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

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 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 child’s hands frequently with antibacterial soap
Maintain good hand washing
Distract child from touching lesions
Deleted periods
Bullet 2: 2 curly apostrophes

7. 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

8. 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
Out of school or daycare for 24h once antibiotics started
Finish full course of antibiotics

9. May also present in diaper area
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 mother’s 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 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

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 child’s 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
Don’t 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)
Rebreak head and center:
Five Common Types of
Tinea infection

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 10:00 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 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

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 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”

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 child’s head
Launder the child’s 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 child’s scalp