LassanskePEDS exam2
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| Recommended caloric intake for an infant | 115 calories/kg/day
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| Recommended caloric intake for toddler | 1300 calories/day
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| Recommended caloric intake for preschooler | 1600-1800 calorie/day
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| Recommended caloric intake for school age | 2100-2500 calories/day
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| Recommended caloric intake for adolescent | 2500-3000 day
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| An infant should be fed formula or breast milk for the first __ months | 6
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| Weight gain for an infant should meet ____ per day | 1/2-1 oz.
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| General rule of thumb when feeding a toddler in reference to how many tablespoons of each food | 1 tablespoon per food group, per year of age
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| this age group tends to be grazers. | Toddler
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| Which age group is most likely to want one food group (chicken nuggets) | Pre-school, feed similar to toddler
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| Child who had a normal growth rate has now fallen below the 5th percentile on ht/wt chart, or deviation from the satisfactory growth on curve | definition of FTT- failure to thrive
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| Organic FTT | Has a physical cause, congenital heart defect, neuro lesion, microcephaly, chronic renal failure, gastroesoph reflux, malabsorption syndrome, endocrine dysfunct, cystic fibrosis, or AIDS
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| Referred to as Maternal deprivation syndrome | Non organic FTT cause of growth failure. Caused by inadequate nutritional intake and copsychological issues of the caregiver.
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| Signs of FTT | growth failure, weight or ht and wt, develop delays; social, motor, adaptive, language. apathy, poor hygiene, withdrawn, no fear of stranger, radar gaze, minimal smiling/verbalization
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| Interventions for family of the child with failure to thrive | wt q. day, age-appropriate food, high calorie formula with polycose or powdered milk, structured time of activities/regular feeding times, teach parents to feed, be positive with parents.
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| Initially confined to diaper area, red confluent rash, inflamed skin; r/t prolonged contact with irritant. Bright red, swollen over diaper area but rarely in groin | Diaper dermatitis
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| Diaper rash that is fiery red with peeling indicates? | Candida albican/fungal infection
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| Treatment for diaper dermatitis? | topical steroids as long as its not an infection.
zinc based creams, protect and have slight antibiotic effect.
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| Causes of contact dermatitis | oils of plants, urushiol (oil of ivy, oak, sumac)
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| Management of contact dermatitis | Wash body quickly and gently with comfortable water temp, do not use soap, most effective within the first hour of exposure, before the oil can soak into skin; the oil has soaked in 2-3 hours after exposure.
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| Which product is recommended to break up the oil of plants to clean clothing, shoes, and pets. | TECNA; anti-oil wash that breaks up the oil, can be used on the body as well.
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| If the oil of plants are not removed within 2-3 hours of skin exposure, what is the resulting pathophys? | Oil metabolizes into quinone derivatives, which in turn attaches to keratins. WBC come to location, rash begins within 8-24 hours of exposure.
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| Management of contact dermatitis | Calamine, burrows solution, aveeno baths, topical corticosteroids, Vitamin C, E, and lots of water, hot water/air. Oatmeal/baking soda, clearisil/salicytic acid, st ives apricot scrub
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| T or F? Atopic dermatitis is caused by emotional factors such as stress. | F- emotional stress can exacerbate the condition but not the cause.
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| Chronic skin disease characterized by extremely itchy, inflamed skin with swelling, cracking, weeping, crusting and scaling | Atopic dermatitis
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| a form of skin inflammation of unknown cause, presents as yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body | seborrheic eczema
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| Cause/assessment of atopic dermatitis? | Skin loses too much moisture from the epidermal layer, causing skin to be very dry, reducing its protective abilities. biopsy may be necessary to determine if the skins immune system overreacts to certain chemicals or preservatives in skin cream.
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| Medications to treat atopic dermatitis | antihistamine, topical steroids for flare ups, topical immunomodulators, antibiotics if infection, Neutrogena T gel
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| Atopic dermatitis has been found to harbor what bacteria? | 80-90% have staph aureus in the lesions
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| Indication regarding topical antibiotics and atopic dermatitis? | those affected with AD tend to be resistant to topical antibiotics
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| What triggers AD? | Dry skin, complex topical agents, microbes, food allergies/environmental allergens, sleep deprivation
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| Care of AD? | Daily baths, gentle cleansers, bland ointments, avoidance of allergic producing products.
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| What types of lotions should be utilized in atopic dermatitis? | Those who list water as the 1st or 2nd ingredient, NO OILS
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| At what time does seborrhea generally occur? | During infancy when sebum production is increased.
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| Known as dandruff in adolescents, and adults | Seborrhea
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| Known as cradle cap, affects the scalp as thick, crusty, yellow scales. | Seborrheic dermatitis
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| Seborrheic dermatitis is generally outgrown by age.... | 3, and child will not normally get seborrheic dermatitis
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| Pathology of seborrheic dermatitis | Sebaceous glands produce too much sebum, later pityrosporum yeast grows excessively in the sebum.
