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Information

  1. INFANTILE ECZEMA (ATOPIC DERMATITIS)
    1. Introduction: Eczema is an allergic skin reaction, most commonly to foods (e.g., cow's milk, eggs). It is most common in infants and young children (under 2 years). Infantile eczema generally undergoes permanent, spontaneous remission by age 3 years; however, approximately 50% of children who have had infantile eczema develop asthma during the preschool or school-age years.
    2. Assessment:
      1. Erythematous lesions, beginning on cheeks and spreading to rest of face and scalp.
      2. May spread to rest of body, especially in flexor surfaces (e.g., antecubital space).
      3. Lesions may ooze or crust over.
      4. Severe pruritus, which may lead to secondary infection.
      5. Lymphadenopathy near site of rash.
      6. Unaffected skin tends to be dry and rough.
      7. Systemic manifestations are rare—but child may be irritable, cranky.
    3. Analysis/nursing diagnosis:
      1. Impaired tissue integrity related to lesions.
      2. Pain related to pruritus.
      3. Risk for (secondary) infection related to breaks in the skin (first line of defense) and itching.
      4. Knowledge deficit related to care of child with eczema, prognosis, how to prevent exacerbations.
    4. Nursing care plan/implementation:
      1. Goal: promote healing of lesions.
        1. Wet method: frequent tepid baths (up to four times a day) followed by immediate application of a lubricant while the skin is still moist; no soap or use very mild, nonperfumed soap (e.g., Dove, Neutrogena); most useful method if child lives in a dry climate.
        2. Dry method: infrequent baths; cleanse skin with nonlipid, hydrophilic agent (e.g., Cetaphil); most useful method if child lives in a humid climate.
        3. Can add cornstarch to bath water to relieve itching and promote healing; keep skin well hydrated by applying emollients containing petrolatum or lanolin, which are occlusive and prevent evaporation of moisture.
        4. pillImageApply wet soaks with Burow's solution (aluminum acetate solution; topical astringent and antiseptic); wet soaks should not be used for more than 3 days at a time
        5. Protect child from possible sources of infection; standard precautions to prevent infection.
        6. Absolutely no immunizations during acute exacerbations of eczema because of the possibility of an overwhelming dermatitis, allergic reaction, shock, or even death.
        7. pillImageApply topical creams/ointments as prescribed: A and D emollient ointment, hydrocortisone cream to promote healing.
      2. Goal: provide relief from itching/keep child from scratching.
        1. pillImageAdminister systemic oral antihistamines as ordered (e.g., Benadryl or Atarax ) to break itch-scratch cycle. Most useful at bedtime when itching tends to increase.
        2. Keep nails trimmed short—may need mittens (preferable not to use elbow restraints, because the antecubital space is a common site for eczema).
        3. Use clothes and bed linens that are nonirritating, that is, pure cotton (no wool or blends).
        4. foodImageInstitute elimination/hypoallergenic diet:
          1. No milk or milk products.
          2. Change to lactose-free formula (e.g., Isomil).
          3. Avoid: eggs, wheat, nuts, beans, chocolate.
        5. No stuffed animals or hairy dolls.
      3. Goal: provide discharge planning/teaching for parents and child.
        1. Include all above information.
        2. Include information on course of disease: characterized by exacerbations and remissions throughout early years.
        3. Include information on prognosis: 50% to 60% will go into spontaneous (and permanent) remission during preschool years; 40% to 50% will develop asthma/hay fever during school-age years.
    5. Evaluation/outcome criteria:
      1. Lesions heal well, without secondary infection.
      2. Adequate relief from itching is achieved.
      3. Parents verbalize understanding of eczema, prognosis, and how to prevent exacerbations.
  2. INFESTATIONS
    1. Lice (pediculosis)
      1. Introduction: In children, the most common form of lice is pediculosis capitis, or head lice. This parasite feeds on the scalp, and its saliva causes severe itching. Head lice are frequently associated with the sharing of combs and brushes, hats, and clothing; thus, they are more common in girls, especially those with long hair. Lice are also associated with overcrowded conditions and poor hair hygiene.
      2. Assessment:
        1. Severe itching of scalp.
        2. Visible eggs/nits on shafts of hair.
      3. Analysis/nursing diagnosis:
        1. Impaired skin integrity related to infestation of scalp with lice.
        2. Risk for impaired skin integrity related to severe pruritus of scalp.
        3. Knowledge deficit related to transmission and prevention of disease and treatment regimen.
      4. Nursing care plan/implementation:
        1. pillImageGoal: eradicate lice infestation. Apply permethrin ( Nix ) as drug of choice for infants and children—rub shampoo in for 4 to 5 minutes, then comb with fine-tooth comb to remove dead lice and nits (eggs).
        2. Goal: prevent spread of lice.
          1. Wear gloves and cap to protect self.
          2. pillImageInspect other family members; treat prn with pediculocide.
          3. Wash all clothes and linens to kill any lice that may have fallen off the child's hair.
          4. Encourage short hair, if acceptable.
          5. Teach preventive measures: do not share comb, brushes, hats.
      5. Evaluation/outcome criteria: lice are eradicated and do not spread.
    2. Pinworms (enterobiasis)
      1. Introduction: In children, the most common helminthic infestation is pinworms. Infestation usually occurs when the child places fingers (and the pinworm eggs) into the mouth. Breaking the anus-to-mouth contamination cycle can best be accomplished by good hygiene, especially hand washing before eating and after toileting. If one family member has pinworms, it is highly likely that other family members are also infested; therefore, treat the entire family to eradicate the parasite. Pinworms are easily eradicated with antiparasitic medications.
      2. Assessment:
        1. Intense perianal itching.
        2. Visible pinworms in the stool.
        3. Vague abdominal discomfort.
        4. Anorexia and weight loss.
      3. Analysis/nursing diagnosis:
        1. Risk for infection/injury related to the anusto-mouth contamination cycle of pinworm infestation, severe rectal itching.
        2. Knowledge deficit related to transmission and prevention of disease and treatment regimen.
      4. Nursing care plan/implementation:
        1. pillImageGoal: eradicate pinworm infestation. Treat all family members simultaneously with an antiparasitic agent (e.g., Vermox, Povan ).
        2. Goal: prevent spread of pinworms.
          1. Launder all underwear, bed linens, and towels in hot soapy water to kill eggs.
          2. Teach family members the importance of good hygiene, especially hand washing before eating (or preparing food) and after toileting. Stress to children to keep their fingers out of their mouths.
      5. Evaluation/outcome criteria: Pinworms are eradicated and do not spread; reinfestation does not occur.