Assays for Determination of Protein UNIT 3.4 ConcentrationampleUnit
Lecture 11 – Unit 3.4
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Transcript of Lecture 11 – Unit 3.4
Lecture 11 – Unit 3.4
Lecture 11 – Unit 3.4
Nursing Care for Health Problems of Toddlers and Preschool
Children Skin Alterations in Children
Gail McIlvain-Simpson, MSN, PNP-BC
1
Topic Areas• Communicable diseases in
children, pathology, diagnosis, nursing assessment, and treatment.
• Screening and treatment for lead poisoning, and poison prevention
• Skin alterations in children • Lyme Disease •
• .
2
Communicable Diseases
• Handouts on Blackboard– Communicable Diseases In Early
Childhood– Integumentary Disorders
3
Communicable Diseases
• Why has the incidence of childhood communicable diseases significantly declined?
• Why have serious complications resulting from such infections been further reduced?
• As nurses what are two key reasons nurses must be familiar with infectious agents?
4
Nursing Process for the Child with Communicable
Disease• Assessment• Diagnosis – Problem ID• Planning• Implementation• Evaluation
5
What to assess if suspicion of communicable disease?
• Recent exposure to known case• Prodromal symptoms• Immunization history• History of having the disease
6
Components of Prevention
Prevention of disease & control of spread to others.
• Primary prevention• Prevent complications
7
A child is admitted with an undiagnosed exanthema – what
should be done in this case?
8
Chicken Pox Varicella
• Weinberg, S. et al, Color Atlas of Pediatric Dermatology, McGraw-Hill, New York, 1998
Chicken Pox - Varicella
Adolescent female» www.vacineinformation.org/photos/variaap002.
jpg» Originally from AAP
10
Chicken Pox - Varicella
4 year old, day 5» www.vacinneinformation.org/photos/varicdc006a.jpg» Originally from CDC
11
Shingles or Herpes Zoster
– Healthy child– www.vaccineinformation.org/photos/variaap015.jpg– Originally from AAP
12
DiptheriaCorynebacterium
diphtheriae
• http://www.vaccineinformation.org/photos/diphiac001.jpg
13
Fifth Disease (Erythema infectiosum)
• Weinberg, S. et al, Color Atlas of Pediatric Dermatology, McGraw-Hill, New York, 1998
Roseola (Exanthema Subitum)
• http://kidshealth.org/parent/infections/skin/roseola.html
15
Rubeola (Measles)
Koplik Spots
• http://lebonheur.adam.com/pages/ency/articleImage.asp?file=2558.jpg&lang=en
16
Rubeola (Measles)
17
Mumps
• http://www.vaccineinformation.org/photos/mumpcdc001a.jpg
18
Mumps
• http://www.immunize.org/catg.d/iped1861/img0016.htm
19
Pertussis
– http://www.vaccineinformation.org/photos/pertaap002.jpg
20
Pertussis (Whooping Cough)
• http://www.vaccineinformation.org/photos/pertiac001.jpg
21
Pertussis Deaths
• “Whooping cough deaths on rise in infants”
• Each year there are an increase of 5000-7000 cases of whooping cough each year and has been steadily rising each year.
