The nurse is caring for the family of a pediatric client during resuscitative efforts of their child following an accident.
Which response by the nurse would be best?

Choice A rationale

The infant's skin has a larger surface area to body weight ratio and a thinner stratum corneum (outermost layer) compared to an adult's. This increased permeability and surface area enhance the systemic absorption of topically applied medications, raising the risk of toxicity, a crucial consideration for safe drug administration in infants.

Choice B rationale

Infants actually have a greater body surface area relative to their weight compared to adults, which contributes to the enhanced systemic absorption of topical drugs. Therefore, the nurse must be more concerned, not less, about the body surface area and its role in drug absorption and potential toxicity.

Choice C rationale

The maturity and structure of the blood vessels are not the primary factors affecting the absorption rate of topical medications across the skin barrier. The most significant physiological factor influencing topical drug absorption in infants is the increased permeability of the epidermis and the large surface area to body weight ratio.

Choice D rationale

Infants have increased, not decreased, absorption rates of topical drugs due to the physiological immaturity of their skin barrier. This means the drug penetrates the skin and enters the bloodstream more readily, which necessitates cautious use and careful monitoring to prevent systemic adverse effects.

Choice A rationale

Permethrin is an antiparasitic medication primarily indicated for the treatment of ectoparasitic infestations such as scabies and pediculosis (lice). It works by acting as a neurotoxin to kill the parasites. It has no antimicrobial properties against the common bacterial pathogens, like Staphylococcus aureus or Streptococcus pyogenes, that typically cause localized skin infections like cellulitis or abscesses, which are suggested by the child's symptoms of redness, pain, swelling, and fever, thus making it ineffective for this condition.

Choice B rationale

Topical antihistamine creams, like diphenhydramine, are used to relieve itching (pruritus) associated with allergic reactions, insect bites, or minor irritations by blocking histamine release locally. The child's symptoms—localized heat, erythema (redness), edema (swelling), pain, and systemic fever—strongly suggest a bacterial infection (cellulitis or abscess). An antihistamine cream would not treat the underlying bacterial pathogen or the systemic inflammatory response, making it inappropriate as a primary treatment intervention.

Choice C rationale

Oral antibiotics are the cornerstone of treatment for localized bacterial infections of the skin and soft tissue, such as cellulitis or an abscess, which are suggested by the classic signs of inflammation (redness, pain, swelling) and systemic symptoms (fever). An antibiotic targeting common skin flora, such as a penicillinase-resistant penicillin or cephalosporin, is necessary to eradicate the invading bacteria and prevent the infection from spreading or becoming systemic, like sepsis.

Choice D rationale

Monitoring daily weight is a critical nursing intervention for any child experiencing an acute illness accompanied by fever and inflammation, as it is the most reliable measure of fluid balance. Fever and infection can increase metabolic demands and insensible fluid losses, potentially leading to dehydration. Furthermore, in cases where the child is admitted or receiving treatment like antibiotics, daily weights help assess hydration status and are essential for accurate weight-based medication dosing. —.