ALMOETE, ABEGAIL C.

NR – 43
GRP. 5-C

NURSING CARE PLAN - BULLOUS IMPETIGO REGIONAL

ASSESSMENT INFERENCE DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Data: Bullous Impetigo is Impaired Skin Short-term Goal: - Identify aggravating - Patients may After 8 hours of
- "Nagsugat po ang characterized by the Integrity related to After 8 hours of factors. Inquire develop bullous nursing intervention,
labi ng anak ko, formation of large injury to the skin as nursing intervention, about recent impetigo in response the goal was met.
kinabukasan bullae on the skin. evidence by multiple the child will not changes in use of to changes in their The child did not
pumutok yung mga Over about a week, large bullae around experience products such as environment. experience
sugat at kumalat na the sores burst and the mouth, pruritus worsening bullous soaps, laundry Extremes of worsened bullous
po sa labi niya" as develop and pain around the impetigo and display products, cosmetics, temperature, impetigo and
verbalized by the honey-colored area, development of healing without new wool or synthetic emotional stress, displayed healing
patient's father. crusts. As evidenced honey-colored crust, formation of blister fibers, cleaning and fatigue may without new
- Reports multiple by multiple large malaise, and solvents, and so contribute to bullous formation of blister
lesions or large bullae around the discomfort Long-term Goal: forth. impetigo
bullae around the mouth and After 7 days of the After 7 days of the
mouth development of nursing intervention, - Educate the patient - It is important to nursing intervention,
honey-colored crust the child will be able and caregiver about maintain the the goal was met.
Objective Data: we inferred that the to maintain optimal proper wound cleanliness of the The child was able to
- Fever with a patient has a bullous skin integrity within hygiene through affected areas by maintain optimal
temperature of 39°C impetigo around the limits of the disease, washing the sores washing with mild skin integrity within
- Dark-brown crust mouth. as evidenced by with soap and water. soap and water. The limits of the disease,
around lesions intact skin. Advise the patient sores may cause as evidenced by
- Malaise and caregiver to mild itching, but it is intact skin.
- Discomfort prevent scratching advisable to prevent
- Pruritus & pain the affected areas. the child from
around the area scratching the
affected areas to
prevent worsening of
the infection.

- Trim the patient's - Long fingernails

fingernails and tend to harbor more
ensure frequent bacteria. Scratching
hand hygiene. the infected skin
Advise the patient areas will allow the
and caregiver to bacteria to transfer
prevent scratching into the fingernails
the affected areas. and onto the
fingertips. When the
patient touches
other people or
objects with infected
hands, the infection
will likely spread.

- Encourage the - One of the first

patient to adopt skin steps in the
care routines to management of
decrease skin impetigo is
irritation: promoting healthy
skin and healing of
skin lesions.

- The affected area - Removal of scabs

should be soaked prior to applying the
first in warm water to topical antibiotic
remove the scabs, promotes good
wet compresses absorption of the
may also be used. medication.
This is followed by
the application of the .
prescribed antibiotic
cream or ointment
directly to the
affected areas.

- Administer
antibiotics as - Impetigo is
prescribed. Ensure generally treated
that the patient through the use
finishes the course of antibiotic therapy.
or antibiotic If the infection is mild
prescribed by the and have not spread
physician. 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. 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.