Chapter 45: Nursing Care of the Child With an Alteration in Tissue Integrity/Integumentary Disorder

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 child has been diagnosed with atopic dermatitis. The nurse is teaching the parents about measures to control this condition. What does the nurse teach the parents? Select all that apply.

"Keep your child's nails trimmed short." "Do not use hot water to cleanse the skin." "Pat dry the skin after a bath. Do not rub." "Apply prescribed moisturizer several times per day." Atopic dermatitis is a chronic disorder with a relapsing and remitting nature. The skin reaction occurs in response to specific allergens, usually foods or environmental triggers. When a trigger occurs, antigen-presenting cells stimulate interleukins to begin the inflammatory process. The skin begins to feel pruritic and then the child starts to scratch. Itchiness occurs first and then the rash appears. The nurse should teach the parents three main topics about care. The first is that the skin needs to stay hydrated. This includes not bathing in hot water, not using products with perfumes or dyes, the use of mild cleansing agents, and to pat dry, do not rub. The skin should remain moist after a bath and moisturizer should be applied to the moist skin. The second is to maintain skin integrity. This includes keeping the nails trimmed short, avoiding tight clothing, avoiding heat, and using 100% cotton clothing. The third is to prevent infection. This includes ways to decrease the scratching. Prescribed antihistamines may be given at bedtime to reduce nighttime scratching and the use of behavioral modification techniques is recommended. Steroidal lotions or ointments can help reduce inflammation, but they would only be needed during a flare-up.

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." Erythema toxicum neonatorum (ETN), or neonatal erythema, is one of the more well-known benign, self-limiting skin eruptions in the newborn period. Incidence estimates range from 50% to 70% of all healthy newborns. The rash usually remits within 1 week with no treatment. It is never appropriate to tell a mother not to be so worried.

An infant has presented at the clinic with impetigo. Which organism usually causes impetigo in infants?

Staphylococcus aureus Staphylococcus aureus is the most common cause of impetigo in infants. MRSA is a hospital-associated infection (HAI), group A beta hemolytic strep is seen in older children, and Escherichia coli is not frequently associated with impetigo.

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 child has been hospitalized with a diagnosis of severe impetigo. The nurse is interviewing the family. Which question will have the greatest impact on the child's care?

"Does your child have any allergies to medications?" Since the child is hospitalized with a severe case of impetigo, the child will likely need intravenous antibiotics, so asking about medication allergies is the question that will have the greatest impact on care. Asking how long the child has had the infection, if the parent has concerns about filling prescriptions, or if there is anything the health care team should know about the family are all appropriate questions that should be asked during an admission interview. However, due to the severity of the infection, asking about medication allergies will impact care the most.

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 [hay fever]). About 30% to 35% of children who have atopic dermatitis will also develop allergic rhinitis (hay fever) and/or asthma. Therefore, the child will be monitored for the development of asthma.

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 include running cool water, not ice, over the burn and covering it with a nonadherent bandage after cleaning with a fragrance-free mild soap. Other care includes not applying butter, ointments or creams; and administering acetaminophen or ibuprofen for pain.

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.

An adolescent with atopic dermatitis reports interest in using herbal preparations to help manage the condition. What response(s) is appropriate? Select all that apply.

"Some people find the use of chamomile beneficial in managing this condition." "Evening primrose oil can be used for dermatitis." Management of the adolescent with atopic dermatitis focuses on promoting skin hydration, maintaining skin integrity, and preventing infection. Taking evening primrose oil and other essential fatty acids as an oral supplement may result in a reduction in redness and scaling. Chamomile preparations for topical use may also be effective and are generally considered safe.

The clinic nurse is assessing a 12-year-old client. The client reports having dandruff and asks the nurse what can be done for it. Which response by the nurse is best?

"Wash your hair with a gentle shampoo daily." In the older child and adolescent, a gentle shampoo should be used daily to control scaling caused by dandruff. A medicated shampoo may be indicated if shampooing with a gentle formula shampoo does not provide relief. Washing hair vigorously twice a day is not recommended. Warm baby oil is recommended for infants with cradle cap (seborrhea).

The nurse is providing teaching on ways to maintain skin integrity and prevent infection for the parents of a boy with atopic dermatitis. Which response indicates a need for further teaching?

