Chapter 45: Nursing Care of the Child With an Alteration in Tissue Integrity/Integumentary Disorder

The nurse is speaking with the mother of a child diagnosed with contact dermatitis from poison ivy. Which statement by the mother indicates a need for further education? "I can buy a medicine to put on him before he goes out to prevent him from getting this again." "When he plays in the woods again, I will make sure he wears long pants and long sleeves." "As long as he takes a shower as soon as he gets inside, he shouldn't get this again." "I will need to make sure the dog gets a bath if he goes in the woods."

"As long as he takes a shower as soon as he gets inside, he shouldn't get this again." Prevention of contact dermatitis from poison ivy, poison oak, or poison sumac includes wearing long pants and long sleeves on outings in the wood. If contact occurs, wash vigorously with soap and water within 10 minutes of contact. The plant's oil residue may be on clothes, pets, toys, and other objects, so these must be washed well with soap and water. Ivy Block is the only preventive treatment approved by the US FDA. It is applied to the skin before exposure.

An adolescent is prescribed isotretinoin. Which statement indicates that the adolescent understands the necessary precautions associated with this drug? "I have to make sure that I do not become pregnant while taking this drug." "This drug can affect my lungs so I need a chest radiograph done first." "I'm going to have to have a blood count done every couple of months." "The drug might cause staining of my clothing."

"I have to make sure that I do not become pregnant while taking this drug." Adolescent girls taking this drug who are sexually active must be on a pregnancy prevention program because the drug causes defects in fetal development. Monthly complete blood counts are required when taking isotretinoin. Isotretinoin is not associated with lung problems, so a chest radiograph is not necessary. Coal tar preparations are associated with staining of the clothing or fabrics. Isotretinoin does not stain clothes or fabrics.

The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply. "This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "It's important I get my CBC blood test when my doctor orders it." "If I am sexually active I need to let my doctor know." "I am young so I won't need to have the liver tests the pamphlet suggests." "As long as I use two forms of birth control I don't need to have monthly pregnancy testing."

"This is not a drug to be used for all forms of acne. My sister has minor acne so I told her this wasn't for her." "It's important I get my CBC blood test when my doctor orders it." "If I am sexually active I need to let my doctor know." Accutane (isotretinoin) is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the physician. Some physicians may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered by the physician, such as the CBC, to monitor the medication's side effects should be obtained.

A nurse is working as part of a response team caring for children who have been involved in an elementary school fire. Which children would the nurse identify as needing a referral to a burn unit? Select all that apply. 9-year-old with asthma and burns to the face 7-year-old with first-degree (superficial) burns over 5% of the body 8-year-old with an inhalation injury 6-year-old with burns involving the knees and hips 10-year-old with second-degree (partial-thickness) burns over 15% of the body

9-year-old with asthma and burns to the face 8-year-old with an inhalation injury 6-year-old with burns involving the knees and hips 10-year-old with second-degree (partial-thickness) burns over 15% of the body Referral to a burn unit should occur for children with inhalation injuries; burns that involve the face, hands and feet, genitalia, perineum, or major joints; partial-thickness or second-degree burns greater than 10% of total body surface; burns and preexisting conditions that might affect the care (such as asthma); or burns and traumatic injuries such as rib fractures. Superficial or first-degree burns over 5% of the body are not a criterion for referring a child to a burn unit.

A nurse is caring for a child with second- and third-degree (partial- and full-thickness) burns over 15% of the body. The child reports severe itching in and around the burn sites. Which action would be most appropriate for the nurse to perform? Administer diphenhydramine. Soak the child in a colloidal bath. Provide diversional activities. Turn the child every 2 hours.

Administer diphenhydramine. As nerve endings heal they cause intense itching that can be relieved with the use of medications (e.g., diphenhydramine hydrochloride, loratadine) and by applying soothing lotions such as Nivea or Eucerin. Turning the child every two hours will not relieve the itching. Soaking in a colloidal bath is contraindicated with burn clients. Although diversional activities can help somewhat, they will not relieve the child's itching.

