Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
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Outline
Lesson Objectives for Eczema (Infantile or Childhood) / Atopic Dermatitis
- Understanding Eczema Pathophysiology:
- Gain knowledge about the pathophysiology of eczema, including the inflammatory processes involved and the impact on the skin barrier.
- Identification of Triggers and Risk Factors:
- Learn to recognize common triggers and risk factors that exacerbate eczema in infants and children, such as environmental allergens, irritants, and genetic predispositions.
- Applying Evidence-Based Nursing Interventions:
- Acquire skills in implementing evidence-based nursing interventions to manage and alleviate symptoms of eczema in pediatric patients, including proper skincare, moisturization, and use of prescribed medications.
- Educating Parents and Caregivers:
- Develop effective strategies for educating parents and caregivers on the condition, emphasizing the importance of a consistent skincare routine, identifying triggers, and adhering to prescribed treatments.
- Monitoring and Assessing Pediatric Patients:
- Understand the key aspects of monitoring and assessing pediatric patients with eczema, including regular skin assessments, evaluating the response to treatments, and addressing any emerging concerns.
Pathophysiology of Eczema (Infantile or Childhood) / Atopic Dermatitis
- Aberrant Immune Response:
- Eczema is characterized by an abnormal immune response, where the immune system reacts excessively to environmental triggers, leading to inflammation and skin irritation.
- Defective Skin Barrier Function:
- Individuals with eczema often have a compromised skin barrier, making it more susceptible to irritants and allergens. This defect allows for increased water loss and makes the skin prone to dryness.
- Inflammatory Mediators Release:
- Immune cells release inflammatory mediators, such as histamines and cytokines, contributing to the redness, itching, and swelling associated with eczematous lesions.
- Genetic Factors:
- Genetic predisposition plays a significant role in the development of eczema. Mutations in certain genes related to skin barrier function and immune response increase susceptibility to the condition.
- Environmental Triggers Activation:
- Exposure to environmental triggers, such as pollen, dust mites, pet dander, or certain foods, can activate the immune response and exacerbate eczematous symptoms in susceptible individuals.
Etiology of Eczema (Infantile or Childhood) / Atopic Dermatitis
- Genetic Factors:
- Eczema often has a genetic component, with a family history of atopic conditions like asthma, hay fever, or eczema increasing the likelihood of a child developing the condition.
- Immune System Dysfunction:
- Abnormalities in the immune system, particularly an overactive response to certain triggers, contribute to the development of eczema.
- Environmental Factors:
- Exposure to environmental allergens and irritants, such as pollen, dust mites, pet dander, certain fabrics, and harsh soaps, can trigger or worsen eczema symptoms.
- Skin Barrier Dysfunction:
- Individuals with eczema often have a compromised skin barrier, allowing irritants and allergens to penetrate the skin more easily, leading to inflammation and itching.
- Hygiene Practices:
- Improper hygiene practices, including the use of harsh soaps or frequent bathing, can strip the skin of its natural oils, further compromising the skin barrier and exacerbating eczema symptoms.
Desired Outcomes for Eczema (Infantile or Childhood) / Atopic Dermatitis
- Improved Skin Integrity:
- The primary goal is to achieve and maintain healthy skin, minimizing inflammation, redness, and dryness associated with eczema.
- Reduced Itching and Discomfort:
- Alleviating itching and discomfort is crucial for enhancing the child’s overall well-being and preventing secondary infections caused by scratching.
- Prevention of Flare-Ups:
- Establishing a management plan that identifies and addresses triggers to prevent future flare-ups and minimize the impact of environmental factors.
- Enhanced Quality of Life:
- Promoting a positive impact on the child’s daily life by managing symptoms effectively, allowing for normal activities, social interactions, and improved sleep.
- Education and Empowerment:
- Providing education to the child and caregivers about eczema management, including skincare routines, allergen avoidance, and early recognition of symptoms, to empower them in self-care practices.
Subjective Data:
- Itching
- Irritability
Objective Data:
- Dry/cracked skin
- Fluid-filled blisters
- Redness or blotchiness of skin
- Rough/Scaly patches of skin
Nursing Assessment for Eczema (Infantile or Childhood) / Atopic Dermatitis
- Medical History:
- Gather information on the child’s medical history, including any previous diagnoses, treatments, and responses to interventions for eczema.
- Skin Assessment:
- Conduct a thorough examination of the skin, noting the location, extent, and characteristics of eczema lesions, such as redness, dryness, oozing, and crusting.
