lOMoAR cPSD| 26582732
PEDS READINGS1
Chapter 36 – integumentary disorders
Eczema
-----a child with an integumentary disorder needs to be monitored for signs of either a skin infection or a
systemic infection.
-superficial inflammatory process involving primarily the epidermis
- associated with family hx of the disorder, allergies, asthma or allergic rhinitis
goal: pruritus, lubricate the skin, reduce inflamation, and prevent or control secondary
infections. Forms:
Infantile: Childhood: Preadolescent and adolescent
Usually begins at 2 to 6 May follow the infantile form; Begins at about 12 years of age and may
months of age and decreases in occurs at 2 to 3 years of age continue into the early adult years or
incidence with aging; indefinitely
-commonly occur in antecubital and
spontaneous remission may
popliteal areas
occur by 3 years
assessment:
-redness, scales, itching, minute papules (firm, elevated, circumscribed lesions ,1cm) and vesicles
(similar to papules but fluid filled)
- weeping, oozing, and crusting of lesions
interventions:
- avoid skin irritants (soaps, detergents, fabric softeners, diaper wipes, powder etc. )
- avoid excessive bathing, and washing of affected areas (lubercate skin after bath )
- Intermittently apply cool, wet compresses for short periods to soothe the skin and
alleviate itching; pat skin dry between cooling treatments.
- Administer antihistamines and topical cortico- steroids as prescribed; corticosteroids are
applied in a thin layer and are rubbed into the area thoroughly.
-pt may be prescribed medications and antibiotics if infection occurs
-minimize scratching by keeping nails short and clean- can place gloves or cotton socks over
hands
- Eliminate conditions that increase itching, such as wet diapers, excessive bathing,
ambient heat, woolen clothes or blankets, and rough fabrics or furry stuffed animals; exposure to
latex should also be avoided.
-instruct parents to wash clothing in a mild deter- gent and rinse thoroughly; putting the clothes
through a second complete wash cycle without detergent minimizes the residue remaining on the
fabric.
-instruct parents about measures to prevent skin infections.
-instruct parents to monitor lesions for signs of infection (honey-colored crusts with surrounding
erythema) and to seek immediate medical intervention if such signs are noted.
Impetigo
- A contagious bacterial infection of the skin caused by β-hemolytic streptococci or
staphylococci, or both; it occurs most commonly during hot, humid months.
occurs because of poor hygiene; it can be a primary infection or occur secondarily at a site that has been
injured or sustained an insect bite, or at a site that was originally a rash, such as atopic dermatitis or
poison ivy or poison oak.
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PEDS READINGS2
- most common infection sites: face, mouth, and then neck, hands, extremities
- lesions begin as vesicles or pustules surrounded by edema and redness
-lesions progress to an exudative and crusting stage- after the crusting of the lesions, the initially
serous vesicular fluid becomes cloudy, and the vesicles rupture, leaving honey coloured crusts
covering ulcerated bases
assessment:
-lesions, erythema, pruritus, burning, secondary lymph node involvement
interventions:
- contact isolation, allow lesions to dry by air exposure, assist child with bathing with
antibacterial soap
-apply warm saline or other prescribed com- presses to the lesions 2 or 3 times daily, followed by
mild soap and water to soften crusts for removal and promote healing; burow’s solution may also
be prescribed to soften the crusts.
-apply topical antibiotic ointments with a clean/ sterile cotton swab without touching the tube
opening with fingers or skin, and instruct parents in the ointment and swab use; the infection is
still communicable for 48 hours beyond initiation of antibiotic treatment.
- administer oral antibiotics, which may be pre- scribed if there is no response to topical
antibiotic treatment; it is extremely important to comply with the prescribed antibiotic regimen
because secondary infections such as glomerulonephritis may result if the infectious agent is of a
streptococcal type that can affect the nephrons.
-to prevent skin cracking, apply emollients and instruct parents in the use of emollients. -instruct
parents in the methods to prevent the spread of the infection, especially careful hand- washing.
-inform parents that the child needs to use separate towels, linens, and dishes.
-inform parents that all linens and clothing used by the child should be washed with detergent in
hot water separately from the linens and clothing of other household members.
