Chapter 28: Integumentary Disorders

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Welcome to the Deep Dive.

Today we're tackling a topic that's absolutely fundamental in nursing,

integumentary disorders.

Think beyond just skin deep.

We're talking about infections, the body's protective barrier, and keeping tissues healthy.

Our guide for this exploration is Chapter 28 of the Saunders Comprehensive Review for the NCLE -XPN Examination.

Exactly.

Our goal isn't just to recite facts, but to really get a handle on the core principles in this chapter.

Right.

We'll be pulling out the key concepts, what you could look for during assessments,

essential clinical procedures, those vital safety measures, and the really crucial first steps in care.

Good.

And we'll definitely break down any medical jargon that pops up along the way.

Okay.

Oh, and remember that critical thinking question from the start of the chapter about the child with suspected impetigo being admitted.

Yeah, preventing spread.

Exactly.

We'll circle back to that later, tie it all together.

Okay, sounds good.

Let's dive right in then.

Starting with a condition many, many nurses will encounter, atopic dermatitis,

or, well, eczema.

It's more than just a rash, isn't it?

What's fundamentally going on with the skin here?

That's right.

Atopic dermatitis is essentially a superficial inflammatory reaction.

It primarily affects the epidermis that's the skin's outermost layer.

Okay.

And the hallmark is intense itching, pruritus is the technical term.

Right, the itching.

What's really interesting is its strong connection to family history, not just of eczema itself, but also, you know, other allergic conditions like asthma or allergic rhinitis, they sort of run together.

So recognizing that family link, that feels like a pretty important first step in assessment then.

Definitely.

What are the big picture goals when we're managing eczema, especially with that relentless itch?

Well, the main objectives are really to break that itch scratch cycle, so relieve the pruritus.

We also need to focus on lubricating the skin, kind of strengthening its protective barrier, reducing the underlying inflammation and being super vigilant about preventing or managing any secondary infections, because those can pop up when the skin is broken from scratching.

Makes sense.

The chapter also breaks down eczema by age, right, mentions different forms.

Yes, it does.

Box 28 -1 outlines three common presentations.

There's infantile eczema, which typically starts really early, between two and six months old.

The good news is it often resolves by age three.

Oh, that's good.

Then there's childhood eczema that can emerge around two or three years old, sometimes following the infantile form.

Okay.

And then you have preadolescent and adolescent eczema.

This one can start around age 12 and unfortunately can sometimes stick around into adulthood.

So knowing these phases helps anticipate how it might play out.

That gives us a useful timeline.

Now, when you as a nurse are assessing someone with suspected eczema, what are the key things you'll be looking for?

What are those telltale signs and symptoms?

The key indicators are redness of the skin, a scaly texture, and of course the patient reporting that intense itching.

You might also see small raised bumps.

Those are papules and tiny fluid -filled blisters, which are vesicles.

Often these lesions can weep or ooze fluid and then they form a crust.

It's also helpful to remember that in teens and young adults, eczema frequently shows up in specific flexural areas, like the antecubital fossa, the inside of the elbow, and the popliteal fossa, which is behind the knee.

Those locations can be a big clue.

Knowing those common spots is really helpful.

So what strategies does the chapter recommend for managing these symptoms and providing some relief?

Okay, so several critical interventions.

First line of defense, avoid anything that can irritate the skin.

Like what?

Things like harsh soaps, detergents with strong perfumes, fabric softeners, those scented diaper wipes, even talcum powder.

Got it.

We also want to limit bathing and washing of the affected areas.

When bathing is necessary, use lukewarm water, not hot.

And the crucial step is to immediately apply a good emollient, a moisturizer right after, to lock in that hydration.

Think of it like sealing the skin's barrier.

That makes perfect sense.

Soothe the irritation, reinforce the defenses.

What about tackling that itch directly?

Yeah, for immediate relief, applying cool, wet compresses intermittently just for short periods can be incredibly soothing.

Just remember to gently pat the skin dry afterward, don't rub.

Medications also play a big role.

Antihistamines can help reduce the itching sensation.

And topical corticosteroids are frequently prescribed to cut down the inflammation.

It's really important to emphasize these should be applied in a thin layer and rubbed in thoroughly, just follow the instructions.

Thin layer, got it.

