Treatment of Scabies Disease - Case Study Example

Case Study Name: Tutor: Course: Date: Scabies disease Introduction From a current survey that was carried out, it was found out that there are around 370 million indigenousness people and the definition of the term varies greatly sometimes the indigenous people can be easily identified such as the Australia’s aboriginal people. The other name that is used to refer to indigenous people is aboriginal, tribal or the minority group. These people are noted to have some similar characteristics among them being the following, they are believed to have a historical continuity and they were also believed to have had strong territories to as well as other natural resources. Among them they were able to form very distinct political, economic and social systems (Michael & Malcolm, 2009, p. 66). These people are able to maintain and reproduce some ancestral environments and systems which help them to manage their affairs away from the state authorities. In Australia there was a poor definition of these indigenous people that makes the group to be marginalized and they remain unrecognized. This reason led to the country’s failure to have any published statistical data concerning their total numbers, health and the social economical status and due to this there is very little systematic information about the health, mortality and mobility rates. Though these indigenous people lived in different places there were several similarities in their health and illness and their determinants exist. The indigenous groups are always at a higher risk of infection than their non-indigenous counterparts and the effects are usually fatal. The nature and depth of the severity of the infectious diseases is mostly dependent on the ages, nutritious status, impaired immunity, the personal environment hygiene as well as exposure to the infections and disease carrying vectors. Skin diseases are very common especially among the young children which are evident in the case of Dave. The family of Dave Agnew lived in a large town. Urbanization is a major factor that is causing migrations from the rural to the urban areas and just like most indigenous groups who are in the industrialized countries like Australia are faced with international health problems which greatly affect their lives(Michael & Malcolm, 2009, p. 65). In Australia this is very common in Barrios which is a small town and also in other remote aboriginal communities. Davis was three years old and he lived with his mother Doris who at the moment was 18 years of age and his father Ron who was a year older than his wife. In addition, there were four of his aunties who lived there with their families in a house that was only three bed-roomed. They also had three dogs that were their pets. After living with his parents for five months in the community, he is diagnosed with scabies when he is taken to the clinic. Scabies is a contagious skin infection that mainly occurs among the humans and other animals. It is caused by a very small and invisible parasite known as the ‘sarcoptes scabies’ which is a female itch mite. It burrows under the skin of the host then it lays eggs and it deposits some fecal material which leads to the formation of short wavy lines that can be seen on the hands, wrists, elbows and on the waistline. This is a condition known as pruritis which can exist to up to three months (Louis & Gena, 2008, p. 531). Due to this, the person develops an allergic itching which later leads to secondary infections. The animals also get another type of scabies that is caused by sarcoptic mange. When Dave was taken to the clinic, this was the same type of scabies that he was diagnosed with. He had diarrhea, looked dehydrated, was scratching in the area around his anus, had a distended tender stomach and was also vomiting. This conclusion was given after a careful medical diagnosis by the nurses in the clinic. There were three major diagnosis cases that were associated with the disease and the rationales for each were established. Nursing diagnosis is a clear judgment that is given in the clinic and it tells about an individual or a particular family or a way in which a community will respond to some health problems in this case it will be the disease scabies. The diagnosis should be accurate and valid so that it can guide the nurses on the kind of interventions that will be very likely to bring forth the desired treatment for scabies. The diagnosis are evidence based and they lead to a better professional care hence, meet the needs of the patients and in this way, they are able to provide the patients’ with enough safety. Nursing diagnosis 1: Appearance of lesion and intense itching is caused by the mite hiding under the skin. The skin is impaired due to the scratching scabies lesions which in this case caused the redness around the anus .If the itching continued then they would become open and even bleed. There would be some fluid known as the serasosanguenous that would ooze from the open wounds that are created by the continuous scratching (Louis & Gena, 2008, p. 532). When the nurse identifies this kind of a problem then the possible interventions that will be given to Dave’s aunt and mother would be to ensure that they cleanse the lesions with an antibacterial soap and a little tepid water rather than using the hot or warm water which will only intensify the itching hence making it worse for the child. This was supposed to be repeated at least three times a day to discourage the deterioration of the wounds. When the skin is kept clean there will be minimal bacterial growth and the micro-organisms present and also decrease the risk of infection. The second step would be the application of the antipyretic lotion which in most cases will be prescribed by the doctor. After through cleansing is done, then the dirt will be removed and the lotion that is applied immediately after