Pediatrics Group Project: Impetigo

Abstract: Impetigo is a skin infection that will be discussed in detail. A basic explanation is provided along with information about how it is caused; its mode of transmission; the duration of time spent sick; characteristic signs and symptoms; diagnostic strategies, and helpful treatments. Certain aspects of the treatment process require consideration and teaching as well as maintenance of childhood integrity. Statistics are provided to demonstrate the commonality of the impetigo skin infection, as well as a suggested care plan to aide nurses sort through and organize the treatment plan of a patient with the infection.

Pediatrics Group Project: Impetigo Impetigo is an extremely contagious and infectious skin disorder that has proven to be a common type of infection among adults and children (Towle & Adams, 2008). Resulting in its clinical signs and symptoms, this skin infection is common because it is usually caused by a difficult strain of bacteria called Streptococcus, or its strain Streptococcus aureus (Williams & Hopper) Impetigo is a skin infection found on the skin’s superficial surface and appears after contact with the infecting bacterial strain (Towle & Adams, 2008).

The Impetigo infection can be passed by touching an infected person who has open sores, or simply by touching a towel, toy or other object that an infected person has touched (Towle and Adams, 2008). Bug bites, scratches and lacerations provide a portal of entry for Impetigo, and therefore a higher risk of spreading the infection exists over the summer months. Impetigo may clear up on its own in two to three weeks; however, antibiotics are often used to shorten the duration of the infection.

Once a patient is on antibiotics for 24-48 hours, they are no longer considered contagious and may resume their normal daily activities. Parents of a child with impetigo should be informed of how contagious the infection actually is, and that the child should not be around others until the infection has cleared up, or until they have been on antibiotics for at least 24-48 hours. Parents should also be provided with adequate information regarding the importance of sanitizing objects an infected child has touched (Towle and Adams, 2008).

The most common sign and symptom of impetigo is red sores that quickly rupture, ooze for a few days, and then form a yellowish brown crust. These sores usually occur around the nose and mouth but can sometimes be spread to other body parts. Another form of impetigo called bullous impetigo includes larger blisters that appear on the diaper region of infants and young children. The more serious form of impetigo called ecthyma, penetrates deeper into the skin, causing painful fluid filled sores that can turn into deep ulcers.

“The diagnosis usually is made clinically, but rarely a culture may be useful” (Cole, 2007). Although, if the sores do not clear up on their own within a few weeks with the help of antibiotics, the doctor will take a sample of the fluid in the sores to test which kind of antibiotic will work best. Treatment of impetigo is commonly topical antibiotics or a combination of topical and systemic antibiotics if rash is more severe. Gentle washing of the wounds with antibacterial soap is usually recommended and repeated use of wet dressings to the lesions.

Recurrent infections should prompt a referral to a specialist. Nursing considerations with impetigo is depended on what antibiotic is prescribed and what patient and parent teachings you as the nurse need to do. As impetigo falls under contact precautions to prevent the spreading on the infection, standard precautions such as hand washing and cleaning surfaces and clothing and bedding are important. As a nurse you also need to consider if these lesions are causing the child pain and if a pain medication needs to be ordered.

While Impetigo can occur in adulthood, it is most prominent in infants and children. Since it is so contagious, it makes sense that children pass it around so easily. They don’t generally preform regular hand hygiene that is needed to wash the bacteria away from their little hands. Because of their poor hand hygiene, and touching their “boo boos” so often, the bacteria gets spread to new areas on the body, and other children. Children who come from unhealthy, deplorable living conditions have a higher occurrence of contracting Impetigo. (kidshealth.org).

While the sores do heal with treatment, they can be embarrassing for the older children. Since they appear most often around the nose and mouth, it isn’t very easy to conceal. Once it heals, there is rarely any scarring, and if there is, it’s usually minimal. (nlm. nih. gov) Other than the obvious consequences of impetigo like being highly contagious and unsightly, there aren’t really any major effects on childhood. Educating the parents and the children is essential in preventing the spread of impetigo and promoting timely healing.