And of course, if a bacterial infection develops because the skin's broken down from scratching,

antibiotics will be needed.

And for our younger patients preventing scratching, that seems like a constant battle.

What practical tips does the chapter offer there?

Oh, absolutely.

Keeping fingernails short and clean is paramount.

For infants and toddlers, using gloves or even cotton socks over their hands, especially at night, can really help prevent significant scratching.

Good idea.

It's also about identifying and eliminating triggers that can make itching worse.

Things like wet diapers left on too long, getting overheated, wool or other rough fabrics,

even those furry stuffed animals, and sometimes latex exposure.

When you're washing the child's clothing, use a mild fragrance -free detergent and make sure it rinses out completely.

Sometimes even doing a second rinse without any detergent is recommended to minimize potential irritants.

Those are all really actionable steps and the chapter emphasizes washing for signs of

What should parents and caregivers be really vigilant for?

Yeah, the telltale signs of a secondary bacterial skin infection and those eczema lesions are the appearance of honey -colored crusts, often with some redness or erythema surrounding them.

Honey -colored crusts, okay.

If those develop, it's crucial to seek medical attention promptly for the right treatment, usually antibiotics.

And the chapter makes a broader point too.

Any child with a skin disorder needs monitoring not just for local skin infections, but also for signs of a more widespread systemic infection.

Good point.

Let's shift gears now to another very common skin condition, especially in kids.

Empedigo.

This is the one we mentioned with the critical thinking question and it's known for being highly contagious, right?

That's absolutely correct.

Empedigo is a highly contagious bacterial infection just affecting the superficial layers of the skin.

It's typically caused by either chemolytic streptococci or staphylococcus aureus or sometimes a mix of both.

It can develop primarily often on otherwise healthy skin, maybe due to poor hygiene or secondarily, meaning it pops up where the skin's already been compromised by things like injuries, infect bites or pre -existing rashes like eczema or poison ivy.

And where on the body do we most often see these Empedigo lesions?

The most common spots are the face, particularly around the mouth and nose, also the hands, the neck and other exposed extremities like arms and legs.

And what does Empedigo typically look like?

How do those characteristic lesions progress?

Well, they usually start as small vesicles, those fluid -filled sacs we talked about with eczema or maybe pustules, which are similar but contain patella.

These are often surrounded by some redness and maybe a bit of swelling, edema.

Over time, they progress to what we call the exudative encrusting stage.

The fluid inside, which was clear, gets cloudy.

Then the vesicle or pustule ruptures and it dries to form a very characteristic honey -colored crust over the base of the lesion, which is often a bit ulcerated underneath.

Figure 28 -1 in the chapter actually has a pretty good picture of this typical look.

That honey -colored crust, definitely a key identifier to remember.

What other signs and symptoms might a nurse observe in a child with Empedigo?

Besides those distinctive lesions, you might see that surrounding redness, the erythema.

The child might complain of itching, parietis or even a burning sensation in the affected areas.

And sometimes you might also notice secondary lymph node involvement.

That means the lymph nodes near the infection might get enlarged and tender.

Given how easily this spreads, what are the most important nursing interventions when caring for a child with Empedigo?

Contact isolation is the absolute top priority for hospitalized children.

Standard precautions also need to be strictly followed, and whatever specific isolation protocols your facility have, those need to be implemented.

Meticulous hygiene is just essential for the patient and for everyone in contact with them.

Makes sense.

Allowing the lesions to air dry can help promote healing.

Daily bathing with an antibacterial soap, if the doctor prescribes it, is often recommended.

Warm saline compresses or other prescribed compresses, applied maybe two or three times a day, followed by gentle washing with mild soap and water, can help to remove those crusts and promote healing.

Sometimes a solution like burro solution might be used to help soften stubborn crests.

And what about the topical antibiotic treatments?

Right, topical antibiotic ointments are frequently prescribed.

It's crucial to apply these using a clean or ideally sterile swab.

You want to avoid introducing more bacteria into the lesion and also prevent contaminating the ointment tube itself.

Good point.

Parents need really clear, step -by -step instructions on how to apply the ointment and use the swabs correctly.

And here's a really important point to stress to families.

The child remains contagious for a full 48 hours after starting antibiotic treatment, whether it's topical or oral.

Wow, 48 hours, okay.

Yeah.