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| Management of seborrheic dermatitis | Mild,nonmed baby shampoo, brushing baby's scalp with soft brush, tar containing shampoo, prescription shampoo that contains 2% ketoconazole (Nizoral)
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| What is the cause of acne? | Follicles (hair shaft) is blocked, the sebaceous gland produces sebum which should drain to the surface. In acne, the sebum is blocked and bacteria grows.
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| R/F for acne | Hormonal changes provoke or aggravate, pregnancy, certain meds such as cortisone, cosmetics or greasy/oily substances, family history, friction/pressure on skin; cell phones, helmets, etc.
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| Caring for inflamed or glandular skin problems. The following should be used to control: select all that apply A. gently cleanser B. facial scrub C. astringents to dry the problem areas D. masks. E. scrubbing hair and face frequently | A. gentle cleanser
E- partially true, hair should be washed frequently
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| Active ingredients in OTC acne products should be? | At least one of the following items should be listed as the main ingredient: benzoyle peroxide, sulfur, resorcinol, salicytic acid, lactic acid, alpha hydroxy acid
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| Prescription lotions for acne? | Tretinoin (Avita, Retin-A, Renova), adapalene (Differin), topical prescription products derived from Vit. A, Reinoids are powerful keratolytic agents, they are bactericides and reverse formation of follicles.
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| Combo of oral contraceptives to tx acne? | norgestimate and ethinyl estradiol (ortho-cyclen and ortho-trycyclen)
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| Manifestation caused by a female mite who burrows into the stratum corneum of the epidermis to deposit eggs. | Scabies
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| How is scabies contracted? | Close contact/poor hygiene
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| Medical management of scabies | Topical scabicide- permethrin cream
Lindane cream, Stromectal 3mg can take up to 4 tabs at once, as prescribed by Physician.
Lvermectin used to treast certain roundworm infection, head or pubic lice and scabies.
Clear nail polish on spot.
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| What has to happen to relieve itching with scabies? | Stratum corneum must be replaced to ease itching; 4-6 weeks
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| In tx of lice or scabies, unwashable items should be set aside in a plastic bag for __ days (mites), and ___ weeks for lice/nits. | 3 days, 23 weeks
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| After tx for scabies contact HCP if A. Itching interferes with sleep, nurse would teach??? B. Rash not cleared within __ week of tx. C. Rash clears then returns D. Rash or sores begin to look..... E. Fever develops F. New nits/burrows appear | A. rash or itch may continue for 2-3 wks post tx.
B. 1.
D. reddened , warm to touch, or oozing secretions
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| Bacterial infection of the skin caused by a scratch or excess moisture especially around face or mouth. | Impetigo
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| Sores appear as gold-brown crusty scabs. | Impetigo
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| Impetigo- contagious? | Highly contagious
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| Management of impetigo? | Removal of crust by antibacterial soaking. After removal, antibacterial ointment is applied possibly oral antibiotics.
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| How do you teach the parents to cleanse articles used to remove the crust of impetigo? | Washed with bleach and NOT touch any other person or part of body.
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| Fungi living on the surface of skin in the dead keritin areas if organism multiplies faster than dead cells are shed then this condition presents | Dermatophytosis, tinea; Ring worm
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| How is ringworm (Dermatophytosis tinea) contracted? | It is highly contagious and transmitted from animal to human
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| How is ringworm diagnosed? | Woods Lamp; it is a blue light under which fungus appears florescent, must be done in a dark room.
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| Medication that tx ringworm? Teaching? | Griseofulvin- complete the dose, take with high fat foods.
Ketoconazole, Diflucan
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| Teaching to prevent infestation or recurrence of ringworm? | *No sharing of clothing, grooming articles.
*Note household pets with condition
*No oils or petroleum jelly
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| Fungal infection that likes moist areas, particularly the diaper area. Skin becomes pruritic, fire engine red with peeling edges. | candidiasis
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| Medical management of candidiasis | *Nystatin drugs; topical/powder
*Amphotercin b
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| Lesions appear as round patches of hair loss that increases in size. Broken hair shafts at surface of scalp, appears as stubble. Scalp scales, mild itch. Affects child 2-10 yrs. Most often males | Tinea capitis
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| Treatment of Tinea capitis | *Admin oral antifungal med (griseofulvin), 6-8 weeks.
*antifungal cream 2x week for 8 wks.
*No need to shave or cut hair. Hair regrowth slow.
*Lesions mildly contagious, can return to school after meds and antifungal shampoos are started.
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| Round pruritic expanding red lesions with well circumscribed borders and central clearing. Scaling on lesion borders. Lesions may be single or multiple. Annular. | tinea corporis
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| Rash that appears on the entire body, especially the face and extremities, uncommon after puberty. | Tinea corporis
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| TX for Tinea corporis | topical antifungal cream 2X daily for 2-4 weeks, continued for several days after clinical cleaning. Continue application of cream for 2 wks following lesion disappearance.
