Nursing Care Plan (NCP) for Impetigo
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Outline
Lesson Objective for Impetigo Nursing Care Plan
- Understanding of Impetigo:
- Gain knowledge about the etiology, pathophysiology, and clinical manifestations of impetigo to provide effective nursing care.
- Infection Control Measures:
- Learn and implement proper infection control measures to prevent the spread of impetigo within healthcare settings and the community.
- Skin Assessment Skills:
- Develop skills in assessing skin lesions characteristic of impetigo, including recognizing the appearance of vesicles, pustules, and honey-colored crusts.
- Topical Medication Administration:
- Understand the administration and proper application of topical antibiotics or antimicrobial ointments prescribed for impetigo treatment.
- Patient and Family Education:
- Acquire knowledge to educate patients and their families on the importance of medication adherence, hygiene practices, and measures to prevent the recurrence of impetigo.
Pathophysiology of Impetigo
- Microbial Invasion:
- Impetigo is primarily caused by the invasion of the skin by bacteria, with the most common culprits being Staphylococcus aureus and Streptococcus pyogenes.
- Breakdown of Skin Barrier:
- The bacteria typically enter the skin through existing breaks, cuts, or insect bites, compromising the natural barrier function of the skin.
- Toxin Production:
- Staphylococcus aureus, in particular, can produce toxins that contribute to the development of characteristic skin lesions associated with impetigo.
- Formation of Vesicles and Pustules:
- The invasion and toxin production lead to the formation of small vesicles and pustules, which may rupture, releasing infectious material.
- Honey-Colored Crusts:
- As the lesions rupture, a characteristic feature of impetigo is the formation of honey-colored crusts on the skin surface, representing a collection of dried serum, bacteria, and inflammatory cells.
- Autoinoculation:
- Scratching or touching the affected areas can lead to autoinoculation, spreading the bacteria to other parts of the body and facilitating the development of new lesions.
- Contagious Nature:
- Impetigo is highly contagious, and direct contact with the skin lesions or items contaminated with the infectious material can contribute to the transmission of the bacteria.
- Environmental Factors:
- Environmental factors, such as warm and humid conditions, may create an optimal environment for bacterial growth and impetigo development. Factors like poor hygiene or crowded living conditions can also contribute.
Etiology of Impetigo
- Bacterial Infection:
- Impetigo is primarily caused by bacterial infections, with the two most common bacteria being Staphylococcus aureus and Streptococcus pyogenes.
- Breaks in the Skin:
- The bacteria enter the skin through breaks, cuts, or abrasions, exploiting any disruption in the skin’s integrity as a point of entry.
- Poor Hygiene:
- Impetigo is more likely to occur in conditions where personal hygiene is compromised, as cleanliness helps prevent bacterial colonization.
- Close Contact and Crowded Conditions:
- The infection spreads easily in environments where there is close person-to-person contact or overcrowded living conditions.
- Warm and Humid Climates:
- Impetigo is more prevalent in warm and humid climates, creating favorable conditions for bacterial growth and skin infections.
- Compromised Immune System:
- Individuals with weakened immune systems, whether due to underlying health conditions, medications, or other factors, may be more susceptible to impetigo.
- Insect Bites and Scratches:
- In addition to breaks in the skin, impetigo can also develop at the sites of insect bites or scratches, providing alternative entry points for bacteria.
- Shared Personal Items:
- Sharing personal items, such as towels, razors, or clothing, can contribute to the transmission of bacteria and increase the risk of impetigo.
- Pre-existing Skin Conditions:
- People with pre-existing skin conditions, like eczema or dermatitis, may have compromised skin barriers, making them more prone to impetigo.
Desired Outcome for Impetigo
- Resolution of Skin Lesions:
- The primary goal is the complete resolution of impetigo lesions, including the disappearance of red sores, blisters, and honey-colored crusts.
- Absence of Itching and Discomfort:
- The patient should experience relief from itching and discomfort associated with impetigo, indicating the successful management of symptoms.
- Prevention of Complications:
- To prevent the spread of infection and potential complications, such as cellulitis or post-streptococcal glomerulonephritis, through timely and effective treatment.
- Negative Bacterial Culture:
- Achieving a negative bacterial culture from skin swabs indicates the eradication of the causative bacteria, confirming the effectiveness of the chosen treatment.
- Improved Hygiene Practices:
- Educating and encouraging patients and caregivers to adopt improved hygiene practices to prevent the recurrence of impetigo and minimize the risk of bacterial skin infections in the future.
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 Assessment for Impetigo
- Skin Examination:
- Perform a comprehensive inspection of the affected areas to identify characteristic impetigo lesions, such as red sores, blisters, and honey-colored crusts.
- Lesion Distribution
- Assess the distribution of lesions to determine if they are localized or widespread, as this information guides treatment planning.
- Skin Integrity:
- Evaluate the overall integrity of the skin around impetigo lesions, checking for signs of inflammation, redness, swelling, or warmth.
- Itching and Discomfort:
- Inquire about the presence and severity of itching and discomfort, as these symptoms can impact the patient’s well-being.
- Patient History:
- Gather a detailed patient history, including any recent skin injuries, exposure to irritants, or previous episodes of impetigo.
- Hygiene Practices:
- Assess the patient’s hygiene practices, including frequency of bathing and handwashing, as poor hygiene can contribute to impetigo.
- Contact History:
- Inquire about recent exposure to individuals with impetigo or other skin infections to identify potential sources of transmission.
- Systemic Symptoms:
- Monitor for systemic symptoms such as fever, which may indicate a more severe infection requiring additional medical attention.
Implementation for Impetigo
- Topical Antibiotic Application:
- Apply prescribed topical antibiotics to impetigo lesions as directed by the healthcare provider. Ensure that the affected areas are covered with the medication.
- Wound Care:
- Instruct the patient and caregivers on proper wound care, emphasizing gentle cleansing of impetigo sores with mild soap and water. Avoid picking at crusts to prevent further infection.
- Isolation Precautions:
- Encourage the practice of good hygiene and recommend isolation precautions to prevent the spread of impetigo. Advise the patient to avoid close contact with others until lesions are healed.
- Education on Contagious Nature:
- Educate the patient and caregivers about the contagious nature of impetigo and the importance of maintaining good personal hygiene to prevent re-infection and transmission.
- Follow-Up Monitoring:
- Schedule follow-up appointments to monitor the progress of impetigo treatment. Assess for any adverse reactions to medications and ensure compliance with the prescribed regimen.
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. |
Evaluation for Impetigo
- Resolution of Lesions:
- Evaluate the patient’s skin for the resolution of impetigo lesions. Assess whether the sores have healed, and crusts or scabs have fallen off, indicating successful treatment.
- Absence of New Lesions:
- Monitor for the absence of new impetigo lesions. A lack of new sores suggests that the implemented interventions have effectively controlled the spread of the infection.
- Patient Compliance:
- Assess the patient’s compliance with the prescribed treatment plan, including the use of topical antibiotics and adherence to hygiene practices. Non-compliance may impede the healing process.
- Reduction in Contagiousness:
- Evaluate whether the patient has become less contagious by observing improvements in isolation precautions and a decrease in the risk of transmitting impetigo to others.
- Patient Education Understanding:
- Engage in discussions with the patient and caregivers to assess their understanding of impetigo, its causes, and preventive measures. Ensure that they are well-informed to prevent recurrence and manage potential future outbreaks effectively.
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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