Scabies Nursing Diagnosis & Care Plans

Scabies is a contagious skin condition caused by tiny mites that burrow into the skin, leading to intense itching and a characteristic rash. This nursing diagnosis is crucial for healthcare providers to understand, as proper identification and management of scabies are essential for patient care and preventing its spread in healthcare settings.

Causes (Related to)

Scabies infestations can result from various factors that increase the risk of exposure or transmission. The following are common causes of scabies:

• Direct skin-to-skin contact with an infected person
• Prolonged close personal contact, such as within families or intimate relationships
• Sharing of contaminated clothing, bedding, or towels
• Living in crowded conditions (e.g., nursing homes, prisons, or refugee camps)
• A compromised immune system, may increase susceptibility
• Poor hygiene practices
• Lack of knowledge about scabies transmission and prevention

Signs and Symptoms (As evidenced by)

Scabies can manifest with a variety of signs and symptoms. In a physical assessment, a patient with scabies may present with one or more of the following:

Subjective: (Patient reports)

• Intense itching, especially at night
• Burning or tingling sensation on the skin
• Discomfort or embarrassment due to visible skin changes
• Sleep disturbances due to itching

Objective: (Nurse assesses)

• Rash with small, red, raised bumps
• Thin, irregular burrow tracks on the skin
• Presence of mites, eggs, or fecal matter under microscopic examination
• Scratching marks or secondary bacterial infections
• Typical distribution of lesions (between fingers, on wrists, elbows, armpits, waist, buttocks, or genitals)
• In severe cases (crusted scabies), thick crusts on the skin containing large numbers of mites and eggs

Expected Outcomes

The following are the common nursing care planning goals and expected outcomes for scabies:

• The patient will report relief from itching within 24-48 hours of treatment initiation
• The patient’s skin condition will show improvement within one week of treatment
• The patient will demonstrate proper application of prescribed medications
• Patient and family members will verbalize understanding of scabies transmission and prevention measures
• All close contacts of the patient will be treated simultaneously to prevent re-infestation
• The patient will show no signs of secondary bacterial infection
• The patient will report improved sleep quality within three days of treatment initiation

Nursing Assessment

The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. The following section will cover subjective and objective data related to scabies.

1. Perform a thorough skin assessment.
   Examine the entire body, paying particular attention to common infestation sites such as finger webs, wrists, elbows, armpits, waist, buttocks, and genitals. Look for characteristic burrows, rashes, or signs of scratching.
2. Document the extent and characteristics of the rash
   Note the distribution, appearance, and any secondary changes due to scratching or infection. This information helps track the progression of treatment and identify potential complications.
3. Assess the severity of itching.
   Quantify the patient’s itching intensity using a numerical scale (e.g., 0-10). This baseline helps evaluate the effectiveness of interventions and treatments.
4. Evaluate the patient’s sleep patterns.
   Inquire about sleep disturbances related to itching, as this can significantly impact the patient’s quality of life and overall health.
5. Assess the patient’s knowledge of scabies.
   Determine the patient’s understanding of scabies transmission, treatment, and prevention to identify areas for education.
6. Identify potential sources of infestation.
   Ask about recent contacts, living conditions, and any shared items that may have contributed to the infestation.
7. Evaluate for signs of secondary bacterial infection
   Look for signs of cellulitis, impetigo, or other bacterial skin infections that may require additional treatment.
8. Assess the patient’s emotional state.
   Scabies can cause significant distress and embarrassment. Evaluate the patient’s psychological well-being and need for emotional support.
9. Review the patient’s medical history.
   Identify any conditions or medications that may affect treatment options or increase the risk of complications.
10. Prepare for diagnostic procedures.
    The healthcare provider may perform a skin scraping for microscopic examination to confirm the diagnosis of scabies.

Nursing Interventions

Nursing interventions and care are essential for the patient’s recovery from scabies and the prevention of its spread. In the following section, you’ll learn about possible nursing interventions for a patient with scabies.

