Saunders | Pediatric: Integumentary

366. The nurse is monitoring a child with burns during treatment for burn shock. The nurse understands that which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation? 1. Skin turgor 2. Neurological assessment 3. Level of edema at burn site 4. Quality of peripheral pulses

2. Neurological assessment Sensorium is an accurate guide to determine the adequacy of fluid resuscitation. The burn injury itself does not affect the sensorium, so the child should be alert and oriented. Any alteration in sensorium should be evaluated further. A neurological assessment would determine the level of sensorium in the child. Options 1, 3, and 4 would not provide an accurate assessment of the adequacy of fluid resuscitation.

367. The mother of a 3-year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin? 1. Fine grayish red lines 2. Purple-colored lesions 3. Thick, honey-colored crusts 4. Clusters of fluid-filled vesicles

1. Fine grayish red lines - Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). - It appears as burrows or fine, grayish red, threadlike lines. - May be difficult to see if they are obscured by excoriation& inflammation. - Purple-colored lesions may indicate various disorders including systemic conditions. - Thick, honey-colored crusts are characteristic of impetigo or secondary infection in eczema. - Clusters of fluid-filled vesicles are seen in herpesvirus infection.

370. The clinic nurse is reviewing the health care provider's prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the child's record? 1. The child is 18 months old. 2. The child is being bottle-fed. 3. A sibling is using lindane for the treatment of scabies. 4. The child has a history of frequent respiratory infections.

1. The child is 18 months old. - Contraindicated for children younger than 2 years because they have more permeable skin, and high systemic absorption may occur, placing the children at risk for central nervous system toxicity and seizures. - Used with caution in children between the ages of 2-10 years. - Siblings and other household members should be treated simultaneously. - Lindane is not recommended for use by a breast-feeding woman. - Options 2 and 4 are unrelated to the use of lindane.

373. The nurse caring for a child who sustained a burn injury plans care based on which pediatric considerations associated with this injury? Select all that apply. 1. Scarring is less severe in a child than in an adult. 2. A delay in growth may occur after a burn injury. 3. An immature immune system presents an increased risk of infection for infants and young children. 4. The lower proportion of body fluid to mass in a child increases the risk of cardiovascular problems. 5. Fluid resuscitation is unnecessary unless the burned area is more than 25% of the total body surface area. 6. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults.

2. A delay in growth may occur after a burn injury. 3. An immature immune system presents an increased risk of infection for infants and young children. 6. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults. More facts: - Scarring is more severe in a child than in an adult. - Burns involving more than 10% of total body surface area require some form of fluid resuscitation.

369. The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which statement, if made by a parent, indicates a need for further instruction? 1. "It is extremely contagious." 2. "It is most common in humid weather." 3. "Lesions most often are located on the arms and chest." 4. "It might show up in an area of broken skin, such as an insect bite."

3. "Lesions most often are located on the arms and chest." - Lesions usually are located around the mouth and nose, but may be present on the hands and extremities. - Most common during hot, humid summer months. - May begin in an area of broken skin, such as an insect bite or atopic dermatitis.

368. Permethrin (Elimite) is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? 1. Apply the lotion to areas of the rash only. 2. Apply the lotion and leave it on for 6 hours. 3. Avoid putting clothes on the child over the lotion. 4. Apply the lotion to cool, dry skin at least 30 minutes after bathing.

4. Apply the lotion to cool, dry skin at least 30 minutes after bathing. Permethrin is massaged thoroughly & gently into all skin surfaces *(not just the areas that have the rash)* from the *head to the soles of the feet*. - Should NOT be applied until at least 30 minutes after bathing - Should be applied only to cool, dry skin. - Should be kept on for 8-14 hours & then the child should be given a bath. - Should be clothed during the 8-14 hours of treatment contact time.