Strep throat (streptococcal pharyngitis) is a bacterial infection caused by group A Streptococcus bacteria. This nursing diagnosis focuses on identifying symptoms, managing pain and discomfort, preventing complications, and limiting transmission to others.
Causes (Related to)
Strep throat affects patients through various contributing factors:
- Bacterial infection from Group A Streptococcus
- Compromised immune system
- Age-related vulnerability (most common in children 5-15)
- Close contact with infected individuals
- Environmental factors including:
- Crowded settings (schools, daycare)
- Poor ventilation
- Seasonal changes (peak in winter/early spring)
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Severe throat pain
- Difficulty swallowing
- Fever and chills
- Headache
- Loss of appetite
- Fatigue
- Nausea (especially in children)
Objective: (Nurse assesses)
- Elevated temperature (>101°F/38.3°C)
- Swollen, red tonsils
- White/yellow patches on tonsils
- Swollen lymph nodes in the neck
- Petechial lesions on the soft palate
- Scarlatiniform rash (if present)
- Tachycardia
- Dehydration signs
Expected Outcomes
- Temperature returns to normal within 24-48 hours of antibiotic initiation
- Pain decreases to manageable levels
- Adequate oral intake is maintained
- No complications develop
- Complete the antibiotic course as prescribed
- Return to normal activities within 5-7 days
- Prevention of transmission to others
Nursing Assessment
Monitor Vital Signs
- Check temperature q4h
- Monitor heart rate
- Assess blood pressure
- Document pain levels
Assess Throat and Oral Status
- Examine throat appearance
- Note the presence of exudates
- Check for enlarged tonsils
- Assess swallowing ability
- Monitor oral intake
Evaluate Hydration Status
- Track fluid intake/output
- Assess skin turgor
- Check mucous membranes
- Monitor urine output
- Document any nausea/vomiting
Check for Complications
- Monitor for peritonsillar abscess
- Assess for rheumatic fever signs
- Watch for kidney inflammation
- Check for sinusitis development
- Document allergic reactions
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to inflammation of pharyngeal tissues as evidenced by reports of severe throat pain, difficulty swallowing, and facial grimacing.
Related Factors:
- Bacterial infection
- Tissue inflammation
- Swollen lymph nodes
- Difficulty swallowing
Nursing Interventions and Rationales:
- Assess pain level q4h
Rationale: Monitors effectiveness of interventions - Administer prescribed analgesics
Rationale: Reduces pain and inflammation - Provide cold liquids/ice chips
Rationale: Soothes throat discomfort - Encourage soft/cold foods
Rationale: Minimizes swallowing discomfort
Desired Outcomes:
- The patient reports decreased pain levels
- Improved ability to swallow
- Increased oral intake
- Better sleep quality
Nursing Care Plan 2: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to streptococcal infection as evidenced by temperature 101.8°F, warm skin, and tachycardia.
Related Factors:
- Bacterial infection
- Inflammatory response
- Dehydration
- Increased metabolic rate
Nursing Interventions and Rationales:
- Monitor temperature q4h
Rationale: Tracks fever progression - Administer antipyretics as ordered
Rationale: Reduces fever - Promote increased fluid intake
Rationale: Prevents dehydration - Apply cooling measures
Rationale: Aids in temperature reduction
Desired Outcomes:
- Temperature returns to normal range
- Improved comfort level
- Adequate hydration maintained
- Normal heart rate achieved
Nursing Care Plan 3: Risk for Infection Transmission
Nursing Diagnosis Statement:
Risk for Infection Transmission related to presence of highly contagious bacteria as evidenced by active strep infection.
Related Factors:
- Bacterial shedding
- Close contact with others
- Limited knowledge of prevention
- Inadequate hand hygiene
Nursing Interventions and Rationales:
- Implement droplet precautions
Rationale: Prevents bacterial spread - Teach proper hand washing
Rationale: Reduces transmission risk - Educate about covering coughs
Rationale: Minimizes droplet spread - Isolate personal items
Rationale: Prevents cross-contamination
Desired Outcomes:
- No transmission to others
- Proper hygiene demonstrated
- Understanding of prevention methods
- Compliance with isolation measures
Nursing Care Plan 4: Deficient Fluid Volume
Nursing Diagnosis Statement:
Deficient Fluid Volume related to decreased oral intake and fever as evidenced by poor skin turgor and decreased urine output.
Related Factors:
- Painful swallowing
- Fever
- Decreased appetite
- Nausea
Nursing Interventions and Rationales:
- Monitor intake/output
Rationale: Ensures fluid balance - Encourage fluid intake
Rationale: Prevents dehydration - Offer preferred beverages
Rationale: Increases compliance - Assess hydration status
Rationale: Monitors effectiveness
Desired Outcomes:
- Adequate hydration maintained
- Improved skin turgor
- Normal urine output
- Moist mucous membranes
Nursing Care Plan 5: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to difficulty swallowing and decreased appetite as evidenced by decreased oral intake and weight loss.
Related Factors:
- Throat pain
- Swallowing difficulty
- Loss of appetite
- Fatigue
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Tracks dietary adequacy - Offer soft, cool foods
Rationale: Reduces swallowing pain - Provide small, frequent meals
Rationale: Increases total intake - Document weight changes
Rationale: Monitors nutritional status
Desired Outcomes:
- Improved nutritional intake
- Weight maintenance
- Better energy levels
- Normal eating patterns resumed
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
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- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
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- Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):e86-102. doi: 10.1093/cid/cis629. Epub 2012 Sep 9. Erratum in: Clin Infect Dis. 2014 May;58(10):1496. Dosage error in article text. PMID: 22965026; PMCID: PMC7108032.
- Steer AC, Lamagni T, Curtis N, Carapetis JR. Invasive group a streptococcal disease: epidemiology, pathogenesis and management. Drugs. 2012 Jun 18;72(9):1213-27. doi: 10.2165/11634180-000000000-00000. PMID: 22686614; PMCID: PMC7100837.
