1. Integumentary
Check main table: is it really Pediatric Differences in or Pediatric Characteristics of

2. 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. Impetigio

5. Impetigo
Most common bacterial skin infection of childhood
Highly contagious
Caused by Staph aureus or Strep

6. 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 days with antibiotic treatment

7. Nursing Management of 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

8. 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
Deleted periods
Bullet 2: 2 curly apostrophes

9. 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)

10. Candidiasis

11. Superficial fungal infection of the oral mucous membranes (thursh)
Candidiasis
Superficial fungal infection of the oral mucous membranes (thursh)
May also present in diaper area (diaper dermatitis)

12. 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

13. Oral Thrush
White, curd-like plaques on tongue, gums, buccal mucosa (not easily removed)

14. Diaper area lesions are bright red
Diaper Dermatitis
Diaper area lesions are bright red
Sharp Border
Satellite lesions

15. 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

16. 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

18. Pediculosis Capitis

19. 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

20. 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)

21. Management -three goals
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

22. Management - three goals
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)

23. Management-three goals
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

24. Atopic Dermatitis

25. 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

26. 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

27. Child Skin appears scaly with dry skin
Can be irritated and itchy by sweating, contact with irritating fabrics, emotional upset

28. 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

29. Tinea

30. Common Types of Tinea Infection
Tinea capitis (scalp)
Tinea cruris (groin, buttocks, and scrotum)
Tinea corporis (trunk, face, extremities)
Tinea pedis (feet)
Rebreak head and center:
Five Common Types of
Tinea infection

31. Tinea Capitis Erythema papular rash of scalp Patches of alopecia
Treated with topical and oral antifungals

32. Tinea Corporis Single circular 1” scaly plaques
Erythema to pale pink/white
Topical antifungals, continue to treat one week after rash gone

33. Tinea Cruis Warm moist environment promotes fungal growth
Common in adolescent male
Topical antifungal
Loose clothing

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

35. 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

36. cellulitis

37. 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

38. 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

39. 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

40. scabies

41. 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

42. 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

43. 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

44. Practice Questions!

45. 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 child’s 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

46. Which procedure, performed by parents 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

47. 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?
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”

48. 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 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

49. 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 child’s scalp

50. The nurse is caring for a child with cellulitis of the foot
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

51. A adolescent female has been diagnosed with recurrent tinea capitis
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