Pediatrics: PrepU: Chapter 23
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 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." Explanation: 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 parent of a 1-week-old infant is concerned with white scales that have begun to flake off the infant's scalp. The parent asks the nurse what to do to treat this. How should the nurse best respond?
"Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil." Infantile seborrheic dermatitis, better known as cradle cap, 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, mineral oil, or a corticosteroid gel on the scalp for 10 to 15 minutes. The area is gently massaged with a soft brush to lift the scales then shampooed again. A fine-toothed comb helps rid the hair of scale debris. Antiseborrheic shampoo is not recommended for infants. Infantile seborrheic dermatitis is not a result of poor hygiene and will not resolve without intervention.
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 Explanation: 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.
The nurse is conducting a focused skin assessment on a child. After inspecting the skin and noting drainage, what will the nurse do next?
Palpate for regional lymphadenopathy. Explanation: To conduct a skin assessment, the nurse begins with a generalized skin survey and notes any distribution of rashes, the types of lesions and the drainage type and amount. Next, the nurse would need to palpate for any regional lymphadenopathy. This is important because lymph nodes drain to specific regions where they are located. If one or more lymph nodes are enlarged, it could be indicative of a systemic infection instead of just a localized skin infection or inflammation. The prodromal symptoms and history of fever would be obtained in the health history and not the skin assessment. The Braden Q scale is a tool to measure risk factor for a pediatric client developing a pressure injury. It could be used in this situation if the child is not eating, is bed bound, etc., but it is not part of the focused assessment process. The findings from the focused assessment would be entered into the tool to calculate risks.
The nurse is collecting data on a child admitted to the burn unit with a partial-thickness or second-degree burn. What is most accurate regarding this type of burn?
The child will likely have blisters. Explanation: 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 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 bullous or nonbullous. Staphylococcal scalded skin syndrome 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 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." Explanation: 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.
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.
An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants?
Staphylococcus aureus
The nurse is caring for a mother and newborn on a postpartum unit. The mother asks if it OK to use baby powder on newborns. Which response by the nurse would be most appropriate?
"Baby powder should not be used on newborns because of the risk of aspiration upon application." Explanation: The use of baby powders 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 nurse is teaching parents about the care of diaper rash. The nurse would be concerned about the parents' level of understanding if they made which statement?
"I should be certain to use fabric softener in the care of the infant's clothes." Fabric softeners should be avoided because their use can result in skin irritation in the infant. Clothing and other baby items should be washed and rinsed thoroughly. Overdressing should be avoided as sweating irritates the rash, and only ointments and creams that are recommended by health care personnel should be used on the infant.
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 monitoring the urinary output of 3-year-old child admitted with a severe burn. The child weighs 44 lb (20 kg). Which would be a desirable and adequate urinary output for this child?
1 to 2 mL/kg/hr Explanation: Following a burn injury, an output of 1 to 2 mL/kg/hr for children weighing 30 kg (66 lb) or less, or 30 to 50 mL/hr for those weighing more than 30 kg is desirable. This child weighs 20 kg (44 lb).
A nurse is providing care to a hospitalized child who has burns over 40% of the body. The child is receiving intravenous fluid replacement with a 24 hour total of 3,216 mL. The nurse is administering the second half of the fluid between 0100 and 1700 hours. What rate should the nurse set the infusion pump? Record your answer using one decimal place.
100.5 First, the nurse divides the total amount of fluid by 2, because there are two doses. 3216 mL ÷ 2 = 1608 mL Next, the nurse divides the single dose amount by the total number of hours, which is 16. 1608 mL ÷ 16 hours = 100.5 mL/hour
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 Explanation: 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.
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.
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 Explanation: 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 white blood cell (WBC) counts increase. Explanation: In the first 24 to 48 hours after a burn, the hematocrit will often be elevated secondary to fluid loss and the WBC count may also be elevated as an acute-phase reaction, which later could indicate infection.
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 care team has a need to improve the skin assessments in the pediatric population. What assessment(s) would be important for the nurses to implement in this multicultural community? Select all that apply.
Inspect the healing skin of a dark-skinned child for hypopigmentation. Inspect the skin of young children for pressure breakdown due to friction. Assess wound healing in dark-skinned children for hypertrophic responses. Monitor for increased vesicle production in dark-skinned children.
The nurse is discussing the use of over-the-counter ointments to manage a mild case of diaper rash. What ingredients should the nurse instruct the parents to look for in a compound? Select all that apply.
Vitamin A Zinc Vitamin D
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.
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 Explanation: 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 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."
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 Explanation: Atopic dermatitis is commonly associated allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.
The nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?
"Flare-ups of lesions are not uncommon following therapy." Explanation: Atopic dermatitis is relapsing and remitting. It may recur when the child is re-exposed to the substance to which he or she is allergic, even following treatment. Approximately 30% of children with atopic dermatitis develop allergic rhinitis and asthma. It does not occur as a result of a strep infection. It is caused by an inflammatory process. The use of periodic hydrocortisone cream will not lead to kidney disease.
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." Explanation: 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.
The nurse is assessing a child who pulled a boiling pot of soup off of the stove top. The child reports pain at a 9 on a scale of 0 to 10. The burn is red and edematous, and also shows areas of charred skin. The nurse is aware that these signs and symptoms are indicative of what kind of burn?
Full-thickness or third-degree Explanation: Full-thickness or third-degree burns may be very painful or numb or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin.
