1. The Child with an Integumentary Disorder/Communicable Disease
Chapter 41:
The Child with an Integumentary Disorder/Communicable Disease

2. Growth and Development of the Integumentary and Immune Systems
The integumentary system, including the accessory structures, is in place at birth and matures as the child grows.
Protecting the body from attacks from microorganisms and helping the body get rid of or resist invasion by foreign materials are the major roles of the immune system.
The immune system matures and develops as the child progresses through childhood.
Mother antibodies cross over the placenta and decrease over the first year aiding the infant with temporary immunuity

3. Integumentary Disorders
Seborrheic dermatitis is known as cradle cap. It appears as yellowish, scaly crusted patches on the scalp and can usually be prevented by daily washing of hair and scalp.
In the child with Miliaria rubra, a rash appears as pinhead-sized erythematous (reddened) papules and usually causes itching. Treatment is primarily preventive by not overdressing, especially in warm weather.

4. Integumentary Disorders
C. albicans is the causative agent for thrush and some cases of diaper rash. It appears as a white coating in the child's mouth and is treated with nystatin.
Skin infections caused by S. aureus are prevented by using good hand washing and following transmission precautions. Methicillin-resistant S. aureus (MRSA) is resistant to the antibiotics used to kill the bacterium.

5. Question
What integumentary disease is commonly known as cradle cap? a. Diaper rash b. Seborrheic dermatitis c. Miliaria rubra d. Flail chest

6. Answer
b. Seborrheic dermatitis Rationale: Seborrheic dermatitis is commonly known as cradle cap.

7. Acne Vulgaris
Acne vulgaris is caused by a variety of factors, including increased hormonal levels, hereditary factors, irritation and irritating substances, and growth of anaerobic bacteria.
Treatment for mild acne is application of a topical medication, such as benzoyl peroxide (Clearasil, Benoxyl) and tretinoin (Retin-A), once or twice a day.
Antibiotics, such as erythromycin and tetracycline, may be administered for inflammatory acne.
Isotretinoin (Accutane) may be used for severe inflammatory acne.

8. Fungal Infections
These occur in various parts of the body and are treated by oral antifungal medications-Griseofulvin
Tinea Capitis (Ringworm of the Scalp) The most common cause is infection with Microsporum audouinii, which is transmitted from person to person through combs, towels, hats, or direct contact.
Tinea Corporis (Ringworm of the Body) usually contracts tinea corporis from contact with an infected dog or cat. The lesions appear as a scaly ring with clearing in the center, occurring on any part of the body.
Tinea pedis, ringworm of the feet, is more commonly known as athlete’s foot. It is evidenced by the scaling or cracking of the skin between the toes.
Tinea cruris, more commonly known as jock itch or ringworm of the inner thighs and inguinal area

9. Parasitic Infections
Pediculosis of the scalp is treated using nonprescription medications such as Pronto, RID, A-200, and permethrin (Nix).
After the hair is shampooed thoroughly and dried, it is combed with a fine-toothed comb dipped in warm white vinegar to remove remaining nits and nit shells.
For protection when treating a child in the hospital, wear a disposable gown, gloves, and head cover.
Scabies is a skin infestation and is treated with permethrin cream (Elimite) or lindane lotion.

10. Allergic Disorders
Hyposensitization is performed for the allergens that produce a positive reaction on skin testing.
The allergist sets up a schedule for injections in gradually increasing doses until a maintenance dose is reached.
Skin and plant allergies resulting in rashes are usually treated with topical preparations, such as lotions or ointments; antihistamines; and cool soaks to reduce the itching and swelling. In severe cases, oral corticosteroids may be used. If the allergen can be identified, preventing the allergic reaction by avoiding or removing it from the child's environment is the best treatment.

11. Atopic Dermatitis (Infantile Eczema)
Atopic dermatitis or infantile eczema is considered, at least in part, an allergic reaction to an irritant. Common allergens involved in eczema are foods, inhalants, and materials.
Goals when caring for the child include preserving skin integrity, maintaining comfort, improving sleep patterns, maintaining good nutrition, and preventing infection of skin lesions.

12. Bites
All animal and human bites should be thoroughly cleaned and observed for signs of infection.
Spider bites can cause serious illness if untreated.
Tick bites can be prevented by wearing long pants, long- sleeved shirts, and using insect repellent when walking in the woods.
Snakebites demand immediate medical intervention.
Insect stings or bites can prove fatal to children who are sensitized, so immediate treatment is required if a child with sensitivity is bitten.

