Pediatrics- NUR 236: Dermatological/Skin Conditions
Bollous vs. Non-Bollous Impetigo?
Bullous impetigo does not form a honey-colored crust. Lesions most commonly form in the intertriginous regions and on the trunk and, unlike nonbullous impetigo, may occur in the buccal membranes. There are typically fewer lesions present than in non-bullous impetigo. Regional lymphadenopathy is absent. (See text image, taken directly from Ricci et al., 2023)
How to prevent seborrheic dermatitis (or cradle cap)?
Daily washing of the neonate's hair and scalp can help prevent it. Caused by an overgrowth of Malassezia yeast (a substance normally found in the skin) that triggers inflammation, causing changes in the skin; typ resolves on it's own but may respond well to trx such as mineral oil & dislodging crust to help promo restoration of skin barrier
Impetigo (Non bollous)
Erythema, regional lymphedema, and small vesicles that develop into plaques with a honey-crusted appearance usually found around the nose and mouth
The nurse is caring for a client who suffered burn injuries to the arms. The arms have blisters, moist red skin, blanching, and intact sensation. What type(s) of treatment is expected for this type of burn injury?
The description of the burn matches a superficial partial-thickness (second-degree) burn. Treatment for a superficial partial-thickness burn includes application of cool damp cloths, moisturizers, and ibuprofen. Treatment lasts 15 to 21 days.
A child is hospitalized with a diagnosis of severe cellulitis. The nurse is preparing the family for discharge. Which instruction is most important for the nurse to convey to the family?
The instruction that is most important for the nurse to convey is to complete the prescribed course of antibiotics. Many times, once the child feels better, the parent stops the medication; this action, though, can cause a rebound infection. Instructing the family to keep follow-up appointments, perform good hand hygiene, and look out for signs of worsening condition are all appropriate, but the most important instruction is to make sure the child completes the course of antibiotics.
Priority intervention w. bee (insect) stings?
admin diphenhydramine (benadryl) as soon as bite identified to minimize local reaction
A 6-year-old child is diagnosed with tinea capitis and treatment is initiated. The nurse instructs the parents to have the child return to school within which time frame?
can return after 1 week
The nurse is providing education to a teenaged boy diagnosed with impetigo. Which statement by the boy indicates the need for further education?
"I will need to cover my son's skin lesions with bandages until it has healed." Impetigo is an infectious bacterial infection. The crusts should be removed after soaking prior to applying topical medications. Leaving the lesions open to air will aid in healing. Children diagnosed with impetigo may attend school during treatment.
Diaper dermatitis
Flat (macular) diffuse, local red rash, may become more involved if allowed to progress; best method is prevention; may trx w. Vit A, D, E or sinc oxide ointment; antibx only if secondary bact infxn ID'd (usually caused by diaper & breakdown of fecal contents)
The nurse is monitoring the urinary output of 3-year-old child admitted with a severe burn. The child weighs 44 lb (20 kg). Which would be a desirable and adequate urinary output for this child?
Following a burn injury, an output of 1 to 2 ml/kg/hr for children weighing 30 kg (66 lb) or less, or 30 to 50 ml/hr for those weighing more than 30 kg is desirable. This child weighs 20 kg (44 lb).
Cellulitis
Infection of the skin; S/S: erythema, pain, swelling, regional lymphedema, & fever
Focused skin assessment
Inspect skin (rashes, drainage, lesions, location/drainage/chars)--> palpate for presence of regional lymphadenopathy (determine if systemic involvement)
A varsity high-school wrestler presents with a "rug burn" type of rash on his shoulder that is not healing as expected, despite use of triple antibiotic cream. Two other wrestlers on his team have a similar abrasion. What infection should the nurse be most concerned about, based on the history?
MRSA (although tinea
Focus of care for child w. atopic dermatitis (3)
Promo of skin hydration, maintenance of skin integrity; prevention of infection
Folliculitis
Red, raised hair follicles
Care of cradle cap (seborrheic dermatitis) in infant?
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 crusts should not be forcibly removed with a cotton swab.
A nurse is providing care to a 3-year-old child hospitalized with second-degree (partial-thickness) and deep partial-thickness burns to the dorsal portion of both legs. The nurse is preparing to change the child's dressings. Which action(s) should the nurse take to elicit the child's cooperation in the dressing change? Select all that apply.
The best actions for the nurse to take to elicit the child's cooperation are to allow the child to choose which leg to start with and to choose a method of distraction. Encouraging the parent to hold the child's hand during the dressing change is also helpful as a form of distraction. Having the parent instruct the child to cooperate or telling the child to watch television during the dressing change are not very helpful. These options are more authoritarian and do not include the child's preferences in his or her care.
Griseofulvin (PO) is admin for?
Tinea captitis (also nails) & widespread/severe tinea cruris or corporis? admin w. fatty meals
A 6-year-old child is diagnosed with tinea pedis. Which prescription will the nurse question?
