Pediatric Skin Diseases and Nursing Care

1. Integumentary

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

7. 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

8. 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

9. 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

10. 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)

11. Candidiasis

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

13. 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

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

15. Diaper Dermatitis • Diaper area lesions are bright red • Sharp Border • Satellite lesions

16. 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

17. 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. PediculosisCapitis

19. PediculosisCapitis(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 pediculicideOTC products (Kwell, Nix, Rid) • Kwell is neurotoxic for infants • RIDis 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)

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 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

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. Burns • Different kind of Burns • Risk • How to manage a child with burn injury • How to do the fluid replacement? • What is the most prominent form of burn in child?

45. Practice Questions!

46. 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

47. 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

48. 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”

49. 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

50. 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