1 of 30

Course: Pediatric Nursing

Topic: Nursing Care of the Child

with Integumentary Disorders Part V

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 30

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 30

Module Goals

Learners will be able to:

Define frostbite and animal bites.
Identify risk population for frostbite and animals bites.
Describe signs and symptoms of frostbite and animal bites.
Describe management of frostbite and animal bites.
Discuss preventive measures for frostbite and animal bites.
Discuss nursing management of a child with frostbite and animal bites.

Contact info: info@nursesinternational.org

4 of 30

Frostbite

Damage to the skin tissue caused by exposure to freezing temperatures (Typically any temperature below -0.55^oC (31^oF)

May affect any part of the body

Body parts most commonly affected:

Cheeks
Ears
Nose
Fingers and toes

NHS, 2021

Contact info: info@nursesinternational.org

5 of 30

Frostbite: High Risk Populations

Children
Elderly
Homeless people
Individuals with conditions that cause blood vessel damage or circulation issues (i.e. diabetes)
Individuals who take medication that constricts the blood vessels (i.e. beta blockers)

NHS, 2021

Contact info: info@nursesinternational.org

6 of 30

Frostbite: Symptoms

Three-stage progression includes

Early stage (Frostnip):

‘Pins and needles’ sensations
Throbbing in the affected area
Cold, numb and white skin

Intermediate stage:

The affected area feels hard and frozen
Erythema and painful blistering
Swelling and itching may be present
Also referred to as superficial frostbite

NHS, 2021

Contact info: info@nursesinternational.org

7 of 30

Frostbite: Symptoms (Continued)

Advanced stage:

Skin becomes white, blue, or discolored.
Underlying tissue feels hard and cold to the touch.
Damage beneath the skin to tendons, muscles, nerves and bones.
Blood-filled blisters form and turn into thick black scabs.

NHS, 2021

Contact info: info@nursesinternational.org

8 of 30

Frostbite: Treatment

Gently remove any clothing covering the affected area.
Change the child into dry, warm clothing.
Slowly warm the area by gently covering it with the hand.
Use warm (not hot) water to slowly reheat affected body parts.
If fingers are affected, may place them in the opposite armpit to rewarm.
Do not massage or rub snow on frostbitten skin.
Seek medical advice immediately if skin is white, waxy or feels numb.

Caring for Kids, 2017

Contact info: info@nursesinternational.org

9 of 30

Frostbite: Prevention

Keep children indoors when temperatures are -27°C (-16°F) or lower.
Reduce the amount of time children spend outside when the temperature falls to -15°C (5°F).
Never send children outside unsupervised in a snowstorm.
Ensure proper skin protection in cold temperatures.

Hat that covers the ears.
Mittens are more effective than gloves.
Waterproof boots that allow space to wiggle toes and wear thick socks.

Caring for Kids, 2017

Contact info: info@nursesinternational.org

10 of 30

Frostbite: Nurse’s Role

Obtaining client history
Head-to-toe physical assessment
Nursing priorities focus on:

Rewarming the extremities
Hourly neurovascular assessments, vital signs, ECG monitoring, and neurologic assessments
Limiting further injury:

Wound care, cleaning and applying an antimicrobial ointment to prevent infection
Analgesics as needed to control pain

Health education:

Preventive measures
First aid

Contact info: info@nursesinternational.org

11 of 30

Critical Thinking Question

Which of the following statements are true regarding frostbite in children? (Select all that apply)

Tissue with advanced stage of frostbite can be cured if identified and treated early
Area with frostbite should not be massaged
Intermediate frostbite can be prevented from progressing to advance stage by quickly warming with hot towel
Children with diabetes are at risk of frostbite
Children taking beta blockers are at risk of frostbite

Contact info: info@nursesinternational.org

12 of 30

Animal Bites

Animal bites pose a major public health problem in children and adults worldwide

Most concerning cases result from

Snakes
Dogs
Cats
Monkeys

WHO, 2018

Contact info: info@nursesinternational.org

13 of 30

Snake Bites

Groups most commonly affected

Agricultural workers
Women
Children

Child victims can suffer lifelong disability, intensifying demands on families and communities
Common locations:

Rural, resource-poor settings
Areas of low-cost, non-mechanical farming or field work

WHO, 2018

Contact info: info@nursesinternational.org

14 of 30

Snake Bite: Treatment

Cornerstone of care at the time of the bite:

Complete immobilization of the affected body part
Prompt transfer to a medical facility
Avoid tourniquets and opening wounds as first aid (Can worsen the effects of venom).
Use of antivenom when indicated
Additional measures:

Wound cleansing to decrease infection risk.
Supportive therapy as needed (airway support).
Administration of tetanus vaccine upon discharge if vaccination status is inadequate.

(WHO, 2018)

Contact info: info@nursesinternational.org

15 of 30

What Would the Nurse Do?

Discussion:

In a community awareness program, an adolescent says that his grandfather had taught him what to do for animals and insect bites. He said that he told him that if a snake bites the limb the part has to be tied with a tourniquet to prevent the venom from spreading.

What would the nurse do?

