Protection

Impermeability-sealing out environment & keeping in electrolytes.

Heat regulation

Sensation from nerve endings

Vitamin D production

Epidermis

Dermis

Subcutaneous

Superficial skin infection caused by staph/strep.

Usually seen on face, hands, neck.

It oftens follows insect bite/scratch.

Highly contagious until lesions heal

Occurs often in toddlers in preschoolers.

Lesions progress from macule (not elevated) to pustule and rupture to honey colored crusts.

Pururitus is very common.

DX: sometimes do bacterial cultures

TX: antibiotics, soaks, handwashing, separate linens, contact precautions.

Very rare.

can develop into glomerulinephritis or rheumatic fever.

Ringworm of the scalp. Scaly patches, alopecia, puritis.

TX: topical antifunal if unsuccessful go to oral antifungal

DX: by symptoms or can do a scraping.

Round/oval scaling ring with clearing in the center found on the body.

usually on soft tissue areas.

TX: topical & oral antifungal

Similar to corporis, but localized in medial and proximal aspects of thigh and groin.

Very rarely seen in preadolescent kids.

Scaley patches with pin sized vesicles on soles of feet or crackling/scaling of skin in between toes. 

Puritis common.

TX: antifungal powders, creams. Keep skin clean & dry.

Sweat glands blocked d/t high temps and humidity.

Sweat escapes to surrounding tissue causing itching. (prickly feeling)

Tiny papules surrounded by erythema in skin folds on chest and neck.

TX: don't overdress child, bathe in clear water or mild soap.

Unknown cause but thought to be allergic response.

1. hereditary

2. hypersensitivity of deeper skin layers to protein or protein like allergens

3.specific allergens to which child is sensitive may be:

a.ingested-milk, eggs, citrus, peanuts

b. inhaled-dust, pollen, animal dander, perfumes, smoke

c. direct contact- wool, plastic, soaps

Infantile Eczema/Atopic Dermatitis

S/SX

Cheeks are where it's usually first seen, but may spread to forehead, scalp, neck, trunk, arms, legs.

Starts as reddened areas followed by papule and vesicle formation.

Vesicles ooze, seep fluid then form crusts.

Itching, irritability.

Open areas prone to staph/strep infection (impetigo)

Infantile Eczema/Atopic Dermatitis

DX/TX

DX: seldom determined during initial episode, usually starts with elimination of foods, etc that are thought to be causing reaction.

TX: major goals:

1. hydrate skin (lotions)

2. relieve puritus (oral steriods, benadryl)

3.reduce inflammation

4.prevent/control infection

Infestation of scalp by parasite.

S/SX: itching on scalp, behind ears, nape of neck, and prescence of nits.

DX: inspection

TX: shampoos/pediculicides

All bedding, clothing laundered, no sharing of items.

Lice do not carry disease, do not jump from head to head.

1. thermal - flames/hot liquid

2. chemicals - bleaches/cleansers

3. electrical

4. radiation - sunburn

TX: relates to amount of tissue destroyed.

Rule of nines not used

% of body surface area burned as well as the depth of the burn. 

Prognosis depends on age, general health and location of wound.

1st degree-superficial epidermis blister heals in about 7 days

2nd degree or partial thickness dermis epidermis. most painful b/c of nerve endings exposed. serous fluid leaking out.

3rd degree or full thickness most severe, no pain b/c nerve endings destroyed. SubQtissue. blackish leathery skin. prolonged healing. usually get grafts

degrees do not vary from child-adult.

Decrease cardiac output.

Lost fluids

Vasodilation

Increase capillary permeability

renal vasoconstriction b/c of loss of fluids leads to depressed glomeruli filtration.

Decreased output

Shunts blood away from liver and GI tract.

Distention occurs and vomitting.

Peristalsis slowed way down

In childrem gets accelerated.

Energy needs are almost twice than normal.

Nutritional supplments are common.

Stop burning process

Observe ABC (airway, breathing circulation)-especially electrical

If small area-apply cool (suppress edema)

Remove clothing near burn to prevent further irritation

Focus on maintaing patient airway and manging for hypovolemic shock.

IVS fluids, TPN, high protein for healing

1st degree burns usually treated as outpatient if determined to involved 15% or more of body surface will require hospilization.

careful monitoring of urinary status. make sure they don't go into renal failure.

infection control, strict sterile technique. sometimes reverse isolation.

pain control, wound care can be painful. theraputic play impt.

