# A 6-year-old child is diagnosed with scabies. Which nursing intervention should be the priority when caring for this child? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542341 > language: ko > subject: Child Health ## 문제 A 6-year-old child is diagnosed with scabies. Which nursing intervention should be the priority when caring for this child? ## 보기 1. Apply topical antibiotic ointment to all affected areas twice daily as prescribed 2. Administer oral antihistamines to reduce itching and discomfort as needed 3. Isolate the child in a private room with contact precautions for 24 hours 4. Educate the family about proper application of prescribed scabicide and treatment of all household members **✔ 정답** **정답: 4** ## 해설 Priority nursing intervention is educating the family on proper scabicide application and treating all household contacts to ensure comprehensive treatment and prevent transmission. Other options address symptoms or secondary issues but do not target the root cause and transmission prevention. ## 심화 해설 Understanding the Priority Intervention for Scabies When a child is diagnosed with scabies, the nurse’s priority must shift from simply treating the individual to managing the infestation as a public health event within the household. The correct answer is educating the family about the proper application of the prescribed scabicide and the critical need to treat all household members simultaneously. Pathophysiology and Clinical Rationale Scabies is a highly contagious skin infestation caused by the ectoparasitic mite Sarcoptes scabiei var. hominis . The intense pruritus, which characteristically worsens at night, is a delayed type-IV hypersensitivity reaction to the mite, its eggs, and its feces. Because the mite can survive off the host and transmission can occur through direct skin-to-skin contact, the infestation spreads rapidly within families and crowded environments . Treating only the symptomatic child while leaving other household members untreated creates a reservoir for reinfestation. An asymptomatic carrier in the incubation period—which can last 4 to 6 weeks for a first-time infestation—will inevitably pass the mite back to the treated child, rendering the therapy ineffective. Why Not the Other Options? Option 1: Apply topical antibiotic ointment. This is not a priority intervention for the primary diagnosis. While secondary bacterial infections, often caused by Staphylococcus aureus or Streptococcus pyogenes*, can occur due to excoriation from scratching , antibiotic ointment treats a complication, not the underlying cause. The immediate priority is eradication of the mite. * Option 2: Administer oral antihistamines. Pruritus management is important for comfort, but antihistamines are a symptomatic measure. They do not kill the mite or stop transmission. Symptom relief is a secondary goal compared to breaking the chain of infection through effective scabicide treatment. * Option 3: Isolate the child in a private room with contact precautions for 24 hours. This intervention reflects a misunderstanding of the infestation’s timeline and transmission dynamics. Standard contact precautions are implemented until 24 hours after effective treatment has been initiated, not for a fixed 24-hour period from diagnosis. The child is not the sole source of infestation; other household members who are already incubating the mite are also contagious. Isolation without concurrent mass treatment fails to control the spread. Translating Evidence into Nursing Practice The nursing intervention must be grounded in the principles of breaking the chain of infection. The efficacy of scabicide treatment, whether topical 5% permethrin lotion or oral ivermectin, is contingent upon correct application and simultaneous treatment of close contacts . A randomized controlled trial evaluating these treatments underscores that failure to treat all members of a household is a primary reason for treatment failure and community outbreaks . Therefore, the nurse’s most impactful action is comprehensive family education. This includes demonstrating how to apply the scabicide from the neck down to the soles of the feet, emphasizing areas like under the fingernails and skin folds, and explaining the exact timing for leaving the lotion on the skin. Crucially, the education must convey that all household members and close contacts require treatment on the same day, even if they are asymptomatic, to prevent the "ping-pong" effect of reinfestation [1, 2]. ## 임상 시나리오 Scabies Outbreak ManagementTreat the Household, Not Just the Patient The priority for scabies is preventing reinfestation by treating all close contacts simultaneously, even if they are asymptomatic. The incubation period for a first-time infestation can last 4 to 6 weeks. Educate families on proper scabicide application: apply from the neck down to the soles of the feet, including under nails, and leave on for the prescribed duration (often 8 to 14 hours). CautionIsolating the child alone is insufficient. Untreated household members act as a reservoir for the mites, leading to a cycle of transmission known as the ping-pong effect. ## 핵심 개념 - **Scabicide** — A medication used to kill scabies mites, such as permethrin cream, which must be applied correctly to all household members. - **Sarcoptes scabiei** — The ectoparasitic mite that causes scabies, transmitted through prolonged skin-to-skin contact. - **Reinfestation** — Recurrence of a parasitic infection, often from untreated asymptomatic carriers within the same household. - **Type IV Hypersensitivity** — A delayed cell-mediated immune response responsible for the intense itching seen in scabies. - **Contact Precautions** — Infection control measures used for scabies patients, typically maintained for 24 hours after the first treatment. ## 같은 주제 문제 - [A nurse is assessing a 6-year-old child who was brought to the clinic by the parents with …](https://mymerci.kr/pages/nclex_q.php?qn_id=542338) - [A nurse is assessing a 6-year-old child who was brought to the clinic by the parents with …](https://mymerci.kr/pages/nclex_q.php?qn_id=542339) - [A 4-year-old preschooler is diagnosed with scabies. 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