of the oral mucous membranes May also present in diaper area
Download
Report
Transcript of the oral mucous membranes May also present in diaper area
Integumentary
Stressors
Increased Risks Caused by
Pediatric Differences in the Skin
Skin is thinner, more susceptible to
irritants and infection
Ratio of skin surface area to body volume
is greater, allowing greater absorption
More susceptible to bacterial invasion
Less ability to regulate temperature
Common Pediatric Skin
Diseases/Disorders
Impetigo
Cellulitis
Candidiasis
Pediculosis
Scabies
Dermatitis
Tinea
Impetigo
Most common bacterial skin
infection of childhood
Highly contagious skin
infection
Caused by Staph aureus
Incubation 7-10 days
Lesions resolve in 12-14 days
with treatment
Clinical Manifestations
Lesions appear around mouth and nose
Small vesicles initially filled with serous fluid
then become pustular
Vesicles (bullae) rupture rapidly
Honey-colored fluid from lesions becomes
crusted mildly pruritic
Nursing Care for a Child
with Impetigo
The child can spread impetigo merely by
touching another part of the skin after
scratching infected areas
Wash the child’s hands frequently with
antibacterial soap
Maintain good hand washing
Distract child from touching lesions
Nursing Management
of Lesions
Gently wash lesions 3 times a day
with warm, soapy washcloth, crusts
carefully removed
Apply topical antibiotic(Bactroban or
Bacitracin)
Oral antibiotics effective against
staphylococcal and streptococcal
organisms
Severe infections treated with IV
antibiotics
Parental Education
Good hand washing to prevent
spread
Cut child’s nails short, wash
hands often with anti-bacterial
soap
Do not share towels, utensils with
infected child
May return to school or daycare
24 hours after antibiotics started
Finish full course of antibiotics
Candidiasis
(thrush)
Superficial fungal infection
(Candida albicans) of the oral
mucous membranes
May also present in diaper
area
Etiology
Neonate
can be acquired during delivery if
mother has infection
Older infant
Immunosupression
during antibiotic therapy,
exposure to mother’s infected
breasts
unclean bottles and pacifiers
Oral Thrush
White, curd-like plaques on tongue,
gums, buccal mucosa (not easily
removed)
Diaper Dermatitis
Diaper area lesions are bright red
Sharp Border
Satellite lesions
Management
Nystatin oral suspension
applied to mucous membranes
Diaper area treated with topical
Nystatin cream
Parental Education
Good hand washing
Thoroughly wash pacifier, bottles
Apply oral Nystatin after feeding to
promote increased absorption
Breasts should be treated with
Nystatin cream if breast feeding
Watch for spread to GI tract: fever,
refusal to eat
Pediculosis Capitis
Head lice
Lice can live on a human host for
48 hours
Nits (eggs) capable of hatching for
10 days
Transmitted by direct contact with
infected persons or indirect
contact with contaminated objects
Clinical Manifestations
Nits are visible on hair shafts close to
scalp usually behind ears and at nape
of neck, difficult to remove
Intense pruritis
Management involves three
goals
1. Kill the active lice
Kwell, Nix, Rid
Kwell is neurotoxic
Use over the counter pyrethrins (RID)
safe and effective
Must treat hair again 1 to 2 weeks after
initial treatment
Over the counter pediculicide (NIX)
kills head lice and eggs with 1
treatment, has residual activity for 10
days
Management involves three
goals
2. Remove nits
Inspect child’s hair with fine-toothed comb
Comb nits out when hair is wet (apply ½ vinegar
½ water mixture prior to combing)
3. Prevent spread or recurrence
Treat environmental objects
Examine and treat family members
Vacuum carpets
Check child for reinfestation 7 to 10 days after
treatment
Wash all bedding, hats in hot water and high dryer
setting
Notify school if reoccurs
Atopic Dermatitis (eczema)
Chronic superficial inflammatory skin
disorder
Affects children usually by age 5 yrs
Children usually also have allergies
75% will develop asthma
Atopic Dermatitis (eczema)
Infant: erythematous areas of oozing and
crusting on cheeks, forehead, scalp, flexor
surfaces of arms and legs
Papulovesicular rash and scaly red plaques
become excoriated
Atopic Dermatitis (eczema)
Childhood: skin appears scaly with dry skin
Can be exacerbated by sweating, contact
with irritating fabrics, emotional upset
Management
Control pruritis
Bathe with lukewarm water, mild, non
perfumed soap
Applying moisturizer while skin is wet
Anti-inflammatory corticosteroids
creams for inflamed areas
Topical immunosuppresants may be
used for longer periods of time than
topical steroids
Identification and avoidance of
allergenic foods
Parental Education
Skin hydration
Support of uncomfortable, irritable
child
Mild detergents and soap
Don’t bundle child
Avoid sun exposure
Humidifier during winter months
Avoid drying agents to skin
Fingernails clean and short
Common Types of Tinea
Infection
Tinea capitis (scalp)
Tinea cruris (groin, buttocks, and scrotum)
Tinea corporis (trunk, face, extremities)
Tinea pedis (feet)
Tinea Capitis
Erythema papular rash of scalp
Patches of alopecia
Treated with topical and oral antifungals
Tinea Corporis
Single circular 1” scaly plaques
Erythema to pale pink/white
Topical antifungals, continue to treat one week
after rash gone
Tinea Cruis
Warm moist environment promotes fungal
growth
Common in adolescent male
Topical antifungal
Loose clothing
Tinea Pedis
Sweaty feet promotes growth
Barefoot in common wet areas
(pools,lockeroom)
Topical antifungal
Fresh socks, toss old shoes
Nursing Considerations: All
Tinea Infections
All members of the family and household
pets should be assessed for fungal
lesions.
