Pediatric integumentary disorers.

The clinic nurse is reviewing the health care provider's prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the child's record? A. The child is 18 mo. old B. The child is being bottle fed C. A sibling is using lindane for the treatment of scabies. D. the child has a history of frequent respiratory infections.

A. Rationale: Lindane is a pediculicide product that may be prescribed to treat scabies. It is contraindicated for children younger than 2 years because they have more permeable skin, and high systemic absorption may occur, placing the child at risk for central nervous system toxicity and seizures. Lindane also is used with caution in children between the ages 2-10 years. Siblings and other household members should be treated simultaneously. Option B & D are unrelated to the use of lindane. Lindane is not recommended for use by breast-feeding women because it is secreted into the breast milk.

The mother of a 3-year old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assess the child and suspects the presence of scabies. The nurse bases this suspicion on which of the finding noted on assessment of the child's skin? A. fine grayish red lines B. Purple-colored lesions C. Thick, honey-colored crusts D. Clusters of fluid-filled vesicles

A. fine grayish red lines. Rationale: Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). Scabies appears as burrows of fine, grayish red, threadlike lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders, including systemic conditions. Thick, honey colored crusts are characteristic of impetigo or secondary infection in eczema. Clusters of fluid-filled vesicles are seen in herpes virus infection.

The nurse is caring for a child who sustained a burn injury plans care based on which pediatric consideration associated with this injury? SELECT ALL THAT APPLY. A. Scarring is less severe in a child than in an adult. B. A delay in growth may occur after a burn injury. C. An immature immune system presents an increased risk of infection for infants and young children. D. The lower proportion of body fluid to mass in a child increases the risk of cardiovascular problems. E. Fluid resuscitation in unnecessary unless the burned area is more than 25% of the total body surface area. F. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and less body fat than adults.

B, C, F. Rationale: Pediatric considerations in the care of a burn victim include the following: scarring is more severe in a child than in an adult. A delay in growth may occur after a burn injury. An immature immune system presents an increase risk of infection for infants and young children. The higher proportion of body fluid to mass in a child increases the risk of cardiovascular problems. Burns involving more than 10% of total body surface area require some form of fluid resuscitation. Infants and young children are at risk for protein and calorie deficiencies because they have smaller muscle mass and less body fat than adults.

The nurse is monitoring a child with burns during treatment for burn shock. The nurse understands that which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation? A. skin turgor B. neurological assessment C. level of edema at burn site D. Quality of peripheral pulses

B. neurological assessment. Rationale: sensorium is an accurate guide to determine the adequacy of fluid resuscitation. The burn injury itself does not affect the sensorium, so the child should be alert and oriented. Any alteration in sensorium should be evaluated further. A neurological assessment would determine the level of sensorium in the child. Options A, C, D would not provide an accurate assessment of the adequacy of fluid resuscitation.

A topical corticosteroid is prescribed by a health care provider for a child with atopic dermatitis (eczema). Which instruction should the nurse give the parent about applying the cream: A. apply the cream over the entire body. B. Apply a thick layer of cream to affective areas only. C. Avoid cleansing the area before application of the cream. D. Apply a thin layer of cream and rub it into the area thoroughly.

C. Rationale: Atopic dermatitis is a superficial inflammatory process involving primarily the epidermis. A topical corticosteroid may be prescribedand should be applied sparingly (thin layer) and rubbed into the area thoroughly. The affected area should be cleaned gently before application. A topical corticosteroid should not be applied over extensive layers. Systemic absorption is more than likely to occur with extensive application.

The school nurse has provided an instructional session about impetigo to parents of the children attending school. Which statement, if made by a parent, indicates a need for further instruction? A. "It is extremely contagious." B. "It is most common in humid weather." C. "Lesions most often are located on the arms and chest" D. "It might show up in an area of broken skin, such as in insect bite."

C. Rationale: Impetigo is a contagious bacterial infection of the skin caused by B-hemolytic streptococci or staphlococci, or both. Impetigo is most common during hot, humid summer months. Impetigo may begin in an area of broken skin, such as an insect bite or atopic dermatitis. Impetigo is extremely contagious. Lesions usually are located around the mouth and the nose, but may be present on the hands and extremities.

Permethrin (Elimite) is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding the use of this treatment? A. apply the lotion to areas of the rash only. B. Apply the lotion and leave it on for 6 hours. C. Avoid putting clothes on the child over the lotion. D. Apply the lotion to cool, dry skin at least 30 minutes after bathing.

D. RATIONALE: Permethrin is massaged thoroughly and gently into all skin surfaces (not just the areas that have the rash) from the head to the soles of the feet. Care should be taken to avoid contact with the eyes. The lotion should not be applies until at least 30 minutes after bathing and should be applies only to cool, dry skin. The lotion should be kept on for 8-14 hours of treatment contact time.

The school nurse is conducting pediculosis capitis (head lice) assessments. Which finding indicates a child has a "positive" head check? A. maculopapular lesions behind the ear. B. lesions in the scalp that extend to the hairline or neck C. White flaky particles throughout the entire scalp region D. White sacs attached to the hair shafts in the occipital area

D. Rationale: Pediculosis capitis is an infestation of the hair and scalp with lice. The nits are visible and attached firmly to the hair shaft near the scalp. The occiput is an area in which nits can be seen. Maculopapular lesions behind the ears or lesions that extend to the hairline or neck are indicative of an infections process, not pediculosis. White flaky particles are indicative of dandruff.