The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a health care provider. What is the most appropriate action for the nurse to do with this child? Administer pain medication. Splint the leg. Briskly scrub the site. Apply ice to the affected area.

Apply ice to the affected area. Spider bites can cause serious illness if untreated. Bites of black widow spiders, brown recluse spiders, and scorpions demand medical attention. Applying ice to the affected area until medical care is obtained can slow absorption of the poison.

The nurse is caring for a child admitted with second-degree (partial-thickness) burns. What is most characteristic of this type of burn? Pain is minimal. Muscle damage occurs. Skin is red and edematous. Blisters appear.

Blisters appear. In first-degree (superficial) burns, the injury is only to the epidermis. The burns are very painful, red, and dry. In second-degree (partial-thickness) burns, the injury is to the epidermis and part of the dermis. These burns are painful, edematous, have a wet appearance and form blisters. In third-degree (full-thickness ) burns, the dermis, epidermis and hypodermis are all involved. There may or may not be pain. These burns are red and edematous and may have peeling, charred skin. Muscle damage can occur.

The nurse is assessing a child who has had an open wound for the last 2 weeks with no signs of healing. The parents report they have been using over-the-counter antibiotic ointment with no signs of improvement. The child is active in football in the fall and the swim team in the winter. What disorder does the nurse suspect? community acquired MRSA impetigo folliculitis staphylococcal scalded skin syndrome

community acquired MRSA Risk factors for community-acquired MRSA (CA-MRSA) are turf burns, towel sharing, participation in team sports, or attendance at day care or outdoor camps. The condition usually presents with a moderate to severe skin infection or with an infection that is not responding as expected to therapy. Impetigo is a readily recognizable skin rash infection. Staphylococcal scalded skin syndrome results from infection with S. aureus that produces a toxin, which then causes exfoliation, and it has abrupt onset. Folliculitis is an infection of a hair follicle.

An adolescent experiencing contact dermatitis reports experiencing pruritis. What intervention will the nurse recommend to relieve the itching? Bathe with a product that is oatmeal-based. Apply calamine lotion if the lesion is weeping. Use a fragrance-free moisturizer. Keep the area covered with clothing.

Bathe with a product that is oatmeal-based. Pruritis is a common problem associated with contact dermatitis. By healing the lesions, the itching will subside. Bathing with oatmeal-based products will accomplish this healing. If the area is too involved, then products like a topical corticosteroid can be used. Calamine lotion is a product that can help with itching, but it is primarily used to dry out weeping lesions. Moisturizers can be applied to the irritated skin, but they must be free of fragrances and dyes. The area should not be covered but allowed to be exposed to air to aid in healing.

What accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn? Hematocrit and white blood cell (WBC) counts decrease. Hematocrit increases and white blood cell (WBC) count decreases. Hemoglobin and white blood cell (WBC) counts decrease. Hematocrit and white blood cell (WBC) counts increase.

Hematocrit and white blood cell (WBC) counts increase. In the first 24 to 48 hours after a burn, the hematocrit will often be elevated secondary to fluid loss and the WBC count may also be elevated as an acute-phase reaction, which later could indicate infection.

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? Third-degree or full-thickness burn Second-degree or partial-thickness burn Fourth-degree or fat-layer burn First-degree or superficial burn

Second-degree or partial-thickness burn A burn that encompasses the epidermis and the underlying dermis is a second-degree burn. A first-degree burn would only involve the epidermis, and a third-degree burn would involve nerve endings as well as destruction of the epidermis and dermis. A fourth-degree burn would extend even deeper into the fat layer.

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at: controlling nausea and vomiting. reducing swelling and relieving itching. regulating skin and body temperature. managing pain and discomfort.

reducing swelling and relieving itching. 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 is providing care to a child diagnosed with varicella zoster. The child has many lesions in various stages of healing, is irritable, and has a temperature of 100°F (37.8°C). The nurse and the child's parent constantly remind the child not to scratch the lesions. Which intervention is most important for the nurse to implement? Administer acetaminophen. Encourage oral fluids. Suggest distraction activities. Administer an oatmeal bath.

