Dermatologic Conditions

Question 1

What aggravates most skin rashes?

Answer 1

Heat aggravates most skin rashes and increases pruritus (itching); coolness decreases pruritus.

Question 2

Macular rash

Answer 2

a flat rash with color changes in circumscribed areas

Question 3

Papular rash

Answer 3

raised small solid lesions with color changes in circumscribed ares

Question 4

Vesicular rash

Answer 4

small, raised circumscribed lesions filled with clear fluid

Question 5

Urticaria

Answer 5

also known as hives and may accompany other symptoms of allergy

Question 6

erythema

Answer 6

redness

Question 7

Interventions for rashes

Answer 7

1. Apply cool, soothing soaks, give baths with added baking soda, or dab site with calamine lotion.
2. Administer antipruritics; give antihistamines if the rash is from an allergy.
3. Distract the child and provide projects that make use of the hands.
4. Keep the affected area clean and pat it dry; expose the affected area to air.
5. Do not apply powder or cornstarch, as they encourage bacterial growth.
6. Do not use commercially prepared diaper wipes on broken skin unless they are alcohol free, as they will irritate and burn.
7. Apply moisturizer to wet skin.
8. Prevent the spread of infection.
a. Teach good hand washing.
b. Keep weeping lesions covered.
c. Teach the child to not share combs or hats and not to scratch.
9. Prevent secondary infections by cutting nails and applying mittens/restraints if needed.
10. Suggest light, loose, nonirritating clothing, such as cotton.
11. A humidifier in the home may improve dry skin.

Question 8

Contact Dermatitis

Diaper Rash

Overview

Answer 8

1. Related to moist, warm environment within the plastic diaper lining.
2. May be caused by clothing dyes or soaps used to wash diapers.
3. May be caused by body soaps, bubble baths, tight clothes, and wool or rough clothing.
   a. Limit soaps.
4. Skin may be further irritated by acidic urine and stool or the formation of ammonia in the diaper.

Question 9

Contact Dermatitis

Diaper Rash

Interventions

Answer 9

1. Keep the diaper area clean and dry.
   a. Change the diaper immediately after voiding/stools.
   b. Wash the area with mild soap and water.
2. Keep the area open to air, if possible.
3. Apply vitamin A and D skin cream or other creams for diaper rash to help skin heal.

Question 10

Contact Dermatitis

Poison Ivy

Overview

Answer 10

1. Poisonous oil on the plant leaf causes a delayed hypersensitivity (T-cell) response; trauma to the leaves releases the sap, which is dragged across the skin.
2. The rash appears 5 to 21 days after the first exposure but 1 to 2 days after subsequent contact.
3. Oils that remain on the clothes and skin are contagious to others; the eruptions are not a source of infection and will not spread the disease.
4. Animals may carry the oils to humans.

Question 11

Contact Dermatitis

Poinson Ivy

Assessment

Answer 11

1. Assess for pruritus.
2. Observe for red, localized streaks that preced vesicles; vesicles break and fluid crusts.

Question 12

Contact Dermatitis

Poinson Ivy

Interventions

Answer 12

1. Wash the oils from the skin with soap and water as soon as possible after contact to prevent absorption through the skin.
2. Do not touch other body parts until the area has been cleansed.
3. Carefully wash resin out of clothes.
4. Apply calamine lotiona dn admin anihistamines, if ordered.
5. Prevent secondary infection from scratching.

Question 13

Impetigo

Overview

Answer 13

1. A superficial infection of the skin caused by group A β-hemolytic streptococci; may also be due to staphylococci
2. Highly contagious until all lesions are healed
   a. The infection is spread by direct contact.
   b. The incubation period is 2 to 5 days after contact.
3. Commonly seen on the face and extremities, but may be spread on other parts of the body by scratching.
4. Can be spread by biting and stinging insects
5. Common in children ages 2 to 5 years

Question 14

Impetigo

Assessment

Answer 14

1. Assess for a macular rash that progresses to a papular and vesicular rash, which oozes and forms a moist, honey-colored crust.
2. Assess for puritis.
3. Ask about bug bites.
4. Ask about others who may have the same rash.

Question 15

Impetigo

Interventions

Answer 15

1. Apply moist soaks to soften the lesions; remove the crusts gently three to four times a day and wash the area.
2. Cover the child’s hands, if necessary to prevent secondary infection; cut the child’s nails.
3. Cover the lesions to prevent their spread.
4. Administer antibiotics for their full course.
5. Explain the finectious nature of the condition to parents.
   a. Patient should use separate towels and linens.

