peds
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| Developmental variances | children under 3 cannot sweat and control their temperatures. Neonate’s dermis is thin and very hydrated which increased risk for fluid loss and serves as an ineffective barrier.
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| Skin lesions | contact with injurious agent (chemicals) , hereditary factors (eczema), external factors that produce a reaction(poison ivy) , systemic disease in which lesions are manifestation (chicken pox)
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| erythema, ecchymoses, petechiae | reddened area. Bruises. tinny red dots
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| secondary lesions; macules, papules, vesicles | flat lesion <1cm (freckle). raised, palapable lesion <1cm (wart). elevated lesion filled with fluid <2cm (blister)
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| Age related skin manifestations | infants (birthmark), early childhood (atopic dermatitis), school-age (ringworm) and adolescence (acne)
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| Therapeutic management | topical agents should only use the prescribed amount. If giving prednisone with low grade fever look for infection. children w/ no WBC wont show signs of infection. Tell parents to wash hands before and after applying topical cream to themselves or child
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| factors that influence haeling | moist, crust-free environment enhances wound healing. Nutritional deficiencies (protein, vitamin C), stress, infection, circulation
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| wound care basics | wash wound with mild soap & water. Avoid povidone-iodine, alcohol and hydrogen peroxide (toxic to wounds). Leave a wide margin of intact skin around dressing, remove dressing if leakage. S/S: inc erythema, edema, purulent exudate, pain, inc temp
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| inflammatory skin disorders | diaper dermatitis usually from irritation of urine and feces, detergents from inadequate rinsing, chemical irritation from diaper wipes. contact and atopic dermatitis (eczema)
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| assessment of inflammatory skin disorders | ID causative agents, cleanse with mild cleaner and apply barrier (zinc), expose to air and each the hazards of baby powder.
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| Seborrheic dermatitis | chronic, recurrent inflammatory reaction of the skin; cause unknown. Commonly occurs on scalp (cradle cap), eyelids, nasolabia folds and ears. Treatment is to remove crust with antiseborrheic shampoo
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| Cradle cap | may cause scaling and reness of the scalp. Wash with mild baby shampoo and brush with a soft brush to help remove the scales. Do not apple baby oil, it is not dry skin and this will only allow for more buildup of the scales
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| nickel allergy | resolves over a few weeks when causative agent is removed. Use Burrow’s solution or topical corticosteroids for itching. In severe cases use oral corticosteroids.
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| Atopic dermatitis (eczema) | type of pruritic eczema that begins during infancy, hereditary. Associated with food allergies, asthma. Hydrate skin to help relieve itch, use cold clothes to vasoconstrict and stop itch. Use mittens for small children to stop itching, cut nails short.
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| Impetigo | most common skin infection in children, causative agent is carried in the nasal area, bacteria invades the superficial skin. Highly contagious skin infection, spread by physical contact, bedding, clothes, towels.
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| Cellulitis | full thickness skin infection w/ dermis & underlying connective tissue. Worry about urinary meatus/tip of penis. hurts to pee, child wont. If eyes or face do a CT scan to check for vision & the brain. Needs IV antibiotics & Tylenol for pain.
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| cellulitis diagnosis and assessment | Diagnosed w/ CBC, blood culture, culture from lesion.Characteristic reddened or lilac-colored, swollen skin that pits when pressed. Boarders indistinct, warm to touch and superficial blistering. Hospitalization if large area or face.
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| viral skin infections | most communicable disease of childhood. Chicken pox, herpes simplex type I & II, verruca
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| Fungal infections | infections that live on the skin. Ringworm cause by flamentous fungi, transmission from person to person or infected animal to human.
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| Poison ivy, oak and sumac | localizes lesions, sensitivity develops after 1-2 exposures. bonds with the dermal layer. Wear long pants in the woods, wash with soap to remove sticky sap. Sap on fur, clothing or shoes can last 1 week. Oral prednisone if extensive-dont stop rapidly
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| Anthropod bites and stings: | mild-moderate discomfort, manage with symptomatic measure and prevent secondary infection. Bees: remove singer asap, sensitization to bee stings may result in anaphylaxis.
