Alterations in Child 's Fluid & Electrolyte & Skin

Question 1

Pediatric Concerns: Fluid Balance

Answer 1

Have proportionately greater amount of body water than adults

Question 2

Isotonic Dehydration

Question 3

Hypotonic Dehydration

Question 4

Hypertonic Dehydration

Question 5

Signs of Dehydration

Answer 5

Dry skin, mucous membrane

Poor turgor

Sunken fontanelle

Poor perfusion

Weight loss

Tachycardia

Tachypnea

High urine specific gravity

Question 6

Clinical Measurement

Answer 6

Daily weights
1kg change=1000ml of change

Wt loss indication of dehydration

5% loss = mild
- Irritable
- Vitals normal
- Skin & fontanelle normal
- Mucous membranes may be dry
- Urine may be low

6-9% loss = moderate

10% or more loss = severe (Shock)
- Lethargic: Comatose
- Low BP
- Increased HR

Question 7

Nursing Care for Extracellular Fluid Volume Deficit

Answer 7

Prevent dehydration

Close assessment

Daily weights

Strict I & Os

Oral rehydration therapy

IV Therapy

Family teaching

Question 8

Differences Between Infant Skin & Adult Skin

Answer 8

Thinner
Loss heat more readily
Contains more water
Bacteria can access easier
Infants are less pigmented placing the infant at risk of skin damage from UV radiation

Question 9

Differences in Dark-Skinned Children

Answer 9

Children tend to have more pronounced cutaneous reaction.

Hypopigmentation or hyperpigmentation can affect areas of healing.

Dark- skinned children tend to have more prominent papules, follicular responses, lichentification, vesicular or bullous reactions.

Hypertrophic scaring and keloid formation occurs more often

Question 10

Causes of Integumentary Disorders

Answer 10

Exposures to infectious microorganisms
Hypersensitivity reactions
Hormonal influences
Genetic predisposition
Injuries

Question 11

Macule

Answer 11

Not-raised

Question 12

Papule

Answer 12

Raised bump

Question 13

Annular

Answer 13

Circular

Question 14

Pruritus

Answer 14

Itching

Question 15

Vesicle/ Pustule

Answer 15

Bump that contains pus

Question 16

Scaling/ Plaques

Question 17

Hypopigmentation

Question 18

Hyperprigmentation

Question 19

Erythematous

Answer 19

Reddening of the skin

Question 20

Integumentary Assessment

Answer 20

Health History
- Determine the chief complaint
- Document HPI, location, duration, characteristics
- Note the child’s general health & discuss recent changes

Physical exam
- Perform complete exam noting any abnormalities

Lab Testing
- Used to help diagnose a disorder
- Most Common:

Question 21

Impetigo

Answer 21

Bacterial infection

Common in summer

Epidermal, contagious
Staph or Strep
Most common sites
- Face, mouth, hands
Vesicles, pustules and redness
Nursing care
- Removal of yellow crust.
- Antibiotics
-Hygiene

Question 22

Folliculitis

Answer 22

Infection of the hair follicle

Occurs due to poor hygiene, contact with contaminated water, maceration, moist environment, or use of occlusive emollient products.

Treatment
- Aggressive hygiene and warm compression
-Topical Mupirocin and occasionally oral antibiotics

Question 23

Cellulitis

Answer 23

Localized infection and inflammation of the skin

The bacteria may gain entry to he skin via an abrasion, laceration , insect bite, foreign body, or impetiginous lesion.