And if the topical treatment isn't cutting it, oral antibiotics might be prescribed.

It's vital, absolutely vital, to stress the importance of completing the entire course of oral antibiotics, even if the lesions look like they're healing.

Why is that so critical?

Particularly in cases caused by streptococcus, because incomplete treatment can lead to serious complications affecting the kidneys, like glomerulonephritis.

It's a big deal.

That's a really critical point about finishing the antibiotics.

Are there other important things parents should be doing at home for care and preventing spread?

Yes, definitely.

If prescribed, applying emollients' moisturizers can help keep the skin around the lesions from getting dry and cracked.

Okay.

Reinforcing good hygiene practices, especially frequent and thorough hand washing for everyone in the house, is paramount in stopping the spread.

Hand washing, always key.

Absolutely.

Okay.

The child should use separate towels, linens, and eating utensils.

Don't share those.

And all linens and clothing the child has used should be washed separately in hot water with detergent.

Got it.

Let's move on to another very common issue, especially with school -aged kids,

pediculosis

or a head lice.

What exactly is this?

Pediculosis is simply an infestation of the hair and scalp by tiny wingless insects' head lice.

Oh.

The most common areas where these little guys like to hang out are the occipital region, which is the back of the head, behind the ears, and at the nape of the neck.

Occasionally, you might even find them on eyebrows and eyelashes.

It always makes you a little itchy just talking about it.

Can you explain their life cycle a bit?

Sure.

The female louse lays her eggs, which we call nits, right on the hair shaft, very close to the scalp.

These nits are glued on pretty tight.

Okay.

They take about 7 to 10 days to hatch into nymphs, which then mature into adult lice.

Adult head lice can actually survive for up to 48 hours away from a human host.

Oh, wow.

And those shed nits can stay viable and hatch within that same 7 to 10 day window.

It's important to remember head lice live and reproduce only on humans.

They're mainly spread through direct head -to -head contact.

But they can also be transmitted indirectly by sharing personal items.

Brushes, hats, towels, bedding.

So it's not necessarily about poor hygiene, which is a common myth, right?

Absolutely correct.

That's a huge misconception.

Head lice can affect anyone, clean hair, dirty hair, doesn't matter.

And the chapter emphasizes checking close contacts.

Yes.

Because they spread so easily through close contact, it's crucial to examine all close contacts, family members, maybe close friends or classmates, and treat them if you find any evidence of lice or nits.

Now, what are the key signs and symptoms that might point to a head lice infestation?

What should parents and nurses look for?

Okay.

Box 28 -2 in the chapter has a good summary.

The most common symptom is intense itching of the scalp.

Itching, yeah.

It's often driven by the movement of the lice and their saliva, irritating the skin.

You'll also likely be able to see the nits attached to the hair shaft.

What do they look like?

They often appear as tiny whitish or grayish oval -shaped specks.

It's important to tell them apart from things like dandruff or hair product residue.

Those can be easily brushed away, but nits are stuck on tight.

Okay.

The adult lice themselves can be harder to spot.

They're small, tan to grayish -white, and they move fast.

You might see them crawling on the scalp, especially near the nape of the neck and behind the ears if you look closely.

Okay.

So you've confirmed lice or nits.

What are the recommended steps for getting rid of them?

What interventions does the chapter highlight?

The main treatment is using a pediculocyte product.

That's a medication specifically designed to kill lice.

They're available over the counter or by prescription.

It's absolutely essential to carefully follow the instructions on the product label application, how long to leave it on, any warnings, especially for using young kids.

Follow the label.

Okay.

After applying the pediculocyte, daily removal of nits using a fine -tooth metal knit comb is a really important step.

Helps prevent reinfestation.

Wearing gloves during this process is often a good idea.

And the combs and brushes?

Yeah.

Hair brushes and combs should either be thrown out or cleaned really wide.

You can soak them in very hot water like 130 degrees Fahrenheit or 55 Celsius for 5 -10 minutes or use a lice -killing product on them.

And what about managing the home environment?

Preventing further spread.

Right.

Important stuff.

Advise parents that siblings and other close contacts need checking and treatment if they're infested too.

Okay.

No sharing personal grooming items like combs and brushes.

Everyone needs their own.

Bedding and clothing worn by the infested person should be changed daily, laundered in hot water with detergent and dried on high heat for at least 20 minutes.