Tinea pedis refers to a fungal infection that typically begins between the toes. The nurse would question the child being out of school for a week. While these infections are highly contagious, children can return to school once treatment is started. Tinea pedis can be treated with topical or oral antifungals or a combination of both. Topical agents, such as luliconazole, are used for 1 to 6 weeks, depending on the brand. Antibacterial soaps help reduce the risk of infection to the affected area. Warm soaks may help soothe painful muscles or joints and can help drain skin infections, if present.
Steven Johnson's Syndrome
erythema multiforme with the addition of inflammatory bullae of at least two types of mucosa
Monolial diaper rash (diaper dermatitis d/t candida albicans)
fiery red lesions (red beefy rash), scaling in the gluteal folds, satellite lesions extending beyond local rxn site (trx w. nystatin cream)
removing an old dressing on a burn?
soak the dressing in tepid water before removing it to loosen the dressing and to decrease the child's discomfort. Removing the old dressing too quickly could cause stripping of new skin and tissue that is attached to the dressing. Dressing changes are done as quickly as possible once the old dressing has been removed because exposure to air and water causes pain.
Toxicodendron radicans or toxicodendrone contact dermatitis
the rash is extremely pruritic and may last for 2 to 4 weeks.; secondary bacterial infection can ensure d/t scratching
Which intervention is the most effective in treating an infected burn wound?
topical antibx applied to the wound site; Topical burn creams are used because the local blood supply to the area of burn injury is destroyed with the burn, and systemic antibiotics thus are not delivered to the burn wound
CDC recs sunscreen use at what age?
6 months old (at least 15 spf)
A school-aged child is brought to the office of the camp nurse with a small, superficial burn (first-degree burn). Which action by the nurse would be most appropriate to take first?
Apply cold compresses to the area. Cool water is an excellent emergency treatment for burns involving small areas. The immediate application of cool compresses or cool water to burn areas appears to inhibit capillary permeability and thus suppress edema, blister formation, and tissue destruction. (Can also run under cool H20 for 5 minutes, immed upon discovery). You shouldn't use ice, or even ice-cold water, on a burn. Extreme cold applied to a burn can further damage the tissue.
The nurse is preparing an assessment guide for the emergency department staff regarding assessment of clients who are admitted with burn injuries. What should the nurse be sure to include in the assessment guide for primary emergency assessment of burns?
Assess for: airway intact; pulse strength; edema presence Later (Secondary): Assess for % of body burned; depth of burns/other chars The primary survey includes evaluation of the child's airway, breathing, and circulation. The secondary survey focuses on evaluation of the burns and other injuries.
What meds exacerbate/trigger acne in adolescent?
Corticosteroids, androgens, phenytoin, lithium (other anticonvulsants), isoniazid
A child with a burn injury is scheduled for skin grafting. Which intervention would be most appropriate for the nurse to include in the child's plan of care?
Provide around the clock pain medication. 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.
Criteria for Burn Unit Referral
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 child is diagnosed with tinea versicolor and is prescribed selenium sulfide for treatment. What instructions should the nurse provide about this medication?
inea versicolor is a fungal disease affecting the skin of the trunk and extremities. It causes hypopigmented oval scaly lesions, especially on the upper back, chest, and proximal arms. It is more noticeable in the summer when the skin of the unaffected areas is tanned. The treatment is selenium sulfide. It is manufactured in a shampoo. The child should apply the shampoo all over the body (face to knees) at bedtime. It should dry and stay on the skin overnight. The shampoo is then rinsed off the next morning. This treatment should be done once weekly for 4 weeks. These instructions are for the shampoo, not a lotion. Even with treatment, the skin lesion pigmentation may not return for several months. The medication does not cause hypersensitivity to the sun, but all people, children and adults, out in the sun should wear sunscreen.
The nurse is completing the care plan for a pediatric client with deep partial-thickness or second-degree burns on the back and legs. Debridement of the burns is performed 2 to 3 times per week. What nursing diagnosis has the highest priority in regard to this treatment modality?
Pain is the highest priority r/t debridement
An adolescent client with seborrhea asks the nurse, "Why is my seborrhea so bad? Will it always be like this?" What is the best response by the nurse?
Seborrhea is a chronic inflammatory dermatitis that may occur on the skin or scalp. The inflammation is worsened by sebaceous involvement related to maternal hormones in the infant and androgens in the adolescent. Therefore, letting the client know why it is worse now addresses the question. While seborrhea can be controlled with certain shampoos, this does not answer the client's question. The adolescent may require daily shampooing with an antidandruff shampoo. Cntrl w.: selenium sulfide, tar, & ketocanzole.
full-thickness (third-degree) burns anticipated trxs:
Skin grafting, intravenous morphine, and surgical debridement
Which conditions caused by S. aureus?
Staphylococcal scalded skin syndrome (SSSS) and bullous impetigo are infections caused by Staphylococcus aureus.
Bollous Impetigo
Staphylococcus aureus - caused by exfoliative toxin; trx. w systemic antibx
The nurse is caring for a child with an order for silver sulfadiazine 1% for a burn. What would make the nurse question this order?
The burn is on the child's face. Silver sulfadiazine 1% is used for burns. It should not be applied to the face or an infant under 2 months of age. It should not be used in children with a sulfa allergy.
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?
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.
