IMPETIGO

CONCEPT
MAPPING
BSN 2Y2-5
 GROUP 2
DAPITAN, CHRISTELYN EUGENIO, KHRISTAL GAYLE

DELA VEGA, GIRLIE FABIA, JANINE MARIE

DEL MAR, JULIANN FLORES, MOLLY

DE VERA, JOSEPH FRANCISCO, KLEARN DIANNE

DULA, STEPHANIE GAMIW, PATRICIA MAY

DUMRIQUE, PRINCESS GARRA, GRACIELLE ANNE

GUMIRAN, ANTHONY GONZALES, VANESSA KRISHA

 CONTENTS
I. Case Scenario
II. Etiology and Diagram
III. Anatomy and Physiology
IV. Pathophysiology
V. Diagnostic and Laboratory
VI. Treatment and Management
VII. Drug Study
VIII. NCP
IX. Discharge Planning
 CASE SCENARIO OF A PATIENT WITH AN
IMPETIGO

Patient JCA is a 2-month old from San Jose Del Monte, Bulacan. He was admitted last January
11, 2020 at Ospital ng Lungsod ng San Jose. His mother noticed that there is presence of
rashes on his cheeks, itchiness, and was diagnosed with an Impetigo.
History of Present Illness: 3 weeks prior to admission, patient experienced rashes in the face and
some parts of his thigh and legs, he felt irritated, so the parents decided to go to Ospital ng Lungsod
ng San Jose Del Monte for consultation and the child was admitted under Dr. Angelina Sevilla, for
further evaluation and management.

Past Medical History: colds 1 month old, immunization BCG, 1 dose of Hepa B, 1 dose of OPV, 1 dose
of DPT given c/o Panaklayan Health Center.

Physical Assessment: skin has reddish and squamous rashes all over his body especially on legs
and feet. Scalp and hair few rashes, face & neck, abdomen with rashes. VS: T- 36. 2 C, CR- 137, RR-
46

Admitting orders, consent for admission, monitor vs q shift, IVF PNSS 500 ml at kVO, Breastfeeding
as tolerated, Oxacillin 130 mg IV q6, Pred 10 syrup p.o, 1 ml BID,Day zinc drops, p.o, 1 ml OD,
Mupirocin ointment apply thinly to affected areas BID, daily bath using mild soap.
January 11, 2020 CBC results - hgb-127 mg/dl, hct-0.38, wbc- 14.6, Segmenters- 0.53
lymphocytes-0.41, eosinophils- 0.03, monocytes- 0.03, platelets- 350

January 16, 2020, Dr. Sevilla made her rounds and ordered MGH anytime once IV antibiotics is
completed, meds, Day zinc drops, p.o , 1 ml OD, Daily bath using mild soap, continue Mupirocin
ointment BID, follow up check up after 1 wk at OPD.
 Etiology
Staphylococcus aureus and Streptococcus pyogenes leads to
infection of superficial epidermis

Modifiable Risk PathoPhysiology

Factors Non- Modifiable
✔ Itchiness Bullous impetigo- caused by Staphylococcus Aureus bacteria that produce a toxin that causes a Age: 2 months old
✔ Irritation break between the top layer (epidermis) and the lower levels of skin forming a blister or bulla. Sex: Male
✔ Rashes
Non-bullous impetigo- caused by both Staphylococcus Aureus and Streptococcus Pyogenes. It
appears as small blister or scabs which then form yellow or honey-colored crust.

Medical Diagnosis

Impetigo

Medical and/or Surgical Treatments

MANAGEMENT & TREATMENT:
Clinical Manifestations
- Monitor vital signs every shift Diagnostic test
✔ Rashes - Breastfeeding as tolerated
✔ Reddish skin - Daily bath using mild soap. ✔ Complete blood count
✔Squamous rashes all (CBC).
over the body MEDICATIONS:
- IVF Plain NSS 500 ml kreep vin open
- 130 mg Oxacillin through IV every 6 hours
- 1 ml Prednisolone syrup by oral administration taken twice a day.
- 1 ml Dayzinc drops by oral administration taken once a day.
- Application of Mupirocin ointment thinly to affected areas twice a day.
 Nursing Diagnosis Significant/ Pertinent Findings

