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What is Enterobiasis
Enterobiasis, also referred to as threadworm, seatworm, or pinworm disease is a benign intestinal infection. Enterobiasis is the most common helminthic disease in the USA, with a prevalence of 40 million infected people; that is caused by the nematode Enterobius vermicularis. Enterobiasis invades the large intestine and may enter the appendix. The contaminated articles with Enterobiasis eggs may spread from one person to another. Enterobiasis infection affects all socioeconomic levels, often occurring in family clusters. An essential point during therapy discussion is that Enterobiasis is not equated to poor sanitary measures.
Pathophysiology of Enterobiasis
Enterobiasis has a life cycle of 6 to 8 weeks, and reinfestation may occur if the condition is not treated.
- The only natural host of E. vermicularis is human beings.
- The common infestation method is fecal-oral contamination, such as fomites and hand-to-mouth contamination.
- Ingested eggs hatch in the small intestine within 6 hours.
- In as little as two weeks, the worms mature and have a lifespan of about two months.
- The full-grown worms inhabit the cecum, terminal ileum, proximal ascending colon, and vermiform appendix, where they live freely in the intestinal lumen.
- After copulation, the female worms move to the rectum, and during defection, if not expelled, they move to the perineum, usually at night, and release about 11,000 eggs.
- Eggs are infectious after 6 to 8 hours and may remain infectious for more than three weeks under optimum conditions.
Statistics and incidences of Enterobiasis
The statistics reveal that the incidences of Enterobiasis are higher among young children.
- In the general population, the prevalence is 5% to 15%, but in recent years the percentage is decreasing; however, prevalence rates are still higher among institutionalized people. The known host for Enterobiasis is humans.
- Children under 18 years are at risk of pinworm infestation, and people taking care of the infected people with a prevalence of about 50%.
- The infestation rate of Enterobiasis increases with an increase in population density and individual habits like sucking thumbs.
- The prevalence cases of E. Vermicularis vary from one country to another; however, infestation occurs globally.
- The study carried out in coastal Tanzania aimed at evaluating the extent of Enterobiasis and helminth infections among preschool, infants, and school-aged kids showed that Enterobiasis vermicularis infections among infants were 4.2%, 16.7% in the preschool kids and 26.3% in the school-aged kids.
- The vigorous scratching from pruritus may lead to secondary bacterial infections.
Clinical Manifestation of Enterobiasis
The symptoms of Enterobiasis include:
- Enterobiasis patient experiences erythema or excoriation of the vulvae, perineum, or both; however, the infestation may occur in the absence of these symptoms.
- Visual worm slighting. In some cases, the evidence of Enterobiasis infestation may be provided by a parent who has seen the worms.
- Abdominal pain. Severe abdominal pains similar to acute appendicitis may indicate an infestation of Enterobiasis.
- Perianal itching. The primary symptoms of Enterobiasis are intense perianal itching which occurs mainly at night. The female worms move from the anus to deposit ova during this time. As a result, the patient experiences difficulties in sleeping which can lead to insomnia and fatigue.
- Anxiety and nervousness. Enterobiasis cause restlessness and discomfort to the patient.
- Change of appetite. The infestation of the pinworm infection can lead to loss of appetite, weight loss, and abdominal discomfort.
- Nausea and vomiting. This happens when the infection is severe.
Enterobiasis Assessment and diagnostic findings
The common method of diagnosing Enterobiasis is to capture the eggs around the anus using cellophane.
- Cellophane tape test: The test is performed early in the morning, as soon as or before the child awakens, using cellophane tape. The tape is taken to the lab, and using the microscope; the tape is examined for the eggs.
- Stool sample: The patient’s stool is collected and analyzed for eggs or pinworm under the microscope.
- Blood test: The blood test determines the presence of pinworm antibodies that indicate past or current infection.
- Visual infection: Visual inspection of the anal area can reveal the presence of eggs or pinworms.
Medical Management of Enterobiasis
The management plans for Enterobiasis involve the following:
- Personal hygiene. The reinfestation of Enterobiasis may be reduced by changing individual habits like nail biting and thumb sucking. The young children should encourage to regularly observe hygiene measures such as changing underclothing daily and bathing regularly. Regular and thorough handwashing is crucial in controlling the transmission of Enterobiasis. The children’s caregivers should be taught the need to keep the children’s fingernails short and tidy.
- Washing clothing and bedding. Thorough and regular washing of clothes and bedding is significant in removing the eggs and pinworms that might be present.
- Avoid sharing personal belongings. Sharing personal items may increase the spread of the infection. Thus, avoiding sharing items like undergarments, washcloths, and towels is essential.
- Avoid reinfection. It is crucial to avoid reinfection by observing hygienic measures and avoiding contaminated objects and surfaces.
