Ask a Nurse About: Scabies

I am not only a nurse to my patients, I am also a nurse to my family, friends, neighbors,
and random strangers in Target and our local grocery store.  On a daily basis, I 
encounter numerous questions about health, medications, and random concerns such 
as "What does it mean when my poop turns green?".  And so I started a new feature here, 
Ask A Nurse, where I will attempt to put into laymen terms the very confusing anatomy 
and physiology of the human body.  Am I an expert?  Hardly.  But I am an 
experienced, certified Medical-Surgical Registered Nurse and a mother of two.  I draw 
from my experiences in my medical practice, my journey through motherhood, and 
my endless collection of credible nursing textbooks and resources.  Remember: this is just 
a blog.  Just as you should never base any serious decision on internet ramblings, so 
should you not take anything you read here as concrete fact.  When in doubt, consult 
your doctor/naturopathic/guru.

This week's topic: Scabies

After Isabelle's great big scabies adventure last week, I got lots of emails inquiring about 
this terrible rash.  I've seen it quite often in the hospital and nursing homes amongst 
my patients but neither of my children have ever had it.  This summer, however, 
multiple cases of scabies broke out in our community and our pediatrician informed us 
that we were her 5th case of the day.  Hopefully, none of you have to become familiar with 
this rash.  Here's some info, though, just in case...

What is it?

Scabies is a highly contagious skin disease caused by the infestation of an itch mite known
as Sarcoptes scabiei.  The itch mites burrow under the skin and cause intense itching,
usually worse as night.  Scabies is spread through direct skin to skin contact and is
most commonly found in communal type settings such as hospitals, day care centers,
and nursing homes.  Symptoms usually appear 2-6 weeks after exposure and often affect
the entire family.

Signs and Symptoms:

Here's where it gets REALLY gross: After exposure to the itch mite by an infected person,
the itch mites then burrow into your skin.  The proteins and feces (YES, feces!!) of the
itch mites then cause an allergic response in your skin, causing intense itching that is
usually worse at night.  A pimple-like rash then begins to form.  This rash is unique
compared to other rashes because it forms a linear pattern, almost as if you can see the
itch mite's path. Some doctors compare the bumps to pencil marks in appearance.  The
rash can cover most of the body or it can be concentrated to only certain areas, most
notably the webbing of the fingers, inside skin folds such as armpits, writs, knees, and
elbows, and around the waist.  In young children, the rash is usually present on the soles
of the feet and palms.

Source

Source

We have all the symptoms: now what?

A trip to the pediatrician/family doctor is definitely in order.  A definitive diagnosis can
be made by scraping a small area of the skin and examining it under a microscope.  The
mites and their eggs are then visible and a proper diagnosis can be confirmed.  The
entire household will need to be treated as scabies is highly contagious and its symptoms
do not show up until several weeks after exposure.

Treatment:

Your doctor will most likely prescribe you a topical cream called Permethrin.  This cream
has been found to be the most effective form of treatment as it kills the itch mites and the
eggs they have burrowed into the skin as well.  The cream should be applied from the
neck down to the toes and should be kept on the skin for 8-12 hours.  After this
prescribed time, shower, clean the cream off, and put on clean clothes.  The CDC
recommends repeating this treatment one week later to ensure that any eggs left behind
are finished off.  The cream may cause very mild irritation to the skin but is overall gentle
and odorless.  Again, everyone in the infected household should be treated whether they
are showing symptoms are not.  This skin disease is very contagious!!!  

What else can we do?

Wash all bed linens, blankets, towels, and recently worn clothes in hot water.  Vacuum
the carpets and upholstered furniture.  Place pillows, stuffed animals, and anything else
you are not able to wash in the dryer for 30 minutes: the heat will blast those suckers
away.  You can also place items too large to wash in a sealed plastic bag for 7 days.  Itch
mites do not live for very long away from the human body so cleaning the house and
washing all linens is sufficient in eradicating them: no pesticides needed. 

Complications:

This rash is very itchy so kids will of course scratch intensely to relieve themselves.
The problem is that kids have lots of germs in their little fingernails and these germs can
then be spread to the skin, causing a bacterial infection.  The most common complication
of scabies is MRSA, also known as "Staph".  This bacteria will often present itself by
infecting the scabies bite marks, forming boils and/or sores, sometimes accompanied by
fever.  If you notice any increased swelling, redness, areas of tenderness or increased
pain, drainage from the skin, foul odor, or red streaking in the skin, notify your
doctor immediately.  A topical triple antibiotic cream should be applied to the skin and
an oral antibiotic, such as Bactrim, may be necessary.  