22
German Measles cdn-write.demandstudios.com/.../70/7/238
23
Rubella
• http://www.vaccineinformation.org/photos/rubecdc002a.jpg 24
Congenital rubella syndrome
• http://www.vaccineinformation.org/photos/rubeiac003.jpg
25
26
Scarlet Fever
• http://www.dermnetnz.org/dna.strept/scarlet.html
27
White and Red Strawberry Tongue
• http://www.dental.mu.edu/oralpath/grad/mucutaneous/sld075.htm
28
Enterobiasus (Pinworms)
• http://ww.dpd.cdc.gov/dpdx/HTML/Enterobiasis.htm
29
Pinworm Life Cycle
Eggs IngestedHatch in small IntestineAttaches to colon wallMatures in 2-3 weeksLives in rectum or colonLays eggs on perianal skinScratch perianal area
30
Pinworm - Symptoms
• Intense itching of perianal area• No systemic reaction• Unexplained irritability• Restlessness• Poor sleep• Short attention span• Perivaginal itching
• www.biosci.ohio~parasite/enterobius.html
31
Pinworms - Diagnosis
• Tape test• Direct visualization with flashlight
www.biosci.ohio~parasite/enterobius.html
32
Pinworms - Treatment
• Medications - Anthelmintic– Mebendazole (Vermox)– Pyrantel pamoate (Antiminth)
33
Pinworms - Treatment
• Environmental– good hand washing– daily showers– wash bedding– clean pajamas– snug underwear– fingernails short
34
Lead Poisoning
• Is a major preventable environmental health problem (CDC – 1997)
• Brain & nervous system damage• Irreversible health effects• Reduced intelligence• Learning disabilities
35
Pathophysiology• Lead can affect any part of body• Most concerning – effect on young child’s developing
brain & nervous system• Lead disrupts biochemical processes & may have direct
effect on release of neurotransmitters, causing alterations in blood brain barrier & may interfere with regulation of synaptic activity
• Mild to moderate levels of lead – can affect cognition & behavior in children
• Can cause longterm neurocognitive signs
36
Lead PoisoningDiagnostic Evaluation
• Children rarely have symptoms • Venous blood specimen • Lead levels greater than 10mcg/dl (has
dropped from 80mcg/dl in 1950’s)• CDC –recommends targeted screening on
basis of each state’s determination of need• Universal screening done at ages 1-2 years
37
Lead Poisoning• Historical perspective• Lead does not decompose• Cultural perspective• Risk factors
38
Lead Exposure
• Lead based paint is the most common source
• Ingestion or Inhalation• See Box 14-6 Wong 8th edition
page 476
39
Other sources of Lead
• Lead crystal decanters and glasses • Pre-1978 tableware and some imported
tableware• Jewelry in vending machines from Jan 2002 to
August 2004• Toys• Chewing on household objects that contain
lead: Brass keys, jewelry, fishing sinkers, pre-1970 furniture, pre-1996 mini-blinds
40
Federal Disclosure Regulations
• Must disclose Known Lead-Based Paint & LBP Hazards when sell or lease house
• Many pre-1978 homes have lead based paint
41
Lead Poison Treatment• Chelation therapy
– Medications• Succimer• Ca Na2EDT
42
Nursing Care Management
• As nurses what is your primary goal?
• ???????• ???????
43
Anticipatory Guidance• Hazards of lead based paints in older
homes• Ways to control led hazard safety• Hazards accompanying repainteing &
renovations of home to houses built before 1978
• Additional exposures (ie dinnerware from other countries)
44
Ingestion of Injurious Agents
45
American Association of Poison Control Center
• Poison Exposure?Call Your Poison Centerat 1-800-222-1222.
• Free, professional, 24/7/365Don’t guess, be sure…
• http://www.1-800-222-1222.info/jingles/engver1.asp
46
Poison Prevention
• Post Poison Control Number
(CDC web site)
47
Poisonings• Significant health concern• Majority occur in children younger than
6 years of age• Can occur with medications & many
other substances• Children poisoned by ingestion due to
their developmental characteristics
48
Most Common Poisonings
• Cleaning substances• Pain relievers• Cosmetics• Personal care products• Plants• Cough and cold preparations• Improper use causing
poisoning49
Diffenbachia (Dumb Cane)
50
Philodendron
51
Poison Prevention
• Store poisons out of children’s reach• Keep products in the original containers• Never call medicine “candy”• Place safety latches on all drawers and
cabinets containing poisonous products• Read labels before using a cleanser or
other chemical product• Post poison Control Center number near• the telephone.
