d) Chicken nuggets

a)Peanut butter and jelly sandwich Explanation: Atopic dermatitis is commonly associated allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.

The nurse is caring for a 10-month-old with a rash. The child's mother reports that the onset was abrupt. The nurse assesses diffuse erythema and skin tenderness with, ruptured bullae in the axillary area with red weeping surface. The nurse suspects which of the following bacterial infections? a) Scalded skin syndrome b) Folliculitis c) Impetigo d) Non-bullous impetigo

a)Scalded skin syndrome Explanation: Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin which then causes exfoliation. It is abrupt in onset and results in diffuse erythema and skin tenderness. It is most common in infancy and rare beyond 5 years of age. Bullous impetigo presents with red macules and bullous eruptions on an erythematous base. Nonbullous impetigo presents as papules progressing to vesicles then painless pustules with a narrow erythematous border. Folliculitis presents with red raised hair follicles.

The nurse is providing education to the parents of a teenaged boy diagnosed with impetigo. Which of the following statements by the boy indicates the need for further education? a) "This condition is contagious." b) "I will need to cover my son's skin lesions with bandages until it has healed." c) "It is important to remove the crusts before applying any topical medications." d) "My son can continue to attend school while he is taking the prescribed antibiotics."

b)"I will need to cover my son's skin lesions with bandages until it has healed." Explanation: Impetigo is an infectious bacterial infection. The crusts should be removed after soaking prior to applying topical medications. Leaving the lesions open to air is not contraindicated. Children diagnosed with impetigo may attend school during treatment.

When doing teaching with a group of caregivers of infants the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash. a) "They told me to use baby powder every time I change her so she won't get diaper rash." b) "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." c) "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash." d) "The formula she drinks sometimes causes her to have a diaper rash."

b)"My child gets diaper rash if I wash her clothes in the same detergent we use for the family." Explanation: Infants may have a sensitivity to some soaps or disposable diaper perfumes, and the use of strong laundry detergents without thorough rinsing can cause diaper rash. Diarrheal stools, prolonged exposure to wet or soiled diapers, use of plastic or rubber pants, infrequently changed disposable diapers, inadequate cleansing of the diaper area (especially after bowel movements), and yeast infections are also causative factors. Exposing the diaper area to the air helps clear up the dermatitis. The use of baby powder when diapering is discouraged because caked powder helps create an environment in which organisms thrive.

The nurse is presenting an in-service to a group of nursing students discussing atopic dermatitis. The following statements were made by the students. Which statement is most accurate related to atopic dermatitis? a) "When children are diagnosed, if they aren't up to date with all of their immunizations they need to get them right away." b) "My sister never gives her 6-month-old eggs because her other kids have all had this disorder." c) "Children with this disorder sleep a lot; sometimes you even have to wake them to feed them." d) "This disorder is usually first recognized by red skin on the child's back."

b)"My sister never gives her 6-month-old eggs because her other kids have all had this disorder." Explanation: The protein of egg white is such a common offender that most pediatricians advise against feeding whole eggs to infants until late in the first year of life. Infantile eczema usually starts on the cheeks and spreads to the extensor surfaces of the arms and legs. Smallpox vaccination is definitely contraindicated for the child with eczema. In fact, such a child must be kept away from anyone who has recently been vaccinated. A serious condition called eczema vaccinatum results when a child with eczema is vaccinated or is exposed to the vaccination of another person.

The nurse is caring for a 15-year-old boy with psoriasis. In addition to the plaques, which of the following would the nurse expect to note? a) Lichenification b) Fissures and scaling on palms and soles c) Hyperpigmentation d) Fever and malaise

b)Fissures and scaling on palms and soles Explanation: Fissures and scaling on the palms and soles are common findings with psoriasis. Fever and malaise, lichenification, and hyperpigmentation are noted with other integumentary disorders but are not typical physical findings with psoriasis.

