Chapter 23: Nursing Care of the Child With an Alteration in Tissue Integrity/Integumentary Disorder
When teaching a group of caregivers of infants, the nurse is discussing the topic of diaper rash. The caregivers in the group make the following statements. Which statement is the most accurate related to the child with diaper rash.
"My child gets diaper rash if I wash her clothes in the same detergent we use for the family."
A child has an order for an erythrocyte sedimentation rate (ESR). The child's mother asks what the purpose of the test is. What is the best response by the nurse?
"This test will tell if your child has an infection or inflammation somewhere in their body."
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?
Complete the prescribed antibiotics.
A 1-year-old child was brought to the clinic for evaluation of dry, itchy red patches of skin on the arms and legs. A diagnosis of atopic dermatitis (eczema) is made. Which would be an essential element to include in the plan of care for this child?
Frequently rehydrating the skin.
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
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."
A nurse is assessing a 6-month-old girl with an integumentary disorder. The nurse notes three virtually identically sized, round red circles with scaling that are symmetrically spaced on both of the girl's inner thighs. What should the nurse ask the mother?
"Does she wear sleepers with metal snaps?"
The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?
"Flare-ups of lesions are not uncommon following therapy."
The nurse admits a 10-year-old who has just eaten lobster and has hives over much of the body. In collecting data regarding this child, which question should the nurse ask the caregiver first?
"Has the child ever eaten shellfish before now?"
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."
A mother brings her 2-year-old son to the clinic with a bumpy rash. Which statement by the mother would lead the nurse to suspect that the child may have atopic dermatitis?
"I feel so bad for him because he has asthma, and now he gets this rash."
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."
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 tends to be worse during your teen years because of hormone levels."
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."
The nurse is providing home care instructions for the parents of an infant with cradle cap (seborrhea). Which response by the parents indicates a need for further teaching?
"We can scrape off the crusts on his scalp with a cotton swab."
A parent expresses a concern about white scales that have begun to flake off the 1-week-old infant's scalp. The parent asks, "What can I do to prevent this?" Which response by the nurse would be most appropriate?
"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."
The nurse has completed client teaching with a 16-year-old female who has been prescribed isotretinoin for cystic acne. Which statements indicate learning has occurred? Select all that apply.
- "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."
Which assessment finding by the nurse would warrant immediate action?
A child with periorbital cellulitis reports changes in vision and pain with eye movement.
A nurse is caring for a child with a wasp sting. Which nursing intervention is a priority?
Administer diphenhydramine per protocol.
The camp nurse is caring for a child who was bitten on the leg by a dangerous spider. The child is being taken to a health care provider. What is the most appropriate action for the nurse to do with this child?
Apply ice to the affected area.
An adolescent experiencing contact dermatitis reports experiencing pruritis. What intervention will the nurse recommend to relieve the itching?
Bathe with a product that is oatmeal-based.
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
A child arrives at the emergency department with moderate hypothermia and frostbite. Which action would be most appropriate for the nurse to perform?
Place heating pads and warmed blankets on the trunk of the body initially.
What is the best technique to perform an assessment of the skin?
Skin assessment involves inspection and palpation in a room with natural daylight.
An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants?
Staphylococcus aureus
The nurse is educating a parent about the treatment for a child's tinea cruris. What medication class would the nurse include in the teaching plan?
antifungal
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
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
The nurse is taking a health history of a 6-year-old girl with suspected Stevens-Johnson syndrome. During the physical examination, the nurse would expect to note which physical findings?
erythema multiforme with inflammatory bullae of at least two types of mucosa
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
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.
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.
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
The client is scheduled to have potassium hydroxide testing performed. What will be needed to complete this test?
skin scrapings
The nurse is assessing the skin of a 5-year-old child and notes several lesions on the arm. The lesions are circumscribed, elevated, and pinpoint size. They contain serous fluid. How would the nurse document these findings?
vesicle
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.
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 newborn has a generalized rash on the skin, which the nurse identifies as erythema toxicum neonatorum. Which information would the nurse include when explaining the condition to the newborn's parent?
"What you see on your newborn's skin is erythema toxicum neonatorum. It is a common newborn skin condition that typically resolves on its own in about 1 week. There is nothing special you will need to do for this."
An adolescent with acne vulgaris who last week was prescribed tretinoin cream reports to the nurse, "The medicine has not helped my acne at all." What is an appropriate response(s) 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 about your daily regimen. While it takes some time for the medicine to work, there may be something in your routine that needs adjusting."
The parent of a 4-year-old child with atopic dermatitis reports having difficulty keeping the 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." - "Give your child a small stuffed animal or ball to squeeze when the child itches instead of scratching." - "Keep a diary of triggers for a week to see what patterns your child has related to this problem."
The nurse is caring for a child who has a severe case of contact dermatitis following exposure to Toxicodendron radicans (poison ivy). The nurse adds the nursing diagnosis, "Knowledge deficit regarding disease process and care of the client," to the care plan. What nursing interventions should the nurse add to the care plan for this nursing diagnosis? Select all that apply.
- Teach the client and parents that even contact with dormant plants or plants perceived to be dead may cause an allergic response. - Inform the client that itching is very common for contact dermatitis. - Notify the client and parents that the rash may last for 2 to 4 weeks. - Encourage the client to not scratch the skin since this can cause a secondary infection.
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
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."
A nurse completes an assessment on an 8-month-old infant seen in the pediatrician's office for a well-child visit. The nurse notes that the infant's buttocks, perineum and inner thighs are covered in a thick coating of white ointment. When questioned, the parent says the infant has a diaper rash and the ointment is to protect the infant's skin. What is the best action for the nurse to take?
Provide instruction on how to care for a diaper rash.
The parents of a child diagnosed 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."
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