First, it is important to know what impetigo is and what to look for. Parents and children should know that it is from a bacterium that causes blisters, which burst and seep honey-colored infectious fluids. (kidshealth. org). The ruptured blisters crust over, and appear quite differently than normal scabs. These blisters can occur anywhere on the body, but are most commonly found around the nose and mouth. (nlm. nih. gov). It is important to teach about the imperativeness of proper, regular hand hygiene and the need to keep fingers off of the sores to prevent the spread of the bacteria.

Keeping children’s finger nails short and clean will also help (kidshealth. org). Parents should know to seek medical help. Impetigo requires antibiotic treatment, and usually begins to heal within three days of the start of treatment. It is no longer contagious after 24 hours of treatment. Parents should keep an eye on the child’s sores and temperature after treatment begins. If a fever starts or the affected area(s) become red, warm, swollen, or painful, the doctor needs to be contacted right away. Cleanliness and medical intervention are of utmost importance in order to prevent and treat Impetigo.

This skin disease, impetigo, can occur at any age but is most common in children, particularly those between the ages of two and five. In fact, 90% of bulbous impetigo occurs in children younger than two years old. However, non-bulbous is the more common of the two forms, making up for 70% of cases reported. As a matter of fact, non-bullous impetigo accounts for 10% of all cutaneous problems in pediatric clinics. Impetigo is vastly more common in those patients already suffering from a previous skin impairing condition.

Studies have shown that those with “intact skin (are) usually resistant to infection”, however, those patients with “atopic dermatitis … particularly those with eczema herpeticum, are at increased risk of developing an infection” (Lewis, 2013). Fortunately however, even without treatment, skin will typically return to normal within two to three weeks. Better yet, with proper treatment, lesions will disappear after seven to ten days. Assessment Nursing Diagnosis Patient Outcome (Goal) Nursing Interventions –Sores around the mouth –Red, dry rash appearing around the sores –Child has a history of eczema.

–Sores transitioning into a yellow – brown crust –Itching and warmth over the affected area –At increased risk for “being invaded by pathogenic organisms” r/t “increased environmental exposure to pathogens” (Ladwig & Ackley, 2011). –Impaired skin related to lesions. –Patient will “demonstrate appropriate care of infection-prone site” after teaching. –Patient will “demonstrate appropriate hygienic measures such as hand-washing, oral care, and perineal care” after teaching (Ladwig & Ackley, 2011). — Meticulous hand hygiene! Patient Teaching: –Cut nails and keep proper hand hygiene.

–Bathe with warm water and soap –Instruct client not to scratch wound –Administer topical bactericide as ordered Care Plan References Cole, C. (2007, March 15). Diagnosis and Treatment of Impetigo – American Family Physician. Retrieved November 31, 2013, from http://www. aafp. org/afp/2007/0315/p859. html Impetigo: MedlinePlus. (2013, October 11). Retrieved November 30, 2013, from http://www. nlm. nih. gov/medlineplus/impetigo. html Impetigo. (n. d. ). Retrieved November 30, 2013, from http://kidshealth. org/kid/health_problems/skin/impetigo. html Ladwig, G. B. , & Ackley, B.J. (2011).

Risk for Infection. In Guide to Nursing Diagnosis (3rd ed. , pp. 456-461). Maryland Heights, MI: Mosby Elsevier. Lewis, L. S. (2013, March 20). Impetigo. Retrieved December 2, 2013, from http://emedicine. medscape. com/article/965254-overviw Towle, M. A. , & Adams, E. (2008). Care of the child with integumentary disorders. In Maternal-Child Nursing Care (p. 724). Upper Saddle River, NJ: Pearson. Williams, L. S. , & Hopper, P. D. (2011). Nursing care of patients with skin disorders. In Understanding Medical Surgical Nursing (p. 1318). Philadelphia, PA: F. A. Davis Co.

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