Wrapping it up:

Because this rash is attributed to an allergic response, you may experience itching for
several weeks after treatment.  Oral antihistamines such as Claritin and Zyrtec may
be prescribed to help with this.  Witch Hazel and oatmeal bathes are also great
natural remedies for itch relief.  Remember to encourage frequent hand washing and
change bed linens regularly. 

Great resources:

CDC

Bed Bugs or scabies?

Identifying childhood rashes

Scabies

Have a question you'd like to ask a nurse?  Leave me a comment and I will address it in a future 

post.  Or, email me at vasqueztribe@yahoo.com.  

Ask A Nurse About: Treating A Cold

I am not only a nurse to my patients, I am also a nurse to my family, friends, neighbors,
and random strangers in Target and our local grocery store.  On a daily basis, I
encounter numerous questions about health, medications, and random concerns such
as "What does it mean when my poop turns green?".  And so I begin a new feature here,
Ask A Nurse, where I will attempt to put into laymen terms the very confusing anatomy
and physiology of the human body.  Am I an expert?  Hardly.  But I am an
experienced, certified Medical-Surgical Registered Nurse and a mother of two.  I draw
from my experiences in my medical practice, my journey through motherhood, and
my endless collection of credible nursing textbooks and resources.  Remember: this is just
a blog.  Just as you should never base any serious decision on internet ramblings, so
should you not take anything you read here as concrete fact.  When in doubt, consult
your doctor/naturopathic/guru.

This week's topic: Natural remedies for the common cold

Unless you and your family live inside some magical protective bubble, chances are at
least one member of your household has been plagued by the common cold this winter:
stuffy nose, sinus pressure, coughing and fever.  Since the common cold is caused by a
virus, there is no antibiotic or cure available to kill this nasty bug.  Instead, you should
focus on treating your symptoms, hopefully shortening the duration of the illness.  There
are tons of over the counter medications that can be used according to the specific
symptoms involved: antihistamines for allergies, cough suppressants, fever reducers,
and nasal decongestants.  But, there are also a number of natural remedies you can try
to help soothe your stuffy nose and itchy throat.
Here are a few I've learned over the years.

Steam: Hot steam is a wonderful way to help loosen up sinus and chest congestion.
Turn your bathroom into a steam room by running the hot water in your tub or shower
and closing the door.  Sit in the steamy room for 10-15 minutes.  For older children
and adults, you can also sit over a bowl or pot of hot, steaming water as well as a
facial steamer.  Hot steam vaporizers, such as this one made by Vic's, can be placed in
your bedroom at night.  Eucalyptus oil can be added to vaporizers to clear nasal passages.
Be careful when using hot steam vaporizers if you have allergies: they can cause mold
growth if your room is not well ventilated, thus exacerbating your allergies even
further.  After using steam, attempt to cough and blow the loosened mucous out.  You
can loosen the mucous on the chest up by cupping your hand and clapping on the front
and back of the chest (where the lungs are).  The force of your clapping should be a
little harder than burping.

Salves: Use a vapor rub salve on the chest and directly under the nose to help clear 
nasal passages.  Vic's Vapo Rub is a staple in this house and has been since I was a little 
girl.  The old folks say that rubbing Vic's on the bottom of your feet will also help to suppress 
a bad cough.

Stay hydrated:  It is so important to stay hydrated with a cold.  Drinking ample
fluids will help thin the mucous, thus making it easier to extract and keeping you 
hydrated.  Hot tea with honey and lemon is soothing for your throat, orange juice is a 
great source of Vitamin C and a natural immune booster, chicken soup or broth to keep 
your nutrient needs intact.

Rest is best:  With a cold, it is so important to get plenty of rest so that your body can
focus all its energy on battling the germ war.  Cuddle up in bed with your favorite
book and/or reality TV show and sleep it off.  As much as your children will allow you,
of course.  Sleep upright as much as possible to prevent mucous from pooling up in your
inner ear and the back of your throat.

