Ward Class

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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Integumentary Disorders: Impetigo

Impetigo Contagiosa
  • Impetigo is a superficial bacterial infection of the skin usually caused by group A beta-hemolytic streptococcus or Staphylococcus aureus
  • mainly affects infants and children
  • highly contagious and transmitted by direct contact with lesions; incubation period is between 2-5 days and the period of communicability is from outbreak of lesions until lesions are healed
  • may be caused by poor sanitation and hygiene but Impetigo can also occur in perfectly healthy skin
  • three types of Impetigo have been identified:
>impetigo contagiosa -most common; often around nose and mouth; itchy and painless
>bullous impetigo - fluid-filled painless blisters in arms, trunk, and legs
>ecthyma- more serious; infection penetrates the dermis; causes ulceration and scarring

Assessment Findings
  1. papulovesicular lesions surrounded by local erythema which become purulent, oozing, and form yellowish-brown crusts (note: most reference books call it honey-colored crusts)
  2. spreads peripherally, most commonly found in face, axilla, and extremities
  3. lesions may be itchy; painful if ulceration is present
  4. swollen lymph nodes (if lesions are numerous)

Medical Management
  1. oral administration of penicillin or erythromycin for ecthyma or severe cases of impetigo contagiosa to avoid complications such as acute glomerulonephritis, rheumatic fever, and MRSA --> mild cases often do not require antibiotic therapy as they resolve on their own in 2 to 3 weeks with hygienic measures
  2. topical application with mupirocin (Bactroban) for a full 10 days--> use with caution around eyes; causes stinging and irritation
  3. hygienic measures --> crusts need to be washed daily with soap and water to promote healing and better absorption of topical medications

Nursing Management
  1. follow contact precautions until 24 hours after initiation of antibiotic therapy
  2. administer oral antibiotics as ordered.
  3. apply Bactroban as ordered--> use caution when applying ointment around eyes
  4. observe patient for signs of complications such as periorbital edema, decreased in urination, painful joints, and high blood pressure
  5. wash skin daily with soap and water -->will soften the crusts and help prevent secondary infections
  6. apply Burrow's solution (aluminum acetate) compresses to skin crusts -->dries weepy skin infections
  7. cover draining lesions lightly with gauze to prevent the spread of infection--> note: impetigo is spread by direct contact with lesions
  8. remove dried crusts gently
  9. provide client teaching and discharge concerning medication regimen, contact precautions, and proper hygiene
  • Instruct parents to let child finish the entire course of medication even if a child gets better. School-aged patients may return to school 24 hours after initiating oral antibiotic therapy. When applying ointment to lesions, gloves should be worn and hands should be washed before and after applying the ointment to prevent spread of infection.
  • Patient's clothes, linens, and towels should be washed everyday and should not be shared with other members of the family.
  • Encourage parents to keep patient's nails short to prevent scratching and to teach child proper handwashing technique.

Prognosis

Impetigo typically isn't dangerous, but may lead to serious complications if left unattended.

Prevention

There is no immunity to Impetigo but it can be prevented by keeping the skin clean and healthy. Cuts, scrapes, rashes, and insect bites should be washed regularly with soap and water to prevent infection.

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