Daily laundry.

Got it.

Keep that up for about a week.

Non -essential bedding and clothes can be sealed in a tightly closed plastic bag for two weeks.

Lice can't survive that long off a host.

Then wash them.

Same for non -washable items like some toys.

Seal them up for two weeks.

Okay.

Two weeks in a bag.

Frequent vacuuming of furniture and carpets, especially where the person spends time, is recommended.

Toss the vacuum bag immediately afterward.

Right.

And finally, ongoing education is key.

Remind kids and families.

Don't share clothing, hats, brushes, combs.

Oh, and if lice are found on eyelashes or eyebrows, they might need to be removed manually, often by a healthcare provider.

Okay.

Good to know.

Let's switch gears again to another itchy skin condition caused by parasites.

Scabies.

What's the little critter responsible for this one?

Scabies is a contagious skin disorder caused by an infestation with the sarcoptis scabymite, which most people just call the itch mite.

Itch mite.

Okay.

It tends to be more common in settings with close personal contact, think school children, people in institutions.

And how does this infestation work?

What's the life cycle of these mites?

Well, the female mites actually burrow into the very top layer of the epidermis.

Ah, burrow.

Yeah.

They lay their eggs there and then they die in the burrow after about four to five weeks.

The eggs hatch pretty quickly, usually within three to five days, and the larvae that come

into adult mites starting the cycle all over again.

And the whole time they're infectious.

The entire period of infestation is considered infectious, yes.

It's really crucial to understand that scabies spreads through direct, prolonged skin -to -skin contact with someone who has it.

Okay.

And because of that, effective management means treating everyone in the household and close contacts at the same time, even if they don't have symptoms yet.

Simultaneous treatment.

Very important.

So what are the characteristic signs that might make a nurse suspect scabies?

What are you looking for?

Box 28 -3 and figure 28 -2 in the chapter are really helpful for this.

The absolute hallmark septum is intense itching, and it's often much worse at night.

Worse at night, okay.

You'll typically see a papular rash, those small raised bumps again.

But a key diagnostic finding, though sometimes hard to spot, are the actual burrows made by the mites in the skin.

The burrows.

What do they look like?

They can appear as very fine, maybe wavy, grayish -white, or reddish lines.

Often just a few millimeters long.

Common places to find these burrows and the rash include between the fingers and toes, on the wrists, elbows, armpits, around the nipples and women, the waistline, and on the external genitalia in men.

In infants and young kids, the rash can be more widespread, sometimes including the head, neck, palms, and soles.

And how is scabies treated effectively?

The main treatment is the topical application of a scabicide.

A medication specifically designed to kill scabies mites.

Permethrin cream is a really common and effective option.

Permethrin.

It's important to note a contraindication, though.

Lindane shampoo, which is sometimes used for other things, should generally be avoided in kids under two.

There's a risk of neurotoxicity and seizures.

Good warning.

So how do you apply the scabicide like Permethrin?

Okay, the skin should be cool and dry.

Wait at least 30 minutes after a bath or shower.

Cool and dry.

Then you need to massage the cream thoroughly and gently into all skin surfaces, from the head down to the soles of the feet.

Not just where the rash is everywhere.

Be careful to avoid the eyes and mucous membranes.

Head to soles.

How long does it stay on?

It's typically left on for eight to 14 hours, whatever the specific directions say, and then you wash it off.

A repeat treatment about a week later is often recommended to kill any mites that hatched after the first round.

And treating everyone at once.

Yes, absolutely essential, as we said.

Treat all household members in close contact simultaneously to prevent ping -ponging it back and forth.

Frequent, thorough hand washing by everyone is also really important.

And what about clothing and bedding?

How do you handle those to get rid of the mites?

Right.

All clothing, bedding, and pillowcases that the infested person used should be changed daily, starting the day of treatment, and continue for one week.

Wash these items in hot water with detergent and dry them in a hot dryer.

Ironing them before reuse, if possible, can add an extra layer of certainty.

Hot wash, hot dry.

What about stuff you can't wash?

For items like some toys or outerwear, seal them tightly in a plastic bag for at least four days.

The mites can't survive that long away from human skin.

Four days in a bag.

Got it.

Anti -itch topical treatments like maybe corticosteroids or Kalamine lotion might be prescribed to help with that intense itching.