Herbs: When not contraindicated by medical conditions and medications you are
currently taking, herbs are nature's most perfect way to battle illness.  In terms of
the common cold, garlic, echinacea, astragalus, zinc, Vitamin D, Vitamin C, ginger,
and elderberry are excellent herbs to combat symptoms and lessen the time of
infection.  These can be used in teas and are also available in pill and capsule form.

When to seek further attention:

If your cold lasts longer than two weeks or keeps coming back

If you develop shortness of breathe, wheezing, or difficulty breathing

Fever greater than 103 degrees or that lasts longer than 3 days

Bluish skin color

Earache or drainage from the ear

Severe pain in your chest, face, or forehead

Hoarseness, cough, or sore throat that lasts longer than 10 days

These symptoms can signal a sinus infection, severe allergies, or a respiratory infection
that needs further treatment.  Consult your family physician if any of these occur. 

Have a question you'd like to ask a nurse?  Leave me a comment and I will address it in a future post.  

Or, email me at vasqueztribe@yahoo.com.  

Ask A Nurse About: The Stomach Flu

I am not only a nurse to my patients, I am also a nurse to my family, friends, neighbors,
and random strangers in Target and our local grocery store.  On a daily basis, I
encounter numerous questions about health, medications, and random concerns such
as "What does it mean when my poop turns green?".  And so I begin a new feature here,
Ask A Nurse, where I will attempt to put into laymen terms the very confusing anatomy
and physiology of the human body.  Am I an expert?  Hardly.  But I am an
experienced, certified Medical-Surgical Registered Nurse and a mother of two.  I draw
from my experiences in my medical practice, my journey through motherhood, and
my endless collection of credible nursing textbooks and resources.  Remember: this is
just a blog.  Just as you should never base any serious decision on internet ramblings,
so should you not take anything you read here as concrete fact.  When in doubt, consult
your doctor/naturopathic/guru.

This week's topic: The Stomach Flu

Also known as gastroenteritis, most of us have encountered a bad case of vomiting
and/or diarrhea at some point in our lives.  It brings with it the very worst of bodily
functions and typically a ton of laundry.
Let's break it down, shall we?

What is the stomach flu and what causes it?

The stomach flu is marked by inflammation of the gastrointestinal tract including both
the stomach and the small intestines causing vomiting, diarrhea, and abdominal
cramping.  The onset of vomiting is typically sudden and can be accompanied by a high
fever.  In adults, the virus is most commonly caused by the norovirus, in kids the
common culprit is the rotavirus.  There are no blood or stool tests to
confirm diagnosis.

How can you tell the difference 
between a stomach flu and food poisoning?

With a stomach flu, the onset of vomiting is very sudden and the patient usually has a
fever.  With food poisoning, the onset of vomiting usually occurs 2-12 hours after eating
and is caused by bad bacteria present in something you ate.  This can be hard to
differentiate so here are a couple of foods that are notorious for causing food
poisoning:  seafood, chicken, spoiled mayonnaise, and beef.  Vomiting with food
poisoning typically does not last longer than 12 hours.  So, if the vomiting does not occur
with a fever, you have an identifiable food source, and you stop vomiting within 12 hours
or so: you more than likely have food poisoning.  No worries, your body will eliminate
the bad stuff for you via the toilet.

There are other causes of vomiting such as Salmonella, E. coli, and intestinal obstructions,

but we'll just stick to the basics today.

With the stomach flu:

The first stage of vomiting is severe.  This is often referred to as "worshiping the
porcelain gods".  Vomiting occurs every 5-30 minutes and may or may not
occur simultaneously with diarrhea.  During this phase of vomiting, do NOT attempt to
eat or drink anything.  Many people fear dehydration and believe they have to keep
sipping fluids in order to stay hydrated.  At this stage, there is no point, your body will
simply throw it all back up.  You are only taxing your gastrointestinal system more by
putting food and fluids into it.

Important: Breast feeding moms: this goes for you, too.  I know, I know: us
breastfeeders DO NOT like to be told we can't breastfeed our babies, EVER.  But this is
one of those instances where even breast is not best.  REST is best and you will often
hear doctors say that during this active phase of vomiting, the patient needs gut rest.
So relax, it actually takes persistent vomiting for several hours to cause severe
dehydration.

