Batches of Scratches: IDENTIFY the Rash Pediatric …tsnoregion4.org/images/downloads/2017_BATCHES_OF_SCRATCHES_PPT...Scabies For a child with SCABIES: STOP (Exclude from School) Exclude

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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!