Peds Integumentary

Primary lesions include macules, papules, patches, nodules, tumors, vesicles, pustules, bullae, and wheals. ___,____,&____ are found in children and adolescents with acne. ___&___ are seen in the child with chickenpox and impetigo. _____ are often seen in the child with an allergic reaction.

Macules, papules, and nodules Vesicles and pustules Wheals

Vesicle 1 cm in diameter Blister

bullae

____can occur after contact with an allergen or skin irritant. In children, the irritant agents that cause this type of skin sensitivity are often soaps or detergents with fragrances or dyes. For infants, the diaper area is especially prone. It is characterized by an erythematous, confluent maculopapular rash that is prominent on convex surfaces and in the folds. Children playing outdoors may encounter plant life that can cause contact dermatitis, such as poison oak, ivy, or sumac.

Contact dermatitis

Maintaining Circulation: Nursing interventions for burn care ensures that circulation to the injured extremity is assessed and maintained. _____ on the tissue includes a fasciotomy and assessment of the muscle compartments. Compartment pressures are measured; greater pressures indicate increased compartment pressure and require emergency surgery. In many cases,______ _____ are the most common sites for severe circulation impairment and eventual amputation.

Decompression of circulation pressure muscle damage is so severe that the extremity cannot be saved, resulting in amputation of the extremity Entry and exit sites

nursing care: Teaching about the medication regimen will assist the family in adherence. Teaching about the typical course of the illness and expectations for return to wellness and full functioning will alleviate child and family fears. Medical Care: ____

Doxycycline is the treatment of choice for RMSF and all rickettsial infections for children of all ages. If treated in the first 5 days with doxycycline, people with RMSF typically recover. Those treated after day 5 may experience a more severe illness requiring hospitalization or intensive care unit. If left untreated, long-term sequelae can include damage to blood vessels throughout the body leading to organ and tissue damage. Supportive therapy for other symptoms resulting from RMSF may include antipyretics, anti-inflammatory medication, and IV fluids.

Prevention: Avoiding play in wooded areas or using precautions in such environments will decrease the incidence of Lyme disease. Children can dress in long sleeves and long pants when in wooded areas; DEET spray is used when age-appropriate. At the end of the day of play (preferably within 2 hours), a shower or bath should be taken, followed by a tick check from scalp to toes nursing care: ____

During the history and physical, the nurse asks the family member if there has been an occurrence of a tick bite.

S/S ■ Mild to moderate ■ Reddened, cool to touch skin ■ Tingling or numbness ■ Mild swelling ■ Pain upon rewarming ■ Severe ■ Pale, waxy, cool skin; feels "wooden" ■ Numbness, insensate (no feeling) that may not improve immediately with rewarming ■ Blisters ■ Extensive swelling ■ Blackened, necrotic (dead or dying) tissue; damage may extend down through the skin to the muscle and bone if severe or prolonged exposure diagnosis:

Frostbite can be identified by the hard, pale, and cold quality of skin that has been exposed to the cold. The extent of the injury is determined upon rewarming.

The diagnosis of tinea is made by visual inspection using a Wood's lamp that discloses yellowish-gold fluorescent coloration. prevention: _____

Have family pets checked at the veterinarian if they experience areas of fur loss, excessive itching, or self-grooming. Encourage good hand washing. Have children and adolescents in sports activities bathe as soon as they are home from practice or games to remove fungal spores that may be on the skin. Do not share fomites (objects that can carry infection) like bath and hand towels, combs and brushes, hats, helmets, and intimate apparel

____is a bacterial staph or strep infection of the skin often found on and around the mouth and nose of the child or elsewhere on the face. It may also appear on the hands, neck, trunk, buttocks, or extremities. Generally is caused by staph aureus but on rare occasion can be casued by MRSA

Impetigo Contagiosa infants and chilren younger than 5 are at greatest risk for impetigo

acne vulgaris is the most common bacterial skin disorder treated by physicians in adolescent. Although acne can occur during any age and could be a clinical manifestation of other conditions, generally it begins in the teen years. s/s: _____

Increased sebum production ■ Follicular hyperkeratinization ■ Propionibacterium acnes (P acnes) within the follicle ■ Inflammation with papules, pustules, nodules, or cysts Signs and symptoms of mild acne include open comedones, closed comedones, and no inflammatory lesions. An open comedo, often called a blackhead, A closed comedo, which has a white head and pustule, has a closed follicular orifice with sebum and keratinous substances.

a tick-borne infection caused by an inflammatory response to the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States. Exposure to disease can occur in any outdoor setting where ticks are endemic. The tick bite is often found on the head and neck, back, arms, or legs. Children between 5 and 14 are at highest risk especially in summer it takes 48 hrs to get a reaction

Lyme Disease

is a circular, anaerobic, gram-positive bacterium prevalent in the nose and skin of most individuals resistant to treatment from beta lactam antibiotics such as methicillin, amoxicillin, penicillin, an oxacillin community acquire is usually skin and soft tissue, hospital is usually systemic