And if secondary bacterial infections pop up from scratching,

antibiotics might be needed, too.

Let's shift focus now to something very different.

Burns in children.

This is a critical area, and the chapter outlines priority nursing actions for a major burn injury.

What are those immediate first steps?

Okay, the absolute first priority is stop the burning process immediately.

Once that's done, quickly assess the child's circulation, airway, and breathing the ABCs.

If there are any issues, start resuscitation efforts right away.

Remove any burned clothing and jewelry.

These can hold heat and cause more damage, and jewelry can get constricting if swelling starts.

Get it off.

Cover the burn wound or wounds with a clean cloth or dressing.

This helps prevent contamination,

reduces pain by covering nerve endings, and helps prevent hypothermia.

Cover the wound.

It's also vital to keep the child warm.

Burn injuries disrupt temperature regulation, so prevent hypothermia.

Keep warm.

And finally, get the child transported to the right medical facility, usually the emergency department, as quickly and safely as possible.

The chapter gives a bit more detail on stopping the burning process.

Can you elaborate on that?

If flames were involved, smother them first.

Teach stop, drop, and roll.

If the child can't, gently lay them down horizontally.

Wide horizontal.

Avoids having flames rise towards the face and airway.

Reduces inhalation risk and potential hair ignition.

If you have a blanket, roll the child in it to smother flames, but keep the face and head uncovered to prevent smoke inhalation.

You mentioned removing burned clothing and jewelry.

Why are those steps so critical right away?

Burned clothing can just hold on to heat and keep burning the skin even after the source is gone, leading to deeper injuries.

And jewelry rings, bracelets, they heat up fast during a burn, causing more damage.

Plus, swelling happens after burns, and that jewelry can cut off circulation.

So getting it off fast minimizes ongoing damage and prevents circulatory problems.

Covering the wound with a clean cloth seems simple, but what are the key benefits right after a burn?

It does several important things.

First, helps prevent contamination of that exposed tissue, reduces infection risk.

Second, it helps reduce pain by protecting those sensitive nerve endings from air and movement.

Ah, pain reduction.

And like we said, it plays a role in preventing hypothermia by cutting down heat loss from the damaged skin.

It's a protective barrier until definitive care starts.

Now the chapter highlights several important ways burns in children differ from burns in adults.

Why is it so important to think about these pediatric differences?

Understanding these differences is critical because they directly impact how severe the injury is, how the child responds to treatment, and potential complications.

Tragically, young kids with severe burns have a higher mortality rate than older individuals with similar burns.

Children's skin is thinner,

so even lower temperatures or shorter heat exposure can cause deeper, more severe burns than in an adult.

Their ability to communicate pain is different, too.

They're at greater risk for fluid and heat loss because they have a larger body surface area relative to their weight.

This can quickly lead to dehydration and metabolic acidosis.

Bigger surface area impact.

They also have a higher proportion of body fluid to body mass,

which increases the risk of cardiovascular problems like shock.

Even burns over 10 % of their total body surface area, TBSA, often need aggressive fluid resuscitation.

Only 10%.

Right.

Plus, kids have less muscle mass and body fat reserves, making them more susceptible to protein and calorie deficiencies during healing.

Nutrition is key, then.

Absolutely.

Scarring also tends to be more severe in children, and the impact on their developing body image can be a huge long -term issue, especially as they grow.

Body image, yeah.

And finally, their immature immune systems mean a higher risk for infections.

And sometimes, burns can even affect their growth and development long -term.

Those are all really significant differences.

When it comes to assessing the extent of a burn, we often hear about the rule of nines for adults, but the chapter says that's not accurate for kids.

Why not?

That's correct.

The rule of nines is a quick way to estimate the percentage of TBSA affected in adults.

Divide the body into sections of about 9%.

But kids have different body proportions.

A child's head is proportionally much larger, while their legs are smaller, for instance.

So using the adult rule on a child gives you an inaccurate TBSA estimate.

So what do you use?

In pediatric clients, we use specialized age -specific burn charts, like the Lundbradder chart.

These account for the changing body proportions as kids grow.

Getting that accurate TBSA calculation is crucial for figuring out fluid needs and the whole management plan.

And you mentioned fluid replacement therapy being essential, especially right at the beginning.

Why is that so critical, and what does it usually involve?