Administer an oatmeal bath. It is most important for the nurse to administer an oatmeal bath, which will result in less itching. Continued scratching could result in secondary infection of the lesions. Acetaminophen administration would be indicated if the child were in pain or if the child's temperature was above 100.4°F (38°C). Providing activities to distract the child would be more helpful once the child was made more comfortable.

A nurse is 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? "Tell me about your family history of allergies." "Has she been exposed to poison ivy?" "Does she wear sleepers with metal snaps?" "Do you change her diapers regularly?"

"Does she wear sleepers with metal snaps?" Small round red circles with scaling, symmetrically located on the girl's 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.

The nurse is discussing skin disorders with a group of caregivers. Which caregiver statement indicates an understanding of tinea capitis? "That is an infection that you get under your fingernails." "My husband had that once and his groin itched so much." "I always tell my daughter to use her own hairbrush." "My son got that infection when he was at the swimming pool."

"I always tell my daughter to use her own hairbrush." Ringworm of the scalp is called tinea capitis or tinea tonsurans. The most common cause is infection with Microsporum audouinii, which is transmitted from person to person through combs, towels, hats, barber scissors, or direct contact. A less common type, Microsporum canis, is transmitted from animal to child.

The nurse is discussing acne vulgaris with a group of adolescents. The teenagers make the following statements regarding the topic. Which statement is the most accurate regarding acne vulgaris? "My mom says I have acne because I eat too much chocolate." "My next door neighbor told me that acne was caused by a fungus." "Sometimes I get acne when I use my sister's makeup." "There is a new immunization that you can get to keep from having acne."

"Sometimes I get acne when I use my sister's makeup." Irritation and irritating substances, such as vigorous scrubbing and cosmetics with a greasy base, can cause acne vulgaris. Increased hormone levels, hereditary factors, and anaerobic bacteria can cause acne vulgaris as well. Eating chocolate and fatty foods does not cause acne, but a well-balanced, nutritious diet does promote healing.

The nurse is teaching the parents of a 6-year-old who has sustained a large laceration about providing care to the wound at home. The nurse determines that the parents need additional teaching when they state: "If we notice some yellowish drainage, we need to call the doctor." "If our son starts telling us that the pain is increasing, we need to have it checked out." "We need to keep the wound tightly bandaged for at least 3 days." "We should call the doctor if the wound becomes red and hot looking."

"We need to keep the wound tightly bandaged for at least 3 days." If a wound is large, it can be covered by a loose dressing, which is changed in about 12 hours and redressed after the wound is cleaned. The wound is then left open to the air after 24 hours have passed from the time of the injury. A wound that is red and hot looking or one with yellowish drainage or increased pain suggests infection, which needs to be evaluated by the practitioner.

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 use a mild soap for sensitive skin." "We should use soap to clean only dirty areas." "We need to avoid any skin product containing perfumes, dyes, or fragrances." "We should bathe our child in hot water, twice a day."

"We should bathe our child in hot water, twice a day." 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 community nurse receives a call from a local day care center. One of the children in the center has been diagnosed with impetigo. Which information related to impetigo will the nurse provide to the day care center? The facility staff should wear masks until all children and adults are healthy. Impetigo is highly contagious and can spread quickly. Impetigo usually develops because of sensitivity to pollens and molds. Impetigo cannot be treated with medication and has to run its course.

Impetigo is highly contagious and can spread quickly. Impetigo is a highly contagious skin infection and can spread quickly. It usually appears as red sores on the face, especially around a child's nose and mouth, and may appear on the hands and feet. The sores burst and develop honey-colored crusts. It is spread by person-to-person contact, not droplet; therefore, masks are not indicated. It is treated with antibiotics, generally penicillin. The cause is not pollens or molds; it is bacterial.

An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants? Methicillin-resistant Staphylococcus aureus (MRSA) Staphylococcus aureus Group A beta hemolytic strep Escherichia coli

Staphylococcus aureus Staphylococcus aureus is the most common cause of impetigo in infants. MRSA is a hospital-associated infection (HAI), group A beta hemolytic strep is seen in older children, and Escherichia coli is not frequently associated with impetigo.