MRSA signs and symptoms can include vesicles, pustules, and other bumps that are painful, red, leaking pus, and/or swollen. The lesion may resemble a spider bite. Skin around a sore is warm or hot to the touch. Upon rupture, the exudate is white to yellow. diagnosed through clinical assessment However, a culture is warranted if the lesion is one of many, a recurrent lesion, or if the child has impaired immunity or has recently been released from the hospital.

prevention:

MRSA is contagious and is passed skin-to-skin and from inanimate surfaces to the skin. Because MRSA can live longer on hard surfaces than soft surfaces, it is important to teach parents to clean surfaces. Children should be taught good hand washing and personal hygienic practices. Athletes should shower immediately after events and avoid sharing personal items. Schools, day cares, and athletic facilities should cleanse the environment regularly with a good bactericidal spray or wash.

Raised and solid; may be clear, deep in the dermis, 2 cm in diameter Lipomas, hemangiomas, neoplasms, benign tumors

tumors Lipomas, hemangiomas, neoplasms, benign tumors

Toddler growth involves separating from the parents and finding independence. The infant freely explores the environment and observes parental behavior, copying it without knowing dangerous consequences. Typical burn injuries seen in toddlers are:

■ A scald burn from pulling down hot items from tall surfaces ■ A scald burn from attempting to turn on the bathtub faucet ■ A flame burn from attempting to ignite a match or lighter ■ A flame and/or an inhalation burn from a house fire ■ A radiation burn from touching hot appliances like curling irons ■ An electrical cord burn to the mouth from chewing an electrical cord that was plugged into the wall

Because children develop in a predictable time frame, they are at risk for certain types of burn injuries at certain ages and developmental stages. Infant growth involves increasing gross motor and fine motor development Typically burn injuries seen in infants are:

■ A scald from reaching for items, like coffee, tea, or hot oil from deep fat fryers ■ A scald from being placed in a bathtub, basin, or pan of water hotter than 120°F (48.9°C) (National Fire Protection Association [NFPA], 2020) ■ A radiation burn from touching hot objects like a wood stove ■ An electrical cord burn to the mouth from chewing on electrical cord that was plugged into the wall ■ A flame and/or inhalation burn from a house fire

Late disease (weeks to months after the initial bite) _____ Diagnosis: determined by physical and history; incidence of tick bite may or may not be reported. Labs can confirm Lyme disease. Lab testing is not appropriate in the child who presents with erythema migrans and lives in or has just visited an area where Lyme disease is endemic. That child should be treated presumptively for Lyme disease.

■ Arthritis, lasting up to many years but not considered chronic ■ Singular joint at a time, migrates from joint to joint, typically larger joints and primarily the knee(s) ■ Swollen and tender, rarely erythematous ■ Can bear weight but is uncomfortable

Signs and symptoms of RMSF include: ■ At onset, fever, headache (severe), malaise, myalgias (muscle pain), arthralgia (joint pain), and nausea with or without vomiting ■ Severe abdominal pain that mimics appendicitis pain (greater than 60% of children) ■ Edema ■ Rash

■ Develops between days 3 and 5 of the disease (10% to 20% of patients will not have a rash) ■ Begins on the wrists and ankles and spreads centrally and out to the palms and soles ■ Macular/papular but may become petechial ■ No urticaria (hives) ■ Nonpruritic ■ Difficult to visualize in darker-skinned individuals

Prevention: Children entering weedy or wooded areas should wear long sleeves, long pants, and socks to prevent contact with poisonous plants. Strict avoidance of known allergens in the home, including soaps and fragrances, will decrease the incidence of allergic contact dermatitis. Prevention of irritant contact dermatitis is avoidance of known substances that have resulted in rash and, for infants, frequent diaper changes. Nursing Care:

Nursing care of diaper dermatitis is aimed at allowing the area to heal in an environment of minimal moisture. This can be accomplished by frequent diaper changes, allowing the area to air dry, and the use of barrier ointments that include white petrolatum or zinc oxide

_____ head lice, is a common childhood condition that can be passed among friends and family. Approximately 6 to 12 million school-aged children are infested yearly. There are three kinds of lice: scalp (pediculosis capitis), body (pediculosis corporis), and pubic area (pediculosis pubis). itching can predispose patient to secondary infection diagnosis: identification of the louse and/or its eggs is important. Persistent itching of the head is the classic sign.

Pediculosis capitis

___is an infestation of the scalp by Pediculus humanus capitis, a parasite in school-age children. Itching is usually the only symptom.

Pediculosis captitis (head lice)

■ ____ - Infection of the groin, commonly known as "jock itch," characterized by red, scaly skin that involves the inner thighs, inguinal creases, or perineal area (rare before adolescence). ■ _____- Infection of scalp hair characterized by scaly, pruritic patches that can be associated with breakage of the hair and is usually seen in prepubertal children between ages 1 and 10. ■ ______(dermatophyte onychomycosis) - Infection of the nail.