52
Poison Control Literature
53
Poisonings
• First Priority is the Child• Terminate Exposure to toxic
substance• Determine poison• Call Poison Control Center before
intervention
54
Gastric Decontamination
• Remove ingested poison: Absorbing toxin with activated charcoal Gastric Lavage Increase bowel motility (catharsis)
55
Activated Charcoal• Most commonly used method of gastric
decompression• odorless, tasteless, fine black powder• give within 1 hour of poison• mix with water, saline or flavoring to make
slurry• give through straw or NG tube• Potential complications – aspiration,
constipation, intestinal obstruction
56
Gastric Lavage• When child admitted to ER• Performed to empty stomach of toxic
contents. • Procedure associated with serious
complications: gastrointestinal perforation, hypoxia, aspiration_
• No longer recommended in cases of ingestion
• To use in cases who present within 1 hr of ingestion, decreased GI motility, sustained release medication ingestion, or massive amounts of life threatening poison 57
Cathartics
• Enhances excretion of charcoal-poison complex
• If charcoal mixed with sorbital - not necessary• 20%Magnesium sulfate 250 mg/kg/dose• Repeat q 1-2 h until stooling begin• Use is controversial particularly in pediatrics
58
Antidotes• Minority of poisons have specific antidotes to
counteract the poison• Highly effective & should be available in all
Emergency facilities• Examples – N-acetlcysteine for
acetaminophen poisoning, oxygen for carbon monoxide inhalation, naloxoned for opioid overdose, romazicon for benzodiazipines (valium) overdose , antivenom for certain poisonous bites
59
Selected Poisonings in Children -
• Corrosives• Hydrocarbons• Plants• Acetaminophen
60
Web sites for Additional Information on Plant
Poisonings
• Guide to Poisonous and Toxic Plants - http://chppm-www.apgea.army.mil/ento/plant.htm
• Most Commonly Ingested Plants -
http://www.kidsource.com/kidsource/content/ingested.html
61
Stages of Acetaminophen
Poisoning• Initial Period (2 to 4 hours after ingestion)
– Nausea, vomiting, sweating, pallor
• Latent period (24 to 36 hours)– patient improves
• Hepatic involvement (may last up to 7 days)– pain in right upper quadrant– jaundice, confusion, stupor– coagulation abnormalities
• Recovery– patients who do not die in hepatic stage gradually– recover
62
Prevention• Prevent recurrence• Discuss difficulties of constantly
watching & safeguarding children• How to identify risk?
63
Skin Alterations in Children
• Review A & P of skin• Know primary skin lesions
64
Primary Skin Lesions
65
www.dermatologyinfo.net/english/chapters/chapter03.htm
• PRIMARY SKIN LESIONS• The primary skin lesions are the original lesions that appear as a
result of different stimuli either internal or external. The different primary skin lesions seen on examination are:
• Macule - a circumscribed flat area of different color from the surrounding skin. Macules may become raised due to edema, where it is then called maculopapules
• Papule - a raised circumscribed elevation of skin.• Nodule or tubercle - a solid elevation of the skin, larger than a papule.• Plaque - a raised thick portion of the skin, which has well defined
edges with a flat or rough surface.• Erythema (redness of the skin surface) -This is the commonest
primary skin lesions, which appears in most skin diseases. Erythema is due to dilatation of dermal blood vessels and edema.
