Is It Scabies?
It can be difficult for the new nurse, and even for the experienced nurse to make a differential judgement between various skin conditions, but the treatment for one might have a negative outcome if improperly used on another. In a nurse run clinic the onus often falls upon the nurse to make a differential diagnosis and start treatment after a careful examination and assessment.
This term I worked my last clinical practicum in a homeless shelter with a nurse run clinic 8-5 on weekdays and unlicensed staff meeting clients' needs outside of these hours. Differential diagnosis faced a further challenge here. Outside of clinical hours, clients would present to unlicensed staff with skin conditions, seeking treatment. Scabies is an infestation which is quite common in this and other homeless shelters, due to poor hygiene, unwashed clothing, close proximity of people, and sharing blankets.
It had come to the attention of the Health office that unlicensed staff were treating for scabies with Nix cream in cases where scabies may not have been the actual cause of the rash. Understanding that Nix is a caustic treatment that is good for scabies but may worsen other conditions, such as contact dermatitis, the Health Office asked me if I would create a tool they they might leave with unlicensed workers to help them make a clearer diagnosis of the skin condition involved and to provide adequate and responsible care, when such conditions come forward outside of clinical hours. This tool would need to accurate in information, written to a lay person's language, be simple and direct, and include photos which present both classic presentations and altered presentations of each condition.
I compiled this tool and left it with the agency's Health Office for consideration for distribution to each floor. While every effort was made to complete this tool with the sole use of photos obtained from copyright free sources, nothing could be found that would be adequate to aid in differential diagnosis. Therefore a complete listing of the source for every photo used was included in the electronic copy of this document left with the agency. Their administration department will be able to deem the suitability of this document for use on the floors and, if deemed necessary by them, seek official permission for each photo included. Should permission be denied or unobtainable, the agency can easily delete photos involved. The end result was the exact tool they requested, and its suitability to be legally distributed remains in their hands to determine. All photos have been stricken from this online posting.
Many thanks to Genevieve, Sandy, Leah, Krista, Kristy, Jane, Karyn, and the rest of the team.
This term I worked my last clinical practicum in a homeless shelter with a nurse run clinic 8-5 on weekdays and unlicensed staff meeting clients' needs outside of these hours. Differential diagnosis faced a further challenge here. Outside of clinical hours, clients would present to unlicensed staff with skin conditions, seeking treatment. Scabies is an infestation which is quite common in this and other homeless shelters, due to poor hygiene, unwashed clothing, close proximity of people, and sharing blankets.
It had come to the attention of the Health office that unlicensed staff were treating for scabies with Nix cream in cases where scabies may not have been the actual cause of the rash. Understanding that Nix is a caustic treatment that is good for scabies but may worsen other conditions, such as contact dermatitis, the Health Office asked me if I would create a tool they they might leave with unlicensed workers to help them make a clearer diagnosis of the skin condition involved and to provide adequate and responsible care, when such conditions come forward outside of clinical hours. This tool would need to accurate in information, written to a lay person's language, be simple and direct, and include photos which present both classic presentations and altered presentations of each condition.
I compiled this tool and left it with the agency's Health Office for consideration for distribution to each floor. While every effort was made to complete this tool with the sole use of photos obtained from copyright free sources, nothing could be found that would be adequate to aid in differential diagnosis. Therefore a complete listing of the source for every photo used was included in the electronic copy of this document left with the agency. Their administration department will be able to deem the suitability of this document for use on the floors and, if deemed necessary by them, seek official permission for each photo included. Should permission be denied or unobtainable, the agency can easily delete photos involved. The end result was the exact tool they requested, and its suitability to be legally distributed remains in their hands to determine. All photos have been stricken from this online posting.
Many thanks to Genevieve, Sandy, Leah, Krista, Kristy, Jane, Karyn, and the rest of the team.