Tinea cruris Tinea capitis Tinea unguium

nursing care: the nurse educates the family about over-the-counter lice treatments that may be helpful in the care of lice. medical care: _____ Education:If a child is unable to tolerate these shampoos, former remedies including the use of asphyxiants like ____. Once the shampoo is rinsed from the hair, remove nits by backcombing with a fine-tooth comb while the hair is still wet (nits are easier to remove when the hair is damp).

Types of pediculicide treatments include pyrethroids, such as permethrin (Nix) and malathion (Ovide), and antiparasitics, including benzyl alcohol (Ulesfia), lindane (Kwell), spinosad (Natroba), and ivermectin (Stromectol). petrolatum and food oils (e.g., olive oil) can be used

Nursing Care: Close and frequent monitoring and assessment of the rash is an important nursing care measure. _____. Moisturizing immediately after bathing with emollients Education: reinforce gentle cleansing and the use of tepid water for bathing as well as use of emollients. Encourage patients to practice itch-scratch avoidance and to keep fingernails trimmed short with no sharp edges. Teach parents the signs and symptoms of secondary infection including _____

Warm, not hot, bathing water will decrease irritation. Encourage the adolescent to keep the water a bit cooler, avoid excessive scrubbing with exfoliating scrubs and cloths, and pat dry a fever remaining above 101.5°F (38.6°C) or evidence of red, painful, pus-filled lesions.

Early disseminated disease (2 weeks after bite until chronic symptoms develop) ■ Expands as a red, roundish, flat, nonpruritic, and nonvesicular (erythema migrans) rash; this is the most common manifestation of this stage ■ Fatigue, headache, arthralgia (joint pain), and fever become more common ■ Possible cranial nerve palsy, especially facial nerve palsy (bilateral facial nerve palsy is pathognomonic for Lyme

[characteristic for specific disease]) ■ Meningitis (1% of affected children) ■ Carditis (less than 1% of affected children) ■ 90% will have positive serological conversion in this stage

Education: Teaching and reinforcing proper skin care and medication management are essential for the adolescent with acne. Acne treatment tends to be very _____ Teaching the teen how to use the medication at bedtime may increase adherence to the treatment regimen.

drying and must not be covered with moisturizers or makeup.

Depressed, moist, loss of part of the epidermis After rupture of vesicle or bulla (e.g., varicella)

erosions

Depth of Burn ■ Superficial Thickness: presents with ____ and pain for 2 to 3 days (e.g., a sunburn). These burns involve an ____ ■ Superficial Partial Thickness: presents with erythema and blister formation. The blisters may burst and weep. It generally has a ____ appearance to it. It bleeds easily and is very painful. The heat of the burn injury has damaged ____

erythema (reddened);intact epidermis without blisters. moist; the epidermis and the outer portion of the dermis. Most of the time, scarring will occur and these burns heal spontaneously within 3 weeks.

Nursing Care: Cellulitis that manifests on the ______is more worrisome as it may cause systemic infection. _____ carries a high risk of morbidity and is treated aggressively with hospitalization for IV antibiotics. Nursing care of a patient with cellulitis includes marking the circumference of the reddened area with a marker to distinguish if the rash is improving or worsening with treatment.

face and neck, genitals, or over a joint Orbital cellulitis

Linear crack in the epidermis may be deeper; moist or dry Athlete's foot; cracks at the corner of the mouth or anus

fissures

an injury that results from prolonged exposure (more than an hour) to severe cold and usually affects the outer extremities (ears, cheeks, nose, hands, and feet). Crystal formations occur in the tissue and blood cells, which result in dehydration of the cells and ischemic damage.

frostbite

children with about 10% of TBSA burn will likely require IV fluid resuscitation. Children who suffer burns greater than 15% TBSA are at risk for developing _____. Children require more fluid per kilogram than adults

hypovolemic and cellular shock the child's urine output determines how well they are tolerating resuscitation; 0.5 to 1 mL/kg/hr of urine output is the goal during the resuscitative phase

prevention:Do not share a bed, clothing, or intimate touch with a person who has scabies. Children should avoid sleeping in the same bed as a parent or sibling with scabies. Even if only one member of the family has scabies, the entire family is treated. nursing care:The nurse teaches the family how to use the medication after a bath and what to look for in the case of minor skin irritation. Furthermore, the nurse reminds the parents that ____ . ____ is approved for infants over 2 months of age.

a dishwasher with no other contents can be used to clean washable toys and hair items. Permethrin 5% cream (Elimite) treating clothing, bedding, towels, and cloth toys by washing them in hot water and then placing them in the dryer is necessary to kill scabies

______is a skin infection caused by a poxvirus, common in the pediatric population. It is caused by ___ and is transmitted mainly by direct contact with infected skin, which can be sexual, nonsexual, or autoinoculation. Clinically, presents as firm rounded papules, pink or skin-colored, with a shiny and umbilicated surface. The duration of the lesions is variable, but in most cases, they are self-limited in a period of 6 to 9 months Transmission is commonly through ____

Molluscum contagiosum molluscum contagiosum virus (MCV) direct contact, skin-to-skin contact, or with contaminated objects.

