Last updated on May 11th, 2022 at 09:59 am
Eczema Nursing Care Plans Diagnosis and Interventions
Eczema NCLEX Review and Nursing Care Plans
Eczema, also known as atopic dermatitis, is a skin condition characterized by red and itchy skin. It is the most common chronic inflammatory skin disease.
The term “eczema” came from the Greek word “ekzein,” which means “to boil.” It is not a contagious skin condition and its severity varies from person to person.
Eczema is a chronic condition that may flares up periodically, typically accompanied by asthma or hay fever.
It is commonly seen in children, but it can also develop at any age. The incidence of eczema is about 15-20% in children and 1-3% in adults.
Signs and Symptoms of Eczema
The signs and symptoms of eczema can be different from person to person. The symptoms may include any of the following:
- Dry and sensitive skin
- Itchy skin – itchiness can range from mild to moderate and is different from person to person; commonly worse at night
- Red, brown, and/or gray skin patches- these discolorations are often seen on the hands, feet, ankles, wrists, neck, upper chest, eyelids, the crease behind the elbow and knees, and on the scalp and face in infants
- Raised bumps that may ooze or crust
- Thick, cracked, scaly skin
- Areas of swelling due to scratching
Causes of Eczema
The exact cause of eczema is unknown. However, its occurrence is believed to be a product of genetic predisposition and inflammatory triggers.
Filaggrin is an essential protein that helps human bodies to keep a healthy top layer on the skin.
A mutation in the genes responsible for the creation of filaggrin is noted on people with eczema.
Low levels of filaggrin in the body can cause inadequate strength in the skin barrier predisposing an individual to inflammation and infection.
Also, it is believed that people with eczema have an overreactive immune system.
When triggered by an irritant, an individual with eczema usually responds by producing inflammation.
This inflammation then causes the signs and symptoms of eczema.
There are other factors that are noted to predispose an individual to develop eczema. They are as follows:
- Family history of eczema
- Having any allergies
- Having hay fever
- Having asthma
Complications of Eczema
The complications of eczema can vary depending on how severe the condition is. The complications may include the following:
- Asthma and Hay Fever. About half of young children diagnosed with eczema develop asthma or hay fever by the age of 13.
- Neurodermatitis. This is a skin condition characterized by chronic itching or scaling. It usually starts as an itchy patch which can turn into a discolored, thick, and leathery patch on the skin due to extreme scratching.
- Skin infections. Due to the scratching involved in eczema, breaks and cuts in the skin can become good entry point for opportunistic microorganisms to enter the body and cause infection.
- Irritant hand dermatitis. This condition is commonly seen in people whose work requires repeated or constant exposure to water, soaps, or any corrosive liquids.
- Allergic contact dermatitis. This type of dermatitis stems from an allergic reaction following contact from an allergen.
- Sleep problems. Sleep disruptions typically occur due to the itch-scratch cycle related to eczema.
Diagnosis of Eczema
The diagnosis of eczema relies strongly on the clinical manifestation. There is usually no diagnostic test involved. Thorough history taking and physical examination are done, and the results will be the basis for the diagnosis. Patch testing may be completed to rule out other skin conditions.
Treatment for Eczema
Treatment for eczema includes the following:
- Medications. Drugs are used to control itching and prevent complications related to it. Different medications can be prescribed to treat eczema.
- Drugs to control itch and promote skin repair. Creams are commonly prescribed by doctors to soothe inflamed skin. Corticosteroids are the drug of choice and will need to be applied as directed. This group of drugs is known to have side effects including thinning of skin. Creams containing calcineurin inhibitor can also be used for patients aged 2 and above. However, these drugs are controversial as there is potential risk for developing cancer.
- Antibiotic creams. Doctors may prescribe antibiotic to prevent infection. Cracks and breaks in the skin can cause bacterial infection.