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| Tinea corporis, teaching for parent | Lesions are mildly contagious, direct contact with other children and animals should be avoided. Child can return to school after tx with topical med has began.
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| Erythematous, scaly eruptions. Not usually seen before adolescence. Often seen in athletes. | Tinea cruris (jock itch)
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| Tinea infection that occurs on the inner thighs and inguinal creases. | Tinea cruris
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| tx for Tinea cruris | *Topical antifungal cream 2x daily for 2-4 wks.
*Keep area dry
*wear loose fitting cotton shorts
*cleanse area daily with water and dry.
*Lesions are mildly contagious and will not affect dry, normal skin
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| Vesicles and erosions on the instep of one or both feet. Fissures btwn toes, with scaling and erythema. Itch/burning rash. Unpleasant foot odor. Most often found in the postpubertal adolescent. | tinea pedis (athletes foot)
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| Tx for tinea pedis? | *If acute: open wet compressions used, Burrows solution 1:80
*Apply topical antifungal cream 2xdaily for 2-4 wks to clean feet.
*Keep feet dry, wear sandals/no shoes.
*Wear cotton socks only, changed 2x daily.
Dry feet after shower.
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| Multiple annular to oval macules or patches with a fine scale. Appears on well-tanned or darkly pigmented children. Lesions are hypopigmented. | Tinea versicolor
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| Area of appearance for tinea versicolor? | Neck, upper back, shoulders, upper arms.
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| Tx for Tinea versicolor? | Wash areas with prescribed medicated shampoo of 1% selenium sulfide or 212% selenium. Blue OTC shampoo (Selsun blue) Q.day for 2-3 wks. Topical imidazole antifungal 2x daily for a week; tapering possible after.
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| Teaching for parents of a child with Tinea versicolor? | It is not contagious, recurrence is likely. For chronic recurrence, systemic antifungals may be indicated. Monthly tx with shampoo can prevent recurrence.
Normal skin color doesn't return for 6-12 months.
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| Distal thickening and yellowing of the nail plate caused by separation of nail bed and entrapment of air between the two structures. Usually found in adolescents. | Tinea unguium, onychomycosis
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| Area of occurence for Tinea unguium | Fingernails/toenails
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| Tx for tinea unguium? | Topical agents not effective; oral antifungals may be used.
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| Description of a first degree burn? appearance? Thickness? painful? | Thickness of superficial epithelium, appears erythemic, painful, sunburn.
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| Second degree burn- thickness? Pain? appearance? Example? | *Partial thickeness, destruction into but not through the epidermis.
*blisters, peeling epidermis, swelling with white or red mottling. Weeping/wet
*painful, hypersensitive to air/touch
*Very deep sunburn or scalds
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| Third degree burn? thickness? Pain? appearance? Example? | *full thickness, damage of skin into the hypoderm. Death to all skin appendages and subcu tissue.
*Translucent, mottle white/tan. Waxy or leathery appearance, mainly dry.
*Initially painless
*Caused by fire/prolonged exposure to hot liquid/electrical
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| Fourth degree burn thickness? Pain? appearance? Example? | *Full thickness, all layers to muscle/bone. *Looks like a third degree burn. *No sensation; nerve damage
*Prolonged flame contact, high voltage electrical injury
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| Rule of nines? | for an adult, the body surface area is divided into areas of 9% or multiples of 9% equal to 18%. When all body areas are summed, 1% remains, assigned to the genitalia/perineum. *page 1348TB*
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| Rule of nines for children under age 15, babies/young children? | Head and neck, 21%, each arm 10%, each leg 13.5%, Genitals 1%, buttocks 5%, abdomen 13%, back 13% **Fig 25-16 pg 1349 TB
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| How do you stop the burn injury? | To remove the heat from the tissues, cool water should be applied to the effected area.
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| Scalding, immersion in water at __a_°C or (_a_° F) causes full thickness burns in two minutes. Full thickness burns develop in 5 seconds of immersion in water at b__°C (_b__°F) | A. 52/126
B. 60/140
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| Water heaters should be set at XX-XX°C (___°-___°) | 49-55°C/120-130°F
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| Water heaters in apartments are usually set to ___°C (___°F) and can cause full thickness burns in one second | 70°C/158°F
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| Why is appropriate season clothing important for the post burn patient? | May not be able to sweat due to damaged sweat glands
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| *UV protection is necessary for how long after a burn? *Hair color can be used- __ wks after, *permanent can be used __ months after | *12-18 months *6 wks *3 months
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| Benefits of VAC system? (Vacuum assisted closure technique) | *Increases the take of skin graft
*speeds recovery
*increases post operative mobility (pt can walk around after procedure)
*decreased pain after surgery
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