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Course: Pediatric Nursing

Topic: Nursing care of Child with Integumentary Disorders Part III

The Nurses International Community

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Module Goals

Learners will be able to:

Define impetigo, scarlet fever, ringworm and scabies.
Identify causes and transmission of these disorders.
Discuss the signs and symptoms of these disorders.
Describe common diagnostic procedures for these disorders.
Explain common treatments for these disorders.
Discuss the preventive measures for these disorders.
Discuss the nursing management of a child with these disorders.

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Bacterial Infection: Impetigo

Bacterial skin infection
Most common in young children (2 to 5 years of age)
Causes:

Group A Streptococcus and
Staphylococcus aureus

Transmission:

Coming in contact with lesions or fluid from the lesions

CDC, 2022

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Impetigo: Sign and Symptoms

CDC, 2022

Most often affects exposed skin (around the nose and mouth or on the arms or legs)

Red, itchy lesions that break open and leak a clear fluid or pus for a few days
Next, a crusty yellow or “honey-colored” scab forms over the lesion, which then heals without leaving a scar

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Impetigo: Risk Factors

Age: Most common in 2 to 5 years old.
Infections or injuries that cause a break the the skin:

Children with scabies infection are at increased risk for impetigo

Close contact or crowding
Climate:

Hot, humid summers and mild winters (subtropics) areas

Poor personal hygiene

CDC, 2022

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Impetigo: Diagnosis/ Treatment

Diagnosis

Physical examination, lab test not needed

Treatment:

Antibiotic cream or ointment (most often for mild impetigo)
Antibiotic tablets or liquid by mouth (oral) (for several areas of impetigo or ecthyma)
Cleaning and bandaging:

Gently washing of child’s skin with mild soap and water
Cover draining areas

CDC, 2022

Stanford Children’s Hospital, n.d

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Impetigo: Prevention (Good Wound Care)

Clean all minor cuts and injuries that break the skin with soap and water
Clean and cover open wounds with clean, dry bandages
Avoid the following if an open wound is present:

Hot tubs
Swimming pools
Natural bodies of water (e.g., lakes, rivers, oceans)

CDC, 2022

Stanford Children’s Hospital, n.d

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Impetigo: Prevention (Hygiene)

Frequent body and hair washing with soap and clean water
Wash hands often for at least 20 seconds
Use an alcohol-based hand rub if soap and water unavailable
Wash the clothes, linens, and towels daily of anyone who has impetigo
Don't share personal items (towels or washcloths)
Keep child's fingernails short to prevent scratching and spreading the infection

CDC, 2022

Stanford Children’s Hospital, n.d

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Critical Thinking Question

A 7 year old is admitted to the unit with a severe case of impetigo. A nurse who is assigned to the child should follow certain precautions while caring for this child.

What would they include?

Droplet Precaution
Airborne Precaution
Contact precaution
Reverse precaution

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Scarlet Fever

CDC, 2022

Also called scarlatina
Child has a sore throat and a rash
Caused by:

Group A Streptococcus (group A strep)
Sometimes makes a toxin that causes a rash — the “scarlet” of scarlet fever

Transmission:

Talking, coughing, or sneezing
From infected sores on the skin

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Scarlet Fever: Sign and Symptoms

Very ‘red’, sore throat
Fever (101°F or higher)
Whitish coating on the tongue early in the illness
“Strawberry” (red and bumpy) tongue
Red skin rash that has a sandpaper feel

in the creases of the underarm, elbow, and groin

Swollen glands in the neck
Other general symptoms:

Headache or body aches
Nausea, vomiting, or abdominal pain

CDC, 2022

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Scarlet Fever: Prevention

Good hand hygiene and respiratory etiquette (cover cough or sneeze)
Treatment with an antibiotic for 12 hours or longer generally eliminates the ability to transmit the bacteria
Stay home from work, school, or daycare until:

Afebrile and
At least 12 hours after starting appropriate antibiotic therapy

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Scarlet Fever: Diagnosis/ Treatment

Diagnosis:

Throat swab: a rapid antigen detection test (RADT)
Throat culture is the gold standard diagnostic test

Treatment:

Antibiotics: Penicillin or amoxicillin
Encourage gargle with warm saline (saltwater) to ease the sore throat
Encourage plenty of fluids
Give acetaminophen or ibuprofen for fever or throat pain

CDC, 2022

Stanford Children’s Health, n.d

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

A area has a recent outbreak of scarlet fever. There have been many rumors and myths about the fever in the community. Therefore, a nurse plans a series of teaching sessions called “Myth buster” for the community. Which of the following statements would the nurse confirm as false about scarlet fever?

Scarlet fever is a viral infection and has rapid transmission
Scarlet fever spreads through drops, sneezes and coughs.
It cause high fever and strawberry tongue
Acetaminophen or ibuprofen can be taken for fever or throat pain.

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Fungal Infection: Ringworm (tinea infection)

CDC, 2020

Fungal skin infection
Called “ringworm” because it can cause a circular rash (shaped like a ring) that is usually red and itchy

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Ringworm (tinea infection): Sign and Symptoms

CDC, 2021

Symptoms typically appear between 4 and 14 days after the skin comes in contact with the fungi that cause ringworm

Itchy skin
Ring-shaped rash
Red, scaly, cracked skin
Hair loss

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Symptoms of ringworm by location on the body:

Feet (tinea pedis or “athlete’s foot”): The symptoms of ringworm on the feet include red, swollen, peeling, itchy skin between the toes (especially between the pinky toe and the one next to it). The sole and heel of the foot may also be affected. In severe cases, the skin on the feet can blister.
Scalp (tinea capitis): Ringworm on the scalp usually looks like a scaly, itchy, red, circular bald spot. The bald spot can grow in size and multiple spots might develop if the infection spreads. Ringworm on the scalp is more common in children than it is in adults.
Groin (tinea cruris or “jock itch”): Ringworm on the groin looks like scaly, itchy, red spots, usually on the inner sides of the skin folds of the thigh.
Beard (tinea barbae): Symptoms of ringworm on the beard include scaly, itchy, red spots on the cheeks, chin, and upper neck. The spots might become crusted over or filled with pus, and the affected hair might fall out

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Ringworm (tinea infection): Risk

Weakened immune system
Use of shared bathrooms or locker rooms
Playing contact sports, such as wrestling
Lives in a warm climate
Has contact with other children or pets that have ringworm
Poor hygiene
Malnourished

CDC, 2021

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Ringworm (tinea infection): Diagnosis/ Treatment

Diagnosis:

Based on a health history and physical exam of the child

Treatment:

Depends on child’s symptoms, age, and general health

Antifungal cream or pill to take by mouth

Clotrimazole (Lotrimin, Mycelex
Miconazole
Terbinafine (Lamisil)
Ketoconazole (Xolegel)

CDC, 2021

Children National, n.d

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Ringworm (tinea infection): Prevention

Good hygiene
Frequent handwashing
Don’t wear other people's hats or clothing
Stay away from someone who has ringworm
Keep skin clean and dry
Wear shoes that allow air to circulate freely around feet
Don’t walk barefoot in areas like public showers
Clip fingernails and toenails -short and clean

CDC, 2021

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Case Study

The school nurse is approached by a 9-year-old girl who is complaining of severe itchy legs and hands.

Upon closer examination, the nurse discovers a circular red scaly skin with rash on the back and dorsal limbs.

What condition would the nurse suspect and what would the nurse do?

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Answer: Ringworm

The nurse should inform the parent that ringworm is very contagious and can be transferred from person to person by direct contact (skin to skin) and also by indirect contacts such as touching an infected person's clothing or even by touching a bench or other object that has contacted an infected person's skin. It can be acquired in pools and hot tub areas by indirect contact. Humans can acquire ringworm from animals (for example, from dogs). Clothing and linen should be washed adn surfaces cleaned frequently to prevent spread.

If treatment is interrupted or not completed, it is possible to have ringworm reoccur.

Most forms of ringworm can be treated with over the counter medications in cream, lotion, or powder forms. These include (Lotrimin, Mycelex, and many others). These medications are antifungal medications. Even if an individual is successfully cured of ringworm, it is still possible to become reinfected if the individual encounters another source of infection (an infected person or contaminated object).

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Parasitic Infection: Scabies

An infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis)
Up to 10% of children in resource-poor areas are affected by scabies
Occurs worldwide but is most common in hot, tropical countries and in areas of high population density

WHO, 2020

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Scabies: Symptoms

WHO, 2020

Pruritus (‘itching’) usually severe
Rash, with small pimples or red bumps
Scaly or crusty skin (with advanced conditions)

Transmitted individual-to-individual through close skin contact (e.g. living in the same residence) with an infected individual

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Scabies: Treatment

Applications of prescription creams and lotions, such as: permethrin and lindane solutions.
Oral antihistamine medication (to relieve itching).
In some cases, topical ointments are recommended.

WHO, 2020

Children National. n.d

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Nurses Role

History taking
Physical examination
Symptom relief:

Encourage plenty of fluids
Acetaminophen or ibuprofen for fever/discomfort

Health Education:

Transmission of diseases
Preventive measures for transmission
Good skin hygiene

Emotional support

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Critical Thinking Question

In an awareness session on the scabies provided by the school nurse, one of the students asks the school nurse how scabies is transmitted.

How should the nurse respond?

What is the causative agent?
What is the mode of transmission?

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References:

CDC. (2022). Impetigo: All You Need to Know. https://www.cdc.gov/groupastrep/diseases-public/impetigo.html#:~:text=Young%20Children%20Are%20at%20Increased%20Risk,-Anyone%20can%20get&text=Age%3A%20Impetigo%20is%20most%20common,increase%20someone%27s%20risk%20of%20impetigo

CDC. (2022). Scarlet Fever: All You Need to Know

https://www.cdc.gov/groupastrep/diseases-public/scarlet-fever.html

CDC. (2022 June 27). Scarlet Fever. https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html#:~:text=Scarlet%20fever%2C%20also%20called%20scarlatina,strep%20pyoderma%20or%20wound%20infections.&text=Characteristics%20of%20the%20rash%20typically,rash%20that%20blanches%20on%20pressure

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References:

CDC.(2020 December 29). Ringworm. https://www.cdc.gov/fungal/diseases/ringworm/index.html

CDC. (2021 January 14). Symptoms of Ringworm Infections. https://www.cdc.gov/fungal/diseases/ringworm/symptoms.html

CDC. (2021 January 14). Ringworm Risk & Prevention. https://www.cdc.gov/fungal/diseases/ringworm/risk-prevention.html

CDC. (2021 January 14). Treatment for Ringworm. https://www.cdc.gov/fungal/diseases/ringworm/treatment.html

Contact info: info@nursesinternational.org

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References:

Children National. (n.d). Pediatric Common Skin Disorders. https://childrensnational.org/visit/conditions-and-treatments/skin-disorders/common-skin-disorders

Children’s National. (n.d). Pediatric Scabies. https://childrensnational.org/visit/conditions-and-treatments/skin-disorders/scabies

Stanford Children’s Hospital. (n.d). Impetigo in Children. https://www.stanfordchildrens.org/en/topic/default?id=impetigo-in-children-90-P01905&sid=

WHO. (2020 August 16). Scabies. https://www.who.int/news-room/fact-sheets/detail/scabies

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