Question

You are a school nurse. A 7-year-old boy has what looks like impetigo on his right forearm. You call the mother at work at 10:00 a.m. and ask her to come immediately and pick up her son and seek medical attention.

1. What did you see that made you suspect impetigo?

2. Why should the child not be sent home on the bus with a note for the mother?

3. How will the mother be expected to care for her son at home? What teaching will the school nurse need to tell mom?

4. What are the primary goals in treating impetigo?

5. When do you expect the child to return to school?

Answer 1

1. Impetigo is a common and highly contagious skin infection that mainly affects children. Impetigo usually appears as red sores on the face, hands and feet. The sores burst and develop honey-colored crusts. It causes red sores that can break open, ooze fluid, and develop a yellow-brown crust. The presence of sores on the child's forearm aided the school nurse to suspect it as impetigo.  It would be begin as small red spots, then change to blisters that eventually break open. The sores are typically not painful, but they may be itchy. Also crust like oozing from the sore is helpful to made the diagnosis.

2. Impetigo is a highly contagious bacterial skin infection. It can be spread to others by close contact with the child. The nurse should not supposed to send the child by school bus as it cause spreading of infection to other children who will be traveling on it afterward through the remaining of oozes. Impetigo spreads easily in schools and crowded places.

3. The school nurse should educate the mother about the precautions that she should take to prevent the spread of disease at home. It includes;

* Advice her to avoid close contact with that person until his or her infection has gone away. Do not share towels, sheets, or clothes until the infection is gone. Wash anything that may have touched the infected area. Scratching the sores can spread the infection to other areas of your body and to other people. Wash your or your child's hands with soap to help prevent spreading the infection.

• Gently wash the affected areas with mild soap and running water and then cover lightly with gauze.
• Wash the child's clothes, linens and towels every day and don't share them with anyone else in your family.
• Wear gloves when applying antibiotic ointment and wash your hands thoroughly afterward.
• Cut the child's nails short to prevent damage from scratching.
• Wash hands frequently.
• Keep your child home until your doctor says he or she isn't contagious.

4. The primary goal of treatment of impetigo is treating infection with antibiotics and preventing the spread of disease to others. Also proper treatment ensures no future complications such as cellulitis, post streptococcal glomerulonephritis or rheumatic fever.

5. Both streptococcus and staphylococcus bacteria cause impetigo. The incubation period (the time between exposure to the bacteria and the first development of symptoms) depends on the infective bacteria. Strep-caused impetigo has a shorter incubation period (one to three days) than staph-caused impetigo (four to 10 days). The child should expect to be away from school for at least 3 weeks.