During the second phase, vomiting decreases to about once every hour to two hours.
At this point, you may start taking small sips of fluids.  It is best to drink an oral
electrolyte solution like Pedialyte, and, of course, breast milk.  Pedialyte offers popsicles
that are perfect for rehydration and also soothing to the belly.  Coconut water is an
excellent source of electrolytes as well.  Peppermint, chamomile, ginger, and lemon all
have anti-emetic properties in them and can soothe an aching belly.  Gatorade and
Powerade contain large amounts of sugar as do apple, pear, and cherry juice.  Therefore,
use these drinks sparingly as sugar can exacerbate vomiting and diarrhea. 

Remember: SMALL sips.  Don't overwhelm your already sensitive,
overworked belly.

During the third phase, vomiting slows down to about every 2-4 hours.  It is now safe to
eat small bites of food.  For both children and adults, it is best to start with the
BRAT diet: bananas, rice, applesauce, and toast.  This diet is bland and will not put too
much stress on the body.  Continue small sips of liquids.

Oral medications will not be of much use to you when you are actively vomiting because
they will just come right back up.  If a high fever occurs and vomiting is persistent, 
rectal suppositories of Acetaminophen for fever and Phenergan for vomiting can 
be prescribed by your doctor.  Phenergan is typically only given for severe 
vomiting, however, so use it conservatively.

Signs and Symptoms of Dehydration:

When monitoring your child for dehydration:

Assess the inside of their mouth: is it moist and pink?  Is there saliva present?  Good
sign!! During dehydration, the inside of the mouth and lips will appear dry.  As it
becomes more severe, there will be very little saliva present.

Assess the eyes and tear ducts: is there moisture present?  Do they have tears when
they cry?  Good sign!!  During dehydration, there will be no tears when they cry.  When
it becomes severe, eyes will appear sunken in.

Assess their activity level: are they a little less active then usual but still playing
and interacting?  Good sign!!  During dehydration, they will become lethargic, meaning
they are limp and not responding to your voice or touch.

Assess how often they are urinating: are they still peeing like normal, maybe a little bit
less?  Good sign!!  During dehydration, you will notice a decrease in the number of
wet diapers or trips to the potty.  Pay close attention to toileting during a virus.  It is
one of the best indicators of dehydration!  When dehydration is severe, urine will
become darker in color and have a strong odor.

Use these assessments as a guideline.  They are applicable to adults as well.  For mild
to moderate dehydration, use the oral electrolytes and BRAT diet mentioned above.
When it becomes severe as in little to no urine, no tears, sunken eyes, and dry mouth:
HEAD TO THE ER!!  Severe dehydration needs to be treated with IV fluids.

When to worry:

1.  If vomiting occurs in babies less than 6 months of age

2.  If stage one vomiting continues past 8 hours in children under one, 12 hours in children 

      one through three years old, and 16 hours in kids four and older.

3.  Severe dehydration

In these cases, contact your medical provider.

Remember, the best line of defense against viruses and bacteria is good old fashioned
hand washing.  

Have a question you'd like to ask a nurse?  Leave me a comment and I will address it in a future post.  

Or, email me at vasqueztribe@yahoo.com.  

Ask A Nurse About: Ear Infections

I am not only a nurse to my patients, I am also a nurse to my family, friends, neighbors,
and random strangers in Target and our local grocery store.  On a daily basis, I
encounter numerous questions about health, medications, and random concerns such
as "What does it mean when my poop turns green?".  And so I begin a new feature here,
Ask A Nurse, where I will attempt to put into laymen terms the very confusing anatomy
and physiology of the human body.  Am I an expert?  Hardly.  But I am an
experienced, certified Medical-Surgical Registered Nurse and a mother of two.  I draw
from my experiences in my medical practice, my journey through motherhood, and
my endless collection of credible nursing textbooks and resources.  Remember: this is
just a blog.  Just as you should never base any serious decision on internet ramblings,
so should you not take anything you read here as concrete fact.  When in doubt, consult
your doctor/naturopathic/guru.

This week's topic: The Dreaded Ear Infection.

It's that time of year: cold, flu, sinus infection time.  With this lovely plethora of
illnesses usually comes the ear infection, one in each ear if you're really lucky.
Let's break it down, shall we?

What are ear infections and why do they occur?

Ear infections occur in the middle ear space, the area right behind the ear drum that
connects to the nose via the Eustachian Tube.  Because children often have Eustachian
tubes that are anatomically too short and angled, mucous from the nose and throat
can migrate into the middle ear, creating a breeding ground for bacteria.  As the mucous
gets stuck in the middle ear region, pus begins to form.  Before you know it, you have an
ear full of fluid, mucous, and pus: thrilling combination.  This yucky stuff puts pressure on
the eardrum, creating an awful lot of pain and discomfort.  It can also lead to
diminished hearing, the same type of feeling one might have with Swimmer's Ear.

