2Vesicles or pustule surrounded by edema and redness ImpetigoVesicles or pustule surrounded by edema and redness
3ImpetigoBegins as a reddish macular rash, commonly seen on face/extremitiesProgresses to papular and vesicular rash that oozes and forms a moist, honey colored crust.Pruritis of skinCommon in 2-5 year age groupDescribe the appearance of impetigo.
4Impetigo group a hemolytic strep infection of skin. Impetigo became infectedgroup a hemolytic strep infection of skin.Incubation period is 2-5 days after contactEasily spread merely by touching another part of skin after scratching infected area.What is the causative organism for impetigo?
5Therpeutic Management Apply warm, moist soaks to soften lesions, remove crustsApply Bactroban TID to cleaned lesionsCephalexin (keflex) for 10 daysTeach good handwashing and hygiene to prevent spread, keep fingernails shortWhat is the treatment?Topical-Systemic-What information must the nurse include when providing instructions for hygiene and contagion for this condition?
6Impetigo Be alert for signs of acute glomerulonephritis, If the impetigo was caused by beta-hemolytic streptococciWhat serious condition occurs as a secondary infection related to impetigo?
7Therapeutic Interventions Goal - prevent scarring and promote positive self-image.Individualize treatment to gender, age, and severity of infection.It takes 4-6 weeks to begin to see improvement, with optimal results in 3-5 months.What is the major nursing implication here?See caring for child with impetigo on page 1343.
8Fungal or yeast infection also known as Thrush Oral CandidiasisFungal or yeast infection also known as ThrushWhat is the causative organism of thrush?
9Oral Candidiasis - causes Passing through an infected birth canalChild who is on immunosuppressant'sExposure to mothers infected breastsUnclean bottles and pacifiersHow does the newborn/infant contract this condition?
10Oral Candidiasis - Manifestations White curdlike plaques on tongue, gums, and buccal mucosaHow to differentiate from milkThrush is very difficult to remove and bleeding of the area when plaques are removed.What are the signs and symptoms? How would the nurse differentiate between thrush and milk curds?
11Oral Candidiasis – Treatment Oral Nystatin suspensionSwish and swallowRub medication on the area with gloved handsApply after mealsOral fluconazole administed 1/day orallyClean pacifiers, bottles, etc.Provide cool liquids for the older childWhat are treatment measures? When is the preferred time of medication?What teaching is important to include in preventing reoccurrence?
12Caused by a group of fungi called dermatophytes Tinea / RingwormCaused by a group of fungi called dermatophytesWhat is the causative organism?
13Clinical Manifestations fungal infection of the stratum corneum, nails and hair(the base of hair shaft causing hair to break off-rarely permanent.Scaly, circumscribed patches to patchy, gray scaling areas of alopecia.Pruritic itchingGenerally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)What are the signs and symptoms?
14Tinea pedis or athletes foot Tinea capitisTinea corpusTinea cruisTinea pedis or athletes footWhat are common sites for infection?
15Drug Therapy: Antifungal Medication: Oral griseofulvin Give with fatty foods to aid in absorptionTreatment is for weeksCan return to day care when lesions are dryAvoid sun exposureNizoral, Diflucan, Lamisil – used only in older children because of risk of hepatoxicityWhat is the treatment?
16See Home Care for Child with Tinea infection on Teachingtransmitted by clothing, bedding, combs and animals (cats)may take 1-3 months to heal completely, even with treatmentChild doesn't return to school until lesions dry.See Home Care for Child with Tinea infection onpage 1347.What are treatment measures?
18Pediculosis Capitis (lice or cooties!) a parasitic skin disorder caused by licethe lice lay eggs which look like white flecks, attached firmly to base of the hair shaft, causing intense pruritusWhat are characteristic features of head lice?What are the signs and symptoms?
19Lice assessmentClose examination of scalp reveals (nits) firmly attached to hair shafts.Easily transmitted by clothing towels, combs, close contact, unrelated to hygiene.What is the most common mechanism of detection?
