Scabies Nursing Diagnosis and Nursing Care Plan

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Scabies Nursing Care Plans Diagnosis and Interventions

Scabies NCLEX Review and Nursing Care Plans

Scabies is a medical condition that involves itchiness of the skin due to Sarcoptes scabiei, a very small burrowing termite. It is a contagious skin disease which can rapidly spread through close physical contact.

Because of this, doctors usually recommend treatment for scabies not just for the patient but also for his/her contact groups, such as significant others, school class, or nursing home.

The signs and symptoms of scabies could be delayed in appearance and may take 6 weeks to appear after exposure. On the other hand, it may only take a few days post exposure before the symptoms appear in a patient who already has a history of previous infestation.

The treatment for scabies should be started immediately through topical medications that can kill the mites and their eggs.

Signs and Symptoms of Scabies

  • Itching – many patients report a stronger urge to scratch the itchy areas at night as the mites are more active at this time of the day
  • Pimple-like skin rash
  • Tiny bumps or blisters on the skin – these are the burrow tracks of the mites located in the folds of the skin, usually in between the fingers, around the waist, insides of the wrists, or in the armpits; infants and young children may have these burrow tracks on their scalp, palms, or soles of the feet

Causes and Risk Factors of Scabies

The human variant of S. scabiei is the causative organism of scabies. It is a microscopic burrowing mite with eight legs and is smaller than bed bugs. In particular, it is the female mite that burrows to reach the underneath of the skin, creating a tunnel where the eggs are deposited.

After hatching, the larvae find their way to the surface of the skin where they can mature and spread, as well as transfer to the skin of other people. Scabies mites feed on the blood of their host.

Itchiness is the main symptom of scabies, and it is caused by the allergic reaction of the body to the mites and eggs. Close physical contact, which includes sharing of bedding or clothes with an infected person, is the main mode of transmission from one person to another.

Animals can also be infected by S. scabiei, and may be transmitted to humans, too. However, this will only cause a temporary skin reaction and will not usually develop into full-blown scabies. This is because the animal variant does not survive long away from their animal host, and the same is true with the human mite.

The risk factors that may increase the likelihood of getting and spreading scabies include:

  • Young age
  • Crowded spaces such as classrooms, nursing homes, care facilities, and prisons
  • Sharing clothes, towels, and beddings
  • Irregular use of showers
  • Poverty or low family income
  • Occupation such as caregivers and healthcare workers

It is a myth that a lack of hygiene can cause scabies, since the mite goes beneath the skin and therefore cannot be easily washed off. Instead, the person has simply had close contact with an infected person.

Complications of Scabies

  1. Secondary bacterial infection. Impetigo or other skin conditions may result from vigorous scratching due to scabies.
  2. Crusted scabies. About 12 to 20 human mites can be found in an infected person. However, severe scabies cases caused by Norwegian crusted mites may involve thousands to millions of mites. Immunocompromised people such as those with HIV, anemia, or ongoing cancer treatment are more susceptible to this particular variant of the human mite.

Diagnosis of Scabies

  • Physical examination – the doctor looks for the signs of scabies mites such as rash and burrow sites; any signs of impetigo or secondary bacterial skin infection due to scratching will also be checked
  • Skin sampling – the doctor may scrape some skin off the burrow site to examine it under a microscope and check if mites or eggs are present

Treatment for Scabies

  1. Medications. Topical creams and lotions will be prescribed by the doctor and must be applied from the neck down to the soles of the feet. The topical medication must be left on the skin for about 8 to 10 hours. Moderate to severe cases of scabies may require repeated applications, especially if a new rash or burrows appear. The treatment will be strongly recommended to the patient’s close contacts even if they are asymptomatic. The most common topical medications for scabies include:
  2. Topical creams and lotions – most of these can be given to children aged 2 months and older, and are also safe for pregnant women and adults. It should be noted that some topical medications for scabies may not be suitable for pregnant women, children, and elderly people.
  3. Antiparasitic medications – specific oral antiparasitic medications may be given to patients with crusted scabies, those with poor immune systems, and those who do not respond to prescription topical medications. However, these may not be suitable for pregnant or lactating women, as well as for children weighing 15 less than 15 kilograms or 33 pounds.
  4. Antihistamines – over-the-counter antihistamines may help relieve the itching
  5. Home remedies. Calamine lotions can be used on the affected skin to soothe the itching and pain due to scabies. The application of a cool, wet washcloth on the affected areas of the body may also help relieve itching. The patient may also soak in an oatmeal bath or cool water to minimize the symptoms.

