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I had this patient that was an interesting case all by herself. "Wrath of God type of stuff." Her communication was severely limited. Her stress level was through the roof. Anything I could say about why would be speculation and an invasion.
There was always something new with her: some new crisis as with failure to thrive, combativeness, ravenous hunger and others all cycling.
Most of the time she had rashy and/or welted skin conditions, and a compulsion to scratch herself bloody. Whenever we had a change of staff bringing in new nurses someone would misdiagnose scabies.
Scabies leave some tell tale signs, of which she had none. They afflict certain places more than others, and that wasn't her problem. They are easily acquired and transferred to others. As with someone who has lice, the mere mention of it starts health care workers scratching everywhere. I'm itchy just writing about it.
Docs would order treatment on the entreaties from nursing, and she'd have to be bathed or examined or salved on some schedule for whatever someone thought they saw. Her roommate never acquired any of this despite the both of them roaming about the locked unit and ending up in each others beds or chairs or clothing.
I've had patients with scabies and it's a challenge. The little critters burrow in the epidermis and leave silvery and sometimes black trails. They lay eggs which can persist through treatments, and the health care worker doing the treating can easily pick up scabies without knowing it for a day or more. Just a hint of wrist between gown and glove, or an ill advised brush of the hair off of a sweaty face and neck can provide the ideal location for an infestation.
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