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

http://www.ecureme.com/quicksearch_reference.asp

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

THE END