Transcript WK 13 Part B Camp Nursing Teacher 08W for email

Camp Nurse
Part B
Where the
kids are kids
2008W Teacher
Dermatology
Fungal Infections
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Tinea capitis – scalp, scaly patches (see p 760)
Tinea corporis – body & nails (see p 760)
Tinea cruris – jock itch
Tinea pedis – athlete’s foot
Candidiasis – thrush, vaginitis, diaper rash
Treatment – antifungal –topical or shampoos or
oral i.e. ketonazole, clotrimazole, miconazole,
Amphotericin B, Nystatin, griseofulvin
Compresses, sitz baths, education re personal
hygiene
Tinea Corporis (Ringworm)
Scabies
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Scabies mite- sarcopes scabei
Female burrows under skin & lay eggs & feces
Intense pruritus-hands, wrists, feet, legs
Linear threadlikeburrows – scratch marks
Dx by scrapings –but may be negative
Tx – scabicide- treat all in close contact
Itching lasts 2-3 weeks
Teach handwashing,
Fresh laundering of clothes & bedding
• Scabies is spread by personal contact,
• e.g., by shaking hands or sleeping together or
by close contact with infected articles such as
clothing, bedding or towels.
• usually found where people are crowded
together or have frequent contact,
• most common among school children, families,
roommates, and sexual partners.
• Scabies can be spread by the insect itself or by
the egg. Prompt action is required to rid a
person of the insects and eggs
Pinworms -Enterobiasis
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Nematode in temperate climates
Crowded conditions
Eggs inhaled or ingested-hand to mouth
Eggs hatch in upper intestine, mature in 2-3 wks,
migrate to ceccal area, lay eggs at anus
• Intense itching
Dx tape test, falshlight
Tx –prevention: handwashing
-antihelminthic ie Pyrantel or mebendazole to
whole family,
-recurrence common,
-washing clothes & bedding
Head Lice
• Pediculosis capitis –parasite that requires
5 meals/day
• Life span 1 mon – lives 48 hrs off body
• Nits hatch in 7-10 days –on or off body
• Itching be crawling insects – visible
Treatment
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Pediculocides -Not recommended for under 2 yrs
Manual removal of nits with comb daily
Evidence of resistance to meds
Education for prevention
• X4 magnification of head lice
Poison Ivy
Leaves of three, let them be….
Plant Recognition: Leaves
Branch in early summer
Male flowers (left); female (right)
Poison sumac
Berries
Autumn foliage
Poison Oak
Leaves Poison Oak in Spring
Poison Oak in Summer
Poison Ivy, Sumac, Oak
• Delayed hypersensitivity
reaction
• Leaves, vines, or sap
• Direct contact
• Cleaning used
equipment i.e. rake
• Smoke from burning
bush can cause inhaled
hypersensivitity
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Treatment:
1. Flush area
immediately with
cold water
2. Launder clothing
3. Oral steroids
4. Antihistamines
**Medical emergency if
inhaled smoke
Regions for Poison Ivy, Oak & Sumac
Poison IVY
Poison SUMAC
Poison oak
Poison OAK
Headaches
• Common complaint
• Associated with different pathologies
– Extracranial disease
– Intracranial disease
– Vascular abnormalities
– Psychogenic disorders
– Combination of the above (see table 37-9)
Migraine Headache
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Autosomal dominant disorder
Cause unknown
Precipitating factors
Symptoms
Symptomatic pain relief
Pharmacologic options
Assessment
• Determine the pattern of h/a: single acute
episode, paroxysmal, acute & recurrent,
chronic & progressive
• Presence of seizures, ataxia, lethargy,
weakness, n&v, personality changes
• Factors r/t early dev’pmt: family hx,
tension h/a (most common in children)
• Questions for evaluating h/a Box 37-16 p. 1671
Treatment of h/a
• Parents / adults to recognize children can
have headaches
• Analgesics incl acetaminophen &
ibuprofen usually most effective
• Biofeedback & relaxation techniques
Epistaxis
• Nosebleed or hemorrhage
from the nose
• Pathophysiology & Etiology
– Local causes
– Systemic causes
– Most are anterior; posterior bleeds are more difficult
to control
• Management
– Sit up & lean forward (not lie down)
– Apply continuous pressure with thumb & forefinger >
10 min
– Cotton pledget/wadded tissue into ea nostril & apply
ice or cold cloth to bridge of nose
– Keep calm & quiet
pinch the entire soft part of
the nose closed for 15
minutes. The nosebleed
should stop.
