Pediatric Nursing Demystified

Teach parents and child to avoid skin irritants such as poison ivy, oak,

or sumac and any objects or clothing that touched these plants.

 Teach child and parents how to care for skin and lesions:

• Specify amount and frequency of ointment application; stress that
  extra ointment or increased frequency could increase systemic levels
  in children so prescribed schedule should be adhered to.


• Caution parents to use clean gauze or applicator for each area being
  cleaned to avoid spread of debris.


• Teach parents and child about lesion relative to method of spread
  and anticipated time for healing because visible skin lesions may
  cause distress due to concern about appearance and self-esteem con-
  cerns as well as concerns that lesion may be contagious.

Wounds

What Went Wrong?

Wounds are disruptions of the skin integrity that result in a normal or abnormal

tissue repair response by the body. All wounds can be classified as acute or

chronic:

Acute wounds heal within an expected, usual time frame without com-

plication:

• Abrasions are superficial rubbing or scraping off of epidermis (and
  portions into the dermis); most common wound of childhood.
  Chronic wounds require a prolonged time for healing or involve additional
  problems such as infection or poor circulation (such as burn injury).
  Generally healing occurs by primary, secondary, or tertiary intention:


• Primary intention involves a clean cut with healing occurring in all
  layers of the wound; margins (edges) join without complication;
  minimal scar.


• Secondary intention happens with ulcer or cut with jagged edges that do
  not meet smoothly or do not meet; debris with cells and exudates gather
  and debridement may be needed to remove. Large scar may be noted.


• Tertiary intention involves delayed closure of wound with great risk
  of infection; wound may be sutured after infection present; large
  deep scar results.

Signs and Symptoms

Wound appearance depends on type and degree of skin and other tissue

disruption and stage of healing.

Initially, wound may be red and swollen due to inflammation with blood

and cells of immunity moving to site for healing (phase I healing).

During the second stage of healing, a collagen mesh begins to form and

appearance is red and shiny with thin layer of epithelial cells; bleeds

easily if traumatized.

2

5

5

CHAPTER 15/ Integumentary Conditions^329