The nurse is caring for a 1-week-old child with a feeding intolerance. The mother expresses a concern with white scales that have began to flake off the infant's scalp and she asks the nurse what she can do to prevent this. Which of the following is the best nursing response? a) "Your child most likely has infantile seborrheic dermatitis, or cradle cap. There is no intervention needed and it should resolve in one week." b) "How often do you bathe your infant? The infant should have a thorough shampooing every day to prevent things like this." c) "Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." d) "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo."

c)"Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." Explanation: Infantile seborrheic dermatitis usually responds well to cleansing the scalp with a mild shampoo. The thick, scaling lesions on the child's scalp can be treated by applying baby oil, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene.

A nurse is caring for a child with tinea pedis. Which of the following assessment findings would the nurse expect to note? a) Inflamed boggy mass filled with pustules b) Erythema, scaling, maceration in the inguinal creases and inner thighs c) Patches of scaling in the scalp with central hair loss d) Red scaling rash on soles and between the toes

d)Red scaling rash on soles and between the toes Explanation: Tinea pedis presents with red scaling rash on soles, and between the toes. Tinea capitis presents with patches of scaling in the scalp with central hair loss and the risk of kerion development (inflamed boggy mass filled with pustules). Tinea cruris presents with erythema, scaling, maceration in the inguinal creases and inner thighs.

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at doing which of the following? a) Regulating skin and body temperature b) Managing pain and discomfort c) Controlling nausea and vomiting d) Reducing swelling and relieving itching

d)Reducing swelling and relieving itching Explanation: Treatment for skin allergies is aimed at reducing the swelling and relieving the itching. With swelling in various parts of the body, the child may have pain, nausea and vomiting, but reducing the swelling would prevent those symptoms from occurring.

A nurse providing teaching on ways to promote skin hydration for the parents of an infant with atopic dermatitis. Which of the following responses indicates a need for further teaching? a) "We need to avoid any skin product containing perfumes, dyes, or fragrances." b) "We should use soap to clean only dirty areas." c) "We should use a mild soap for sensitive skin." d) "We should bathe our child in hot water, twice a day."

d)"We should bathe our child in hot water, twice a day." Explanation: The nurse should emphasize that the parents should avoid hot water. The child should be bathed twice a day in warm water. The other statements are correct.

The nurse is providing home care instructions for the parents of an infant with cradle cap. Which response by the parents indicates a need for further teaching? a) "We can safely use a selenium sulfide shampoo on his hair." b) "We should wash or shampoo the scalp areas with mild soap." c) "We can scrape off the crusts on his scalp with a cotton swab." d) "We can massage his head with mineral oil first and then shampoo it."

"We can scrape off the crusts on his scalp with a cotton swab." Explanation: The crusts should not be forcibly removed with a cotton swab. The affected areas are washed or shampooed with a mild soap. In the infant, mineral oil is applied to the scalp, massaged in well with a washcloth, and then shampooed 10 to 15 minutes later using a brush to gently lift the crusts. Selenium shampoo can be used safely on an infant.

The nurse is providing teaching on ways to maintaining skin integrity and preventing infection for the parents of a boy with atopic dermatitis. Which of the following responses indicates a need for further teaching? a) "We should avoid using petroleum jelly." b) "We should avoid tight clothing and heat." c) "We need to develop ways to prevent him from scratching." d) "We should keep his fingernails short and clean."

a)"We should avoid using petroleum jelly." Explanation: It is important to apply moisture multiply times through the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available. The other statements are correct.

The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children. Which of the following disorders is the nurse most likely referring to? a) Candidiasis b) Seborrheic dermatitis c) Impetigo d) Miliaria rubra

c)Impetigo Explanation: Impetigo is a superficial bacterial skin infection.

