Pediatric Integumentary Disorders: Eczema, Impetigo, Lice, Scabies, and Burn Care Explained | Chapter 28 from Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition)

Welcome to Chapter 28 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri. This chapter focuses on the most common pediatric integumentary disorders—atopic dermatitis, impetigo, pediculosis capitis, scabies, and pediatric burns—equipping nursing students with the clinical skills and infection control knowledge necessary for safe and effective care. Understanding the unique features of pediatric skin, infection risks, and emergency management will prepare you for both NCLEX-style questions and real-world practice.

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Atopic Dermatitis (Eczema): Assessment and Interventions

• Types: Infantile, childhood, and adolescent eczema, often triggered by allergens, stress, or skin irritants.
• Clinical Features: Intense itching, erythematous patches, oozing, crusting, and lichenification.
• Management: Gentle skin care, daily moisturizing, cool compresses, topical corticosteroids, and oral antihistamines for severe itching. Avoid triggers and teach families about proper bathing and skincare routines.

Impetigo: Contagion and Care

• Etiology: Highly contagious bacterial skin infection (usually Staphylococcus aureus or Streptococcus pyogenes).
• Signs: Honey-colored crusted lesions, usually around the mouth and nose.
• Nursing Priorities: Initiate contact precautions, administer topical/oral antibiotics as prescribed, reinforce strict hand hygiene, and prevent scratching/spread.

Pediculosis Capitis (Head Lice): Detection and Eradication

• Identification: Itchy scalp, visible nits (eggs) attached to hair shafts, excoriations from scratching.
• Treatment: Pediculicide shampoos, daily nit removal with a fine-tooth comb, and a second treatment 7–10 days later to kill newly hatched lice.
• Environmental Control: Wash bedding and clothing in hot water, vacuum furniture/carpets, and seal nonwashable items in plastic bags for 2+ weeks.

Scabies: Mite Infestation and Family Management

• Cause: Infestation by the Sarcoptes scabiei mite, resulting in intense pruritus, especially at night.
• Symptoms: Linear burrows, papules, and vesicles in web spaces of fingers, wrists, and axillae.
• Treatment: Apply permethrin cream to all skin surfaces from neck down, repeat in 7 days if needed. Treat all household contacts simultaneously. Wash bedding/clothing in hot water; items unable to be washed should be bagged for 7–14 days.

Pediatric Burns: Assessment, Emergency Response, and Prevention

• Risks: Children are prone to rapid dehydration, fluid/electrolyte imbalances, metabolic acidosis, infection, and delayed growth.
• Emergency Care: Ensure airway/breathing/circulation, initiate fluid resuscitation, monitor urine output, and prevent infection with sterile dressings and isolation as necessary.
• Assessment: The Rule of Nines is less accurate in children—use pediatric TBSA (Total Body Surface Area) charts for burn estimation.
• Parent Teaching: Fire safety, hot water temperature checks, and installing smoke detectors to prevent burns at home.

Medication Safety and Home Hygiene

• Use corticosteroids and antibiotics exactly as prescribed—avoid overuse or early discontinuation.
• Educate families on environmental decontamination for lice and scabies to prevent reinfestation and community spread.
• Reinforce hand hygiene and isolation precautions for contagious skin infections.

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Conclusion: Mastering Pediatric Dermatologic Nursing

Chapter 28 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) arms students with the knowledge and skills needed to recognize, manage, and prevent common integumentary disorders in children. Mastering infection control, medication safety, and emergency burn management will prepare you for the NCLEX-PN and effective clinical practice.

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