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Batches of Scratches: IDENTIFY the Rash Pediatric...
Transcript of Batches of Scratches: IDENTIFY the Rash Pediatric...
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Batches of Scratches:
Pediatric Skin Patches
For School Nurses
2017
By Jane Chevako, MD
Game Plan• I am a pediatrician.
• I want to show you LOTS of rashes.
• I want you to be able to:
• IDENTIFY the Rash
• KNOW what to do for the child:
STOP: EXCLUDE FROM SCHOOL
CAUTION: Nursing discretion advised.
GO: SEND BACK TO CLASS
• Follow YOUR local rules..
GO
Tinea Corporis: “Ringworm”
Kerion:
Marked inflammatory response to the fungus.
Needs RX oral antifungal
for 6-8 WEEKS!
Tinea Capitis
Tinea Pedis:Athlete’s Foot
Tinea Cruris:Jock Itch
For a child with TINEA:
STOP (Exclude from School)
Caution: Nursing Discretion Advised.
Can you allow the student to GO
back to class until the end of the day
if lesions can be covered?
Student should be treated with
antifungal for 24 hours.
GO
CAUTION
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Candida Diaper Rash
Candida Diaper Rashes
Oral Candidiasis: Thrush
For a child with CANDIDA:
GO (Back to Class)When the rash is covered.
GO
Alopecia Areata Alopecia TotalisAlopecia Universalis Traction Alopecia
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Pityriasis Rosea: Herald Patch Pityriasis Rosea
Pityriasis Rosea
For a child with PITYRIASIS ROSEA:
GO (Back to Class)The child is not contagious.
GO
Roseola
For a child with ROSEOLA:
GO (Back to Class)The rash appears after the fever is gone
and the student is no longer contagious.
The student should have been excluded
from school during the febrile period,
2-5 days before the onset of the rash.
GO
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Erythema Infectiosum Erythema Infectiosum
Children with 5th Disease should not
be around pregnant women.
Pregnant women exposed to
5th Disease should contact their OB.
Erythema Infectiosum
(5TH DISEASE):
For a child with 5TH DISEASE:
STOP (Exclude from School)Student may return when they have
had no fever for 24 hours.
Contact all exposed pregnant women.CAUTION
Aphthous Ulcer:
Canker Sore
Geographic
Tongue
Contact
Dermatitis:
Lip-Lickers
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Bullous
Impetigo:
Bacterial
Infection STOP (Exclude from School)Student should be treated with
antibiotics for 24 hours.
For a child with OOZING LESIONS:
Enterovirus: Herpangina
Enterovirus:
Coxsackie Stomatitis
Enterovirus: Coxsackie Hand, Foot And Mouth
For a child with COXSACKIE:
STOP (Exclude from School)
Student may return when they have
had no fever for 24 hours.
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Streptococcus:
Strawberry Tongue
Streptococcus:
Raspberry Tongue Streptococcus: Scarlet Fever
Streptococcus: Scarlet FeverStreptococcus:
Scarlet Fever
Streptococcus:
Perianal Strep
STOP (Exclude from School)
For a child with STREP:
Exclude from school until treated for
12-24 hours. More studies are showing
that the child is not contagious 12
hours after starting antibiotics.
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For a child with ECZEMA:
GO (Back to Class)Eczema is not contagious. Watch for
signs of secondary bacterial infection.GO
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Acute Urticaria:
Hives Acute Urticaria Acute Urticaria
For ALLERGIC REACTIONS:
GO (Back to Class)If mild and controlled with antihistamine.
Caution: Nursing Discretion Advised.
Observe if larger, more extensive
reaction or the reaction is not
controlled with antihistamine.
GO
CAUTION
For a severe ALLERGIC REACTION and with any signs of anaphylaxis:
STOPUse EPI PEN
Call 911
Erythema Multiforme
For a child with Erythema Multiforme:
STOP (Exclude from School)Student may return when they have
had no fever for 24 hours.
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STOPCall 911
For a child with MENINGOCOCCUS:For a child with MENINGOCOCCUS:
Molluscum
Contagiousum Molluscum Contagiousum
Human Papillomavirus
(HPV)
Verruca vulgaris:
Common Warts
For a child with MOLLUSCUM or WARTS:
GO (Back to Class)Exclusion is not warranted.
GO
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Contact Dermatitis: Nickel Allergy
Contact Dermatitis: Rhus Dermatitis
Poison Ivy: Urushiol
Mongolian Spots
Vitiligo
Café au Lait Spot Nevi Hairy Nevus
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Chicken PoxChicken Pox
Chicken Pox
For a child with CHICKENPOX:
STOP (Exclude from School)
Exclude from School until all lesions
have crusted over.
Shingles
For a child with SHINGLES:
STOP (Exclude from School)
Exclude from School until all lesions
have crusted over.
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Herpes Simplex
For a child with Herpes Simplex:
STOP (Exclude from School)Exclude from school until all lesions
have crusted over.
CAUTION
Acute Conjuntivitis
Allergic Conjuntivitis
For a child with “PINK EYE”:
YIELD (Use Caution)Check for other causes of red eye,
such as eye injury, exposure.
GO
CAUTION
STOP (Exclude from School)Student with purulent drainage goes home.
GO (Back to Class)Red eye with clear or no drainage,
especially during allergy season.
Periorbital Cellulitis
Call 911
For a child with PERIORBITAL CELLULITIS:
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Scabies Scabies
Scabies
For a child with SCABIES:
STOP (Exclude from School)
Exclude from School until treated 24 hours.
Nits Head Lice
For a child with HEAD LICE:
STOP (Exclude from School)
YIELD (Use Caution)
Exclude from School until treated 24 hours.
Child has been infested for weeks.
GO
CAUTION
GO (Back to Class)Is “No Nit Policy” acceptable?
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Flea Bites
Mosquito
Bites
Bed Bug Bites Bed Bug Bites
Bed Bugs
For a child with FLEA, INSECT and
BED BUG BITES:
GO (Back to Class)The bites are not contagious.
GO
YIELD (Use Caution)What if you see bugs?
CAUTION
Impetigo Erysipelas:
Group A Streptococcus
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Staphylococcal Infection: Pustules Staphylococcal Infection: Abscess
Staphylococcal Infection:
Cellulitis, Pustules For a child with STAPH INFECTION:
STOP (Exclude from School)
Exclude from School until treated 24 hours.
It is extremely helpful to circle the area that
is red so that it is easy to so progression.
Education is Safety
1. Wash hands regularly.
2. Wear gloves before you touch!
3. Keep draining wounds covered.
4. Do not share potentially contaminated items.
5. Do not allow participation in activities involving skin contact until wounds are healed.
6. Clean toys, desks, equipment, stethoscopes and other environmental surfaces.
7. Send the student home if they are contagious.
8. Follow-up to make sure there is improvement.
Adapted from Gorwitz R, et al. Strategies for Clinical Management of MRSA in the Community: Summary of an Experts’
Meeting Convened by the Centers for Disease Control and Prevention. March,2006.
Thank You.
For ALWAYS washing your hands!