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Rashes and the School Nurse . Suzey Delger RN, MSN, FNP-c There is no conflict of interest-rats. HISTORY, HISTORY & MORE. Get a history: MOST IMPORTANT! Location? Localized or generalized? Where on body? Frequency? Has it happened before Quantity? Can you count the bumps?
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Rashes and the School Nurse Suzey Delger RN, MSN, FNP-c There is no conflict of interest-rats
HISTORY, HISTORY & MORE • Get a history: MOST IMPORTANT! • Location? Localized or generalized? Where on body? • Frequency? Has it happened before • Quantity? Can you count the bumps? • Quality? Describe the lesion. • Associated Phenomenon: Serious rashes kids will appear ACUTELY ILL!
History • Aggravating factors: what made it worse? • Alleviating factors: what made it better?
Arrangement • Discrete: distinct and discretely separate from each other • Linear: Straight line • Annular: Circle • Grouped: closely adjacent to each other, herpes will always be grouped. • Serpiginous: wave/snake like eg. scabies
Macule: <1.0 cm • Flat • Color Changes • Café-au-lait • Vitiligo • Fifths Disease
Patch >1.0cm • Large macule • Flat • > 1 cm • Port Wine Stain • Diffuse vitilligo • Peri-anal strep
Papule < 1.0 cm • Solid, raised • Roseola • Molluscum* • Lichen Planus
Plaque >1.0cm • Solid • Raised • Flat top • Distinct borders • Ecema • Psoriaisis*
Nodule • Raised • Solid lesions • Indistinct borders • Palpable • This is a wart
Wheal or Uticaria • Can be associated with allergy, strep, • & viral illness. • Virtually anything can cause HIVES
Vesicles • Raised Lesions • Clear Fluid • <1.0 cm • Chicken Pox*
Bullae >1.0 cm • Raised lesion filled with clear/bloody fluid • Staph • These are treated warts with Blister Beetle Juice.
Cyst • Raised lesion that contains a palpable sac filled with more solid fluid. • Gangilion cyst not pus filled but fiberous that can be broken down with pressure.
Pustules • Raised lesions filled with fluid or excudate. • Can be benign or sign of infection. • These are pimples up close.
Petechiae/Purpura • Always worrisome if they appear for no apparent reason. • r/o leukemia, but can be simply a decrease in platelets/viral infection caused.
Dermatitis: What does it mean to you? • Dermatitis to most of us means a “rash”, associated with • Itchy Skin • Visible Flexural dermatitis/ecema • Onset under age of 2
Contact Dermatitis • Intense,redness, blisters. • Allergic reaction to metals. SNAPS ON PANTS. • Or it can be contact with Poison Ivy.
Contact Dermatitis cont. • This is Poison Ivy exposure.
Common childhood skin disorders/ Scabies • This is a picture of highly contagious scabies. • Must be treated with Ovide or Lindane. • Do not touch with bare hands.
Chiggers • Chiggers are more common in the south. What can you teach me about these bugs? • How do you treat them?
Bed Bugs are BACK! • There has been an increase in bed bugs in the USA. • These bugs can live in the WOOD of the bed frame for months. • Treatment is a PESTICIDE.
Ticks and diseases. • Can cause many different diseases, such as Lymes disease, Rocky Mtn. Spotted Fever, and Tulermia.
Lymes disease. • Target lesions. • Spirochete that mimicks syphillis. • Can cause permanent brain damage. • Important part of “rash surveillance”
Hand, Foot and Mouth Disease • Common among elementary, especially primary grades. • No known treatment caused by Coxsaxie virus. • Avoid exposure newly pg. women.
Toxic Shock Syndrome • Don’t forget about this life threatening disease among young teen girls and boys too. • Caused usually by Staph, can occur post-partum.
From the SEA! • This is a lesion caused from a Man-o-war, sting ray. • Very painful, • No antidote.
Continued from the Sea! • Jelly fish bite, again very painful. • Treatment? I learned from my Alabama friends that ‘ammonia’, urine, and meat tenderizer is the most common cure!
Impetigo • Our favorite! Usually caused by strep or staph. • Can be tx. With antibiotic ointment, or oral antibiotics.
What could this possibly be? • What is this critter that is spread by brushes, hats, and mostly sleep-over’s and MAKE SCHOOL NURSE’S NUTTY?
Web sites that work for you! • What is this? • www.dermnet.com • www.dermatlas.com • Click on photo gallery and be ready to be entertained! • Thanks for having me!