INTEGUMENTARY

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

IMPETIGIO

IMPETIGO

•Most common bacterial skin infection of childhood

•Highly contagious

•Caused by Staph aureus or Strep

CLINICAL MANIFESTATIONS

• Lesions appear around mouth and nose

• Small vesicles filled with Honey-colored fluid serous fluid

• Vesicles rupture rapidly become crusted and mildly pruritic

• Lesions resolve in 12-14 days with antibiotic treatment

NURSING MANAGEMENTOF LESIONS

• Gently wash lesions 3 times a day with warm, soapy washcloth, crusts carefully removed

• Apply topical antibiotic as ordered

• Administer oral antibiotics as ordered

• Severe infections may need to be treated with IV antibiotics

NURSING CARE FOR A CHILD WITH IMPETIGO

• Child can spread impetigo by touching another part of the skin after scratching infected areas

•Wash the child’s hands frequently with antibacterial soap

• Distract child from touching lesions

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 (usually 10 days)

CANDIDIASIS

CANDIDIASIS

•Superficial fungal infection of the oral mucous membranes (thursh)

•May also present in diaper area (diaper dermatitis)

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 with gloved finger after feeding

•Diaper area treated by applying topical Nystatin cream with every diaper change

PARENTAL EDUCATION

•Good hand washing

• Thoroughly wash pacifier, bottles

•Breasts should be treated with Nystatin cream if breast feeding

•Watch for spread to GI tract: fever, refusal to eat

PEDICULOSIS CAPITIS

PEDICULOSIS CAPITIS(HEAD LICE)

• Lice infection transmitted by direct contact with infected persons or indirect contact with contaminated objects• • Lice can live on a human host consuming

scalp blood and lay eggs

• Lice can live off of human for 48 hours without blood

• Nits (eggs) capable of hatching for 10 days

CLINICAL MANIFESTATIONS

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

• Once hatch crawling causes intense pruritis• (itchy scalp)

MANAGEMENT -THREE GOALS

1. Kill the active lice using pediculicide OTC products (Kwell, Nix, Rid)

• Kwell is neurotoxic for infants

• RID is safe and effective, must treat hair again 1 to 2 weeks after initial treatment

• NIX kills head lice and eggs with 1 treatment, may have residual activity for 10 days

MANAGEMENT - 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)

MANAGEMENT-THREE GOALS

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

ATOPIC DERMATITIS (ECZEMA)

• Chronic superficial inflammatory skin disorder

• Affects infants and young children

• Children usually also have allergies

• 75% of children with atopic dermatitis and allergies will develop asthma

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

CHILD

• Skin appears scaly with dry skin

• Can be irritated and itchy by sweating, contact with irritating fabrics, emotional upset

MANAGEMENT- CONTROL PRURITUS

• Bathe with lukewarm water, mild, non-perfumed soap

• Applying moisturizer while skin is wet to hydrate skin, Avoid drying agents to skin

• Anti-inflammatory corticosteroids creams for inflamed areas

• Topical immunosuppresants may be used for longer periods of time than topical steroids

• Identification and avoidance of triggers

• Fingernails clean and short

TINEA

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 CONSIDERATIONSALL 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

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• Usually associated

with elevated WBC

TREATMENT

• Culture will assist in identification of organism

• Requires aggressive antibiotics

• May progress into abscess or bacteremia-watch for increasing WBC, may need blood cultures

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

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. Frequent colloid bathsb. Topical steroid to affected areasc. Avoidance of wool clothingd. 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 behaviorb. Inform the child that her parents will be

notified if she fails to cooperatec. Allow the child to apply the shampoosd. 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 30-minutes

b. Vacuum floor and furniturec. Have mother use a bright light and magnifying

glass to examine the child’s head after lice shampoo

d. Launder the child’s bedding and clothing in hot water with detergent and dry in a hot dryer for 20 minutes

e. Shave the child’s head and throw out the hair

Permethrin 5% (Elimite) is prescribed for a 10-year-old child diagnosed with scabies. What instructions should the nurse provide for the mother?

a. Apply the lotion liberally from neck to toeb. Wrap the child in a clean sheet after

treatmentc. Leave the lotion on for 10 minutes then

rinsed. 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 BID2. Application of topical antibiotics3. WBC and culture of infected site4. 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. Hats2. Bathing suits3. Shirts4. Socks