Pediculosis capitis (lice)
- refers to an infestation of the hair and scalp with lice
-most common areas: occipital area, ears, neck, eyebrows, and eyelashes
- nit lays eggs on the hair shaft, close to the scalp- incubation period is 7 to 10 days
-lice can survive for 48 hours away from the host- nits shed in the environment can hatch in 7 to
10 days
-head life live reproduce on only humans and are transmitted by direct and indirect contact-
sharing brushes, hats, towels and bedding
-all contacts on the infested child should be examined and treated prn
assessment:
-excessive scalp scratching, nits (white eggs) on hair shaft, adult lice are difficult to see, they
appear as small tan or gray specks
interventions:
-use a pediculicide product, daily removal of nits using an extra-fine tooth metal nit comb (
disgard comb after use )
-parents and siblings should be treated as well
- bedding and clothing should be changed daily, laundered in hot water with detergent and dried
in a hot dryer for 20 minutes for a week
- toys should be sealed in a bag for 2 weeks (the ones that cannot be washed ) -
lice on eyebrows or eyelashes may need to be removed manually
Scabies
- parasitic skin disorder caused by an infestation of sarcoptes scabiei (itch mite )
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PEDS READINGS3
- epidemic among school children and institutionalized people (close contact )
incubation period: female mite burrows into the epidermis lays eggs, and dies in the burrow after 4 to 5
weeks
infectious period:
During the entire course of the infestation
assessment: transmitted by close personal contact with an infected person. Household members and
contacts
Of an infected child need to be treated simultaneously
interventions:
-topical application of a scabicide such as permethrin kills the mites- apply to cool dry skin at
least 30 minutes after bathing (rub in everywhere not just the rash), leave on skin 8 to 14 hours,
then remove by bathing
- lindane shampoo, should not be used with children < 2 years (neurotoxicity and seizures ) -
frequent hand washing
-wash all clothing, bedding, and pillowcases daily- washed in hot water, dryer, and ironed for a
week
- keep nonwashable toys in a sealed bag for 4 days
-anti itch topical treatments, and antibiotics if a secondary infection develops
Burn injuries:
***priority actions
1. Stop the burning process
2. Assess abcs
3. Begin resuscitation measures
4. Remove burned clothing and jewelry
5. Cover the wounds with a clean cloth
6. Keep child warm 7. Transport child to er pediatric considerations:
Very young children who have been burned severely have a higher mortality rate than older
children and adults with comparable burns.
-lower burn temperatures and shorter exposure to heat can cause a more severe burn in a child
than in an adult because a child’s skin is thinner.
-the degree of pain experienced by the child and the ability to communicate it are different than
in an adult with the same exposure.
-severely burned children are at increased risk for fluid and heat loss, dehydration, and metabolic
acidosis compared with adults.
- the higher proportion of body fluid to body mass in children increases the risk of cardiovascular
problems.
-burns involving more than 10% of the total body surface area require some form of fluid
resuscitation
-infants and children are at increased risk for protein and calorie deficiency because they have
smaller muscle mass and less body fat than adults - scarring is more severe- at risk for
disturbed body image
-immature immune system presents an increased risk for infection for infants and young children
-delay in growth after burn can occur
fluid replacement therapy
-to determine adequacy of fluid resuscitation, vital signs (**hr), urine output, adequacy of
capillary filling and sensorium status are assessed
-fluid replacement is necessary during the initial 24-hour period after burn injury because of the
fluid shifts that occur as a result of the injury
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PEDS READINGS4
-crystalloid solutions are used during the initial phase of therapy, colloid solutions such as
albumin, plasma lyte or fresh frozen plasma can be used to maintain plasma volume extent of burn
injuries
- rule of nines
Chapter 37 – hematological disorders
Sickle cell anemia
constitutes a group of diseases termed hemoglobinopathies, in which hemoglobin a is partly or
completely replaced by abnormal sickle hemoglobin s.
- caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. risk
factors include having parents heterozygous for hemoglobin s or being of african american descent.
screening purposes the sickle-turbidity test (sickledex) is frequently used because it can be performed on
blood from a fingerstick and yields accurate results in 3 minutes. However, if the test result is positive,
hemoglobin (hgb) electrophoresis is necessary to distinguish between children with the trait and those
with the disease.
- hemoglobin s is sensitive to changes in the oxygen content of the red blood cells
-insufficient oxygen causes cells to assume sickle shape (cells are rigid, clumped & obstructs capillary
blood flow)
-clinical manifestations occur because of the obstruction caused by the sickled rbc and increased red
blood cell destruction
situations that precipitate sickling… fever, dehydration, stress or any condition that increases the need or
alters the transport of oxygen can result in a sickle cell crisis
sickle cell crises are acute exacerbations of the disease (vary in severity and frequency) (can include
vaso-oclusive crisis, splenic sequestration, hyperthermolytic crsis and aplastic crisis)
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PEDS READINGS1
Chapter 36 – integumentary disorders
Eczema
-----a child with an integumentary disorder needs to be monitored for signs of either a skin infection or a
systemic infection.
