Scarlet f.case Pres2

8/3/2019 Scarlet f.case Pres2

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SCARLET

FEVER


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INTRODUCTION Scarlet fever is a disease that, for so

many years, has been plaguing

mankind-- although, in a sporadic

basis.

Historians believe that the first case of

scarlet fever was diagnosed during the

time of Hippocrates, but it was only inthe year 1884 that the infective

organism was discovered and named..

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The organism was a Gram (+), Group A

beta-hemolytic bacteria calledStreptococcus Pyogenes.

S. pyogenes is notorious for its

communicability because it can easilybe transmitted through a direct contact

with any of the hosts bodily fluid. Once

compromised by the organism, thesymptomssymptoms that will be manifested by the

host may includes:

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Body ache

Headache

High fever

Sore throat

Nausea, with or without vomiting

Lymphadenopathy

Red rashes (with a sandpaper-liketexture)

Strawberry tongue

White coating on the back of the throat

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As contagious as it is, scarlet fever is

not without cure. In fact, mild cases of itcan be cured with bed rest and some

antibiotic. But as many diseases are, its

precipitation can vary from mild to evenfatal.Pneumonia and Rheumatic fever

can precipitate from the disease if left

untreated.

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As was previously stated, scarlet fever is

actually very manageable and yet, many

people, especially children, still fall as

victims to the disease. As health care

practitioners of the future, we shoulder the

responsibility of disseminating our knowledge to the susceptible population. In

light of this statement, it is our goal that

may the initiation of this study serve as a

catalyst to further the right to health of the

people to whom this knowledge will be

conveyed to.

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Name: J.M.G.

Age: 6 years old

Address: #24 Finance St., Project 8, Quezon CityGender: Male

Civil Status: Child

Occupation: N/A

Educational Attainment: Elementary (Grade 1)

Date of Admission: December 31, 2011

Admitting Diagnosis: Scarlet Fever

DEMOGRAPHIC

PROFILE

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ChiefComplaint:

Fever with associated dysphagia and rashes

on upper extremities

History of Present Illness:4 days PTA, (+) appearance of rashes on the

face

3 days PTA, (+) fever with coldsFew hours PTC, with spreading rashes all

over the body, persistence of the symptoms

prompted, consult.

MEDICAL HISTORY

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Past Medical History:The patient has never been hospitalized

prior to present hospital admission.

Family History:Mother side: (+) history of breast cancer

Father side: (+) history of hypertension

Socio-economic History:

The patients father works as a

Framer while the patients mother is aplain housewife.

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ErikEriksons Psychological Stages

This theory is a series of eight stages

used to characterize development fromcradle to grave.

He calls them psychosocial stages

because he believes that the psychologicaldevelopment of individuals depends on the

social relations established at various points

in life.

DEVELOPMENTAL

HISTORY

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At each stage, there are problems or

crises to be confronted. Each stage

calls to attention the kind of problems

people encounter during life:

Patient J.M.G. is a 6 years old grade

1 pupil, falling under the Industry vs.

Inferiority (6-12 years) stage of Psychological development.

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This stage of psychological developmentis characterized as the stage where

children learn from school the socialvalues.

These includes not only reading and

writing, but also physical skills and theability to share responsibility and getalong with others.

Significant relations includeneighborhood and the school.Competence in social, intellectual andphysical skills are its favorable outcome.

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Success or failure while learning these

skills can have a lasting effects on achilds feeling of adequacy. If their

efforts are succesful, children develope

feelings of competence, while

unsuccessful efforts result to feeling of

inferiority.

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Sigmund Freuds Theory onPsychosexual Development

Freud believed that the first few yearsof life are the most important for thedevelopment of a childs personality and

character.He conceptualized several distinct

stages of development and called them

psychosexual stages, each is concernedwith a major biological function andinfluences personality development.

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Under the psychosexual stages of

human development, Patient J.M.G. is

under the Latency Stage (6-puberty).

