February 28, 2020

Nursing care of Children with Skin Infections Integumentary System Changes

New born Skin
- Skin is very thin

- Epidermis is loosely bound to the dermis

- Eccrine sweat glands function, product sweat

and respond to heat and emotional stimuli

- Aprocine sweat glands are small and

nonfunctional

- Less melanin is present at birth so skin is lighter

Adolescent
- skin thickens

- Epidermis and derm is are tightly bound

increasing resistance to infection and irritation

- Eccrine sweat glands achieve full function

- Apocrine sweat glands mature

- Melanin determines skin color and serve as

shield against ultra violet radiation

Skin Findings in Children that Suggest Illness

1. Central Bluish Color
Indication:

- Cyanosis from decrease respiratory function or

cyanotic heart disease.

Skin Anatomy
- Acrocyanosis (blue hands and feet) is normal in
newborn for first 48 hours

2. White Color
- edema accumulated subcutaneous fluid is
stretching the skin

3. Pale Color
- Anemia a decrease circulation to body part

4. Reddened areas
- local inflammation or increase systemic
temperature
5. Linear Abrasion
- Scratch marks from local irritation from an
insect bite or allergic reaction

6. Ecchymosis (black and blue marks)

- main function: protect - Recent injury to the skin

- Largest organ of the body

7. Petechiae (pinpoint blood marks)
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- Blood dyscrasia (poor clotting ability)
Secondary Skin Lesions
8. Yellow color 1. Scale - heaped-up, horny layer of dead epidermis;
may develop as a result of inflammatory changes
- Jaundice from increase bilirubin in
becomes color black, dead skin cells

subcutaneous tissue; carotenemia (excess

carotene in the skin)
2. Crust- covering formed by the drying of serum,
blood, or pus on the skin

9. Moistures
- Excess perspiration from elevated temperature
3. Excoriation - linear scratch marks or traumatized
areas of skin. Involves second layer of skin. Ex. butas
10. Localized cold temperature kapag nagprick ng pimple

- Decreased circulation to particular body part

4. Fissure - cracks in the skin, usually from marked
drying and longstanding inflammation

11. Warm Temperature

5. Ulcer - lesion formed by local destruction of the
- Local irritation or elevated systemic temperature
epidermis and by any part or all of the underlying
12. Poor Turgor dermis Ex. Singaw

- Dehydration
6. Lichenification - thickening of the skin accompanied
by accentuation of skin markings.

13. Rash
7. Scar - new formation of connective tissue that
- Infectious childhood illness, excessive heat, replaces the loss of substance in the dermis as a
allergy
result of injury or disease. Second layer of skin is
involved

Skin Lesions 8. Burrow – a narrow, raised irregular channel caused

by a parasite ex. Scabis

Primary Skin Lesions

9. Comedone – a plug of sebaceous and keratin
1. Macule - is a flat circumscribed discoloration of skin; material in a follicle inner part ang may problem

may have any size or shape.

10. Erosion – loss of superficial epidermis; moist but

2. Papule - solid, elevated lesion less than 1 cm. wide does not bleed. Magaspang ang kamay

(0.4 in.)

11. Keloid – overdevelopment or hypertrophy of scar

3. Nodule - raised, solid lesion larger than 1 cm. wide that extent beyond wound edges and above skin due
(0.4 in.)
to excess colagen post-surgery
4. Vesicle - circumscribed elevated lesion less than 1 Assessment
cm that contains fluid

History:

5. Bulla - a vesicle or blister larger than 1 cm. wide

Chief Concern: Does child have a fever, general

6. Pustule - circumscribed raised lesion that contains malaise, vomiting, or diarrhea? Was child recently
pus; may form as a result of purulent changes in a exposed to someone with an infection?

vesicle. ex. Pimple

Past medical history: are child’s immunization current?

