Case Study of a Paediatric Patient with Scabies Infection

This case study presents the case of a 1-year-old Aboriginal female, K, diagnosed with scabies. The assignment begins with an introduction to scabies, caused by Sarcoptes scabei, highlighting its prevalence in Aboriginal communities and the importance of hygiene and awareness. The case study details K's presentation, background, and cultural context, including her mother's understanding of English and cultural beliefs. The pathophysiology of scabies is explained, focusing on the mite's life cycle and the resulting allergic reaction. The study emphasizes the higher incidence rate of scabies among Aboriginal and Torres Islander communities. Nursing interventions include cultural safety considerations, such as referring the patient and her mother to an Aboriginal RN and Health Counsellor for effective communication and education. Drug therapy options, like benzyl benzoate or malathion, are mentioned, along with the importance of skin assessment and patient education. The assignment also references relevant research studies and the NSQHS Standards to ensure effective and culturally sensitive care delivery, including strategies to prevent transmission of the infection. The case study underscores the importance of understanding the disease, its spread, and providing appropriate care to the patient and the community.

CASE STUDY OF A PAEDIATRIC PATIENT SUFFERING FROM SCABIES - Student Name:
Tammi Knight and student ID: 1130139
Introduction:
Scabies is a condition of skin infection that is caused by the causative agent
Sarcoptes scabei. The clinical symptoms of the condition include a sensation of
itching and emergence of reddish rashes. Sarcoptes Scabei is classified as an 8-
legged microscopic mite which produced toxic wastes. The toxic waste product
produced by the mite generated an immunological response that triggers an
allergic reaction. A wide number of research studies state that skin infections
are common within the members of the Aboriginal and Torres Islander
community (Tasani et al.2016). Specifically in this regard, it should be
mentioned that the condition majorly affects children who fall under the age
group of 0 to 10 years. Research studies further mention that the common
cause for the high prevalence of the skin disorder among the identified
Indigenous Community is due to lack of proper hygiene and lack of knowledge
in relation to the disease condition and the manner in which it spreads to other
people (Hardy, Engelman and Steer 2017; Tasani et al. 2016). Scabies is highly
contagious and on account of this property of the disease, it is extremely
important to adapt appropriate measures so as to ensure that the infection
does not spread to other healthy individuals. Proper maintenance of hygiene
and awareness with regard to the nature of the disorder can help to promote
positive health outcome. Having discussed the overview about the skin
infection, this poster would discuss the case study of a 1 year old aboriginal
female, K who was presented by her mother to the clinic and was diagnosed to
be suffering from Scabies.
Pathophysiology/Prevalence in Indigenous communities:
The pathophysiology of Scabies is similar to that of an allergic
reaction that occurs in between the mite proteins and host. The toxic
wastes of mites comprise of mite proteins that enter inside the gut
and deposit under the skin layers. The mite protein is toxic to the
human body and upon entering the body generates an immune
response that is caused due to the IgE-antibody mediation. There is
also a possibility that the mites directly enter the host and binds with
it. Upon binding, the mite mates on the skin surface and after the
process, the male mate does not survive. The female mite survives
and burrows through the upper skin layers and lay approximately 60-
90 eggs (Tasani et al., 2016). The eggs progress through the larval
stage and mature into adult mites within a span of 10 days. Overall,
the life-span of the mites is completed within a period of 30 days
(Tasani et al., 2016). It should be noted here that the allergic
symptoms might sustain even after the mites perish. Also, there
could be a possibility that after the mites are killed, skin lesions
might reoccur and last for a longer duration.
Research studies mention that the incidence rate of Scabies is higher
among the Aboriginal and Torres Islander community members. As
mentioned by Boyd et al. (2016), approximately 50% of the
paediatric hospitalizations are on account of skin infections such as
scabies, fungal infection or allergic reactions (Thomas et al. 2015). A
study conducted by Boyd et al. (2016), stated that inappropriate
knowledge and awareness with regard to hygiene and awareness
about the causative agent and pathophysiology of the diseases have
contributed to the increased disease burden.