20Goals of CareKill the active liceRemove NitsPrevent Spread
21Treatment and Nursing Care pediculicide, permethrin (NIX) crème rinseApplied to washed and towel dried hair. Massage into the hair and scalp one section at a time.**Wet hair dilutes the product and may contribute to treatment failure.Leave in place for 10 minutes and rinseTowel dryComb hair with a fine-tooth comb to remove any remaining nits.Repeat in 1-2 weeks
22Treatment and Nursing Care OvideApproved for treatment in older children only.Must have prolong contact (8-10 hrs) to be effectiveLindane (Kwell) is no longer approved for treatment
24ScabiesSarcoptes scabei mite. Females are 0.3 to 0.4 mm longand 0.25 to 0.35 mm wide. Males are slightly more thanhalf that size.a parasitic skin disorder (stratum corneum- not living tissue) caused by a female mite.The mite burrows into the skin depositing eggs and fecal material; between fingers, toes, palms, axillaepruritic & grayish-brown, thread-like lesion
25ScabiesScabies is spread from person to person mainly by prolonged direct skin-to-skin contact, such as touching a person who has scabies. In rare cases, scabies can spread by contact with clothes, towels, bedding, and other personal items that were recently in contact with an infected person.The mites live on human blood and need the warmthof the human body to survive. Away from the body, they die within 48 hours.
26ScabiesScabies between thumb and index finger On foot
27Therapeutic Interventions transmitted by clothing, towels, close contactDiagnosis confirmed by demonstration from skin scrapings.treatment: application of scabicide cream which is left on for a specific number of hours (4 to 14)to kill miterash and itch will continue until stratum corneum is replace (2-3 weeks)
28Care: Fresh laundered linen and underclothing should be used. Contacts should be reduced until treatment is completed.
29DERMATITISInflammation of the skin that occurs in response to contact with an allergen or irritant
30Dermatitis Common Irritants Soap, fabric softeners, lotions, urine and stoolCommon AllergensPoison ivy, Poison oakLanolinLatex, rubberNickelFragrances
31Dermatitis – Signs and Symptoms ErythemaEdemaPururitusVesicles or bullae that rupture, ooze and crust
32Dermatitis - Treatment MedicationsApplication of a corticosteroid topical agent – remind to continue use for 2-3 weeks after signs of healingApplication of protective barrier ointmentsOatmeal baths, Cool compressesAntihistamines given for sedative effect
34Chronic superficial skin disorder characterized by intense pruritis EczemaChronic superficial skin disorder characterized by intense pruritis7. What is the etiology an d
35Eczema Immune disorder of the skin Influenced by genetic predisposition and external triggersTends to occur in children with hereditary allergic tendencies
36Eczema – Signs and Symptoms Erythematous patches with vesiclesPruritusExudate and crustsDrying and scalingLichenification (thickening of the skin)
37Reduce the amount of allergen exposure Goal of TreatmentHydrate the SkinReduce the amount of allergen exposureRelieve Pruritis
38AcneInflammatory disease of the skin involving the sebaceous glands and hair follicles.
39Acne- Three Main Types ACNE Comedomal- noninflammatory follicular plug Cystic- nodules and cystsPapulopustular- papules and pustules
40Precipitating factors HeredityHormonal influencesEmotional stressHeat and Humidity
41Patient TeachingDo not pick! this increases the bacterial count on the surface of the skin and opens lesions to infection which worsens scarring.Remind patients that the treatment will not show improvement until about 4-6 weeks but they must consistently follow the regime set up by the physician.
42Medical Therapy for Acne Topical: Benzoyl Peroxide, Tretinoin (RetinA), tetracycline and erythromycin. Topical agents are preferred treatment to systemic antibiotics, however increases in antibiotic resistant bacteria may require use of systemic antibiotics.Oral: Tetracycline, minocycline, erythromycin and clindamycin- used for severe inflammatory acne or resistant to topical medications. Estrogen may also work for female patients. Isotretinoin (Accutane)- side effects include cataracts, dry skin, pruritius, conjunctivitis, nosebleeds and depression. Also a teratogen!