cleansing serve to retain the moisture. Thirdly, the nurse will advice the mother and the aunt to ensure that the baby’s nails are maintained to be very short and smooth which is a rationale of avoiding to break the skin more and creating more lesions. When the parent or the guardian taking care of the kid notices that the child is scratching the lesions then it is advisable to press them before the child breaks them and makes them bleed even more. This is a soothing gesture that calms the nerve endings and makes the child have less sensation of itching. When the skin is not broken by scratching then it will be appropriate since the entry of micro organisms will not make their entry. Finally the nurse should explain that the scratching does not stop immediately and this does not necessarily mean that the treatment with scabicide was not effective since. The skin reaction to the toxins and the secretion of the itch mites can continue for up to three months until the time all the itch mites will be killed by the scabicide (Louis & Gena, 2008, p. 532).When healing from home efforts should be made to ensure that the indoor temperatures are maintained at 68-78 degrees since very high temperatures will only make the scratching even worse. When the room humidity is maintained at constant levels, then the skin will not dry very much hence is making the child comfortable. Nursing diagnosis 2: The nurse diagnosed that Auntie and Doris had very little knowledge about the infection and control measures in regard to treatment and prevention protocols which was clearly portrayed when the auntie suggested that the vomiting of the boy after he had had his meal of spaghetti could have been a symptom of having the infestation of the worms in the body. They were also ignorant and did not even notice the lesions that were causing the scratching around the body and were bound to spread to the rest of the body. There was also the risk of having the other people living in the house getting infected with scabies since it was a very infectious disease especially in an overcrowded area. Since the house was already too small to house the thirteen of them then even the hygiene was bound to be very low therefore accelerating the rates of infections. The nurse should be able to give clear directions on how to apply the scabicide correctly in order to avoid the infection to the rest of the family members as well as how to maintain very high standards of hygiene in the house. The first intervention would be for the nurse to try and gather as much information as possible from the two ladies regarding what they know about the disease. This would serve as baseline to be able to develop their knowledge and expound on some points that they may have problems understanding. It is important for them to know that scabies is transferred from one person to another when the clothes or any article that are freshly contaminated by the child who is already suffering from scabies get into contact with the skin(Lynn, 2007, p. 520). It is also important to note that the indigenous families living in Australia, the disease could affect any person from any social, economic and the levels. This was the main reason why it would be important to take uttermost care during the treatment period of the child at home. It is very important for the nurse to emphasize the need to follow strictly on the use of the scabicide lotion as directed by the doctor so as to ensure that the healing process does not take longer than expected and also ensure that all the mites causing the recurring itching are all killed. The nurse would be expected to give a little practical training on how to handle the lotion and how leave it on the skin for the recommended time. The treatment protocol should be frequently reviewed so that when the treatment is done a home then there will be no chances of making mistakes that will be left. Points like the child should be cleaned well using the directions earlier given before applying the lotion not only to the part where the child was scratching most but to the entire body since the lesions were still going to spread out. It is also advisable to apply the scabicide when the child is going to bed to allow the lotion to remain on the skin for at least 8-12 hours so as to kill the microorganisms and the itch mites that are on the skin. After the lotion has been applied on the child’s skin then it is advisable for the aunty or Dave’s mother to thoroughly clean their arms under hot or warm water preferably using an anti bacterial soap for not less than 10 seconds (Medical zone). Emphasis should be put on the areas under the fingernails which could be hiding some of the itch mites that were collected while applying the medicine. It should be made a house rule that, under no circumstance should anyone share the personal clothing which included the towels, the personal clothing’s, bed linen, or even the pillows. This is because when an individual who is well gets into contact with the garments which have already been used by the infected person then they will definitely catch the disease. When cleaning the clothing of the sick child including the beddings, it is advisable to use hot water and a detergent and a disinfectant and where possible it is good to boil them. Thorough rinsing should also be done and finally these clothes should be dried outside so as to kill all the remaining germs from the ultraviolet rays. Finally, the parent should be advised to ensure that a daily bath is given to the child using the antibacterial soap as well as clean water. Afterwards, a clean towel should be used to dry the body and particular attention should be paid to the areas between the toes and fingers and any other folding on the body so that the itch mites do not get the chance to hide there. Nursing diagnosis 3: The nurse was able to notice after examination that Dave had his stomach distended and very