Nurs 341 – Final Exam Study Guide
Chapter 23: Nursing Care of the Child with an Alteration in Tissue Integrity/Integumentary
Disorder
Know the skin differences of infants/children and adults
- The infant’s epidermis is thinner than the adult’s, and the blood vessels lie closer to the
surface because there is a decreased amount of subcutaneous fat. Thus, the infant loses
heat more readily through the skin’s surface than the older child or adult does; less
pigmented than that of the adult (in all races), placing the infant at increased risk of skin
damage from ultraviolet radiation.
Know the causes of skin disorders
Know common meds and lab tests
- COMMON LABORATORY AND DIAGNOSTIC TESTS 23.1 P875
- Atopic dermatitis: Serum immunoglobulin E (IgE) levels may be elevated in the child
with atopic dermatitis. Skin prick allergy testing may determine the food or
environmental allergen to which the child is sensitive.
- Burn:
Pulmonary status may be evaluated via pulse oximetry and end-tidal CO2 monitoring,
arterial blood gases, carboxyhemoglobin levels, and chest radiography.
Fiberoptic bronchoscopy and xenon ventilation–perfusion scanning may be used to
evaluate inhalation injury.
Electrocardiographic monitoring is important for the child who has suffered an
electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours
after a burn injury.
Know Burns – assessment, management, prevention
EMERGENCY ASSESSMENT OF THE BURNED CHILD
PRIMARY SURVEY
• Assess the child’s airway, noting whether it is patent, maintainable, or unmaintainable.
• Suspect airway injury from burn or smoke inhalation if any of the following are present: burns
around the mouth, nose, or eyes; carbonaceous (black-colored) sputum; hoarseness or stridor.
• Evaluate the child’s skin color, respiratory effort, symmetry of breathing, and breath sounds.
• Determine the pulse strength, perfusion status, and heart rate. Note extent and location of edema.
SECONDARY SURVEY
• Determine burn depth.
• Estimate burn extent by determining the percentage of body surface area affected. Use a chart
for estimation (see Fig. 23.21) or rapidly estimate by using the child’s palm size, which is
equivalent to about 1% of the child’s body surface area.
Inspect the child for other traumatic injuries (children who have jumped or fallen from a
house fire may suffer cervical spine or internal injuries).
- Superficial burn—painful but without blisters.
, - Partial-thickness burn—very painful, with blistering.
- Full-thickness burn—color ranges from red to charred, or white, minimal pain, marked
edema.
Know your infectious disorders – assessment & management
Nonbullous • Papules progressing to vesicles, • Limited amount: treat topically with
impetigo then painless pustules with a narrow mupirocin ointment.
erythematous border • Honey- • If numerous lesions, oral first-generation
colored exudate when the vesicles cephalosporin is indicated.
or pustules rupture, which forms a • Clindamycin may be needed for MRSA.
crust on the ulcer-like base (see Fig. • Remove honey-colored crust with cool
23.2) compresses twice daily.
Bullous impetigo • Red macules and bullous • Oral first-generation cephalosporin.
eruptions on an erythematous • Good hygiene.
base
• Size may be from a few
millimeters to several
centimeters
Folliculitis • Red, raised hair follicles • Treat with aggressive hygiene: warm
compresses after washing with soap and
water several times a day.
• Topical mupirocin is indicated; occasionally
oral antibiotics are required.
Cellulitis • Localized reaction: erythema, • Mild cases are usually treated with cephalexin
pain, edema, warmth at site of skin or amoxicillin/clavulanic acid.
disruption (see Fig. 23.3) • More severe cases and periorbital or orbital
cellulitis require IV cephalosporins.
Staphylococcal • Flattish bullae that rupture within • Mild to moderate cases are treated with oral
scalded skin hours • Red, weeping surface is cephalexin, dicloxacillin, or
syndrome left, most commonly on face, groin, amoxicillin/clavulanic acid.
neck, and axillary region (see Fig. • Severe cases are managed similar to burns
23.4) with aggressive fluid management and IV
oxacillin or clindamycin.
•
•
Tinea corporis • Annular lesion with raised • Topical antifungal cream is required for at
(ringworm) peripheral scaling and central least 4 weeks.
clearing (looks like a ring) (Fig.