"We should avoid using petroleum jelly." It is important to apply moisture multiple times throughout the day. Petroleum jelly is a recommended moisturizer that is inexpensive and readily available. The other statements are correct.

A health care provider has prescribed cephalexin 30 mg/kg PO daily in 4 divided doses for a child diagnosed with impetigo. The child weighs 30 lb (14 kg). How many milligrams should the child receive each day?

420 The nurse will use the client's weight in kilograms and multiply it by the prescribed dosage. 14 kg × 30 mg/kg = 420 mg

A nurse is caring for a child with a wasp sting. Which nursing intervention is a priority?

Administer diphenhydramine per protocol. The nurse should administer diphenhydramine as soon as possible after the sting in an attempt to minimize a reaction. The other actions are important for an insect sting, but the priority intervention is to administer diphenhydramine.

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. 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 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. The instruction that is most important for the nurse to convey is to complete the prescribed course of antibiotics. Many times, once the child feels better, the parent stops the medication; this action, though, can cause a rebound infection. Instructing the family to keep follow-up appointments, perform good hand hygiene, and look out for signs of worsening condition are all appropriate, but the most important instruction is to make sure the child completes the course of antibiotics.

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 child with an order for silver sulfadiazine 1% for a burn. What would make the nurse question this order?

The burn is on the child's face. Silver sulfadiazine 1% is used for burns. It should not be applied to the face or an infant under 2 months of age. It should not be used in children with a sulfa allergy.

The nurse is caring for a child on the burn unit weighing 100 lb (45.5 kg) who has second-degree (partial-thickness) 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 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 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.

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.

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 Adverse effects associated with topical retinoid therapy include burning, dryness, and photosensitivity. Flu-like symptoms and headache are associated with topical immune modulators.

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 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 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 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 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 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 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, especially on the upper back and chest and proximal arms, are indicative of tinea versicolor.

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.

Which assessment finding by the nurse would warrant immediate action?

A child with periorbital cellulitis reports changes in vision and pain with eye movement. In a child with periorbital cellulitis, the nurse musty notify the health care provider immediately if signs of progression to orbital cellulitis occur, such as conjunctival redness, change in vision, pain with eye movement, eye muscle weakness or paralysis, or proptosis. This assessment finding warrants immediate action. In nonbullous impetigo, a honey-colored exudate when the vesicles or pustules rupture may be noted on the skin. This assessment finding would be expected. A localized cellulitis will present with erythema, pain, edema, and warmth at the site of the skin disruption (such as a cut or spider bite). This assessment finding warrants further follow-up but not immediate attention. Fever may occur with bullous impetigo or cellulitis and is common with scalded skin syndrome; therefore, this assessment finding also warrants further, but not immediate, follow-up.

The nursing diagnosis of risk for infection related to a disruption in the protective skin barrier is noted on a child's plan of care. Which action would be of greatest importance?

using appropriate hand hygiene Hand hygiene would be the priority because the child's risk for infection is increased and hand hygiene is crucial to preventing the transmission of infectious organisms. Monitoring the child's temperature is important to evaluate for possible fever and infection, but this would not be the most important action. Although nutritional status can influence wound healing, urging adequate nutritional intake would not be the most important action. Although obtaining a culture provides information about the cause of an infection, the child is at risk for infection, so a culture would not provide any information about the risk.

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." 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 nurse is evaluating the parents' understanding of atopic dermatitis. Which statement shows their understanding?

"Flare-ups of lesions are not uncommon following therapy." 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.

A topical corticosteroid is prescribed for a child with contact dermatitis. Which statement by the mother would indicate the teaching was successful?

"I should not cover the area with plastic wrap after applying the cream." An occlusive dressing such as plastic wrap over the area should not be used with topical corticosteroids. High-potency preparations should not be used. There is no need to shake topical corticosteroids. Benzoyl peroxide requires shaking before use. Applying the medication at night and rinsing off in the morning is used for coal tar preparations.

The nurse is caring for a child with a prescription for PO prednisone. Which statement by the child's mother would indicate a need for further education?

"I will give it to ny child at least 1 hour before all meals." Systemic corticosteroids such as prednisone should be administered with food to decrease gastrointestinal 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.