The nurse stresses to the caregiver to implement house-cleaning (e.g., dust, vacuum, and scrub); wash clothing and bedding; and wipe off hats, helmets, and toys. If a soft or cloth toy like a stuffed animal is not washable, it must be ____Launder all bed linens in hot water. Pillows are washed if possible or thrown away. Antilice sprays can be used for furniture and other environmental objects that are not disposable, but the most important cleaning step is ____. Hair care items can be_____

bagged in a sealed plastic bag and away from family members' rooms for 14 days. vacuuming boiled (hot water above 140°F) or soaked in antilice shampoo and never shared.

is a bacterial infection that occurs when bacteria, most commonly streptococcus and staphylococcus, enter through a crack or break in the skin. Animal bites can cause cellulitis. Bacteria can also enter through areas of dry, flaky, or swollen skin. ■ Red to purplish-red ■ Swollen or indurated ■ Warm or hot to touch ■ Tender or painful to touch

cellulitis A complete history and physical is the usual method of diagnosis. Lab tests, radiological testing, or surgical biopsy is used only in the presence of severe infection. Complete blood counts and blood cultures are ordered to rule out septicemia (infection of the blood) if symptoms warrant.

Prevention: Acne can be prevented in some adolescents with care in skin _____ Avoiding oil-based cleansing and moisturizing products in the areas where acne breakouts commonly occur, such as the forehead and nose (T-zone), may also be beneficial. Oil-based makeup does not resolve acne breakouts and may worsen them. Stress may make acne worse in some adolescents at particularly taxing times. Most adolescent acne improves with cleansing and proper moisturizing with a water-soluble moisturizer.

cleansing along with decreasing rubbing and picking of the existing comedones.

Education: The child is checked periodically throughout treatment to be sure a proper response is noted. The nurse must stress the importance of ____ For treatment of tinea pedis, education should include wearing light-weight dry socks, well-ventilated shoes, and adequate cleaning of shower areas to prevent spread of the infection.

completing the recommended treatment even after the lesions appear to be cleared.

Dried body fluid on the skin surface: serum, pus, or blood Disease where the skin weeps: eczema, impetigo, seborrhea

crusts

Secondary lesions are those that result from changes from the primary lesions. They include _____

crusts, scales, lichenification, scars, keloids, fissures, erosions, and ulcers

The human papillomavirus causes warts by invading the epithelial cells in the skin. The wart is transmitted by _____. The usual incubation period is 2 to 6 months, but in some cases there is a latency period. Three types of warts occur in children: _____ Common warts can appear anywhere on the body and appear: ■ Rough (cauliflower appearance) ■ Raised or flat ■ Flesh-colored At times, there will be a central black dot. They may appear alone or in clusters

direct skin-to-skin or mucous membrane contact and from hard surface areas such as plantar warts from gymnasium floors common warts (verruca vulgaris), plantar warts (verruca plantaris), and flat warts (verruca plana).

School-age children and adolescents have more freedom and access to adult items. This age group may use their independence to cook, light candles, and investigate situations without thinking about the danger. Typical burn injuries in school-aged children and adolescents include:

■ A scald burn from cooking in the microwave, stove, or oven ■ A flame burn from trying to ignite a lighter or a match ■ A chemical burn from experimentation with chemical agents ■ An electrical burn from climbing trees where electrical power lines of 14,000 volts or more are passing through the tree

Preschool child growth involves increased mobility and independence. The preschooler becomes inventive and uses magical thinking in daily activities. Typically burn injuries in preschoolers are:

■ A scald burn may happen when running into the kitchen and getting in the way while a parent is cooking ■ A radiation burn from touching hot appliances like a stove burner ■ An electrical burn from playing with an electrical cord that had a frayed wire ■ A radiation burn from touching hot appliances like a clothing iron ■ A flame burn from trying to ignite a lighter or a match ■ A flame and/or an inhalation burn from a house fire

Signs and symptoms of contact dermatitis include: ___ A complete history of both indoor and outdoor exposures for a child presenting with a rash helps determine diagnosis. If a differential diagnosis is required because of atypical lesions, a biopsy may be performed. Vesicular lesions that present in children may also include varicella and impetigo. These etiologies are ruled out before a diagnosis of contact dermatitis is considered.

■ Irritated, inflamed, and pruritic rash within 48 hours of contact with the offending agent ■ Vesicles and bullae may be present in the area ■ Urticaria (hives) when there is contact with an allergen ■ Vesicles that may weep serous fluid

Lyme disease presents in three stages: Early localized disease (3-30 days after bite) _____

■ Red macule at the bite site ■ Bulls-eye rash with a central macule and surrounding clear area, then an expanding rash (5-50 cm in circumference) ■ Possible systemic symptoms ■ Fatigue, headache, arthralgia (joint pain), neck pain, fever, and myalgia (muscle pain) (listed in order of prevalence)

first line of treatment for MRSA is oral antbiotics and or topical antibiotic cream

■ Vancomycin (Vancocin) (IV) ■ Clindamycin (Cleocin) (IV/IM/PO), dicloxacillin (PO) ■ Mupirocin (Bactroban (topical)

prevention of cellulitis:

■ Wash the child's wound daily with soap and water. ■ Apply an over-the-counter antibiotic cream or ointment. ■ Watch for signs of infection such as redness, pain, and drainage.

medical care: generally self resolve medical treatment may require the daily use of topical ____ to irritate the skin and in turn stimulate the immune system to respond to this viral condition. If this is unsuccessful, the health-care provider may choose curettage (cutting away) or cryotherapy (freezing each lesion with liquid nitrogen). Complications from these treatments may include scarring. A secondary infection would require treatment with topical or oral antibiotics. Education: ____

tretinoin (Retin A) The nurse instructs the family in good hand hygiene, redirecting the child from picking at the lesion to prevent autoinoculation, and allowing scabbing to fall off naturally.

Concave, moist, loss of epidermis and dermis Ulceration: stasis, decubitus

ulcers

S/S: the lesions begin as a ____ surrounded by edema (swelling) and erythema (redness). Later these lesions erupt, leaving honey-colored exudate. This exudate becomes crusty in appearance and sticky to the touch. The child may experience ____ that is not usually painful. Over time, impetigo clears, leaving no residual scarring in the absence of scratching or picking. diagnosed through assessment- culture is needed if the HCP is unsure of the exact diagnosis

vesicle or pustule pruritus (itching)

Raised, circumscribed, superficial, filled with serous fluid, 1 cm in diameter Varicella, herpes zoster (shingles)

vesicles

Balanced nutrition is essential during burn recovery because a balanced diet is necessary for wound healing. Patients are _____. Patients not tolerating an oral diet must receive total parenteral and enteral nutrition. Advancement to enteral feedings and eventually oral feedings happen as the child recovers and can tolerate the diet. As soon as the patient is able, they are encouraged to _____ Topical _____ is a tricyclic medication with potent histamine receptor-blocking abilities

weighed at twice a week sit in a chair, get out of bed, and walk, which may stimulate the appetite. doxepin (Sinequan)

Raised, irregular shape, cutaneous swelling, solid; diameter is variable (usually transient) Urticaria, insect bites, allergic reaction

wheals

Depth: Deep Partial Thickness: presents with a _____ There are ______. This type of burn is extremely painful. If it does not become infected, it will heal within 3 to 9 weeks. Scarring will occur with this type of burn because it will take longer than 2 weeks to heal. Sometimes excision and grafting are performed to aid the healing process and diminish the severity of scarring. Full Thickness: _____A deep full-thickness burn may also damage the nerves, bones, and muscles.

white or pale color to the injured tissue; generally huge blisters, which burst, and the pale dermis is visible destroys the epidermis and dermis, and eschar is visible.

_____, commonly known is ringworm, is a fungal infection caused by a group of closely related fungi that invade the stratum corneum, hair, and nails. These infections live on (not in) the skin.

Dermatophytosis

Pain Management: The nurse administers IV pain medication_____ before a dressing change using IV narcotics such as _____ Nonnarcotic pain control methods are also important. ____ may assist with pain control. Involving child life services during the dressing change can be beneficial. Children as young as 3 can participate in the dressing change by removing the dressing with supervision from the nurse or child life therapist. By participating in the dressing change, the child is given ____

20 to 30 minutes morphine sulfate (MS-Contin). Diversional activities such as music, television, and visualization control over this painful procedure and may better be able to cope.

During stage three, the individual will experience: ■ Temperature less than 86°F (less than 30°C) ■ Stops shivering ■ Reduced consciousness moving to stupor ■ Paradoxical behavior (unusual); undressing ■ Metabolism slows to 1/2 of normal ■ Bradycardia and tachyarrhythmias ■ Respirations slow ■ Central nervous system stops ■ Multiple organ failure ■ Death (Avci & Kocak, 2018) Diagnosis:

A diagnosis of hypothermia in children is based on body temperature and relevant behaviors. With no etiology of prolonged exposure to the cold, the child will need differential diagnostics to determine if the etiology is neurological or metabolic.

Medical Care: 2-week course of oral antibiotics is given if infection is suspected. ____ are the most often used antibiotics in children 8 or younger; however, the American Academy of Pediatrics recommends the use of Doxycycline (Vibramycin) or Tetracycline (Sumycin) in children less than 8 years of age for up to 21 days of treatment. Education:

Amoxicillin (Amoxil) or cefuroxime (Ceftin) Teaching methods of tick bite prevention is invaluable. If the child is treated for Lyme disease, whether presumptively or because of positive lab tests, the nurse reinforces the proper use of antibiotics, including compliance. Furthermore, the nurse reminds the family of follow-up appointments with the health-care provider.

_____ is often described as "the itch that scratches" with pruritis as a classic clinical characteristic. This chronic skin condition has three distinct phases (acute, subacute, and chronic) with no known etiology this condition has a genetic basis tends to begin early in life in those with a predisposition to allergies.

