Frequently Asked Questions
While you’re working at night in a pediatric health clinic, a mother brings in a 16-
month-old child because of a fever and a large, reddened, and swollen left cheek that
is painful and warm to the touch. The child is fussy and irritable and has a
temperature of 39.5 degrees Celsius (103 degrees Fahrenheit) even after receiving
acetaminophen only an hour ago. You notice that the swelling has a large hard
center and seems to be increasing in size and tension, covering more of the face and
even moving toward the eye and ear. The primary health care provider diagnoses
facial cellulitis and tells the mother she needs to take the child to the hospital for
treatment and care. The child’s mother is very anxious and states she would prefer
to go home with medications if necessary. Why is it important for the child to be
hospitalized for treatment?
Cellulitis is a bacterial infection involving the dermis and the subcutaneous tissues.
Streptococcus pyogenes and Staphylococcus aureus are the most common bacteria that
cause this infection. Children with facial cellulitis, particularly with accompanying
lymphadenopathy and systemic symptoms, are at risk for developing meningitis, a more
serious infection. Prompt administration of systemic antibiotics is the best treatment
method in eradicating the infection and in monitoring and preventing more serious
problems. After a day or two of hospital care, children may go home and continue
intravenous (IV) antibiotic therapy under home health supervision.
Helga, the 16-month-old with facial cellulitis, has been receiving antibiotics for 10
days. She was discharged home with home health care administration of her
medications. When you as the home health nurse arrive, Helga’s mom is frantic and
in tears. She states, “Helga has another infection! She has large white spots on her
tongue and the sides of her mouth! Even her bottom and between her legs have red
blisters! What’s happening now?” What information should you provide to Helga’s
Helga has a condition called thrush or candidiasis, a fungal infection. The most likely
cause of the condition is the antibiotics she has been on for the last 10 days. Antibiotics
often result in diarrhea and gastrointestinal changes where normal flora is lost. Helga’s
mom needs reassurance that this infection is not serious and can be helped with
administering nystatin in both oral and ointment forms. In addition, Helga should be
encouraged to eat yogurt, which will help reestablish her normal intestinal flora. Helga
should be given the nystatin 2 days beyond the disappearance of the white patches and
rash. Helga’s mom will also need education about good personal handwashing before and
after feeding and changing diapers, and about good skin care for Helga. Skin care might
include washing the skin with mild soap and water and air drying before replacing her
While you’re working in your office, a teacher brings in Sophia for you to talk to
and to evaluate. Sophia has been restless and constantly scratching her head. She
has even made large red scratch marks at the back of her head and neck. As you
speak with Sophia, you notice that she immediately begins to scratch the back of her head and above her ears. She reports that the itching happens all day long, and she will even wake up at night to scratch her head. As you examine Sophia’s head and hair you notice that she feels warm. You also spot a small, white oval-shaped object. Your suspicion is correct: Sophia has head lice. How will you proceed?
Using a pediculocide is the most effective treatment of head lice (pediculosis capitis). The pediculocide of choice is Nix, which is also ovicidal (kills lice and eggs). It usually only requires one treatment. Following shampooing with Nix, Sophia will need to comb her hair using a special fine-tooth comb to remove lice and nits (loose eggs). It is suggested that a rinse of half distilled water and half vinegar is done before trying to comb through the hair. It will also be important for Sophia’s family to be assessed and
evaluated for head lice and return treatment if infected. The family should check or be checked for lice and nits every 2 to 3 days until all lice and nits are gone. Sophia’s family
will also need to carefully clean the house and launder linens and clothing. The family will also need education on good handwashing and methods for preventing further infestations. It will also be important to assess all the children in Sophia’s class and to follow the same strategy used for Sophia and her family.
As a school nurse, you have had several nurses from the local junior high school to present to the students information about acne. What will you include in your presentation?
Acne vulgaris, or acne, is a skin disease that most commonly affects adolescents. It may persist into adulthood for some. Acne can cause severe facial pits and scars. The emotional scars may not be so visible. Approximately 85% of adolescents will experience some degree of acne. Various situations may precipitate or worsen the condition, including heat, humidity, oil-based cosmetics, hormonal changes, and stress. Many treatments are available that may shorten or lessen the course of the disease. The goals of treatment are to improve appearance, prevent or lessen scar damage, decrease discomfort, and promote the physical and emotional health and well-being of the adolescent. It will be important to let everyone know that treatments and responses will be individualized. Education on skin care, diet, and rest as well as help for adolescents in identifying their support systems will also be important.
It is your first year as a camp nurse for a small mountain resort. What common skin problems can you expect to see and need to care for?
A variety of skin issues can be a part of camp life. These include scrapes and abrasions, sunburn, contact dermatitis, insect bites and stings, rashes, and head lice. You will need to have medications such as acetaminophen and ibuprofen, antibiotic ointments, lotions like calamine, salves like Vaseline, and baby powder as part of methods to provide comfort measures. You may wish to provide a brief lecture on safe skin care, instructing campers to wear sunscreen and hats, protect the lips, stay away from unknown bushes and “weeds,” use bug spray, and practice good hygiene. Don’t forget that care should be
taken to clean cuts and scrapes with either plain water or water with mild soap and to dry
thoroughly. You should have a brief medical history for each camper, but always ask about allergies. In addition, be supportive and provide other comfort such as words of encouragement and a listening ear.
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