The nurse is educating a parent about the treatment for a child's tinea cruris. What medication class would the nurse include in the teaching plan? antihistamine antifungal corticosteroid antibiotic

antifungal Tinea cruris is a fungal infection of the groin area. Treatment would include antifungals. Antihistamines are typically used for the treatment of hypersensitivity and allergy disorders. Corticosteroids are used in the treatment of allergies and dermatitis. Antibiotics would be used to treat bacterial infections of the skin.

An adolescent is to receive topical retinoid therapy for his moderately severe acne. The nurse would instruct the adolescent about which adverse effects? Select all that apply. burning dryness flu-like symptoms photosensitivity headache

burning photosensitivity dryness Adverse effects associated with topical retinoid therapy include burning, dryness, and photosensitivity. Flu-like symptoms and headache are associated with topical immune modulators.

A nurse is caring for a 5-year-old child in Buck traction. When conducting a skin examination for signs of pressure injuries, the nurse pays particular attention to which area? sacral area occiput hip area upper arm

occiput Buck traction is a type of traction used to promote rest on an injured lower extremity or used to prevent spasms in the affected lower extremity. Skin traction is applied in the affected lower leg and the force of pull is on a straight line. The hip and the affected extremity are allowed limited movement; thus, pressure injuries can potentially develop on the sacral area as well as on the lower leg where the actual bandage used for traction is applied. The head and neck, both upper extremities and unaffected lower leg can move freely.

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)? splash patterns stocking-glove pattern on hands or feet spattering pattern nonuniform pattern

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).

The nurse is caring for a 10-year-old male in a pediatric clinic with presenting symptoms of small circular patches of hair loss on the scalp. Which skin condition does the child most likely have? tinea cruris tinea faciei tinea capitis tinea corporis

tinea capitis Tinea capitis is a fungal infection of the scalp that causes circular patches of hair loss. Tinea faciei is a fungal infection of the face; tinea cruris is a fungal infection of the inner thighs and inguinal creases; and tinea corporis is a fungal infection located on the entire body.

A nurse is teaching a group of parents about burn safety. Which statement made by a parent requires intervention by the nurse? "We made a song out of 'stop, drop and roll' to teach our children fire safety." "I always make sure the little ones stay out of the kitchen when I am cooking." "We installed smoke detectors on every floor in our home." "I had our plumber lower our water heater temperature to 130°F (53°C).

"I had our plumber lower our water heater temperature to 130°F (53°C). Water heater temperature should be 120°F (49°C) or lower to prevent significant burns. Installing smoke detectors on every floor of a home is recommended. Keeping young children out of the kitchen during food preparation is important. Teaching children to stop, drop, and roll is important for fire safety.

The nurse is caring for a child with a prescription for PO prednisone. Which statement by the child's mother would indicate a need for further education? "My child should take the entire prescription as prescribed by the health care provider." "Since my child has type 1 diabetes, I will need to monitor my child's blood sugar levels closely while on this medication. "I will give it to ny child at least 1 hour before all meals." "I will have to watch my child closely for signs of infection."

"I will give it to my child at least 1 hour before all meals." Systemic corticosteroids such as prednisone should be administered with food to decrease gastrointestinal upset. These medications may mask signs of infection. This medication may increase blood sugar levels. Corticosteroid doses should be tapered and should not be stopped abruptly.

The nurse is caring for a child with a second-degree (partial-thickness) burn. What assessment findings would the nurse expect to observe? Peeling skin with eschar Edema with dry or waxy-looking skin Reddened and leathery skin Edema with wet blistering skin

Edema with wet blistering skin Partial-thickness or second-degree burns are very painful and edematous and have a wet appearance or the presence of blisters. Third-degree (full-thickness) burns appear red, edematous, leathery, dry, or waxy and may display red or charred skin (eschar).

Which intervention is the most beneficial for a burn client undergoing a skin graft? Provide pain medication on a PRN schedule as soon as pain is reported. Provide an egg-crate mattress or gel mattress for the client to lie upon. Provide diversional activities for the client. Provide around-the-clock pain medication as soon as pain is reported.

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.