Atopic dermatitis/eczema Characteristically, rashes occur on the head, face (especially the cheeks), neck, elbow and knee creases, and ankles in infants. In the older child, the rash presents in the folds of the arms and legs and occasionally on the eyelids and neck

Local anesthetics such as lidocaine are used to diminish nerve impulses by blocking sodium channels on neuronal cell membranes. _____ has been shown to reduce pruritus because it forms an occlusive barrier on the skin and maintains optimal levels of hydration in the skin. ______ have been used for scar maturation for many years. The mechanism of this is not clear, but it may be associated with a reduction in inflammatory cells and a decrease in histamine release.

Colloidal oatmeal Compression garments

Prevention: adequate protection is essential information to pass along to parents. Appropriate cold weather clothing is vital to keeping warm. Covering the head will help the child stay warm; covering the ears, hands, and feet helps reduce the chance of frostbite. Warm socks under waterproof footwear as well as mittens work well for children who are outdoors for short periods of time in the cold weather. Nursing Care: Treatment for frostbite is much like core hypothermia treatment. ___

Place the child in a warm area, remove all wet and cold clothing, and replace with warm, nonrestrictive clothing. Remove watches and rings if present. Add warm blankets around the child and use the Bair Hugger® if available. Do not rub, massage, or soak the frostbitten area. Massage causes the crystals that have formed in the capillaries to break through the skin, causing damage in the area. After rewarming is complete, the affected extremity is wrapped in a soft cloth or gauze, and the child can be encouraged to rest. If no subsequent problems arise, the child can remove the soft cloth and return to indoor activities. If parents suspect continued problems, the health-care practitioner should be notified.

■ Clothing: ■ Cooling: ■ Cleaning: Chemoprophylaxis: Bacitracin (BAK-tracin) may be used topically to prevent infection. Other types of anti-infective agents are used in moderate and major burns. A tetanus booster (Td) is also administered if not administered within the previous 5 years. ■ Covering: Comfort: Give acetaminophen (Children's Tylenol) or ibuprofen (Children's Advil) to decrease the pain.

Remove any clothing that is hot or has been in contact with the offending chemical, if it is a new burn. Burns need to be cooled immediately with cool (54°F) (12.2°C) saline-soaked gauze or any available clean cloth soaked in cool water, if it is a new burn. Caution: Do not use ice! Wash wound with mild soap and rinse well with water with each dressing change. Cover the burn with gauze to prevent infection, to decrease pain, and to absorb drainage. A moist wound heals much better than an open wound.

____a multisystem disease that can be mild, moderate, or severe. The onset can be either gradual or sudden. The greatest risk of mortality is to the child younger than 4 or who presents late in the illness or without the characteristic rash Some ticks, such as the American dog tick and the ______, harbor the organism Rickettsia rickettsii that can be transmitted to the human host after a tick bite. The rash is generally made up of small spots of bleeding and starts on the wrists and ankles.

Rocky Moutain Spotted Fever Rocky Mountain wood tick

most common bacterial skin infections: ___,___&___ Viral infections can be caused by any number of viruses, but those encountered most often include a member of the ____. Fungal infections are also caused by a wide variety of pathogens, the most common being Candida albicans.

Staphylococcus aureus, Streptococcus, and Pseudomonas. poxvirus group, herpes simplex I or II, and the human papillomavirus

signs and symptoms of molluscum contagiosum include small flesh- or pink-colored papules (pearl-like) that are no larger than 2 to 6 mm in diameter. The central depression of the papule may have an exudative plug. Groups of papules range from a few to several hundred. In children, the papules are found predominately on the trunk and face. Papules are never seen on the palms or soles in any age group. diagnosis: ___

The condition is diagnosed by assessing the skin for lesion typology. A family history may reveal that the virus has recently affected other family members

s/s: The child with atopic dermatitis has a red, raised rash that is pruritic and may cause some discomfort or pain A complete family history and visual assessment of the child reveals the common signs of this condition. Blood tests reveal an increase in circulating IgE antibodies. Prevention:

The priority preventive measure is stopping a secondary infection, which can be accomplished with good skin care and close monitoring. When a child has atopic dermatitis, prevention of secondary infection is very important and requires adhering to good hygiene processes, following prescribed treatment protocols, and maintaining skin hydration.

Diagnosis: based on the classic triad of presenting symptoms, which include _____. Often symptoms are vague and particularly difficult to diagnose if the child or parents do not recall a tick bite. The nurse asks questions about the child's history: outdoor play, playing with animals, and appearance of a singular macule/papule that may have been the original tick bite site. A nonspecific rash with fever and a poor history will lead to laboratory testing.

rash, fever, and history of a tick bite

Infants and young children are at higher risk because of their_____ Older children are at high risk for hypothermia because they may lack the cognitive ability to evaluate risky situations. Adolescents are at risk for hypothermia because of _____ In children of any age, trauma, brain disorder, or severe sepsis can also cause hypothermia because these conditions interfere with the thermoregulation system.