Question 16

Cutaneous Fungal Infections/Ringworm

Tinea Corporis

Overview

Answer 16

Overview:
1. Tinea refers to an infection by a fungus.
2. Tinea corporis or ringworm involves the trunk, extremities, and groin.’

Assessment:
a. Can be transferred from other body parts or from household contacts or from animals
b. May have one or more lesions
1. Lesions may be annular (ring shaped)
2. Annular, scaling erythematous plaques with sharply marginated, indurated, and hyperkeratotic borders.
3. Center of the ring may be clear.
4. Ring may consist of vesicles.

Interventions:
Apply antifungal medications. Creams should be applied to the lesion and the surrounding skin, since this fungus spreads outward.

Question 17

Cutaneous Fungal Infections/Ringworm

Tinea Capitis

Answer 17

Overview:
Tinea capitis involves the scalp hair.
a. Common in school-age children
b. Transmitted by personal contact and occasionally by pets

Assessment:
Scaling scalp or patchy hair loss.
a. Organism invades the hair shaft; hair breaks off in affected area causing spotty areas of alopecia.
b. It spreads in a circular pattern.

Interventions:
  a. Apply oral and topical antifungal medications. 
	b. Shampoo with Selsun Blue; have all household contacts do the same.
	c. Clean all contaminated objects to prevent reinfeciton.

Question 18

Cutaneous Fungal Infections/Ringworm

Tinea Cruris

Answer 18

Overview:
Tinea cruris is “jock itch”; it is not contagious to others.

Assessment:
In crural folds of the groin
a. Itching increases when child has been sweating after exercise or on warm days.
b. Inflammation occurs with continued wearing of occlusive clothing.

Interventions:
  a. Apply antifungal powders, creams, or lotions.
	b. Avoid tight-fitting clothing; wear loose underwear instead of briefs.
	c. Change underwear often, especially when hot and sweaty.
	d. Shower after exercise and then apply the antifungal preparation.
	e. Avoid storing damp clothing in a locker or gym bag; wash clothes after each wearing to avoid reinfection.

Question 19

Cutaneous Fungal Infections/Ringworm

Tinea Pedis

Answer 19

Overview:
Tinea pedis is “athlete’s foot”.

Assessment:
Usually is interdigital
a. Itching or pain in affected area.
b. May have fissures between toes with underlying erythematous skin that may weep.

Interventions:
  a. Wear shoes while showering in public facilities to prevent spread.
	b. Apply antifungal cream, powder, or spray.

Question 20

Pediculosis/Lice

Answer 20

Children do not need to stay out of school due to lice; they do not cause disease and are not contagious if contact is prevented.

Question 20

Scabies

Answer 20

Overview:
eggs hatch over 30 days (the incubation is 1-2 months)

Assessment:
intense itching, worse at night

Interventions:
1. Application of scabicide (Elimite) is applied to areas below the neck and leave on for 8 to 12 hours; then wash off.
2. Household contacts should also be treated.
3. Wash all clothing and linens in hot cycle; if articles cannot be washed, seal in a plastic bag for 3 weeks.

Question 21

Acne

Answer 21

1. Wash the face twice daily with soap and water.
2. Apply topical benzoyl peroxide; oral antibiotics may be recommended.
3. Accutane (isotrentinoin), female patients need a pregnancy test and both males and females need to be celebate while on this medication due to its extreme teratogenic properties.

Question 22

Burns

Overview

Answer 22

1. Most pediatric burns occur in children under age 5.
2. Burns are the third largest cause of accidental death in children, after motor vehicle accidents and drowning.
3. Under age 3, most burns result from contact with hot liquids or electricity.
4. Older children are most commonly burned by flames.
5. The rule of nines has proved inaccurate for children because the head can account for 13% to 19% of body surface area; the legs account for 10% to 16%, depending on the age and size of the child.

Question 23

Burns

Assessment

Answer 23

**1. Assess for first-degree burn
a. dry, painful, red skin with edema
b. looks like sunburn
2. Assess for second-degree burn
a. moist weeping blisters with edema
b. very painful
3. Asses for third-degree burns
a. dry, pale, leathery skin
b. avascular without blanching or pain
4. Assess for fluid shift from intravascular to interstitial compartments.
5. assess for hypovolemia & symptoms of shock from fluid shift, including renal function.
6. Assess for infection due to altered skin integrity.
7. Assess for diuresis 2 to 5 days after the burn, as fluid shifts back.

