Lippincott the child with dermatologic health problems

1. A 17-year -old female with severe nodular acne is considering treatment with isotretinoin (Accutane). Prior to beginning the medication, the nurse explains that the client will be required to: 1. Enroll in a risk management plan. 2. Have proof of a mental health evaluation. 3. Begin an effective form of birth control. 4. Temporarily give up sports.

1. 1. Because of the risk of birth defects with isotretinoin, risk management plans require all clients to meet certain requirements to obtain the medication. Providers are advised to closely monitor clients for signs of depression, but a mental health evaluation is not universally required. Women of child-bearing age must use two forms of effective birth control for 2 months before, during, and 1 month after taking the drug. Isotretinoin may cause muscle aches and extreme exercise should be avoided, but general participation in sports should be considered on an individual basis.

10. A 5 -year-old child with burns on the trunk and arms has no appetite. The nurse and the mother develop a plan of care to stimulate the child's appetite. Which of the following suggestions made by the mother would indicate that she needs additional teaching? 1. Deciding that she will feed the child herself. 2. Withholding dessert and treats unless meals are eaten.3. Offering the child finger foods that the child likes. 4. Serving smaller and more frequent meals.

10. 2. Withholding certain foods until the child complies is punitive and rarely successful. Allowing the mother to feed the child, serving smaller and more frequent meals, and offering finger foods are all acceptable interventions for a 5-year-old child. This is true whether the child is well or ill.

11. After teaching the mother of a child with severe burns about the importance of specific nutritional support in burn management, which of the following, if chosen by the mother from the child's diet menu, indicates the need for further instruction? 1. Bacon, lettuce, and tomato sandwich; milk; and celery and carrot sticks. 2. Cheeseburger, cottage cheese and pineapple salad, chocolate milk, and a brownie. 3. Chicken nuggets, orange and grapefruit sections, and a vanilla milkshake. 4. Beef, bean, and cheese burrito; a banana; fruit-flavored yogurt; and skim milk.

11. 1. Hypoproteinemia is common after severe burns. The child's diet should be high in protein to compensate for protein loss and to promote tissue healing. The child will also require a diet that is high in calories and rich in iron. The menu of bacon , lettuce, and tomato sandwich; milk; and celery sticks is lacking in sufficient protein and calories.

12. When caring for a child with moderate burns from the waist down, which of the following should the nurse do when positioning the child? 1. Place the child in a position of comfort. 2. Allow the child to lie on the abdomen. 3. Ensure the application of leg splints. 4. Have the child flex the hips and knees.

12. 3. A child with moderate burns is at high risk for contractures. A position of comfort would encourage contracture formation. Therefore, splints need to be applied to maintain proper positioning and joint function, thereby preventing contractures and loss of function. Allowing the child to lie on the abdomen or with the hips and knees flexed often encourages contracture formation.

3. A 9-month-old infant with eczema has lesions that are secondarily infected. Which of the following is most appropriate to help the parents best meet the needs of the child? 1. Preventing siblings from being in close contact. 2. Sending the child to day care as usual. 3. Playing video games for several hours each evening. 4. Playing with the child every day.

3. 4. The parents can best meet the needs of their 9-month-old infant by playing with the child every day. All infants need time with their parents to develop trust and thus attain optimal development. The parents of a child with a chronic problem may need more guidance to meet the child's needs because of the focus on medical problems. The child's lesions are secondarily infected and therefore should not be contagious. Siblings do not need to stay away. Even with lesions that are infected, the child can still attend day care, but the child needs attention from the parents as well. Playing video games for several hours is not appropriate for a 9-month-old infant.

4. After the nurse teaches the mother of a child with atopic dermatitis how to bathe her child, which of the following statements by the mother indicates effective teaching? 1. "I let my child play in the tub for 30 minutes every night." 2. "My child loves the bubble bath I put in the tub." 3. "When my child gets out of the tub I just pat the skin dry." 4. "I make sure my child has a bath every night."

4. 3. Atopic dermatitis is a chronic pruritic dermatitis that usually begins in infancy. Many of the children diagnosed with it have a family history of eczema, allergies, or asthma. Atopic dermatitis is best treated with hydrating the skin, controlling the pruritus, and preventing secondary infection. Patting the skin dry removes less natural skin moisturizer and thus maintains skin hydration. Water has a drying effect on the skin. Playing in the tub for 30 minutes each night would deplete the skin of its natural moisturizers, thereby leading to increased pruritus and dry skin. Bubble baths are to be avoided in children with atopic dermatitis because they may act as an irritant , possibly exacerbating the condition. Also, bubble baths deplete the skin of its natural moisturizers. The issue is not whether the child bathes every night. Rather, the goal is to decrease dryness and itching.

