02.02 Impetigo

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Impetigo on the Back of Neck (Image)
Impetigo Around Mouth (Image)
Skin Lesions (Cheat Sheet)

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Hey there! This presentation will be covering the diagnosis of impetigo.

Impetigo is the most common bacterial skin infection for kids ages 2-6 years. The two types of bacteria that we see cause it most often are Staphylococcus aureus or Group A Strep.

Okay let’s talk a little bit about what you need to be looking for in an assessment.

The Nonbullous impetigo rash is characterized by pustules typically found around the nose and mouth, once these pustules burst, they excrete a honey coloured fluid that leaves the characteristic crust. Not to totally gross you out, but some have described the yellow crust as looking like cornflakes are stuck to the skin.

Typically a patient with nonbullous impetigo is systemically well- other than perhaps some lymphadenopathy.

So, what specifically do we mean when we say a child is generally well? This means they do not have a fever and are eating, drinking, peeing, playing and sleeping as they normally would. If they do have a fever and aren’t eating drinking sleeping peeing and playing well - they probably have something else going on. And it’s not just a simple skin infection.

Therapeutic Management of impetigo centers around wound care, antibiotic therapy. Wound care management focuses on keeping the wound clean and preventing the spread of the infection. Mild impetigo can be treated with topical antibiotics. If it is widespread or hasn’t responded to topical antibiotics the patient will likely need oral antibiotics.

Because Impetigo can usually be managed in the outpatient setting- much of the nursing care will focus on patient education. As impetigo is spread via contact, the patient should be placed on contact precautions, and strict hand hygiene enforced.

Caregivers should be instructed to keep the wound clean, avoid scratching and keep nails short. If the child is prescribed topical antibiotics parents should be educated to clean the wound with antibacterial soap - being careful to remove the crusted/scabbed areas so that the ointment can be effective. To prevent the highly contagious infection from spreading to others in the house - they should not share towels and the child should be kept out of school for 24 hours after the start of antibiotics.

Okay that covers the basics of Impetigo, now I’d like to take a few minutes to talk about a complication that can occur with Impetigo called Acute Post Streptococcal Glomerulonephritis.

So what is Acute Post Streptococcal Glomerulonephritis. Let’s just break it down word by word.

Acute- sudden onset, Post Streptococcal- meaning after a strep infection, Glomerulonephritis- inflammation in the Glomeruli which are these tiny little units in the kidneys that actually filter the blood.

So basically it’s inflammation that can occur in the kidney’s after someone has had an infection caused by a strep infection. It’s not actually caused by the bacteria but by the body’s immune system that gets confused and accidentally attacks the glomeruli in the kidney.

So this means not only impetigo, but also strep throat and scarlet fever other infections caused by strep can cause this post streptococcal glomerulonephritis. This usually happens between 10-14 days after the initial strep infection. It can happen in adults, but it’s most common in kids ages 4-12 years.

So, because the kidneys are damaged a child with APSGN will most likely present with Edema, HTN, and hematuria.

These three symptoms are the triad of symptoms to remember for APSGN. If you ever see pediatric patient with edema, HTN, hematuria it should should stand out to you okay? Because these are not the kind of symptoms we see everyday with kids. So if you do, remember to ask about recent illnesses because it could be that their kidneys are damaged from a strep infection.

Your priority nursing concepts for a patient with impetigo are infection control and tissue/skin integrity.
So, Impetigo is really a pretty straight forward diagnosis. All of your patient education and nursing care stem from the 3 facts you see listed here. First, remember that it is a bacterial rash, so from this you should be able to remember that it’s treated with antibiotics, that common causes are strep and staph bacteria and lastly that a complication may be acute post streptococcal glomerulonephritis. Number two don’t forget that it has a unique honey-coloured crust. Number three, it highly contagious! So it will require contact precautions and patient education to prevent spreading!

Like I said- just remember these three things, you’ll be set!
That’s it for our lesson on Impetigo. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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