MEDICAL SURGICAL NURSING 1 NUR 2114

SR. NURASIKIN MOHAMAD SHARIFF

GROUP MEMBERS : Mufidatul Hazirah Bt Othman Mohd Zuhair bin Mohd Yusof Aiminatul Najwa binti Roslan Siti Norsyuhada binti Ramli Nur Ainsyafinaz binti Shamsuddin Mohd Sharafuddin bin Mohammed Shahdan

1. 2. 3. 4. 5. 6. 7. 8.

To describe impetigo To identify types of impetigo To understand pathophysiology of impetigo To know sign and symptom of impetigo To learn etiology of impetigo To differentiate impetigo and other skin diseases To know management of impetigo To avoid any complication of impetigo

IMPETIGO

Definition
Highly contagious gram-positive bacterial

infection of the superficial layers of the epidermis.(Amini,

2010)
usually affects children. develop if bacteria get into healthy skin or into minor cuts, scrapes, or any other small bites.

Other terms for impetigo are pyoderma and impetigo

contagiosa. Occur superficially with no Chern, 2009)

scarring (Mallory, Bree &

Types
There are 3 types : Bullous Non-bullous Ecthyma

bullous

primarily affects infants and children younger than 2 years. usually on the trunk, arms and legs caused only by Staph bacteria.

bacteria produce a toxin

reduces cell-to-cell stickiness (adhesion)

causing separation between epidermis and dermis

leads to the formation of a blister (bullae)

blisters are fragile and contain a clear yellowcolored fluid. dark crust will commonly develop during the final stages of development.

The bullae are delicate and often break and leave red, raw skin with a ragged edge.

With healing, this crust will resolve. (Rockoff & Mersch, 2011,Impetigo, 2010)

Non bullous

Most common form of impetigo. usually starts as a red sore on patients face, most often around the nose and mouth caused by both Staph and Strep bacteria

Initially presents as small red papules similar to insect bites

These lesions rapidly evolve to small blisters The sore ruptures quickly, oozing either fluid or pus

Begins to pustules

Honey-colored crust is formed.

Eventually the crust disappears.

A red mark is left which heals without scarring. (Rockoff & Mersch, 2011, Impetigo, 2011)

Ecthyma
This more serious form of impetigo
penetrates deeper into the skin's second layer (dermis).

Clinical manifestation:

ulcers

painful fluid or pus-filled sores that turn into deep

usually on the legs and feet

The sores break open and scab over with a hard, thick, gray-yellow crust. Scars can remain after the sores heal. Also cause swollen lymph nodes in the affected area (Impetigo, 2010).

Epidemiology
International
About 2.6 episodes per 100 person-weeks have been reported.

Sex
Males = females.

Age
More commonly in children. Neonates are a particularly high-risk group (Rashid, 2010).

Climates
Common in hot, humid climates or in crowded environments (Mallory, Bree & Chern, 2009)

Pathophysiology
Intact skin is an effective barrier that keeps bacteria from entering and growing in the body When there is a break in the skin, bacteria can enter the body and grow there, causing inflammation and infection (Vorwick, 2010) Occur to the skin that has already been irritated by other skin problems:
eczema, poison ivy, insect bites, and cuts or scrapes due to minor trauma. (Durani, 2011)

Develops in skin that's perfectly healthy or skin where there is no visible break (Vorwick, 2010). Infection is spread by scratching it and then touching other parts of the body (Lewis, 2010). Comes into contact with infected skin or other items, such as clothing, towels, and bed linens (Durani, 2011).

Causes/Etiology
Two types of bacteria cause impetigo

Staphylococcus aureus Streptococcus pyogenes

Lives harmlessly on skin until it enters through a cut or other wound causing an infection Methicillin-resistant Staphylococcus aureus (MRSA) is also becoming an important cause of impetigo (Durani, 2011).

Clinical Manifestation
A single or possibly many blisters filled with pus
easy to pop causes a reddish raw-looking base when broken (infants)

Itching blister:
Filled with yellow or honey-colored fluid Oozing and crusting over

Rash:
begin as a single spot, spread to other areas if it is scratched

Skin lesions - face, lips, arms, or legs Swollen lymph nodes near the infection (lymphadenopathy)

Complication
Kidney failure (rare) Many patches of impetigo (in children) Permanent skin damage and scarring (very rare) Spread of the infection to other parts of the body (common)(Lewis, 2010) Poststreptococcal glomerulonephritis (all age groups) Meningitis or sepsis (infants) Ecthyma Erysipelas Deep cellulitis Bacteremia Osteomyelitis Pneumonia (Rashid, 2010)

Treatment
Seldom serious and usually clear on its own

Minor impetigo - hygienic measures Antibiotic ointment or oral antibiotics (Durani, 2011) Commonly mild cases be handled by gentle cleansing, removing crusts and applying the cream (Lee, 2005). Applying a nonstick dressing to the infected area (Impetigo, 2010).