Fluid replacement is absolutely critical in the first 24 to 48 hours after a major burn because of the massive fluid shifts that happen.

Fluid shifts?

Yeah.

The damaged blood vessels in the burned tissue get leaky.

Fluid and electrolytes seep out of the bloodstream into the surrounding tissues.

This causes edema, swelling, and, crucially, a drop in circulating blood volume.

Ah, leading to shock.

Exactly.

Hypovolemic shock, if it's not addressed fast.

There are various formulas to calculate how much fluid a child needs based on their weight and the burn size, TBSA.

The choice depends on the provider.

What kind of fluids?

Typically, isotonic crystalloid solutions, like lactated ringers, are used for the initial resuscitation.

Later, colloid solutions, things like albumin, plasma light, or fresh frozen plasma, might be used to help keep fluid in the bloodstream, maintain plasma volume.

And how do you know if it's working?

Throughout resuscitation, you have to closely monitor vital signs, especially heart rate, blood pressure, respiratory rate, and urine output.

Also capillary refill and the child's level of consciousness, their sensorium.

These signs tell you if the fluid replacement is adequate.

Chapter 39 of the Saunders Review actually goes into more detail on fluid and electrolytes.

Okay.

Finally, the chapter provides some really important instructions for parents on preventing burn injuries in kids.

What are some key safety measures families should put in place?

Burn prevention is huge, yeah.

Several vital steps.

Keep matches and lighters completely out of reach and sight.

Obvious, but critical.

Right.

Check smoke detectors regularly.

Make sure they work.

Install them on every level.

Test the detectors.

Set the thermostat on the hot water heater to a max of 120 degrees Fahrenheit.

That's 48 .8 Celsius.

Prevent scalds.

Lower the water temp.

Good one.

When cooking, always turn pot handles inward toward the back of the stove so kids can't grab them.

Pot handles in.

Teach kids stop, drop, and roll and practice it.

Keep kids away from outdoor grills while they're hot and right after, and also indoor wood burning stoves or fireplaces.

Keep away from heat sources.

And conduct periodic fire drills at home.

Helps everyone know what to do in an emergency.

That's all incredibly valuable.

Now, to help solidify this, the chapter has some practice questions.

Let's walk through a few.

First one, question 206, asks which home care instructions should parents get for a child with pediculocis capitis head lice?

Options are, one, siblings might need treatment, two, use anti -lice sprays on bedding furniture, three, use pediculocyte shampoo, repeat in 14 days, four, don't share combs brushes, five, launder bedding clothing in hot water, dry, high heat, six, vacuum floors, play areas, furniture, which are correct.

Okay, the correct instructions here are numbers one, four, five, and six.

So check siblings.

Yes, check and potentially treat siblings and close contacts.

Option one.

Don't share grooming items.

Correct.

Avoid sharing.

Option four.

Hot water laundry.

Yes, launder bedding clothing, hot, dry, high.

Option five.

And vacuuming.

And vacuuming helps remove stray hairs with knits.

Option six.

So why not two and three?

Option two is wrong because those anti -lice sprays aren't recommended for furniture bedding.

Can even be harmful.

Okay.

No sprays.

And option three.

Well, you use a pediculocyte, yes, but the repeat timing depends entirely on the specific product.

It's not always 14 days.

You follow the package instructions.

Got it.

Next question, 287.

Which statement by a parent of a three year old with scabies indicates they need more teaching?

Options.

One.

Leave scabicide on for four hours and wash off.

Two.

Seal non -washable toys in a bag for four days.

Three.

Everyone in contact needs treatment.

Four.

Wash all clothes bedding in hot water detergent, dry hot.

Which one shows a misunderstanding?

The one that shows a need for more teaching is option one.

The four hours one.

Yeah.

Leave the scabicide on for four hours.

As we discussed, scabicides like permethrin usually need to be left on much longer, typically eight to 14 hours to actually work and kill the mites.

Four hours isn't enough.

Eight to 14 hours.

The other statements, options two, three, and four, all show correct understanding.

Sealing items, treating contacts, and proper laundering.

Okay.

Question 288 asks us to pick all the pediatric considerations for burn injuries that apply.

Options.

One.

Sparring less severe than adults.

Two.

Growth delay possible.

Three.

Immature immune system a gills infection risk.

