Integumentary Stressors

1
Integumentary Stressors
2
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

3
Common Pediatric Skin Diseases/Disorders

• Impetigo
• Cellulitis
• Candidiasis
• Pediculosis
• Scabies
• Dermatitis
• Tinea

4
Impetigo

• Most common bacterial skin infection of childhood
  
• Highly contagious
• S. aureus
• Incubation 7-10 days
• Lesions resolve in 12-14 days with treatment

5
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

6
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 childs hands frequently with
  antibacterial soap
• Maintain good hand washing
• Distract child from touching lesions

7
Nursing Managementof 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

8
Parental Education

• Good hand washing to prevent spread
• Cut childs nails short, wash hands often with
  anti-bacterial soap
• Do not share towels, utensils with infected child
• Out of school or daycare for 24h once antibiotics
  started
• Finish full course of antibiotics

9
Candidiasis(thrush)

• Superficial fungal infection (Candida albicans)
  of the oral mucous membranes
• May also present in diaper area

10
Etiology

• Neonate
• can be acquired during delivery if mother has
  infection
• Older infant
• Immunosupression
• during antibiotic therapy,
• exposure to mothers infected breasts
• unclean bottles and pacifiers

11
Oral Thrush

• White, curd-like plaques on tongue, gums, buccal
  mucosa (not easily removed)

12
Diaper Dermatitis

• Diaper area lesions are bright red
• Sharp Border
• Satellite lesions

13
Management

• Nystatin oral suspension applied to mucous
  membranes
• Diaper area treated with topical Nystatin cream

14
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

15
Pediculosis CapitisHead 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

16
Clinical Manifestations

• Nits are visible on hair shafts close to scalp
  usually behind ears and at nape of neck,
  difficult to remove
• Intense pruritis

17
Management involves three goals

• 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

18
Management involves three goals

• Remove nits
• Inspect childs hair with fine-toothed comb
• Comb nits out when hair is wet (apply ½ vinegar ½
  water mixture prior to combing)
• 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

19
Atopic Dermatitis (eczema)

• Chronic superficial inflammatory skin disorder
• Affects children usually by age 5 yrs
• Children usually also have allergies
• 75 will develop asthma

20
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

21
Atopic Dermatitis (eczema)

• Childhood skin appears scaly with dry skin
• Can be exacerbated by sweating, contact with
  irritating fabrics, emotional upset

22
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

23
Parental Education

• Skin hydration
• Support of uncomfortable, irritable child
• Mild detergents and soap
• Dont bundle child
• Avoid sun exposure
• Humidifier during winter months
• Turn undergarments inside out
• Fingernails clean and short

24
Common Types of Tinea Infection

• Tinea capitis (scalp)
• Tinea cruris (groin, buttocks, and scrotum)
• Tinea corporis (trunk, face, extremities)
• Tinea pedis (feet)

25
Tinea Capitis

• Erythema papular rash of scalp
• Patches of alopecia
• Treated with topical and oral antifungals

26
Tinea Corporis

• Single circular 1 scaly plaques
• Erythema to pale pink/white
• Topical antifungals, continue to treat one week
  after rash gone

27
Tinea Cruis

• Warm moist environment promotes fungal growth
• Common in adolescent male
• Topical antifungal
• Loose clothing

28
Tinea Pedis

• Sweaty feet promotes growth
• Barefoot in common wet areas (pools,lockeroom)
• Topical antifungal
• Fresh socks, toss old shoes

29
Cellulitis

• Bacterial infection of skin
• Infected area will be edetamous, erythematous,
  very tender, warm-hot
• May have discharge
• Usually associated with elevated WBC
• Can progress into bacterima
• Aggressive antibiotics

30
Scabies

• Mite infection-burrow under skin
• Female mite burrows under skin and lays egg
• hatch in 3-5 days and cause severe intense
  itching
• Secondary infections (impetigo, cellulitis)
  common

31
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

32
Management

• Elimite
• Kwell can be used over 2 years of age but not
  preferred
• Family members even if asymptomatic and day time
  contacts should be treated
• Wash all bedding, clothing in hot water similar
  to that for pediculosis

33

• Case Study

34

• You are a school nurse. A 7-year-old boy has what
  looks like impetigo on his right forearm. You
  call the mother at work at 1000 am and ask her
  to come immediately to pick up her son and seek
  medical attention.

35

• What did you see that made you suspect impetigo?

36

• Why should the child not be sent home on the bus
  with a note for the mother?

37

• How will the mother be expected to care for her
  son at home?

38

• What are the primary goals in treating impetigo?

39

• When do you expect the child to return to school?

40

• The MD has recommended frequent baths for
  hydration for a child with eczema. Following each
  bath, the nurse should
• Apply a light coating of emollient to the childs
  skin while still wet
• Dry the skin thoroughly and apply baby powder
• Dry the skin thoroughly and leave it exposed to
  air
• Apply a dilute solution of 1 part hydrogen
  peroxide mixed with 9 parts normal saline

41

• Which procedure, performed by patients of an
  infant with eczema would lead the nurse to
  realize that additional health teaching is
  necessary?
• Frequent colloid baths
• Topical steroid to affected areas
• Avoidance of wool clothing
• Application of alcohol to crusted area

42

• 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 childs
  cooperation during the necessary treatment?
• Offer the child a reward for good behavior
• Inform the child that her parents will be
  notified if she fails to cooperate
• Allow the child to apply the shampoos
• Make a game of the treatment Beauty Parlor

43

• 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)
• Immerse combs and brushes in boiling water for
  30-minutes
• Vacuum floor and furniture
• Have mother use a bright light and magnifying
  glass to examine the childs head
• Launder the childs bedding and clothing in hot
  water with detergent and dry in a hot dryer for
  20 minutes
• Teach children to not share combs, brushes and
  hats

44

• Permethrin 5 (Elimite) is prescribed for a
  10-year-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 childs scalp