The nurse is caring for a pediatric client with multiple wounds from a bike accident. What is the best method for cleansing or washing out the wound? Use iodine solution to wash the wound. Use an antibiotic wash to cleanse the wound. Use normal saline solution to wash the wound. Use sterile water to wash out the wound.

Use normal saline solution to wash the wound. Normal saline is still considered the best solution to wash out wounds because of its relative isotonicity and minimal effect on tissue regeneration.

The nurse is caring for a 13-year-old client who asks about acne prevention. Which would be most appropriate for the nurse to suggest? Avoid chocolate and greasy foods. Pop the pimples to make them go away. Wash the face with abrasive soaps three times a day. Wash the face twice a day with a mild soap then pat dry.

Wash the face twice a day with a mild soap then pat dry. The face should be washed twice per day with a mild soap and lukewarm water then patted dry. Avoiding certain foods will not prevent acne. Popping pimples does not make acne go away and can cause scarring. Washing the face with abrasive soaps can aggravate the acne and cause more flare-ups.

The nurse is caring for a child brought to a pediatric clinic for swelling in the lower extremities. The skin is reddened with undefined borders and pits slightly when pressed. Based on the assessment findings, which of the following would the nurse suspect? impetigo cat scratch disease cellulitis staphylococcal scalded skin syndrome (SSSS)

cellulitis Cellulitis is characterized by reddened or lilac-colored, swollen skin that pits when pressed by the fingertips. Impetigo has superficial lesions that can be bullous or nonbullous. SSSS involves bullae that enlarge and rupture, leaving a red, scalded-looking lesion. Cat scratch disease involves a benign, subacute, chronic course of lymphadenopathy that usually resolves spontaneously in 2 to 3 months.

The nurse admits a child who has sustained a severe burn. The child's immunizations are up to date. Which immunization would the child most likely be given at this time? hepatitis B vaccine hepatitis A vaccine tetanus toxoid vaccine Haemophilus influenzae type B vaccine

tetanus toxoid vaccine If inoculations are up to date, a booster dose of tetanus toxoid is required to protect the child from infection introduced into the burn.

The nurse is providing education to an adolescent client diagnosed with tinea pedis. Which statement will the nurse include in the teaching? "Keep your feet moist and open to the air as much as possible." "You need to wear nylon or synthetic socks every day." "Avoid applying soap to the affected area until healed." "Be sure to dry the area between your toes really well."

"Be sure to dry the area between your toes really well." Keeping the feet clean and dry is key for the adolescent with tinea pedis. This includes rinsing the feet with water or a water/vinegar mixture and drying them well, especially between the toes. The adolescent should wear cotton socks and shoes that allow the feet to breathe. The client should clean the area with soap daily to reduce the risk of infection.

The nurse is caring for a child who experienced deep partial-thickness (deep second-degree) burns to the front of the body after falling into a campfire approximately 25 minutes prior. What action would the nurse include in the plan of care for the child? apply ice to areas of burnt skin and tissue avoid taping the endotracheal tube to prevent further skin damage administer cooled intravenous fluids via an infusion pump prepare to administer analgesics via the intravenous route

prepare to administer analgesics via the intravenous route Pain management is vital to the care of a child with areas with deep partial-thickness (deep second-degree) burns. The nurse would assure the tracheal tube is taped in a very secure manner, because edema will make reintubation (if the tube is inadvertently dislodged) difficult. IV fluids would be warmed, to prevent hypothermia. Hypothermia is a risk due to the loss of the dermis. Ice is not applied to the burned skin or tissue to prevent further damage.

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." "Baby powder should not be used since so many people are allergic to the ingredients in it." "Baby powder can be used anytime with no concerns." "Baby powder may be used if sprinkled on your hand away from the baby to prevent aspiration."

"Baby powder should not be used on newborns due to the risk of aspiration upon application." The use of baby powder containing "talc" (also 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 can contribute to the pathogenesis of diaper dermatitis.

A parent is observing a nurse provide care for the parent's 2-year-old toddler who was burned in a house fire. When the nurse is finished, the parent tells the nurse "I cannot believe this has happened. I should have been able to prevent this from happening." What is the best action for the nurse to take? .Tell the parent to be thankful that the child is alive. Tell the parent he or she could not have prevented the fire Encourage the parent to talk more about feelings. Give the parent a hug.

