SoniaV.

Pilonidal Cyst Overview A pilonidal cyst is a tunnel that usually forms in the coccyx area, filled with ingrown hair, and skin waste. If it becomes infected it grows into a painful abscess filled with pus and/or blood. The American Academy of Family Physicians indicates acute treatment is often incision and drainage with a 60% success rate. In the other 40%, the abscess returns, or several sinuses may form. Most common in younger people with sedentary life or work style. This chronic condition is known as Pilonidal Sinus Disease. The patient lives with a persistent skin condition, knowing that it's there even when you don't feel it, enduring the incision and drainage with every flare-up. Surgical Treatment The next step the doctor might recommend is the surgical removal of the pilonidal tract altogether. To help narrow down the best procedure for the patient, because no one procedure is preferred over all the rest, three topics to consider are: Healing time depends on the chosen procedure Post-op care and prevention of infection No guarantee of a cure, it has the possibility of recurrence even after surgery Healing time depends on the chosen procedure The objective of pilonidal sinus surgery is to remove all or as much of the cyst and surrounding tissue. Seal the sinus to keep it free of debris. National Library of Medicine article listed four main methods for operative management of Pilonidal Sinus Disease: Incision & Drainage Excision and healing by secondary intention Excision and primary closure Excision and reconstruction flap techniques Depending on the procedure, the surgical treatment may involve local or general anesthesia, outpatient or hospital stay, and post-op dressing changes upon discharge home. Complete recovery can be from 1-3 months, depending on the chosen procedure. It also mentioned a new move toward endoscopic treatment such as Video Assisted-Ablation of Pilonidal Sinus (VAAPS) and Endoscopic pilonidal sinus treatment (EPiST). It requires local anesthesia, usually no dressing changes, other than wound evaluation, and keeping up with good hygiene practices in the area. Patients' general time off from work is between 1-5 days without complications. This newer approach does take longer to perform and requires specialist, expensive equipment. Post-op care and Infection prevention Standard principal of wound care will apply and patient education upon discharge. The patient should keep any follow-up appointments with the doctor. There will be prescribed pain medication because of pain in the coccyx area, and abstain from vigorous activity at least for a month. No sitting for long periods on hard areas or surfaces. Use a donut cushion to sit on. Follow wound care as per doctors' instructions to prevent infection or recurrence. Instructions on when to contact the doctors such as fever, drainage from the incision, escalating pain, redness, warmth to touch, or inflammation near the incision. There might be scarring to the area, but it usually fades with time. No Guarantees Sadly pilonidal sinus disease can come back even after surgery. For example, an excision technique leaving the wound open has shown a low recurrence rate, but a longer healing time. This procedure will require general anesthesia, some days in the hospital post-op, not to mention a lengthy recovery (8-10 weeks). If the patient does not adhere to wound care instructions as prescribed, a new sinus can form or the site becomes infected. Following preventive measures will be the key to keeping the cyst from forming again. Performing and maintaining hair removal procedures, like laser hair removal, waxing, or using hair removal products every 2-3 weeks may prevent the cyst from coming back once healing has been completed. Conclusion Pilonidal Sinus Disease is unbearable during a sudden flare-up, The awkwardness of receiving treatment in a private area of the body is uncomfortable, and the loss of workdays indirectly affects the patient in the long run. The encouraging news is there are several options to contemplate. The best source to talk to regarding what will best fix the sufferer’s chronic condition is to speak to the treating surgeon or patient’s doctor. Postoperatively, implementing improved lifestyle changes such as avoiding a sedentary way of life and keeping up with hair removal practices might prevent the return of a cyst back into existence. References Pilonidal Disease Management: Guidelines from the ASCRS Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment Pilonidal Cyst Surgery Procedures and Recovery What Causes a Skin Abscess? What Is a Pilonidal Cyst? Pilonidal cyst