• Blister - a skin bleb filled with clear fluid• Vesicle - a small blister.• Bulla - a large vesicle• Pustule - a skin elevation filled with pus• Cyst - a cavity filled with fluid.• Nevus - hereditary skin disorders due to deficiency or excess of the
normal constituents of the skin and usually defined as nevi.• 66
Skin LesionsEtiologic Factors
• Contact with injurious agents• Highly individualized responses• Child’s age is an important factor
67
Integument of Infants & Young Children
• Epidermis loosely bound to dermis• More susceptible to superficial bacterial
infections• More likely to have associated systemic
symptoms• React to a primary irritant versus sensitizing
antigen
68
Pathophysiology of Dermatitis
• More than half the problems in children – dermatitis
• Inflammatory changes in skin – grossly & microscopically similar but different in course &causation
• Changes reversible • More permanent issues with chronic
problem
69
Integumentary - Nursing History
– Painful, itching, tingling– Restless or irritable– Favor or avoid a body part– Access to chemicals, been in the
woods, around a woodpile– Eaten a new food– Taking any medications– Have any allergies– Playmates with similar lesions
70
Nursing Assessment
• Describe color, shape, size, distribution of lesions
• Palpate for temperature, moisture, elasticity and edema
72
Therapeutic Management
• Eliminate cause• Prevent further damage• Prevent complications• Provide relief
73
Pruritis
• Mittens• Fingernails short, well-trimmed• Antipruritic medications -
Benadryl, Atarax
74
Topical Management
• Glucocorticoids– anti-inflammatory effects
• Topical therapy– cool compresses– Burrow’s solution– Oatmeal baths (Aveeno)
75
Impetigo contagiosa
• Superficial infection of skin• Easily spread - very contagious• Staph or strep• Reddish macule, becomes
vesicular
76
Impetigo
• Weinberg, S. et al, Color Atlas of Pediatric Dermatology, McGraw-Hill, New York, 1998
Treatment of Impetigo
• Topical antibiotics• Oral or parenteral antibiotics in
severe or extensive cases• Tends to heal without scarring• Common in toddler, preschooler• May superimpose on eczema
78
Scalded Skin Syndrome
• Staph aureus infection• Macular erythema with sandpaper
texture of involved skin• Large bullae• Systemic antibiotics• Burow solution
79
Scalded Skin Syndrome
• Weinberg, S. et al, Color Atlas of Pediatric Dermatology, McGraw-Hill, New York, 1998
Tinea Capitis (Fungal)
• Ringworm of scalp• Fungal infection• Scaly circumscribed patches and or
patchy scaling areas of alopecia• Pruritic• Person to person or animal to person
transmission
81
Tinea Capitis
• http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=108
82
Tinea Capitis
• Lissauer, Tom and Clayden, Graham, Illustrated Textbook of Paediatrics, Mosby, Philadelphia, 1997, p. 263
Tinea Capitis
• Oral griseofulvin - for weeks or months
• Selenium sulfide shampoos• Topical antifungal agents
– inactivates organisms on hair
84
Teaching
• No exchange of anything that touches area
• Use own towel • Protective cap at night• Examine pets• Watch public seats with headrests
85
Pediculosis Capitis
• Head lice • Pediculus humanus capitisCommon parasite in school age children
86
87
Pediculosis Capitis
88
Pediculosis Capitis
• Lay eggs at junction of a hair shaft• Nits hatch in 7-10 days• Itching is usually the only
symptom
89
Nit Case under Microscope
• Weinberg, S. et al, Color Atlas of Pediatric Dermatology, McGraw-Hill, New York, 1998
Empty & Live Nit Case
CDC Fact sheet – Head Lice
Infestation
92
93
Pediculosis capitis• Symptoms
– Pruritic• Diagnosis
94
Three Steps to Treatment
• Application of pediculicidal product– Permethrin (1%) crème rinse– Pyrethin Preparations – RID– Lindane shampoos - 1% Kwell,
Scabene– Malathion 0.5%Ovide
• Manual removal of nit cases• Environmental
95
Application of Pediculocidal Product– Do not administer after warm bath or
shower– Must remain on scalp and hair for
several minutes– Keep off rest of body
96
Removal of Nit Cases
– Soak hair in vinegar solution– Extra fine-tooth comb– “nit-picking”– Examine head daily for 2 weeks
97
Lice combs
98
Environmental - Teaching
– Anyone can get them– Can be transmitted on personal items– Wash clothing and linens in hot water– Dry clothing in hot dryer– Seal non-washable items in plastic bags for
14 days– Soak combs in lice-killing products for 1
hour or in boiling water for 10 minutes– Vacuum car seats, furniture, stuffed
animals
99
100
Lyme Disease
• Recognized in 1975• Most common tick borne disease in US• Spirochete - Borrelia burgdorferi• Deer tick - Ixodes Dammini in northeast• Host - white tailed deer and white
footed mice
101
Distribution of Lyme Disease
102
103
Ixodes dammini nymph
105
• From “Your Dog may be at Risk from Lyme Disease”, Fort Dodge Laboratories, 1995.