Cultural safety in Nursing Practice:
The Standard 2 under the NSQHS Standards mention that nursing professionals
must effectively partner with the clients and ensure effective care delivery
(Safetyandquality.gov.au 2019). Further, the NSQHS standard also expects care
professionals to render effective care to the members of the Aboriginal and the
Torres Islander Community so as to comply with the policy of ‘close the gap’
and render effective care delivery (Safetyandquality.gov.au 2019). In this case,
in order to render a culturally safe care delivery, the patient and her mother
would be referred to an Aboriginal RN. This would be done so as to ensure that
effective communication takes place between the patient and the care
professional. Further, the mother of the patient would also be referred to an
Aboriginal Health Counsellor who would explain her about the pathophysiology
of the disorder and explain her the rationale of complying with the prescribed
medication regime. This would help to acquire effective care outcome.
Case Presentment:
• The patient K, was a 1 year old aboriginal female who was presented to the clinic by her mother. Upon presentment, the baby appeared to be extremely
distressed and was observed to be crying continuously. K’s mother, S mentioned that K had been crying a lot since the last 3 days, but today she just doesn’t
seem to stop. S further stated that, while changing her diaper, she noticed K had developed red rashes in her diaper area and guessed it was probably the
rashes that bothered K.
• Patient Background:
• Name: K (Anonymity maintained for patient privacy)
• Age: 1 year old
• Religion: Aboriginal Religion
• Family Support: stays with parents
• Medications: None
• Any medical history or surgical history available: Not Available
• Allergies: None
• Patient condition before commencement of nursing care: Presence of reddish skin-sores with inflammation within the diaper area. No pain sensation.
• Cultural Assessment: Patient’s mother can understand English but cannot speak English as it is not her first language. Patient’s mother is greatly influenced by
cultural beliefs and feels pharmacological therapy can worsen the condition of her baby. Patient’s mother has specific dietary preferences.
Nursing Interventions and Drug Therapy:
Research studies mention that the condition of Scabies must be appropriately diagnosed and the care
interventions must be focused on destruction of the causative agent as well as management of the manifested
symptoms (Kearns et al. 2015; Tasani et al. 2016). The use of benzyl benzoate or malathion can help to reinforce
recovery (Kearns et al. 2015). However, a care professional must conduct an appropriate skin assessment before
the prescribing the ointment. Parameters such as drug tolerance and estimation of drug toxicity are integral
before prescribing a particular ointment (Kearns et al., 2015). Apart from the prescription of ointment, the
patient’s mother would be educated about the disease condition and the precautionary measures that she
should undertake so as to make sure that the condition does not aggravate. Further, she would also be
educated about the strategies that she should undertake in case there is another child who could potentially
acquire the infection from K. This would be done to prevent the transmission of infection.
References:
Boyd, R., Patel, M., Currie, B. J., Holt, D. C., Harris, T., & Krause, V. (2016). High burden of invasive group A streptococcal disease in the Northern Territory of Australia. Epidemiology & Infection, 144(5), 1018-1027. DOI: https://doi.org/10.1017/S0950268815002010
Hardy, M., Engelman, D., & Steer, A. (2017). Scabies: a clinical update. Australian family physician, 46(5), 264. Retrieved from: https://search.informit.com.au/documentSummary;dn=792850003767604;res=IELHEA
Kearns, T. M., Speare, R., Cheng, A. C., McCarthy, J., Carapetis, J. R., Holt, D. C., ... & Bundhala, L. (2015). Impact of an ivermectin mass drug administration on scabies prevalence in a remote Australian Aboriginal community. PLoS neglected tropical diseases, 9(10), e0004151. DOI: https://doi.org/10.1371/journal.pntd.0004151
Safetyandquality.gov.au (2019). [online] Safetyandquality.gov.au. Available at: https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf [Accessed 29 Aug. 2019].
Tasani, M., Tong, S. Y., Andrews, R. M., Holt, D. C., Currie, B. J., Carapetis, J. R., & Bowen, A. C. (2016). The importance of scabies coinfection in the treatment considerations for impetigo. The Pediatric infectious disease journal, 35(4), 374-378. DOI: https://doi.org/10.1097/INF.0000000000001013
Thomas, J., Peterson, G. M., Walton, S. F., Carson, C. F., Naunton, M., & Baby, K. E. (2015). Scabies: an ancient global disease with a need for new therapies. BMC infectious diseases, 15(1), 250. Retrieved From: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-0983-z