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Pediatrics 14

  1. Fungal Infections of Skin

      1. Moniliasis candidiasis (thrush)
        1. Etiology: fungus, candida albicans
        2. Pathophysiology: acquired via birthing process, antibiotics, inhaled steroids
        3. Findings
          1. white plaques on tongue, gums or buccal mucosa
          2. possible ulcerations in oral mucosa
          3. itching
        4. Management
          1. oral antifungals (swish and swallow) after feeding
          2. education on mouth rinsing after inhaled steroid
        5. Concern: may spread to groin, buttocks
      2. Tinea (ringworm) (illustration 1  illustration 2  illustration 3)
        1. Etiology: dermatophytes
        2. Pathophysiology
          1. transmitted person to person, animal contact, contact with contaminated fomites (nonliving "host")
          2. associated with poor hygiene, friction from tight clothing

    Kinds of tinea, findings, and management

          1. Concerns
            1. compliance, good hygiene
            2. contagion, teach client never share clothing/hair brushes
            3. overuse of OTC products, especially for feet

  2. Infestations

      1. Pediculosis (lice) (illustration 1illustration 2)
        1. Definition: lice infestation
        2. Etiology: pediculus humanus capitis (parasite)
        3. Pathophysiology:
          1. these lice live only on humans, are transmitted by direct and indirect contact
          2. types include: scalp (capitis), body (corporis), pubic area (pubis) and eyelashes
          3. all pierce skin and suck blood, with females laying eggs (nits) at the base of hair shaft
        4. Findings
          1. nits (tiny silvery or grayish-white specks) and pruritis
          2. with corporis, papular rose-colored dermatitis
        5. Management
          1. topical medicated shampoos or body ointments
          2. teach client to prevent recurrence and spread: wash clothes in hot water, no sharing of clothes or hair brushes
        6. Concern
          1. compliance and recurrence
          2. lindane (Kwell) shampoo is neurotoxic in children under five
          3. lice are highly contagious; in hospital, infested client requires contact isolation. For information on isolation see Lesson 2: Safety and Infection Control
      2. Scabies (itch mite) Scabies (illustration)
        1. Definition: mite infestation
        2. Etiology: mite (sarcoptes scabiei)
        3. Pathophysiology
          1. female mite burrows into epidermis, lays eggs
          2. mites, eggs and excrement all cause intense pruritis (due to histamine release)
        4. Findings
          1. pruritis, burrows (fine, grayish brown threadlike lines)
          2. papule like eczema in infants
        5. Management
          1. scabicide topicals, creams
          2. anti-steroidal
          3. wash clothes and bedding in hot water
          4. all persons in close contact with affected child will need treatment
    1. Temperature-Related Disorders

     

    1. Caused by cold
    1. Sunburn
    1. Burns
  3. Caused by cold
  4. Types:
    1. chilblain: skin (usually extremities) becomes red and swollen when it is intermittently exposed to cold temperatures
    2. frostbite: tissue damage when ice crystals form in tissue
  5. Findings
    1. chilblain: redness, edema of hands and feet, may burn or itch
    2. frostbite
      1. blanching, decreased sensation, mottled
      2. second degree (cold after rewarming): blisters and possible bulla
      3. third degree: cyanosis, mottling- then red with swelling, local necrosis, hemorrhagic vesicles
      4. fourth degree: complete necrosis, gangrene, loss of body part
    3. hypothermia: cooling of the body's core temperature to injurious levels (below 35 degrees Celsius)
  6. Management
    1. cover area immediately but NO massaging
    2. rewarm rapidly in 96 to 106 degrees Fahrenheit degree water
    3. give analgesics and sedatives for severe pain during rewarming
    4. hypothermia: heat lamps, immersion in water bath
  7. Sunburn
  8. Etiology: overexposure to ultraviolet light waves UVA (minor burning) UVB (tanning, burning, harmful effects)
  9. Factors influencing degree of burn
    1. genetic makeup and skin type
    2. season of year, altitude, time of day
    3. window or glass, light reflected by snow or water
    4. medications, underlying conditions, topical products
  10. Prevention
    1. avoid sun
    2. wear good clothing and eye wear
    3. apply child appropriate topical sunscreens and blocks liberally
    4. no direct sun between 10 am to 3 pm
  11. Management: like a first degree burn (see next page)
    12.
  12. Burns
    1. Etiologies: thermal, chemical, electrical, secondary to irradiation; thermal types most common in children
    2. Pathophysiology
      1. severity affected by: location, concurrent inhalation injury, trauma, underlying condition, age of child
      2. anatomy and physiology of burns
        1. depth
          • amount of local tissue destroyed or damaged
          • related to length of exposure and temperature
        2. types: first, second, third, fourth degree (illustration)
          partial thickness: first and second degree
          full thickness: third and fourth degree
        3. fourth degree: involves muscle, fascia and bone. Wound appears dull and dry and ligaments, tendons and bone may be exposed.
        4. severity: classified as minor (<10% TBSA), moderate (10-20% TBSA) or uncomplicated major (>20% TBSA); determined by the amount of systemic disruption beyond what the body could normally compensate.
      3. extent of burn determines responses: local or systemic
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