NURSING CARE OF CHILDREN WITH IMMUNOLOGIC DISORDERS
Perennial Allergic Rhinitis
- an inflammatory condition of the nose characterized by nasal obstruction, sneezing, itching, or rhinorrhoea,
occurring for an hour or more on most days throughout the year.
Etiology: Signs and Symptoms:
- Dust mites
- Pet hair or dander
- Cockroaches or mold
Medical Management:
3 Major Categories of treatment:
(1) Environment control measures and allergen avoidance.
(2) Pharmacological management, and
(3) Immunotherapy
Nursing Management:
- Assess patient history
- Identify the allergen
- Use nasal sprays
- Encourage patient to thoroughly clean house
- Encourage medication compliance
Atopic Dermatitis (Infantile Eczema)
- A form of eczema, a non-contagious disorder characterized by chronically inflamed skin and intolerable
itching. Begins as early as the second month of life and possibly lasting until child is 2 to 3 years old.
Etiology:
- Genetic and Environmental factors
Signs and Symptoms:
Medical and Nursing Management:
(1) Identifying and avoiding skin irritants
(2) Therapies (wet therapy, light therapy and counseling)
(3) Avoid extreme temperatures
(4) Give baby a short bath in warm water and applying a cream or ointment while the skin is still damp
Cradle Cap
-also known as Crusta lacteal, Honeycomb disease, milk crust, Pityriasis capitis, and Infantile seborrhoeic
dermatitis of the scalp of the newborn.
-Is a greasy, yellowish, scaly rash that appears in patches on infants.
Etiology:
- Probably caused by hormones from the mother.
- Caused by overactive sebaceous glands and/or fungal infection.
Signs and Symptoms:
Medical Management:
(1) Cradle cap usually doesn't require medical treatment, as it usually goes away on its own.
(2) Lifestyle and Home remedies
(3) Visit a health-care practitioner
(4) The doctor may prescribe a course of antibiotics, a mild steroid-based cream (e.g. hydrocortisone), and
and anti-fungal shampoo/soap (e.g. ketoconazole)
Nursing Management:
- A gentle wash of the baby’s head using a mild baby shampoo
- A delicate brush of the scalp with a soft brush which helps loosen the scales.
Diaper Rash
- can be very mild or quite extensive that is seen in the baby’s groin to a private area.
- it is most common in babies below 15 months of age.
Etiology:
- Can be caused by anything from a new food to a baby's own urine.
- Wetness
- Chafing or chemical sensitivity
- Infection
- Babies on antibiotics (whose breastfeeding mothers on antibiotics)
- Thrush
Signs and symptoms:
Treatment:
(1) Keep the baby clean and dry by changing his diaper frequently.
(2) Rinse the diaper area well at each diaper change. Pat dry and don’t rub..
(3) Use a barrier ointment
(4) Put diaper on loosely to allow for a better air circulation
Prevention:
- Skip the talcum powder
- Introduce one food at a time
- Breastfeed baby for as long as you can
Contact Dermatitis
- is a type of eczema triggered by contact with a particular substance.
Etiology:
Three types of contact dermatitis:
(1) Allergic contact dermatitis - develops an allergic reaction after being exposed to a foreign substance.
(2) Irritant contact dermatitis - the most common type of contact dermatitis, the skin comes in contact
with a toxic material.
(3) Photocontact dermatitis- less common, occurs when the active ingredients in a skin product are
exposed to the sun and result in irritation.
Signs and Symptoms:
Allergic Contact Dermatitis
Irritant Contact Dermatitis
Treatment:
(1) Avoid scratching irritated skin
(2) Clean skin with mild soap and lukewarm water to remove any irritants.
(3) Stop using any product that can trigger allergy
(4) Try using anti-itch treatments such as calamine lotion or hydrocortisone cream (Cortisone-10)
Acne
- A common skin condition it happens where hair follicles under the skin becomes clogged.
- It is a chronic, inflammatory skin condition that causes spots and pimples, especially on the face, shoulders,
back, neck, chest,and upper arms.
Types:
Whiteheads- small and remain under the skin
Blackheads: Clearly visible, black and appear on the surface on the skin
Papules: Small, usually pink bumps, visible on the surface of the skin
Pustules: Clearly visible on the surface of the skin, red at their base and have pus at the top\
Nodules: Clearly visible on the surface of the skin, large, solid, painful pimples that are embedded deep in the
skin
Cysts: Painful and filled with pus, can cause scars
Etiology:
- The glands produce and oily liquid called sebum - which carries dead skin cells through the follicles to
the surface of the skin. Pimples grow when these follicles get blocked, and oil builds up under the skin.
- Plugs get infected with bacteria, and swelling results. Pimple starts to develop when the plug begins to
break down.