- Hgb- 127 mg/dl

Impaired skin integrity related to alteration in - Hct- 0.38
skin appearance as evidence by presence of - Wbc- 14.6
rashes and reddish skin. - Segmenters- 0.53
- Lymphocytes- 0.41
- Eosinophils- 0.03
- Monocytes- 0.03
- Platelets- 350

Nursing Interventions
Expected Outcomes
INDEPENDENT:
- Monitor vital signs: note fever SHORT TERM GOALS:
- Monitor skin color, the existence of redness. - The mother stated that there was a
- Assess skin for lesions: note color and presence of crusting. decreased redness and rashes on the
- Encourage the family to maintain clean, dry clothes preferably baby’s body and reported that there was
cotton fabric. no spread of infection.
- Advice proper hygiene.
- Trim the fingernails of the baby and clean use mittens or socks LONG TERM GOALS:
on the hands of infants as appropriate - After 2 days of rendering proper nursing
interventions, the patient will display timely
DEPENDENT: healing of skin rashes and redness without
- Give medication as prescribed by the physician (oxacillin, complication
prednisolone and mupirocin ointment)
ANATOMY AND PHYSIOLOGY
PathoPhysiology
 THEORETICAL BASED

Infection of superficial epidermis cause

Non bullous impetigo: by Staphylococcus Aureus and Bullous impetigo:
Streptococcus Pyogenes
Staphylococcus Aureus and Staphylococcus Aureus
Streptococcus Pyogenes

Poor hygiene, Warm weather/ area, Over Disruption of

Crowded unsanitary environment and skin
pre-existing cutaneous disease.

Disruption of skin
Invade the skin epidermal
layer

scratching, insect bite, lice,

Teichoic acid burns, varicella, herpes and
trauma Local production of exfoliant
toxin

Fibronectin (not available on

the skin)
Desmoglein 1
 Bacteria Infiltrate to
Bacterial growth and
invade
inflammatory reaction

Single erythematous macule Inflammatory reaction

developing to vesicle/pustule
<2cm

Small vesicle progressing

Punch-out into superficial bullae
Rupture
ulceration

Large flaccid bullae, erythematous

Vesicular lesion and pustules with
base with collarettes of scale at
honey colored crust and moist
peripheral of ruptured lesion
erythematous base
 CLIENT-BASED

Presence rashes on the cheeks

and itchiness

3 weeks prior to admission:

rashes in the face and some parts of his thigh and legs, he felt
irritated

Physical Assessment

Patient skin has reddish and

squamous rashes all over his
body especially on legs and
feet. Scalp and hair few rashes,
face & neck, abdomen with
Single erythematous macule Small vesicle progressing
rashes.
developing to vesicle/pustule into superficial bullae
<2cm
Vesicular lesion and pustules with Large flaccid bullae, erythematous
honey colored crust and moist base with collarettes of scale at
erythematous base peripheral of ruptured lesion

Non-Bullous Impetigo Bullous Impetigo

IMPETIGO
 DIAGNOSTIC TEST
COMPLETE BLOOD COUNT

LABORATORY TEST RESULT NORMAL VALUES FINDINGS ANALYSIS

HEMOGLOBIN 127 mg/dl 95-130g/dL Normal Within normal range

HEMATOCRIT 0.38/ 38% 30%-40% Normal Normal volume of red blood

cells

WHITE BLOOD CELL 14.6 6 x103/µL -17.5 x103/µL Normal The immune system is working
to destroy the infection

SEGMENTERS 0.53/ 53% 13%-33% High Sign of bacterial infection

LYMPHOCYTES 0.41/ 41% 41%-71% Normal Normal response to infection

EOSINOPHILS 0.03/ 3% 0-3% Normal Within normal range

MONOCYTES 0.03/ 3% 4%-14% Low Increase the vulnerability to

infection that occur in the skin

PLATELETS 350 150 x103/µL -450 x103/µL Normal No clotting or bleeding

 TREATMENT AND MANAGEMENT
MANAGEMENT AND TREATMENT

- Monitor vital signs every shift.

- Breastfeeding as tolerated.
- Daily bath using mild soap.

MEDICATIONS

- IVF Plain NSS 500 ml kreep vin open.

