Infants and Children Skin Topics Macule flat Papule

Infants and Children Skin Topics

Macule (flat)

Papule

Vesicle (fluid filled)

Atopic Dermatitis (Eczema) • Acute or Chronic, superficial inflammatory skin disorder causes severe itching • Affects 17% infants, children, adolescents • 65% first year of life • 90% by 5 years • Research shows r/t asthma • 85% allergic form of eczema

Atopic Dermatitis (Eczema) Etiology: • Unknown • Immune system, genetics, environmental exposure, defects in skin barrier function and immune responses • Eczema tends to occur with allergic reactions to irritants • Symptoms:

Treatment and Nursing Care Atopic Dermatitis • Tepid baths with no soap (or little) application of emollient within 3 minutes • Food allergy management • Help parents cope with acute flare ups • Medication • Research

Eczema (Atopic Dermatitis)

Atopic Dermatitis

Nursing Diagnosis • Impaired Skin Integrity • Disturbed Body Image • Impaired Comfort • Risk from infection

Review of atopic dermatitis • What is cause of atopic dermatitis? • What is another term for atopic dermatitis? • What skin areas is eczema frequently seen? • What is a RAST test ? • What history might be found in family of children with atopic dermatitis? • What is the goal of care for children with atopic dermatitis?

Impetigo (Staph or Strep infection) • Highly contagious • Common on face • Etiology • S/S: Typical honey colored crusted lesion

Impetigo

Impetigo

Nursing management/Treatment of Impetigo • Hand washing, universal precautions • Cleanse, soak and remove crusts • Topical antibiotic or oral antibiotic Mucopurin ointment TID 5 -7 days Retamulin ointment (Altabax) BID 5 days Lang, 2009

Risk factors for burns in children • Water heaters set too high • Access to hot items (coffee) • Access to stovetops • Unguarded bathroom faucets • Cooking without supervision • Playing with fire or matches • Child abuse: % depends on study

Scald burn prevention in children • https: //www. youtube. com/watch? v=0 ad. Pjd. Cqja. A

Degree of burns in children • First degree • Second degree: (partial thickness) • Third degree: (full thickness) • Fourth degree: damage to deep tissue, muscles, bones

Burn Type • Minor < 15% BSA and not involving face, hands, feet, or genitalia • Moderate burns Partial thickness, second degree, covering > 15% but < 30 % BSA or full thickness <10 BSA • Major (severe) burns Partial thickness, 2 nd degree, involving 30% BSA or full thickness involving > 10% BSA or face, hands, feet, genitalia

Major burns • Face, hands, feet, perinea are treated as major burns • Circumferential burns (surrounding thorax or extremity), anterior chest burns, smoke inhalation • Regardless of BSA considered major

Treatment of Burns • Minor burns: • Emergency Care: • Moderate/Major

Complications of burns in children • Children have larger body surface area which puts them at high risk for fluid volume, heat loss and leads to ______. • Shock Respiratory injury 2 ndary smoke inhalation Pulmonary edema, pneumonia Infection Stress ulcer, gi bleeding Contracture deformities, scarring, body image changes

Head Lice Pediculosis Capitis

Head Lice • Infestation of scalp • Symptom: severe itching • Lice are not select

Head Lice • Lice don’t jump or fly • Anyone can get lice • Transmission

Assessment and Diagnosis of Lice • History • Assessment for lice and nits

Treatment for Lice • Nix (Permethrin 1%) • Pyrethrin (Rid) • Lindane (Kwell): lice resistance and toxic Not approved by APA • Malathion (ovide): flammable and expensive

Nursing Considerations for children with lice infestations • Directions for application of shampoo • Lice resistance to treatment • Nit combing after shampoo most important cure • • Housecleaning

Nit Comb

Lice treatment • https: //www. youtube. com/watch? v=a. A 7 r. Z 2 d. I 5 lw

Review questions • What should the nurse teach the parent to do if Nix gets in the child’s eyes? • What is the most important activity to teach parents after the Nix rinse for lice? • What does the nurse teach the parent about house cleaning when child has lice? • How long should the Nix rinse be left on the child’s hair? Amount to apply?

Scabies (Sarcoptes scabei mite) • Highly contagious, spread by skin to skin • Rash with varying lesions on infants and children • Diagnosis exam under microscope

Scabies • Symptoms: severe itching (itching worse at night) • Nodules and itching persist for weeks after TX

Linear borough with brown gray color

Scabies linear tracking early stages

Treatment and Nursing Care of children with scabies • Precede treatment with warm bath • Cool dry skin • Wash linens very hot water and hot dryer • Eli mite (permethrin) cream: leave on 8 to 12 hours

Review question • Which of the following should be included in teaching families about scabies?

Review • a. Apply cream in morning and evening • b. The cream must remain in place 8 -12 hours. • c. The drug of choice is lindane • d. Treat others in house only if symptomatic • e. Check dogs and cats for human scabies

Dermatophytoses Fungal Infections • Tinea Capitus (head) Tinea Corpris (body) Ringworm, Tinea Cruris (jock fungus) Treatment: Antifungal creams: Lotrimin, Tinactin • Grisiofulvin orally 8 -12 weeks • Selenium sulfide shampoos leave on 10 min before rinsing.

Tinea Capitus

Tinea Corporis

Tinea Corporis (trunk or body)

Tinea Pedis (athletes foot) • Itching, vesicles, erosion, fissures, scaley • Peeling and maceration Treatment: same as tinea corporis and Many new nail ointments Allow air dry Use 100% cotton socks

Tinea pedis (athletes foot)

Nursing Considerations for families with fungal infections Teach children and families • Don’t exchange clothing • Check pets • How to apply topical cream • Give Grisiofulvin with high fat foods

Give Grisiofulvin with high fat foods

Peanut Butter

Check pets for fungus

Check cats for fungus

Keep hats and gloves separate

The nurse is teaching a family about transmission of fungal infection. Included in teaching should be the following: (Choose best answer) a. Fungal infections are transmitted by close contact with other persons. b. Fungal infections can be contagious from pets, humans, and clothing from infected persons. c. Fungal infections are only contagious from animals. d. Fungal infections are easily transmitted and rapidly cured.

Review Study • How should the family be taught to treat the other members of the family and household items when a member has a fungal infection?

Cystic acne

Management • Wash skin • Retinoic acid • Mild Papulopustular Acne • Moderate to severe papulopustular acne • Accutane isotretoin-TERATOGENIC

Contact Dermatitis • Contact diaper rash RX, corn starch, barrier cream • Candida Albicans: complication antibiotics or thrush: fire red and in the skin folds, satellite lesions RX antifungal (lotrimin) check mouth: thrush • Contact Dermatitis: changes occur in skin due to stimuli

Seborrhea Dermatitis (cradle cap) • Recurrent inflammatory skin condition • Cradle cap • Infants up to 3 months and adolescents • Treat infants • Treat adolescents

Seborrhea Dermatitis (Cradle Cap)

Review • What is causative agent of impetigo? • What is cause of seborrheic dermatitis? • What is difference between diaper dermatitis form feces and urine which spares the skin folds--- • and a dermatitis that does not spare the skin folds? • What is candida albicans? How is it treated?