When caring for a male client with severe impetigo, the nurse should include which intervention in the plan of care?
A. Placing mitts on the client’s hands.
B. Administering systemic antibiotics as prescribed.
C. Applying topical antibiotics as prescribed.
D. Continuing to administer antibiotics for 21 days as prescribed.
Correct Answer: B. Administering systemic antibiotics as prescribed.
Impetigo is a contagious, superficial skin infection caused by beta-hemolytic streptococci. If the condition is severe, the physician typically prescribes systemic antibiotics for 7 to 10 days to prevent glomerulonephritis, a dangerous complication. Systemic antibiotics should be prescribed for all cases of bullous impetigo and cases of non-bullous impetigo with more than five lesions, deep tissue involvement, systemic signs of infection, lymphadenopathy, or lesions in the oral cavity.
Option A: The client’s nails should be kept trimmed to avoid scratching; however, mitts aren’t necessary. Children with impetigo should maintain good personal hygiene and avoid other children during the active outbreak. It is important to wash hands, linens, clothes, and affected areas that may have come into contact with infected fluids.
Option C: Topical antibiotics are less effective than systemic antibiotics in treating impetigo. Topical antibiotics alone or in conjunction with systemic antibiotics are used to treat impetigo. Antibiotic coverage should cover both S aureus and S pyogenes (i.e. GABHS). While untreated impetigo is often self-limiting, antibiotics decrease the duration of illness and spread of lesions.
Option D: Without treatment, the infection heals in 14-21 days. About 20% of cases resolve spontaneously. Scarring is rare but some patients may develop pigmentation changes. Some patients may develop ecthyma. With treatment, cure occurs within 10 days. Neonates may develop meningitis. A rare complication is acute post-streptococcal glomerulonephritis, which occurs 2-3 weeks after the skin infection.
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