Question 24

Stevens Johnson Syndrome | Overview

Answer 24

1. Cause unknown; **medications (especially antibiotics and sulfa drugs) and infections can initiate it**; thought to be hypersensitivity complex affecting skin and mucous membranes. 2. Cell deth causes epidermis to separate from the dermis; considered to be a dermatologic emergency.

Question 25

Stevens Johnson Syndrome | Assessment

Answer 25

1. Symptoms start with fever, sore throat, and fatigue. 2. Ulcers and other lesions appear on mouth and lips and can occur in genital and anal regions, and conjunctiva; they may interfere with eating. 3. A painful red or purplish rash develops throughout the body; the rash blisters cause the top layer of skin to die and shed.

Question 26

Stevens Johnson Syndrome | Interventions

Answer 26

1. **All medications will be dicontinued,** except those to treat mycoplasma infeciton. 2. Treat similar to burn patients: IV fluids, nasogastric or parenteral feedings, **analgesic mouth rinse (magic mouthwash) for mouth ulcers.** 3. Prevent sepsis. 4. **Attention to eye care, via lubrication, will prevent eye damage and potential blindness.** 5. Skin care; cool moist saline compresses and topical anesthetics.

Question 27

Infection of piercing

Answer 27

**Do not remove jewelry as this will result in an abscess; treat infection with the jewelry still in**

Question 28

Braden QD Scale

Answer 28

Used to assess risk of both immobility and device-related pressure injury in pediatric patients. 1. Measures intensity and duration of pressure (mobility, activity, sensory perception) and tolerance of skin and supporting structures (moisture, friction, nutrition, and tissue perfusion and oxygenation).

Question 29

Stevens Johnson Syndrome is most commonly...

Answer 29

a reaction to a drug (most commonly penicillins, anticonvulsants, or non-steroidal anti-inflammatory drugs). It can also be caused by an infection (e.g., herpes, influenza, HIV) or physical stimuli (radiation therapy). Treatment is to discontinue the offending drug immediately, apply moist wound healing dressings as used in burn care, and apply eye lubrication to decrease dryness and the chance of vision loss. There is no indication to examine the urine for catecholamines. The lesions are painful, not pruritic.

Question 30

You are a primary care nurse caring for a child with small, localized area of tinea corporis (ring worm) on his leg. His mother wants to know how to treat it. You correctly tell her: a. Apply antifungal cream twice daily. b. Take antifungal oral medication twice daily. c. There is no treatment for ring worm; it goes away in 7-10 days. d. Apply corticosteroid cream twice daily for 10 days.

Answer 30

a Ring worm is treated first with an OTC antifungal cream. If the cream is not effective, an oral anti-fungal may be prescribed. Ring worm needs to be treated to prevent worsening and potential development of bacterial super-infection. Corticosteroids are not used to treat ring worm.

Question 31

When educating the parents of a toddler with scabies, the nurse correctly teaches the parents to: a. Give antibiotics twice a day for 10 days as ordered. b. Apply scabicide cream to all skin areas below the neck and wash off after 8-12 hours. Then repeat one week later. c. Apply scabicide cream to affected areas twice per day. d. Give scabicide oral medication twice daily for 10 days.

Answer 31

b Treatment for scabies is the application of a scabicide cream applied on all skin surfaces below the neck and leaving on for 8-12 hours and repeating one week later to assure treatment. Scabies is not treated with any type of oral medication.

Question 32

You are caring for a school-age child with Stevens-Johnson syndrome. Which of the following would be anticipated to be included in his care? a. Examine urine for catecholamines. b. Apply lubricant to eyes. c. Apply calamine lotion to the lesions. d. Administer antibiotics to treat the causative organism.

Answer 32

b Stevens-Johnson syndrome is most commonly a reaction to a drug (most commonly penicillins, anticonvulsants, or non-steroidal anti-inflammatory drugs). It can also be caused by an infection (e.g., herpes, influenza, HIV) or physical stimuli (e.g., radiation therapy). Treatment for Stevens-Johnson syndrome is to discontinue the offending drug immediately, apply moist wound healing dressings as used in burn care, and apply eye lubrication to decrease dryness and the chance of vision loss. There is no indication to examine the urine for catecholamines. The lesions are painful, not pruritic (itchy).

Question 33

The nurse is preparing an in-service on pressure injury prevention. The most common cause of pressure injuries in infants and young children is due to: a. Pressure to the back of the head from immobility after trauma. b. Pressure from medical devices. c. Pressure to the coccyx from immobility. d. Breakdown from excessive moisture to the axillary area.

Answer 33

b Most pressure injuries infants and young children have are due to medical devices.