PEDIA FINALS NOTES #4
Care of Pediatric Client with Dermatologic Disorder
Pediculosis
- is a parasitic infectious process that occurs
with the infestation of bloodsucking lice.
2 Types:
1. Pediculosis capitis- ( head lice infestation)an
infestation of the hair & scalp with lice. The
most common sites of involvement are the
occipital area, behind the ears at the nape of
the neck, & occasionally the eyebrows &
eyelashes.
- Pediculosis capitis commonly
occurs with the school age child.
2. Pediculosis pubis ( lice infestation of the
pubic hair region). Mostly found with
adolescents & is spread by physical contact.
3. Pediculosis corporis- body louse/ clothing
- The lice are rarely visible;
however. The eggs are seen as
white flecks on hair shafts.
- The female louse lays her eggs (nits) on the
hair shaft close to the scalp, the incubation
period is 8-10 days. Head lice live &
reproduce only on humans & are transmitted
by direct & indirect contact such as sharing
of brushes, hats, towels, & bedding
- The itching from the pediculosis can cause
secondary infection.
- All contacts of the infested child should be
examined.
Assessment:
- Intense pruritus. Adult lice are difficult to see
& appear as small gray specks. Nits are
visible & firmly attached to the hair shaft
near the scalp; they are tiny silver or gray
specks resembling dandruff.
- Excoriation of skin from itching
- Lice visible behind ears & at the base of
hairline.
Nursing Implications:
1. Inspect all school children regularly for head lice.
2. Evaluate any complains of scalp itching or
intense pubic area itching & assess for lice.
3. Explain to the child & parents that lice infestation
can occur to any child regardless of the
cleanliness of the child.
4. Inspect all family members for infestation.
5. Educate the family & child that lice do not fly
from person to person; however, they crawl from
one place to another.
6. Explain to adolescents with pediculosis pubis
that this is spread via physical contact, & all
intimate partners need to be evaluated.
7. Educate sexually active adolescents on the
dangers of sexually transmitted disease, &
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encourage them to use protection if they are
going to be sexually active.
8. Refer all children with pediculosis pubis for
further evaluation of possible sexual abuse.
9. Explain to parents that need to do this is to
protect the child & that it is not an accusation
against them.
10.
Teach parents & children with pediculosis about the
treatment with Lindane ( Kwell shampoo
contraindicated in children under 2 ) or pyrethrin.
11.
Inform the parents that they will need to Comb to
remove the parasitic eggs (nits).
12.
Have parents remove the shampoo according to the
manufacturers directions to avoid neurotoxicity.
13.
Tell the parents & the adolescent child to continue
treatment for 7 days.
14.
Educate the parents on the need also to launder the
child’s linens & clothes worn Recently because
lice spread easily.
15.
Do not allow the child to share combs or towels after
gym or to share hair ornaments or hats so as to
discourage parasitic spread further.
16.
Inform parents of the need to spray rugs &
upholstered furniture with special spray, such as R
& C spray.
17.
Use of a pediculocide shampoo; the hair is towel
dried; the nits are removed w/ a fine-toothed
comb; & the treatment is repeated in 7 days.
Use of permethrin (nix) rinse:
1. Apply to washed & towel-dried hair, leave in
place for 10 minutes & then rinse.
2. After rinsing, towel dry the hair & remove the
nits w/ a fine-toothed combed
3. instruct the parents that bedding & clothing
used by the child should be changed daily,
laundered in hot water w/ detergent & dried
in hot dryer for 20 minutes.
4. Instruct the parents in the use of shampoo &
rinse as prescribed.
5. Instruct the parents that nonessential
bedding & clothing can be stored in a tightly
sealed bag
6. Instruct the parents that furniture & carpets
need to be vacuumed frequently.
7. Teach the child not to share clothing,
headwear, brushes or combs.
Scabies
- is a parasitic skin disorder caused by a
female mite Acarus scabei (itch mite).