Lyme Disease Carrier IDFort Dodge Laboratories,
1995
106
Univ. of Chicago – 2006 article from Infectious
Disease Society of America• http://
www.journals.uchicago.edu/CID/journal/issues/v43n9/40897/40897.html
107
Lyme Disease - Stages
• Stage 1– Yick bite– Erythematous papule– Bull’s eye rash
108
• Erythema Migrans -• Bull’s eye rash
Erythema migrans
• www.acponline.org/shell- cgi/printhappy.pl/lyme/patient/diagnosis.htm
• 110
Lyme Disease Stages
• Stage 2– systemic involvement of neurologic,
cardiac and musculoskeletal systems• Stage 3
– Musculoskeletal pain– Arthritis
111
Lyme arthritis
Lyme Disease
• Diagnosis– By symptoms– Elisa, Western Blot, PCR
• Management– Doxycycline or Amoxicillin
113
Teaching - Prevention &
Education• avoid areas where deer are
frequently seen• walk in the center of trails• wear long pants and long-sleeved
shirts that fit tightly at the ankles and wrists
• wear a hat• tuck pant legs into socks• wear shoes that leave no part of
the foot exposed 114
Lyme Disease Prevention
• Wear light colored clothing• Carefully examine for ticks• No DEET - insect repellent - for
infants and small children
• www.cdc.gov/ncidod/ticktips2005
115
Steven-Johnson Syndrome
• Erythema multiforme exudativum• lesions of skin and mucous membranes• Hypersensitivity reaction to certain
drugs• Erythematous papular rash on any
cutaneous surface
116
Nursing
• Protective isolation• Monitor IV• Maintain fluid and electrolyte
balance• Liquid diet• Viscous lidocaine• Meticulous mouth care• Administer Antibiotics• Artificial tears
117
Scabies
• Sarcoptes Scabiei - Parasitic mite
118
Scabies
• Lissauer, Tom and Clayden, Graham, Illustrated Textbook of Paediatrics, Mosby, Philadelphia, 1997, p. 264
Scabies
• Burrows• Intense pruritis - esp. at night• Maculopapular lesions• Intertriginous areas
120
Management
• 5% Permethrin (Elimite)• 1% Gamma benzene hexaxhloride
(Lindane)• Soothing ointments or lotions
121
Contact Dermatitis• Inflammatory reaction of the skin to chemical
substances (natural or synthetic)• Causes a hypersensitivity response or direct
irritationInitial reaction in exposed area• Sharp delineation between inflamed & normal skin
(faint erythema to massive bullae)• Itching is constant primary irritant or sensitizing agent• Infants – contact dermatitis occurs on convex surface of
diaper area• Other agents – plants (poison ivy), animal irritants (fur),
metal etc
122
Treatment of Contact Dermatitis
• Major goal – to prevent further exposure of the skin to offending substance
• Otherwise based on severity• Following exposure cleanse as soon as
possible• Prevention – avoiding contact
123
Atopic DermatitisEczema
• Descriptive category of Dermatologic diseases• Pruritic eczema• Usually occurs during infancy & is associated
with allergic tendancy• 3 Forms based on age & distribution of
lesions:• Infantile eczema• Childhood• Preadolewscent & adolescent,
124
Atopic Dermatitis• Diagnosed via combination of
history & morphologic findings• Cause unknown• Majority of those affected have
eczema, asthma, food allergies or allergic rhinitis
125
Atopic Dermatitis Management
• Major goals: hydrate the skin, relieve pruritis, reduce flare-ups, prevent & control secondary
infection.• Avoid skin irritants & overheating• Administer medications
126
Nursing Care Management• Take history – atopy in family• History of previous involvement• Fingernails & toenails shortened
127
The END
128