Contact info: info@nursesinternational.org

16 of 30

Dog Bites

Children in mid-to-late childhood are the most commonly affected population.
The risk of injury to the head and neck is greater in children than in adults.
The fatality rates are higher in low- and middle-income countries than in high-income countries, since rabies is a problem in many of these countries.

WHO, 2018

Contact info: info@nursesinternational.org

17 of 30

Dog Bites: Treatment

Early medical management.
Irrigation and cleansing of the wound.
Primary closure if the wound is low-risk for developing infection.
Prophylactic antibiotics for high-risk wounds or those with immunodeficiencies.
Rabies post-exposure treatment depending on the dog’s vaccination status.
Administration of tetanus vaccine if the the child has not been adequately vaccinated.

WHO, 2018

Contact info: info@nursesinternational.org

18 of 30

Dog Bites: Prevention

Educate children regarding prevention techniques:

Remain motionless (i.e. "be still like a tree") when approached by an unfamiliar dog.

Curl into a ball with the head tucked and hands covering the ears and neck if a dog attacks.

Immediately inform an adult about stray dogs.

WHO, 2018

CDC, n.d

Contact info: info@nursesinternational.org

19 of 30

Dog Bites: Prevention (Continued)

Educate children to avoid:

Approaching an unfamiliar dog
Running from a dog
Panicking or making loud noises
Disturbing a dog that is sleeping, eating, or caring for puppies
Petting a dog without an owner or without asking for permission
Encouraging the dog to play aggressively
Letting small children play with a dog unsupervised

WHO, 2018

CDC, n.d

Contact info: info@nursesinternational.org

20 of 30

What Would the Nurse Do?

A child was rushed into the emergency room with complaint of dog bite in the left leg. After quick assessment of the wound area and history taking, the wound was identified as a bite from a dog whose rabies shot status was unknown. What should the nurse do next?

Provide rabies shot to the child
Irrigate and clean the wound
Ask the parents if the child was vaccinated with rabies shot
Administer antiviral drug to treat rabies
Administer antibiotic drug to treat infection

Contact info: info@nursesinternational.org

21 of 30

Cat Bites

Cats have many harmful bacteria on their teeth and claws.

Cat bites and scratches are typically inflicted on the head, neck, or upper extremities.

Risk of infection from puncture wounds.

Better Health, 2014

Contact info: info@nursesinternational.org

22 of 30

Cat Bites: Treatment

Bites or scratches must be thoroughly washed and disinfected.

Prophylactic antibiotics decrease risk of infection.

Rabies post-exposure treatment depending on the animal vaccination status.

Administration of tetanus vaccine if the child has not been adequately vaccinated.

WHO, 2022

Better Health, 2014

Contact info: info@nursesinternational.org

23 of 30

Insect Stings and Bites

If a bee, wasp, or ant stings a child:

Encourage the child to stay still and calm.
Remove stingers immediately, since venom is injected within 30 seconds of a sting.

Use a blunt edge to remove the stinger, using a gentle flicking motion.
Do not squeeze or dig into the skin.

Bees leave a stinger, wasps do not.
Wrap ice in a wet cloth and place it on the affected area.
If pain and swelling persist, seek medical attention.

Better Health,2014

Contact info: info@nursesinternational.org

24 of 30

Nurse’s Role

Obtaining client history
Head-to-toe physical assessment

Signs and symptoms of bites
Signs and symptoms of wound infections

First aid measures
Referrals as necessary
Emotional support
Health education to child and families

Preventive measures
Danger of bites

Contact info: info@nursesinternational.org

25 of 30

Case Study

Discussion:

A child came to the clinic saying that he was playing with a cat that bit him on the arm and ran away.

On assessment, the nurse notes that the child’s arm is bleeding.

What would be the nurse’s immediate intervention?

Contact info: info@nursesinternational.org

26 of 30

Red Flags

Snake bites
Rabies symptoms after animal bites

The first symptoms of rabies may be similar to the flu, including weakness or discomfort, fever, or headache.
There also may be discomfort, prickling, or an itching sensation at the site of the bite. These symptoms may last for days.
Symptoms then progress to cerebral dysfunction, anxiety, confusion, and agitation.

CDC, 2021

Contact info: info@nursesinternational.org

27 of 30

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

Contact info: info@nursesinternational.org

28 of 30

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 affect 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

Contact info: info@nursesinternational.org

29 of 30

References:

Better Health. (2014). Animals and child safety. https://www.betterhealth.vic.gov.au/health/healthyliving/animals-and-child-safety#child-safety-and-dogs

CDC. (n.d). Preventing Dog Bites. http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/features/dog-bite-prevention/index.html

Caring for Kids. (2017). Frostbite. https://caringforkids.cps.ca/handouts/safety-and-injury-prevention/frostbite

NHS. (2021 August 24). Frostbite. https://www.nhs.uk/conditions/frostbite/

Weimer, S. & Staubli, L. (2013). Fending off disaster for a frostbite victim. https://www.myamericannurse.com/fending-off-disaster-for-a-frostbite-victim/#:~:text=Nursing%20priorities%20focus%20on%20rewarming,ointment%20to%20help%20prevent%20infection.

WHO. ( 2018 February 5). Animal Bites. https://www.who.int/news-room/fact-sheets/detail/animal-bites

Contact info: info@nursesinternational.org

30 of 30

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org