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Integumentary
Stressors
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
Common Pediatric Skin
Diseases/Disorders
 Impetigo
 Cellulitis
 Candidiasis
 Pediculosis
 Scabies
 Dermatitis
 Tinea
Impetigo
 Most common bacterial skin
infection of childhood
 Highly contagious skin
infection
 Caused by Staph aureus
 Incubation 7-10 days
 Lesions resolve in 12-14 days
with treatment
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
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
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
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
Candidiasis
(thrush)
 Superficial fungal infection
(Candida albicans) of the oral
mucous membranes
 May also present in diaper
area
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
 Diaper area treated with topical
Nystatin cream
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
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
Clinical Manifestations
 Nits are visible on hair shafts close to
scalp usually behind ears and at nape
of neck, difficult to remove
 Intense pruritis
Management involves three
goals
1. 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
Management involves 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)
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 (eczema)
 Chronic superficial inflammatory skin
disorder
 Affects children usually by age 5 yrs
 Children usually also have allergies
 75% will develop asthma
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
Atopic Dermatitis (eczema)
 Childhood: skin appears scaly with dry skin
 Can be exacerbated by sweating, contact
with irritating fabrics, emotional upset
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
Parental Education
 Skin hydration
 Support of uncomfortable, irritable
child
 Mild detergents and soap
 Don’t bundle child
 Avoid sun exposure
 Humidifier during winter months
 Avoid drying agents to skin
 Fingernails clean and short
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 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)
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
Treatment
 Usually associated with elevated WBC
 Culture will assist in identification of
organism
 Requires aggressive antibiotics
 May progress into abscess or bacteremia
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
 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.
b.
c.
d.
Frequent colloid baths
Topical steroid to affected areas
Avoidance of wool clothing
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 behavior
b. Inform the child that her parents will be notified
if she fails to cooperate
c. Allow the child to apply the shampoos
d. 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 30b.
c.
d.
e.
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
a.
b.
c.
d.
Permethrin 5% (Elimite) is prescribed for a 10year-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
 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
 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