- Itching and Discomfort:
- Assess the level of itching and discomfort experienced by the child, as this can significantly impact their quality of life. Use a standardized scale to quantify itching severity.
- Trigger Identification:
- Work with the child and caregivers to identify potential triggers for eczema flare-ups, such as specific allergens, irritants, or environmental factors.
- Nutritional Assessment:
- Evaluate the child’s nutritional status, considering any dietary factors that may influence eczema symptoms. Address any potential deficiencies or sensitivities.
- Sleep Patterns:
- Explore the child’s sleep patterns and quality of sleep, as inadequate sleep can exacerbate eczema symptoms. Assess any disruptions caused by itching or discomfort.
- Psychosocial Assessment:
- Assess the impact of eczema on the child’s psychosocial well-being, including emotional and social aspects. Identify any signs of stress, anxiety, or self-esteem issues.
- Family Dynamics:
- Consider the family’s dynamics and their ability to support the child’s eczema management. Assess their understanding of the condition and willingness to participate in care.
Implementation for Eczema (Infantile or Childhood) / Atopic Dermatitis
- Topical Treatments:
- Apply prescribed topical medications, such as corticosteroids or calcineurin inhibitors, as directed by the healthcare provider. Educate caregivers on proper application techniques and frequency.
- Emollient Use:
- Instruct caregivers to regularly apply emollients or moisturizers to maintain skin hydration. Emphasize the importance of choosing products free from potential irritants and allergens.
- Avoidance of Triggers:
- Collaborate with the child and caregivers to identify and minimize exposure to triggers, such as certain foods, environmental allergens, or irritants. Provide guidance on creating an eczema-friendly environment.
- Education on Bathing Practices:
- Educate caregivers on proper bathing practices, including the use of mild, fragrance-free cleansers and lukewarm water. Emphasize the importance of patting the skin dry and avoiding harsh scrubbing.
- Itch Management Strategies:
- Implement strategies to manage itching, such as keeping fingernails short, using cool compresses, and providing distraction techniques for the child. Consider the use of antihistamines as prescribed to alleviate itching.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Assess patient’s skin, noting open areas, drainage, or signs of infection; observe for effectiveness of interventions | Bacterial skin infections are common due to excoriation from scratching. Crusting of broken blisters may be present. |
| Routinely monitor skin to determine effectiveness of interventions. | |
| Obtain history from patient and parents/caregivers to determine triggers | Most flare-ups are related to sensitivities to foods, items that contact the skin, hygiene products, changes in weather and immune response. |
| Encourage proper skin care including bathing and regular use of emollient creams (petroleum jelly, etc.) | Over washing and using harsh soaps can make symptoms worse. Dry skin is prone to cracks and infection.
Encourage fragrance and dye free soaps when bathing. Avoid frequent baths. Infants do not need daily baths unless visibly dirty. Apply emollient creams frequently to keep skin soft and hydrated. |
| Assist with allergy testing, including patient/parent education | Allergy patch testing may be done to determine allergens and triggers for atopic dermatitis. Education should be provided on how to prepare for the patch test (no lotions, creams) and when to return to be evaluated. |
| Apply topical medications and bandages as appropriate. | Topical corticosteroids are the first line of treatment for eczema flare ups.
Wet-wrap bandages are sometimes used for more severe cases of childhood eczema, but must be done carefully to avoid serious side effects. |
| Administer oral medications as required | Oral antihistamines may be given to help relieve symptoms of itching and manage allergies. Be mindful of sedative effects of antihistamines.
Oral steroids may be given short-term for severe symptoms. |
| Provide resources and referral information and education for prevention | Parents must be educated to be aware of triggers (often foods) and avoid them.
Diligence must be given to ridding the home of other allergens such as pet dander and dust mites.
Make sure child’s nails are short and clean; use mittens or socks on infant’s hands
Itching is the most prevalent symptom. Long, sharp or dirty nails can cause secondary infections to develop on the skin. |
Evaluation for Eczema (Infantile or Childhood) / Atopic Dermatitis
- Assessment of Skin Condition:
- Regularly evaluate the child’s skin condition, looking for signs of improvement or exacerbation. Assess the extent of erythema, edema, and excoriation to gauge the effectiveness of interventions.
- Monitoring Itching and Discomfort:
- Utilize a standardized scale or subjective reporting to assess the level of itching and discomfort experienced by the child. This helps in determining the impact of the care plan on symptom management.
- Review of Trigger Avoidance:
- Evaluate the success of trigger avoidance strategies by assessing whether caregivers have effectively minimized the child’s exposure to known irritants, allergens, or environmental triggers.