This stage of psychosexual

development is a stage where thechilds libidal energy is suppressed. As

the child starts schooling they become

more interested with recreational

activities and peer relationships. This is

often called as the time of quiet and

calm.

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Vital Signs:

P.R. : 96bpmR.R : 25cpm

Temp : 37.9 C

PHYSICAL ASSESSMENTS

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BODY PARTBODY PART ASSESSMENTASSESSMENT

TECHNIQUETECHNIQUE

NORMAL FINDINGSNORMAL FINDINGS ACTUAL FINDINGSACTUAL FINDINGS

1. Skin Inspection

Palpation

Fair complexion,

absence of rashes,scars and lesions.

Warm to touch

Good skin turgor

Skin intact. No

discharge

Flushed skin

with Macular rashes

Itching sensation

Sandpaper-like texture

Warm to touch

Good skin turgor

Skin intact. No discharge.

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2. Scalp Inspection

Palpation

No lice and nits.

No lumps and lesion.

No lice and and nits

No lumps and lesions.

3. Hair Inspection

Palpation

Evenly distributed hair.

Color varies mostly in

black.

Smooth in texture and

shiny.

Evenly distributed black hair.

Dry and oily

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4. Face Inspection Symmetr ical face

movement

Smooth, absence of

rashes, scars and

lesions.

Symmetrical face movement

with Macular rashes

5) Eyes Inspection Round cornea, Black

color, White sclera.

Palpebral Conjunctiva

is pinkish in color

Round cornea, Black color, White

sclera.

Palpebral conjunctiva is pinkish in

color

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6) Eyebrows Inspection Hair evenly

distributed with skin

intact, symmetrically

aligned with equal

movement.

Hair evenly distributed with skin

intact, symmetrically aligned

with equal movement.

7) Eyelids Inspection No discoloration. Lids

able to close

symmetrically.

No discoloration.

Lids able to close

symmetrically

Puffy eyelids

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8) Ears Inspection

Palpation

Same color as facial

skin

Proportion to the

head and no active

discharge.

Able to identify

sound

No lesions noted

Same color as facial skin

Proportion to the head and

no active discharge.

Able to identify sound

No lesions noted

9) Nose Inspection Midline symmetrical to

face, no lesions, no

nasal discharges or

flaring. Uniform in

color.

Midline symmetrical to face, no

lesions, no nasal discharges or

flaring. Uniform in color.

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10) Mouth/

Throat

Inspection Proportional and

symmetrical with

face.

Proportional and symmetrical

with face.

Ulcers in the mouth

Difficulty opening the mouth

With sore throat

Difficulty swallowing

11) Lips Inspection Pink in color, smooth,

no lesions.

Dry lips and mucous membrane,

with lesions

Red in color

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12) Teeth Inspection Complete without

dentures.

Complete without dentures.

13) Tongue Inspection Position, pink in color,moist, no lesions or

swelling.

Tongue floor is in

central

Red in color, moist, no lesions orswelling.

Tongue floor is in central

With strawberry tongue

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14) Heart Auscultation Normal rate, rhythm,

no murmur.

Normal rate, rhythm, no

murmur.

15) Chest/

Lungs

Inspection

Auscultation

Symmetrical during

lung expansion and

recoil.

Symmetrical during lung

expansion and recoil.

Spontaneous non-labored

breathing

Productive cough: white

Wheezing breath sound are

present

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16) Abdomen/

GIT

Inspection

Auscultation

Palpation

No masses &

tenderness

No abnormal bowel

sounds

No masses or

tenderness

No masses & tenderness

No abnormal bowel sounds

No masses or tenderness

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17) Upper

extremities

Inspection

palpation

Able to move freely

without discomfort.

Able to adduct,

abduct, flex and

extend

No tenderness, no

palpable mass

noted.

Palpable brachialand radial pulse.

Able to move freely without

discomfort

Able to adduct, abduct, flex and

extend

No tenderness, no palpable

mass noted.

