Child with an integumentary disorder

The nurse is caring for a mom and her baby on a postpartum unit. The mom states she has received advice not to use baby powder on newborns. She asks the nurse if this is true, and if so, why. Which nurse response is correct?

"Baby powder should not be used on newborns due to the risk of aspiration upon application." The use of baby powder containing "talc" or known as "talcum powder" can cause accidental aspiration, pneumonia, and death. Aspiration is predominantly caused when the baby receives a "puff of smoke" when the powder is shaken from the container directly onto the baby's skin. In addition, the use of talcum powder is abrasive and is considered to contribute to the pathogenesis of diaper dermatitis

A nurse is providing teaching on ways to promote skin hydration for the parents of an infant with atopic dermatitis. Which response indicates a need for further teaching?

"We should bathe our child in hot water, twice a day."

Classification criteria for burn

-Assigned by extent of injury. -Super fail: only dermis. -Partial thickness: involves epidermis and portions of dermis. -Deep partial thickness: extends deeper into dermis. -Full thickness: extends through the epidermis, Demi's and hypodermis.

Laboratory and Diagnostic Tests for burns

-Electrolytes and complete blood count -Culture of wound drainage -Nutritional indices -Pulmonary status -Scanning for inhalation injury -Electrocardiographic monitoring for electrical injury

contact dermatitis causes:

-Response to an antigenic substance exposure -Allergy to nickel or cobalt in clothing, hardware, or dyes -Exposure to highly allergenic plants: poison ivy, oak, and sumac

Contact dermatitis complications

-Secondary bacterial skin infection -Lichenification or hyperpigmentation

If there's anything abnormal on the skin what should we look for?

-asymmetry -border -color -diameter -elevation -after skin biopsy

Nursing assessment for urticaria/Hives

-detailed history of new food, medications, symptoms of recent infection, changes in environment, or unusual stress -inspect the skin for raised edematous hives on body or mucous membranes. -assess airway and breathing as hypersensitivity may affect respiratory status.

Risk factors for CA-MRSA

-turf burns -towel sharing -participation in team sports -attendance at day care or outdoor camps

Common medical treatment

-wet dressings. -occlusive dressings. -emollient dressings: aquaphor( act as a barrier) -therapeutic bathing -skin biopsy

second degree burn

A burn marked by pain, blistering, and superficial destruction of dermis with edema and hyperemia of the tissues beneath the burn.

What are some types of inflammatory skin conditions

Acute hypersensitivity reaction (inflammatory response) -diaper dermatitis, contact dermatitis, erythema multi force and urticaria Chronic hypersensitivity disorder -atopic dermatitis (eczema) Chronic inflammatory skin disorder not from hypersensitivity -seborrhea (itchy scalp patches) and psoriasis

contact dermatitis

An inflammation of the skin caused by having contact with certain chemicals or substances,

Hypersensitivity reactions and causative agents

An inflammatory reaction in the skin due to stimulus (bee sting) or a result of a systemic reaction to an allergen (erythema multiforme) -can be acute or chronic (atopic dermatitis)

Types of infection of the skin

Bactrerial: bulbous and nonbullous, impetigo, folliculitis, cellulitis, MRSA, staphylococcal scaled kin syndrome Fungal: multiple types of tinea (pedis, corporals, versicolor, capitals and curries) Candida albicans Viral: viral exam themes (skin manifestation), herpes simplex.

Classification of acne: Moderate

Comedowns plus inflammatory lesions such as papules or pustules (localized to face or back)

The parents of a child diagnosed with atopic dermatitis ask the nurse, "My child has a skin disorder. I don't understand why a complete blood count (CBC) was ordered?" What is the appropriate response by the nurse?

Eosinophils are a type of white blood cell that are often elevated with atopic dermatitis. These are part of the CBC and helps in making the diagnosis."

What are causes of integumentary disorders in children

Exposure to infectious microorganisms Hypersensitivity reactions Hormonal influences (estrogen and testateron) Injuries

Causes of Uticaria (hives)

Food, drugs, animal stings, infections, environmental stimuli, stress

Fungal infection of the skin: Tinea corporis

Fungal infection of the arms or legs

Fungal infections of the skin: Tinea capitols

Fungal infection of the scalp, eyebrows or eyelashes

Fungal infection of the skin: Tinea cruris

Fungal infection on the groin

Fungal infections of skin: Tinea versicolor

Fungal infection on the trunk and extremities

Erythema Multiforme (EM)

Hypersensitivity reaction characterized by bulls-eye-shape lesion -acute and self-limiting, occur in response to viral or bacterial infections, drug or food reaction

What skin condition is darker skin more prone too

Hypertrophic scaring and keloids

common lab and diagnostic tests

Labs: CBC Erythrocyte sedimentation rate ERS (inflammatory maker) Immunoglobulin E (IgE) Culture and sensitivity of wound drainage Potassium hydroxide (KOH) PREP Patch or skin allergy testing Wood lamp

Classification of acne: severe

Lesions similar to moderate acne, but more widespread and/or presence of cyst or nodules, associated more frequently with scaring