immature thermoregulatory system, thinner skin, and lack of subcutaneous fat. risk-taking behaviors such as participating in outdoor activities without proper clothing and potentially ingesting alcohol or other illicit drugs. ■ Temperature between 93.2°F and 96.8°F (34°C-36°C) ■ Shivering and piloerection (goose flesh) ■ Vasoconstriction ■ Increased metabolism ■ Shallow breathing, fatigue, nausea, and visual disturbances ■ Poor fine motor coordination ■ Local reaction: burning and numbness of extremities, pallor (pale/blue-gray) to erythema (redness) Stage two symptoms include: ■ Temperature between 86°F and 93°F (30°C-34°C) ■ Violent shivering, pallor, and distal cyanosis ■ Poor gross motor coordination; stumbling ■ Confused but awake and alert ■ Local reaction: insensate (no feeling) and skin may blister from frostbite ■ Mild to moderate frostbite can resolve in rewarming with little to no sequelae (pathological conditions)

Bacterial infections commonly cause _____, while most viral infections cause _______ Examples of the latter include the herpes simplex I virus and warts.

impetigo and acne inflammation and vesiculation.

The first stage, _____, reflects the skin's initial healing response and lasts about 2 to 5 days. This is a preparatory stage for repair. Under normal circumstances, the wound seals itself with blood coagulation, followed by vasodilation that allows the leukocytes to ingest the bacteria and debris at the site of the injury

inflammation

Fibrous tissue (scar) of irregular shape, raised and grown beyond the boundary of the original wound Postoperative wound healing (more common in persons of color)

keloids

Rough, thickened epidermal area often in the flexor surface of extremity Chronic dermatitis

lichenification

Notably visible _____, or the thickening of the skin with hyperpigmentation, is often found on children who have atopic dermatitis. ____ may be associated with cancer. Scars are the result of a wound. ____, seen mainly in persons of color, result from hypertrophy of the scar tissue that extends beyond the wound edges

lichenification Ulcers Keloids

Prevention: A child who has molluscum contagiosum should use the bathtub a_____. Special covering of the lesions is not required for normal activities of daily living because the child and family may already have or have had the viral infection. Nursing Care: no specific diagnostic testing or intervention is required for mild cases because they resolve on their own. If medications are prescribed, proper instruction in medication name, dose, interval, and potential adverse effects are discussed.

lone rather than bathe communally with siblings The tub must be disinfected after a bath, and the child's towels should not be shared.

Flat, circumscribed area that has color change: <1 cm in diameter Freckles, flat moles, petechiae, measles, scarlet fever

macules

Topical antibiotics such as ____ may be used if the skin lesions are limited. Oral antibiotics are given for widespread infections and may include _____ Other common medications for impetigo include cephalexin (Keflex) (oral) and clindamycin (Cleocin) (oral).

mupirocin (Bactroban) amoxicillin/clavulanate (Augmentin), dicloxacillin, or erythromycin (E.S.S.)

Raised, firm, circumscribed (deeper than a papule), 1-2 cm diameter Lipomas, erythema nodosum

nodules

Moderate acne will have a mix of ______, while severe acne will have an increased number of ______ Severe acne is a significant progression of the signs and symptoms listed.

noninflammatory comedones and inflammatory pustules and papules inflammatory papules, pustules, and nodules with evidence of scarring.

Infection management: Dressing change to wounds is performed ____ Maintaining aseptic technique during the dressing changes is essential. With patients who have burn injuries greater than 80%, _____ Dressing changes to the face of an intubated child always require two nurses. When the dressing change is complete, the physical therapist performs _____ ____are also done once or twice per week to monitor for infection as well as monitor the type of bacteria that may be growing on the skin.

once or twice daily. two nurses perform the dressing change. range of motion exercises and applies splints. Wound cultures

Raised, circumscribed area: 1 cm diameter Warts, moles, lichen planus, scabies

papules

Macule that is flat and nonpalpable, irregular shape: 1 cm diameter Port-wine stains, café-au-lait spots, capillary hemangiomas

patches

The nurse instructs the family member to remove nits from eyelashes by applying _____ to the eyelashes twice a day for 8 days. The family member can check the school's antilice policy; children must remain home from school until lice-free. The child may be required to be checked by the school nurse or day-care provider before returning. Tell the family member that the child should be rechecked for infestation in ____

petrolatum jelly 7 to 10 days, sooner if they are scratching incessantly or the itching is interfering with sleep.

In the second phase, ____, the blood flow is re-established to the site and natural debridement occurs. In this phase, lasting 2 days to 3 weeks, the wound contracts and a fine layer of epithelial cells cover the site of new collagen.