13. Burns
Superficial or first-degree burns occur when the epidermis is injured but there is no destruction of tissue or nerve endings.
Partial-thickness or second-degree burns occur when the epidermis and underlying dermis are both injured and devitalized or destroyed. Blistering usually occurs, as does an escape of body plasma.
With full-thickness or third-degree burns, the epidermis, dermis, and nerve endings are all destroyed. Pain is minimal, and there is no longer any barrier to infection or any remaining viable epithelial cells.

14. Burns (cont.)
Emergency treatment for burns involving small areas is the immediate application of cool compresses or cool water to burn areas to inhibit capillary permeability and thus suppress edema, blister formation, and tissue destruction.
For moderate burns, immersing a burned extremity in cool water alleviates pain and may prevent additional thermal injury.
In severe burns, the airway, breathing, and circulation must be observed and restored if necessary and the child transported to a medical facility for assessment.

15. Burns (cont.)
Hypovolemic shock is the major manifestation in the first 48 hours in massive burns.
Intense pain is seldom a major factor. Symptoms of shock are low blood pressure, rapid pulse, pallor, and considerable apprehension. Airway
As extracellular fluid pours into the burned area, it collects in enormous quantities, which dehydrates the body and causes the symptoms of shock to occur.

16. Burns (cont.)
Major causes of burns in children include hot liquids, fire, and electricity.
Nursing care for the child with a burn focuses on preventing infection, maintaining adequate nutrition, reducing pain, increasing mobility, and relieving anxiety as well as optimizing healing and decreasing complications to minimize permanent disability.

18. Sexually Transmitted Infections
Children infected after the neonatal period must be considered victims of sexual abuse until disproved. Severe or repeated cases of pelvic inflammatory disease (PID) or severe genital warts are warning signs that a girl should be tested for HIV.
Human papillomaviruses (HPV) is the most common sexually transmitted infection seen in the adolescent. Immunizations are given to males and females at age 11 or 12 to prevent HPV.
Gonorrhea is caused by the organism Neisseria gonorrhoeae. Chlamydia is caused by Chlamydia trachomatis. Genital herpes is caused by herpes simplex type 2. Syphilis is caused by T. pallidum.

19. Sexually Transmitted Diseases
The drug of choice to treat gonorrhea is ceftriaxone (Rocephin) followed by a week of oral azithromycin (Zithromax) or doxycycline (Vibramycin) to prevent an accompanying chlamydial infection.
Doxycycline or azithromycin is used to treat chlamydial infection.
Acyclovir (Zovirax) is useful in relieving or suppressing the symptoms of genital herpes.
Syphilis responds to one intramuscular injection of benzathine penicillin G; if the individual is sensitive to penicillin, oral doxycycline, tetracycline, or erythromycin can be administered.

20. Human Immunodeficiency Virus
The human immunodeficiency virus (HIV) is transmitted by contact with infected blood or sexual contact with an infected person.
Nursing care focuses on maintaining the highest level of wellness possible by preventing infection and the spread of the infection, maintaining skin integrity, minimizing pain, improving nutrition, alleviating social isolation, and diminishing a feeling of hopelessness.

21. Infectious Mononucleosis
Infectious mononucleosis (“mono”) is caused by the Epstein–Barr virus, which is one of the herpes virus groups.
The organism is transmitted through saliva, and treatment is symptomatic.

22. Communicable Diseases of Childhood
Modes of transmission of communicable diseases include droplet, direct or indirect contact with body fluids and discharges, and contaminated blood, food, or water.
Many communicable diseases can be prevented by immunization with vaccinations and the use of standard precautions.
See table 41-4

23. Communicable Diseases
Active immunity occurs when antibodies are formed after immunization with a vaccine.
Natural immunity is often genetically determined and gives a person a resistance to a pathogen.
Passive immunity occurs when a person who has been exposed to a certain disease is given antibodies that have been obtained from an immune person.

24. Nursing Interventions For Child With Communicable Disease
Nursing interventions for the child with a communicable disease are usually supportive.
Depending on the disease symptoms, the implementations might include providing rest, adequate nutrition and fluids, following transmission precautions, giving medications as appropriate, and offering comfort measures.