Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by itchy, dry, and inflamed skin. This nursing diagnosis is crucial for developing effective care plans to manage symptoms, prevent complications, and improve the patient’s quality of life.
Causes (Related to)
Eczema can result from various factors that compromise the skin barrier function and trigger an immune response. Common causes of eczema include:
- Genetic predisposition
- Environmental triggers
- Immune system dysfunction
- Skin barrier defects
- Stress
- Hormonal changes
- Climate conditions (extreme heat or cold)
- Certain foods (in some cases)
Signs and Symptoms (As evidenced by)
Eczema manifests with a variety of signs and symptoms. During a physical assessment, a patient with eczema may present with one or more of the following:
Subjective: (Patient reports)
- Intense itching (pruritus)
- Burning or stinging sensation
- Sleep disturbances due to itching
- Anxiety or stress related to appearance or discomfort
Objective: (Nurse assesses)
- Dry, scaly skin
- Redness (erythema)
- Swelling (edema)
- Crusting or oozing of affected areas
- Skin thickening (lichenification) in chronic cases
- Scratching marks or excoriations
- Patches of discolored skin
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for eczema:
- The patient will report reduced itching and discomfort
- The patient will demonstrate proper skin care techniques
- The patient’s skin condition will show visible improvement (reduced redness, scaling, and inflammation)
- The patient will identify and avoid personal triggers
- The patient will adhere to the prescribed treatment regimen
- The patient will report improved sleep quality
- The patient will demonstrate effective stress management techniques
Nursing Assessment
The first step of nursing care is the assessment, during which the nurse gathers physical, psychosocial, emotional, and diagnostic data. The following section covers subjective and objective data related to eczema.
- Perform a comprehensive skin assessment.
Examine the entire skin surface, noting the location, extent, and characteristics of eczematous lesions. This helps determine the severity and progression of the condition. - Assess the patient’s itching patterns.
Inquire about the frequency, intensity, and timing of itching episodes. This information helps develop strategies for managing pruritus effectively. - Evaluate the patient’s current skincare routine.
Ask about the products and methods for cleansing, moisturizing, and managing symptoms. This helps identify potential irritants and areas for improvement in skin care. - Assess for signs of secondary infection.
Look for signs such as increased redness, warmth, swelling, or purulent discharge, which may indicate a secondary bacterial infection requiring additional treatment. - Evaluate the patient’s sleep patterns.
Inquire about sleep disturbances related to itching or discomfort. Poor sleep can exacerbate eczema symptoms and affect overall well-being. - Assess the patient’s knowledge of eczema.
Determine the patient’s understanding of the condition, triggers, and management strategies. This helps tailor patient education efforts. - Evaluate the patient’s emotional state.
Assess for signs of anxiety, depression, or social withdrawal related to eczema. The visible nature of the condition can have significant psychological impacts. - Review the patient’s medical history.
Note any history of allergies, asthma, or other atopic conditions, as these are often associated with eczema and may influence treatment approaches. - Assess the patient’s diet.
Inquire about any suspected food triggers or dietary restrictions. Some patients may have food-related exacerbations of their eczema. - Evaluate the patient’s home and work environment.
Identify potential environmental triggers such as dust, pet dander, or harsh chemicals that may contribute to eczema flares.
Nursing Interventions
Nursing interventions and care are essential for managing eczema effectively. The following section outlines possible nursing interventions for a patient with eczema.
- Implement proper skin care techniques.
Teach the patient to bathe in lukewarm water, pat the skin dry gently, and apply moisturizer immediately after bathing to lock in hydration. - Educate on proper medication application.
Demonstrate the correct application of prescribed topical medications, emphasizing the importance of using the right amount and frequency. - Recommend appropriate clothing choices.
Advise the patient to wear soft, breathable fabrics like cotton and avoid wool or synthetic materials that can irritate the skin. - Implement itch management strategies.
Teach techniques such as applying cool compresses, using over-the-counter anti-itch creams, or practicing distraction methods to manage itching. - Promote a healthy sleep environment.