PEDIA FINALS NOTES #4
- The mite burrows into the skin & deposits
eggs in areas that are thin & moist,
particularly the areas between fingers &
toes, palms, in the axilla & in the groin,
although in the young child, the sites may be
much more scattered in location.
- Is endemic among school children &
institutionalized populations as a result of
close personal contact.
Assessment:
- Intense pruritus,or severe itching, esp. at
night
- Black-colored burrows ( fine grayish red lines
that may be difficult to see ) on the skin,
contaminated by mite feces, approximately
½ inch in length visible.
Secondary infections:
- Breaks in the skin
Incubation period:
a) Female mite burrows into epidermis, lays
eggs, & dies in the burrow after 4 to 5 weeks.
b) The eggs hatch in 3 to 5 days & larvae
migrate to the skin to mature & complete
their life cycle.
*Infectious period- during the course of the
infestation.
Transmission- by close personal contact w/ infected
person.
Nursing Implications/ Intervention:
1.Thoroughly inspect the skin to identify burrows &
rule out other skin disorders.
2.Wash the child thoroughly with soap & warm water
using a rough washcloth, & towel dry.
3.Apply topical lindane cream( kwell lotion),
crotamiton( eurax) or permethrin 5% (Elimite) on
child’s body. Not used in children younger than age
2 because of the risk of neurotoxicity & seizures.
4.Instruct the parents in the application of the
scabicide / Lindane cream(Kwell):
a) Application should be preceded by a warm
soap & water bath.
b) Skin must be cool & dry before the
application of the lotion.
c) Lotion is left in place for 8 to 14 hours before
it is washed off.
5.When permethrin 5% (Elimite) is used, the cream is
thoroughly & gently massaged into all skin
surfaces ( not just the areas that have the rash)
from the head to the soles of the feet, care should
be taken to avoid contact with the eyes.
6. Household members & contacts of the infected
child need to be treated at the same time.
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7. Instruct the parents about frequent hand washing.
8. Instruct parents that all clothing, bedding & pillow
cases used by the child need to be changed daily,
washed in hot water w/ detergent, dried in a hot
dryer & ironed before reuse.
9. Instruct the parents that non- washable toys &
other items should be sealed in plastic bags for 4
days.
Impetigo
- a superficial infection of the skin usually
caused by beta-hemolytic streptococcus,
group A (non – bullous) or possibly
Staphylococcus aureus (bullous).
- Is only mildly infectious because it seems to
be transmitted only by direct contact.
- Is often seen as secondary infections of
insect bites or in children who have pierced
ears.
- Although rare, complications of rheumatic
fever or acute glomerulonephritis may occur
following impetigo as they may after other
streptococcal infections.
Incubation period: 2 to 5 days
- Period of communicability- From
outbreak of lesions until lesions are
healed.
- Mode of transmission: direct contact with
lesions
Immunity: None
Assessment Findings
- Papulovesicular lesions surrounded by
erythema, most commonly on face &
extremities.
- Vesicle becoming purulent, oozing, & forming
honey-colored crusts
- Local adenopathy
Incidence:
- In children with poor hygiene who live in
overcrowded places & are malnourished.
- Maybe primary or a complication of
chickenpox, mosquito bites, etc.
- Manifestations- lesions commonly found on
the face, mouth & nose are progressive
Nursing implications:
1. Assure the parents that streptococcal organisms
are so numerous that the cleanest child can
contact this disease.
2. Assure the parents that the presence of the
infection reflects on the number of Organisms
available, not the child’s care.
PEDIA FINALS NOTES #4 Murillo2018-2019
3. Caution parents to seek health supervision for any
lesion that appears reddened or filled with pus
(infected) because the causative agent may be a
particularly virulent form of streptococcus.
4. Advise the parents about the adminis-tration of
oral penicillin or erythromycin or the application of
mupirocin (Bactroban) ointment for a full 10-day
period.
5. Inform the parents & child that the lesion heal
most quickly if the crusts are washed daily with
soap & water.
6. Instruct the parents & child to avoid touching or
scratching the lesions and to Wash hands after
applying the ointment.