PEDIATRIC INTEGUMENTARY

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 assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which 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 Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). Scabies appears as burrows or 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 herpesvirus infection.

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 months 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. The child is 18 months old 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 children at risk for central nervous system toxicity and seizures. Lindane also is used with caution in children between the ages of 2 and 10 years. Siblings and other household members should be treated simultaneously

The nurse caring for a child who sustained a burn injury plans care based on which pediatric considerations 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 is 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. 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. 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. 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 increased 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 increased risk for protein and calorie deficiencies because they have smaller muscle mass and less body fat than adults.

The school nurse has provided an instructional session about impetigo to parents of the children attending the 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 an insect bite."

C. Lesions most often are located on the arms and chest." Lesions usually are located around the mouth and nose, but may be present on the hands and extremities.

When planning care for a male client with burns on the upper torso, which nursing diagnosis should take the highest priority? A. Ineffective airway clearance related to edema of the respiratory passages B. Impaired physical mobility related to the disease process C. Disturbed sleep pattern related to facility environment D. Risk for infection related to breaks in the skin

Correct Answer: A. Ineffective airway clearance related to edema of the respiratory passages When caring for a client with upper torso burns, the nurse's primary goal is to maintain respiratory integrity. Therefore, option A should take the highest priority. Immediately assess the patient's airway, breathing, and circulation. Be especially alert for signs of smoke inhalation, and pulmonary damage: singed nasal hairs, mucosal burns, voice changes, coughing, wheezing, soot in the mouth or nose, and darkened sputum. Option B: This nursing diagnosis isn't appropriate because burns aren't a disease. Option C: Disturbed sleep pattern may be appropriate, but don't command a higher priority than the ineffective airway clearance because they don't reflect immediately life-threatening problems. Option D: Examine wounds daily, note and document changes in appearance, odor, or quantity of drainage. Indicators of sepsis (often occurs with full-thickness burn) requiring prompt evaluation and intervention. Note: Changes in sensorium, bowel habits, and the respiratory rate usually precede fever and alteration of laboratory studies.

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?1.Apply the cream over the entire body.2.Apply a thick layer of cream to affected areas only.3.Avoid cleansing the area before application of the cream.4.Apply a thin layer of cream and rub it into the area thoroughly.

D. Apply a thin layer of cream and rub it into the area thoroughly. Atopic dermatitis is a superficial inflammatory process involving primarily the epidermis. A topical corticosteroid may be prescribed and 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 areas. Systemic absorption is more likely to occur with extensive application.

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 ears 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.White sacs attached to the hair shafts in the occipital area 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 infectious process, not pediculosis. White flaky particles are indicative of dandruff.

A child has impetigo and is being treated with oral antibiotics. The father asks when the child can be allowed to return to school. Your answer is: A. After 72 hours from the start of the treatment B. After 24 hours from the start of the treatment C. After 48 hours from the start of the treatment D. After 1 week from the start of the treatment

The answer is B. Impetigo is highly contagious. Therefore, if the child is taking oral antibiotics for the treatment of this condition they are no longer contagious after 24 hours from the start of treatment. If the child was using topical antibiotic ointment for the treatment of this condition, they would no longer be contagious after 48 hours from the start of treatment. Therefore, the child can return to school after being on oral antibiotics for 24 hours.

You're providing education to a group of parents about impetigo. Which statement is CORRECT about this disease? a. "it tends to affect the preadolescent and adolescent population." B. "Cases of impetigo most likely to occur during the summer when the weather is warm." C. "Most cases of impetigo are not contagious." D. "Impetigo is caused by a mite parasite."

The answer is B. This is the only correct statement about impetigo. All the other statements are FALSE.

A 2 year old with impetigo is ordered topical antibiotic ointment. You're teaching the child's mother how to apply the ointment. Which action by the mother during application of the ointment requires you to re-educate the parent? A. The mother washes her hands before and after the application of the ointment. B. The mother applies a layer of ointment directly over the crust of the lesion. C. The mother uses warm water and antibacterial soap to cleanse the lesions prior to application of ointment. D. The mother uses a cotton swab to apply the ointment.

The answer is B. It is very important to REMOVE any crust from the lesion BEFORE applying antibiotic ointment to the lesion. This allows the ointment to come into contact with the skin, which is where the bacteria reside. To remove the crust, use warm water and antibacterial soap. All the other options are correct.

A 4 year old is admitted to your unit with a severe case of impetigo. It is important the nurse follows _______________ while providing care to this patient: A. Droplet precautions B. Standard precautions only C. Contact precautions D. Airborne precaution

The answer is C. The nurse will follow contact precautions, which includes following standard precautions as well. Impetigo is a HIGHLY contagious skin infection. Therefore, the nurse should always where a gown and gloves when providing care to the patient to prevent transmission of the infection.

A parent brings her child into the clinic due to skin lesions that fail to heal. The lesions are red, reported to be itchy, and exhibit exudate. You suspect the child may have impetigo. What is a hallmark finding with this condition? A. Round patches with light pink centers B. Short grey lines on the skin C. Silver colored scales over the lesions D. Yellow crusts over the lesions

The answer is D. Yellow crusted over lesions are a hallmark of impetigo. Option A is a hallmark found with ringworm (tinea corporis), Option C is psoriasis, and Option B is scabies.

Impetigo tends to be most commonly found on: A. Mouth B. Ears C. Nose D. Torso E. Toes

The answers are A and C. Impetigo most commonly tends to be found on the face like the mouth and nose. It can be found on the hands, arms, and legs.

A child with impetigo has a 24 month old sister at home. What will you be sure to include in your teaching to the parents about this condition? A. Keep the child's nails short B. Separate towels and other linens used by the child C. Wash hands with antibacterial soap regularly D. Prevent the child from scratching the lesions E. Vacuum carpets and furniture regularly F. Store stuffed animals and toys in plastic bags for 5 days

The answers are A, B, C and D. Impetigo is contagious and can be spread to other family members. Therefore, the child with the lesions should have their nails cut short to prevent scratching and spreading the infection. In addition, the child's towels, linens, toys etc. should be separated from other family members until the lesions are healed and wash hands regularly with antibacterial soap. Option E represents steps on how to prevent the spreading of lice, and option F represents the steps on how to prevent the spread of scabies.

Select all the most common infectious agents that cause impetigo: A. Sacroptes scabiei B. Staphylococcus aureus C. Klebsiella pneumoniae D. Haemophilus influenzae E. Streptococcus pyogenes F. Listeria monocytogenes

The answers are: B and E. These are the two types of bacteria that tend to cause impetigo....staphylococcus aureus and streptococcus pyogenes.