RINGWORM

Laura Nasser
RINGWORM
 It’s not actually a worm

 Fungal infection involving the hair shaft of the

scalp
 Geophyllic- fungi that inhabit soil
 Zoophylic- live on animals
 Anthropophilic- live on humans
 EPIDEMIOLOGY

 In the past most infections were from animals

 Now most infections are spread through

people
 Predominately seen in ages 4-7

 Most affected race is African-American

HOW IS IT SPREAD

 Can be spread through

 Infected hairs
 Hats
 Combs
 Brushes
 Pillow cases
 Towels
THE GREAT MASQUERADERS

 Presents in a way that may be confused with

other skin disorders

 Subtle with dandruff like scaling

 Slight pruritus
 Pustule masses- confused for abscesses
 Confused with dermatitis, psoriasis
DIAGNOSIS
 Microscopic exam/ fungal culture to confirm
 Culture sample can be obtained with cotton swab
or toothbrush

Wood’s lamp
DEVELOPMENTAL CONSIDERATIONS

 Erikson’s Stage of Development- Industry vs.

Inferiority- patient is 9 years old

 Starting to view self as individual

 They form moral values, recognize cultural and

individual differences and are able to manage
most of their personal needs and grooming with
minimal assistance.

 Erikson viewed the elementary school years as

critical for the development of self-confidence.
TEACHING

 How it is spread

 Medication-
 Griseofulvin
 Take for 6-8 weeks- must take full amount
 Should be taken with food or milk to enhance absorption

 Most common side-effects are headaches and GI

complaints
 May effect oral contraceptives
TEACHING
 Shampoo- Selenium sulfide
 Eliminates the shedding of viable spores
 Used with oral treatment
 Will prevent the spread of fungus, but will not get
rid of it.
 May use it on other children in the home 2-3 times
a weeks for 6 weeks.
 Rarely occurs in adults, so they do not need to use
the shampoo.
 Wash towels in warm soapy water after each use
 Soak combs and brushes is half bleach/half water.
TEACHING
 May need to keep child out of school until
anti-fungal shampoo has been started.
 There is usually no permanent hair loss.
NURSING DIAGNOSIS 1
 Impaired comfort related to itching secondary to
tinea capitis AEB patient stating his scalp itches.
 Goal: The patient will state strategies to reduce
itching (cold packs, topical cream, shampoo,
distraction) by time of discharge.
 Interventions
 Assess current level of comfort.
 Inform the patient of options for control of discomfort-
creams, shampoo, cold packs.
 Teach patient distraction techniques- games, music,
television.
 Keep a cool environment as sweating may increase the
discomfort on the scalp.
 Teach to follow up with physician if discomfort persists or
worsens.
NURSING DIAGNOSIS 2
 Impaired skin integrity r/t presence of macules
associated with fungus.
 Goals- The patient will describe measures to
protect and heal the skin AEB patient stating that
he will use the recommended shampoo (Selsun
Blue) and any topical creams that may be
prescribed by time of discharge.
 Interventions
 Assess site of skin impairment.
 Implement a written treatment plan for topical treatment of
the skin impairment.
 Educate the patient and caregivers on the signs and
symptoms on infection.
 Teach the patient proper hygiene and to clean linens at
home to prevent re-infection.
 Teach the patient about prescribed medications and
therapies.
NURSING DIAGNOSIS 3
 Risk for infection: transmission to others: Risk
factor: contagious fungus.
 Goals- The patient will state ways to prevent
spreading infection: implement hair washing with
medicated shampoo(Selsun Blue); wash linens; do
not share combs/brushes; by time of discharge.
 Interventions:
 Assess the patient’s knowledge of tinea capitis and how it is
spread.
 Assess if there are any other symptomatic people in the
household.
 Instruct patient to contact barber and inform them of his
infection.
 Teach patient to clean all combs/brushes in half
bleach/water for one hour.
 Teach patient to wash all linens in warm soapy water after
each use.
NURSING DIAGNOSIS 4
 Risk for disturbed body image related to possible
hair loss.
 Goals: The patient will state strategies that can
enhance appearance of possible hair loss AEB
patient verbalizing that he can grow his hair longer
or maintain a short haircut; he will also verbalize
his understanding that hair loss is only a
possibility; by time of discharge.
 Interventions:
 Assess for any current disturbed body images or low self-
esteem.
 Assist patient in voicing his concerns about his possible hair
loss.
 Encourage the patient to voice any concerns about peer
opinion.
 Encourage families to support the patient as needed.
 Teach the patient how shampoo hair with Selsun Blue for ten
minutes and to not scratch his scalp.
DISCUSSION QUESTIONS

I have a cat at home that may have ringworms,

do I need to get ride of it?

I have Lamisil at home, can’t I just use that?

REFERENCES
 Ball, J. Bindler, R., Cowen, K., (2012) Principles of Pediatric
Nursing: Caring for children (5e.). Boston:Pearson.

 Meadows-Oliver, M. (2009, September-October). Tinea capitis:

diagnostic criteria and treatment options. Dermatology
Nursing, 21(5), 281+.