Encourage the parent to talk more about feelings. The best action for the nurse to take is to encourage the parent to talk about his or her feelings. This gives the parent the opportunity to share feelings and concerns. Giving the parent a spontaneous hug may not be welcomed. Telling the parent he or she could not have prevented the fire or to be thankful that the child is alive is not therapeutic and negates the parent's feelings.

A 2-year-old child is brought to the urgent care center for treatment of burns on both hands. The parent reports that the child pulled the coffee pot over and the hot liquid splashed on to the child's hands. The nurse examines the child and notes that the backs of the hands are reddened with a well-defined line of demarcation at the wrists. Several medium to large blisters are also present. What initial action should the nurse take? Determine the depth of the burn injuries. Place ice packs on the hands to stop the burning. Contact the authorities to report suspected child abuse (child mistreatment). Make arrangements to transfer the child to the hospital.

Make arrangements to transfer the child to the hospital. The nurse's initial action to make arrangements for the child to be transferred to the hospital. Burns on the hands or feet of a child are criteria for admission to a burn center. In addition, the nurse should suspect child abuse (child mistreatment) because of the defined lines of demarcation on the burns (glove pattern) which indicates that the child's hands were placed in scalding liquid versus a splash pattern if the pot had been knocked over. Although the nurse may suspect child abuse (child mistreatment), the initial action should be to get the child to the hospital. The depth of the burns can be determined at the hospital. Applying an ice pack could cause additional damage, most notably by breaking the blisters and increasing the risk of infection. Blisters should be left intact. Cool water can be applied to stop the burning and provide some comfort.

An adolescent girl is going to be treated for a severe case of acne vulgaris. A pregnancy test should be done prior to the adolescent starting treatment with: benzoyl peroxide. tretinoin. erythromycin. isotretinoin.

isotretinoin. Isotretinoin is a drug used to treat cystic acne after at least 3 months of antibiotic therapy has not been successful. Isotretinoin is a pregnancy category X drug. It must not be used at all during pregnancy because of serious risk of fetal abnormalities. Tretinoin is used to treat severe acne vulgaris. Instruction for the use of this medication include using sunscreen. Benzoyl peroxide can be used for mild acne and can be used with topical antibiotics. Erythromycin is an antibiotic that has no pregnancy contraindications. It is used for many skin infections.

Which assessment finding by the nurse would warrant immediate action? A child with periorbital cellulitis reports changes in vision and pain with eye movement. A child with impetigo has honey-colored drainage noted on the skin area. A child has a red, warm, edematous area over an old spider bite. A child with cellulitis has a temporal temperature of 101°F (38.3°C).

A child with periorbital cellulitis reports changes in vision and pain with eye movement. In a child with periorbital cellulitis, the nurse musty notify the health care provider immediately if signs of progression to orbital cellulitis occur, such as conjunctival redness, change in vision, pain with eye movement, eye muscle weakness or paralysis, or proptosis. This assessment finding warrants immediate action. In nonbullous impetigo, a honey-colored exudate when the vesicles or pustules rupture may be noted on the skin. This assessment finding would be expected. A localized cellulitis will present with erythema, pain, edema, and warmth at the site of the skin disruption (such as a cut or spider bite). This assessment finding warrants further follow-up but not immediate attention. Fever may occur with bullous impetigo or cellulitis and is common with scalded skin syndrome; therefore, this assessment finding also warrants further, but not immediate, follow-up.

The nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement? "I should be certain to use fabric softener in the care of the infant's clothes." "I should only use ointments and creams as instructed by the health care provider." "I should not overdress the infant." "I need to wash and rinse clothes thoroughly to be sure all of the detergent is washed out."

"I should be certain to use fabric softener in the care of the infant's clothes." Fabric softeners should be avoided because their use can result in skin irritation in the infant. Clothing and other baby items should be washed and rinsed thoroughly. Overdressing should be avoided as sweating irritates the rash, and only ointments and creams that are recommended by health care personnel should be used on the infant.