Criteria for Transfer to a Burn Unit

Partial thickness burns greater than 10% of total body surface area Burns that involve the face Burns that involve the hands and feet, genitalia, perineum, or major joints Electrical burns, including lightning injury Chemical burns Inhalation injury Burn injury in children who have preexisting conditions that might affect their care Persons with burns and traumatic injuries Persons who will require special social, emotional, or long-term rehabilitative care Burned children in a hospital without qualified personnel or equipment for the care of children

Classification of acne: Mild

Primarily noninflammatory lesions (comedowns)

Nursing interventions for children with extensive burns

Promoting oxygenation and ventilation Restoring and maintaining fluid volume Preventing hypothermia Cleansing the burn Preventing infection Managing pain with atraumatic care Treating infected burns Providing burn rehabilitation

Which intervention is the most beneficial for a burn client undergoing a skin graft?

Provide around-the-clock pain medication as soon as pain is reported. When the child undergoes a procedure, such as skin grafting, that is known to produce prolonged pain, administer pain medication on a scheduled basis, rather than as needed once pain is reported. Around-the-clock pain medication will serve to diminish peaks and valleys in pain relief. Diversional activities and an egg-crate mattress are not effective treatments for severe pain.

A young child has just been admitted to the emergency department with a burn that encompasses the epidermis and the underlying dermis. From which type of burn does this child suffer?

Second-degree or partial-thickness burn

Scaling plaques

Secondary lesions

The nurse is caring for a client with burns in a pediatric hospital. The child is scheduled to be discharged the following day and the nurse is going over discharge education with the parents. Which is the best intervention for the parents when removing an old dressing?

Soak the old dressing in tepid water before attempting to remove.

Extreme form of erythema multiforme (EM)

Stevens-Johnson and toxic epidermal necrosis

The nurse is caring for a 7-year-old with burns. Which finding would be highly suggestive of a burn induced by child abuse (child maltreatment)?

Stocking-glove pattern on hands or feet A stocking-glove pattern on the hands or feet or a circumferential ring appearing around the extremity points to the caregiver forcefully holding the child under extremely hot water. A nonuniform pattern and splash or spattering patterns are not typical indicators of child abuse (child maltreatment).

first degree burn

Superficial burns through only the epidermis. A mild burn characterized by heat, pain, and reddening of the burned surface but not exhibiting blistering or charring of tissues.

The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) burns over 30% of the body. During the beginning shift assessment, which assessment finding is of most concern to the nurse?

Urine output of 15 mL per hour over the last 4 hours Fluid and electrolyte imbalance is a primary concern when caring for the client with burns. The urine output should be a minimum of 1 ml/kg/hour. The client weighs 45.5 kg, so output should equal approximately 45 ml/hour. Pain is a major concern, but the higher priority at this time is the decreased output. Refusal of one meal is not a high priority. Weight gain of 0.9 kg over 2 days is not a concern at this time.

Chronic hypersensitivity disorder

atopic dermatitis (eczema)

fourth degree burn

burn in which full thickness of the skin and underlying muscle and bone is damaged. extend even deeper into the fat layer.

Annular

circular

Acute hypersensitivity reaction (inflammatory response)

diaper dermatitis, contact dermatitis, erythema multi force and urticaria

Macule

flat skin lesion with only a color change

The nurse is caring for a child with a severe burn. The treatment for this child during the first 48 hours will be most likely be related to:

hypovolemic shock

third degree burn

involves destruction of epidermis, dermis and subcutaneous layer

The nurse is caring for a child with a suspected fungal infection. Which test would the nurse anticipate as being ordered?

potassium hydroxide (KOH) prep. Potassium hydroxide (KOH) prep is indicated for identifying a fungal infection. Patch or skin testing is indicated for evaluation of atopic or contact dermatitis. ESR is a nonspecific test used to determine the presence of infection or inflammation. Culture of wound/drainage is used to identify the specific organism.

Chronic inflammatory skin disorder not from hypersensitivity

seborrhea (itchy scalp patches) and psoria

papule

small, solid, raised lesion on surface of the skin

Prevention and management of diaper dermatitis

• Change diapers frequently. Change stool-soiled diapers as soon as possible. • Avoid rubber pants. • Gently wash the diaper area with a soft cloth, avoiding harsh soaps. • Use baby wipes in most children but avoid wipes that contain fragrance or preservatives. • Once a rash has occurred, follow all the prevention tips above and add the following: • Allow the infant or child to go diaperless for a period of time each day to allow the rash to heal. • Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3 to 5 minutes.

Common medications

•Antibiotics (topical, systemic) •Corticosteroids (topical) •Antifungals (topical, systemic) •Topical immune modulators (moderate to severe atopic dermatitis) •Antihistamines •Isotretinoin (cystic or severe acne) •Coal tar preparations (psoriasis, atopic dermatitis) •Silver sulfadiazine 1% (burns) Viral examthem like rosella- nothing to do Antiviral (herpes simplex)