Treating Scabies in Indigenous Paediatric Patients

Evidence based practice for treating scabies in indigenous
paediatric patients
Introduction:
Scabies can be defined as a skin condition that is characterised by the
manifestation of rashes and intense itching. The condition can be explained as a
dermatological condition which is caused by the causative agent
Sarcoptes scabei
(Yeoh et al. 2017). The causative agent can be identified as an eight legged
microscopic mite and the infection manifests itself as an immunological response to
the toxic waste or allergens produced by the mite. Research studies have shown
that the incidence of skin infection or skin sores caused due
to Group A
streptococcus is extremely common within the aboriginal community (Yeoh et al.
2016). Further, research studies also suggest that the recent years have witnessed
an increase in the incidence rate of skin infections among the children aged
between 0 to 5 years who belong to the aboriginal and Torres Islander community
(Esposito and Veraldi 2018). The primary reasons that can be attributed to the high
prevalence of scabies among the aboriginal community members can be explained
as living in unhygienic and crowded surroundings and lack of awareness about the
contagious causative agent and skin infections (Esposito and Veraldi his parents
and complained of severe itching and discomfort. 2018). This poster intends to
present a case study of a 10 year old, male, aboriginal paediatric patient who
presented to the outpatient department of XYZ hospital with
Case Scenario:
JK was a 10 year old, aboriginal male who presented to the
outpatient clinic with his parents and his presenting complaint
included intense itching, redness and inflammation of the arm-pit
area.
• Client background:
• Name: JK
• Age: 10
• Religion: Aboriginal Religion
• Family support: Lives with parents
• Residence: Tiwi Islands, Northern Territory
• Schooling: Pursuing fifth grade in Pularumpi school
• Medications: None
• Previous medical and surgical history: None
• Condition prior to nursing care: Redness, inflammation and
visible skin sores in the underarm area with persistent itching;
absence of pain sensation
• Cultural needs assessment: English is not the first language of
the patient and the patient as well as the patient’s family
members, need effective culturally competent nursing care so
as to positively participate in the care process to acquire
positive patient outcome
Application of cultural safety framework to practice:
The National Safety and Quality Health Service Standards for nursing
and midwifery practice mentions that nurses and healthcare workers
while caring for Aboriginal and Torres Islander consumers must
positively partner with the patients in the care process and ensure
cultural safety such that effective care is provided to the patients
(Safetyandquality.gov.au 2019). In order to ensure a culturally safe
nursing care intervention, the preference of the patient and his family
members would be asked and accordingly an aboriginal RN would be
referred (Safetyandquality.gov.au 2019). The rationale can be
explained as ensuring convenience while communicating with the
nurse as the patient or the family members of the patient do not
speak English as their first language. This would ensure a culturally
safe care delivery and would alleviate the patient care outcome. In
addition to this, as revealed by the evidence base, scabies happens
to be the most common skin infection that aboriginal children
experience. On account of the contagious nature of the skin infection,
the parents of the patient would be educated about the risk factors
that could possibly trigger the manifestation in them. Further, they
would also be made aware about the importance of ensuring patient
hygiene so as to minimise the risk of the infection burden.
Pathophysiology and Prevalence of Scabies:
The pathophysiology of scabies can be explained as under (May et al. 2019):
The causative symptoms are triggered by an allergic reaction between the body of the host and the mite proteins
The mite-proteins generally enter into the gut through mite-faeces and are deposited under the surface of the skin
The manifested allergic reaction can either be cell-mediated which is a delayed response of an antibody-mediated immediate response that includes the mediation of
IgE antibody
The symptoms of allergy include redness or allergy that can persist up to weeks even after the mites are killed
A probability exists that new skin lesions might appear even after the mites are killed. Further, there is also a possibility that nodular lesions that manifest on account of
scabies might continue to be symptomatic even after a week after the mites have been killed
The mite spreads through direct contact or prolonged contact in between hosts
The mite therefore remains viable for a span of 2-5 days on inanimate objects which leads to transmission of infection through substances such as clothing or bedding
Post being bound to the host, almost 10-15 mites mate on the skin surfacen
Post copulation, the male mite does not survive, however, the female mite burrows deep down into the superficial skin layers and lays up to 60 to 90 eggs
The ova or the eggs laid by the female mites progress from the larval and nymph stages to become adult mites within 10 days
The life cycle of the mite is completed within the human epidermis and is completed within the time frame of 30 days
The prevalence of the scabies among the children of Aboriginal and Torres Strait islander is high and on an average, statistical evidence reveal that 50% of the
paediatric patient cases presented to the hospital include infectious diseases with 16% being skin infections such as fungal infections and scabies, 16% being ear
infections and 13% being upper respiratory tract infections (MacMorran et al. 2017). The prevalence statistics shows that scabies is one of the prime skin infections that
add to the disease burden of the patients.
Evidence based nursing interventions:
The evidence base suggests that scabies should be appropriately diagnosed and the care goal should focus on
symptom management and eradication of the mite to prevent further infections. Research studies mention that the
use of pharmacological interventions such as prescribing tropical ointments such as malathion, lindane or benzyl
benzoate can help to assist with the recovery process (Page, Weston and Loh 2016). The choice of the ointment should
be done on the basis of evaluation of the parameters such as drug toxicity and estimation of drug tolerance. In
addition to this, rendering effective health literacy to the patient and the family members about the protocol of
applying the ointment and imparting awareness in relation to the risk factors that could trigger aggravation of the
symptoms is essential and can help in improved management of the symptoms (Brennan, Dutton and Magann 2019).
References
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