PEDS Practice: Chapter 23: Nursing Care of the Child With an Alteration in Tissue Integrity/Integumentary Disorder

The nurse is caring for a child with suspected child abuse-induced burns. Which assessment findings would support this?

A burn to the entire right hand up to 2 cm above wrist with consistent edges A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water) is one sign is one sign of child abuse-induced burns. Inconsistent history given by caregivers, delay in seeking treatment by caregivers and a lack of splattering of water burns are all indicators of child abuse-induced burns.

The nurse has completed client teaching with a 16-year-old female who has been prescribed Accutane (isotretinoin) for cystic acne. Which statements indicate learning has occurred? Select all that apply.

"If I am sexually active I need to let my doctor know." "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." 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, such as the CBC, by the physician to monitor the medication's side effects should be obtained.

The mother of a 4-year-old child with atopic dermatitis reports she is having difficulty keeping her child from scratching. What information can be provided by the nurse? Select all that apply.

"Keep your child's finger nails trimmed and filed." "Distract your child with activities when you notice scratching." "Keep a diary of triggers for a week to see what patterns your child has related to this problem." Itching is a chief concern with atopic dermatitis. Strategies should be employed to reduce scratching. Keeping the finger nails trimmed is helpful in preventing cuts to the skin and introducing bacteria to open wounds. Distracting the child with activities is helpful when they are experiencing sensations of itching. A small ball or stuffed animal can be used to focus attention to something else when the urge to scratch is present. A diary can be useful when trying to identify patterns of behavior related to triggers of this condition. Flannel sheets may be irritating and should be avoided.

When doing teaching with 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." 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.

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?

"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, oak or sumac, include 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 preventative treatment approved by the US FDA. It is applied to the skin before exposure.

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

"Eosinophils are a type of white blood cell that are often elevated with atopic dermatitis. These are part of the CBC and helps in making the diagnosis." Atopic dermatitis is a type of allergic skin disorder, not a bacterial infection, in which the eosinophil count is often elevated. This is one test that will help in diagnosing the disorder. This explanation addresses the parents' question.

The nurse is evaluating parents' understanding of atopic dermatitis. Which statement shows their understanding?

"Flare-ups of lesions are not uncommon following therapy." Atopic dermatitis may recur when the child is re-exposed to the substance to which he or she is allergic

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?

"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 includes running cool water, not ice, over the burn. Covering it with a nonadherent bandage after cleaning with a fragrance-fee mild soap. Other care includes not applying butter, ointments or creams, and administering acetaminophen or ibuprofen for pain

The nurse is caring for a child with an order for PO prednisone. Which statement by the child's mother would indicate a need for further education?

"I will give it to her at least 1 hour before all of her meals." Systemic corticosteroids such as prednisone should be administered with food to decrease GI 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 brought to the emergency department by the parents. Upon assessment the physician suspects the child has been bitten by a spider. While obtaining the nursing history of the present condition, which statement by the parent will require clarification from the nurse?

"Since my child just has a rash around the area of the bite there is nothing to worry about." A rash does could be an indication of a systemic reaction and the child should be monitored closely for other signs of a systemic, or possible anaphylactic, reaction. Protective clothing for prevention of insect or spider bites, cleansing the wound to help with infection control, and ice for prevention of swelling are all effective actions.

The nurse is reviewing the integumentary system during a presentation to a group of nurses. Which statement made by the nurse is the most accurate regarding the integumentary system?

"The largest organ of the body helps regulate body temperature." The skin is the largest organ of the body. The skin helps regulate the body temperature by heating and cooling. The sebaceous and sweat glands are not fully functional until middle childhood. The major role of the skin is to protect the organs and structures of the body against bacteria, chemicals, and injury. Excretion in the form of perspiration is also a function of the skin glands, called the sweat glands. Sebaceous glands in the skin secrete oils to lubricate the skin and hair. The integumentary system is in place at birth, but the system is immature. A function of the respiratory system is to distribute oxygen to body cells.