In nursing, our role is not to just treat the person standing before us, but to be advocates for those who cannot speak or protect themselves. One of our mandate responsibilities is reporting child abuse. The consequence of making a CPS call based solely on the obvious injury without any other gathering of information can have disruptive consequences to the child, the family, and beyond. That is why as a nurse it is good practice to consider other evidence surrounding the injury before making a CPS call, such as contacting the child's pediatrician if possible, talking to parents and caregivers separately. Collect current information regarding the medical history or behavioral changes observed. This offers confidence in reporting to CPS since other systems align with the injury or not. Here are 3 injuries that can look like child abuse at a quick glance: Skin or Fractured Injuries, and Genital Infections. Skin Injury Cultural practices for medicinal purposes can look like bruising, such as coining, a common practice used by the Asian Community. It consists of dipping a coin in oil and rubbing it on someone's back, causing the skin to look like petechiae or purpura. A remedy believed to rid the body of negative energy or body heat. Another such practice by Middle Eastern Cultures, Egypt, and China is the cupping practice to increase circulation and relief congestion. This is done by placing warm cups on the back resulting in circular blotches and bruising. Bleeding disorders, especially in infants, might have more and larger bruising than a normal infant or child. Therefore, the marking and the area of a contusion is detail to consider. Hemophilia and von Willebrand disease are two examples of bleeding disorders that display large and deep bruising. Mongolian spots can look like bruising because of their color appearance of blue-gray or blue-green tones. Commonly present at birth, the spots usually disappear with time and don't harm or cause pain to the baby while he/she has them. Fracture Injury Broken bones or displacement of bones may look like physical abuse at first assessment to a nurse. Authors of a 2017 study in the American Journal of Roentgenology said, "In the case of infants and young children, especially under 3 years old, a bone disorder may predispose the child to fractures without any incident of trauma abuse.” Two conditions that can look like physical abuse are Osteogenesis Imprefecta or Ricketts, both disorders that mean fragile bones. Usually, these disorders are differentiated from abuse by the physical display and x-ray imaging results. In the assessment of injury, several factors are reviewed, like the age of the child, the location, the type of breakage, and the stage of development of the child. If the child is of talking age he/she might be able to explain what happened. Additionally, one considers the surrounding details of the accident as reported by the parents or caregiver. Does the injury make sense with the story? Genital Infections It can be easy to mistake normal findings with sexual abuse especially if you're not familiar with the differences or have not had frequent exposure to sexual abuse assessments. Mimickers of sexual abuse in children can range from redness to area ulcers in genital and anal areas. Perianal streptococcal dermatitis will display redness, itching, and even rectal pain. A culture swab from an area with discharge will differentiate STD from bacterial infection. When in doubt it is a good idea to consult with an experienced clinician or refer to a Sexual Assault Nurse Examiner (SANE) if part of hospital staff. Cuts, bruising or a gash in the genital area could be considered sexual abuse but could be a result of an injury while at play. Most often it involves falling onto a bike rail or falling from climbing. Uncertainty, confusion, and hesitation in reporting any case of abuse might be a common feeling for any new and even experienced nurse. As a nurse, you know the results of reporting a case could possibly involve removing the child from the home to be placed with other relatives or a foster home. It could require parents to attend parenting classes, in addition to other demands plus continue to keep it together with work and at home. It might prevent parents from seeing their child until the investigation results conclude, yes there was abuse or no, no findings of abuse. Regardless of the outcome, the period during separation and investigation is long and traumatic for all members involved. Learning to recognize the difference between conditions that look like abuse but are not is just good knowledge to have. Having access to an experienced clinician or Sexual Assault Nurse Examiner (SANE) when these cases present themselves is a great backup if experiencing doubt. Keeping your supervisor abreast of the case and referring to them for guidance is another accessible support. The bottom line is we are mandatory reporters and the safety of the child takes priority over doubt. The extra knowledge just makes you better equipped to care for the patient and family. References/Resources Medical Mimics of Child Abuse Patterns of skeletal fractures in child abuse: systematic review When it's not abuse: things that mimic sexual abuse in pediatric forensic exams Nurses are Mandated Reporters – Not a Judge or Jury Brittle bone disease 'mistaken for child abuse'