-superficial inflammatory process involving primarily the epidermis
- associated with family hx of the disorder, allergies, asthma or allergic rhinitis
goal: pruritus, lubricate the skin, reduce inflamation, and prevent or control secondary
infections. Forms:
Infantile: Childhood: Preadolescent and adolescent
Usually begins at 2 to 6 May follow the infantile form; Begins at about 12 years of age and may
months of age and decreases in occurs at 2 to 3 years of age continue into the early adult years or
incidence with aging; indefinitely
-commonly occur in antecubital and
spontaneous remission may
popliteal areas
occur by 3 years
assessment:
-redness, scales, itching, minute papules (firm, elevated, circumscribed lesions ,1cm) and vesicles
(similar to papules but fluid filled)
- weeping, oozing, and crusting of lesions
interventions:
- avoid skin irritants (soaps, detergents, fabric softeners, diaper wipes, powder etc. )
- avoid excessive bathing, and washing of affected areas (lubercate skin after bath )
- Intermittently apply cool, wet compresses for short periods to soothe the skin and
alleviate itching; pat skin dry between cooling treatments.
- Administer antihistamines and topical cortico- steroids as prescribed; corticosteroids are
applied in a thin layer and are rubbed into the area thoroughly.
-pt may be prescribed medications and antibiotics if infection occurs
-minimize scratching by keeping nails short and clean- can place gloves or cotton socks over
hands
- Eliminate conditions that increase itching, such as wet diapers, excessive bathing,
ambient heat, woolen clothes or blankets, and rough fabrics or furry stuffed animals; exposure to
latex should also be avoided.
-instruct parents to wash clothing in a mild deter- gent and rinse thoroughly; putting the clothes
through a second complete wash cycle without detergent minimizes the residue remaining on the
fabric.
-instruct parents about measures to prevent skin infections.
-instruct parents to monitor lesions for signs of infection (honey-colored crusts with surrounding
erythema) and to seek immediate medical intervention if such signs are noted.
Impetigo
- A contagious bacterial infection of the skin caused by β-hemolytic streptococci or
staphylococci, or both; it occurs most commonly during hot, humid months.
occurs because of poor hygiene; it can be a primary infection or occur secondarily at a site that has been
injured or sustained an insect bite, or at a site that was originally a rash, such as atopic dermatitis or
poison ivy or poison oak.
Downloaded by NELSON KIIRU
()
, lOMoAR cPSD| 26582732
PEDS READINGS2
- most common infection sites: face, mouth, and then neck, hands, extremities
- lesions begin as vesicles or pustules surrounded by edema and redness
-lesions progress to an exudative and crusting stage- after the crusting of the lesions, the initially
serous vesicular fluid becomes cloudy, and the vesicles rupture, leaving honey coloured crusts
covering ulcerated bases
assessment:
-lesions, erythema, pruritus, burning, secondary lymph node involvement
interventions:
- contact isolation, allow lesions to dry by air exposure, assist child with bathing with
antibacterial soap
-apply warm saline or other prescribed com- presses to the lesions 2 or 3 times daily, followed by
mild soap and water to soften crusts for removal and promote healing; burow’s solution may also
be prescribed to soften the crusts.
-apply topical antibiotic ointments with a clean/ sterile cotton swab without touching the tube
opening with fingers or skin, and instruct parents in the ointment and swab use; the infection is
still communicable for 48 hours beyond initiation of antibiotic treatment.
- administer oral antibiotics, which may be pre- scribed if there is no response to topical
antibiotic treatment; it is extremely important to comply with the prescribed antibiotic regimen
because secondary infections such as glomerulonephritis may result if the infectious agent is of a
streptococcal type that can affect the nephrons.
-to prevent skin cracking, apply emollients and instruct parents in the use of emollients. -instruct
parents in the methods to prevent the spread of the infection, especially careful hand- washing.
-inform parents that the child needs to use separate towels, linens, and dishes.
-inform parents that all linens and clothing used by the child should be washed with detergent in
hot water separately from the linens and clothing of other household members.
