Bacterial Infections (Pyodermas) Nursing Management

Definition and Risk factors
Impetigo
  • Is a superficial skin infection caused by streptococci, staphylococci, or multiple bacteria.  It is especially common among children living in poor hygienic conditions.
Folliculitis
  • Is a staphylococcal infection arising in hair follicles. It is commonly seen in the beard area of men who shave and on women’s legs.
Furuncle (also known as boil)
  • Is an acute inflammation arising deep in one or more hair follicles and spreading into the surrounding dermis.
Carbuncle
  • Is abscess of skin and subcutaneous tissue representing extension of a large, deep-seated furuncle that has invaded several follicles.

pyodermas

Pathophysiology

Bacterial infections of the skin may be primary or secondary.

  • Primary skin infections originate in previously normal-appearing skin and are usually caused by a single organism.
  • Secondary skin infections arise from a preexisting skin disorder or from disruption of the skin integrity resulting from injury or surgery.
Assessment/Clinical Manifestations/Signs and Symptoms

Clinical manifestations vary depending on the specific infections.

Impetigo
  • Begins as small, red macules and rapidly progresses to discrete, thin-walled vesicle. These vesicles rupture and become covered with a loosely adherent, honey-yellow crust.
Folliculitis
  • Produces single or multiple, superficial or deep papules or pustules closet to hair follicles.
Furuncle
  • Is marked by tenderness, pain, and surrounding cellulitis. After the furuncles localizes, a boggy center with a yellow or white head on the skin surface may be noted.
Carbuncle
  • Is marked by skin abscess along with systemic symptoms, such as fever, pain, prostration and lukocytosis.
Medical Management
Impetigo
  • Agents for nonbullous impetigo: benzathine penicillin or oral penicillin or erythromycin.
  • Agents for bullous impetigo: penicillinase-resistant penicillin or erythromycin
  • Topical antibacterial therapy Is the usual treatment for disease that is limited to a small area. The topical preparation is applied to lesions several times daily for 1 week. Lesions are soaked or washed with soap solution to remove central site of bacterial growth and to give the topical antibiotic an opportunity to reach the infected site.
Folliculitis, Furuncles, and Carbuncles
  • Systemic antibiotic therapy is generally indicated. Oral cloxacillin, dicloxacillin, are first-line medications.
  • Cephalosphorins and erythromycin are also effective.
  • When the pus has localized and is fluctuant, a small incision with a scalpel can speed resolution by relieving the tension and ensuring direct evacuation of the pus and slough.
  • The patient is instructed to keep the draining lesion covered with a dressing.
Nursing Diagnosis
  • Impaired skin integrity
  • Deficient knowledge
  • Disturbed body image
  • Acute pain
  • Imbalanced nutrition: less than body requirements
  • Risk for infection
Nursing Management
  1. Administer medications which may include systemic or topical antibiotics. Soak and wash lesions with mild soap solution to remove the central site of bacterial growth before applying topical antibiotics.
  2. Prevent infection and infection transmission.
    • Instruct the client not to squeeze a boil or pimple; the protective wall of induration that localizes the infection should not rupture or be destroyed.
    • Instruct the client to bathe at least daily with bactericidal soap.
    • Inform the client and families that impetigo is a contagious disease. Cleanliness is a priority. Encourage the use of separate towels for family members.
    • Isolate drainage in severe cases of folliculitis, furuncles, or carbuncles. Cover the mattress and pillow with plastic material.
  3. Promote comfort measures.
    • IV fluids, fever sponges, and other supportive treatments, are indicated for clients who are very ill or suffering with toxicity.
    • Apply warm, moist compresses to increase vascularization and help with resolution of the furuncle or carbuncle.
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