23.5)
Tinea capitis • Patches of scaling in the scalp • Oral griseofulvin for 4–6 weeks.
with central hair loss • Risk of • Selenium sulfide shampoo may be used to
Chapter 23: Nursing Care of the Child with an Alteration in Tissue Integrity/Integumentary
Disorder
Know the skin differences of infants/children and adults
- The infant’s epidermis is thinner than the adult’s, and the blood vessels lie closer to the
surface because there is a decreased amount of subcutaneous fat. Thus, the infant loses
heat more readily through the skin’s surface than the older child or adult does; less
pigmented than that of the adult (in all races), placing the infant at increased risk of skin
damage from ultraviolet radiation.
Know the causes of skin disorders
Know common meds and lab tests
- COMMON LABORATORY AND DIAGNOSTIC TESTS 23.1 P875
- Atopic dermatitis: Serum immunoglobulin E (IgE) levels may be elevated in the child
with atopic dermatitis. Skin prick allergy testing may determine the food or
environmental allergen to which the child is sensitive.
- Burn:
Pulmonary status may be evaluated via pulse oximetry and end-tidal CO2 monitoring,
arterial blood gases, carboxyhemoglobin levels, and chest radiography.
Fiberoptic bronchoscopy and xenon ventilation–perfusion scanning may be used to
evaluate inhalation injury.
Electrocardiographic monitoring is important for the child who has suffered an
electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours
after a burn injury.
Know Burns – assessment, management, prevention
EMERGENCY ASSESSMENT OF THE BURNED CHILD
PRIMARY SURVEY
• Assess the child’s airway, noting whether it is patent, maintainable, or unmaintainable.
• Suspect airway injury from burn or smoke inhalation if any of the following are present: burns
around the mouth, nose, or eyes; carbonaceous (black-colored) sputum; hoarseness or stridor.
• Evaluate the child’s skin color, respiratory effort, symmetry of breathing, and breath sounds.
• Determine the pulse strength, perfusion status, and heart rate. Note extent and location of edema.
SECONDARY SURVEY
• Determine burn depth.
• Estimate burn extent by determining the percentage of body surface area affected. Use a chart
for estimation (see Fig. 23.21) or rapidly estimate by using the child’s palm size, which is
equivalent to about 1% of the child’s body surface area.
Inspect the child for other traumatic injuries (children who have jumped or fallen from a
house fire may suffer cervical spine or internal injuries).
- Superficial burn—painful but without blisters.
, - Partial-thickness burn—very painful, with blistering.
- Full-thickness burn—color ranges from red to charred, or white, minimal pain, marked
edema.
Know your infectious disorders – assessment & management
Nonbullous • Papules progressing to vesicles, • Limited amount: treat topically with
impetigo then painless pustules with a narrow mupirocin ointment.
erythematous border • Honey- • If numerous lesions, oral first-generation
colored exudate when the vesicles cephalosporin is indicated.
or pustules rupture, which forms a • Clindamycin may be needed for MRSA.
crust on the ulcer-like base (see Fig. • Remove honey-colored crust with cool
23.2) compresses twice daily.
Bullous impetigo • Red macules and bullous • Oral first-generation cephalosporin.
eruptions on an erythematous • Good hygiene.
base
• Size may be from a few
millimeters to several
centimeters
Folliculitis • Red, raised hair follicles • Treat with aggressive hygiene: warm
compresses after washing with soap and
water several times a day.
• Topical mupirocin is indicated; occasionally
oral antibiotics are required.
Cellulitis • Localized reaction: erythema, • Mild cases are usually treated with cephalexin
pain, edema, warmth at site of skin or amoxicillin/clavulanic acid.
disruption (see Fig. 23.3) • More severe cases and periorbital or orbital
cellulitis require IV cephalosporins.
Staphylococcal • Flattish bullae that rupture within • Mild to moderate cases are treated with oral
scalded skin hours • Red, weeping surface is cephalexin, dicloxacillin, or
syndrome left, most commonly on face, groin, amoxicillin/clavulanic acid.
neck, and axillary region (see Fig. • Severe cases are managed similar to burns
23.4) with aggressive fluid management and IV
oxacillin or clindamycin.
•
•
Tinea corporis • Annular lesion with raised • Topical antifungal cream is required for at
(ringworm) peripheral scaling and central least 4 weeks.
clearing (looks like a ring) (Fig.
23.5)
Tinea capitis • Patches of scaling in the scalp • Oral griseofulvin for 4–6 weeks.
with central hair loss • Risk of • Selenium sulfide shampoo may be used to