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| Scabies | caused by mite as female burrows into epidermis to deposit eggs. Inflammation occur 30-60 days later. Pruritus profound at night. Lesions on palms, soles & axillae. Permethrin cream is best drug. Massage into skin leave on for 8-14 hr. no face
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| Peduculosis capitus (head lice) | head lice 1-40% of children. Most common ages 5-12, less common in blacks. Treatment is pediculicides and removal of nits. Anti-lice shampoo, wash bedding with hot soapy water, vacuum all floors. Can return to school after one treatment
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| Acne | chronic inflammatory process of pilosebaceous follicles 85% of teens 15-17. Skin cells “plug” cores causing white and black heads. Treatment of OTC, topical retinoid, topical antibiotics mau cause bacterial resistance, hormone therapy and Accutane.
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| Cold injury | : frostbite is tissue damage caused by ice crystals in the tissue, blisters appear 24-48hrs after rewarming, treatment similar to burn treatment. Cholblain is redness/swelling, vasodilation, edema, symptoms continue after rewarming.
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| Burns | toddles: hot water scalds, older children: flame related burns, child abuse, child with matches- 1 in 10 house fires. Burns of >10% require fluid resuscitation. Infants and children increased risk for protein &calorie deficiency. Scarring is more severe.
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| Immediate interventions of burns | get admission weight, NG tube to maintain gastric decompression, foley catheter for urine specimen & output. Determine extent & depth of injury. Ascertain adequate airway, give oxygen, prepare for intubation. Large bore needle to deliver sufficient fluids
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| complications from burns | immediate threat of airway compromise, profound shock, infection, inhalation injuries, pulmonary edema, pulmonary embolus.
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| Burn management | airway maintenance, fluid replacement therapy in first 24hr, nutrition (high protein/calorie, increased vitamin A &C).meds (antibiotics, analgesics). Remove all metal and jewelry
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| Inhalation injury | trauma following inhalation of heated gases and toxic chemicals. Head damange below vocal cords is rare. Upper airway obstruction may require endotracheal intubation. Look for ash and soot around nares. If unconscious may be due to hypoxia.
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| characteristics of burn injury | first degree is superficial, second degree is partial thickness, third degree is full thickness and fourth degree is full thickness and underlying tissue.
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| degree of burns | 1st: only the epidermis, area hot, red, painful, no swelling or blisters. 2nd: epidermis & part of underlying. Pain severe, area red. Moist & seeping, swollen with blisters. 3rd: injury to all skin layers, destroys nerve & blood vessels. No pain at first.
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| Primary excisions: | early excision of deep partial and full-thickness burns reduce the incidence of infection and the threat of sepsis.
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| Managing burn wounds | exposure: wounds left open; crusts on partial & eschar on full. Open: topical agent applied directly to wound. Modified: AMC applied to a thin gauze then secured to area. Occlusive: AMC applied to gauze and placed with multiple layers over bulky gauze.
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| biologic skin coverings of burns | homograft: skin from human cadaver, severe immunosuppression occurs while allograft adheres. Xenograft: mainly from pig, changed q1-3d. Synthetic skin: wound needs to be free of debris before applied.
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| prognosis of burns | the younger the child the more affected they’ll be. Mortality rate much higher in young children then in older children and adults. Many children who survive have long term functional and cosmetic impairments.
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| Atraumatic care | have all supplies ready, give analgesic, give child time to prepare. Allow child to: test and approve of temp of water, select what part of the body to begin on, request short break during procedure. Give something constructive to do and praise child
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| Feedings | oral feedings if child is able to, need encouragement to eat, lots of patients and help. Painful procedures should not be scheduled near feedings, child will be to physically exhausted and emotionally upset
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