Nursing Care Plan (NCP) for Impetigo

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Outline

Pathophysiology

Impetigo is the most common bacterial skin infection in children. It is highly contagious and normally appears around the nose, mouth and extremities. It is characterized by blisters with yellow fluid that rupture and leave a honey-colored crust. Impetigo is spread through direct contact with sores and scratching may cause the lesions to spread.  The normal course of infection typically lasts 2-3 weeks without treatment. Systemic complications, including rheumatic fever and glomerulonephritis are rare, but can occur.

Etiology

Impetigo is caused by common bacteria, usually Group A beta-hemolytic streptococcus or Staphylococcus aureus that enters through breaks in the skin.  It often accompanies poor hygiene and is more prevalent in warm temperatures. The condition is considered contagious as long as lesions are present.

Desired Outcome

Patient will be free from infection and exhibit an absence of skin lesions; patient will not have systemic complications

Subjective Data:

  • Generalized weakness
  • Malaise
  • Itching

Objective Data:

  • Multiple lesions or bullae around the mouth and nose or extremities
  • Honey-colored crust around lesions
  • Fever
  • Diarrhea

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess skin for lesions; note color and presence of crusting Open sores or blisters may form around mouth and nose, but may also be located on trunk and extremities. Ruptured blisters and sores may have yellow crusting on or around the lesions.
Assess vitals; note fever Monitor for signs of systemic infection or complication
Maintain contact precautions Disease is spread through direct contact with lesions. Use PPE and sanitize equipment or tools (or use disposable equipment if available)
Apply topical antibiotics with sterile, individual applicators Topical antibiotics may be appropriate when a small area is affected. A 7 day course is generally required.

Make sure to avoid contamination of container and other areas when applying topical treatments.

Administer oral antibiotics Oral antibiotics may provide better treatment of infection than topical treatments alone. There should be signs of improvement after 2-3 days of treatment.
Make sure patient’s fingernails are trimmed and clean; use mittens or socks on the hands of infants as appropriate Itching is a common symptom. Scratching lesions will cause the disease to spread to other parts of the body, or other people.
Educate patient and caregivers about how to prevent the spread of disease to others Infected child should use their own towels and linens which should be washed alone.

Ensure good hand washing habits;

Avoid contact with others who may have depressed immune system.

Avoid outside play, high temperatures that will make the sores worse.

Writing a Nursing Care Plan (NCP) for Impetigo

A Nursing Care Plan (NCP) for Impetigo starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://emedicine.medscape.com/article/965254-overview

https://www.mayoclinic.org/diseases-conditions/impetigo/symptoms-causes/syc-20352352

https://my.clevelandclinic.org/health/diseases/15134-impetigo

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Transcript

Hi everyone. Today, we are going to be creating a nursing care plan for impetigo. Say that once with me: impetigo. Perfect. Let’s get started. So I’m going to go over the pathophys. So infantigo is the most common bacterial skin infection in children. It is highly contagious and normally appears around the nose, mouth, and extremities. It is characterized by blisters with yellow fluid that ruptures and leaves a honey color. Some nursing interventions or nursing considerations: we want to do a full skin assessment, vital signs, administer medications, maintain contact precautions, and educate the patient and family. Some desired outcomes: the patient will be free from infection and exhibit an absence of skin lesions. The patient will also not have any sort of systemic complications. So here you’re going to see an example of impetigo. You’re going to notice these lesions and this honey color type crusting here on the chin. So we’re going to go ahead and go into the care plan. 

We’re going to be going over and writing down some subjective data and some objective data. So what we’re going to see with these patients: one of the main things is that they’re going to be complaining of itchiness. So it’s going to be really, really itchy and it’s always around like the mouth, the nose, or the extremities. They’ll also have generalized weakness, a fever and diarrhea. 

Some interventions: we want to make sure that we are assessing those skin lesions. So doing a skin assessment, making sure you’re noting the color and the presence of the crusting. Some open source or blisters may form around the mouth and the nose, but they also might be located on the trunk or the extremities. Ruptured blisters, and sores may also have that yellow crusting on or around the lesions. You also want to make sure that you’re going to be assessing the vital signs, noticing a fever and monitoring for signs of any sort of systemic infection or any complications. Another intervention that we’re going to be doing is maintaining contact precautions. The disease is spread through direct contact with the lesions, so you want to make sure you’re using that proper PPE and sanitize the equipment or tools that are used, and dispose of the equipment as needed. Other interventions we’re going to be doing. We’re going to apply any sort of topical antibiotics using sterile individual applicators. You want to make sure to avoid any contamination of the container in other areas when you’re applying those topical treatments. You can also administer oral antibiotics as  this may help to better treat the infection. The topical antibiotics are not as effective. There should be signs of improvement within two to three days of treatment. 

Other interventions that we want to do, you want to make sure that the fingernails are trimmed and clean for infants. You want to use mittens or socks because the constant scratching of lesions can spread the infection and we want to make sure they’re not spreading it to other parts of the body or to other people. You want to make sure that you’re cutting the fingernails. And then the next intervention we want to do is we want to make sure that we’re doing good education for the patient. So you want to educate on prevention and treatment. You want to ensure that they’re doing good hand hygiene, and making sure that they’re washing their hands prior to applying any sort of topical antibiotic and after touching anything. They should avoid any sort of contact with others who have any sort of a depressed immune system. I also want to note to avoid being outside for play during high temperatures as that will make the sores worse. 

All right, we are moving on to the key points. So it is a common bacterial skin infection in children. It is highly contagious, appearing around the nose, mouth and extremities. It is characterized by blisters with yellow fluid that ruptures leaving that honey colored crust, which is very classic for this. It is caused by the group A beta-hemolytic strep or streptococcus. Some subjective and objective data: what you’re going to see with the patient? They’re going to complain of a lot of itching, generalized weakness, multiple lesions around the nose, mouth, or the extremities with honey colored crust around the lesions, fever, and diarrhea. You want to assess and put them on contact precautions. So, full skin assessment, monitoring those vital signs for fever, and maintaining those contact precautions. You want to give that medication and do proper education. So you’re going to apply some of the topical antibiotics or give oral antibiotics. You want to make sure you’re keeping fingernails trimmed and making sure you’re educating on prevention and the spread of the disease to the other body parts or to other people. And there you have it, the completed care plan for today. 

You guys are doing awesome. We love you guys. Go out, be your best self today, and as always happy nursing.

 

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