Treatment- Mild cases are treated with Cephalexin or Augmentin
-More severe cases or orbital cellulitis requires IV management

Question 24

Risk Factors for MRSA

Answer 24

Turf burns
Towel sharing
Participation in team sports
Attendance at daycare or outdoor camps

Question 25

Tinea Capitis

Answer 25

Fungal infection affecting the scalp

Question 26

Tinea Cruris

Answer 26

Fungal infection affecting the groin

Question 27

Tinea Pedis

Answer 27

Fungal infection affecting the feet

Question 28

Tinea Corporis

Answer 28

Affecting any other parts of the body

Question 29

Tinea vesicolor

Answer 29

Presents differently, hypopigmented lesions on upper body due to fungal infection

Question 30

Oral Candidiasis

Answer 30

Sources:
- Breastfedding infant
- Corticosteroids
- Antibiotics
- Immunocompromised

Treatment:
- Nystatin or Clotrimazole (adult)

Nursing Care:
- Boil pacifier, bottles, nipples
- Apply med w/ swab or swish and swallow

Question 31

Dermatophytoses

Answer 31

Common sites
-Hand, skin and nails
Dry scaly patches
-May be circular
-Immunocompromised

Treatment
-Keep area cleana and dry
-Oral anti-fungals such as Griseofulvin.
-Check pets and family members for infection

Question 32

Acne Vulgaris

Answer 32

Affects about 85% of adolescents between the ages of 7-16

This occurs most frequently on the face, chest and back.

Risk factors include pre or adolescent age, male gender( due to androgens), and oily conplexion.

Management
-Focuses on reduction of propionbacteriem acne, sebum production, normalizing skin shedding, and elimination inflammation.
- Meds- benzoyl peroxide, salicylic acid, retinoids, and topical or oral antibiotics

Question 33

Atopic Dermatitis

Answer 33

Genetic Immune disorder

Erythematous patches
- Vesicles , crusts
- Pruritus

Nursing care
-Wet dressings for oozing
- Occlusive for moisture
-Assess environment
- Meds- antihistamine, corticosteriods, antibiotics,
immunomodulators

Question 34

Contact Dermatitis

Answer 34

Causes
Antigenic substance exposure
Allergy to nickle or cobalt in clothing, hardware, or dyes
Exposure to highly allergenic plants; poison ivy, oak, and sumac

Complications
Secondary bacterial infections
Licenification or hyperpigmentation
- Meds- antihistamine, corticosteriods, antibiotics,

Question 35

Diaper Dermatitis

Answer 35

Inflammatory reaction of the skin in the diaper area.

This is a non-immunologic response to a skin irritant
- Prolonged exposure to urine and feces may lead to skin breakdown.

Nursing care
-Prevention is the best management
-Frequent diaper changes
- Topical agents such as vitamins A,D and E; zinc oxide, nystatin, or petrolatum

Question 36

Seborrheic Dermatitis

Answer 36

Inflammatory dermatitis that may occur to the skin or scalp.

In infants it occur most often to the scalp and it is called Cradle cap
- This usually resolves over weeks or months
- In adolescents it usually develops on the scalp, eyebrows, eyelashes, behind the ears, and between the shoulder blades.

Nursing care
- Meds-antidandruff shampoo containing selenium sulfate, ketoconazole, corticosteroids

Question 37

Pediculosis

Answer 37

Transmitted from human hair

Nits are attached to shaft

Nursing Management
-Assess with bright light and magnifying glass
-Nit removal/pediculocide shampoo
-Prevention/ envirnmental

Question 38

Scabies

Answer 38

Transmitted skin/skin
Mite burrows in epidermis
Papules, pustules, burrows
Pruitus

Nursing Management
-Scabicide lotion
-Prevention/ environmental

Question 39

Erythema Multiforme

Answer 39

This a acute, self limiting hypersensitivity reaction.
It may occur in response to a viral infections, such as Adenovirus or Epstein- Barr virus;Mycoplasma pneumoniae infection; or a drug( sulfa drug, penicillins or immunizations) or food reaction

Stevens- Johnson syndrome and toxic epidermal necrolysis are the most severe form of erythema multiforme

Nursing care
-Management is generally supportive care because it resolves on its own

Question 40

What is the 3rd leading cause of accidental death of children in U.S. ?

Answer 40

Burns

Question 41

High Risk Groups for Burns

Answer 41

Children under 4 years.
Working males
Elderly over 70 years

Question 42

Burn Assessment

Answer 42

Risks Associated with Age.

Infant: thermal burns
-Accident or abuse.