1. Administer prescribed medications
   Apply scabicides as ordered, typically permethrin 5% cream or oral ivermectin. Ensure proper application technique and timing of treatment.
2. Implement isolation precautions
   Use contact precautions until 24 hours after treatment initiation to prevent transmission to healthcare workers and other patients.
3. Provide symptomatic relief
   Administer antihistamines or apply cool compresses to alleviate itching. Trim the patient’s nails to minimize skin damage from scratching.
4. Educate the patient and family.
   Provide comprehensive education on scabies transmission, treatment, and prevention measures. Emphasize the importance of treating all close contacts simultaneously.
5. Manage contaminated items
   Instruct the patient to wash all clothing, bedding, and towels used in the past 3 days in hot water and dry on high heat. Items that cannot be washed should be sealed in plastic bags for at least 72 hours.
6. Monitor for treatment effectiveness.
   Assess for improvement in symptoms and skin condition. Notify the healthcare provider if symptoms do not improve after one week or worsen.
7. Assess and treat secondary bacterial infections.
   Monitor for signs of secondary infection and administer antibiotics if prescribed.
8. Provide emotional support
   Offer reassurance and address any concerns or anxieties the patient may have about the condition or its social implications.
9. Collaborate with the healthcare team.
   Work closely with physicians, dermatologists, and infection control specialists to ensure comprehensive care and prevent outbreaks in healthcare settings.
10. Document and report
    Maintain accurate records of assessments, interventions, and patient responses. Report any unusual findings or complications promptly.

Nursing Care Plans

Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for scabies.

Nursing Care Plan 1: Impaired Skin Integrity

Nursing Diagnosis: Impaired Skin Integrity related to scabies infestation as evidenced by pruritic rash and visible burrows on the skin.

Related factors/causes:

• Presence of Sarcoptes scabiei mites
• Scratching due to intense itching
• Potential secondary bacterial infection

Nursing Interventions and Rationales:

1. Perform a thorough skin assessment daily.
   Rationale: Regular assessment allows for monitoring of treatment effectiveness and early detection of complications.
2. Administer prescribed scabicide medications as ordered.
   Rationale: Proper application of scabicides is essential for eradicating the mites and treating the infestation.
3. Educate the patient on proper application techniques and timing of treatment.
   Rationale: Ensuring correct medication use increases treatment efficacy and prevents reinfestation.
4. Implement contact precautions for 24 hours after treatment initiation.
   Rationale: Prevents transmission of scabies to healthcare workers and other patients.
5. Provide cool compresses and administer antihistamines as prescribed to relieve itching.
   Rationale: Alleviating itching reduces the risk of skin damage from scratching and improves patient comfort.

Desired Outcomes:

• Patient will demonstrate improvement in skin integrity within 1 week of treatment initiation.
• The patient will report decreased itching within 24-48 hours of treatment.
• Patient will show no signs of secondary bacterial infection throughout the treatment course.

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Nursing Care Plan 2: Disturbed Sleep Pattern

Nursing Diagnosis: Disturbed Sleep Pattern related to nocturnal itching associated with scabies infestation as evidenced by patient reports of difficulty falling asleep and frequent night awakenings.

Related factors/causes:

• Intense itching, particularly at night
• Anxiety related to the condition
• Discomfort from skin lesions

Nursing Interventions and Rationales:

1. Assess sleep patterns and factors affecting sleep quality.
   Rationale: Identifying specific sleep disturbances helps tailor interventions to improve sleep quality.
2. Administer prescribed antihistamines before bedtime as ordered.
   Rationale: Antihistamines can reduce itching and have a sedative effect, promoting better sleep.
3. Encourage the use of cotton gloves at night to prevent scratching during sleep.
   Rationale: Minimizing scratching during sleep reduces skin damage and promotes healing.
4. Teach relaxation techniques such as deep breathing or progressive muscle relaxation.
   Rationale: Relaxation techniques can help reduce anxiety and promote sleep onset.
5. Ensure a comfortable sleep environment (e.g., cool temperature, minimal noise and light).
   Rationale: A conducive sleep environment supports better sleep quality.

Desired Outcomes:

• Patient will report improved sleep quality within three days of treatment initiation.
• The patient will demonstrate the use of at least one relaxation technique before bedtime.
• Patient will report feeling rested upon awakening within one week of treatment initiation.

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Nursing Care Plan 3:

Nursing Diagnosis: Risk for Infection related to skin barrier disruption secondary to scabies infestation and scratching.