To improve sleep quality, suggest keeping the bedroom cool, using hypoallergenic bedding, and maintaining a consistent sleep schedule. - Educate on trigger avoidance.
Help the patient identify and avoid personal triggers, such as certain soaps, detergents, or environmental factors exacerbating their eczema. - Teach stress management techniques.
Introduce relaxation methods like deep breathing exercises, meditation, or guided imagery to help manage stress-related eczema flares. - Provide nutritional guidance
Offer advice on maintaining a balanced diet and consider recommending a food diary to identify potential dietary triggers. - Educate on infection prevention.
Teach proper hand hygiene and advise against scratching to reduce the risk of secondary skin infections. - Offer psychosocial support
Provide emotional support and consider referring the patient to support groups or counseling services if needed. - Demonstrate wet wrap therapy.
Teach the patient or caregiver how to perform wet wrap therapy to soothe severe eczema flares when appropriate. - Educate on proper bathing techniques.
Advise on optimal bathing frequency, water temperature, and mild, fragrance-free cleansers to avoid skin irritation.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. The following section provides nursing care plan examples for eczema.
Care Plan 1: Impaired Skin Integrity
Nursing Diagnosis Statement: Impaired Skin Integrity related to inflammation and pruritus secondary to eczema as evidenced by dry, scaly patches and excoriations on arms and legs.
Related factors/causes:
- Chronic inflammatory skin condition
- Excessive scratching due to intense itching
- Compromised skin barrier function
Nursing Interventions and Rationales:
- Assess skin condition daily, noting characteristics of lesions and any changes.
Rationale: Regular assessment allows for early detection of improvements or complications. - Teach and demonstrate proper application of prescribed topical medications.
Rationale: Correct application ensures optimal effectiveness of treatment. - Educate the patient on proper bathing techniques and the importance of moisturizing.
Rationale: Proper skin care helps maintain skin hydration and reduce inflammation. - Implement itch management strategies such as cool compresses or distraction techniques.
Rationale: Reducing scratching helps prevent further skin damage and promotes healing.
Desired Outcomes:
- The patient will demonstrate improved skin integrity within two weeks, as evidenced by reduced redness, scaling, and excoriations.
- The patient will verbalize understanding of proper skin care techniques and medication application by the end of the education session.
Care Plan 2: Disturbed Sleep Pattern
Nursing Diagnosis Statement: Disturbed Sleep Pattern related to nocturnal pruritus secondary to eczema as evidenced by patient reports of frequent night-time awakenings and daytime fatigue.
Related factors/causes:
- Intense itching during night-time hours
- Discomfort from inflamed skin
- Anxiety related to eczema symptoms
Nursing Interventions and Rationales:
- Assess sleep patterns and factors contributing to sleep disturbances.
Rationale: Identifying specific issues helps tailor interventions to improve sleep quality. - Educate on sleep hygiene practices, including maintaining a cool bedroom temperature and using hypoallergenic bedding.
Rationale: Optimizing the sleep environment can reduce night-time itching and improve sleep quality. - Administer prescribed antihistamines or other medications before bedtime as ordered.
Rationale: Medications can help reduce night-time itching and promote better sleep. - Teach relaxation techniques such as deep breathing or progressive muscle relaxation.
Rationale: Relaxation methods can help reduce anxiety and promote sleep onset.
Desired Outcomes:
- The patient will report improved sleep quality with fewer night-time awakenings within 1 week.
- The patient will demonstrate using at least two sleep-promoting strategies by the end of the education session.
Care Plan 3: Risk for Infection
Nursing Diagnosis Statement: Risk for Infection related to breaks in skin integrity secondary to eczema and scratching.
Related factors/causes:
- Compromised skin barrier
- Frequent scratching leads to open wounds
- Presence of Staphylococcus aureus on the skin
Nursing Interventions and Rationales:
- Assess skin regularly for signs of infection, such as increased redness, warmth, or purulent discharge.
Rationale: Early detection of infection allows for prompt treatment. - Educate the patient on proper hand hygiene and the importance of keeping nails short and clean.