The nurse is collecting data on a child with a diagnosis of atopic dermatitis. While interviewing the caregiver, the nurse will direct questions to the caregiver recognizing that which of the following are common allergens involved in eczema? Select all that apply. a) Eggs b) Animal dander c) Cotton d) Oatmeal e) Nylon f) Cow's milk

f)Cow's milk b)Animal dander e)Nylon Explanation: The most common allergens involved in eczema are eggs, cow's milk, wheat products, orange juice, tomato juice, house dust, pollens, animal dander, wool, nylon, and plastic.

The nurse is presenting an in-service to a group of nurses who will be working in a dermatology clinic. One participant asks the nurse about a bacterial skin infection that she has seen in children. Which of the following disorders is the nurse most likely referring to? a) Impetigo b) Miliaria rubra c) Seborrheic dermatitis d) Candidiasis

a)Impetigo Explanation: Impetigo is a superficial bacterial skin infection.

The nurse is discussing the use of over-the-counter ointments to manage a mild case of diaper rash. What ingredients should the nurse instruct the parents to look for in a compound? Select all that apply. a) Vitamin D b) Vitamin A c) Vitamin B12 d) Vitamin B6 e) Zinc

b)Vitamin A e)Zinc a)Vitamin D Explanation: The treatment of diaper rash may include topical ointments containing vitamins A and D as well as zinc.

The nursing diagnosis of risk for infection related to a disruption in the protective skin barrier is noted on a child's plan of care. Which action would be of greatest importance? a) Assessing temperature every 4 hours b) Obtaining a culture of the impaired skin area c) Using appropriate hand hygiene d) Urging adequate nutritional intake

c)Using appropriate hand hygiene Explanation: Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk.

A group of nursing students are reviewing information about atopic dermatitis. Which of the following indicate that the students understand the information? Select all that apply. a) The reaction occurs in response to specific allergens. b) Scratching initiates the reaction, which then becomes pruritic. c) Changes in temperature can contribute to flare-ups. d) Excessively humid environments often lessen the severity of the reaction. e) The disorder is chronic with periods of remissions.

e)The disorder is chronic with periods of remissions. a)The reaction occurs in response to specific allergens. c)Changes in temperature can contribute to flare-ups. Explanation: Atopic dermatitis is a chronic disorder with a relapsing and remitting nature. The skin reaction occurs in response to specific allergens, usually foods, or environmental triggers. Changes in ambient temperature can contribute to flare-ups. Excessively humid or dry environments can cause the condition to worsen. When a trigger occurs, antigen-presenting cells stimulate interleukins to begin the inflammatory process. The skin begins to feel pruritic and then the child starts to scratch. Itchiness occurs first and then the rash appears.

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful? a) "I should use the highest-potency steroid cream I can find." b) "I should not cover the area with plastic wrap after applying the cream." c) "I should apply the medicine at bedtime and rinse it off in the morning." d) "I need to shake the preparation before using it."

b)"I should not cover the area with plastic wrap after applying the cream." Explanation: An occlusive dressing such as plastic wrap over the area should not be used with topical corticosteroids. High-potency preparations should not be used. There is no need to shake topical corticosteroids. Benzoyl peroxide requires shaking before use. Applying the medication at night and rinsing off in the morning is used for coal tar preparations.

A nurse assessing a 6-month-old girl with an integumentary disorder. The nurse notes three virtually identically sized, round red circles with scaling that are symmetrically spaced on both of the girl's inner thighs. What should the nurse ask the mother? a) "Does she wear sleepers with metal snaps?" b) "Do you change her diapers regularly?" c) "Tell me about your family history of allergies." d) "Has she been exposed to poison ivy?"

a)"Does she wear sleepers with metal snaps?" Explanation: Small round red circles with scaling, symmetrically located on the girls' inner thighs point to nickel dermatitis that may occur from contact with jewelry, eyeglasses, belts, or clothing snaps. The nurse should inquire about any sleepers or clothing with metal snaps. The girl does not have a rash in her diaper area. It is unlikely that an infant this age would have her inner thighs exposed to a highly allergenic plant. Discussing family allergy history is important, but the nurse should first inquire about any clothing with metal that could have come into contact with the girl's skin when she displays a symmetrical rash.