Person-to-person transmission is cause
Treat all asymptomatic family members for
recurrence
Good hygiene helps in prevention
(don’t share towels, clothing, hats, etc)
Cellulitis
Bacterial infection of skin
Acute inflammation of dermis and connective
tissue
Infected area will be edematous, erythematous,
very tender, warm-hot
May have discharge
Enlarged lymph nodes
Treatment
Usually associated with elevated WBC
Culture will assist in identification of
organism
Requires aggressive antibiotics
May progress into abscess or bacteremia
Nursing Care
Warm compresses to the affected area
four times daily
Elevation of the affected limb if possible
Bed rest
Administer PO or IV antibiotics
Monitor WBC, fever, spread of infection in
tissue
Scabies
Mite infection-burrow under skin
Spread by skin to skin contact
Female mite burrows under skin and lays
egg
hatch in 3-5 days and cause severe
intense itching
Secondary infections (impetigo, cellulitis)
common
Clinical Manifestations
Intense, severe pruritis esp. at night
Papular-vesicluar rash mainly in wrists, fingers,
elbows, axilla and groin
May see a faint burrow pattern
Management
Elimite- prescription
Application applies neck to toe and must
remain on for 8-12 hours
Family members even if asymptomatic
and day time contacts should be treated
Wash all bedding, clothing in hot water
similar to that for pediculosis
Practice Questions!
The MD has recommended frequent baths for
hydration for a child with eczema. Following
each bath, the nurse should:
a. Apply a light coating of emollient to the child’s
skin while still wet
b. Dry the skin thoroughly and apply baby
powder
c. Dry the skin thoroughly and leave it exposed
to air
d. Apply a dilute solution of 1 part hydrogen
peroxide mixed with 9 parts normal saline
Which procedure, performed by parents of an
infant with eczema would lead the nurse to
realize that additional health teaching is
necessary?
a.
b.
c.
d.
Frequent colloid baths
Topical steroid to affected areas
Avoidance of wool clothing
Application of alcohol to crusted area
A preschooler has head lice and must have
her head shampooed with a pediculicide that
must remain on the scalp and hair for several
minutes. How could the nurse best gain this
child’s cooperation during the necessary
treatment?
a. Offer the child a reward for good behavior
b. Inform the child that her parents will be notified
if she fails to cooperate
c. Allow the child to apply the shampoos
d. Make a game of the treatment “Beauty Parlor”
The nurse is providing home care instructions
for a family with a toddler diagnosed with lice,
the nurse includes which of the following
instructions in the teaching plan? (select all
that apply)
a. Immerse combs and brushes in boiling water for 30b.
c.
d.
e.
minutes
Vacuum floor and furniture
Have mother use a bright light and magnifying glass to
examine the child’s head after lice shampoo
Launder the child’s bedding and clothing in hot water
with detergent and dry in a hot dryer for 20 minutes
Shave the child’s head and throw out the hair
a.
b.
c.
d.
Permethrin 5% (Elimite) is prescribed for a 10year-old child diagnosed with scabies. What
instructions should the nurse provide for the
mother?
Apply the lotion liberally from neck to toe
Wrap the child in a clean sheet after treatment
Leave the lotion on for 10 minutes then rinse
Apply the lotion only to the child’s scalp
The nurse is caring for a child with cellulitis
of the foot. The nurse anticipates the
physician ordering:
1. Cold packs BID
2. Application of topical antibiotics
3. WBC and culture of infected site
4. Ace wrap foot and ankle
A adolescent female has been diagnosed
with recurrent tinea capitis. The nurse
should discuss the impotence of not
sharing her friends:
1. Hats
2. Bathing suits
3. Shirts
4. Socks