5. A 5-year-old child brought to the clinic with several superficial sores on the front of the left leg is diagnosed with impetigo. Which of the following instructions should the nurse give the parent? 1. Wash the child's legs gently three times per day with a mild soap. 2. Cover the sores with loose gauze. 3. Allow the child to go back to school after 24 hours of treatment. 4. Have the child return to the clinic the next week for a follow-up examination.

5. 3. Impetigo involving several superficial lesions is usually treated topically, including washing the affected areas, removing crusts, and applying antibiotic ointment several times a day. The child can return to day care or school after being treated for 24 hours. The lesions do not need to be covered, they can remain open to the air. There is no need for follow-up

6. When developing the teaching plan for the mother of a 2-year-old child diagnosed with scabies, which of the following points should the nurse expect to include? 1. The floors of the house should be cleaned with a damp mop.2. The child should be held frequently. 3. Itching should cease in a few days. 4. The entire family should be treated.

6. 4. Scabies is caused by the scabies mite, Sarcoptes scabiei. The mite burrows into the stratum corneum of the epidermis, where the female deposits eggs and fecal material. These burrows are linear . Scabies is highly contagious. The length of time from infestation to physical symptoms is 30 to 60 days, so everyone in close contact with the child will need to be treated. The bed linens and the child's clothing should be washed in hot water and dried on the hot setting. It is not necessary to damp mop the floors to prevent the spread of scabies. The child should be held minimally until treatment is completed. Family members should wash their hands after contact with the child . Itching lasts for 2 to 3 weeks until the stratum corneum is replaced.

7. A 10-year-old has just spilled hot liquid on his arm, and a 4-inch (10.2-cm) area on his forearm is severely burned. His mother calls the emergency department. What should the nurse advise the mother to do? 1. Keep the child warm. 2. Cover the burned area with an antibiotic cream. 3. Apply cool water to the burned area. 4. Call 911 to transport the child to the hospital.

7. 3. To prevent further injury to the skin, the mother should apply cool water to the burn site. Doing so causes vasoconstriction, retards further damage to tissues, and decreases fluid loss. Keeping the child warm promotes vasodilation, increases fluid loss, and decreases blood pressure and, thus , circulation to the area. Applying ointment to the burn is contraindicated because it does not allow healing to occur and may need to be removed in the hospital . Only a clean cloth should be used to cover the wound to prevent contamination or decrease pain or chilling. If only the arm is burned , a call to 911 for emergency care is not necessary, but the mother should seek health care services immediately.

A school-age child who has received burns over 60% of his body is to receive 2,000 mL of IV fluid over the next 8 hours. At what rate (in milliliters per hour ) should the nurse set the infusion pump? _______________ mL/ h.

8. 250 mL/ h

9. Which of the following would be most appropriate to institute when a school-age child with burns becomes angry and combative when it is time to change the dressings and apply mafenide acetate? 1. Ensure parental support during the dressing changes. 2. Allow the child to assist in removing the dressings and applying the cream. 3. Give the child permission to cry during the procedure. 4. Allow the child to schedule the time for dressing changes.

9. 2. Expressions of anger and combativeness areoften the result of loss of control and a feeling of powerlessness. Some control over the situation is regained by allowing the child to participate in care. Although having parental support during the dressing changes may be helpful, this action does nothing to allow the child control. Giving the child permission to cry may help with verbalizing feelings, but doing so does nothing to provide the child with control over the situation. Although allowing the child to determine the time for dressing changes may provide a sense of control over the situation, doing so is inappropriate because the dressing changes need to be performed as prescribed to ensure effectiveness and healing.

2. When teaching an adolescent with facial acne about skin care, the nurse should instruct the adolescent to: 1. Wash the face twice a day with mild soap and water. 2. Remove whiteheads and comedones after washing his face with antibacterial soap.3. Apply vitamin E ointment twice daily to the affected skin. 4. Apply tretinoin (Retin-A) daily in the morning and expose the face to the sun.

mild soap removes fatty acids from the skin. Acne is an inflammation of the sebaceous glands that produce sebum. Washing the face with mild soap and water keeps the sebaceous glands from becoming plugged. Excessive washing or squeezing the eruptions can cause rupture of these glands, spreading the sebum and causing further inflammation. Applying vitamin E to the lesions does not reduce the inflammation and, due to the greasiness of the preparation, may plug the ducts . Retin-A should be applied at night. Exposure to the sun can result in sunburn and an increased risk of skin cancer and should be avoided. Sunscreen with a sun protection factor of at least 15 must be applied before the client can be exposed to the sun.