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:

"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.

The nurse is providing teaching on ways to maintain skin integrity and prevent infection for the parents of a boy with atopic dermatitis. Which response indicates a need for further teaching?

"We should avoid using petroleum jelly." It is important to apply moisture multiply times through the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available. The other statements are correct.

An adolescent has been diagnosed with psoriasis. After speaking with the nurse about treatment options suggested by the physician, the client states, "Since ultraviolet rays help, I am going to buy a tanning package so I can tan year round." How should the nurse respond?

"While ultraviolet therapy is an option, year round tanning is not what was intended. Tanning puts you at high risk for skin cancer and other problems." Acknowledging that ultraviolet therapy is an option while clarifying what is meant by ultraviolet therapy and the risks of tanning year round addresses all concerns. Asking if that's what the doctor said may lead the adolescent to think this is a viable option. Advising them to not get burned is giving approval for tanning. Simply telling the teen it isn't a good option will be ineffective.

A nurse is caring for a child with a wasp sting. Which nursing intervention is priority?

Administer diphenhydramine per protocol The nurse should administer diphenhydramine as soon as possible after the sting in an attempt to minimize a reaction. The other actions are important for an insect sting, but the priority intervention is to administer diphenhydramine.

The nurse is caring for a child with urticaria. What is the priority action?

Assessing the child's airway and breathing and noting any wheezing or stridor Urticaria is a type I hypersensitivity reaction. Therefore, the priority nursing assessment is to carefully assess airway and breathing, as hypersensitivity reactions may affect respiratory status. A detailed history, skin inspection, and evaluation of the hives are other appropriate assessments, but determining respiratory status is the priority.

The process of removing necrotic tissue in the treatment of burns is known as:

Debridement Debridement (removal of necrotic tissue), usually preceded by hydrotherapy (use of water in treatment), is performed in the treatment of burns. Debridement is extremely painful, and the child must have an analgesic administered before the therapy

An adolescent with tinea versicolor is admitted for treatment of the disorder. Which nursing diagnosis will the nurse identify as having the highest priority for this client?

Disturbed body image Tinea versicolor is a superficial tan or hypopigmented oval scaly lesions, especially on upper back and chest and proximal arms. It may take several months for pigmentation to return to normal; therefore, disturbed body image is going to be a high priority for an adolescent client.

What accurately depicts the hemodynamic changes that occur in the body within the first 24 to 48 hours after a burn?

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

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:

Isotretinoin (Accutane) Isotretinoin is a pregnancy category X drug: it must not be used at all during pregnancy because of serious risk of fetal abnormalities.

The nurse is discussing dietary intake with the parents of a 4-year-old child who has been diagnosed with atopic dermatitis. Later, the nurse notes the menu selection made by the parents for the child. Which selection indicates the need for further instruction?

Peanut butter and jelly sandwich Atopic dermatitis is commonly associated allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.

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

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

The nurse caring for a child with a skin allergy recognizes that the highest priority in the treatment for skin allergies is aimed at:

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 14-year-old child is diagnosed with tinea versicolor. What would the nurse expect the nurse practitioner to order?

Selenium sulfide Selenium sulfide is used to treat tinea versicolor. Topical nystatin is used to treat monilial diaper rash. Griseofulvin is used to treat tinea capitis. Diphenhydramine is an antihistamine used to treat hypersensitivity reactions, atopic dermatitis, or contact dermatitis that is highly pruritic.

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

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.

The nurse is conducting a primary survey of a child with burns. Which assessment finding points to airway injury from burn or smoke inhalation?

Stridor Airway injury from burn or smoke inhalation should be suspected if stridor is present. Cervical spine or internal injures would not point to airway injury. Burns on hands would not be indicative of airway injury.

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?

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 collecting data on a child admitted to the burn unit with a partial-thickness burn. What is most accurate regarding this type of burn?