7. Wheal - elevation of the skin that lasts less than 24

hours. Caused by edema of the dermis; may be Physical Examination:
surrounded by erythema or blanching
Mouth: lesions on mucous membrane (Koplik’s spot);
8. Plaque - solid, elevated lesion on the skin or mucous White plaques on mucous membrane (thrush); pinpoint
membrane, larger than 1 cm. in its largest diameter, papule on an erythematous base (herpes simplex)

psoriasis is commonly manifested as plaques on the Skin: warm and dry from fever; rash present

skin; leukoplakia is an example of plaques on

mucous membranes
Pharynx: Reddened, swollen pharynx (infectious
mononucleosis, pharyngitis); Gray membrane in
9. Cyst- soft or firm mass in the skin, filled with pharynx (diphtheria)

semisolid or with liquid material contained in a sac.

Knees: circular, scaly ring (tinea corporis)

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Feet: Flesh-colored papule (plantar warf)
Infections of the Skin in Children
Head: Linear abrasions on scalp; sandlike particles on I. Bacterial Infection
hair shafts (pediculosis)

A. Staphyloccocal Infection – are normally found

Nose: Watery discharge (prodromal symptoms of on the skin

measles)

A.1 Furuncolosis (Boils) – infection of the hair

Parotid: Swollen parotid gland (mumps)
follicle

Hands/Fingers: oozing, honey-colored, crusty lesions Signs and Symptoms

of face & hands (impetigo); crusty lesions between 1. Localized redness

fingers (scabies)
2. Pain

3. Edema of the surrounding skin

History and Assessment

4. Yellow pustules forms at the site

C - haracter

L - ocation
A.2 Cellulitis – inflammation of the deeper
I - ntensity
layers of the skin

T - ime
Signs and Symptoms

A - associated factors
- Skin feels warm, edematous and reddened

A - ggravating factors

Treatment:

Integumentary Dysfunctions - systemic antibiotic

- warm soaks to relieve pain and inflammation

A. Seborrheic dermatitis

B. Atopic dermatitis
Causative Agent:
C. Infections of the Skin

• Streptococcus

D. Infestations

E. Drug Sensitivity Reactions

• Staphylococcus

A.3. Impetigo - superficial infection of the skin

Seborrheic dermatitis
Causative agent:

- common skin disease that causes an itchy rash with • Streptococcus(beta-hemolytic)-non-bollous

flaky scales; dandruff

• Staphyloccocus aureus (bollus)

Causes:

• Stress
Incubation Period: 2-5 days

• Genes

- Period of communicability from outbreak of

• Cold/dry weather

lesions until lesions are healed.

• Immune system response

Signs and Symptoms:

Who are at risk?

• Newborns
- Single papulovesicles become purulent, ooze
• Adults (30 to 60 y/o)
and form honey-colored crust

- Found most commonly on face and extremities

Atopic dermatitis (Secondary to insect bites)

- “atopic eczema”
Therapeutic Management:

- Inflammation of the skin that results in itchy, red, -Oral administration of penicilin or erythromycin

swollen and cracked skin

-Application of “mopurocin” (Bactroban)

Cause: Unknown
-Ointment for 7-10 days

Onset: Childhood

-Wash the crust daily with soap and water

-Observe contact precaution under 24 hrs. after

initiation of therapy

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II. Fungal Infections - Usually spare penis and scrotum

1. Oral Candidiasis (Thrust or Moniliasis) - Scalely erythematous eruption symmetric bilaterally

- acute condition in newborn acquired during Causative Agent:

birth from the vaginal canal of an infected

mother.
• Epidormophyton floccosum

• Trichophyton rubrum

- characterized by white patches that looks like

coagulated milk on the oral mucosa and may
bleed when removed.
Treatment:

- infant may refuse to feed because of discomfort

1. Local application of Clotrimazole or Econazole liquid
or powder

Treatment: 2. Wash body with sylenium sulfide shampoo

1. Oral nystatin suspension or clotrimazole applied 3. Decrease moisture and occlusion to area

to the mouth and tongue after feeding

2. Tinea pedis “athlete’s foot”

2. Fluconazole or Itraconazole for immuno
compromised patient
- Vesicles or erosion or instep or between toes (fissures
red scaly)

3. If severe, that it invades other body system, oral

fluconazole or IV of amphotericin B for 21 days
Signs and symptoms:
Nursing Management: - pruritic pinpoint vesicles