In working with infants diagnosed with atopic dermatitis, the nurse anticipates that when these children are older they will likely have a tendency to have which of the following disorders? a) Asthma b) Rheumatoid arthritis c) Hemophilia d) Otitis media

a)Asthma Explanation: Infants who have eczema tend to have allergic rhinitis or asthma later in life.

The nurse is caring for a 1-year-old patient in a pediatric clinic. The patient was brought to the clinic with symptoms of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which of the following is a key element in the treatment regimen for this diagnosis? a) Frequently rehydrating the skin b) Applying topical antibiotics routinely c) Teaching the child not to scratch the "itchy" skin d) Daily oral cortisone

a)Frequently rehydrating the skin Explanation: Frequently rehydrating the skin is a key element of the treatment regimen. To maintain healthy skin in the child with AD, hydration practices should be implemented to replace moisture in the stratum corneum and prevent transdermal water losses. Scratching the itchy skin is a reflex that is very difficult to stop; preventing the itch is more effective. Topical antibiotics and oral cortisone are not treatments for atopic dermatitis.

The nurse is developing the plan of care for a 3-year-old child diagnosed with atopic dermatitis. When reviewing the desired patient outcomes which of the following are common focuses for a child with this diagnosis? Select all that apply. a) Maintenance of skin integrity b) Prevention of infection c) Promotion of skin hydration d) Pain management e) Reduction in anxiety

c)Promotion of skin hydration a)Maintenance of skin integrity b)Prevention of infection Explanation: When caring for the child with atopic dermatitis the focus of care will be on the prevention of infection, maintenance of skin integrity, and promotion of skin hydration.

Which of the following is the best technique to perform an assessment of the skin? a) Skin assessment involves inspection and palpation in a room with yellow walls and bright white light. b) Skin assessment involves inspection and palpation using latex gloves. c) Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. d) Skin assessment involves inspection and palpation using vinyl gloves.

c)Skin assessment involves inspection and palpation in a room with white walls and bright fluorescent light. Explanation: Physical assessment of the skin involves two basic techniques: inspection and palpation. The ideal environment for the physical assessment is a well-lit room with white walls, not yellow. Bright white fluorescent ceiling lighting is optimal, because it does not cast a yellow hue on the skin. Skin assessment does not require the use of gloves unless there are body fluids or open lesions on the skin. If gloves are required, they should be vinyl to prevent an allergic reaction.

The nurse is caring for an infant who has impetigo and is hospitalized. Which of the following nursing interventions is the highest priority for this child? a) The nurse applies elbow restraints to the infant. b) The nurse applies topical antibiotics to the lesions. c) The nurse follows contact precautions. d) The nurse soaks the skin with warm water.

c)The nurse follows contact precautions. Explanation: Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.

An 8-month-old has been diagnosed with infantile eczema. At a follow-up appointment, the child's caregiver seems exhausted and angry. He explains that he has done all of the child's care because his wife is repulsed by the child's raw and uncomfortable appearance. Which of the following responses would be appropriate for the nurse to say to this caregiver? a) "That's not fair to you; she should get some counseling to learn how to cope with illness better." b) "That's not an uncommon reaction, although it's hard on you and on your child." c) "He will be better soon and your family can get back to normal." d) "I understand her feelings. It is hard to see a child in pain sometimes."

b)"That's not an uncommon reaction, although it's hard on you and on your child." Explanation: The family caregivers of the child with eczema are often frustrated and exhausted. Family caregivers may feel apprehensive or repulsed by this unsightly child. Support them in expressing their feelings and help them view this as a distressing but temporary skin condition. Although the caregiver can be assured that most cases of eczema clear up by the age of 2, this does little to relieve the present situation.