Topic 2 Peds Immunizations and Integumentary Disorders

• What is diaper dermatitis caused by?

  Prolonged contact with an irritant like urine, feces, soaps, detergents, ointments, friction.
• Where does diaper dermatitis usually occur on?

  Convex surfaces or in folds.
• What are the nursing interventions focused on when dealing with dermatitis?

  Wetness, pH, and fecal irritants.
• What is the peak age of occurrence for diaper dermatitis?

  9 - 12 months of age.
• What group has a higher incidence of diaper dermatitis?

  Bottle-fed infants compared to breastfed infants.
• How do you control diaper rash?

  • Keep skin dry - use superabsorbent disposable diapers
  • Expose skin to air
  • Apply zinc oxide ointment
  • Avoid over-washing skin - do not use perfumed soap or commercial wipes
• What is another name for seborrheic dermatitis?

  Cradle cap.
• What is cradle cap?

  Chronic, recurrent inflammatory reaction usually on the scalp.
• What are manifestations of cradle cap?

  Thick, adherent, yellowish, scaly, oily patches.
• How do you treat cradle cap?

  Shampoo daily with mild soap or baby shampoo, use a fine tooth comb or soft brush to loosen crusts after shampooing.
• What other areas can dermatitis occur on a child's body?

  Eyelids, external ear canals, nasolabial folds, inguinal region.
• What is atopic dermatitis (AD)?

  A type of puritic eczema that usually begins during infancy and is associated with an allergic contact dermatitis with a hereditary tendency (atopy).
• How does AD usually manifest?

  Three forms based on the child's age:

  Infantile, childhood, preadolescent and adolescent.
• What happens with infantile AD?

  Usually begins at 2 - 6 months and generally undergoes spontaneous remission by 3 years old.
• When does childhood AD start?

  2 - 3 years of age.
• When does preadolescent and adolescent AD start?

  About 12 years of age and may continue into early adult years or indefinitely.
• How is AD diagnosed?

  A combination of history, clinical manifestations, and sometimes morphological findings. Family history of eczema, asthma, food allergies, or allergic rhinitis can contribute as well.
• The cause for atopic dermatitis (eczema) is unknown but is related to abnormal skin function.
• How do the weather and seasons affect eczema?


  Eczema improves in humid climates and gets worse in the fall and winter when homes are heated and humidity is lowered.
• How is infantile eczema distributed?

  Generalized, especially cheeks, scalp, trunk, and extensor surfaces of extremities.
• How is childhood eczema distributed?

  Flexural areas (antecubital and popliteal fossae, neck), wrists, ankles, and feet.
• How is preadolescent and adolescent eczema distributed?

  Faces, sides of neck, hands, feet, face, antecubital and popliteal fossae (to a lesser extent).
• How does infantile eczema appear?

  Erythema, vesicles, papules, weeping, oozing, crusting, scaling, often asymmetric.
• How does childhood eczema appear?

  Symmetric involvement with clusters of small erythematous or flesh colored papules or minimally scaling patches.
• How does adolescent or adult eczema appear?

  Same as childhood, with thick and dry lesions common. Papules may merge together.
• What can help manage eczema?

  • Hydrate the skin to relieve pruritis
  • Tepid baths
  • Emollient lotions
  • Antihistamines (Benadryl)
• What are side effects of giving Benadryl for eczema?

  Drowsiness, dizziness, fatigue, disturbed coordination.
• What are more likely side effects to occur with children who take Benadryl?

  Nightmares, nervousness, irritability.
• What is therapeutic management for eczema focused on?

  Prevention of flare ups or inflammation and control secondary infections with antibiotics (topical or oral).
• How can you prevent flare ups or inflammation with eczema?

  Keep nails cut short, topical steroids, new topical immunomodulators.
• What are possible local side effects of topical steroids?

  Striae, skin atrophy, pigment changes.
• What interprofessional care may happen for atopic dermatitis?

  Consult with dietician for hypoallergenic diet. Stress can aggravate the severity of the condition. Emotional stress is increased during acute phases.
• What is impetigo contagiosa?

  Very contagious bacterial skin infection.
• What bacteria causes impetigo contagiosa?

  Staphylococci.
• What are manifestations of impetigo contagiosa?

  • Starts as reddish macule that is very vesicular
  • Ruptures easily
  • Exudate dries to form heavy, honey-colored crusts
  • Pruritis is common
• How do you manage impetigo contagiosa?

  • Topical bactericidal ointment like Mupirocin (Bactroban) or triple antibiotic ointment
  • Oral or parenteral antibiotics for severe or extensive lesions
  • Penicillin is used
  • Vancomycin is used for lesions due to MRSA
  • Tends to heal without scarring
• What is cellulitis caused by?

  Streptococci, staphylococci, Haemophilus influenza.
• What are manifestations of cellulitis?

  • Inflammation of skin and subcutaneous tissues
  • Intense redness, swelling, firm infiltration
  • "Streaking" is often seen
  • Involvement of regional lymph nodes
  • May progress to abscess formation
  • Systemic effects are: Fever, malaise.
• How is cellulitis managed?

  • Oral or parenteral antibiotics
  • Rest and immobilization of both affected area and the child
  • Hospitalization may be required if child has systemic symptoms
• What is pediculosis capitis?

  Lice.