Palpable brachial and radial

pulse.

18) Palms Inspection Pink in color, no

lesions

Slightly red in color, no lesions.

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19) Finger nails Iinspection Nails well-groomed.

Symmetrical

Pink nail beds

With no present of

clubbing

Capillary refill: 1-3

secs.

Nails well-groomed

Symmetrical

Pink nail beds

With no present of clubbing

Capillary refill: 2 secs.

20) Lowerextremities

Inspection

Palpation

Symmetrically to thebody.

No lesions noted

muscle appears in

equal and good

muscle tone.

Symmetrically to the body.

No lesions noted muscle appears

in equal and good muscle tone.

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21) Toenails Inspection Pink nails with

capillary refill less

than 2secs.

Pink nails with capillary refill

less than 2secs.

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ANATOMY AND

PHYS

IOLOGY

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MAIN TYPES OF RASHES

MACULE

PAPULE

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V

esicular Rashes

Maculopapular Rash

Papulosquamous rash:

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Non-modifiable factor

yAge

Modifiable factor

yEnvironment

Bacterial Invasion

Multiplication of

bacteria

Release of toxins

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Interruption in the

bodys normal

homeostasis

Immune

response

Increase WBC

subsequent to pus

formation

Cytokines &

Prostaglandins

release

Tonsillar

exudate

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Body induces the

action of the cytokines

& prostaglandins

Inflammation of the buccal

membrane

The body

responds

Fever

Increased blood flow in

tongue papillae

Strawberry

tongue

Increased

capillarypermeability

Macule Rash

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MEDICAL MANAGEMENTDATEDATE PHYSICIANPHYSICIAN

PROGRESS NOTEPROGRESS NOTE

DOCTORSDOCTORS

ORDERORDER

RATIONALERATIONALE

12-31-11

06:00

pm

T:T: 36.136.1

PR:PR:140bpm140bpm

RR:RR:28cpm28cpmBP:BP:90/60mmH90/60mmH

gg

+ flushed skin+ flushed skin

+strawberry+strawberrytonguetongue

Admit to

Pav. VII

Secureconsent on

admission

The informed

consent is used tosecure that the

procedure was

already explained

to the patient and

also to secure thatthe patient agreed

on the procedure or

treatment that will

be given to him.

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12-31-11

06:00 pm

Soft diet

please

Monitor v/s

every shift

Sore throat may

cause difficulty

swallowing, a dry

throat and painful

swallowing. Softfoods that are easy

to swallow andgentle on your throat

are often best

tolerated.

To check and

assess

patients

condition for

the time being.All documents

must be

formally

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12-31-11

06:00 pm

Monitor I/o

every shift

and record

D5 0.3 NaCl

of 500cc/ hr

Therapeutics:Paracetamol

250mg/5ml

give 4ml

every 4hrs

for 37.8

To check for

the stability

of patient;s

health statusand (+/-)

nutritional,

fluid and

electrolyte

imbalances


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12-31-11

06:00 pm

Hydrite 2

sachet in

500ml of

distilled waterPen G

230,000u

ANST every

6 hrs

Diagnostics:

CBC and

Platelets

B

loodB

S/C

SESR

CRP

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12-31-11

06:00 pm

6:40pm T:T: 38.338.3PR:PR:120bpm120bpm

RR:RR:28cpm28cpm

BP:BP:90/60mmH90/60mmH

gg

Dra. G.

informed of

admission

Pls. admit toPav. VII

Refer

S

CARLET FEVER

- - :: or roa o now w a


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- -

6:00 am

9:25 am

:: ..

PR:PR:115bpm115bpm

RR:RR:23cpm23cpm

BP:BP:90/60mmH90/60mmH

gg

Patient seen

asleep

(-) appetite

or roa

swab

refer

o now w a

is the

specific

bacteria

present inthe throat.