- Propionibacterium acnes a (P. Acnes) bacterium that live on the skin and contributes to the infection of
pimples.
- Some medications that contain androgen and lithium
- Greasy cosmetics
- Hormonal changes
- Emotional stress, and
- Menstruation
Medical Management:
(1) OTC acne remedies:
(2) Therapies such as ligh therapy, chemical peel, drainage and extraction, and steroid injection.
(3) Lifestyle and home remedies
(4) Coping and support, and
(5) Make an appointment for dermatologist consultation.
NURSING CARE OF CHILDREN WITH INFECTIOUS DISORDERS
Cellulitis
- A common infection of the skin and the soft tissues underneath.
Risk Factors:
- Trauma to the skin
- Diabetes
- Circulatory problems
- Liver disease like chronic hepatitis or cirrhosis
- Skin disorder such as eczema, psoriasis, or infectious diseases that cause sores, like chickenpox.
Etiology:
- Injuries that tear the skin
- Indections acter surgery
- Long-term skin conditions such as eczema or psoriasis
- Foreign objectd in the skin
- Bone infections underneath the skin (e.g. a long standing, open wound deep enough to expose the bone
to bacteria).
How to Diagnose?
- Medical History
- Physical examination
- Blood test, X-ray, and Culture and sensitivity test
Treatment:
MILD CASES
(1) Rest the area
(2) Elevate the area to ease swelling and discomfort
(3) Use OTC relievers like acetaminophen or ibuprofen to ease the pain, as well as keep for fever.
(4) Antibiotics for a week to 14 days
SEVERE CASES
IV or IM antibiotics if:
(1) Infection is severe
(2) Have other medical problems.
(3) Very young or old
(4) The cellulitis covers large areas, on hands, or is close to body parts like the eyes.
(5) The infection worsens even after taking antibiotics for 2 to 3 days.
Thrush (Oropharyngeal Candidiasis)
- A common yeast infection that affects men and women. It is most common in newborns, the elderly, and
people with weak immune systems.
Etiology:
- Is caused by the fungus called candida that is normally harmless.
Signs and Symptoms:
Medical Management:
(1) Antifungal medicines like nystatin, clotrimazole, and fluconazole.
(2) Rinsing the mouth with chlorhexidine (CHX) mouthwash may help prevent infections in people with
weakened immune systems.
Genital Yeast Infection (Vaginal Candidiasis)
- A yeast infection typically happens when the balance in the vagina changes.
Signs and Symptoms:
Tinea Infections
- Are superficial fungal infections caused by three species of fungi collectively known as dermatophytes.
Types:
Tinea corporis (general skin) - Commonly known as ringworm. Refers to anywhere on the body except the
scalp, beard, feet, or hands.
Tinea cruris (groin) - known as “Jock itch”, characterized by red scaling plaque.
Tinea pedis (feet)
Etiology:
- Caused by fungus and is a contagious skin infection.
Treatment:
(1) Skin moisture
(2) Antifungal agent
(3) Allylamine medication (Naftifine and Naftin) and terbinafine (Lamisil)
(4) Inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent.
Scabies
- an itchy skin condition caused by a tiny burrowing mite called “Sarcoptes scabiei”.- Scabies is easily
transmitted from person to person through physical contact; animal and fomite transmission probably also
occurs.
Etiology:
- Sexually active individuals
- Poor housing
Signs and Symptoms:
Types:
Classic scabies - In classic scabies infection, typically 10-15 mites (range, 3-50) live on the host; little evidence
of infection exists during the first month (range, 2-6 wk), but after 4 weeks and with subsequent infections, a
delayed type IV hypersensitivity reaction to the mites, eggs, and scybala (feces) occurs.
Crusted scabies - Crusted, or Norwegian, scabies (so named because the first description was from Norway in
the mid-1800s) is a distinctive and highly contagious form of the disease; in this variant, hundreds to millions of
mites infest the host individual, who is usually immunocompromised, elderly, or physically or mentally
disabled and impaired.
Nodular scabies - Nodules occur in 7-10% of patients with scabies, particularly young children; in neonates
unable to scratch, pinkish brown nodules ranging in size from 2-20 mm in diameter may develop.
Prevention:
(1) Clean all clothes and linen
(2) Starve the mites
(3) Avoid direct skin-to-skin contact with an infested person.
Medical Management:
(1) Topical permethrin should be administered every 2-3 days for 1-2 weeks to treat crusted scabies
(2) Benzyl benzoate may be used as an alternative topical agent to permethrin.
(3) Decontamination
(4) Antiparasitic agents, Topical antibiotics, and Topical corticosteroids
Nursing Management:
- Prevent infection by doing hand washing and sanitation.
- Restore skin integrity.
- Relieve pain
