Introduction
Atopic eczema is a lasting inflammatory skin disease associated with dryness and itching, recurrent exacerbations, and other non-cutaneous symptoms (Čepelak, Dodig & Pavić 2019). It’s a pediatric form of atopic dermatitis that can occur in people of any age. Many other atopic conditions, like asthma and also allergic rhinitis, usually develop around the same time as atopic dermatitis. Although multifaceted, it is considered to have multifactorial etiology (i.e., genetic and also environmental factors). Atopic eczema is a very severely ill condition that has a significant impact on the quality of life, is prevalent across different age groups, and is caused by complex hereditary and environmental effects (Lifschitz, 2015).
Atopic eczema is not only an illness that a considerable number of children have but also, individuals between 10 to 20 % of the adult population of developed countries develop it (Blome et al., 2016). This additionally may be chronic, lasting into adulthood, and having a life-long effect on people. The effect can be highly profound on individual health, which could lead to several discomforts, sleep disturbances, and decreased quality of life. Atopic eczema, with a highly complex etiology, genetic predisposition, and environmental triggers, is an interesting and challenging LTC to explore (Hebert et al., 2023). It is believed that atopic eczema occurs in 15% to 20% of children and 1% to 3% of the adult population in industrialized countries. A prevalence difference occurs between regions and ethnicities, while higher rates are observed at certain ages. The role of family history in the prevalence of atopic eczema cannot be underestimated, with the concordance rates of these grabbing 77% in monozygotic twins and 15% in the dizygotic twins reported (Thomas et al., 2014).
The pathophysiology of atopic dermatitis consists of genetic predisposition and environmental factors. Filaggrin gene mutations that affect skin barrier function and immune regulation cause impaired skin barrier function and increased IgE sensitization to allergens (Gábor Mócsai et al., 2015). Immunological disorders in which Th2-dependent inflammation plays a significant role have been associated with disease development and progression. The nursing process is the systematic approach that nurses use in the patient care process: patient assessment, diagnosis, planning, intervention, and evaluation. The nursing process, which aims at holistic care and incorporates the physical and psychosocial aspects of the patient, is essential for the care of patients with atopic eczema by facilitating effective management and coping strategies (Klinnert et al., 2018).
The nursing process is an integral part of the Practice to enable patient-centered care, develop continuity of care, and improve patient outcomes. Dermatitis is a collective name for the types of skin inflammation of different etiology. The typical symptoms include redness, peeling, blisters, itching, and thickening, where there is more chronic inflammation. However, the characteristics of dermatitis are usually particular; in clinical practice, such differentiation is sometimes tricky and can be challenging, especially when other inflammatory skin conditions are also present. (Mowad et al., 2016)
Assessment
Healthcare assessment is quintessential for detecting hazards, steering interventions, and enhancing outcomes. Through structured data collection methods, healthcare providers ascertain subjective and objective information to determine the overall health status of a patient. It comprises of obtaining the patient’s medical history, physical checkup, and standardized assessment tools such as the ABCDE approach and NEWS score (Hebert et al., 2023).
Some essential assessment domains involve monitoring vital signs, physical examination, and laboratory tests. Vital signs, for example, blood pressure, heart rate, and temperature, are essential since they give an understanding of a patient’s physiological status and can help in the detection of danger signs (Sapra, 2023). The physical examination is valuable in the assessment of many body systems. This helps identify abnormalities or clinical manifestations of underlying diseases (Hebert et al., 2023). Also, disease pathophysiology is essential since it improves the clinician’s decision-making and planning. Under conditions like eczema, a dysfunctional skin barrier, dysregulated immune response, and genetics play a role in its occurrence and evolution. In the case of these processes, however, interventions are designed to regulate them, to prevent a disease progression if possible, and to provide symptom avoidance through resilience promotion. Alongside physical health, mental health is another area that ought to be considered since it involves the investigation of mood, cognition, and behavior for the diagnosis and treatment of psychiatric conditions (WHO, 2022). Integrated assessment that brings together various assessment techniques can facilitate the provision of patient-centered care.
Chronic atopic eczema can be diagnosed by collecting a complete medical history of a patient, performing a physical examination, and conducting relevant laboratory tests to determine the extent of the disease, the possible triggers, the treatment outcomes, and its adverse effects (Andersen et al., 2015). At the same time, healthcare providers gather information about at what time the symptoms started, how long they have been, whether and which other members of the family and patient have had these symptoms in the past, and possible triggers of the symptoms like allergens in the environment or stressors (Hebert et al., 2023).
Additionally, the EASI and standardized instruments were used to evaluate disease severity by objective means and track the treatment effect (Chopra et al., 2017). The scoring scale evaluates the degree as well as the severity of erythema, induration, excoriation, and also lichenification, respectively, in different parts of the body, according to a paper by Maintz et al. (2021). The panel of tests done in the clinical laboratory can comprise a blood eosinophil count, a serum IgE level, and also skin testing for some allergens to specify causes of an allergic nature, among others, that might have provoked the exacerbation of eczema. On the other hand, patch testing helps to remove the allergenic irritants that are the causative factor to eczema disorders and suggests prevention measures in the subsequent management.
Planning
Hence, comprehensive planning is the key to successful long-term control of AE as the pathway is organized systematically to tackle the complex elements of the disease that will result in good patient outcomes (Fahad, 2021). In this step, an elaborate care plan is designed with a clear understanding of the patient-specific needs. This is done with a focus on practice-based evidence and setting the proper control to achieve symptom control, prevention of exacerbations, and improvement of quality of life. Planning enables clinical professionals to determine the rank of the treatments, rationally distribute resources, and collaborate to provide a patient with therapy under AE (Chopra et al., 2017).
