SCABIES, JIA, SCABIES, IMPETIGO, PEDICULOUS

• Juvenile Idiopathic Arthritis (JIA)


  Also called juvenile arthritis (JA) or juvenile rheumatoid arthritis (JRA), is an autoimmune disorder characterized by inflammation primarily affecting the joints
• Groups that have developed criteria to classify children with arthritis

  • American College of Rheumatology (ACR)
  • European League Against Rheumatism (EULAR)
  • International League of Associations for Rheumatology (ILAR)
• ACR-accepted terminology (2021) for JIA


  Children younger than 16 years who have chronic arthritis (swelling or effusion, or presence of two or more of the following signs: limitation of range of motion, tenderness or pain on motion, and increased heat) in one or more joints (lasting more than 6 weeks) and in whom no other specific cause of arthritis can be identified
• Onset types of JIA

  • Polyarticular
  • Oligoarticular
  • Systemic
  • Enthesitis-related arthritis
• Polyarticular JIA


  • Five or more inflamed joints, often involving weight-bearing joints. Rheumatoid nodules may be seen in patients with rheumatoid factor (RF)-positive disease and symmetrical involvement of small joints in the hands
• Oligoarticular JIA


  • Less than five inflamed joints. Large, weight-bearing joints, such as the knees and ankles, are typically affected. Females are more at risk than males. Some older children with oligoarticular JIA may develop "extended" arthritis that involves many joints and lasts into adulthood
• Systemic JIA


  • Persistent fevers that can be 103°F or higher and are often accompanied by an intermittently occurring salmon-colored rash
• Enthesitis-related arthritis


  • A form of JIA that often involves attachments of ligaments as well as the spine. These children may have joint pain without obvious swelling and may complain of back pain and stiffness
• ILAR classification of JIA

  • Systemic-onset JIA
  • Oligoarticular JIA
  • Polyarticular JIA
  • Psoriatic arthritis
  • Enthesitis-related arthritis
  • Undifferentiated arthritis
• EULAR criteria for Juvenile Chronic Arthritis (JCA)

  • Pauciarticular (one to four joints)
  • Polyarticular (five or more joints)
  • Presence of RF (two positive tests at least 3 months apart)
  • Systemic onset with characteristic features
  • Positivity for RF
  • Juvenile ankylosing spondylitis
  • Juvenile psoriatic arthritis
• Etiology and Pathophysiology of JIA

  Cause is unknown. Infection, trauma, and stress are possible triggers. Autoantibodies primarily target the synovial joints, resulting in decreased mobility, swelling, and pain. Once the synovium is inflamed, excessive thin, watery fluid is produced, diminishing the lubricating and cushion effects. Structures outside the joints may also become involved in the process, leading to further damage and deterioration
• Potential complications of JIA

  • Tendonitis
  • Adhesions between joint surfaces
  • Ankylosis of the joints
  • Soft tissue contractures
• Clinical Presentation of JIA

  • Joint inflammation, such as pain, redness, warmth, stiffness and swelling. Inactivity causes increases the stiffness and pain
• Assessment and Diagnosis of JIA

  • Note any history of irritability as an infant or a young child
  • Note any history of the child complaining of pain or not wanting to play or get out of bed in the morning
  • Ask whether the child has history of fever
  • Assess for delayed growth and development and signs of current systemic disease such as fever, rash, limping, or guarding of a joint or extremities
  • Inspect and palate joints for edema, redness, warmth, tenderness or preferred position of comfort
• Lab Results for JIA

  • Mild to moderate anemia
  • Elevated erythrocyte sedimentation rate
  • Positive antinuclear antibody with the pauciarticular form
  • Positive rheumatoid factor with polyarticular form
• Therapeutic Management of JIA

  • Daily Activities and Exercise
  • Heat Application
  • Nutrition
  • Medication (NSAIDs, Slow-acting antirheumatic drugs, Methotrexate, Steroids)
• Nursing Diagnosis for JIA

  Knowledge deficiency related to care necessary to manage disease symptoms
• Outcome Evaluation for JIA

  • Parents and child follow instructions regarding exercise and medication
  • Evaluate how well children are managing their symptoms in addition to how they view themselves
  • The few children who develop joint contractures may require soft tissue surgery or orthopedic surgery
  • About half of children with JA recover at the end of adolescence. The others will continue to have the disease into adulthood
• Scabies


  A skin infestation caused by scabies mite Sarcoptes scabiei. The female mite burrows in areas between the fingers and toes and in warm folds of the body, such as the axilla, buttocks, and groin, to lay eggs. Transmission occurs through close personal skin-to-skin contact
• Clinical findings of Scabies

  • Pruritus
  • Eczematous eruption; minute grayish-brown threadlike burrows with a black dot at end (mite)
  • Distribution of lesions primarily in folds (axillary, antecubital, popliteal, inguinal), hands/wrist,feet/ ankles
  • Secondary infection: papules and vesicles
• Therapeutic interventions for Scabies

  • Permethrin cream (Elimite)
  • Crotamiton cream (Eurax)
• Prevention of Scabies

  • Wash all clothes and linen
  • Starve the mites
  • Clean and vacuum
• Pediculosis


  Lice infestation, may be caused by Pediculus humanus capitis (head lice), or Pthirus pubis (pubic lice). Head lice are most common infestation in children. Head lice are passed from child to child by direct contact or indirectly by contact with combs, headgear, or bed linen
• Clinical Manifestation of Pediculosis

  • Severe itching of the scalp
  • Small, white dots on hair shaft (nits or eggs of lice)
• Treatment of Pediculosis

  • Wash hair with shampoo such as lindane (Kwell)
  • Comb nits from hair with a fine-toothed comb
  • Wash bedsheets, recently worn clothes
  • Vacuum pillows, mattresses, or other items unable to be washed
  • Teach children not to exchange combs, hair barrettes, or other personal items
• Scabies


  Skin infestation caused by mites
• Scabies treatment

  Treat all who had close contact with the child within 30 to 60-day period
• Scabies prevention

  • Wash all clothes and linen
  • Starve the mites
  • Clean and vacuum
• Pediculosis


  Lice infestation
• Types of pediculosis


  • Pediculus humanus capitis (head lice)
  • Pthirus pubis (pubic lice)
• Head lice transmission


  Passed from child to child by direct contact or indirectly by contact with combs, headgear, or bed linen
• Head lice clinical manifestation

  • Severe itching of the scalp
  • Small, white dots on hair shaft (nits or eggs of lice)
• Head lice treatment

  1. Wash hair with shampoo such as lindane (Kwell)

  2. Comb nits from hair with a fine-toothed comb

  3. Wash bedsheets, recently worn clothes

  4. Vacuum pillows, mattresses, or other items unable to be washed

  5. Teach children not to exchange combs, hair barrettes, or other personal items
• Impetigo


  Bacterial skin infection
• Impetigo causative agents

  Beta-hemolytic streptococcus, group A or Staphylococcus aureus including methicillin-resistant Staphylococcus aureus (MRSA)
• Impetigo incubation period

  7 to 10 days
• Impetigo period of communicability

  From outbreak of lesions until lesions are healed
• Impetigo mode of transmission

  Direct contact with lesions
• There is no immunity to impetigo
• It is common to see several children in a family with identical impetigo lesions as it is spread by direct contact