NURSING CARE IN Scabies

 SCABIES

Definition of Scabies
According to Handoko (2007), scabies is a contagious skin disease caused by infestation and sensitization to mite (mite) Sarcoptes scabei. The disease is also known as the itch, scabies, or itch Agogo.
Disease scabies is a contagious disease by lice infestation is itching Sarcoptes scabei, the tick enters the skin stratum corneum, forming canaliculi or straight or curved tunnel along the 0.6 to 1.2 centimeters.Classification of Scabies
There are several forms of atypical scabies are rare and hard to recognize, so that it can lead to misdiagnosis. Some forms include (Sungkar, S, 1995):
a. Scabies on the net (scabies of cultivated).
This form is characterized by lesions in the form of papules and tunnels are few in number so it is very difficult to find.
b. Scabies incognito.
This form occurs in scabies treated with corticosteroids that symptoms and clinical signs improved, but the mites remain and transmission can still occur. Scabies incognito often also show clinical symptoms of unusual, atypical distribution, lesion area and similar other diseases.
c. Nodular scabies
In this form of lymph node lesions are itchy reddish brown. Node there is usually a closed area, especially on the male genitalia, inguinal and axillary. These nodes arise as a reaction to the mites scabies hipersensetivitas.
On the node that was more than a month mites are rarely found. Nodes may persist for several months to a year although it had been given anti-scabies treatment and corticosteroids.
d. Scabies is transmitted through animals.
In America, the main source of scabies is a dog. The disorder is different from human scabies that there are no tunnels, no attack between the fingers and external genitalia. Lesions are usually found in areas where people often contact / hug pet the thigh, abdomen, chest and arms. The incubation period is shorter and easier transmission. This disorder is temporary (4-8 weeks) and can heal itself because S. scabiei var. animals can not continue its life cycle in humans.
e. Norwegian scabies.
Norwegian scabies or scabies krustosa characterized by extensive lesions with crusting, and hyperkeratosis skuama generalized thick. Place predilection usually scalp hair, ears buttocks, elbows, knees, palms and feet that can be accompanied by nail dystrophy. In contrast with ordinary scabies, itching in patients with Norwegian scabies is not prominent but form is highly contagious because the number of mites that infest so many (thousands). Norwegian scabies caused by immunologic deficiency so the body's immune system fails to limit the proliferation of mites can multiply with ease.
f. Scabies in infants and children.
Scabies lesions in children can affect the entire body, including the entire head, neck, palms, soles of the feet, frequent infections and secondary impetigo, ektima so the tunnels are rarely found. In infants, lesions on the face. (Harahap. M, 2000).
g. Scabies lying in bed (bed ridden).
Patients with chronic illnesses and the elderly who are forced to stay in bed suffering from scabies which lesions can be limited. (Harahap. M, 2000).Etiology Scabies
Scabies can be caused by fleas or germs sercoptes scabei hominis variants. Sarcoptes Arthopoda scabieiini including phylum, class of arachnids, the order Ackarina, Sarcoptes superfamily. In humans is called Sarcoptes scabiei var. hominis. Unless there is S. scabiei others in goats and pigs. In morphologic a mite small, oval, convex back and abdomen flat. Mite is transient, dirty white, and not-eyed.Scabies Clinical Manifestations
Diagnosis is made by finding two of the four cardinal signs of the following:
- Noktuma Pruritus (itch at night) because the activity of mites was higher in the humid and hot temperatures.
- Commonly found in a group of humans, for example about seliruhanggota eluarga.
- The tunnel (kunikulus) in predilection sites are white or grayish, forming straight or curved lines, the average length of 1cm, the uung be pimorfi (pustu, ekskoriosi). Place of predilection are usually areas with komeum tpis stratum, ie between the fingers, the volar wrist, elbow the outside, fold the front of the armpits, breast and fold aerola glutea, umbilicus, buttocks, external genitalia, and lower abdomen. In infants can affect the palms and soles of the feet and even the entire surface ulit. In adolescents and adults may occur on the scalp and face.