Signs and Symptoms of an ear infection:

Rule of Thumb: If your child has a legitimate ear infection, they will most likely have
2 or more of the following:

Cold symptoms.  Ear infections are almost always the result of the common cold.
Remember: the mucous stewing inside the ear that is not draining properly is the
culprit of the infection.
Low grade fever (Not always present)
Complaining of ear pain or difficulty hearing
Increased fussiness
Disrupted sleep pattern and not wanting to lie down flat
Drainage from the ear, most notably blood and/or pus due to a ruptured eardrum 
(don't panic, eardrums heal up quite nicely)

Myth debunked: Ear pulling is very often associated with ear infections.  This is not
a credible sign of a possible infection as young children are not cognitively able to localize
pain.  If ear pulling takes place without any of the symptoms listed above, they are more
than likely pulling on their ears because ears are cool and fun and weird.  They could also
be teething and think that the pain from their gums is hiding deep inside their ears.
Poor little loves...

Treatment:

Some parents might chose to let the infection run its course, which it is completely capable
of pending any complications.  I try to use common sense when deciding what course
of treatment to take with my girls.  If they are running a fever, have a copious amount
of mucous and congestion present, and seem to be very uncomfortable, off to the
pediatrician we go for antibiotic therapy.  If they are simply complaining of ear pain that
is relieved by over the counter Motrin but otherwise seem comfortable, we hold off on a
visit to the doctor and use our favorite homeopathic treatments.

Why choose antibiotic therapy?

Myth debunked: Antibiotics, when used appropriately and conservatively, are
therapeutic and beneficial.  They speed the recovery process up and prevent infection
from spreading and/or getting worse.

Your doctor should first check the ears with an otoscope, examining the eardrums
and assessing whether or not they are red and bulging.  If an infection is confirmed, the
doctor should then ask you if your child is allergic to anything, most notably penicillin.
They should then prescribe the first line, most basic antibiotic first, in this case
Amoxicillin.  DO NOT be tempted to ask for something stronger simply because it will
involve a shorter, more convenient treatment schedule.  This can cause the body to
become resistant to the antibiotic, a common problem in today's medical society.

Remember: ALWAYS finish the ENTIRE antibiotic cycle, even if your child begins to
feel better.  This helps reduce antibiotic resistance as well.

Myth debunked: Teething DOES NOT cause ear infections.  Teething causes
excessive drool, not mucous production.  Don't excuse a bad cold and it's complications
on teething, that's not the correct culprit and will only deny your child the proper
treatment.

The road to recovery:

As with any illness, you want to look at the big picture and treat all symptoms.  If
the infection warrants treatment, give the entire antibiotic cycle.  Use Motrin and/or
Tylenol for fever and ear pain.  You can also use warm compresses and analgesic ear
drops prescribed by your doc.  An expectorant, like Mucinex, works great to dry up all
the mean, nasty snot that started this whole nightmare in the first place.  Lots of fluids,
rest, Vitamin C, Echinacea, Saline Nose Drops, and Vick's Vapo Rub to soothe those
tired bones.  Breastfeeding has been scientifically proven (really, I'm not just saying that)
to lower the chance of ear infections and to decrease the severity of the infection when
it occurs.  Feed your baby upright as much as possible so that more fluid does not
accumulate in the ear.

To sum it all up:

Ear infections occur, typically, because of a basic anatomical inability to drain mucous.
They are NOT contagious.  They can be treated with antibiotics to stop the infection.
After antibiotic therapy, some fluid may remain in the ear.  Antibiotics are NOT meant
to drain the fluid from the ear, they are meant to kill the bacteria IN the fluid.  The fluid
could take anywhere from 3 days to 3 months to drain, sometimes requiring tiny tubes to
be placed by an ENT when fluid is chronic.  Also remember that antibiotics do NOT treat
the common cold, which is caused by a virus.  Cold medicines will be needed to address
those issues.  Treat the symptoms, get rest, and be patient.
These things usually heal up in no time.

Have a question you'd like to ask a nurse?  Leave me a comment and I will address it in a future post.  

Or, email me at vasqueztribe@yahoo.com.