- Anti-inflammatory drugs. Oral corticosteroids are sometimes used for eczema. They are used to control inflammation. However, they can only be used for the prescribed amount of time due to the related side effects.
- Injectable biologics (monoclonal antibody). A new drug recently approved by the Food and Drug Authority can be used to treat eczema in patients who are not responding to other treatments.
- Therapies
- Wet dressing. Application of wet dressings is commonly performed in the hospital. It requires the application of a wet bandage over the lesions covered by corticosteroids.
- Light therapy. This therapy is also known as phototherapy. It involves the controlled exposure of the skin to natural sunlight. Light therapy is deemed to be effective, however, it must be done under the advice of the doctor as it may cause harmful side effects, including premature skin aging and the risk of skin cancer.
- Counselling. Counselling is known to help people with eczema deal with their frustration of their skin condition.
- Relaxation, behavior modification and biofeedback. These techniques can provide help with habitual scratching.
In infants with eczema, treatment includes the regular lubrication of their skin with creams, moisturizers, ointments, or baby oils. Avoiding extreme temperatures and irritants are also helpful.
Nursing Diagnosis for Eczema
Nursing Care Plan for Eczema 1
Nursing Diagnosis: Impaired Skin Integrity related to infection of the skin secondary to eczema, as evidenced by dry and sensitive skin, itchy skin, red, brown, and/or gray skin patches, oozing raised bumps, and thick, cracked, scaly skin
Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for eczema.
| Eczema Nursing Interventions | Rationale |
| Assess the patient’s skin on his/her whole body. | To determine the severity of eczema and any affected areas that require special attention or wound care. |
| Remove any allergens or irritants in the patient’s environment. | The exact cause of eczema remains unknown, but environmental triggers such as irritants or allergens are believed to contribute to the skin inflammation. |
| Apply wet dressings over the affected areas. | Moderate to severe eczema requires the application of a wet bandage over the lesions covered by corticosteroids. |
| Administer the medications as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician. | Eczema is generally treated through the use of the following medications: Antibiotic creams. Doctors may prescribe antibiotic to prevent infection. Cracks and breaks in the skin can cause bacterial infection. Anti-inflammatory drugs. Oral corticosteroids are sometimes used for eczema. They are used to control inflammation. However, they can only be used for the prescribed amount of time due to the related side effects. Injectable biologics (monoclonal antibody). A new drug recently approved by the Food and Drug Authority can be used to treat eczema in patients who are not responding to other treatments. |
| Educate the patient and caregiver about proper wound hygiene through washing the lesions with soap and water. Advise the patient and caregiver to prevent scratching the affected areas. | It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The lesions may be itchy, but it is advisable to prevent the child from scratching the affected areas to prevent any worsening of the infection. |
| Educate the patient about phototherapy and how it is performed. | Phototherapy involves the controlled exposure of the skin to natural sunlight. Light therapy is deemed to be effective, however, it must be done under the advice of the doctor as it may cause harmful side effects, including premature skin aging and the risk of skin cancer. |
Nursing Care Plan for Eczema 2
Nursing Diagnosis: Risk for Infection secondary to eczema
Desired Outcome: The patient will prevent new infections to the rest of the body by following treatment regimen for eczema.
| Eczema Nursing Interventions | Rationale |
| Assess the patient’s skin on his/her whole body. | To determine the severity of eczema and any affected areas that require special attention or wound care. |
| Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician. | Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance. |
| Educate the patient and caregiver about proper wound hygiene through washing the lesions with soap and water. | It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The lesions can be very itchy, but it is advisable to prevent the child from scratching the affected areas to prevent worsening of the infection. |
| Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas. | Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will create further breaks in the skin, which can result to complications such neurodermatitis or other skin infections. |
| Teach the patient to perform relaxation exercises (such as deep breathing and meditation), behavior modification activities and biofeedback. | These techniques can provide help with habitual scratching. |
More Eczema Nursing Diagnosis
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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