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Hookworms
By Marianne Belleza, RN - January 18, 2019 0

Hookworm Infection Nursing Care Management

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Jess has been scratching a lot at himself lately. His legs

are so full of scratches, some even turning into wounds.
He also seemed pale in comparison with his classmates.
The school nurse decided to have Jess meet the school
physician, who wanted to examine Jessʼ stool. The
physicianʼs suspicion that Jess has hookworms was
confirmed when the stool exam results came out.

1 Description
2 Pathophysiology
3 Statistics and Incidences
4 Causes
5 Clinical Manifestations
6 Assessment and Diagnostic Findings
7 Medical Management
7.1 Pharmacologic Management
8 Nursing Management
8.1 Nursing Assessment
8.2 Nursing Diagnosis
8.3 Nursing Care Planning and Goals
8.4 Nursing Interventions
8.5 Evaluation
8.6 Documentation Guidelines
9 Practice Quiz: Hookworm
10 See Also
11 Further Reading

Description

Historically, hookworm infection has

disproportionately affected the poorest among the
least-developed nations, largely as a consequence of
inadequate access to clean water, sanitation, and health
education.

Human hookworm
disease is a common
helminth infection
that is predominantly
caused by the
nematode parasites
Necator americanus
and Ancylostoma
Ancylostoma caninum, a type of
duodenale;
hookworm, attached to the
organisms that play a intestinal mucosa. | Centers for
Disease Control and Prevention
lesser role include
Ancylostoma
ceylonicum, Ancylostoma braziliense, and
Ancylostoma caninum.
Hookworm infection is acquired through skin
exposure to larvae in soil contaminated by human
feces.
Soil becomes infectious about 9 days after
contamination and remains so for weeks, depending
on conditions.

Pathophysiology

The life cycle of hookworms begins with the passing of

hookworm eggs in human feces and their deposition
into the soil.

Each day in the

intestine, a mature
female A duodenale
worm produces about
10,000-30,000 eggs,
and a mature female
N americanus worm
produces 5000-
Ancylostoma braziliense mouth
10,000 eggs.
parts. Hookworm, parasite. |
After deposition onto Centers for Disease Control and
Prevention
soil and under
appropriate
conditions, each egg develops into an infective larva.
These larvae are developmentally arrested and
nonfeeding; if they are unable to infect a new host,
they die when their metabolic reserves are
exhausted, usually in about 6 weeks.
Larval growth is most proliferative in favorable soil
that is sandy and moist, with an optimal temperature
of 20-30°C; under these conditions, the larvae hatch
in 1 or 2 days to become rhabditiform larvae, also
known as L1.

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The rhabditiform larvae

feed on the feces and
undergo 2 successive
molts; after 5-10 days,
they become infective
filariform larvae or L3.
These L3 go through
developmental arrest
Life Cycle of A Hookworm |
and can survive in CDC – Department of Parasitic
Diseases
damp soil for as long
as 2 years; however,
they quickly become desiccated if exposed to direct
sunlight, drying, or salt water. L3 live in the top 2.5
cm of soil and move vertically toward moisture and
oxygen.
The larvae migrate through the dermis, entering the
bloodstream and moving to the lungs within 10 days;
once in the lungs, they break into alveoli, causing a
mild and usually asymptomatic alveolitis with
eosinophilia.
In 3-5 weeks, the adults become sexually mature,
and the female worms begin to produce eggs that
appear in the feces of the host.

Statistics and Incidences

Worldwide, hookworms infect an estimated 472 million

people.

Hookworm infection
and disease are now
most likely to be
found in immigrants,
refugees, and
adoptees from
tropical countries.
Cutaneous larva
A hookworm (Ancylostoma
migrans is endemic in
caninum) egg via microscope at
the southeastern 1000x. | Wikipedia

states and Puerto

Rico; the canine
hookworm A caninum has reportedly caused
eosinophilic enteritis in Australia and the United
States.
Human infection with A duodenale or N americanus
is estimated to affect approximately 472 million
people worldwide.
Infection is most prevalent in tropical and subtropical
zones, roughly between the latitudes of 45°N and
30°S; in some communities, prevalence may be as
high as 90%.