Medication
TOPICAL ANTIBIOTICS

Topical antibiotic treatment is the treatment of choice for uncomplicated localized pyoderma,

Mupirocin (Bactroban)

Retapamulin (Altabax)

SYSTEMIC ANTIBIOTICS

Systemic antibiotic treatment is indicated for widespread or complicated pyoderma

Cephalexin

Augmentin

Dicloxacillin

Erythromycin
(Lewis, 2010)

Nursing Diagnosis - Actual

Impaired skin integrity related to infection as evidence by sign and symptoms of impetigo Restore normal skin integrity: tissue and membrane Wound will heal within 4 days

INTERVENTION
Assess site of skin impairment and determine etiology (etc. skin leisure) Monitor site of skin impairment at least once a day for colour changes, redness, swelling, warmth, pain, and other signs of infection Individualize plan according to patients skin condition, needs, and preferences. Avoid harsh cleansing agents, hot water and extreme friction

RATIONALE
For proper identification of nursing intervention

To identify impending problem earlier

To avoid any upcoming complication

Evaluate for use of specialty mattress or beds

Selects a topical treatment that will maintain a moist wound healing environment Avoid massaging around the site of skin impairment Assess patients nutritional status

To reduce friction

To balance with the need of the skin and to absorb exudate

Massage may lead to deep tissue trauma Inadequate nutritional intake may risk for skin breakdown and compromised healing

Nursing Diagnosis - Potential

Risk for secondary infection to other parts of body or to other people related to poor hygienic conditions and open oozing areas
Remains free from symptoms of infection States symptoms of infection of which to be aware Demonstrate appropriate care of infection Maintain WBC and differential within normal limits Demonstrate appropriate hygienic measure eg. hand washing

INTERVENTION
Observe and report sign of infection Eg. Temperature, skin colour, moisture, texture and turgor Note and report laboratory values of WBC

RATIONALE
To determine the risk of early infection To identify the risk of infection

Encourage balance diet, emphasizing proteins

To complete the regimen of antibiotic prescribed by doctor

To feed immune system

To avoid any complication later on

Avoid physical contact between infected person and other people

To limit the spread of infection

Place patient on isolation precaution Eg: Separate the bed linens, towels, and clothing from those of other family members, and wash these items in hot water. Wear gloves when giving care Pay special attention to areas of the skin that have been injured, eg cuts, scrapes, bug bites, eczema, and rashes. Keep these areas clean and covered

To limit the spread of organism to other patient

Encourage cleanliness and good hygiene practices

use antiseptic solution to clean the

To limit the spread of bacteria to other parts of body and other person

skin instruct patients and family to bath regularly with bactericidal soap not to share bath towels, linen and wash clothes cut the fingernails

Teach how to maintain good hygiene - to do proper hand washing

Patient have knowledge on how to maintain good hygiene environment

Cleanliness is half of Iman

"Allah loves those who turn to Him constantly and He loves those who keep themselves pure and clean." (2: 22) When you prepare for prayer wash your faces, and your hands (and arms) to the elbows; rub your heads (with water) and (wash) your feet up to the ankles. If you are ritually impure bathe your whole body." (5: 6)
"Believers!

Amini, S. (2010, 27 July). Dermatologic Manifestations of Impetigo. Retrieved September 15, 2011, from http://emedicine.medscape.com/article/1052709-overview Baddour, L. M. (2009, October 5). Patient information : Impetigo. Retrieved September 15, 2011, from http://www.uptodate.com/contents/patient-informationimpetigo Barnhill, R. L. (2003). Textbook of Dermatopathology. United States: McGraw Hill. Durani, Y. (2011, May). Impetigo. Retrieved September 15, 2011, fromhttp://kidshealth.org/parent/infections/bacterial_viral/I mpetigo.html# Impetigo. (n.d.). Retrieved September 15, 2011, from http://en.wikipedia.org/wiki/Impetigo