If a nosebleed doesn't stop
with pinching, blow out all
the blood. Now spray
several times into the
bleeding nostril with a nasal
decongestant spray. Again
hold the entire soft part of
the nose shut for 15
minutes.
A cold-pack may slow
the bleeding, but
shouldn't interfere with
pinching the nose
After the nosebleed stops, rest for a
half hour. Leave your nose
completely alone. Resist the
temptation to wipe the clots out and
blow the nose. Once things settle
down, put a little lubricating gel or
ointment just inside the nostril.
ointment should be applied very gently,
only about 1 cm inside the nostril. Repeat
twice a day for a week.
Diabetes
Hypoglycemica vs hyperglycemia
• Hypoglycemia
– Behavioural changes,
confusion, slurred
speech, belligerence
– Diaphoresis
– Tremours
– Palpitations,
tachycardia
• Hyperglycemia
– Mental status
changes, fatigue,
weakness
– Dry, flushed skin
– Blurred vision
– Abdominal cramping,
nausea, vomiting,
fruity breath odour
Hypoglycemia
• Imbalances of food intake, insulin & activity
• Gastroenteritis, N&V, excitement, exercise
• S&S
Prolonged- seizures, coma & possible death
Emergency Treatment of Hypoglycemia
• Mild Reaction:
– simple carb must be followed up by protein
• Moderate Reaction:
– administer 15 g carbs, simple carbar = 125mL OJ; recheck BS
q5min, readminster OJ if pt still alert & able to swallow
– If pt altered LOC, administer glucagon if no IV access
• Severe Reaction
– Unresponsive: IV access with 1 amp Dextrose 50%
Contusion
• Most common sports injury
• Damage to soft tissue, subq & muscle
• Hemorrhage, edema & pain, ecchymosis
Crush injuries
under nailbed –release with cautery
Head Injury
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Assess ABC
Assess LOC & q 2h
Stabilize neck & spine
Clean abrasions
Keep NPO
No sedation
NVS q4h
Seek medical attention
Near Drowning
• Prognosis is best if the water is cool and
the victim is immersed for less than 5
minutes
• 90% occur in swimming pools
• Boys 5:1
• 50% occur under age 4 years
Pathology- Near Drowning
• Laryngospasm & aspiration
• Cardiopulmonary arrest after 4-6 minutes
• Hypoxia causes cellular damage—brain
after 4-6 minutes; heart and lungs after 30
minutes = Most organ systems affected
• Pulmonary edema, atelectasis, airway
spasm, pneumonitis
• All children should be hospitalized for 1248 hrs even in near-drowning
Management – Near Drowning
• ICU-Respiratory assessments, V/S,
mechanical ventilation and/or
tracheostomy, blood gases, chest therapy,
IV therapy
• Emotional support for family
• If no purposeful movement within 24 hours
= severe neurological damage or death
Nursing Care
• V/S, respiratory assessment, close
observation
• O2 administration. May need mechanical
ventilation
• Fluids need strict monitoring to avoid
pulmonary edema
Pediatric CPR
• Arrest most often r/t prolonged hypoxemia
• Causes – injuries, suffocation, foreign
body aspiration, smoke inhalation, SIDS,
infection, drowning
• Respiratory arrest better survival rate (87
%) than cardiac (25%)
• In hospital be familiar with emergency
equipment (see p 1335- 1341)
• Transport by EMS preferred if in
community
When to transfer a camper off site
– Class discussion