Peds Integumenary

NURSING MANAGEMENT

  • The key areas to focus on are:

    • PROMOTE skin integrity.

    • PREVENT infection.

    • PROVIDE comfort.

    • EDUCATE families and patients regarding care.

INFLAMMATORY SKIN CONDITIONS
ATOPIC DERMATITIS (ECZEMA)

  • S/S:

    • Very dry skin, erythematous patches particularly around the cheeks and skin folds, and extreme pruritus.

    • Lichenification: Thickening of the skin at areas of chronic eczema.

  • Treatment:

    • Avoid triggers, maintain skin hydration with emollients, and use topical steroids as needed.

  • Education:

    • Instruct regarding medication usage, trigger management, and prevention of secondary infections.

    • Chronic hypersensitivity disorder associated with IgE sensitization is emphasized.

ANIMAL BITES

ASSESSMENT:

  • Inquire about:

    • Type of animal (wild or domestic).

    • Timing of the bite.

    • Provocation of the animal.

    • The vaccination history of the animal.

TREATMENT:

  • Clean and irrigate the wound, administer PO antibiotics, offer analgesics, and consider the tetanus vaccine as needed. Monitor for signs and symptoms of infection.

PREVENTION:

  • Preventative measures include:

    • Never leaving young children alone with animals.

    • Teaching children not to engage in rough play with animals and being cautious with unknown dogs, always asking permission to pet them.

    • Approaching dogs with a closed fist initially for them to sniff.

PEDIATRIC BURNS
TYPES OF BURNS:

  • THERMAL (SCALDING BURNS):

    • Examples include pulling a hot pan off the stove, immersion in hot bath water, or touching hot objects.

  • CHEMICAL:

    • Result from contact with household cleaning agents.

  • AIRWAY/INHALATION:

    • Caused by exposure to heat, smoke, or chemicals.

CLASSIFICATION OF BURNS:

  • Superficial: Only affects the epidermis.

  • Partial Thickness: Involves both the epidermis and portions of the dermis.

  • Deep Partial Thickness: Extends deeper into the dermis.

  • Full Thickness: Affects the epidermis, dermis, and hypodermis.

  • Developmental Consideration: The cause of injury often correlates with the child's developmental level. Consider potential abuse if a distinct pattern exists.

CRITERIA FOR BURN CENTER ADMISSION:

  • Partial-thickness burns affecting over 10%10\% of BSA.

  • Burns involving the face, hands, feet, joints, or genitalia.

  • Full-thickness burns in children of any age.

  • Inhalation injury, regardless of burn type.

  • Complex recovery potential due to pre-existing medical conditions.

  • Chemical burns, electrical burns, and suspected child abuse should also be concerns for admission.

NURSING INTERVENTIONS FOR PEDIATRIC BURNS:

  • Promote oxygenation and ventilation.

  • Restore and maintain fluid volume.

  • Maintain normal body temperature.

  • Provide pain relief.

  • Ensure adequate nutrition for healing.

  • Promote wound healing while preventing infection.

  • Preserve skin integrity and offer psychosocial support.

PREVENTING PEDIATRIC BURNS:

  • Keep the hot water heater set to 120°F120\degree F (48.9°C48.9\degree C) or lower.

  • Monitor the temperature of bath water before use.

  • Keep hot liquids and hot beverages out of children's reach.

  • Position pots and pans on the back burner of the stove with handles turned towards the back.

  • Never leave children unattended near heat sources such as the stove or oven.

  • Secure matches, lighters, and cleaning products to prevent access by children.

  • Look for frayed electrical wires and cover outlets, teaching children safety near electricity.

  • Have a fire escape plan and train older children to "stop, drop, and roll" in case of fire.