Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis

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Outline

Pathophysiology

Eczema is a chronic condition that causes inflammation of the skin. There are several types of eczema. The most common form is atopic dermatitis which can be triggered by foods, skin irritants, or environmental exposures. Eczema normally appears during infancy and often resolves by the teenage years. It most often affects the face, hands, feet, inner elbows and the back of the knees and causes an itchy rash to develop.

Etiology

While it is believed to be genetic, eczema is also more common among infants who are formula-fed or received solid foods prior to 6 months of age and those with a family history of asthma or allergies.  Atopic dermatitis is thought to be due to a deficiency of a skin protein. Without this protein, the skin becomes more sensitive to environmental factors and irritants.

Desired Outcome

Patient will be free of rash and pain; patient’s skin will be free from excoriation and infection

Subjective Data:

  • Itching
  • Irritability

Objective Data:

  • Dry/cracked skin
  • Fluid-filled blisters
  • Redness or blotchiness of skin
  • Rough/Scaly patches of skin

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.

Writing a Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis

A Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


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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