BACTERIAL INFECTIONS-IMPETIGO
Definition
Impetigo is a common and highly contagious skin infection that mainly affects infants and children. Impetigo usually appears as red sores on the face, especially around a child's nose and mouth, and on hands and feet. The sores burst and develop honey-colored crusts.
Health Education
Signs and Symptoms
Classic signs and symptoms of impetigo involve red sores that quickly rupture, ooze for a few days and then form a yellowish-brown crust. The sores usually occur around the nose and mouth but can be spread to other areas of the body by fingers, clothing and towels. Itching and soreness are generally mild.
Causes
It's usually caused by one of two bacteria: Staphylococcus aureus or Streptococcus pyogenes (also called group A streptococcus, which also causes strep throat). Methicillin-resistant Staphylococcus aureus (MRSA) is also becoming an important cause of impetigo.
Risk Factors
Age. Impetigo most commonly occurs in children ages 2 to 5.
Crowded conditions. Impetigo spreads easily in schools and child care settings.
Warm, humid weather. Impetigo infections are more common in summer.
Certain sports. Participation in sports that involve skin-to-skin contact, such as football or wrestling, increases your risk of developing impetigo
Broken skin. The bacteria that cause impetigo often enter your skin through a small skin injury, insect bite or rash.
Complications
Cellulitis. This potentially serious infection affects the tissues underlying your skin and eventually may spread to your lymph nodes and bloodstream. Untreated cellulitis can quickly become life-threatening.
Kidney problems. One of the types of bacteria that cause impetigo can also damage your kidneys
Scarring. The ulcers associated with ecthyma can leave scars
Pathophysiology
Gently wash the affected areas with mild soap and running water and then cover lightly with gauze.
Wash an infected person's clothes, linens and towels every day and don't share them with anyone else in your family.
Wear gloves when applying antibiotic ointment and wash your hands thoroughly afterward.
Cut an infected child's nails short to prevent damage from scratching
Wash hands frequently.
Keep your child home until your doctor says he or she isn't contagious.
Classification
Primary Impetigo
Secondary Impetigo
Where the bacteria invades the skin because the barrier has been broken by another infection like scabies or eczema
When the bacteria invades the skin through a cut ,bite or injury
Depending on the clinical presentation it can be Bullous or Non-Bullous
Intact skin is usually resistant to colonization or infection by S aureus or GABHS. These bacteria can be introduced from the environment and only transiently colonize the cutaneous surface. Experimental studies have shown that inoculation of multiple strains of GABHS on to the surface of subjects did not produce cutaneous disease unless skin disruption had occurred.
Medical Mangement
Children < 7 years 12-25mg/kg 6 hourly for 5 days
Children > 7 years and Adults Flucloxacillin 500mg 6 hourly for 5 days and Cephacallin 500mg 6 hourly for 5 days.
Surgical Management
None
Nursing Management
Impetigo is one of the medical conditions listed in the nurse prescribers' extended formulary, which provides guidance on the use of oral antibacterials for the treatment of impetigo. As an independent nurse prescriber, it is important to recognise that the management of impetigo is multifaceted. It is important that the practitioner has an up-to-date clinical and pharmaceutical knowledge, is aware of their limitations, and is also aware of local and national policies in place.
Diagnostic Procedures
Physical Examination
Nursing Care Plan
Disturbed sensory perception related to impaired nerve stimulation.
Outcomes and Goals
The patient will display timely healing of wounds without complication.
The patient will maintain optimal nutrition and physical well-being.
The patient will participate in prevention measures and treatment program.
The patient will verbalize feelings of increased self-esteem.
Nursing Intervention
Monitor complications. Observe for complications to monitor progress of wound healing.
Clean the area. Keep the area clean and dry and carefully dress wounds to assist body’s natural process of repair.
Wound care. Use appropriate barrier dressings and wound covering to protect the wound and surrounding tissues.
Create a care plan. Consult with wound specialist as indicated to assist with developing plan of care for potentially serious wounds.
Evaluation
Patient displayed timely healing of wounds without complication.
Patient maintained optimal nutrition and physical well-being.
Patient participated in prevention measures and treatment program.
Patient verbalized feelings of increased self-esteem.