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1-2-12

6:00 am

T:T: 37.737.7

PR:PR:86bpm86bpm

RR:RR:22cpm22cpm

BP:BP:90/60mmH90/60mmHgg

((--))DOB

(-) good

appetite

Throat swab

Continue

antibiotics

refer

to know what

is the

specific

bacteriapresent in

the throat.to prevent

resistance of

the drugs

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-3-12

:00 am

T:T: 37.337.3

PR:PR:120bpm120bpm

RR:RR:18cpm18cpm

BP:

BP:9

0/60mmH9

0/60mmHgg

(+) flushed skin(+) flushed skin

(+) strawberry(+) strawberry

tonguetongue

((--)) papularpapular rashrash(+) scarlet(+) scarlet feverfever

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HEMATOLOGY

LABORATORY RESULTS

Normal Values Results Significance

WBC

RBC

Hemoglobin

Hematocrit

4.8-10.8 109/L

4.7-6.1 1012/L

13-17g/L

40-52 %

12.8

3.98

11.14

32.01

Increased indicates

infection

Decreased indicatesanemia

Decreased indicates

anemia

Decreased indicatesdestruction of RBC

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MCV

MCH

MCHC

Platelet

count

(82-98)

(28-33)

33-36g\L

150-

400109/L

80.42

28

34.82

280

Decreased

indicates

iron

deficiency

Adequate

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RDW

Neutrophils

Lymphocyte

s

Eosinophil

Monocytes

Basophils

11.4-14.0 %

40-70 %

19-48 %

2-8 %

3-9 %

0-5 %

13.65

78.7

9

4

7.8

1.5

Increased

Decreased

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THROAT SWAB RESULT

Date:

01/01/2012Time: 7:45 am

Reveals (+) Group A Streptococci.

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DRUGNAME ACTION INDICATION CONTRAINDICATION ADVERSE REACTION NURSING

MANAGEMENTGeneric name:

Penicillin G

Brand name:

Benzyl Penicillin

Classification:

AntiinfectivePenicillin

Route:

IV

Dosage:

230,000 u

Frequency:

q6

Inhibits

bacterial wall

synthesis

during

bacterial

multiplication.

Treatment of

respiratory tract

infection, skin and

soft tissue

infections; dental

and surgical

infections. Some

types of sub-acute bacterial

endocarditis,

meningitis, otitis

media and

osteomyelitis.

hypersensitivity Hypersensitivity

reactions

Sensitizations

Mild

gastrointestinal

tract irritation

Assess patient

for

hypersensitivity

to the

medication;

perform

sensitivity test.

Assess for signsand symptoms

of infection;

increasedWBC,

fever

For IM use, give

deep into large

muscle; injection

may also beextremely

painful

Monitor renal

function closely.

Monitor cbc

DRUG STUDY

SCARLET FEVER

Drug name Action Indication Contraindication Adverse effect Nursing


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Management

Generic name:

Paracetamol

Brand name:

Aeknil

Classification:

antipyretics,nonopi

oid analgesics

Route:IV

Dosage:

250 mg/5ml

Frequency:

q4

Decreases

fever by

inhibiting the

effects of

pyrogens on

the

hypothalamic

heat regulating

centers and by

a hypothalamic

action leadingto a sweating

vasodilation.

Relief of mild-

to-moderate

pain; treatment

of fear.

Hypersensitivit

y; intolerance

to tartrazine,

alcohol, table

sugar

saccharin

Stimulation

Drowsiness

Nausea

Vomiting

Abdominal pain

Hepatotoxicity

Hepatic seizure

Renal failure

Leucopenia

Neutropenia

Rash

Urticaria

Jaundice

Rash

cyanosis

assess

patients

fever or

pain: type

of pain,

locaton,int

ensity,dur

ation,tem

perature,d

iaphoresis

assesshepatoxici

ty

monitor

liver and

renal

function

checkinput and

output

ratio

assess

chronic

positionin

g

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Management

Generic name:

hydrite

Brand name:

hydrite

Classification:

Oral rehydration

salts

Route:Oral

Dosage:

2 sachets in 500

ml.