Pediculosis capitis (lice)
- refers to an infestation of the hair and scalp with lice
-most common areas: occipital area, ears, neck, eyebrows, and eyelashes
- nit lays eggs on the hair shaft, close to the scalp- incubation period is 7 to 10 days
-lice can survive for 48 hours away from the host- nits shed in the environment can hatch in 7 to
10 days
-head life live reproduce on only humans and are transmitted by direct and indirect contact-
sharing brushes, hats, towels and bedding
-all contacts on the infested child should be examined and treated prn
assessment:
-excessive scalp scratching, nits (white eggs) on hair shaft, adult lice are difficult to see, they
appear as small tan or gray specks
interventions:
-use a pediculicide product, daily removal of nits using an extra-fine tooth metal nit comb (
disgard comb after use )
-parents and siblings should be treated as well
- bedding and clothing should be changed daily, laundered in hot water with detergent and dried
in a hot dryer for 20 minutes for a week
- toys should be sealed in a bag for 2 weeks (the ones that cannot be washed ) -
lice on eyebrows or eyelashes may need to be removed manually
Scabies
- parasitic skin disorder caused by an infestation of sarcoptes scabiei (itch mite )
Downloaded by NELSON KIIRU ()
, lOMoAR cPSD| 26582732
PEDS READINGS3
- epidemic among school children and institutionalized people (close contact )
incubation period: female mite burrows into the epidermis lays eggs, and dies in the burrow after 4 to 5
weeks
infectious period:
During the entire course of the infestation
assessment: transmitted by close personal contact with an infected person. Household members and
contacts
Of an infected child need to be treated simultaneously
interventions:
-topical application of a scabicide such as permethrin kills the mites- apply to cool dry skin at
least 30 minutes after bathing (rub in everywhere not just the rash), leave on skin 8 to 14 hours,
then remove by bathing
- lindane shampoo, should not be used with children < 2 years (neurotoxicity and seizures ) -
frequent hand washing
-wash all clothing, bedding, and pillowcases daily- washed in hot water, dryer, and ironed for a
week
- keep nonwashable toys in a sealed bag for 4 days
-anti itch topical treatments, and antibiotics if a secondary infection develops
Burn injuries:
***priority actions
1. Stop the burning process
2. Assess abcs
3. Begin resuscitation measures
4. Remove burned clothing and jewelry
5. Cover the wounds with a clean cloth
6. Keep child warm 7. Transport child to er pediatric considerations:
Very young children who have been burned severely have a higher mortality rate than older
children and adults with comparable burns.
-lower burn temperatures and shorter exposure to heat can cause a more severe burn in a child
than in an adult because a child’s skin is thinner.
-the degree of pain experienced by the child and the ability to communicate it are different than
in an adult with the same exposure.
-severely burned children are at increased risk for fluid and heat loss, dehydration, and metabolic
acidosis compared with adults.
- the higher proportion of body fluid to body mass in children increases the risk of cardiovascular
problems.
-burns involving more than 10% of the total body surface area require some form of fluid
resuscitation
-infants and children are at increased risk for protein and calorie deficiency because they have
smaller muscle mass and less body fat than adults - scarring is more severe- at risk for
disturbed body image
-immature immune system presents an increased risk for infection for infants and young children
-delay in growth after burn can occur
fluid replacement therapy
-to determine adequacy of fluid resuscitation, vital signs (**hr), urine output, adequacy of
capillary filling and sensorium status are assessed
-fluid replacement is necessary during the initial 24-hour period after burn injury because of the
fluid shifts that occur as a result of the injury
Downloaded by NELSON KIIRU
()
, lOMoAR cPSD| 26582732
PEDS READINGS4
-crystalloid solutions are used during the initial phase of therapy, colloid solutions such as
albumin, plasma lyte or fresh frozen plasma can be used to maintain plasma volume extent of burn
injuries
- rule of nines
Chapter 37 – hematological disorders
Sickle cell anemia
constitutes a group of diseases termed hemoglobinopathies, in which hemoglobin a is partly or
completely replaced by abnormal sickle hemoglobin s.
- caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. risk
factors include having parents heterozygous for hemoglobin s or being of african american descent.
screening purposes the sickle-turbidity test (sickledex) is frequently used because it can be performed on
blood from a fingerstick and yields accurate results in 3 minutes. However, if the test result is positive,
hemoglobin (hgb) electrophoresis is necessary to distinguish between children with the trait and those
with the disease.
- hemoglobin s is sensitive to changes in the oxygen content of the red blood cells
-insufficient oxygen causes cells to assume sickle shape (cells are rigid, clumped & obstructs capillary
blood flow)
-clinical manifestations occur because of the obstruction caused by the sickled rbc and increased red
blood cell destruction
situations that precipitate sickling… fever, dehydration, stress or any condition that increases the need or
alters the transport of oxygen can result in a sickle cell crisis
sickle cell crises are acute exacerbations of the disease (vary in severity and frequency) (can include
vaso-oclusive crisis, splenic sequestration, hyperthermolytic crsis and aplastic crisis)
Downloaded by NELSON KIIRU ()