proliferation

Raised, superficial, like vesicle, but fluid is purulent Impetigo, acne

pustules

Hypothermia is also present in victims of burns, when large amounts of skin are no longer present, or the child no longer has the capacity to hold heat. Mild hypothermia is a condition in which the child's core body temperature falls below 93.2°F (34°C). Hypothermia is a life-threatening emergency. The body loses heat in one of five ways: ____

radiation, conduction, convection, evaporation, and respiration

Finally, during ____, the third phase, collagen production allows for scar formation. This phase, lasting 3 weeks to 2 years, allows the collagen to increase the tensile strength of the newly mended tissue. Scar strength is only 80% as strong as the original tissue

remodeling

nursing care:The nurse initiates emergency medical care by calling the emergency response team and conducting a complete assessment of airway, breathing, and circulation. Cardiopulmonary resuscitation is initiated if the child's condition warrants. The nurse must record core body temperature. Rectal temperatures are most accurate and are used during the rewarming process. Important Nursing measures include:

removing all cold and wet clothing, wrapping the child in warmed blankets, and administering warmed oxygen and warmed IV fluids to promote cardiac output. Vital signs and urine output are also monitored during the rewarming process. Electrocardiograms are used because ventricular or atrial dysrhythmias are possible in hypothermia. After these critical measures are implemented, the nurse raises the child's body temperature by using a forced air warming system (e.g., the Bair Hugger®). This type of system uses convection to heat the trunk area first.

_____Children with a weakened immune system are at increased risk. transmitted by close personal contact with an infected person and is more common in persons who live in crowded conditions or share a bed. The mite burrows under the epidermis layer of the skin, laying eggs and fecal matter that causes irritation and severe itching. The burrows appear as small black lines under the skin on physical examination. mite cannot survive for more than 3 days away from the skin.

scabies Mite infestation is highly transferable, and although children of all ages are affected, it is most commonly seen in children younger than 2. The classic clinical feature of scabies is pruritus. It is often severe and usually worse at night. Pruritus results from a delayed hypersensitivity reaction to the mite, mite feces, and mite eggs

_____ mite burrows in the stratum corneum of the epidermis, where she deposits her eggs and feces. An inflammatory response to the eggs and feces under the skin causes intense pruritus. Lesions are characteristically located in intertriginous areas: the interdigital surfaces, axillar-cubital area, popliteal folds, and inguinal region. Therefore, the nursing assessment should include observation for _____

scabies discrete papules, burrows, or vesicles

Raised cluster of keratinized cells, irregular, diameter is variable, can be thick or thin, dry or oily Seborrheic dermatitis, dry skin, skin flaking after allergic reaction

scales

Fibrous tissue, thin or thick, coloration may be lighter or darker than surrounding skin Healing wound of any etiology

scars

When assessing the skin for a lesion, it is important to note the ____

size, shape, color, and texture.

diagnosis: A thorough ___&___ is the method of diagnosis for acne. The nurse can prepare the teen for an assessment by making sure their face, scalp, chest, and back are exposed and cleansed of all makeup and powders. Laboratory tests are ordered when an underlying endocrine disorder is suspected.

skin assessment and a complete health history

If a child has a severe case of cellulitis, hospitalization and IV antibiotics may be necessary. In addition, ____ to decrease inflammation such as _____ may be ordered but are not routine. Another nursing intervention is the administration of an anti-inflammatory medication such as _____ Medications in the management of cellulitis: ■ Penicillin G (Bicillin) IM ■ Amoxicillin (Amoxil) ■ Ceftriaxone (Rocephin) ■ Cephalexin (Keflex) ■ Clindamycin (Cleocin)

steroids prednisolone (Pediapred) ibuprofen (Children's Advil) or acetaminophen (Children's Tylenol).

_____ are the most common type of burn in childhood and occur as a result of contact with a flame, flash, or scald. ____ burns occur when the skin of the child comes in contact with radiofrequency or ionizing agents. The most common radiation burn injury is sunbur ____ comes in contact with a chemical agent ____electricity passes through or around the body as it seeks the fastest path of least resistance to the ground.

thermal burns Radiation burns --However, cancer patients undergoing radiation therapy can also suffer a radiation burn. Chemical Burn Electrical burns

Education:Usually, a child can return to school, but time for rest must be allowed during and after the school day. The family may need to work with the school system to allow for limited hours and the ability to complete work at home. Sports and other activities can be resumed as the child begins to tolerate normal activity levels monitoring may be more warrented if ___

they were very ill and/or had prolonged hospitalization.

■ ____ - Infection of body surfaces other than the feet, groin, face, scalp hair, or beard hair characterized by a round to oval lesion with maculopapular border with central clearing and often with scaling seen in children and adolescents; ■ ______- Infection of the foot, also known as "athlete's foot," characterized by red, scaly, pruritic skin that may develop weeping in areas of the toes and feet. This infection can occur in children and adolescents.

tinea corporis- sometimes referred to by the common term ringworm even though no "worm" is involved. Tinea pedis

nursing care: the nurse must stress that everyone in the family needs to be treated and that it is essential not to share hairbrushes or bath towels. Specifically, with tinea capitis, the affected area of hair growth may take 6 to 12 months to grow or may not grow back at all. medical care:

topical or systemic antifungal drugs are often effective therapies. Most superficial cutaneous dermatophyte infections can be managed with topical therapy with agents such as azoles, allylamines, butenafine, ciclopirox, and tolnaftate

Prevention: very contagious and is passed by ______

touch from the infected child to others Good hand washing and keeping a child at home for 24 hours after the induction of the antibiotic will decrease the spread of impetigo in the child's environment.