Toddler : thermal, electrical, contact.
-Exploration of environment

Preschool : scalding, contact
-Hot appliances

School- Age and Adolescent: All Types
-Experimentation

In children the head is greater in proportion to other body parts or surface area and children have greater proportion
- The head proportion decreases as they grow

Question 43

Locations of Burns & Factors

Answer 43

Head and neck-smoke inhalation, lung damage, alteration in respirations.

Circumferential- circular occlusion of chest or extremity.

Electrical - causes deep damage, electrical conduction can affect the heart.

Perineal-high risk of contamination

Question 44

1st Degree Burns

Answer 44

Superficial, Partial Thickness Loss

Epidermis only, quick healing, sunburn

Question 45

2nd Degree Burns

Answer 45

Partial Thickness Loss

Epidermis plus upper dermis, 10-14 day healing, very painful.

Question 46

3rd Degree Burns

Answer 46

Full Thickness Loss

All layers, no pain, grafting required, underlying structures affected, no pain because nerves are destroyed

Question 47

Intercellular Dehydration, Extracellular Edema – Hemovolemic Stage

Answer 47

Increase in capillary permeability

Plasma seeps into surrounding tissues, causing edema
- Occurs from time of burn, first 24 +hours after the burn.

Increased heart rate, decreased cardiac output.

Decrease in blood flow

Oliguria

Increase in epinephrine, ADH, and aldosterone

Fluid shifts from vascular to interstitial spaces, causing intracellular dehydration, and extracellular edema.

Increase HCT

Monitor VS, I &O’s, give IV fluids, encourage po fluids, give blood replacement as ordered.

Increased heart rate, decreased cardiac output.

Metabolic acidosis state

Question 48

Full Thickness Burn Care: Initial

Answer 48

Assess airway- HOB elevated, pulse ox.

Maintain fluids(third spacing can lead to hypovolemic shock)

Promote tissue perfusion- assess eschar carefully.

Control pain- medicate before all dressing changes

Prevent of infection-gown, gloves, mask

Question 49

Full Thickness Burn Care: Special Care Needs

Answer 49

Escharotomy

Debridement

Grafting
-Auto, Xeno, Homo

Eye, lip, hand damage

Perineal

Question 50

Full Thickness Burn Care: Later

Answer 50

Control Pain

Prevent Infection

Promote physical mobility

Moniter for GI aleratons

Ensure adequate nutrition and fluid balance

Provide anxiety management

Treat body- image issues.

Question 51

Restoring & Maintaining Fluid Volume: Burns

Answer 51

Fluid calculation based on the body surface area burned (Fig. 45.22)

Use of a crystalloid (Ringer’s lactate) during the first 24 hours; in smaller children, a small amount of dextrose may be added

Administration of most of the volume during the first 8 hours (amounts and timing of fluid volume resuscitation will vary from child to child)

Reassessment of the child and adjustment of the fluid rate accordingly; fluid requirements greatly decrease after 24 hours and should be adjusted to reflect this.

Administration of a colloid fluid later in therapy once capillary permeability is less of a concern

Monitoring of the child’s urine output as part of ongoing assessment of response to therapy, expecting at least 1 mL/kg/hr

Daily weights obtained at the same time each day (the best indicator of fluid volume status)

Monitoring of electrolyte levels (particularly sodium and potassium) for their return to normal levels

Question 52

Child-Abuse Burns

Answer 52

Inconsistent history given when caregivers are interviewed separately.

Delay in seeking treatment by caregiver.

Uniform appearance of the burn, with clear delineation of burned and nonburned area (as with a hot object applied to the skin).

In the case of a scald-induced burn, lack of spattering of water but evidence of the so-called “porcelain-contact sparing,” where the portion of the child’s skin that was in contact with the tub or sink is not burned (commonly seen with a forced immersion in extremely hot water used as punishment).

Flexor-sparing burns or burns that involve the dorsum of the hand.

A stocking/glove pattern on the hands or feet (circumferential ring appearing around the extremity, resulting from a caregiver forcefully holding the child under extremely hot water)