The child will likely have blisters. In a partial-thickness or second-degree burn, the epidermis and underlying dermis are both injured and devitalized or destroyed. Blistering usually occurs with an escape of body plasma, but regeneration of the skin occurs from the remaining viable epithelial cells in the dermis.

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

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

The nursing diagnosis of risk for infection related to a disruption in the protective skin barrier is noted on a child's plan of care. Which action would be of greatest importance?

Using appropriate hand hygiene Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk.

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. The nurse most likely is referring to:

impetigo. Impetigo is a superficial bacterial skin infection.

The parents of a child recently diagnosed with atopic dermatitis voice concern to the nurse that their child may develop asthma at some point. How should the nurse respond?

"I can understand your concern. We will closely monitor your child for asthma development." Atopic dermatitis (eczema) is one of the disorders in the atopy family (along with asthma and allergic rhinitis). About 30% to 35% of children who have atopic dermatitis will also develop allergic rhinitis and/or asthma. Therefore, the child will be monitored for the development of asthma.

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

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

In working with infants diagnosed with atopic dermatitis, the nurse anticipates that when these children are older they will likely have a tendency to have which disorder?

Asthma Infants who have eczema tend to have allergic rhinitis or asthma later in life.

The nurse is caring for a child admitted with partial thickness burns. What is most characteristic of this type of burn?

Blisters appear In partial-thickness or second-degree burns, blistering usually occurs with an escape of body plasma.

A 10-year-old has been bitten on the lower posterior arm by a dog, requiring several stitches. The child was just admitted to the hospital for 3 days of antibiotic therapy. When developing the care plan, the nurse identifies which nursing diagnoses as being the top 2 priorities?

Impaired skin integrity Risk for infection The wound was not a clean wound, such as a surgical wound, so risk for infection would be a top priority. The child has impaired skin integrity from the wound and from the IV. Since the wound is new and on the arm the nursing diagnosis disturbed body image would not be a top 2 priority at this time. It is unlikely that a great deal of fluid has been lost from this wound. Knowledge deficit of wound care would not be a top 2 priority at this time, but would be an important nursing diagnosis to address later.

The nurse is working in a community setting and receives a call from a local day care center. One of the children in the center has been diagnosed with impetigo, and the director of the day care center wants to know whether she should be concerned. The nurse's response should reflect what information related to impetigo?

Impetigo is highly contagious and can spread quickly. Impetigo is highly contagious and can spread quickly. Impetigo in the newborn nursery is cause for immediate concern.

The nurse is caring for an infant who has impetigo and is hospitalized. Which nursing intervention is the highest priority for this child?

The nurse follows contact precautions. Impetigo is highly contagious and can spread quickly. The nurse should follow contact (skin and wound) precautions, including wearing a cover gown and gloves. The nurse will soak the crusts with warm water, apply topical antibiotics, and apply elbow restraints, but these are not as high a priority as trying to prevent the spread of the infection by following contact precautions.

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 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 1-week-old child with a feeding intolerance. The mother expresses a concern with white scales that have began to flake off the infant's scalp and she asks the nurse what she can do to prevent this. What is the best nursing response?

"Your child most likely has infantile seborrheic dermatitis, or cradle cap. You can care for it by cleansing the hair and scalp daily with baby shampoo. You can also apply baby oil to the area for 10 to 15 minutes and then rinse away the flakes." Infantile seborrheic dermatitis 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, salicylic acid in mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft toothbrush; then the scales can be rinsed away. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Accusing a parent of poor hygiene is inappropriate. Infantile seborrheic dermatitis is not a result of poor hygiene.

The nurse is completing the care plan for a pediatric client with deep partial-thickness burns on the back and back of the legs. Debridement of the burns is performed 2 to 3 times per week. What nursing diagnosis has the highest priority in regards to this treatment modality?