Frequency:OD

Hydrite is an

oral rehydration

fluid used to

replace fluid

and electrolytes

lost due to

diarrhea and/or

vomiting. It

corrects mild to

moderate

dehydrationduring the initial

phase of oral

rehydration

therapy. It also

prevents

recurrence of

dehydrationafter initial

correction of

dehydration.

Treatment of

childn & adults

w/ dehydration

due to

diarrhea.

Replaces fluid

& electrolytes

lost due to

diarrhea &

vomiting.

newborn

babies or

those less

than 2

months

taking with

ongoing IV

fluid

Constipatio

n

Hypersensit

ivity

reaction

Flatulence

Abdominal

pain or

discomfort

Dry mouth

Assess

patients

diarrhea and

bowel pattern

before starting

therapy.

Assess for

abdominal

distention,toxic

megacolon

wih may causein ulcerative

colitis.

Assess

hydration

Assess for

possible

adversereaction

Assess

patients and

familys

knowledge of

drug therapy.

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NURSING SCIENTIFICGOAL

NURSINGEVALUATION


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CUESNURSING

DIAGNOSIS

SCIENTIFIC

REASONDESIRED

OUTCOME

NURSING

INTERVENTIONSRATIONALE STANDARD CRITERIA

SUBJECTIVE

:

Nilalagnat

pa nga siya,

pero bumaba

na hindi

katulad nung

naunang

araw as

verbalized by

the patients

mother.

OBJECTIVE:

* T = 37.9

c

* With

flushed

skin

* Warm to

touch

Hyperthermia

r/t the disease

process

(illness)

Due to the

immune

response of

the body from

the

interruption of

the normal

homeostasis,

Cytokines &

Prostaglandin

s is released,

the Body

induces the

action of the

cytokines &

prostaglandin

s, and

increase in

body

temperature is

experience as

body

response.

(Communicabl

e and

infectious

disease, 2nd

edition, pg.59)

SHORTTERM

GOAL:

At the end of

my 6hrs. Shift,

Patients body

temperature

will decrease.

LONG TERM

GOAL:

Within

hospitalization,

Patient will

maintain core

temperature

within normal

range.

Independent:

Assessed and

monitored Vital

Signs esp. Body

Temperature.

Provided Tepid

sponge bath

Instructed to

maintain bed

rest.

Encouraged

more fluid intake.

Dependent:

Administer

antipyretics as

prescribed.

y Provides

comparativ

e baseline.

y Helps

lower body

temperatur

e.

y To reduce

metabolic

demands/

oxygen

consumpti

on.

y For better

circulating

volume

and tissue

perfusion.

y It also

helps to

lower body

Patients

body

temperature

will decrease.

Within

hospitalizatio

n, Patient will

maintain core

temperature

within normal

range.

GOALMET.

Patient body

temperature

decreases

from 37.9 to

37.6c.


NURSINGEVALUATION

STANDARD CRITERIA


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SCARLET FEVER

CUESNURSING

DIAGNOSIS

SCIENTIFIC

REASONDESIRED

OUTCOME

NURSING

INTERVENTIONSRATIONALE

STANDARD CRITERIA

SUBJECTIV

E:

eto nga po

ang daminiyang

rashes at

nanganagti

na siyaas

verbalized

by the

patients

mother.

OBJECTIVE

:

* With

macule

rashes

* With

Flushe

d skin

Impaired

Skin

Integrity r/t

the diseaseprocesss

Streptococci

may be

alpha-

hemolytic(partial

hemolysis),

beta-

hemolytic

(complete

hemolysis),

or gamma-

hemolytic

(no

hemolysis).

Most

streptococci

excrete

hemolyzing

enzymesand toxins.

Erythrogenic

toxins cause

the rash of

scarlet

fever.

SHORT

TERM

GOAL:

At the end ofmy 6-hrs.