Four.

Fluid resuscitation only needed if 25 % TBSA.

Five.

Lower fluid proportion equals higher cardio risk.

Six.

Increased risk for protein calorie deficiency due to less muscle fat.

Okay.

The ones that correctly apply are two, three, and six.

So growth delay.

Yes.

A delay in growth can happen after a significant burn.

Option two.

Immune system.

Their immature immune systems definitely put infants and young kids at higher infection risk.

Option three.

And nutrition.

And yes, their smaller muscle mass and less body fat increase their risk for protein and calorie deficiencies.

Option six.

What's wrong with the others?

Option one is wrong.

Scarring is generally more severe in kids.

More severe.

Right.

Option four is wrong.

Fluid resuscitation is usually needed for burns over 10 % TBSA in children.

10%, not 25%.

Correct.

And option five is wrong.

It's the higher proportion of body fluid to body mass that increases their cardiovascular risk.

Higher proportion.

Okay.

Question 289.

Topical corticosteroid is prescribed for a child with eczema.

What instructions should the nurse give the parent about applying the cream?

Options.

Apply over entire body.

Two.

Apply thick layer to affected areas.

Three.

Avoid cleansing before application.

Four.

Apply thin layer.

Rub in thoroughly.

The correct instruction is definitely option four.

Thin layer.

Rub in.

Yes.

Apply a thin layer of cream and rub it into the affected area thoroughly.

Topical steroids should be used sparingly, just on the inflamed spots, usually after gently cleansing the skin.

Why not the others?

Applying it everywhere.

Option one.

Or using a thick layer.

Option two.

Increases the risk of systemic absorption and side effects.

And you should cleanse the area first, making option three incorrect, to remove irritants and help the medicine absorb better.

Makes sense.

Final practice question number 290.

Which finding indicates a positive head check for pediculosis capitis lyslice?

Options.

One.

Macula papilla lesions behind ears.

Two.

Lesions on scalp extending to hairline neck.

Three.

White flaky particles all over scalp.

Four.

White sacs attached to hair shafts and occipital area.

The finding that screams lice is option four.

The white sacs.

Yes.

White sacs attached to the hair shafts in the occipital area.

Those are the nits, the eggs.

That's your positive sign.

And the others?

Macula papilla lesions.

Option one could be something else.

Lesions extending down, option two, aren't specific to lice.

And white flaky particles everywhere, option three, is most likely just dandruff or dry scalp.

You're looking for those nits glued onto the hair shafts, especially in warm spots like the back of the head and behind the ears.

Got it.

That brings us full circle to our critical thinking question from the beginning.

What specific nursing actions should be implemented when a child with suspected impetigo is admitted to the pediatric unit to prevent the spread of that highly contagious infection?

Right.

So based on everything we've discussed, the priority nursing actions would be immediately institute strict contact precautions.

That's on top of standard precautions, of course.

Contact precautions first.

Yes.

And it's essential to follow whatever specific isolation protocols your facility has for contagious skin infections like impetigo.

Beyond that,

all health care staff visitors needs to be thoroughly informed about the necessary precautions.

Like what?

Like meticulous hand hygiene, always wearing gloves and gowns when in contact with the patient or potentially contaminated items, and ensuring proper handling and disposal of anything contaminated like dressings or linens.

It's all about breaking that chain of transmission.

So it really looks like we've thoroughly navigated Chapter 28 of the Saunders Comprehensive Review for the NCLE -XPN examination.

We've hit all those essential nursing concepts for common integumentary disorders in kids.

Assessment procedures, safety priorities, even the review questions.

Yeah.

And define the medical terms along the way.

Right.

Yes.

I think we've taken a pretty deep dive into atopic dermatitis, impetigo, lice, scabies, and those really important considerations for caring for the burned child.

Pulled out that core knowledge that's so vital for nursing practice.

Definitely.

So for our final thought today, let's think about the absolutely crucial role of patient and family education in managing these conditions at home and preventing spread in the community.

How can you, as nurses, really empower families with the knowledge and resources they need?

Think about helping them implement treatment plans effectively,

recognize early warning signs of complications, and just generally promote overall skin health.

It really highlights how our role goes beyond just the hands -on care, doesn't it?

It really does.

Equipping individuals and families to be active partners in their own well -being.

That's powerful stuff.