- 130 mg Oxacillin through IV every 6 hours.
- 1 ml Prednisolone syrup by oral administration taken twice a day.
- 1 ml Dayzinc drops by oral administration taken once a day.
- Application of Mupirocin ointment thinly to affected areas twice a day.
DRUG STUDY
 MUPIROCIN OINTMENT

Generic Name Mechanism of Indication Contraindication Side effects Nursing

Action Considerations

Mupirocin Mupirocin inhibits BACTROBAN ointment is BACTROBAN Rash If applied topically to skin
bacterial protein indicated for the topical ointment is lesions, monitor any new
Brand Name: synthesis by treatment of impetigo contraindicated in Nausea or increased skin
reversibly and due to susceptible reactions, including
patients with known
Bactroban, Centany specifically isolates of localized pain, burning,
hypersensitivity to Skin irritation
binding to Staphylococcus aureus itching, or stinging. Report
bacterial (S. aureus) and mupirocin or any of severe or prolonged skin
Classification:
isoleucyl-transfer Streptococcus the excipients of reactions to the
Topical Antibacterial RNA (tRNA) pyogenes (S. BACTROBAN physician.
synthetase. pyogenes). ointment.
Agents, Other Topical
Always wash hands
Nasal Anti-infectives
thoroughly and disinfect
equipment (whirlpools,
Dosage, Frequency, and
electrotherapeutic
Route of administration
devices, treatment tables,
and so forth) to help
- For Topical Use Only.
prevent the spread of
infection. Use universal
-Apply thinly to affected
precautions or isolation
areas BID. procedures as indicated
for specific patients.

Prolonged use may

cause overgrowth of
non-susceptible bacteria
and fungi.
PHARMACOKINETICS
Administered
topically to the skin MUPIROCIN
or the nares.

Protein-bounded: 97% Half-life: 17–36 min.

METABOLISM
AND
EXCRETION
DISTRIBUTION

Remains in the stratum It is rapidly metabolized

corneum after topical
use for prolonged periods
of time (72 hr).
 Oxacillin

Generic Name Mechanism of Indication Contraindication Side Nursing Considerations

Action effects

Oxacillin By binding to specific Treatment of the Asthma, Fever Watch for seizures; notify physician
penicillin-binding following carbapenem immediately if patient develops or
Brand Name: proteins (PBPs) located infections due to hypersensitivity, Rash increases seizure activity.
cephalosporin
inside the bacterial cell penicillinase-prod
Bactocill hypersensitivity, Monitor signs of allergic reactions and
wall, Oxacillin inhibits ucing eczema, penicillin anaphylaxis, including pulmonary
the third and last stage staphylococci. hypersensitivity. symptoms (tightness in the throat
Classification:
of bacterial cell wall and chest, wheezing, cough dyspnea)
Penicillinase-Resista synthesis. Cell lysis is or skin reactions (rash, pruritus,
nt Penicillin then mediated by urticaria). Notify physician or nursing
bacterial cell wall staff immediately if these reactions
Antibiotics
autolytic enzymes such occur.
Dosage, Frequency, as autolysins; it is
Assess muscle aches and joint pain
and Route of possible that Oxacillin
(arthralgia) that may be caused by
administration interferes with an
serum sickness. Notify physician if
autolysin inhibitor. these symptoms seem to be
- Oxacillin 130 mg IV drug-related rather than caused by
q6 musculoskeletal injury or if muscle
and joint pain are accompanied by
allergy-like reactions (fever, rashes,
etc.)

Monitor injection site for pain, swelling,

and irritation. Report prolonged or
excessive injection site reactions to
the physician.
PHARMACOKINETICS
OXACILLIN

Half life:
Drugs enters the body
INTRAVENOUSLY approximately 30
minutes

Protein-bounded: 89%-94% Completely absorbed following IV

administration; well absorbed from IM
sites.
DISTRIBUTION

Widely
ABSORPTION distributed
 Prednisolone

Generic Name Mechanism of Indication Contraindication Side effects Nursing

Action Considerations

Prednisolone Decreases It is used to treat Hypersensitivity to Nausea Be alert to subclinical

inflammation via conditions such as, the active substance signs of lack of
Brand Name: suppression of the blood problems, or to any of the Vomiting improvement such
immune system
migration of excipients as continued
disorders, skin
Pediapred, FloPred, polymorphonuclear GI irritation drainage, low-grade
conditions, and
Orapred, Orapred leukocytes and severe allergies. fever, and interrupted
ODT, Millipred, reversing increased healing. In diseases
Millipred DP, Prelone capillary caused by
Syrup, and Veripred permeability. It also microorganisms,
20 suppresses the infection may be
immune system by masked, activated, or
Classification: reducing the activity enhanced by
and the volume of corticosteroids.
Glucocorticoid/Anti-i the immune system Observe and report
nflammatory exacerbation of
symptoms after short
Dosage period of therapeutic
response.
10 syrup p.o, 1 ml BID
PHARMACOKINETICS
PREDNISOLONE
Metabolized in liver

