Paediatric Nursing Skills for Australian Nurses

Introduction

To assist your understanding of this chapter, it is recommended that you review the functions and pathophysiology of the skin in a general anatomy and physiology textbook. The skin is the largest organ in the body, and provides a protective barrier against infection. It is essential to maintain and preserve skin integrity and to detect alterations in skin integrity promptly to protect patients. This is of the utmost importance in the young, hospitalised patient, who is often compromised or, if very young, can lack subcutaneous tissue and is therefore very vulnerable to skin damage (Baharestani, 2007a; Schlüer, 2016). Neonatal and infant patients are additionally more susceptible to the risk of infection and skin damage, which can precede life-threatening sepsis (Denyer, 2011). Further, very young infants have particular skin needs about which the paediatric nurse requires knowledge.

Children frequently present to hospital with wounds such as lacerations and burns, and may acquire wounds in hospital through epidermal stripping, incontinence-associated dermatitis, pressure injuries, extravasation or surgical intervention (Schlüer, Schols & Halfens, 2013), or may have alteration to skin integrity related to an infective process (rash), allergies (such as eczema) infestation such as scabies, or due to a congenital condition such as epidermolysis bullosa (Baharestani, 2007a). Understanding the basic principles of caring for common skin conditions in the paediatric population will assist you when providing effective skin care.

Regular and thorough skin assessment is an important part of care of infants, children and young people, and while the principles for wound care and healing are generally not greatly different from those applied to adults, paediatric nurses require additional skills and knowledge to manage wounds and alterations in skin integrity in the younger patient. There are also risks to paediatric patients in the hospital that can impact on skin integrity, such as cross-infection, hygiene or extravasation, as well as the potential for pressure or moisture injuries. It is important to understand related risks for impaired skin integrity, identify patients who are at risk and take preventative measures to ensure patient safety. As with all paediatric nursing, the involvement, support and education of the parents or caregivers is essential for the optimum outcomes.