In 2010, it was
estimated that 117
million individuals in
sub-Saharan Africa
were infected with
hookworms, as well as
64 million in East Asia,
140 million in South
An infected foot of a female
Asia, 77 million in patient. | Canadian Press

Southeast Asia, 30
million in Latin America
and the Caribbean, 10 million in Oceania, and 4.6
million in the Middle East and North Africa.
In endemic areas, the highest prevalences are
reported among school-aged children and
adolescents, possibly because of age-related
changes in exposure and the acquisition of immunity.
Studies from China and Brazil indicate a consistently
increasing prevalence, from 15% at age 10 years to
60% at age 70 years and older; egg counts in stool
also increase in a similar pattern.
Males and females are equally susceptible to
hookworm infection.

Causes

Hookworms may persist for many years in the host and

impair the physical and intellectual development of
children and the economic development of
communities.

Necator americanus. N americanus is the globally

predominant human hookworm and is the only
member of its genus known to infect human; it is a
small, cylindrical, off-white worm; adult males
measure 7-9 mm, and adult females measure 9-11
mm.
Poor sanitation. Poor hygiene habits and sanitation
contribute to the development of hookworm
infestations as they thrive in dirty, unkempt
surroundings.
Limited access to clean water. Ingestion of water
infested with eggs of hookworms leads to the
development of hookworm in humans.

Clinical Manifestations

The early and late signs of hookworm infection are:

Ground or dew
itch. An
erythematous,
pruritic,
papulovesicular rash
develops at the site
of initial infection on
the palms or soles
Hookworms causing lumps and
and may persist for 1-
streaks beneath the skin.
2 weeks after initial
infection; intense
scratching may lead to a secondary bacterial
infection, which is quite common.
Pulmonary symptoms. When the worms break
through from the venous circulation into the
pulmonary air spaces, cough, fever, and a reactive
bronchoconstriction may be observed, with
wheezing heard on auscultation.
GI symptoms. Migration of the worms into the
gastrointestinal (GI) tract may cause GI discomfort
secondary to irritation; as the worms mature in the
jejunum, patients may experience diarrhea, vague
abdominal pain, colic, flatulence, nausea, or
anorexia.
Symptoms of anemia. Signs of iron-deficiency
anemia are often insensitive.; patients may exhibit
pallor, chlorosis (greenish-yellow skin discoloration),
hypothermia, spooning nails, tachycardia, or signs of
high-output cardiac failure.
Cutaneous larva migrans. Cutaneous larva migrans
manifests as pathognomonic, raised serpiginous
tracts (creeping eruptions) with surrounding
erythema that may last as long as 1 month if
untreated; lesions are most commonly seen on lower
extremities but may be limited to the trunk or upper
extremities, depending on the site at which the
infective larvae entered the body.

Assessment and Diagnostic Findings

Diagnosis of hookworm infection is made through the

following:

Blood studies. Anemia is confirmed by CBC and

peripheral blood smear results that demonstrate
signs typical of iron-deficiency anemia; microscopy
reveals hypochromic, microcytic red blood cells
(RBCs); eosinophilia is surprisingly persistent and
may be due to attachment of the adult worms to the
intestinal mucosa.
Stool examination. The diagnosis is confirmed with
direct microscopic analysis of fecal samples to verify
the presence of hookworm eggs; the specimen is
fixed in formalin and prepared as a wet mount.

Medical Management

Most cases of classic hookworm disease can be

managed on an outpatient basis with anthelmintic and
iron therapy, complemented by an appropriate diet.

Iron therapy. Patients with anemia and malnutrition

may require both iron supplements and nutritional
support (including folate supplementation).
Antihelmintics. For patients with cutaneous larva
migrans who have minimal symptoms, specific
anthelmintic treatment may be unnecessary.
Blood transfusions. Blood transfusion is indicated
in rare cases of acute severe gastrointestinal (GI)
hemorrhage; in patients with chronic anemia, blood
transfusions (ie, packed red blood cells [RBCs])
should be administered slowly and are usually
followed by a diuretic to prevent rapid fluid overload.

