Impetigo

Impetigo Nursing Diagnosis Interventions and Care Plans

Impetigo NCLEX Review Care Plans

Nursing Study Guide on Impetigo

Impetigo is a highly communicable infection of the skin, often seen among infants and children.

Although it is a common skin disorder, it is not usually serious in nature.

Impetigo is characterized by facial red sores or blisters, especially around the nose and mouth area, hands and feet.

The sores can develop into honey-colored crusts once it burst.

Antibiotic treatment is mostly recommended to assist in the prevention of the spread of infection to other individuals.

If a child is diagnosed with impetigo, it is important to stay at home until the child is no longer contagious, which is usually 24 hours after the start of the antibiotic therapy.

Signs and Symptoms of Impetigo

The classic signs and symptoms of impetigo are:

  • red sores – often rupture quickly; usually occur around the area of the nose and mouth, it can also be spread by the fingers, clothing and use of towels, to different areas of the body
  • discharge from the sores for a couple of days
  • development of yellowish-brown crust
  •  mild itching, pain and/or soreness,
  • Bullous impetigo – occurs less frequently; characterized by larger blisters found in the trunk of infants and young children
  • Ecthyma – another form of impetigo that infiltrates deeper into the skin, causing painful sores filled with pus and fluid. It is more serious and can lead into deep ulcers

Causes and Risk Factors of Impetigo

Impetigo is caused by bacterial exposure through direct contact with the lesions of an infected individual.

It can also be contracted indirectly by touching contaminated items such as used towels, linens, toys and clothing.

Impetigo is caused by group A Streptococcus and Staphylococcus aureus.

The bacteria produce a toxin that causes the breakdown of the epidermis, the top layer of the skin, and stratum granulosum, resulting in the formation of blisters.

Immediate rupture of the blisters results in the development of yellow crust in the affected areas of the body.

The following are different factors that increase the risk of impetigo:

  • Age – impetigo commonly affects children between the age of 2 and 5
  • Environment -crowded places such as school and childcare settings can increase the spread of impetigo
  • Temperature – the warm and humid weather during summer season can cause impetigo infections.
  • Sports – direct skin-to-skin contact such as football and wrestling
  • Impaired skin integrity – insect bites, rash, open wounds, or any skin injury that result in skin breakdown increase the risk for bacterial infection
  • Immunosuppression – certain conditions such as diabetes, that can cause the immune system of an individual to weaken may lead to the development of ecthyma

Complications of Impetigo

Impetigo generally is not a dangerous condition; the sores brought about by mild infection often heal without the development of scars.

In rare occasions, impetigo may cause the following complications:

  1. Cellulitis. An infection that involves the underlying tissue of the skin and may extend to the lymph nodes and bloodstream is called cellulitis. This can cause potential serious and life-threatening problems if not treated properly.
  2. Kidney problems. The damage in the kidneys can be brought about by the bacteria that causes impetigo.
  3. Scarring. A severe form of impetigo called ecthyma can lead to the development of deep ulcers causing the formation of scars.

Diagnosis of Impetigo

  • Visual examination of the distinctive sores
  • Laboratory tests – generally, the need to perform laboratory test may be unnecessary. However, in cases where the sores are unresponsive to antibiotic therapy, the doctor may take a fluid sample from the sore to determine the best type of antibiotic to use because some bacteria may be resistant to certain antibacterial drugs.

Treatment of Impetigo

  1. Antibiotics. Impetigo is generally treated through the use of antibiotic therapy. The affected area should be soaked first in warm water to remove the scabs, wet compresses may also be used. This is followed by the application of the prescribed antibiotic cream or ointment directly to the affected areas. Removal of scabs prior to applying the topical antibiotic promotes good absorption of the medication. If the infection is mild and have not spread to other areas of the body, the sores can be treated through the use of over-the-counter antibiotic cream containing bacitracin, as a home remedy. Application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection. The doctor may also prescribe oral antibiotic drugs in patients who have a lot of impetigo sores. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.
  2. Proper wound hygiene. It is also important to maintain the cleanliness of the affected areas by washing with mild soap and water. The sores may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent worsening of the infection.

Nursing Care Plans on Impetigo

Nursing Care Plan 1

Nursing Diagnosis: Impaired Skin Integrity related to infection of the skin secondary to impetigo, as evidenced by red sores around the area of the nose and mouth, discharge from the sores for a couple of days, development of yellowish-brown crust,  mild itching, pain and soreness

Desired Outcome: The patient will re-establish healthy skin integrity by following treatment regimen for impetigo.

InterventionRationale
Assess the patient’s skin on his/her whole body.To determine the severity of impetigo and any affected areas that require special attention or wound care.
Isolate the patient in his/her room, at home ideally for 10 days.Impetigo is an infectious/ communicable skin disease. The patient needs to be isolated ideally for 7 to 10 days after starting treatment.
The affected area should be soaked first in warm water to remove the scabs, wet compresses may also be used. This is followed by the application of the prescribed antibiotic cream or ointment directly to the affected areas.Removal of scabs prior to applying the topical antibiotic promotes good absorption of the medication.
Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician.Impetigo is generally treated through the use of antibiotic therapy. If the infection is mild and have not spread to other areas of the body, the sores can be treated through the use of over-the-counter antibiotic cream containing bacitracin, as a home remedy. Application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection. The doctor may also prescribe oral antibiotic drugs in patients who have a lot of impetigo sores. Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.
Educate the patient and caregiver about proper wound hygiene through washing the sores with soap and water. Advise the patient and caregiver to prevent scratching the affected areas.It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The sores may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent worsening of the infection.
Teach the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection.Proper application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection.

Nursing Care Plan 2

Risk for Infection related to contagious skin infection

Desired Outcome: The patient will prevent spread of infection to the rest of the body, as well as cross-contamination to other people by following treatment regimen for impetigo.

InterventionRationale
Assess the patient’s skin on his/her whole body.To determine the severity of impetigo and any affected areas that require special attention or wound care.
Isolate the patient in his/her room, at home ideally for 10 days.Impetigo is an infectious/ communicable skin disease. The patient needs to be isolated ideally for 7 to 10 days after starting treatment.
Administer antibiotics as prescribed. Ensure that the patient finishes the course of antibiotic prescribed by the physician.Even if the symptoms have already improved and healing is evident, it is still important to finish the course of antibiotic therapy to prevent recurrence of infection and antibiotic resistance.
Educate the patient and caregiver about proper wound hygiene through washing the sores with soap and water.It is important to maintain the cleanliness of the affected areas by washing with mild soap and water. The sores may cause mild itching, but it is advisable to prevent the child from scratching the affected areas to prevent worsening and spread of the infection.
Trim the patient’s fingernails and ensure frequent hand hygiene. Advise the patient and caregiver to prevent scratching the affected areas.Long fingernails tend to harbor more bacteria. Scratching the infected skin areas will allow the bacteria to transfer into the fingernails and onto the fingerpads. When the patient touches other people or objects with infected hands, the infection will likely spread.
Teach the patient/ caregiver the proper application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection.Proper application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection.

Other possible nursing diagnoses:

  • Disturbed Body Image
  • Anxiety
  • Knowledge Deficit

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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