Within the assessment process, the setting may be determined for care planning against AE as a chronic condition. For patients with high BMI, our care plan comprises weight management intervention strategies that include dieting, regular exercises, and referral of patients to specialist services for the management of obesity (Dominique Durrer Schutz et al., 2019). Patients with elevated blood pressure may also need continuation of monitoring and lifestyle changes, which include a low-salt diet, smoking cessation, and management of stress.
Also, blood tests are recommended to see how many inflammatory markers there are, to check allergic sensitization, and to monitor the possible side effects of systemic immunosuppressive drugs or biological drugs used for long-term therapy. Furthermore, mental health evaluation and assistance are incorporated into AE management, as it has been understood that chronic skin conditions significantly affect emotional health, self-confidence, and quality of life (Yuen et al., 2023). Therefore, a care plan may include referral to psychological services, for example, the Improving Access to Psychological Therapies (IAPT) program, to provide cognitive- The care plan aims to accomplish this holistically, covering all these facets with a view of optimizing the management of AE as a chronic disease and improving patient’s overall well-being.
Implementation
The part of LTC management that deals with the AE focuses on PCC and MDT collaboration, which are substantive elements for wholesome and efficient management. PCC incorporates adjusting the treatment plans to the personal needs, wishes, and also convictions of the patients, fostering informed decision-making and enabling patients to be an active part of their care. This method positions the patients as co-stewards of their health story, recognizing their competency in their journey and expressing wishes (LaFrance et al. 2019). Planning collaborative activities in the (AE) of MDT is the inclusion of professionals from different disciplines, including dermatologists, general practitioners, nurses, pharmacists, dietitians, and psychologists, to address the complex requirements of the patients at the same time (NICE, 2023). This integration makes sure that the care plan is of high quality, coordinated, and specific to an individual in light of his holistic needs, taking into account the medical and also social aspects of the condition.
The referral type depends on the person’s identified needs during the assessment and the care-planning phase. For example, a patient with psychological distress due to AR is a candidate for referral to psychologists or mental health professionals for CBT that will address anxiety, depression, or coping strategies (Lorentzen et al. 2020). Dietitians can offer many recommendations on dietary changes for the demanding population with co-existing conditions, a group whose AE symptoms can be aggravated. Drug administration is a very compounding role of pharmacists who take care of any medication’s safety and effectiveness, including topical corticosteroids or immunomodulators, and teach the patients the correct application of these treatments and possible side effects.
When it comes to medication management, a change of medication is planned. One of the most common drugs in treating atopic eczema is tacrolimus, a topical calcineurin inhibitor. Tacrolimus is used for patients with moderate to severe acute eczema (AE) who have no improvement from previous treatments or cannot tolerate topical corticosteroids. The usual adverse effects of tacrolimus include skin irritation, burning, itching, and reddening of the application site (Kelleher, 2021). Healthcare providers must educate patients about these possible side effects and monitor the patient’s response to treatment closely to maximize outcomes and reduce adverse reactions. LTC management involves PCC and MDT collaboration.
The Role of Patient-centered Care (PCC)
PCC is important in the management of chronic health conditions like atopic eczema because PCC requires designing treatment plans that are tailored to the individual demands, preferences, and ideas of the client (Flagg, 2015). The patient’s involvement in decision-making is a priority when devising a change in medication for the patient. The patient should be given information about the options and treatment, their effects, as well as all the relevant data, and their opinion and concerns as an essential part of the process. This approach creates a networking relationship between patients and healthcare providers, in which the patients become the participants who make decisions on their treatment and act accordingly.
An AE treatment switch is often considered one of the medications. Tacrolimus is an example of it being a topical calcineurin inhibitor. Tacrolimus may be prescribed for patients with moderate to severe AE who have not been effectively treated with other interventions or who are hypersensitive to topical corticosteroids. Skin reactions to tacrolimus, such as irritation, burning, itching, and rash, can also occur (Jade et al., 2015). These side effects are typically mild-to-moderate severity and can be improved with further use and adjustment in application frequency or dosage.
Evaluation
The outcome of the critical assessment of care is the evaluation of whether interventions (e.g., dietary advice from a dietitian to decrease BMI) worked for the patient (Morgan-Bathke et al., 2023). Suppose the patient needs to show a sufficient decrease in BMI after intervention. In that case, the next step will be to review the patient’s diet and lifestyle habits, identify the obstacles to weight loss, and consider alternative strategies, such as more physical activity or behavioral therapy. Reasoning for the change of care after assessment comes from the requirement for interventions to be customized to the particular patient’s response and developments, consequently improving the health outcomes and the patient’s overall health (Sacristán, 2013). This applies the emphasis on critical thinking and the healthcare provider’s actions to constantly assess and adapt care plans accordingly to achieve patient goals and well-being.
Conclusion
Suitable management of atopic eczema requires detailed appraisal and individualized planning. PCC principles are about finding patient-specific approaches, and MDT is for holistic support. Care implementation assessment is imperative and should be regularly monitored to measure effectiveness and tweak where necessary.
Recommendations
The recommendations indicate continuing patient engagement and comprehensive support for self-managing atopic eczema. Promoting continuing education makes patients a partner in their treatment process and ensures the success of customer-centered health behavior. The follow-up appointment enables a regular assessment, making timely interventions and adjustments possible if necessary. Also, teamwork across disciplines will be more effective in providing coordinated care and comprehensive support to patients. Integration of mental health care recognizes that eczema has a significant psychological impact and, therefore, offers essential psychosocial support. Healthcare providers can achieve better outcomes and promote general well-being in patients suffering from atopic eczema through patient-centered, multidisciplinary methods and an adaptable approach to therapy.
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