- Finding mites are the most diagnostic. Can ditemikan one or more life stages of this mite.
In patients who always maintain hygiene, lesions that arise only slightly so that the diagnosis is sometimes difficult to enforce. If the illness lasts a long time, can arise likenifikasi, impetigo, and furunkulsis.Scabies pathophysiology
Skin disorders may be caused not only from scabies mites, but also by patients themselves due to scratching. And because shaking hands or arm so that it contacts the skin is strong, causing lesions arise on the wrist. Itching that occurs due to leh sensitization to mites ekskret secret and that takes about a month after infestation. At the moment it resembles a skin disorder ditemuannya dermatitis with papules, vesicles, and Urtica. By scratching may arise erosion, ekskoriasi, crusting, and secondary infections. And itchy skin disorder that occurs can be wider than the location of mites.Management of Scabies
Terms ideal drug is effective against all stages of mites, not to cause irritation and toxic, no smell or dirty, no damage or color of clothing, easily available and cheap.
Types of topical drugs:
- Sulfur creep (sulfur presipitatum) 40-20% in the form of ointment or cream. In infants and adults presipitatum 5% sulfur in oil is very safe and effective. The drawback is the use must not be less than 3 days because it is not effective against the egg stage, smelly, dirty clothes and can cause irritation.
- Benzyl-benzoate emulsion 20-25% effective against all stages, is given every night for 3 times. These drugs are difficult to obtain, often giving irritation, and sometimes more itchy after use.
- Gama benzene hexa chloride (gameksan) 1% cream or lotion form daam, including choice of drugs effective against all stages of the arena, easy to use, and rarely gives irritation. The drug is not dianurkan in children under 6 years old and pregnant because toksi Wanta central nervous system. Gift cup once in 8 hours. If masihada symptoms, repeated a week later.
- Krokamiton 10% dalamkrim or lotion as antiscabies mempunyaidua effects and itching. Should be kept away from eyes, mouth, and urethra. Cream (eurax) efetif only in 50-60% of patients. Used for 2 consecutive nights and after 24 hours of usage dbersihkan Evaluasiir teraKriteria.
- 5% permethrin cream was the drug most effective and safe arena for deadly parasites S.scabei and have low toxicity in humans.
- Antibiotics can be used if there is secondary infection, such as pus in the affected area (between your fingers, genitalia) caused by scratching.Basic Concepts Askep Scabies
Nursing Assessment
Biodata
a. The identity of the patient
b. The identity of responsible
Riwyat health
a. The main complaint
In patients with skin lesions of scabies are the back and feel the itch mainly at night.
b. Health history now
Patients began to feel the itch that heats up and then be due to edema due to scratching an itch that was great.
c. Past medical history
Patients had admission due to allergies
d. Family health history
In families of patients are suffering from illnesses such as a natural client is ringworm, scabies.
Patterns of health functions
a. The pattern of perceptions of health
When sick, regular clients in TKO membeliobat atauapabila terdeat drug does not change the patient push yourself to the nearest clinic or hospital.
b. The pattern of exercise activity
Exercise activity during the illness:
Eat
Bath
Dress
Elimination
Mobilization in bed
c. The pattern of bed rest
In patients with sleep pattern disturbance scabies occur due to intense itching at night.
d. Nutritional patterns of metabolic
No disturbances in metabolic nutrition.
e. The pattern of elimination
Clients CHAPTER 1x a day, with mushy consistency, characteristic odor and yellow color BAK 4-5x a day, with clear yellow color characteristic odor.
f. The pattern of cognitive perceptual
Currently Kien sober assessment, clear speech, hearing and normal vision.
g. The pattern of role relationships
j. Patterns of sexual reproduction
On the client scabies impaired in sexual reproduction.
k. Coping patterns
The main problem that occurred during the client's illness, the client always feels itchy, and the patient became lazy to work.
Loss or changes in clients lazy to perform daily activities.