1. Educate parents to give oral medications to - fissuring especially the toes may occur

infants swab to apply suspension to the buccal - Dry scaly patches or plaques with mild
mucosa and tongue surface. Allow the infant to erythema on plantar surfaces of the foot

swallow remaining suspension

Causative Agent:

2. Older children should be told to swish the

• Trichophyton rubrum

solution around the mouth before swallowing

• Trichophyton Mentagrophytes

3. Prevent re-infection – use sterile nipples and

pacifiers

Treatment:
2. Dermatrophytores (Ring Worm) 1. Broad spectrum topical anti fungal agent that has
bacterial properties (econasol)

- Fungal infection that affects the skin, hair or

nails.
2. Keep feet dry with absorbent talc

- may be spread from person to person, animal to 3. Allow air to dry

person or by contact to with inanimate objects

4. Use 100% cotton socks, change twice daily

Kinds:
3. Tinea capitis (ring worm)
1. Tinea capitis - head
- begins in a single hair follicle but spreads rapidly in a
2. Tinea corporis - arms & legs
circular pattern to produce a lesion.

3. Tinea cruris - Jock itch

- mild itching

- course of disease may be 3 months

Superficial Fungal Infections seen in children: Causative Agent:

1. Tinea cruris “jock itch” • Trichophyton tonsurans

• Trichophyton violaceum

- occurs in the inner aspects of the thighs and may • Microsporum canis

spread to abdomen, buttocks, and upper thighs.

- it is pruritic
Treatment:

- Tinea crusis may have spread by hand to groin area

1. Griseofulvin given orally for 6-8 weeks or 2 weeks
after symptoms disappear

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2. Avoid strong sunlight during therapy- because of - occurs among children of all socio-economic levels

photosensitivity

- They live and reproduce only on humans

3. Not to exchange towels or combs though not very

contagious
- transmitted by direct hair-to-hair contact or indirect
contact such as sharing of accessories, brushes, hats,
4. Selenium sulfide shampoo 2-3 times weekly, leave towels and bedding.

on for 10 mins. before rinsing to help eliminate scalp

spores
- Lice crawls quickly. They do not fly or jump. Female
louse lays her eggs (nits) on the hair shaft, close to the
5. Alternative antifungal agents are flucunazole, scalp.

itraconazole

- Incubation period for eggs to hatch is 8-10 days

4. Tinea corporis
Clinical Manifestation

- involves the epidermal layer of the skin

1. Intense Pruritis

- pink scaly ring of inflammation with a clear area in the

center; anywhere of the body
2. Complaints of “dandruff” that sticks to the hair
and “bugs” in the hair

- usually acquired from contact with infected humans,

cats , dogs or horses
3. Secondary effects of scratching – inflammation,
pustules and bacterial infection

Causative agent:
• Trichophyton mentagrophytes
Treatment:

• Trichophyton rubrum
1. Pediculicide shampoo such as pyrethrum with
Treatment:
an enzymatic lice remover

1. Clotrimazole, Miconazole, ketonazole, topical cream 2. Omicidal sensi –pumethrin (nix) as a cream is
twice a day for 4 weeks
applied to washed and towel dried hair. It is
applied left in place for 10 mins and then rinsed.
2. Wash body with selenium sulfide shampoo
Nits are removed.

Diagnosis 3. Home remedies – Petroleum jelly caused

1. Microscopic examination of hair and scale significant louse mortality and allowed 6% of
scraping using potassium hydroxide wet mount eggs to hatch

– reveal rose and chains of spores

Nursing Management:
2. Fungal culture taken from scalp lesion
1. Assess children exposed using bright light and
3. Wood’s lamp – identify some form of tinea magnifying glass. Nits are silvery white, yellow darker –
fluoresce under ultra violet light
1 mm teardrops

- Trichophyton Tonsurans (cause of tinea 2. Tell parents not to return to school until after the
capitis) - does not fluoresce
pediculicide treatment is completed

Nursing Management 3. Tell parents that the shampoo are pesticide and
must be used for the time specified and as directed.