Prevention of Scabies

  1. Wash all clothing, bedding, and towels with hot, soapy water immediately prior to starting the treatment.
  2. Dry the clothes and linen with high heat.
  3. Use dry cleaning services for items that cannot be washed at home.
  4. Starving the mites is also an option as the mites die when they don’t have blood for food for a few days. This can be done by placing the clothes and linen in a sealed plastic bag and leaving it in the storage room, garage, or other out-of-the-way place.

Nursing Diagnosis for Scabies

Scabies Nursing Care Plan 1

Nursing Diagnosis: Impaired Skin Integrity related to infection of the skin secondary to scabies, as evidenced by tiny bumps and blisters on the skin (mite burrow sites), pimple-like rash, itching, pain and soreness

Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for scabies.

Scabies Nursing InterventionsRationale
Assess the patient’s skin on his/her whole body.To determine the severity of scabies and any affected areas that require special attention or wound care.
Isolate the patient in his/her room. The patient should be isolated ideally for 24 hours after finishing treatment.Scabies is an infectious/ communicable skin disease. Isolation can help reduce transmission to other human hosts.
Prior to application of the prescribed topical medication for scabies, the affected area should be soaked first in warm water to remove the scabs. Wet compresses may also be used.Removal of scabs prior to applying the topical antibiotic promotes good absorption of the medication.
Apply the prescribed topical cream or lotion from the neck down to the soles of the feet. The topical medication must be left on the skin for about 8 to 10 hours. Moderate to severe cases of scabies may require repeated applications, especially if a new rash or burrows appear.To facilitate effective treatment of scabies.
Educate the patient and carer about proper wound hygiene through washing the sores with soap and water. Also, advise the patient and carer 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 sores may cause mild itching, but it is advisable to prevent the patient from scratching the affected areas to prevent worsening of the infection.
For a patient with crusted scabies, administer oral antiparasitic medication as prescribed. Prior to administration, check if the patient is pregnant or lactating. For young children, assess the weight first.Specific oral antiparasitic medications may be given to patients with crusted scabies, those with poor immune systems, and those who do not respond to prescription topical medications. However, these may not be suitable for pregnant or lactating women, as well as for children weighing 15 less than 15 kilograms or 33 pounds.  
Administer antihistamines as prescribed. These may also be available over-the-counter for patients who are not admitted.Over-the-counter antihistamines may help relieve the itching.
Teach the patient some home remedies for symptomatic management.Calamine lotions can be used on the affected skin to soothe the itching and pain due to scabies. The application of a cool, wet washcloth on the affected areas of the body may also help relieve itching. The patient may also soak in an oatmeal bath or cool water to minimize the symptoms.  

Scabies Nursing Care Plan 2


Risk for Infection related to contagious skin infection

Desired Outcome: The patient will prevent spread of infection to the rest of the body, as well as cross-contamination to other people by following treatment regimen for scabies.

Scabies Nursing InterventionsRationale
Assess the patient’s skin on his/her whole body.To determine the severity of scabies and any affected areas that require special attention or wound care.
Isolate the patient in his/her room. The patient should be isolated ideally for 24 hours after finishing treatment.Scabies is an infectious/ communicable skin disease. Isolation can help reduce transmission to other human hosts.
Apply the prescribed topical cream or lotion from the neck down to the soles of the feet.To facilitate effective treatment of scabies.
Recommend the treatment to the patient’s close contacts even if they are asymptomatic.Scabies is a contagious skin disease which can rapidly spread through close physical contact.
Educate the patient and carer about proper wound hygiene through washing the affected sites with soap and water.It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. Scabies may cause severe itching, but it is advisable to prevent the infected person from scratching the affected areas to prevent worsening and spread of the infection.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and carer to prevent scratching the affected areas.Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. When the patient touches other people or objects with infected hands, the infection will likely spread.
Teach the patient and close contacts to perform preventive measures such as:Wash all clothing, bedding, and towels with hot, soapy water immediately prior to starting the treatment.Dry the clothes and linen with high heat. Use dry cleaning services for items that cannot be washed at home.  To prevent the spread of scabies mites and reduce the risk of prolonged scabies infection as well as lessen the possibility of a secondary infection such as impetigo.

More Scabies 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

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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