Sometimes PT depending on where they were burned. Scar tissue limits mobility.

24-96hrs after injury the child will revert and go into diuretic phase.

Have to cut back on IVS otherwise they'll go into hypervolemic.

Output will increase dramatically.

Affects newborns.

Deformity can affect one or sometimes both feet.

Foot is inverted, heel is drawn up, front of foot is adducted (turning inward).

Can be associated with other defects.

Cause unknown. Increased incidence in males.

May be d/t positioning in utero or maybe fixed deformity

Ultrasound

Xray catscan

Also can be readily seen.

Affected foot is usually smaller.

Limb is often shorter. There may be atrophy in calf muscle.

Nonsurgical: cast application up to mid thigh. Changed frequently. Possibly orthopedic shoes or denis browne splint (following casting).

Surgery to release tendons. Possible pin fixation.

Proper cast care, circulation checks, cap refill, keep cast dry.

Congenital hip dysplasia (DDP)

Developmental Dysplasia of hip

shortening of femus, uneven thigh and gluteal folds, limited abduction of hip along with clicking sound.

Increased risk in utero in breach position and can be hereditary.

Can develop lordosis if not fixed and lead to hip, back, and posture problems when child begins to walk. Also potential for possible limp.

Hip maintained in abducted position through use of diapers or harness.

Good skin care with harness.

If cast necessary observe closely for breathing difficulty or vomitting after feeds as well as good skin care.

Harness can't go on bare skin. Check skin periodically.

Break in continuity of bone accompanied by vascular and soft tissue damage.

Infancy fx tends to be abuse or trauma.

process of ossification continues up to 20.

Growth in width and length until eppiphyseal plate becomes aligned and cartilage is no longer present during this time.

Bones are more sponge like, more fragile, but they also heal quicker.

FX spirals around bone.

CHild abuse.

Exclusive to kids that are growing.

Compresses growth plate.

They need frequent monitoring afterwords b/c it can affect their growth.

S/SX: swelling, pain, bruising, abnormal movement, redness

DX: xray

TX: ORIF if extensive damage

Casting, but splint first to let swelling go down 24-48hrs.

Possibly traction-do ROM, diversional activities, deep breath

inherited that causes muscular degeneration and wasting.

Due to an abscence of dystrophin protein involved in maintaining muscle integrity. Progressess over the years.

Most common form: duschenne dystrophy

Carried by women and passed onto men.

difficulty standing and walking, trunk muscle weakness

tire very easily, tripping & falling

waddling gait, have lordosis by schoolage

gowers manuever (use upper extremities to sit upright)

mild-mod mental impairment, age 10-12 wheelchair bound

death from respiratory paralysis.

Observation, serum creatinine phosphokinase (CPK levels)

muscle biopsy

TX: no cure, child kept as active for as long as possible. PT, braces, wheelchair as needed, respiratory and cardiac problems become focus near end.

Affects females more. Autoimmune disorder.

Most common connective tissue disease in children.

Peak ages of onset 1-3 & 8-12 years.

70% of children will go into permanent remission by adulthood.

3 types: systemic, pauciarticular, polyarticular

joint inflamm and pain

can result in irreversible changes in joint cartilage, ligaments, and menisces.

Systemic SX: fever, lympadenopathy, splenomegaly, hepatomegaly

Periods of remissions and exacerbations

lab tests may include positive rheumatoid factor as well as atinuclear antibodies

TX: pain relief, NSAIDs, aspirin, steroids, immunosuppressants

PT for ROM, hydrotherapy, muscle strengthening, splints to immobilize joints for pain relief, moist heat

Family and child must be taught med management, PT, child should be kept as active as possible.

30% of children with juvenile RA are at risk for developing inflammation of the eye structures including the iris, ciliary body, chorid.

This can lead to vision loss.

They also are at risk for needing a joint replacement.

lateral curvature of the spine with rotation of spine and hips.

Functional-d/t posture, muscle spasms or unequal length.

Structural-more common, unknown cause. Congential deformitis of spine as it grows.

develop slowly, shoulders and hips different heights

may be one sided hump and prominent scapular from rotation of vertebra and ribs

spinal column curved when child bends over.

DX: screenings followed by xray to confirm

TX: depends on degree of curvature

Limit/stop progression of deformity

mild: tx with exercise, improves muscle tone and posture

Moderate: brace 23hours/day

Severe: sometimes traction, involved surgery, fusing spine with rods and screws...very painful (ouch!)