In the later stage of scabies, one of the following is the primary symptom?

IGNOU Post B. SC. Nursing entrance -2021

Medical & Surgical Nursing

Medium

Appeared in: IGNOU Post B. SC. Nursing entrance -2021

Explanation

Itching (pruritus) is the primary and most distressing symptom of scabies, which is a subjective experience reported by the patient.
This intense itching, which is classically worse at night, develops approximately 2-6 weeks after the initial infestation.
The delay corresponds to the 'later stage' when the body becomes sensitized and mounts a hypersensitivity (allergic) reaction to the mite, its eggs, and its feces.
The other options are objective signs that a healthcare provider can observe, not symptoms that the patient feels.

Option A: Vesicles and pustules are observable skin lesions, making them clinical signs, not subjective symptoms. They often arise as part of the inflammatory rash or due to secondary bacterial infection from scratching.
Option B: The white, tortuous, thread-like lines are the burrows made by the female mite. These are the pathognomonic (specifically characteristic) sign of scabies, an objective finding, not a symptom.
Option C: This option describes the common locations of scabies burrows. Like the burrows themselves, their location is a clinical sign, not a symptom.

Clinical Relevance

Nursing practice connection: Knowing Signs vs. Symptoms in Scabies helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing role is educating patients that itching can persist for 2-4 weeks even after successful treatment (post-scabetic pruritus). This prevents unnecessary anxiety and repeated, potentially irritating, treatments.
What if? If a patient in a nursing home presents with a widespread, crusted rash but minimal or no itching, a nurse should have a high index of suspicion for crusted (Norwegian) scabies. This form is highly contagious and requires immediate isolation and more aggressive treatment protocols.
Nurses must emphasize the importance of treating all close contacts simultaneously and performing environmental decontamination (e.g., washing linens in hot water) to eradicate the mites and prevent community or facility-wide outbreaks.

How to Approach the Question

First, identify the key terms in the question stem: 'later stage,' 'primary,' and most importantly, 'symptom.'
Recall the fundamental difference between a 'symptom' and a 'sign.' A symptom is a subjective experience felt by the patient (e.g., pain, nausea, itching). A sign is an objective finding that can be observed or measured (e.g., rash, fever, blood pressure).
Evaluate each option based on this distinction. 'Vesicles,' 'pustules,' and 'thread-like lines' (burrows) are all visible findings, making them signs.
'Itching' is a sensation, a classic symptom.
Confirm the choice by recalling the pathophysiology of scabies. The intense itching is caused by a delayed allergic reaction that develops weeks after the initial infestation, which aligns with the 'later stage' mentioned in the question.
Therefore, itching is the only option that is a primary symptom of a later-stage infestation.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 1633-1635

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1982-1984