Rationale: Good hygiene practices reduce the risk of introducing bacteria into damaged skin. - Demonstrate proper wound care for any open or weeping lesions.
Rationale: Appropriate wound care promotes healing and prevents infection. - Advise on using cotton gloves at night to prevent scratching during sleep.
Rationale: Reducing unconscious scratching helps maintain skin integrity and reduce infection risk.
Desired Outcomes:
- The patient will demonstrate proper hand hygiene techniques by the end of the education session.
- The patient’s skin will remain free from signs of infection throughout the treatment period.
Care Plan 4: Deficient Knowledge
Nursing Diagnosis Statement: Deficient Knowledge related to eczema management as evidenced by the patient’s inability to identify triggers and verbalize proper skin care techniques.
Related factors/causes:
- Lack of exposure to eczema education
- Misunderstandings about the chronic nature of the condition
- Overwhelming amount of information available online
Nursing Interventions and Rationales:
- Assess the patient’s current knowledge and understanding of eczema.
Rationale: Identifying knowledge gaps allows for targeted education. - Provide comprehensive education on eczema, including its causes, triggers, and management strategies.
Rationale: Improved understanding empowers the patient to actively participate in their care. - Demonstrate and practice proper skin care techniques with the patient.
Rationale: Hands-on practice reinforces learning and improves confidence in self-care. - Provide written materials and reliable online resources for future reference.
Rationale: Take-home resources allow the patient to review information and reinforce learning.
Desired Outcomes:
- The patient will verbalize understanding of eczema triggers and management strategies by the end of the education session.
- The patient will demonstrate proper skin care techniques without prompting within 3 days.
Care Plan 5: Anxiety
Nursing Diagnosis Statement: Anxiety related to visible skin changes and chronic nature of eczema as evidenced by patient expressing concerns about appearance and future flare-ups.
Related factors/causes:
- Visible nature of skin lesions
- Unpredictability of eczema flares
- Chronic, recurring nature of the condition
Nursing Interventions and Rationales:
- Assess patient’s level of anxiety and its impact on daily life.
Rationale: Understanding the extent of anxiety helps tailor appropriate interventions. - Provide emotional support and active listening.
Rationale: Empathetic communication helps build trust and reduces feelings of isolation. - Teach stress management techniques such as mindfulness or guided imagery.
Rationale: Stress reduction can help manage anxiety and potentially reduce eczema flares. - Refer to support groups or counseling services if needed.
Rationale: Peer support and professional counseling can provide additional coping strategies.
Desired Outcomes:
- The patient will report decreased anxiety levels related to eczema within 2 weeks.
- The patient will demonstrate using at least one stress management technique by the end of the education session.
References
- Eichenfield, L. F., Tom, W. L., Chamlin, S. L., Feldman, S. R., Hanifin, J. M., Simpson, E. L., … & Sidbury, R. (2014). Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American Academy of Dermatology, 70(2), 338-351.
- Wollenberg, A., Barbarot, S., Bieber, T., Christen-Zaech, S., Deleuran, M., Fink-Wagner, A., … & Czarnecka-Operacz, M. (2018). Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. Journal of the European Academy of Dermatology and Venereology, 32(5), 657-682.
- LeBovidge, J. S., Elverson, W., Timmons, K. G., Hawryluk, E. B., Rea, C., Lee, M., … & Schneider, L. C. (2016). Multidisciplinary interventions in the management of atopic dermatitis. Journal of Allergy and Clinical Immunology, 138(2), 325-334.
- Silverberg, J. I., & Kantor, R. (2017). The role of interleukins 4 and/or 13 in the pathophysiology and treatment of atopic dermatitis. Dermatologic clinics, 35(3), 327-334.
- Drucker, A. M., Wang, A. R., Li, W. Q., Sevetson, E., Block, J. K., & Qureshi, A. A. (2017). The burden of atopic dermatitis: summary of a report for the National Eczema Association. Journal of Investigative Dermatology, 137(1), 26-30.