1. All members of the family and household pets should

be assessed
4. Use small – toothed comb, tweezers and basin filled
alcohol to dip then thou that adhere to the hair shaft
2. Sharing of hair accessories, brushes and hats should must be manually pulled.

be wash

5. Child’s bedding and clothing should be changed

3. Teach parents and older children that fungi are found daily, laundered in hot water with detergent and dried in
in soil and animals and are transmitted direct contact
hot dryer

6. Hair accessories, brushes and comb should be

discharged

III. Infestations
7. Vacuum furniture and carpets

1. Pediculosis capitis (head lice) – “Pediculusis

humanus capitis” Pediculosis capitis 

(head lice)

- Lice infestation of the hair and scalp

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2. Pediculosis cruris (pubic lice) treatment is completed. If they do, thorough
hand washing

*same signs and symptoms and treatment with

pediculosis capitis
4. Use of emmoliants because treatment dries the
skin

3. Scabies
5. Educate child and parents

- highly contagious infestation caused by “sarcoptes

scabies” female mites burrows into the outer layer of Drug Sensitivity Reaction
the epidermis (stratism corneum) to lay her eggs, - “Drug Rash”

leaving a trail of debris and feces.

- occurs up to eight weeks after first exposure to the

- spread by skin to skin contact
responsible drug

- all ages and both sexes can be affected

- Unexpected reaction to a medicine, which affects
- larvae hatch in 2-4days and proceed toward the several organ systems at the same time

surfaces of the skin and repeated every 14-17days.

Clinical Manifestation:
Signs and Symptoms
- High fever

- Extensive skin rash

1. Intense pruritus and irritation – 1 month after

infestation to hypersensitivity to the ova and mite - Organ involvement

feces.

Treatment:
2. Lesions are located at the web of fingers, intergluteal
- Topical corticosteroids

folds, around the axilla, palms, wrist, head and neck.

Rashes with various types of lesions and pruritus - Emmollients

worsen at night.
- Oral antihistamines

Diagnosis
Nursing Diagnosis and Related Interventions
- Examination under microscope of scrapings from a
burrow – reveals actively moving mites, fecal pellets, I. Pain related to pruritus from skin lesions
eggs or nits
(Pruritus is a form of minimal pain)

Treatment

Outcome Evaluation:

1. Application of scabicides such as 5% perimetrine

- Child states he is more comfortable: not scratching

lotion (Elimite) or malathione (Ovide) over the entire

body. Scalp and forehead only in infant plus face in Intervention:

older children

1. Analgesic – acetaminophen

2. Precipitated sulfur in petroleum for 3 successive

nights. For infants under 2 months – not toxic, but it 2. Antihistamine – Diphenhydramine hydrochloride
is maladorous, messy and stains the bedding and (Benadryl)

clothings – unpopular to parent

3. Calamine Lotion – nonprescription lotion that is

3. Second treatment is use 1 week later
cooling and soothing

4. Itching may persist 1-2 weeks after treatment, 4. Colloidal Bath (Baking Soda) or oatmeal (1 cup to 3
antihistamine maybe prescribed.
inches of water)

5. Antibiotic for secondary infection

- use luke warm water not hot. It increases sensation
of itching

Nursing Management

5. Dress child with light cotton – Remove whool

1. Clothing, bedding and pillow case used should blankets

be changed daily, washed with hot water

6. Cut child’s fingernail short

2. Non-washable toys should be sealed in plastic

bags for 5-7 days
7. Putting cotton gloves at night

3. Family members who are not infected should 8. Offer adequate fluid. Dry skin increases discomfort

avoid touching the affected child until after

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II. Social Isolation related to required activity
restriction associated with precautions to prevent
disease transmission.
Outcome Evaluation:
Child states reason for restriction

Rationale:
Isolation is associated to punishment.

Intervention:

1. Make few trips in and out of the room to limit

pathogen spread but do not make visits seem
hurried.

2. Use time to read a story play card etc.

3. If hospital requires transmission – based infection

control precaution, parents should follow.

J. Cal N2C