Drug enters the body

orally

METABOLISM

Protein-Bounded
( only unbound portion is active)
Delivered to muscle,
liver, skin,intestine, and
kidneys
EXCRETION
DISTRIBUTION
- Inactive metabolites and small amounts of
unmetabolized are excreted in URINE.
- Insignificant amount excreted in FECES
NURSING CARE PLAN
 IMPETIGO

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS

SUBJECTIVE DATA: Impaired skin integrity SHORT-TERM GOALS: INDEPENDENT: Monitor for signs of After 6 hours of
related to alteration in systemic infection or nursing intervention
"Napansin kong may skin appearance as After 6 hours of nursing Monitor vital signs; note complication the goal was met:
rashes na sa buong evidence by presence intervention the patient’s fever (short-term)
katawan ng anak of rashes and reddish mother will able to: To know the progression
ko"As verbalized by skin. Monitor skin color, the of the disease and the The mother stated
the mother ● State a existence of redness effectiveness of actions that there was a
decrease of taken. decreased of
OBJECTIVE DATA: redness and redness and rashes
rashes on the on the baby’s body
Open sores or blisters
● Reddish baby’s body. Assess skin for lesions; note may form around mouth and reported that
skin color and presence of and nose, but may also there was no spread
● Squamous crusting be located on trunk and of infection.
rashes all extremities. Ruptured
over the blisters and sores may
● Prevent spread After 2 days of
body have yellow crusting on
of infection to rendering of proper
or around the lesions.
the rest of the nursing intervention
body, as well as the goal was met
cross- Skin friction caused by (long-term)
Encourage the family to
contamination stiff or rough clothes
maintain clean, dry clothes,
to other people. leads to irritation. The patient
preferably cotton fabric
displayed timely
Prevent further infection healing of skin
from bacteria rashes and redness
without
Advice to have a proper
complications.
hygiene
LONG-TERM GOALS: Trim the fingernails of Scratching lesions will
the baby; use mittens or cause the disease to
After 2 days of socks on the hands of spread to other parts of
the body, or other
rendering proper infants as appropriate
people
nursing intervention, the
patient will Display DEPENDENT:
timely healing of skin
rashes and redness Give medication as
without complication. prescribed by the
Antibiotics may provide
physician (oxacillin,
better treatment of
prednisolone and infection than topical
mupirocin ointment) treatments alone.
 DISCHARGE PLANNING
MEDICATION - Day Zinc drops p.o. 1 mL OD at 8AM
- Application of Mupirocin ointment thinly to affected areas twice a day at 9am after bath and 7pm.

ENVIRONMENT - Clean and well-ventilated environment to attain comfort and rapid healing.
- Proper hygienic environment to prevent the risk of having skin infection.
- Wash household items that have been in contact to the spread of infection.
- Keep the child at home.

TREATMENT - Encourage the parents to administer the prescribed medication with accurate dosage and time.
- Application of the topical antibiotic to affected area twice a day.
- Advise the parent to give bath daily using mild soap.

HEALTH TEACHING - Make sure that the parents are well informed about the purpose of the medication by the health care
provider.
- Advise the parents to maintain the child’s adequate rest.
- Recommend the parents to often perform hand hygiene.
- Advice the parents to avoid sharing towels between the infant and other family members.
- Recommend the parents to always keep their fingernails cut short.
- Advice the parents to separate bed linens, towels, and clothing of the baby to prevent the spread of
infection
OUTPATIENT - Follow up check-up after 1 week at outpatient department.

DIET - Continue to provide breast milk.

SPIRITUAL - Encourage the parents to pray and continue to have faith for their child’s fast recovery.
- “I have heard your prayer and seen your tears; I will heal you.” 2 King 20:5
THANK YOU FOR
LISTENING!

HAVE A NICE DAY!

CLINICAL INSTRUCTOR:

MA’AM DAISY YADAN & MA’AM BELEN UY