Pain Debridement involves the removal of loose skin and eschar (dead, charred skin). This procedure is usually performed with sterile scissors and a pair of forceps or with a gauze sponge. Debridement is a necessary, but often excruciatingly painful, procedure. Thus, pain management needs of the child are of utmost importance. All of the nursing diagnoses options would be applicable to a burn client, but pain is the highest priority in regards to debridement.

The nurse is caring for a 10-month-old with a rash. The child's mother reports that the onset was abrupt. The nurse assesses diffuse erythema and skin tenderness with ruptured bullae in the axillary area with red weeping surface. The nurse suspects which bacterial infection?

Scalded skin syndrome Staphylococcal scalded skin syndrome results from infection with Staphylococcus aureus that produces a toxin, which then causes exfoliation. It is abrupt in onset and results in diffuse erythema and skin tenderness. It is most common in infancy and rare beyond 5 years of age. Bullous impetigo presents with red macules and bullous eruptions on an erythematous base. Non-bullous impetigo presents as papules progressing to vesicles then painless pustules with a narrow erythematous border. Folliculitis presents with red, raised hair follicles.

The nurse is examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite?

Second degree frostbite Second degree frostbite demonstrates blistering with erythema and edema. First degree frostbite results in superficial white plaques with surrounding erythema. In third degree frostbite, the nurse would note hemorrhagic blisters that would progress to tissue necrosis and sloughing when the fourth degree is reached.

A nurse 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. Which should the nurse ask the mother?

"Does she wear sleepers with metal snaps?" Small round red circles with scaling, symmetrically located on the girls' 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 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 is not contraindicated. Children diagnosed with impetigo may attend school during treatment.

The nurse is providing home care instructions for the parents of an infant with cradle cap. Which response by the parents indicates a need for further teaching?

"We can scrape off the crusts on his scalp with a cotton swab." The crusts should not be forcibly removed with a cotton swab. 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 nurse is caring for a client brought to a pediatric clinic for swelling in the lower extremities with reddened skin that has undefined borders and pits slightly when pressed. What is the most likely diagnosis of the client's skin alteration?

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 bulbous or nonbulbous. 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 is caring for a 1-year-old in a pediatric clinic. The child was brought to the clinic with symptoms of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. What is a key element in the treatment regimen for this diagnosis?

Frequently rehydrating the skin Frequently rehydrating the skin is a key element of the treatment regimen. To maintain healthy skin in the child with AD, hydration practices should be implemented to replace moisture in the stratum corneum and prevent transdermal water losses. Scratching the itchy skin is a reflex that is very difficult to stop; preventing the itch is more effective. Topical antibiotics and oral cortisone are not treatments for atopic dermatitis.

The nurse is assessing a child who was brought into the clinic. The nurse notes honey-colored crusting on the toddler's face, as seen in the figure. The nurse recognizes this to be what type of infection?

Impetigo Impetigo is a readily recognizable skin rash that is characterized with honey-colored crusting. Nonbullous impetigo generally follows some type of skin trauma or may arise as a secondary bacterial infection of another skin disorder, such as atopic dermatitis. Bullous impetigo demonstrates a sporadic occurrence pattern and develops on intact skin, resulting from toxin production by S. aureus.

The nurse is providing education to a teen who has tinea pedis. What information should be included in the discussion? Select all that apply.

Keep feet clean and dry. Wear cotton socks. Tinea pedis is a fungal infection of the feet. Care recommended includes keeping the feet clean and dry. Cotton fiber socks should be worn. Feet should be rinsed with vinegar and water solution not a hydrogen peroxide and water solution. Talcum powder and petroleum jelly is not recommended for this condition.

A nurse is caring for a child with tinea pedis. Which assessment finding should the nurse expect?

Red scaling rash on soles and between the toes Tinea pedis presents with red scaling rash on soles, and between the toes. Tinea capitis presents with patches of scaling in the scalp with central hair loss and the risk of kerion development (inflamed boggy mass filled with pustules). Tinea cruris presents with erythema, scaling, maceration in the inguinal creases and inner thighs.

