Essentials of Pediatric Nursing - Chapter 23

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 child with a burn injury is scheduled for skin grafting. Which intervention would be most appropriate for the nurse to include in the child's plan of care?

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

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 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.

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 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 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.

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.

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." Erythrocyte sedimentation rate (ESR) is a nonspecific test used to detect the presence of infection or inflammation.

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.

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.

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 caring for a 6-year-old child brought into the emergency department for burns from a house fire. The nurse notes burn areas surrounding the client's nose and mouth upon initial assessment. Which priority complication should the nurse be alert for?

Airway obstruction related to upper respiratory swelling Airway obstruction related to swelling is a priority complication to be alert for when signs of inhalation injury such as burns on the mouth and nose are present. Presence of an ileus, increased nutritional requirements, and hypovolemic shock are all complications of burns; however, airway obstruction is the priority.

A nurse is providing care to an infant who is admitted with burns over the face, neck and chest. The nurse identifies which goal as priority for planning the infant's care?

Airway remains patent The priority goal is maintain a patent airway especially because the burns affect the face and neck. Adequate output, maintaining pain at a tolerable level, and having the burns infection free are all appropriate goals for this infant, but maintaining a patent airway is the priority.

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

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 atopic dermatitis (infantile eczema) tend to have allergic rhinitis or asthma later in life.

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

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

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.

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

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

A parent brings an infant to the clinic for a well child visit. During the assessment, the parent asks the nurse why the infant never seems to sweat. What action should the nurse take?

Explain that this normal mechanism keeps the infant from losing too much water through the skin. The sweat glands of an infant are immature and this normal mechanism keeps the infant from losing too much insensible water. Because this is a normal occurrence, there is no reason to make a note to inform the health care provider or to refer the infant to a specialist. An infant's temperature does not run lower than an adult's temperature.

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 community nurse receives a call from a local day care center. One of the children in the center has been diagnosed with impetigo. Which information related to impetigo will the nurse provide to the day care center?

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

A child is hospitalized with burns over 25% of the body. The nurse is preparing to perform a dressing change. What aspect of changing the child's dressings is most important for the nurse to consider?

Infection prevention Preventing infection is the most important aspect of burn wound care that the nurse should consider. Burn wound infections can quickly progress to life-threatening sepsis. Communicating therapeutically with the child, providing distraction activities, and pain management are important aspects to consider but preventing infection is most important.

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.

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.

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.

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 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.

A child is admitted to the acute care facility with a burn injury. The nurse would check the child's immunization status, specifically for which of the following?

Tetanus For any burn, check the child's tetanus immunization status on admission and ensure that tetanus toxoid is given if the child's immunizations are not up to date, because anaerobic and aerobic bacteria can grow at the interface between burned and healthy tissue. Pertusis, diiptheria and meningitis are not important immunizations to check for with a burn patient.

A child enters the acute care setting following a burn injury. The nurse should check for which immunization booster?

Tetanus For any burn, the nurse should check the child's tetanus immunization status on admission and ensure that tetanus toxoid is given if the child's immunizations are not up to date. Anaerobic and aerobic bacteria can grow at the interface between burned and healthy tissue causing infection and possible sepsis. Pertussis, diphtheria and meningitis are communicable diseases and, therefore, not related to burn injuries.

The nurse is caring for a female child in a pediatric intensive care unit who was struck by lightening while playing softball. The parents state to the nurse, "I don't understand why our child has to be here; the doctor said she was fine?" What is the best response by the nurse?

"A child who has suffered an electrical burn can develop cardiac arrhythmias up to 72 hours after a burn injury, so we need to monitor her." Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury; therefore, informing the parents that this is why the child has been admitted effectively answers their question. "If she develops complications" is very elusive and may frighten the parents.

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.

An adolescent is prescribed isotretinoin. Which statement indicates that the adolescent understands the necessary precautions associated with this drug?

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

The 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.

A parent is observing a nurse provide care for the parent's 2-year-old toddler who was burned in a house fire. When the nurse is finished, the parent tells the nurse "I cannot believe this has happened. I should have been able to prevent this from happening." What is the best action for the nurse to take?

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

The nurse is completing the care plan for a pediatric client with deep partial-thickness or second-degree 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.

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. If the skin is inspected with the lighting in the room, 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 non-latex to prevent an allergic reaction.

The school nurse is leading a discussion with a group of adolescents on the various sexually transmitted infections (STIs). The nurse determines the session is successful when the students correctly choose which STIs as considered curable with proper treatment? Select all that apply.

chlamydia gonorrhea trichomoniasis Chlamydia and gonorrhea are curable with antibiotic therapy. Trichomoniasis is curable with metronidazole or tinidazole. Although the warts (condylomata acuminata) can be removed, the virus remains and is not cured. Antivirals control the symptoms of condylomata acuminata and herpes type II virus but do not cure the diseases.

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 caring for a child brought to a pediatric clinic for swelling in the lower extremities. The skin is reddened with undefined borders and pits slightly when pressed. Based on the assessment findings, which of the following would the nurse suspect?

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

The nurse 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.

An infant is seen in the emergency department with several raised red welts over the abdomen and lower extremities. The parent states that the symptoms developed suddenly over the past few hours. The infant is fussy and has a low grade temperature. What assessment is mostimportant for the nurse to perform?

Observe the infant's respiratory effort The raised red welts are likely urticaria or hives, an allergic response to a substance (food, drugs, plants, etc.). As such, it is most important to observe the infant's respiratory effort since that reaction can involve the lips, tongue and airway. Cyanosis would not be visible unless the airway was blocked and then it would be central cyanosis, not just circumoral. Questioning the parent about methods of punishment is unnecessary as the welts are not a sign of trauma. It is appropriate to determine if the infant is breastfed or formula fed because it might be related to the hives the especially if the infant was switched from breast milk to formula, but it is not the most important assessment.

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." Accutane (isotretinoin) is a powerful medication used for severe forms of acne and cystic acne when other treatment methods are not effective. Sexual activity should be reported to the physician. Some physicians may order monthly pregnancy tests even if the client says she is not sexually active because of the risk of birth defects to a fetus. No matter what form of birth control is used, pregnancy is possible, so monthly pregnancy tests are still necessary. Liver function tests are important regardless of age because of the side effects of the medication. Any labs ordered by the physician, such as the CBC, to monitor the medication's side effects should be obtained.

A teen has experienced a minor burn from a hair styling appliance. What interventions will be of benefit? Select all that apply.

Cover with a clean nonadhesive bandage. When caring for a minor burn at home the area may be rinsed with cool water. Ice should not be applied. Covering the burn with a clean nonadhesive bandage is recommended. Butter, creams and ointments should be avoided. Aspirin is not recommended. Acetaminophen or ibuprofen is recommended.