The parent of a 1-week-old infant is concerned with white scales that have begun to flake off the infant's scalp. The parent asks the nurse what to do to treat this. How should the nurse best respond? "The infant should have a thorough shampooing every day to prevent things like this." "Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil." "Your child most likely has dandruff. You can treat it with daily with antiseborrheic shampoo." "Cradle cap (seborrhea) will resolve by itself. There is no intervention needed."

"Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil." Infantile seborrheic dermatitis, better known as cradle cap, 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, mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft brush to lift the scales then shampooed again. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Infantile seborrheic dermatitis is not a result of poor hygiene and will not resolve without intervention.

The school nurse has completed an educational program on first aid practices in the home. Which statement about burn care by a participant would indicate a need for further education? "If my child has a superficial burn, I will run cool water over it." "Mild soap can be used to clean a superficial burn." "For a superficial burn, I can cover it with a clean nonadherent dressing." "I guess my mom was right; she always put ice on our burns when we were kids."

"I guess my mom was right; she always put ice on our burns when we were kids." Steps for providing burn care at home to a first-degree (superficial) burn include running cool water, not ice, over the burn and covering it with a nonadherent bandage after cleaning with a fragrance-free mild soap. Other care includes not applying butter, ointments or creams; and administering acetaminophen or ibuprofen for pain.

When teaching 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. "My child gets diaper rash if I wash her clothes in the same detergent we use for the family." "The formula she drinks sometimes causes her to have a diaper rash." "Sometimes if I leave the diaper off and let him be in the sunshine he gets diaper rash." "They told me to use baby powder every time I change her so she won't get diaper rash."

"My child gets diaper rash if I wash her clothes in the same detergent we use for the family." 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.

A pediatric client was brought to the emergency department by the parents after experiencing extensive urticaria following consumption of a seafood dinner. Upon discharge from the facility the nurse provided client teaching. Which statement by the parents indicate learning occurred? "We will give our child an antihistamine and corticosteroid next time we eat seafood." "The hives should not last over a couple of days. If they last longer it means we need to contact our physician immediately." "We need to get our child a medical alert bracelet as soon as possible in case this happens again." "Since our child only had hives, we could allow our child to try seafood again to see if there is a true allergy present."

"We need to get our child a medical alert bracelet as soon as possible in case this happens again." A medical alert bracelet would identify the child's allergies in case the parents were not with the child or if the child was incapacitated following a reaction. Urticaria, commonly called hives, is a type I hypersensitivity reaction, which indicates a serious reaction. The child should not try to eat seafood again. Urticaria usually begins rapidly and may disappear in a few days or may take up to 6 to 8 weeks to resolve.

The dermatologist treating a 16-year-old girl with a history of severe acne has ordered a pregnancy test so she can be started on a course of isotretinoin. The teen's caregiver has said that her daughter is a virgin and she refuses to allow her to have the required pregnancy testing. What would be the best action for the nurse to take? Speak with the teen alone to ask her if she is sexually active. If she says she is not sexually active, let the provider know that it is okay to write the prescription. Arrange for the daughter to have the pregnancy testing without the caregiver's knowledge. Have the caregiver sign a permission form acknowledging that the girl has been given the drug without pregnancy testing. Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication.

Acknowledge the caregiver's discomfort about the pregnancy testing but encourage her to allow the daughter to have the testing so that she can use the medication. Isotretinoin is a pregnancy category X drug: It must not be used at all during pregnancy because of serious risk of fetal abnormalities. To rule out pregnancy, a urine test is done before beginning treatment. For the sexually active adolescent girl, an effective form of contraception must be used for a month before beginning and during isotretinoin therapy. The risk to the fetus, should pregnancy occur, should be discussed with the girl whether she is sexually active or not.

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 that involves honey-colored crusted lesions. The nurse most likely is referring to: candidiasis. impetigo. seborrheic dermatitis. miliaria rubra (heat rash).

impetigo. Impetigo is a superficial bacterial skin infection. Impetigo in the newborn is usually bullous (blister-like, fluid filled); in the older child, the lesions are nonbullous and have a honey-colored, crusted appearance.