Fearful of violence: no
Outlook towards the future
Clients optimistic for recoveryNursing Diagnosis In Askep Scabies
1. Acute pain associated with injury to biological agents
2. Disturbances in sleep patterns associated with pain
3. Body image disturbance associated with changes in secondary penampian
4. Anxiety associated with changes in health status
5. risk of infection associated with tissue damage biscuits and invasive procedures
6. Damage to skin integrity related to edemaNursing Intervention On Scabies Askep
Diagnosis 1
Acute pain associated with injury to biological agents
After the action of nursing care for 3 × 24 hours, is expected to be resolved with the client's pain Evaluation Criteria:
- Pain control
- Itching started to disappear
- Puss missing
- The skin is reddened
Intervention:
- Assess pain intensity, characteristics and note the location of
- Provide frequent skin care, get rid of the unpleasant stimuli lingungan
- Collaboration with physicians in the delivery of analgesics
- Collaboration of antibiotics
Diagnosis 2
Disturbances in sleep patterns associated with pain
After the action of nursing care for 3 × 24 hours of sleep the client is not expected to interfere with Evaluation Criteria:
- The client's eyes are not swollen anymore
- Clients do not often awake at night
Intervention:
- Give comfort to the client (the client hygiene bed)
- Collaboration with physicians in the delivery of analgesic
- Record the number of clients awake at night
- Provide a comfortable environment and reduce noise
- Give a warm drink (milk) if necessary
- Give classical music as a bedtime
Diagnosis 3
Body image disturbance associated with changes in secondary penampian
After the action of nursing care for 3 × 24 hour client expected a disruption in how the application of self-image with the Evaluation Criteria:
- Reveal the acceptance of the disease in its natural
- Recognizing and re-establish the existing support systems
- Encourage individuals to express feelings, especially about the thoughts, views himself
- Encourage individuals to ask about handling problems, development of health
Diagnosis 4
Anxiety associated with changes in health status
After the action of nursing care for 3 × 24 hours is expected the client is not concerned anymore with the Evaluation Criteria:
- Clients do not fret
- The client was calm and able to accept bank on the fact
- Clients are able to identify and express symptoms of anxiety
- Posture facial expressions, body language and showed reduced activity levels of anxiety
- Identification of anxiety
- Use a calm approach
- Accompany the patient to memberian security and reduce fear
- Help patients recognize situations that cause anxiety
- Provide factual information about diagnosis, prognosis action
Diagnosis 5
Risk of infection associated with tissue damage biscuits and invasive procedures
After the action of nursing care for 3 × 24 hours the client is expected to occur no risk of infection with the Evaluation Criteria:
- Clients are free from signs and symptoms of infection
- Indicates the ability to prevent infection
- Demonstrate healthy behavior
- Describe the process of transmission of the disease, factors that influence the transmission and management
- Monitor for signs and symptoms of infection
- Monitor susceptibility to infection
- Limit visitors when necessary
- Instruct visitors to wash their hands when visiting remedy and after leaving the patient
- Maintain aseptic lingkngan during the installation of equipment
- Provide skin care in the area epidema
- Inspection of skin and mucous membranes of the redness, heat
- Inspection of the wound condition
- Provide antibiotic therapy if necessary
- Teach how to avoid infection
Diagnosis 6
Damage to skin integrity related to edema
After the action of nursing care During a 3 × 24 hour skin layer clients are expected to look normal, with the Evaluation Criteria:
- The integrity of the skin which can sink dipetahankan (sensation, elasticity, temperature)
- No cuts or lesions on the skin
- Able to protect the skin and keep skin moist and natural treatments
- Well tissue perfusion
- Keep the skin clean to keep them clean and dry
- Monitor the existence of skin redness
- Bathe the patient with warm water and soapImplementation of Nursing
1. Assessing pain intensity, characteristics and note the location
2. Provide frequent skin care, get rid of unpleasant environmental stimuli
3. Collaborate with physicians in the delivery of analgesics and antibioticsNursing Evaluation
Interference problem is said to comfort the pain is resolved if:
- Pain control
- Itching began to disappear
- Puss missing
- Skin does not redden