The nurse is conducting a primary survey of a 12-year-old child involved in a motor vehicle accident. Which assessment finding most concerns the nurse?
The presence of stridor Explanation: The nurse would suspect an airway injury since stridor is present. This would most concern the nurse as this indicates potential loss of airway. Burns on the hands, a broken tibia, and an inability to state own's name are concerning and require intervention. However, these are not indicative of an airway injury and not priority.
The nurse is caring for a child, weighing 100 lb (45.5 kg), on the burn unit who has partial-thickness or second-degree 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 Explanation: 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 high priority. Weight gain of 0.9 kg over 2 days is not a concern at this time.
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." Explanation: 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 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. Explanation: 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 antibiotics, generally penicillin. The cause is not pollens or molds; it is bacterial.
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 Explanation: 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.
A young child has just been admitted to the emergency department with a burn that encompasses the epidermis and the underlying dermis. From which type of burn does this child suffer?
Second-degree or partial-thickness burn Explanation: A burn that encompasses the epidermis and the underlying dermis is a second-degree burn. A first-degree burn would only involve the epidermis, and a third-degree burn would involve nerve endings as well as destruction of the epidermis and dermis. A fourth-degree burn would extend even deeper into the fat layer.
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. Explanation: 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
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 Explanation: 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).
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." Explanation: 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.
An adolescent is diagnosed with psoriasis. After speaking with the nurse about treatment options suggested by the primary health care provider, the adolescent states, "Since ultraviolet rays help, I am going to buy a tanning package so I can tan year round." How will the nurse respond?
"Year round tanning is not what your health care provider intended. Tanning puts you at high risk for skin cancer and other problems." Explanation: 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 is what the doctor said may lead the adolescent to think year-round tanning is a viable option. Advising the adolescent to not get burned is giving approval for tanning. Simply telling the adolescent it is not a good option will be ineffective.
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: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 Isotretinoin is a drug used to treat cystic acne after at least 3 months of antibiotic therapy has not been successful. Isotretinoin is a pregnancy category X drug. It must not be used at all during pregnancy because of serious risk of fetal abnormalities. Tretinoin is used to treat severe acne vulgaris. Instruction for the use of this medication include using sunscreen. Benzoyl peroxide can be used for mild acne and can be used with topical antibiotics. Erythromycin is an antibiotic that has no pregnancy contraindications. It is used for many skin infections1
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." Explanation: 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.
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."
The nurse is caring for a child with burns in a pediatric hospital. What would be an appropriate nursing diagnosis for this client?
Acute pain related to thermal injuries and procedures Explanation: Management of acute pain is crucial for the burn client. Knowledge of the daily procedures at the acute care setting is not a priority for this child. Risk for aspiration would not be an appropriate nursing diagnosis.
A nurse is caring for a child with second- and third-degree (partial- and full-thickness) burns over 15% of the body. The child reports severe itching in and around the burn sites. Which action would be most appropriate for the nurse to perform?
Administer diphenhydramine. Explanation: As nerve endings heal they cause intense itching that can be relieved with the use of medications (e.g., diphenhydramine hydrochloride, loratadine) and by applying soothing lotions such as Nivea or Eucerin. Turning the child every two hours will not relieve the itching. Soaking in a colloidal bath in contraindicated with burn clients. Although diversional activities can help somewhat, they will not relieve the child's itching.
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 Explanation: 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 examining a child for indications of frostbite and notes blistering with erythema and edema. The nurse notes which degree of frostbite?
Second degree frostbite Explanation: 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.
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 Explanation: 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 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.
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?" Explanation: 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.
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 most important 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.
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 most important for the nurse to perform?
Observe the infant's respiratory effort Explanation: 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.
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. Explanation: The best action for the nurse to take is to provide instruction on how to care for a diaper rash. This would include changing diapers frequently to prevent a rash, how to apply rash ointment, and how using too much ointment can cause the infant's skin to absorb the ointment. It is important to praise parents on taking good care of their child, but the best action is to provide instruction on the correct way to do so.
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." Explanation: 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 admitted with second-degree (partial-thickness) burns. What is most characteristic of this type of burn?
Blisters appear. In first-degree (superficial) burns, the injury is only to the epidermis. The burns are very painful, red, and dry. In second-degree (partial-thickness) 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 third-degree (full-thickness ) 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.
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." Explanation: 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 with burns. The child is scheduled to be discharged the following day, and the nurse is going over discharge instructions with the parents. After teaching the parents about caring for the burn, the nurse determines that the teaching was successful when the parents make which statement about removing an old dressing?
"We need to soak the old dressing in tepid water just before we take it off." Explanation: The nurse should instruct the parents to soak the dressing in tepid water before removing it to loosen the dressing and to decrease the child's discomfort. Removing the old dressing too quickly could cause stripping of new skin and tissue that is attached to the dressing. Dressing changes are done as quickly as possible once the old dressing has been removed because exposure to air and water causes pain.
A parent calls the pediatric clinic and tells the nurse that the child has developed a large rash. Which question is most important for the nurse to ask the parent?
"What more can you tell me about the rash?" Explanation: It is most important for the nurse to find out more about the child's rash (the color, the location, is there any itching). This will help the nurse determine if this is a contact dermatitis or a bacterial or viral infection. Asking how long the child has had the rash, whether the child has had a change in behavior, and whether the child is current with immunizations are also appropriate. However, gathering more information about the rash itself is most important.