The parents of an 8-year-old boy diagnosed with frostbite are distraught and state to the nurse, "We can't believe we didn't make our child come inside when he complained about his fingers being numb and hurting." How should the nurse respond?

"I can't imagine how you are feeling right now, but I'm sure you had no idea frostbite could happen. We will take good care of your son." The unintentional injury has already occurred so the nurse must be compassionate and supportive of the parents. The other options are judgmental and do not serve a purpose. Instruction can be given with teaching to prevent future incidents when the parents are ready for teaching.

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 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.

When reviewing bathing habits for a child with dermatitis, which statements by the child's mother indicates the need for further instruction? Select all that apply.

"Antibacterial soap will be helpful in preventing infections at the site of the rash." "I should use the warmest water my child can tolerate during the bath. Bathing and hygiene practices used for the child with dermatitis are important in the treatment. It is important to bath using warm and not hot water temperatures. Soaps used should be free of dye and perfumes. Antibacterial soaps are not recommended as they may be harsh and irritating. Topical medications should be applied after the bath.

The nurse is developing the plan of care for a 3-year-old child diagnosed with atopic dermatitis. Which client outcomes are common focuses for a child with this diagnosis? Select all that apply.

Promotion of skin hydration Maintenance of skin integrity Prevention of infection When caring for the child with atopic dermatitis the focus of care will be on the prevention of infection, maintenance of skin integrity, and promotion of skin hydration.

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 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 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 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 working in a community based clinic recently gave a presentation to parents of toddlers regarding care for injuries in the home. The child of one of the couples that attended the presentation pulled a cup of hot coffee off their kitchen table, causing superficial burns on the hands. Which initial actions by the parents demonstrate learning occurred from the presentation? Select all that apply.

The parents ran cool water over the child's hands The parents covered the burns with a clean non-adhesive bandage The parents contacted their physician for an appointment Suggested care for superficial burns includes running cool water over the burned area until the pain lessens, not applying ice, butter, ointment, or cream to the skin, covering the burn lightly with a clean, nonadhesive bandage, and administering acetaminophen or ibuprofen for pain. Have the child seen by the physician or nurse practitioner within 24 hours.

A teen experiencing contact dermatitis reports that he is experiencing pruritis. What recommendation may reduce this occurrence?

Take oatmeal baths. Pruritis is a common problem associated with dermatitis. Tepid oatmeal baths are helpful in managing this occurrence. Hot baths and showers should be avoided as this may promote itching. Topical antihistamines should be avoided as they may promote sensitization

An adolescent female with acne vulgaris reports to the nurse that the therapy their doctor prescribed last week "has not helped my acne at all." What are appropriate responses by the nurse? Select all that apply.

"I know it must be hard waiting for improvement, but it may take 4 to 6 weeks for the medication to begin working." "Be sure to avoid oil-based cosmetics and hair products because their use may block pores and worsen your acne." "Tell me what your daily regimen is. While it takes some time for the medicine to work, there may be something in your routine that needs adjusting." Teach adolescents that the prescribed topical medications must be used daily and that it may take 4 to 6 weeks to see results. Chocolate, skim milk, and French fries have not been proven to contribute to the incidence or severity of acne. Oil based cosmetics or moisturizers can worsen acne. Asking about the daily routine may alert the nurse to something the teen is doing that can worsen the acne. The client should avoid the use of over-the-counter preparations because they are irritating and aggravate the drying effect of prescription acne treatments.

The nurse is caring for a 2-month-old in a pediatric clinic. The mom states she is going on vacation in Florida in a month and she is concerned about sunburn. She asks if it is okay to use a sunscreen lotion made for children. What is the correct nursing response?

"Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." Do not use sunscreens on children younger than 6 months of age. Instead, use hats, bonnets, and light-colored clothes to shield the skin, and keep the infant away from direct exposure to the sun. Telling the mother not to take the infant to Florida is inappropriate

The nurse is caring for a 12-year-old in a pediatric clinic at a wellness checkup. The child reports having dandruff and asks the nurse what can be done for it. What is the best nursing response after a quick scalp assessment confirms the presence of dandruff?