- Medication Adherence:
- Assess adherence to prescribed medications, including topical treatments and, if applicable, oral antihistamines. Non-adherence may impact the effectiveness of the treatment plan.
- Feedback and Communication:
- Regularly communicate with caregivers and the child to gather feedback on the overall impact of the care plan. Address any concerns, provide additional education as needed, and make adjustments to the plan based on the evaluation outcomes.
References
https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273
https://my.clevelandclinic.org/health/diseases/9998-eczema
https://emedicine.medscape.com/article/911574-treatment
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Transcript
Hi everyone. Today, we are going to be creating a nursing care plan for eczema / atopic dermatitis. So let’s get started. First, we’re going to go over the pathophysiology. So eczema is a chronic condition that causes inflammation of the skin. There’s several types of eczema, with the most common form being atopic dermatitis. Some nursing considerations: we want to make sure we’re doing a skin assessment, a patient history, proper skin care, allergy testing, administering any sort of medications, and educating the parent or caregiver. Desired outcome: the patient will be free from a rash and pain and patient skin will be free from exacerbation and infection. So here is a picture I wanted to show you guys of atopic dermatitis. You’re going to notice some of the red blotches here on the skin; this is pretty common, especially if you’re one that washes your hands often and they get pretty dry. They’re like scaly patches.
So we’ll go ahead and go into the care plan. We’re going to be writing down some subjective data and we’re going to be writing down some objective data that we’re going to see with these patients. So one of the main things is they’re going to be complaining of itching. The other thing they’re going to notice is that they’re going to have some dry, cracked skin, some redness and/or blotchiness. You might see some irritability, some fluid filled blisters, and some rough scaly patches on the skin, too.
Some interventions that we’re going to be doing, we want to assess the patient’s skin. You want to notice any open areas or drainage and signs of infection. So you’re going to make sure you’re doing all those assessments. Bacterial skin infections are common due to scratching. So crusting of the broken down blisters may be present. You want to routinely monitor skin to determine the effectiveness of any of, of interventions that you’re doing. We also want to make sure we’re obtaining any history from the patient, noting if there’s any sort of trigger that’s causing the flare up. Most flare ups are related to certain sensitivities, such as food, contact to skin, and hygiene products. Even changes in weather and any sort of immune response can cause this. Another intervention we want to do: proper skin care. Over-washing and using harsh soaps can make the symptoms worse. Dry skin is prone to cracking. So you want to see about using fragrant free and dye free products so it’s not irritating to the skin. You want to avoid frequent baths as that will dry the skin out or irritate the skin more. You want to apply any sort of emollient cream, such as petroleum jelly; this will help keep the skin soft and hydrated. Another invention we’re going to be doin is we want to make sure that we’re doing allergy testing. If you’re not sure what’s causing it, you do an allergy skin test to determine the allergens and it can trigger for the a atopic dermatitis. You want to make sure when you do these tests, you’re not applying any sort of lotions or creams.
Another intervention that we want to be doing is applying any sort of medications and or bandages as appropriate. They usually use topical corticosteroids as the first line of treatment for eczema flare ups. You can wet wrap bandages; this is sometimes used for more severe cases of childhood eczema, but most must be done carefully to avoid any sort of serious side effects. And or if you’re not applying any sort of topicals, you may have oral medications required. So you may give antihistamines that will help relieve the itching and manage the allergies. Just be mindful within a histamine of the sedative effects. Oral steroids can be given to help with the inflammation, especially in severe cases. Another intervention is that you want to make sure that you’re providing any sort of resources and education.There might certain things from the home that are causing the outbreaks or flare up such as pet dander and dust mites. You want to make sure the child’s nails are short and clean using mittens or socks on an infant’s hand because we know that secondary infection from all the scratching from the itchiness can cause an infection.
Okay, we’re going to move on to the key points. So eczema / atopic dermatitis is a chronic condition that causes inflammation of the skin. It can be triggered by foods, skin, irritants, or environmental factors. Subjective and objective data: the patient will be irritable, lots of itching, dry crack skin fluid, filled blisters, redness, or blotches, and rough, scaly patches of the skin. You want to do a thorough assessment of skincare. So you want to make sure you’re getting a history to determine the triggers, any allergy testing, encouraging proper skin care and hand hygiene, medication, and education. You want to administer any medications such as corticosteroids, antihistamines, and provide education on preventing future flare ups. And there we have it.
We love you guys. You guys are doing wonderful. Go out, be your best self today. And, as always, happy nursing.
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