Nursing Paper Example on Scabies

Nursing Paper Example on Scabies

Scabies is a highly contagious skin condition caused by the mite Sarcoptes scabiei var. hominis. It affects people worldwide, with outbreaks commonly occurring in overcrowded living conditions such as nursing homes, shelters, and prisons. Scabies presents with intense itching and a characteristic rash, primarily due to the body’s allergic reaction to the mites, their eggs, and waste. Understanding scabies’ causes, symptoms, etiology, pathophysiology, diagnosis, treatment, and patient education is critical for its management and control.

Causes

Scabies is caused by an infestation of the microscopic mite Sarcoptes scabiei. The female mites burrow into the outer layer of the skin (the epidermis) and lay eggs, which hatch and mature, continuing the infestation cycle. Scabies spreads primarily through direct, prolonged skin-to-skin contact with an infected person, though indirect transmission can occur via contaminated clothing, bedding, or furniture. Intimate contact or close living quarters often facilitate transmission, making scabies outbreaks common in households, hospitals, and residential care facilities.

(Nursing Paper Example on Scabies)

Signs and Symptoms

The symptoms of scabies generally appear 4 to 6 weeks after initial exposure, although they may develop faster in individuals who have had scabies before. Common symptoms include:

1. Intense itching: This is the hallmark symptom of scabies, often worsening at night.
2. Rash: Small red bumps or blisters appear on the skin, typically between the fingers, on the wrists, elbows, armpits, waist, and genitals. The rash may resemble eczema or other skin conditions.
3. Burrow tracks: Fine, thread-like lines may be visible on the skin’s surface, representing the mites’ burrowing paths.
4. Secondary infections: Scratching the rash may lead to bacterial skin infections like impetigo.
5. Crusted scabies (Norwegian scabies): A more severe form, often seen in immunocompromised individuals, presents with thick crusts of skin containing large numbers of mites. It is highly contagious and harder to treat.

(Nursing Paper Example on Scabies)

Etiology

The mite Sarcoptes scabiei is responsible for scabies. These mites are microscopic, with females measuring about 0.3 to 0.4 mm in length. After mating on the skin’s surface, female mites burrow into the skin to lay eggs, which hatch into larvae within 3 to 4 days. The larvae mature into adult mites in about two weeks, continuing the cycle of infestation.

Risk factors for scabies include close contact with infected individuals, crowded living conditions, poor hygiene, and weak immune systems. Certain populations, such as the elderly, young children, and immunocompromised individuals (e.g., those with HIV/AIDS), are particularly susceptible to more severe forms of scabies, including crusted scabies.

Pathophysiology

The symptoms of scabies result from the body’s immune response to the presence of the mites, their eggs, and their waste. The itching is primarily an allergic reaction, which can intensify with repeated exposure. The mites burrow into the skin, laying eggs that hatch and mature, continuing the infestation cycle. Scratching exacerbates the condition, potentially leading to skin damage and secondary bacterial infections.

In crusted scabies, large numbers of mites are present in thick skin crusts, which significantly increases the risk of transmission. This form is often seen in immunocompromised individuals, where the body’s immune response is not strong enough to control the infestation effectively.

(Nursing Paper Example on Scabies)

Diagnosis

The diagnosis of scabies is primarily clinical, based on a physical examination of the characteristic rash, itching, and burrow tracks. A definitive diagnosis can be made by identifying mites, eggs, or fecal pellets under a microscope. This is done by performing a skin scraping, which involves scraping a small area of affected skin and examining it under a microscope for signs of mites. Dermoscopy, a tool used to magnify and illuminate the skin, may also help visualize burrows and mites.

In crusted scabies, the sheer number of mites can make diagnosis easier, but clinical suspicion must remain high, especially in patients who are immunocompromised or living in institutional settings.

Treatment Regimens

Scabies treatment involves the application of topical scabicides to eliminate the mites and their eggs. The following are standard treatment options:

1. Topical medications:
   • Permethrin cream (5%): This is the first-line treatment for scabies, applied to the entire body from the neck down and left on for 8 to 14 hours before washing off. A second treatment may be necessary after one week.
   • Lindane lotion: An alternative to permethrin, though it is not recommended for use in infants, the elderly, or pregnant women due to potential neurotoxicity.
   • Benzyl benzoate lotion: Another topical scabicide, effective but may cause skin irritation.
2. Oral medications:
   • Ivermectin: An oral antiparasitic medication used in cases of crusted scabies or when topical treatments have failed. It is particularly useful in treating outbreaks in institutional settings.
3. Antihistamines: These may be prescribed to relieve itching.
4. Antibiotics: Secondary bacterial infections caused by scratching may require antibiotic treatment.
5. Crusted scabies treatment: Patients with crusted scabies require more intensive treatment, often combining topical and oral scabicides and frequent follow-up care to ensure eradication.

Patient Education

Patient education is crucial in preventing reinfestation and spreading scabies to others. Key points include:

1. Treating all contacts: Household members, close contacts, and sexual partners should be treated simultaneously, regardless of whether they show symptoms.
2. Washing bedding and clothing: All clothing, bedding, and towels used within the past week should be washed in hot water and dried on a high heat setting. Items that cannot be washed should be sealed in a plastic bag for at least 72 hours.
3. Personal hygiene: While poor hygiene is not a direct cause of scabies, maintaining good personal and household hygiene can help prevent reinfestation.
4. Itching after treatment: Itching may persist for a few weeks even after successful treatment, as the immune system continues to react to the dead mites. Patients should be reassured that this is normal and does not indicate treatment failure.

Conclusion

Scabies is a highly contagious condition caused by Sarcoptes scabiei mites, characterized by intense itching and a distinctive rash. Effective treatment requires prompt diagnosis, application of scabicidal medications, and treating all close contacts to prevent reinfestation. Patient education about hygiene, treatment protocols, and prevention of reinfestation is crucial to controlling outbreaks, especially in institutional settings. With appropriate treatment and preventive measures, scabies can be managed effectively, even in high-risk populations.

References

Centers for Disease Control and Prevention. (2022). Scabies. https://www.cdc.gov/parasites/scabies/

World Health Organization. (2020). Scabies. https://www.who.int/news-room/fact-sheets/detail/scabies

Fawcett, R. S. (2018). Scabies and Pediculosis Pubis: An Update. American Family Physician, 86(7), 653-660. https://www.aafp.org