Related factors/causes:

• Breaks in skin integrity due to mite burrows and scratching
• The potential introduction of bacteria through scratching
• Compromised immune function (in some cases)

Nursing Interventions and Rationales:

1. Assess the skin daily for signs of secondary bacterial infection (e.g., increased redness, warmth, swelling, purulent discharge).
   Rationale: Early detection of secondary infection allows for prompt treatment.
2. Teach proper hand hygiene techniques to the patient and family members.
   Rationale: Good hand hygiene reduces the risk of introducing bacteria to damaged skin.
3. Encourage the patient to keep their nails short and clean.
   Rationale: Short, clean nails minimize skin damage from scratching and reduce the risk of bacterial introduction.
4. Apply emollients to the skin after bathing to maintain skin hydration.
   Rationale: Well-hydrated skin is more resistant to bacterial invasion.
5. Systemic antibiotics should be administered if prescribed for secondary infection.
   Rationale: Prompt treatment of secondary bacterial infections prevents further complications.

Desired Outcomes:

• The patient will demonstrate proper hand hygiene techniques when asked.
• The patient will maintain skin integrity without signs of secondary infection throughout the treatment course.
• The patient will verbalize understanding of measures to prevent secondary skin infections.

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Nursing Care Plan 4: Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to scabies transmission, treatment, and prevention as evidenced by the patient’s questions and misconceptions about the condition.

Related factors/causes:

• Lack of exposure to information about scabies
• Misunderstanding of the mode of transmission
• Anxiety interfering with information retention

Nursing Interventions and Rationales:

1. Assess the patient’s current knowledge and understanding of scabies.
   Rationale: Identifying knowledge gaps allows for targeted education.
2. Provide comprehensive education on scabies transmission, treatment, and prevention measures.
   Rationale: Accurate information empowers patients to manage their condition effectively and prevent re-infestation.
3. Demonstrate proper application of scabicide medications.
   Rationale: Ensuring correct medication use increases treatment efficacy.
4. Educate on the importance of treating all close contacts simultaneously.
   Rationale: Treating all contacts prevents reinfestation and breaks the transmission cycle.
5. Provide written materials on scabies management for reference.
   Rationale: Written information reinforces verbal teaching and serves as a future resource.

Desired Outcomes:

• Patient will verbalize understanding of scabies transmission and prevention within 24 hours of education.
• The patient will demonstrate proper application of scabicide medication when asked.
• Patient will identify at least three measures to prevent reinfestation by discharge.

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Nursing Care Plan 5: Anxiety

Nursing Diagnosis: Anxiety related to diagnosis of scabies and concerns about social stigma as evidenced by verbalized worries and increased tension.

Related factors/causes:

• Lack of knowledge about the condition
• Fear of social rejection or embarrassment
• Concerns about transmitting the infestation to others

Nursing Interventions and Rationales:

1. Assess the patient’s level of anxiety and specific concerns.
   Rationale: Understanding the patient’s anxieties allows for targeted interventions and support.
2. Provide accurate information about scabies to dispel myths and misconceptions.
   Rationale: Correct information can alleviate unfounded fears and reduce anxiety.
3. Encourage the patient to express feelings and concerns about the diagnosis.
   Rationale: Verbal expression of emotions can help reduce anxiety and allow for addressing specific worries.
4. Teach coping strategies such as deep breathing exercises or guided imagery.
   Rationale: These techniques can help manage anxiety symptoms effectively.
5. Refer to mental health services if anxiety persists or significantly impacts daily functioning.
   Rationale: Professional mental health support may be necessary for persistent or severe anxiety.

Desired Outcomes:

• Patient will report decreased anxiety levels within 48 hours of interventions.
• The patient will demonstrate the use of at least one coping strategy when feeling anxious.
• Patient will verbalize increased confidence in managing the condition and its social implications by discharge.

References

1. Centers for Disease Control and Prevention. (2022). Scabies.
2. Chandler, D. J., & Fuller, L. C. (2019). A Review of Scabies: An Infestation More than Skin Deep. Dermatology, 235(2), 79-90. https://doi.org/10.1159/000495290
3. Arlian, L. G., & Morgan, M. S. (2017). A review of Sarcoptes scabiei: past, present and future. Parasites & Vectors, 10(1), 297. https://doi.org/10.1186/s13071-017-2234-1
4. Salavastru, C. M., Chosidow, O., Boffa, M. J., Janier, M., & Tiplica, G. S. (2017). European guideline for the management of scabies. Journal of the European Academy of Dermatology and Venereology, 31(8), 1248-1253. https://doi.org/10.1111/jdv.14351
5. Thompson, R., Westbury, S., & Slape, D. (2021). Paediatrics: How to manage scabies. Drugs in Context, 10. https://doi.org/10.7573/dic.2020-12-3
6. Hardy, M., Engelman, D., & Steer, A. (2017). Scabies: A clinical update. Australian Family Physician, 46(5), 264-268.