"Wash your hair with an antiseborrheic shampoo daily." In the older child and adolescent, an antiseborrheic shampoo should be used daily to control scaling caused by dandruff. Corticosteriod creams can be applied two to four times a day for severe cases. Washing hair vigorously twice a day is not recommended. Light-colored clothing is a good suggestion; however, it is not an intervention to control the prevalence of dandruff.

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?

"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.

An 8-month-old has been diagnosed with infantile eczema. At a follow-up appointment, the child's caregiver seems exhausted and angry. He explains that he has done all of the child's care because his wife is repulsed by the child's raw and uncomfortable appearance. What responses would be appropriate for the nurse to say to this caregiver?

"That's not an uncommon reaction, although it's hard on you and on your child." The family caregivers of the child with eczema are often frustrated and exhausted. Family caregivers may feel apprehensive or repulsed by this unsightly child. Support them in expressing their feelings and help them view this as a distressing but temporary skin condition. Although the caregiver can be assured that most cases of eczema clear up by the age of 2, this does little to relieve the present situation.

What is the best technique to perform an assessment of the skin?

Skin assessment involves inspection and palpation in a room with natural daylight. Physical assessment of the skin involves two basic techniques: inspection and palpation. The best lighting for examination of the skin is natural daylight. Bright white fluorescent ceiling lighting is optimal, because it does not cast a yellow hue on the skin. Skin assessment does not require the use of gloves unless there are body fluids or open lesions on the skin. If gloves are required, they should be vinyl to prevent an allergic reaction.

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?

"I should not cover the area with plastic wrap after applying the cream." An occlusive dressing such as plastic wrap over the area should not be used with topical corticosteroids. High-potency preparations should not be used. There is no need to shake topical corticosteroids. Benzoyl peroxide requires shaking before use. Applying the medication at night and rinsing off in the morning is used for coal tar preparations.

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 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 nurse is caring for a child with a partial-thickness burn. What assessment findings would the nurse expect to observe?

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

The client is scheduled to have potassium hydroxide testing performed. What will be needed to complete this test?

Skin scrapings Potassium hydroxide (KOH) testing is done to assess for the presence of a fungal infection. Skin scrapings are placed on a microscope slide and a drop of KOH 20% drop is added.

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

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

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 care provider. What is the most appropriate action for the nurse to do with this child?

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.

In caring for a 3 ½-year-old child admitted after being severely burned, the nurse collects the following data. What finding would be most important for the nurse to report immediately?

The child's respiratory rate is 32 breaths a minute. An increase in the respiratory rate after a severe burn may be an indication of possible serious respiratory complications and should be reported immediately in case an endotracheal tube needs to be inserted. A temperature of 101.2° F (38.4° C), hourly urine output of 150 cc, and pain rating of 7 need to be documented and reported but are not as urgent as reporting respiratory concerns.

The nurse is caring for an infant with diaper dermatitis. Which statement by the child's parent would indicate a need for further education?

"I will use rubber pants over the cloth diapers in the future." Prevention and management of diaper dermatitis includes avoiding rubber pants, avoiding diaper wipes with fragrance or preservatives. Treatment of a rash includes allowing the child to go diaperless for a period of time each day and using a warm blow dryer on the area for 3 to 5 minutes.

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?

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 conducting a physical examination of a boy with erythema multiforme. Which assessment finding should the nurse expect?

Lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk Erythema multiforme typically manifests in lesions over the hands and feet, and extensor surfaces of the extremities with spread to the trunk. Thick or flaky/greasy yellow scales are signs of seborrhea. Silvery or yellow-white scale plaques and sharply demarcated borders define psoriasis. Superficial tan or hypopigmented oval-shaped scaly lesions specially on upper back and chest and proximal arms are indicative of tinea versicolor.