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INTEGUMENTARY
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
IMPETIGIO
IMPETIGO
• Most common bacterial skin
infection of childhood
• Highly contagious
• Caused by Staph aureus or
Strep
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
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
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
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)
CANDIDIASIS
CANDIDIASIS
• Superficial fungal infection of the
oral mucous membranes (thursh)
• May also present in diaper area
(diaper dermatitis)
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 with
gloved finger after feeding
• Diaper area treated by applying
topical Nystatin cream with
every diaper change
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
PEDICULOSIS CAPITIS
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
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)
MANAGEMENT -THREE GOALS
1. 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
MANAGEMENT - THREE GOALS
2. Remove nits
• Inspect child’s hair with finetoothed comb
• Comb nits out when hair is wet
(apply ½ vinegar ½ water
mixture prior to combing)
MANAGEMENT-THREE GOALS
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
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
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
CHILD
• Skin appears scaly
with dry skin
• Can be irritated
and itchy by
sweating, contact
with irritating
fabrics, emotional
upset
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
TINEA
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
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
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
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
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!
a.
b.
c.
d.
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
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.
b.
c.
d.
e.
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
a.
b.
c.
d.
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
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