tender to palpate. After questioning the aunt and the parent of the child, the nurse was able gather that even though the house was overcrowded, they still had dogs living with them under the same shelter. The human and dog derived, Sarcoptes Scabies was mostly common in such conditions and this was what had caused the illness of the child hence the very tender stomach. It was very important for the nurse to emphasize the importance of keeping the distance of the individuals and the animals even though they were considered as our pets. Since the children were always found to be fonder of holding the dogs, care should be taken to avoid the infection from being transferred from the dog to the child. The itch mite could also hide under the fur of the animals especially if hygiene is not observed for the both the animal pets and the children and the entire family as well. It is also wrong to share the same utensils and eat the same food with the pets since food hygiene is also important in maintaining the health of the family. The nurse diagnosed that lack of proper hygiene in the environment could have been a leading factor to the diarrhea and vomiting that were exhibited by the child (Lynn, 2007, p. 895). The family was advised to take the preventive measure of separating the place where the dogs stayed and where they lived. This was important in order to reduce the risks of getting infected and re-infected with the disease which also is fatal to both human and animal. Dehydration When Dave was taken to the clinic he had mild signs of being dehydrated. This is one of the most critical clinical manifestations since the symptoms could easily deteriorate if not quickly rectified and it is extremely fatal. The nurse need explain some basic facts about dehydration to the parents in case it occurs at home when they least expected it. For the nurse to be able to assess the levels of dehydration, then it is important to first categorize the dehydrated child according to its clinical symptoms as well as the signs that will be seen after an analysis is done on the blood sample. Since the primary symptoms that the child was reported to have been vomiting and diarrhea, then it was evident that a substantial amount of body fluid was also lost and this was a major cause of dehydration (Medical zone). According to the details given by aunty and the parent of the child then Dave was suffering from moderate dehydration which in terms of percentage could be expressed as 8%.In case the nurse decides to treat the child for being dehydrated then Dave will be hospitalized and will be given the necessary treatment that would restore the levels of the blood that were lost in the fluids while vomiting and having stomach problems. This could also be reining forced by scheduling for follow up visits to estimate the levels of dehydration. To be able to determine this nurse analyzed the state of the child in terms of how alert was the child. In the course of their examination they would determine if the child was becoming more lethargic or floppy especially if the child had cyanotic extremities. They would also analyze if the child was restless or if it was getting irritated when touched. The nurse would also analyze if the child has sunken eyes, absent tears, loss of skin moisture and if the sin of the child is wrinkled. This would help the nurse assess the level of the dehydration correctly. The blood pressure could also be assessed to know if there was dehydration in the body or not. Normally for moderate to severe dehydration, there pulse was always felt to either be rapid or very weak. For moderate dehydration he pulse rate is lower than normal and for the severe cases it is too fast such that it is even difficult to record it. The last assessment test would be to look at the capillary refill time which is measured by pressing the nail and measuring the time taken for the nail redness to reappear. Normally this should only take 0.8 seconds. For any moderate dehydration the time will be between 1.5-3 seconds and for a severe dehydration the time was taken to be more than 3 seconds. On another note when the skin is pinched in normal situations it will rapidly go back to its normal position but incase the child is dehydrated then the skin will take longer than expected. This is also used as another test to determine if a child is dehydrated. Before the patients left the clinic it was important to make it known to them that a pediatrician of GP is available and it would be good to see him and have him examine the child before they left for their home. This would help them learn more about how to care for the sick child. In the clinic there is an indigenous health worker who will always be available to educate and treat these families especially on the infectious diseases. Conclusion As with other skin disorders Scabies is a disease that needs proper management by the nurses. This was directed towards providing comfort, promoting healing and preventing re-infections as well as fostering a positive attitude to enable the client to be able to cope with the physical discomfort that will be associated with the disease(Louis & Gena, 2008, p. 537). References: Engel, J. (2006). Pediatric Assessment. Canada: Mosby Elsevier. Lynn, Y. (2007). Maternal, Neonatal and Women health nursing, US. New York: University Press. Lois, W. & Gena, D. (2008). Medical-surgical nursing: an integrated approach. Boston: USA Michael, G. & Malcolm, K. (2009). Indigenous health part 1: determinants and disease patterns, The lancent, Vol. 374, Issue 9683, Pages 65 – 75. Medical zone. Nursing interventions for scabies. Retrieved 18th May, 2011 from Pillitteri, A. (2007). Maternal & Child Health Care of the Childbearing and Childrearing Family. New York: Lippincott Williams & Wilkins. Suzane C., Janice, L, Brunner’s & Surrdath’s. (2009). Textbook of medical surgical nursing. New York: University Press.   Read More