Pharmacologic Management

Antihelmintics are the drug of choice for hookworm

infections.

Antihelmintics. Anthelmintic drugs effective against

hookworms include benzimidazoles (eg,
albendazole, mebendazole) and pyrantel pamoate;
the Centers for Disease Control and Prevention
(CDC) continues to recommend a 400-mg single
dose of albendazole on its Website (July 26, 2018),
but notes that albendazole is still not FDA approved
for the treatment of hookworm infection.

Nursing Management

Nursing care for a child with hookworms include the

following:

Nursing Assessment

Assessment of the child include:

History. The majority of individuals who develop

hookworm infection are from known endemic areas;
they frequently have a history of wearing open
footwear or walking barefoot in such areas.
Physical exam. Skin and pulmonary findings are
minimal; physical findings in the early (larval
migration) stage of the disease differ from those in
the late (established GI infection) stage.

Nursing Diagnosis

Based on the assessment data, the major nursing

diagnoses are:

Acute pain related to mucosal irritation.

Ineffective tissue perfusion related to blood loss.
Impaired skin integrity related to persistent
scratching of the affected area.
Deficient knowledge related to the disease process
and treatment.

Nursing Care Planning and Goals

The major nursing care planning goals for patients with

hookworm are:

The child will have diminished pain.

The childʼs perfusion will return to normal.
The child will have reduced itching and scratching.
The child and caregivers will acquire enough
knowledge about the disease process and its
treatment.

Nursing Interventions

Nursing interventions for a child with hookworm include

the following:

Reduce or diminish pain. Provide rest periods to

promote relief, sleep, and relaxation; acknowledge
reports of pain immediately; get rid of additional
sources of discomfort, and determine the
appropriate pain relief method.
Improve tissue perfusion. Submit patient to
diagnostic tests as indicated; administer blood
transfusion as indicated.
Protect skin integrity. Monitor site of impaired
tissue integrity at least once daily for color changes,
redness, swelling, warmth, pain, or other signs of
infection; provide skin care as needed; keep a sterile
dressing technique during wound care; clip the
patientʼs nails as necessary; and teach patient and
significant others about proper handwashing, wound
cleansing, dressing changes, and application of
topical medications.
Enforce knowledge about the disease and its
treatment. Determine priority of learning needs
within the overall care plan; render physical comfort
for the patient; grant a calm and peaceful
environment without interruption; include the patient
in creating the teaching plan; help the patient in
integrating information into daily life; and provide
clear, thorough, and understandable explanations
and demonstrations.

Evaluation

Goals are met as evidenced by:

The childʼs pain was diminished.

The childʼs perfusion is returned to normal.
The child has reduced itching and scratching.
The child and caregivers have acquired enough
knowledge about the disease process and its
treatment.

Documentation Guidelines

Documentation in a child with hookworm include the

following:

Individual findings, including factors affecting,

interactions, nature of social exchanges, specifics of
individual behavior.
Cultural and religious beliefs, and expectations.
Plan of care.
Teaching plan.
Responses to interventions, teaching, and actions
performed.
Attainment or progress toward the desired outcome.

Practice Quiz: Hookworm

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Practice Quiz: Hookworm

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See Also

Related topics to this study guide:

Pediatric Nursing Study Guides

Nursing Notes: Study Guides for Various Topics
Pediatric Nursing NCLEX Practice Questions

Further Reading

Recommended resources and books for pediatric

nursing:

i. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's

Clinical Pocket Guides)
k. Pediatric Nursing Made Incredibly Easy
l. Wong's Essentials of Pediatric Nursing
m. Pediatric Nursing: The Critical Components of
Nursing Care

Hookworm Infection Nursing Care Management

TAGS Albendazole anemia Antihelmintics

benzimidazoles blood transfusion

Centers for Disease Control and Prevention (CDC)

Cutaneous larva migrans dew itch folate supplementation

Ground itch handwashing hookworm

Human infection with A duodenale mebendazole

N americanus Pediatric Poor sanitation

Stool examination

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