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. 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 is contraindicated with burn clients. Although diversional activities can help somewhat, they will not relieve the child's itching.

The nurse is caring for a pediatric client in the emergency department with moderate frostbite of an extremity. Which nursing intervention is appropriate for this client?

Immerse the affected part in 104°F (40°C) water for 15 to 30 minutes. The appropriate intervention is to immerse the affected part in 104°F (40°C) water for 15 to 30 minutes. Using dry heat such as heating pads to treat frostbite or rubbing a frostbitten area may cause further damage to the tissues and should be avoided. Increasing the room temperature to 100°F (37.8°C) does not specifically address the problem of rewarming the affected extremity that has frostbite.

The nurse is caring for a child with suspected child abuse (child mistreatment)-induced burns. Which assessment findings would support this?

a burn to the entire right hand up to 2 cm above wrist with consistent edges 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 of child abuse (child mistreatment)-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 (child mistreatment)-induced burns.

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 caring for a client who suffered burn injuries to the arms. The arms have blisters, moist red skin, blanching, and intact sensation. What type(s) of treatment is expected for this type of burn injury? Select all that apply.

use of moisturizers application of cool, damp cloths The description of the burn matches a superficial partial-thickness (second-degree) burn. Treatment for a superficial partial-thickness burn includes application of cool damp cloths, moisturizers, and ibuprofen. Treatment lasts 15 to 21 days. Skin grafting, intravenous morphine, and surgical debridement are indicated for full-thickness (third-degree) burns.

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?" Small round red circles with scaling, symmetrically located on the girl's 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 nurse is caring for an infant who has impetigo and is hospitalized. Which nursing action is priority?

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.

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." 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 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." Prevention and management of diaper dermatitis include avoiding rubber pants, avoiding diaper wipes with fragrance or preservatives. Treatment of a rash includes allowing the child to go diaperless for a period of time each day and using a warm blow dryer on the area for 3 to 5 minutes.

The nurse is caring for a 2-month-old infant. The parent asks if it is okay to use a sunscreen lotion made for children. Which response by the nurse would be most accurate?

"Sunscreen is not recommended until 6 months of age. Use light clothing and a hat to completely cover the child when in the sun." The American Academy of Pediatrics recommends that children younger than 6 months of age should not be exposed to direct sunlight because their sensitive skin and decreased sweating rate places them more at risk for heat stroke. If avoiding direct sunlight is not possible, dress infants in lightweight long pants, long-sleeved shirts, and brimmed hats. Telling the mother not to take the infant into sunny locations is inappropriate.

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? q

"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 instructor is reviewing the integumentary system during a presentation to a group of student nurses. Which statement made by the instructor 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 4-month-old infant is experiencing dermatitis in the diaper area. What treatments will be beneficial to this condition? Select all that apply.

Allow the diaper area to air dry. Apply petroleum jelly to the diaper area. Apply ointment with vitamin A to the diaper area Use ointments containing zinc on the diaper area. Diaper dermatitis starts as a flat red rash in the convex skin creases. It may appear red and shiny and may or may not also have papules. Keeping the diaper area clean and dry are key to healing. Air drying may promote healing. Topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum are helpful to provide a barrier to the skin. Talc powder is not recommended.

A nurse is reviewing a plan of care for a 5-year-old child hospitalized with severe burns. Due to systemic changes that occur secondary to the burn injuries, what intervention(s) related to nutrition should the nurse expect to implement? Select all that apply.

Insert a nasogastric tube. Administer a proton pump inhibitor. Offer the child's favorite foods. Initiate total parenteral nutrition Systemic changes related to nutrition that can occur with severe burn injuries include a paralytic ileus and anorexia. The nurse should expect to insert a nasogastric tube in the presence of an ileus. Administration of a proton pump inhibitor would prevent the occurrence of a stress ulcer (also known as a curling ulcer). If the child is able to take food by mouth, to promote adequate nutrition, it is important to offer the child's favorite foods. If all else fails, total parenteral nutrition would be started to ensure the child received adequate nutrition. A high-protein diet promotes healing, not a low-protein one.

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 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.

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.

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 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 with allergies to food. Common culprits may include peanuts, eggs, orange juice, and wheat-containing products.