impetigo vesicles or pustule surrounded by edema and redness
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Impetigo
Vesicles or pustule surrounded by edema and redness
Impetigo
Begins as a reddish macular rash, commonly seen on face/extremities
Progresses to papular and vesicular rash that oozes and forms a moist, honey colored crust.
Pruritis of skin
Common in 2-5 year age group
Impetigo
Impetigo became infected
group a hemolytic strep infection of skin. Incubation period is 2-5 days after contact Easily spread merely by touching another part of
skin after scratching infected area.
Therpeutic Management
Apply warm, moist soaks to soften lesions, Apply warm, moist soaks to soften lesions, remove crustsremove crusts
Apply Bactroban TID to cleaned lesions
Cephalexin (keflex) for 10 days
Teach good handwashing and hygiene to prevent spread, keep fingernails short
Impetigo
Be alert for signs of acute glomerulonephritis,
If the impetigo was caused by beta-hemolytic streptococci
Therapeutic Interventions
Goal - prevent scarring and promote positive self-image.
Individualize treatment to gender, age, and severity of infection.
It takes 4-6 weeks to begin to see improvement, with optimal results in 3-5 months.
What is the major nursing implication here?
Oral Candidiasis
Fungal or yeast infection also known as Thrush
Oral Candidiasis - causes
Passing through an infected birth canal
Child who is on immunosuppressant's
Exposure to mothers infected breasts
Unclean bottles and pacifiers
Oral Candidiasis - Manifestations
White curdlike plaques on tongue, gums, and buccal mucosa
How to differentiate from milk Thrush is very difficult to remove and bleeding of
the area when plaques are removed.
Oral Candidiasis – Treatment
Oral Nystatin suspension Swish and swallow Rub medication on the area with gloved hands Apply after meals
Oral fluconazole administed 1/day orally
Clean pacifiers, bottles, etc.
Provide cool liquids for the older child
Tinea / Ringworm
Caused by a group of fungi called dermatophytes
Clinical Manifestations
fungal infection of the stratum corneum, nails and hair(the base of hair shaft causing hair to break off-rarely permanent.
Scaly, circumscribed patches to patchy, gray scaling areas of alopecia.
Pruritic itching
Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)
Tinea capitis
Tinea corpus
Tinea cruis
Tinea pedis or athletes foot
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Drug Therapy:
Antifungal Medication:Oral griseofulvin
Give with fatty foods to aid in absorptionTreatment is for 6- 8 weeksCan return to day care when lesions are dryAvoid sun exposure
Nizoral, Diflucan, Lamisil – used only in older children because of risk of hepatoxicity
Teaching
transmitted by clothing, bedding, combs and animals (cats)
may take 1-3 months to heal completely, even with treatment
Child doesn't return to school until lesions dry.
See Home Care for Child with Tinea infection on
page 1347.
Pediculosis
Lice infestation
Pediculosis Capitis (lice or cooties!)
a parasitic skin disorder caused by lice the lice lay eggs which look like white flecks, attached
firmly to base of the hair shaft, causing intense pruritus
Lice assessment
Close examination of scalp reveals (nits) firmly attached to hair shafts.
Easily transmitted by clothing towels, combs, close contact, unrelated to hygiene.
Goals of Care
Treatment and Nursing Care
pediculicide, permethrin (NIX) crème rinse Applied to washed and towel dried hair. Massage
into the hair and scalp one section at a time.
**Wet hair dilutes the product and may contribute to treatment failure.
Leave in place for 10 minutes and rinse Towel dry Comb hair with a fine-tooth comb to remove any
remaining nits. Repeat in 1-2 weeks
Treatment and Nursing Care
Ovide Approved for treatment in older children only. Must have prolong contact (8-10 hrs) to be effective
Lindane (Kwell) is no longer approved for treatment
Scabies
Mite infestation
Scabies
Sarcoptes scabei mite. Females are 0.3 to 0.4 mm long
and 0.25 to 0.35 mm wide. Males are slightly more than
half that size.
a parasitic skin disorder (stratum corneum- not living tissue) caused by a female mite.
The mite burrows into the skin depositing eggs and fecal material; between fingers, toes, palms, axillae
pruritic & grayish-brown, thread-like lesion
Scabies
Scabies is spread from person to person mainly by prolonged direct skin-to-skin contact, such as touching a person who has scabies. In rare cases, scabies can spread by contact with clothes, towels, bedding, and other personal items that were recently in contact with an infected person.
The mites live on human blood and need the warmth
of the human body to survive. Away from the body, they die within 48 hours.
Scabies
Scabies between thumb
and index finger
On foot
Therapeutic Interventions
transmitted by clothing, towels, close contact Diagnosis confirmed by demonstration from
skin scrapings. treatment: application of scabicide cream
which is left on for a specific number of hours (4 to 14)to kill mite
rash and itch will continue until stratum corneum is replace (2-3 weeks)
Care:
Fresh laundered linen and underclothing should be used.
Contacts should be reduced until treatment is completed.
DERMATITISInflammation of the skin that occurs in response to contact with an allergen or irritant
Dermatitis
Common Irritants Soap, fabric softeners, lotions, urine and stool
Common Allergens Poison ivy, Poison oak Lanolin Latex, rubber Nickel Fragrances
Dermatitis – Signs and Symptoms
ErythemaEdemaPururitusVesicles or bullae that rupture, ooze and
crust
Dermatitis - Treatment
Medications Application of a corticosteroid topical agent –
remind to continue use for 2-3 weeks after signs of healing
Application of protective barrier ointments
Oatmeal baths, Cool compresses Antihistamines given for sedative effect
Treatment of Dermatitis
EczemaChronic superficial skin disorder characterized
by intense pruritis
Eczema
Immune disorder of the skin
Influenced by genetic predisposition and external triggers
Tends to occur in children with hereditary allergic tendencies
Eczema – Signs and Symptoms
Erythematous patches with vesicles
Pruritus
Exudate and crusts
Drying and scaling
Lichenification (thickening of the skin)
Goal of Treatment
Hydrate the Skin
Reduce the amount of allergen exposure
Relieve Pruritis
Acne Acne
Inflammatory disease of the skin involving the sebaceous glands and hair follicles.
Acne- Three Main Types
ACNE
Comedomal- noninflammatory follicular plug
Papulopustular- papules and pustules
Cystic- nodules and cysts
Precipitating factors
Heredity
Hormonal influences
Emotional stress
Heat and Humidity
Patient Teaching
Do not pick! this increases the bacterial count on the surface of the skin and opens lesions to infection which worsens scarring.
Remind patients that the treatment will not show improvement until about 4-6 weeks but they must consistently follow the regime set up by the physician.
Medical Therapy for Acne
Topical: Benzoyl Peroxide, Tretinoin (RetinA), tetracycline and erythromycin. Topical agents are preferred treatment to systemic antibiotics, however increases in antibiotic resistant bacteria may require use of systemic antibiotics.
Oral: Tetracycline, minocycline, erythromycin and clindamycin- used for severe inflammatory acne or resistant to topical medications. Estrogen may also work for female patients. Isotretinoin (Accutane)- side effects include cataracts, dry skin, pruritius, conjunctivitis, nosebleeds and depression. Also a teratogen!
Acne – Nursing Care
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