Pharmacological Management of Enterobiasis
The current standard drug therapy in the treatment of Enterobiasis includes Mebendazole, Pyrantel, or Albendazole.
- Anal albendazole. Helps in treating patients with pruritus ani symptoms. It is taken as a single dose and works by interfering with the ability of the pinworm to absorb glucose. Albendazole is taken as a single dose.
- Pyrantel Pamoate. It is sometimes taken to as the treatment for pinworm. It paralyzes the pinworms and is excreted from the body. It has tolerable side effects and is usually taken as a single dose.
- It is a common treatment for pinworm infections. It also functions by interrupting the ability of pinworms to absorb glucose, leading to their death. It has tolerable side effects and is mainly taken in a single dose.
Nursing Management of Enterobiasis
The nursing management of children with Enterobiasis includes:
Nursing Assessment of Enterobiasis
The nursing assessment of Enterobiasis includes:
- Physical examination: The worms can either be found in the patient’s perineum in the morning before bathing or in the stools.
- History: The nurse may evaluate the patient via questions about the symptoms, recent exposure to contaminated objects or surfaces, and recent travel.
- Assessment of the Patient’s Symptoms: The nurse may examine the patient’s symptoms, including anal area discomfort, abdominal pain, itching, nausea or vomiting, difficulty sleeping, and loss of appetite.
- Medication History: The nurse might determine the patient’s medical history, such as recent use of anthelmintics, to conclude on the appropriate course of treatment.
- Hygiene Practices : The nurse might evaluate the patient’s hygienic practices and provide the appropriate personal hygiene practices to minimize the spread of the infection.
Nursing diagnosis of Enterobiasis
- Acute pain. Associated with smooth muscle spasms resulting from migration of parasites to the stomach.
- Imbalanced dietary. Bellow body requirements associated with vomiting and anorexia.
- Associated with a reduction in circulation as a result of hydration
- Risk for compromised skin integrity. It is linked to increased perianal scratching.
- Sleeping problems. It is associated with discomfort due to itching in the anal area.
- Risk for infection. It is linked to the presence of pinworms.
Nursing Care Planning and Goals for Enterobiasis Patients
- Provide relief from perianal itching. Provide appropriate medication like albendazole or albendazole to relieve pinworm symptoms like abdominal pain, insomnia, and itching.
- Balance the nutritional requirements of the patient. Provide dietary support to the patient to prevent reinfection and promote healthy digestion.
- Prevention of the spread of Enterobiasis. Educate the whole family about proper hygiene practices like regularly washing hands, keeping the house clean, and avoiding scratching the anal area.
- Proper hygiene. Encourage the victim to maintain appropriate hygiene, like regularly changing bed linens and underwear and taking showers daily.
- Follow-up care. To monitor patient progress, arrange follow-up care to ensure effective infection treatment.
- Patient education and counseling. Educate the entire family about symptoms, treatment, and transmission modes of Enterobiasis to ensure adequate understanding and minimize reinfection.
Nursing Interventions for Enterobiasis Patients
The nursing interventions for Enterobiasis patients include:
- Enhance skin integrity. To control scratching, the application of albendazole or antipruritic ointment is vital. Trim the fingernails of the patient to prevent excoriations.
- Lessen pain. Patients with Enterobiasis should be prescribed anthelminthic drugs.
- Upgrade on the hygienic level. Refrain from nil-biting and scratching, which cause autoinfection. Regular and thorough handwashing is vital before and after the meal. The bed linen should not be shaken to prevent the aerosolization of eggs that might have been dropped on the bedding.
- Educate the patient on the impacts of pyrantel. The patient’s stool may look bright red causing vomiting. Aspirin-sensitive people should not be given the tablet form of this drug because it is aspirin coated.
- Give medications as prescribed. Drug therapy with Mebendazole, albendazole, and pyrantel is significant in destroying Enterobiasis parasites. In addition, treating the entire patient’s household members is crucial to eradicating the parasites effectively.
- Reduce temperature. Provide antipyretics as directed. Tepid sponge baths are also crucial to the patient.
Nursing Evaluation of Enterobiasis
The goals of Enterobiasis nursing management are achieved if:
- The optimum patient temperature is reached.
- The patient’s pain is optimized to tolerable levels.
- The nutritional requirements of the patient are attained.
- The discomfort from perianal itching is minimized.
Nursing Documentation Guidelines
Documentation of Enterobiasis patients includes:
- Reaction to teachings, intervention, and actions are taken.
- Patient’s care plan
- Progress or achievement towards desired results.
- Religious and cultural beliefs of the patient and the expectations.
- Personal findings include factors affecting their interactions, specifics of individual behavior, and the nature of social exchange.
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