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NURS 341 Final Exam Study Guide. Latest 2023

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Nurs 341 – Final Exam Study Guide Chapter 23: Nursing Care of the Child with an Alteration in Tissue Integrity/Integumentary Disorder  Know the skin differences of infants/children and adults - The infant’s epidermis is thinner than the adult’s, and the blood vessels lie closer to the ...

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  • 19 juillet 2023
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Nurs 341 – Final Exam Study Guide
Chapter 23: Nursing Care of the Child with an Alteration in Tissue Integrity/Integumentary
Disorder
 Know the skin differences of infants/children and adults
- The infant’s epidermis is thinner than the adult’s, and the blood vessels lie closer to the
surface because there is a decreased amount of subcutaneous fat. Thus, the infant loses
heat more readily through the skin’s surface than the older child or adult does; less
pigmented than that of the adult (in all races), placing the infant at increased risk of skin
damage from ultraviolet radiation.

 Know the causes of skin disorders
 Know common meds and lab tests
- COMMON LABORATORY AND DIAGNOSTIC TESTS 23.1 P875
- Atopic dermatitis: Serum immunoglobulin E (IgE) levels may be elevated in the child
with atopic dermatitis. Skin prick allergy testing may determine the food or
environmental allergen to which the child is sensitive.
- Burn:
Pulmonary status may be evaluated via pulse oximetry and end-tidal CO2 monitoring,
arterial blood gases, carboxyhemoglobin levels, and chest radiography.
Fiberoptic bronchoscopy and xenon ventilation–perfusion scanning may be used to
evaluate inhalation injury.
Electrocardiographic monitoring is important for the child who has suffered an
electrical burn to identify cardiac arrhythmias, which can be noted for up to 72 hours
after a burn injury.

 Know Burns – assessment, management, prevention

EMERGENCY ASSESSMENT OF THE BURNED CHILD
PRIMARY SURVEY
• Assess the child’s airway, noting whether it is patent, maintainable, or unmaintainable.
• Suspect airway injury from burn or smoke inhalation if any of the following are present: burns
around the mouth, nose, or eyes; carbonaceous (black-colored) sputum; hoarseness or stridor.
• Evaluate the child’s skin color, respiratory effort, symmetry of breathing, and breath sounds.
• Determine the pulse strength, perfusion status, and heart rate. Note extent and location of edema.
SECONDARY SURVEY
• Determine burn depth.
• Estimate burn extent by determining the percentage of body surface area affected. Use a chart
for estimation (see Fig. 23.21) or rapidly estimate by using the child’s palm size, which is
equivalent to about 1% of the child’s body surface area.
 Inspect the child for other traumatic injuries (children who have jumped or fallen from a
house fire may suffer cervical spine or internal injuries).

- Superficial burn—painful but without blisters.

, - Partial-thickness burn—very painful, with blistering.
- Full-thickness burn—color ranges from red to charred, or white, minimal pain, marked
edema.

 Know your infectious disorders – assessment & management


Nonbullous • Papules progressing to vesicles, • Limited amount: treat topically with
impetigo then painless pustules with a narrow mupirocin ointment.
erythematous border • Honey- • If numerous lesions, oral first-generation
colored exudate when the vesicles cephalosporin is indicated.
or pustules rupture, which forms a • Clindamycin may be needed for MRSA.
crust on the ulcer-like base (see Fig. • Remove honey-colored crust with cool
23.2) compresses twice daily.
Bullous impetigo • Red macules and bullous • Oral first-generation cephalosporin.
eruptions on an erythematous • Good hygiene.
base
• Size may be from a few
millimeters to several
centimeters
Folliculitis • Red, raised hair follicles • Treat with aggressive hygiene: warm
compresses after washing with soap and
water several times a day.
• Topical mupirocin is indicated; occasionally
oral antibiotics are required.
Cellulitis • Localized reaction: erythema, • Mild cases are usually treated with cephalexin
pain, edema, warmth at site of skin or amoxicillin/clavulanic acid.
disruption (see Fig. 23.3) • More severe cases and periorbital or orbital
cellulitis require IV cephalosporins.
Staphylococcal • Flattish bullae that rupture within • Mild to moderate cases are treated with oral
scalded skin hours • Red, weeping surface is cephalexin, dicloxacillin, or
syndrome left, most commonly on face, groin, amoxicillin/clavulanic acid.
neck, and axillary region (see Fig. • Severe cases are managed similar to burns
23.4) with aggressive fluid management and IV
oxacillin or clindamycin.



Tinea corporis • Annular lesion with raised • Topical antifungal cream is required for at
(ringworm) peripheral scaling and central least 4 weeks.
clearing (looks like a ring) (Fig.
23.5)
Tinea capitis • Patches of scaling in the scalp • Oral griseofulvin for 4–6 weeks.
with central hair loss • Risk of • Selenium sulfide shampoo may be used to

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