Shift,

patients

mother will

verbalize

understandin

g of the

disease,

prevention

and

treatment.

Independent:

Assessed skin.Note color,

sensation.Described andmeasuredrashes andobserved

changes.

Demonstratedgood skinhygiene (e.g.wash

thoroughly andpat drycarefully)

Emphasizedimportance ofadequate fluid

intake.

Establishescomparative

baselineprovidingopportunityfor timelyintervention.

Maintainingclean anddry skinprovides

barrier toinfection.

Hydrationwill improveskin

condition.

Patients

mother willverbalizeunderstandi

ng of thedisease,preventionandtreatment.

Withinhospitalizati

on, Patientwill displaytimelyhealing ofskin

rashes/lesions withoutcomplication.

GOAL

MET.Patientsmother

verbalizedunderstanding of thedisease,prevention

andtreatment.

SCARLET FEVER

LONG Instructed the Long and


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http://em

edicine.

medscap

e.com/art

icle/8039

74-overview

#a0104

LONG

TERM

GOAL:

Within

hospitaliza

tion,

Patient

will

display

timely

healing of

skin

rashes/les

ions

without

complicati

on.

Instructed the

mother to cut and

file nails of thepatient regularly.

Provided a health

teaching about the

disease, the

prevention and

treatment

Dependent:

Administer

Medication as

prescribed (If any).

Long and

rough nails

increase riskof skin

damage.

Serves as

additional

information.

To promote

faster

healing.

SCARLET FEVER


NURSINGEVALUATION

STANDARD CRITERIA


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SCARLET FEVER

CUESNURSING

DIAGNOSIS

SCIENTIFIC

REASONDESIRED

OUTCOME

NURSING

INTERVENTIONSRATIONALE

STANDARD CRITERIA

SUBJECTI

VE:

Medyo

hirap pasiyang

lununok

ngayon

as

verbalized

by the

patients

mother.

OBJECTIV

E:

With Sore

throat

Body

weaknessLoss of

appetite.

Risk for

Imbalanced

Nutrition: less

than body

requirements

r/t difficulty of

swallowing.

Due to the

immune

response of the

body from the

interruption of

the normal

homeostasis,

Cytokines&

Prostaglandins

is released and

thus, tonsillar

exudate

happens. And

when the

tonsil/throat is

inflamed,

difficulty or

dysphagia is

usually

experience.

(http://medicine.

medscape.com/a

rticle/803974-

overview#a0104

7775)

SHORT TERM

GOAL:

At the end of

my 6-hrs. Shift,

patients mother

will verbalize

understanding

of causative

factor and

necessary

intervention.

LONG TERM

GOAL:

Within

hospitalization,

patient will

continuously

Maintain a

good appetite

and good eating

habit

Independent:

Assessed

weight, age,

body fluid,strength,

activity/rest

level.

Advised

mother to

provide diet

modifications(e.g. small

feedings, soft

foods)

Advisedmother to

promote

pleasant,relaxing

environment

includingsocialization if

possible andprovide foods

that are

appealing.

Providescomparative

baseline

For easyswallowing

of foods.

To enhance

intake and

appetite.

Patients

mother will

verbalize

understanding

of causative

factor and

necessary

intervention.

Within

hospitalizatio

n, patient will

continuously

Maintain a

good appetite

and good

eating habit

GOAL MET.

Patients

mother

verbalized

understandin

g of

causative

factor and

necessary

intervention.

SCARLET FEVER


58/59

LONG

TERM

GOAL:

Withinhospitaliza

tion,

patient will

continuous

ly

Maintain agood

appetite

and good

eating

habit

Dependent:

Administer

meds as

prescribed

(e.g.

Penicillin)

Collaborative:

Consult with

the

Nutritional/dietician support

team as

necessary.

To promote

faster

healing and

recovery of

the affected

area of thethroat

To know the

right food to

be given.

SCARLET FEVER


59/59

- END -THANKYOU!

Date post:	06-Apr-2018
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